In November 2022, the American Association for Cancer Research (AACR) announced that the world had just taken a massive leap forward in the battle against breast cancer. This followed the landmark discovery that premenopausal women could benefit from RANKL inhibition to help prevent breast cancer. Credit for this discovery was given to Professor Adetunji Toriola of the Division of Public Health Sciences, Washington University School of Medicine, in St. Louis, Missouri.
To put this in context, RANKL (Receptor Activator of Nuclear Factor Kappa B Ligand) is a protein that plays a major role in bone remodelling and immune function. It controls the activation and differentiation of osteoclasts, which are cells that break down bone tissue during bone remodelling. Specifically for breast cancer, the RANKL signalling pathway has been shown to stimulate breast cancer stem cells, which are believed to be responsible for tumour initiation, and to promote the formation of metastases in bone tissue. Thus, inhibition of this protein (which certain drugs, such as denosumab, now hep to achieve) slows down tumour growth and reduce the risk of bone metastasis.
According to the AACR, Toriola was the first researcher to report a positive association between the receptor activator of nuclear factor-κB (RANK) pathway gene expression and mammographic breast density in premenopausal women. He demonstrated the potential utility of targeting the RANK pathway for primary breast cancer prevention in this patient population. Toriola demonstrated that plasma levels of RANK-pathway proteins could be used as biomarkers of mammographic breast density in premenopausal women, and that RANK ligand (RANKL) signalling is associated with mammographic breast density among such women with elevated progesterone levels.
Toriola is also acclaimed for establishing a leading research programme at the Siteman Cancer Centre, in Missouri, with the goal of identifying additional targetable determinants of mammographic density, especially in premenopausal women. He also established a platform to rapidly translate preclinical and clinical research findings into chemoprevention clinical trials in high-risk premenopausal women.
In recognition of these accomplishments, the AACR – the first and largest cancer research organisation with more than 58,000 members in 138 countries and territories – gave Toriola the 2022 “Outstanding Investigator Award for Breast Cancer Research”. According to the association, the award celebrates an investigator “whose novel and significant work has had or may have a far-reaching impact on the aetiology, detection, diagnosis, treatment, or prevention of breast cancer.”
Professor Carlos L. Arteaga, a former president of AACR, remarked that Toriola’s ground-breaking research is “an exceptional example of the progress we have accomplished in breast cancer, as well as a roadmap for next steps to continue to improve cure rates for patients with breast cancer and those who are at risk of developing this disease.”
Unparalleled devotion
Toriola is a professor of Surgery at Washington University School of Medicine, Missouri, United States. His research focuses on applying various omics approaches — metabolomics, transcriptomics, genomics, proteomics — to identify novel targetable markers and pathways that are associated with mammographic breast density and breast cancer development, especially in premenopausal women.
He is currently the principal investigator on two National Institutes of Health (NIH) funded researches on mammographic breast density and breast cancer prevention. One of these is aimed at understanding the molecular basis of breast density and the mechanisms by which dense breasts increase the risk of breast cancer; the other, a Merit Award, supports a phase 2 clinical trial evaluating whether targeting a signalling pathway can reduce breast density and levels of biomarkers known to increase breast cancer risk.
Toriola also performs molecular epidemiologic studies on colorectal and pancreatic cancers, evaluating the utility of biomarkers to investigate the associations of energetics, and inflammation with risk/mortality. He is a principal investigator on the ColoCare Study, a large multicentre cohort of colorectal cancer (CRC) patients for interdisciplinary studies of CRC prognosis and outcomes.
Toriola has authored and co-authored multiple peer-reviewed scientific papers. He has also made innovative presentations at many national and international conferences, including the seminal lecture he presented at the AACR on “Breast cancer prevention in premenopausal women: Accelerating transition from discoveries to clinical translation.” His contributions have received recognitions from leading experts from around the world.
Profound background and education
Three of the key factors that have continued to drive Toriola’s phenomenal career success are his robust background and upbringing, his uncommon passion for preventative and translational care, as well as his multidisciplinary medical training. According to him, “Most of my experiences from my childhood, within my home and school environment, prepared me and opened up my eyes to what I do now and why I do what I do… Initially, I desired to be a physician, but in the later part of my career, I streamlined my focus on research that impacts people individually.”
Toriola was born in the 70’s in Ibadan, Oyo State, and was raised by a university registrar father and a nurse mother, both of whom he says greatly influenced different aspects of his life. He attended Government College, Ibadan (GCI), which, according to him, “also shaped how I looked at the world. We were exposed to several wonderful achievers in school that made us believe we could achieve anything.” Thereafter, he studied Medicine at Obafemi Awolowo University, Ile-Ife, and graduated in 1998.
After his housemanship and NYSC programme, Toriola started his residency training in Anaesthesia at the University College Hospital (UCH), Ibadan. Within the five years he spent there, he made some poignant and career-defining observations. “We would have recorded a reduced number of patients if our preventive services were top-notch. That sparked the desire in me to undergo more training and increase my expertise in prevention,” he said.
Toriola proceeded to the University of Eastern Finland, in Kuopio, Finland, where he obtained a master’s degree in Public Health. He subsequently obtained a PhD in Health and Epidemiology from the University of Tampere, Tampere, Finland, in 2011. Thereafter, he conducted postdoctoral studies at the German Cancer Research Centre (DKFZ), Heidelberg, Germany, between 2011 and 2012.
It was while at Heidelberg that he got a job opportunity at Washington University for a faculty position as an assistant lecturer. He became an associate professor of surgery in 2019 and a full professor in 2022.
Awards and recognitions
Aside from the “Outstanding Investigator Award for Breast Cancer Research” from AACR, Toriola has received many other prestigious honours and recognitions. Earlier in 2022, he was named a William H. Danforth Washington University Physician Scholar, the second physician-researcher named as part of the School of Medicine’s new Physician-Scientist Investigators Initiative. The initiative supports pioneering physician-scientists whose work already has transformed their fields.
Prof. Timothy J. Eberlein, MD, director of Siteman Cancer Centre at Barnes-Jewish Hospital and Washington University School of Medicine, said of the award: “Dr Toriola’s research fulfils a critical unmet need in premenopausal breast cancer prevention, given the limited number of chemoprevention options available. His research represents cutting-edge precision prevention research.” Also reacting, Prof. Wayne M. Yokoyama, associate dean, Division of Physician-Scientists, Washington University School of Medicine, said: “Dr Toriola is part of a bustling community of physician-scientists who are excelling and poised to advance their fields in innovative and profound ways. It is an exciting time to be a physician-scientist on the Washington University Medical Campus.”
Toriola has also received the Susan G. Komen Career Catalyst Award, which, among other objectives, “supports basic, translational and clinical research that has unlocked new knowledge about breast cancer and helped advance patient care, improve patient outcomes and save the lives of those impacted by breast cancer.”
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