Ciscar, MarinaTrinidad, Eva MPerez-Chacon, GemaAlsaleem, MansourJimenez, MariaJimenez-Santos, Maria JPerez-Montoyo, HectorSanz-Moreno, AdrianVethencourt, AndreaToss, MichaelPetit, AnnaSoler-Monso, Maria TLopez, VictorGomez-Miragaya, JorgeGomez-Aleza, ClaraDobrolecki, Lacey ELewis, Michael TBruna, AlejandraMouron, SilvanaAl-Shahrour, FatimaQuintela Fandino, Miguel AngelMartinez-Aranda, AntonioSierra, AngelsGreen, Andrew RRakha, EmadGonzalez-Suarez, EvaCiscar, MarinaTrinidad, Eva MPerez-Chacon, GemaAlsaleem, MansourJimenez, MariaJimenez-Santos, Maria JPerez-Montoyo, HectorSanz-Moreno, AdrianVethencourt, AndreaToss, MichaelPetit, AnnaSoler-Monso, Maria TLopez, VictorGomez-Miragaya, JorgeGomez-Aleza, ClaraDobrolecki, Lacey ELewis, Michael TBruna, AlejandraMouron, SilvanaMartinez-Aranda, AntonioSierra, AngelsGreen, Andrew RRakha, EmadGonzalez-Suarez, Eva2024-10-162024-10-162023-04-11EMBO Mol Med . 2023 Apr 11;15(4):e16715.https://hdl.handle.net/20.500.12105/25172Despite strong preclinical data, the therapeutic benefit of the RANKL inhibitor, denosumab, in breast cancer patients, beyond the bone, is unclear. Aiming to select patients who may benefit from denosumab, we hereby analyzed RANK and RANKL protein expression in more than 2,000 breast tumors (777 estrogen receptor-negative, ER ) from four independent cohorts. RANK protein expression was more frequent in ER tumors, where it associated with poor outcome and poor response to chemotherapy. In ER breast cancer patient-derived orthoxenografts (PDXs), RANKL inhibition reduced tumor cell proliferation and stemness, regulated tumor immunity and metabolism, and improved response to chemotherapy. Intriguingly, tumor RANK protein expression associated with poor prognosis in postmenopausal breast cancer patients, activation of NFKB signaling, and modulation of immune and metabolic pathways, suggesting that RANK signaling increases after menopause. Our results demonstrate that RANK protein expression is an independent biomarker of poor prognosis in postmenopausal and ER breast cancer patients and support the therapeutic benefit of RANK pathway inhibitors, such as denosumab, in breast cancer patients with RANK ER tumors after menopause.engVoRhttp://creativecommons.org/licenses/by/4.0/ER negative breast cancerRANK-RANKLbreast cancer patient-derived xenograftsmenopausepharmacological RANKL inhibitorsAttribution 4.0 International36880458154e16715Embo Molecular Medicineopen access