PAK4 regulates stemness and progression in endocrine resistant ERpositive metastatic breast cancer

Angélica Santiago-Gómez, Thomas Kedward, Bruno M Simoes, Illaria Dragoni, Roisin NicAmhlaoibh, Elisabeth Trivier, Verity Sabin, Julia M Gee, Andrew H Sims, Sacha J Howell, Robert B Clarke

Research output: Contribution to journalArticlepeer-review


Despite the effectiveness of endocrine therapies to treat estrogen receptor-positive (ER+) breast tumours, two thirds of patients will eventually relapse due to de novo or acquired resistance to these agents. Cancer Stem-like Cells (CSCs), a rare cell population within the tumour, accumulate after anti-estrogen treatments and are likely to contribute to their failure. Here we studied the role of p21-activated kinase 4 (PAK4) as a promising target to overcome endocrine resistance and disease progression in ER+ breast cancers. PAK4 predicts for resistance to tamoxifen and poor prognosis in 2 independent cohorts of ER+ tumours. We observed that PAK4 strongly correlates with CSC activity in metastatic patient-derived samples irrespective of breast cancer subtype. However, PAK4-driven mammosphere-forming CSC activity increases alongside progression only in ER+ metastatic samples. PAK4 activity increases in ER+ models during acquired resistance to endocrine therapies. Targeting PAK4 with either CRT PAKi, a small molecule inhibitor of PAK4, or with specific siRNAs abrogates CSC activity/self-renewal in clinical samples and endocrine-resistant cells. Together, our findings establish that PAK4 regulates stemness during disease progression and that its inhibition reverses endocrine resistance in ER+ breast cancers.
Original languageEnglish
Article number10.1016/j.canlet.2019.05.014
Number of pages11
JournalCancer Letters
Early online date20 May 2019
Publication statusPublished - 28 Aug 2019


  • Breast cancer
  • endocrine resistance
  • PAK4
  • Cancer stem cells

Research Beacons, Institutes and Platforms

  • Cancer
  • Manchester Cancer Research Centre


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