Hotspot ESR1 Mutations Are Multimodal and Contextual Modulators of Breast Cancer Metastasis

Zheqi Li, Yang Wu, Megan E. Yates, Nilgun Tasdemir, Amir Bahreini, Jian Chen, Kevin M. Levine, Nolan M. Priedigkeit, Azadeh Nasrazadani, Simak Ali, Laki Buluwela, Spencer Arnesen, Jason Gertz, Jennifer K. Richer, Benjamin Troness, Dorraya El-Ashry, Qiang Zhang, Lorenzo Gerratana, Youbin Zhang, Massimo CristofanilliMaritza A. Montanez, Prithu Sundd, Callen T. Wallace, Simon C. Watkins, Caterina Fumagalli, Elena Guerini-Rocco, Li Zhu, George C. Tseng, Nikhil Wagle, Jason S. Carroll, Paul Jank, Carsten Denkert, Maria M. Karsten, Jens Uwe Blohmer, Ben H. Park, Peter C. Lucas, Jennifer M. Atkinson, Adrian V. Lee, Steffi Oesterreich*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Constitutively active estrogen receptor a (ER/ESR1) mutations have been identified in approximately one-third of ER metastatic breast cancers. Although these mutations are known as mediators of endocrine resistance, their potential role in promoting metastatic disease has not yet been mechanistically addressed. In this study, we show the presence of ESR1 mutations exclusively in distant but not local recurrences in five independent breast cancer cohorts. In concordance with transcriptomic profiling of ESR1-mutant tumors, genome-edited ESR1 Y537S and D538G-mutant cell models exhibited a reprogrammed cell adhesive gene network via alterations in desmosome/gap junction genes and the TIMP3/MMP axis, which functionally conferred enhanced cell-cell contacts while decreasing cell-extracellular matrix adhesion. In vivo studies showed ESR1- mutant cells were associated with larger multicellular circulating tumor cell (CTC) clusters with increased compactness compared with ESR1 wild-type CTCs. These preclinical findings translated to clinical observations, where CTC clusters were enriched in patients with ESR1-mutated metastatic breast cancer. Conversely, contextdependent migratory phenotypes revealed cotargeting of Wnt and ER as a vulnerability in a D538G cell model. Mechanistically, mutant ESR1 exhibited noncanonical regulation of several metastatic pathways, including secondary transcriptional regulation and de novo FOXA1-driven chromatin remodeling. Collectively, these data provide evidence for ESR1 mutation-modulated metastasis and suggest future therapeutic strategies for targeting ESR1-mutant breast cancer.

Original languageEnglish (US)
Pages (from-to)1321-1339
Number of pages19
JournalCancer Research
Issue number7
StatePublished - Apr 1 2022

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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