There is evidence to suggest that
follicle-stimulating hormone (FSH) can facilitate the neovascularization of
ovarian cancers by increasing
vascular endothelial growth factor (
VEGF) expression in
cancer cells, although the underlying molecular mechanism of this process is not well known. Therefore, we investigated the effect of FSH on
VEGF expression in the
ovarian cancer cell lines SKOV-3 and ES-2. Treatment with FSH significantly increased
VEGF expression in a dose- and time-dependent manner. In addition, FSH treatment enhanced the expression of
survivin and
hypoxia-inducible factor-1 (HIF-1alpha). Knockdown of
survivin or HIF-1alpha suppressed
VEGF expression, but only knockdown of
survivin inhibited FSH-stimulated
VEGF expression. Pretreatment with
LY294002, a
phosphoinositide 3-kinase (PI3K)/AKT inhibitor, neutralized the enhanced expression of
survivin induced by FSH, but treatment with
U0126, a
mitogen-activated protein kinase/
extracellular signal-regulated kinase inhibitor, had no such effect. We further showed that ovarian
serous cystadenocarcinoma samples had much higher incidence of positive AKT and phosphorylated AKT (pAKT)
protein staining than did benign ovarian
cystadenoma samples (p < 0.01). The 5-year survival rate was only about 15% in patients with ovarian
serous cystadenocarcinoma who had AKT and pAKT expression, whereas it was about 80% in those who did not have AKT or pAKT expression. Taken together, these results indicate that FSH increases the expression of
VEGF by upregulating the expression of
survivin, which is activated by the PI3K/AKT signaling pathway. Understanding the role of the PI3K/AKT pathway in FSH-stimulated expression of
survivin and
VEGF will be beneficial for evaluating the prognosis for patients with ovarian
serous cystadenocarcinoma and for pursuing effective treatment against this disease.