The function of membrane-associated molecules in acquired resistance to antiestrogens in breast cancer

Long-term clinical adjuvant antihormone therapy for breast cancer has significantly improved survival of estrogen receptor (ER)-positive breast cancer patients, but acquired resistance to antiestrogens is a major challenge in clinic. The evolution of acquired resistance to selective estrogen receptor modulators (SERMs) is unique because the growth of resistant tumors is dependent on SERMs. Thus, it appears that acquired resistance to SERMs is initially able to utilize either estrogen (E2) or a SERM as the growth stimulus in the ER-positive SERM-resistant breast tumors. However, no mechanism has been established to explain this paradox. Our newly established cell model MCF-7: PF, for the first time, replicates Phase I acquired resistance to SERMs in vitro. The cells are stimulated to grow robustly with E2 and SERMs through the ER which is confirmed by the evidence that pure antiestrogen ICI 182,780 (ICI) completely blocks the stimulation induced by E2 or SERMs. In contrast to E2 that activates classical ER-target genes, SERMs continue to function as effective antiestrogens to inhibit classical ER-target genes, even at the time of growth stimulation. A significant alteration of ER function observed in SERM-resistant cells is the enhancement of the non-genomic pathway of ER and the activation of multiple membrane function-associated molecules including focal adhesion molecules and adapter proteins to further increase phosphorylation of insulin-like growth factor-1 receptor (IGF-1R). Inhibition of membrane-associated signaling, IGF-1R and focal adhesion kinase (FAK), completely abolishes 4-OHT-stimulated cell growth. Overall, the constant nuclear pressure causes broad activation of membrane-associated signaling to aid breast cancer cell survival during the selection process required for acquired SERM resistance. The targeting of these membrane function-associated pathways and seeking new unanticipated combination therapies may have further clinical potential to decipher and treat endocrine-resistant breast cancer.