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Role of AMPK/mTOR-independent autophagy in clear cell renal cell carcinoma
  1. Milan Radovanovic1,
  2. Sasenka Vidicevic2,
  3. Jelena Tasic2,
  4. Nina Tomonjic2,
  5. Zeljka Stanojevic2,
  6. Predrag Nikic1,
  7. Aleksandar Vuksanovic1,
  8. Zoran Dzamic1,
  9. Uros Bumbasirevic1,
  10. Aleksandra Isakovic2,
  11. Vladimir Trajkovic3
  1. 1 Clinic of Urology, Clinical Center of Serbia, Belgrade, Serbia
  2. 2 Institute of Medical and Clinical Biochemistry, University of Belgrade Faculty of Medicine, Belgrade, Serbia
  3. 3 Institute of Microbiology and Immunology, University of Belgrade Faculty of Medicine, Belgrade, Serbia
  1. Correspondence to Professor Vladimir Trajkovic, Institute of Microbiology and Immunology, University of Belgrade Faculty of Medicine, Belgrade 11000, Serbia; vladimir.trajkovic{at}


We examined the status and role of autophagy, a process of lysosomal recycling of cellular material, in clear cell renal cell carcinoma (ccRCC). Paired samples of tumor and adjacent non-malignant tissue were collected from 20 patients with ccRCC after radical nephrectomy. The mRNA levels of apoptosis (BAD, BAX, BCL2, BCLXL, BIM) and autophagy (ATG4, BECN1, GABARAP, p62, UVRAG) regulators were measured by RT-qPCR. The protein levels of autophagosome-associated LC3-II, autophagy receptor p62, apoptotic marker PARP, as well as phosphorylation of autophagy initiator Unc 51-like kinase 1 (ULK1), its activator AMP-activated protein kinase (AMPK) and 4EBP1, the substrate of ULK1 inhibitor mechanistic target of rapamycin (mTOR), were analyzed by immunoblotting. The mRNA levels of pro-apoptotic BAX, anti-apoptotic BCLXL and pro-autophagic ATG4, p62 and UVRAG were higher in ccRCC tumors. Autophagy induction was confirmed by an increase in phospho-ULK1 and degradation of the autophagic target p62, while apoptotic PARP cleavage was unaltered. AMPK phosphorylation was reduced and 4EBP1 phosphorylation was increased in ccRCC tissue. The expression of apoptosis regulators did not correlate with clinicopathological features of ccRCC. Conversely, high mRNA levels of ATG4, GABARAP and p62 were associated with lower tumor stage, as well as with smaller tumor size and better disease-specific 5-year survival (ATG4 and p62). Accordingly, low p62 protein levels, corresponding to increased autophagic flux, were associated with lower tumor stage, reduced metastasis and improved 5-year survival. These data demonstrate that transcriptional induction of autophagy in ccRCC is accompanied by AMPK/mTOR-independent increase in ULK1 activation and autophagic flux, which might slow tumor progression and metastasis independently of apoptosis.

  • apoptosis
  • carcinoma
  • cell death
  • kidney
  • prognosis

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  • Contributors MR, AV, ZD, AI and VT designed the study. MR, PN and UB collected the samples and provided clinical data. SV, JT, NT and ZS performed the in vitro assays. AI and VT analyzed and interpreted the data, and wrote the first draft of the manuscript. All authors revised the work critically and read and approved the final version of the manuscript.

  • Funding This work was supported by a grant from the Ministry of Education, Science and Technology of the Republic of Serbia (grant no. 41025).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Ethics Committee of the Faculty of Medicine, University Belgrade (number 29/X-14). The research conformed to the Declaration of Helsinki, and the written informed consent for the general research use of surplus tissue was obtained from all participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are available from the corresponding author (Vladimir Trajkovic,, upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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