Estrogen Receptor-Α Directly Regulates the Hypoxia- Inducible Factor 1 Pathway Associated with Antiestrogen Response in Breast Cancer

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Estrogen Receptor-Α Directly Regulates the Hypoxia- Inducible Factor 1 Pathway Associated with Antiestrogen Response in Breast Cancer Estrogen receptor-α directly regulates the hypoxia- inducible factor 1 pathway associated with antiestrogen response in breast cancer Jun Yanga,b,1, Alaa AlTahanb, Dylan T. Jonesa, Francesca M. Buffaa, Esther Bridgesa, Rodrigo B. Interianob, Chunxu Quc, Nathan Vogtb, Ji-Liang Lia, Dilair Baband, Jiannis Ragoussisd,2, Robert Nicholsone, Andrew M. Davidoffb, and Adrian L. Harrisa aGrowth Factor Group, Cancer Research UK, Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DS, United Kingdom; bDepartment of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105; cDepartment of Bioinformatics, St. Jude Children’s Research Hospital, Memphis, TN 38105; dGenomics Group, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom; and eTenovus Centre for Cancer Research, Welsh School of Pharmacy, Cardiff University, Cardiff CF10 3NB, United Kingdom Edited by Joan S. Brugge, Harvard Medical School, Boston, MA, and approved October 13, 2015 (received for review November 17, 2014) + A majority of breast cancers are driven by estrogen via estrogen resistance in neoadjuvant, primary therapy of ERα breast cancers receptor-α (ERα). Our previous studies indicate that hypoxia-induc- (12), as well as resistance to chemoendocrine therapy (13). ible factor 1α (HIF-1α) cooperates with ERα in breast cancer cells. HIF-1α is a master regulator of oxygen homeostasis, which is However, whether ERα is implicated in the direct regulation of rapidly degraded in normoxia by the tumor suppressor, von Hippel– HIF-1α and the role of HIF-1α in endocrine therapy response are un- Lindau protein (VHL), but is stabilized in hypoxia (14). This pro- known. In this study we found that a subpopulation of HIF-1α targets, cess is mainly determined by the hydroxylation of HIF-1α catalyzed many of them bearing both hypoxia response elements and estrogen by prolyl hydroxylases. HIF-1α has been associated with an ag- response elements, are regulated by ERα in normoxia and hypoxia. gressive phenotype of breast cancer: that is, large tumor size, high Interestingly, the HIF-1α gene itself also bears an estrogen response grade, high proliferation, and lymph node metastasis (15). In- element, and its expression is directly regulated by ERα.Clinicaldata creased HIF-1α is also associated with ERα-positivity (15), revealed that expression of the HIF-1α gene or a hypoxia metagene whereas HIF-1β, the partner of HIF-1α, has been shown to signature is associated with a poor outcome to endocrine treatment function as a potent coactivator of ER-dependent transcription + + in ERα breast cancer. HIF-1α was able to confer endocrine therapy (16). Further studies revealed that in ER T47D breast cancer + resistance to ERα breast cancer cells. Our findings define, for the first cells, combined hypoxia and E2 treatment had additive effects on time to our knowledge, a direct regulatory pathway between ERα expression of some genes (17), although the mechanism is not and HIF-1α, which might modulate hormone response in treatment. clear. We have previously shown that HIF-1α and ERα can co- ordinate expression of genes, such as lysine-specific demethylase ERα | HIF-1α | tamoxifen 4B/Jumonji domain-containing 2B (KDM4B/JMJD2B), an H3K9me3/me2 histone demethylase, which is targeted by both strogen receptor-α (ERα) is an estrogen-dependent nuclear ERα and HIF-1α and epigenetically regulates cell cycle progression Etranscription factor that is critical for mammary epithelial cell division and breast cancer progression (1, 2). ERα is Significance expressed in ∼70% of breast tumors (3), the majority of which depend on estrogen signaling, thereby providing the rationale for About 1.7 million new cases of breast cancer occur every year, 70% using antiestrogens as adjuvant therapy to treat breast cancer (4). of which are estrogen receptor-α (ERα) positive. Antiestrogen Tamoxifen is a first generation selective ER modulator and has therapy to block ERα function is the most important approach in + been widely used in breast cancer prevention and treatment (4). treatmentofERα patients. However, resistance eventually will Although now replaced by aromatase inhibitors as first-line develop for various reasons. Here we demonstrate that hypoxia- treatment in postmenopausal women, it still remains important inducible factor 1α (HIF-1α) is a direct transcriptional target of ERα, α in premenopausal breast cancer and after failure of aromatase which may compensate for ER function loss because many other α α α inhibitors. Tamoxifen acts as an antagonist in breast cancer cells ER targets are also HIF-1 targets. We further show that HIF-1 α by competing with estrogen for the ER. Tamoxifen-bound ER is able to confer cancer cell resistance to ER antagonists tamox- ifen and fulvestrant, and the expression of HIF-1α is associated recruits the nuclear receptor corepressor and histone deacetylase + with poor survival to endocrine therapy in ERα patients. Our (HDAC), as opposed to coactivators, leading to transcriptional findings thus have revealed a previously unidentified mechanism repression (5). Although hundreds of thousands of patients have for antiestrogen resistance. benefited from tamoxifen treatment, its efficacy is limited to an average time of 15 mo in patients with metastatic disease (6), as Author contributions: J.Y., A.M.D., and A.L.H. designed research; J.Y., A.A., D.T.J., E.B., R.B.I., resistance often develops (7). Many mechanisms have been proposed to N.V., D.B., and J.R. performed research; J.Y., J.-L.L., and R.N. contributed new reagents/ account for tamoxifen resistance (8), including loss of ERα ex- analytic tools; J.Y., A.A., F.M.B., and C.Q. analyzed data; and J.Y., A.M.D., and A.L.H. wrote the paper. pression or expression of truncated ER isoforms, posttranslational The authors declare no conflict of interest. modification of ERα, deregulation of ERα coactivators, and in- creased receptor tyrosine kinase signaling. Recent studies further This article is a PNAS Direct Submission. α Data deposition: The data reported in this paper have been deposited in the Gene Ex- indicate that somatic ER mutation (9, 10), as well as genomic pression Omnibus (GEO) database, www.ncbi.nlm.nih.gov/geo (accession no. GSE61799). amplification of distant ER response elements (11), could con- 1To whom correspondence should be addressed. Email: [email protected]. tribute to hormone therapy resistance. 2Present address: McGill University and Genome Quebec Innovation Centre, McGill Uni- Our clinical studies suggest that the in vivo tumor environment versity, Montreal, QC, Canada. may play a role in tamoxifen resistance, as hypoxia-inducible factor This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10. 1α (HIF-1α) protein expression was associated with tamoxifen 1073/pnas.1422015112/-/DCSupplemental. 15172–15177 | PNAS | December 8, 2015 | vol. 112 | no. 49 www.pnas.org/cgi/doi/10.1073/pnas.1422015112 Downloaded by guest on September 29, 2021 (18). The genomic locus of KDM4B bears both HIF-1α and ERα directly regulate their expression. The top hits were ERα and binding elements (18, 19). These data collectively suggest that HIF-1α (Fig. 1C). Thus, these data indicate that a subgroup of HIF-1α and ERα are functionally associated. However, how these genes that are targeted by hypoxia/HIF-1α is also regulated by two important oncogenic pathways interact has not yet been de- ERα signaling, which is dual responsive to hormone and oxygen. fined. In addition, whether HIF-1α plays an autonomous role in Interestingly, some of these genes can be bound by p53 in murine modulating endocrine therapy efficacy, such as tamoxifen re- embryonic stem cells although the biological function is unclear sistance, is unknown. In this study, we investigated the role of ERα (20). Cancer genomic sequencing reveals that p53 is more com- + in the regulation of HIF-1 signaling and how HIF-1 signaling is monly mutated in triple-negative breast cancers than ERα involved in endocrine drug response. patients (21), whereas MCF7 is p53 wild-type. ZNF263 is a tran- scription factor that regulates FoxA1 expression (22). FoxA1 is a Results pioneer factor that facilitates ERα for genomic binding (23), ERα Signaling Regulates Hypoxia/HIF-1α Pathway. We have previously which further suggests that the estrogen-ER signaling pathway is shown that knockdown of ERα significantly down-regulated his- involved in hypoxia/HIF response. tone demethylase KDM4B expression (18), a HIF-1α transcrip- To further confirm that ERα and HIF-1α directly bind their tional target, suggesting that HIF-1α function is compromised by response elements in a subgroup of genes, we reanalyzed pub- loss of ERα even in hypoxia. To study whether ERα signaling is lished ChIP sequencing data (24, 25). We found that among the involved in the regulation of the hypoxia/HIF pathway, we used a 356 genes bound by HIF-1α, 202 (57%) of them were identified + chemical genetics approach in which the ERα breast cancer cell as the common genes bound by ERα as well (Fig. 1D and Table line MCF7 was treated with ICI182780 (fulvestrant) in normoxia S1). KDM4B was one of the targets of both ERα and HIF-1α and hypoxia to perform a global gene-expression profile analysis (Table S1), consistent with our previous studies (18, 26). Pathway (Fig. 1A). ICI182780 is an ER antagonist with no agonist effects, analysis reveals that these common genes
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