title: Expression of the K303R estrogen receptor-alpha breast cancer mutation induces resistance to an aromatase inhibitor via addiction to the PI3K/Akt kinase pathway.
abstract: Aromatase inhibitors (AI) are rapidly becoming the first choice for hormonal treatment of estrogen receptor-alpha (ERalpha)-positive breast cancer in postmenopausal women. However, de novo and acquired resistance frequently occurs. We have previously identified a lysine to arginine transition at residue 303 (K303R) in ERalpha in premalignant breast lesions and invasive breast cancers, which confers estrogen hypersensitivity and resistance to tamoxifen treatment. Thus, we questioned whether resistance to AIs could arise in breast cancer cells expressing the ERalpha mutation. As preclinical models to directly test this possibility, we generated K303R-overexpressing MCF-7 cells stably transfected with an aromatase expression vector. Cells were stimulated with the aromatase substrate, androstenedione, with or without the AI anastrozole (Ana). We found that Ana decreased androstenedione-stimulated growth of wild-type cells, whereas K303R-expressing cells were resistant to the inhibitory effect of Ana on growth. We propose that a mechanism of resistance involves an increased binding between the mutant receptor and the p85alpha regulatory subunit of phosphatidylinositol-3-OH kinase (PI3K), leading to increased PI3K activity and activation of protein kinase B/Akt survival pathways. Inhibition of the selective "addiction" to the PI3K/Akt pathway reversed AI resistance associated with expression of the mutant receptor. Our findings suggest that the K303R ERalpha mutation might be a new predictive marker of response to AIs in mutation-positive breast tumors, and that targeting the PI3K/Akt pathway may be a useful strategy for treating patients with tumors resistant to hormone therapy.
authors.affiliation: Breast Center and Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Ines
authors.initials: I
authors.lastname: Barone
authors.forename: Yukun
authors.initials: Y
authors.lastname: Cui
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Herynk
authors.forename: Arnoldo
authors.initials: A
authors.lastname: Corona-Rodriguez
authors.forename: Cinzia
authors.initials: C
authors.lastname: Giordano
authors.forename: Jennifer
authors.initials: J
authors.lastname: Selever
authors.forename: Amanda
authors.initials: A
authors.lastname: Beyer
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Andò
authors.forename: Suzanne A W
authors.initials: SA
authors.lastname: Fuqua
mesh_terms: D019943:Amino Acid Substitution / Q000235:genetics; D000818:Animals; D001120:Arginine / Q000235:genetics; D047072:Aromatase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D016466:CHO Cells; D006224:Cricetinae; D003412:Cricetulus; D019008:Drug Resistance, Neoplasm / Q000235:genetics*; D047628:Estrogen Receptor alpha / Q000235:genetics*; D005260:Female; D006801:Humans; D008239:Lysine / Q000235:genetics; D051379:Mice; D008819:Mice, Nude; D020125:Mutation, Missense / Q000502:physiology; D051058:Oncogene Protein v-akt / Q000378:metabolism / Q000502:physiology*; D019869:Phosphatidylinositol 3-Kinases / Q000378:metabolism / Q000502:physiology*; D011379:Prognosis; D015398:Signal Transduction / Q000187:drug effects / Q000235:genetics / Q000502:physiology; D014407:Tumor Cells, Cultured; D023041:Xenograft Model Antitumor Assays
chemical_list: D047072:Aromatase Inhibitors; D047628:Estrogen Receptor alpha; D001120:Arginine; D019869:Phosphatidylinositol 3-Kinases; D051058:Oncogene Protein v-akt; D008239:Lysine