Abstract 4672: Targeting MEK/MAPK1/2 in vivo to eradicate antiestrogen resistance
Authors: Conger Jason , Manning Matthew , Anosike Kingsley , Elsherbini Ahmed , Ware Brandon , Bass Emily , Thangaraju Mathusamy , Browning Darren , Schoenlein Patricia V. 
Published: July 2016

Abstract
Tamoxifen (TAM), an antiestrogen and selective estrogen receptor modifier (SERM) has become a widely utilized therapeutic drug for treating ER+ breast cancer, however many cases develop TAM resistance. In previous in vitro studies, TAM combined with the selective Mitogen/Extracellular signal-regulated Kinase pathway (MEK) inhibitor U0126 (U) led to increased levels of the proapoptotic protein BimEL. This combined treatment was more effective at killing estrogen receptor expressing (ER+) breast cancer cells than either agent alone via a Bim-dependent mechanism [Periyasamy-Thandavan el al., Breast Cancer Res. 14(2), 2012]. In this study, we aimed to recapitulate the superior efficacy of this combined treatment strategy with the clinically relevant MEK inhibitor Selumetinib (SEL) using the TAM sensitive, ER+ MCF-7 breast cancer cell line. In addition, we utilized MCF7-TAM resistant cells (TR5), created in vitro through exposures to incremental increases in TAM concentration(100ng to 5.0μM). MCF-7 cells that were treated with TAM, SEL, U, or combination therapies in vitro demonstrated a similar efficacy between U and SEL with the lowest cell viability resulting from TAM plus U or SEL compared to TAM, U, or SEL as single agents. Western blot analysis of U- or SEL-treated MCF7 cells showed a similar robust upregulation of BimEL in the presence or absence of TAM. Comparison of the TR5 TAM resistant cells to parent MCF-7 cells showed elevated levels of active MAPK1/2 protein (p-MAPK) that mediated the phosphorylation and subsequent proteasomal degradation of BimEL. Importantly, inhibition of MEK/MAPK1/2 by SEL or U in TR5 cells in vitro significantly increased BimEL levels and TAM induced apoptosis as evidenced by increased levels of cleaved PARP and/or lamin A. In a pilot in vivo study, we further demonstrated that TR5 cells were highly tumorigenic with the xenografts being estrogen independent and insensitive to TAM inhibition. In contrast, the TR5 xenografts were sensitive to SEL when delivered in the presence or absence of TAM. Further, tissue analyzed from SEL-treated TR5 xenografts showed significantly higher levels of BimEL than tissue analyzed from TAM- or E2-treated xenografts. These initial studies provide strong data that MEK1/MAPK1/2 inhibition will be required in vivo to raise BimEL levels to negatively affect breast cancer growth. These studies also support the concept of combining SEL with antiestrogen treatment (as a combined adjuvant therapy) to reduce the emergence of antiestrogen resistant cells and to include SEL as part of a regimen to treat antiestrogen resistant breast cancer.
Citation Format: Jason Conger, Matthew Manning, Kingsley Anosike, Ahmed Elsherbini, Brandon Ware, Emily Bass, Mathusamy Thangaraju, Darren Browning, Patricia V. Schoenlein. Targeting MEK/MAPK1/2 in vivo to eradicate antiestrogen resistance. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4672.