Benign and malignant adrenocortical tumours are associated with a high morbidity caused by the hypersecretion of adrenocortical hormones found in approximately 60% of patients. Moreover, adrenocortical carcinomas (ACC) have poor prognosis with a 5 years survival rate of 16 to 38%. This aggressiveness results from both the presence of metastases at diagnosis in most patients (30 to 40% of cases) and the absence of therapeutic approaches apart from surgical resection of primary tumours. At the start of my thesis, the molecular mechanisms involved in the development of benign and malignant adrenocortical tumours were largely unknown. Abnormal activation of the Wnt/ßcatenin pathway found in 48% of benign tumours and 37% of malignant tumours suggests that as in other tissues, this pathway could participate in tumour development in the adrenal cortex. To confirm this hypothesis, we developed and characterized a transgenic mouse model with constitutive activation of ßcatenin, specifically in the adrenal cortex (∆Cat mice). With this model, we demonstrated for the first time that ßcatenin acted as an adrenocortical oncogene but that this activation was insufficient to systematically induce the development of adrenocortical carcinomas. In almost 90% of patients, CCS formation is associated with the overexpression of the growth factor IGF2. However, the development of a model of Igf2 overexpression in transgenic mice, allowed us to demonstrate that this overexpression could not initiate tumour formation and that it had a mild effect on tumour progression. This suggested that other alterations were necessary for malignant progression. Our encouraging preliminary results suggest that upregulation of the histone methyltransferase EZH2 and the resulting epigenetic defects could be the cause of ACC development. In parallel, we demonstrated that constitutive ßcatenin activation induced primary hyperaldosteronism development in ∆Cat mice suggesting that aberrant activation of the Wnt pathway could be involved in formation of aldosterone-producing adenomas (APA) in patients. Indeed, we showed that constitutive activation of ßcatenin was the most frequent molecular alteration in APA with a prevalence of 68%. In vitro analysis allowed us to demonstrate that ßcatenin stimulates aldosterone production by controlling directly and indirectly the expression of two key enzymes of aldosterone synthesis –CYP21 and CYP11B2- and of the angiotensin II receptor, AT1R. Furthermore, we showed that excessive aldosterone production in ∆Cat mice could be controlled by a diet enriched in quercetin, a natural inhibitor of the transcriptional activity of ßcatenin. Altogether these results demonstrate the essential role of the Wnt/ßcatenin pathway in adrenocortical tumorigenesis and aldosterone secretion. Consequently, this pathway could be a new potential therapeutic target for the treatment of most adrenal tumours.
