Autophagy-centered regulation of PI3K/Akt/mTOR and MAPK signaling by traditional Chinese medicine in gastric cancer

Abstract

Gastric cancer (GC) remains a major global health burden, with high incidence and mortality rates, particularly in East Asia, driven by factors such as Helicobacter pylori infection, dietary risks, and genetic predispositions. Conventional treatments like surgery and chemotherapy are limited by resistance, toxicity, and poor outcomes in advanced stages. The PI3K/Akt/mTOR and MAPK signaling pathways are central to GC pathogenesis, promoting proliferation, survival, metabolic reprogramming, epithelial-mesenchymal transition (EMT), and metastasis through aberrations like PIK3CA mutations, PTEN loss, and KRAS alterations. These pathways exhibit extensive crosstalk, contributing to therapeutic resistance. This review explores the regulatory effects of Traditional Chinese Medicine (TCM) on these pathways in GC, grounded in TCM principles such as Qi deficiency, Damp-Heat, and disharmony of the Spleen and Stomach. Single herbal monomers (e.g., curcumin, berberine, resveratrol) inhibit PI3K/Akt/mTOR by upregulating PTEN and suppressing mTOR, inducing autophagy and apoptosis. Classical herbs like Huangqin and Huanglian modulate Akt and ERK phosphorylation, while compound formulas (e.g., Banxia Xiexin Decoction, Sijunzi Decoction) synergistically target both pathways, reversing EMT and chemoresistance. TCM addresses crosstalk by disrupting feedback loops and reducing inflammation, enhancing efficacy in combination with Western therapies like chemotherapy and immunotherapy. Network pharmacology and multi-omics analyses reveal TCM's multitarget mechanisms, aligning with ZHENG-based personalization. Challenges include research variability, standardization issues, and incomplete mechanistic validation. Future directions emphasize high-quality trials, omics integration, and precision TCM for clinical translation. TCM offers low-toxicity, holistic options for integrative GC management, potentially improving survival and quality of life.

Keywords: Apoptosis; Autophagy; Gastric cancer; MAPK pathway; PI3K/Akt/mTOR pathway; Signaling crosstalk; Traditional Chinese medicine.