Research ArticleCancer

Epigenetic Reprogramming of HOXC10 in Endocrine-Resistant Breast Cancer

Science Translational Medicine  26 Mar 2014:
Vol. 6, Issue 229, pp. 229ra41
DOI: 10.1126/scitranslmed.3008326

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Playing Tug-of-War with HOXC10

Aromatase inhibitors are drugs that prevent androgens from being converted into estrogen, and they are frequently used to treat breast cancers that express the estrogen receptor. Unfortunately, some patients’ tumors never respond to these drugs, and others gradually become resistant over time. Although the development of resistance to aromatase inhibitors has been investigated in some previous studies and some potential mechanisms have been proposed, much about this process remains unknown.

Pathiraja and colleagues began by performing a genome-wide methylation screen in breast cancer cells, which identified the developmental gene HOXC10 as a target of epigenetic silencing in the context of long-term estrogen withdrawal. When HOXC10 is active, it interferes with proliferation and can stimulate apoptosis, but estrogen suppresses its activity, thereby promoting tumor growth. By decreasing estrogen production, aromatase inhibitors up-regulate HOXC10, accounting for some of their antitumor activity. However, long-term estrogen deprivation eventually has the opposite effect, leading to methylation of HOXC10 and its long-term suppression even in the absence of estrogen. These findings suggest that a rational approach for overcoming aromatase resistance in breast cancer may involve the addition of demethylating drugs to overcome the methylation of HOXC10 and take advantage of its antitumor effects, although this remains to be demonstrated directly.