Dickkopf-1 is regulated by the mevalonate pathway in breast cancer

Research output: Contribution to journalResearch articleContributedpeer-review



INTRODUCTION: Amino-bisphosphonates and statins inhibit the mevalonate pathway, and may exert anti-tumor effects. The Wnt inhibitor dickkopf-1 (DKK-1) promotes osteolytic bone lesions by inhibiting osteoblast functions and has been implicated as an adverse marker in multiple cancers. We assessed the effects of mevalonate pathway inhibition on DKK-1 expression in osteotropic breast cancer.

METHODS: Regulation of DKK-1 by bisphosphonates and statins was assessed in human breast cancer cell lines, and the role of the mevalonate pathway and downstream targets was analyzed. Moreover, the potential of breast cancer cells to modulate osteoblastogenesis via DKK-1 was studied in mC2C12 cells. Clinical relevance was validated by analyzing DKK-1 expression in the tissue and serum of women with breast cancer exposed to bisphosphonates.

RESULTS: DKK-1 was highly expressed in receptor-negative breast cancer cell lines. Patients with receptor-negative tumors displayed elevated levels of DKK-1 at the tissue and serum level compared to healthy controls. Zoledronic acid and atorvastatin potently suppressed DKK-1 in vitro by inhibiting geranylgeranylation of CDC42 and Rho. Regulation of DKK-1 was strongest in osteolytic breast cancer cell lines with abundant DKK-1 expression. Suppression of DKK-1 inhibited the ability of breast cancer cells to block WNT3A-induced production of alkaline phosphates and bone-protective osteoprotegerin in preosteoblastic C2C12 cells. In line with the in vitro data, treatment of breast cancer patients with zoledronic acid decreased DKK-1 levels by a mean of 60% after 12 months of treatment.

CONCLUSION: DKK-1 is a novel target of the mevalonate pathway that is suppressed by zoledronic acid and atorvastatin in breast cancer.


Original languageEnglish
Article numberR20
JournalBreast Cancer Research
Issue number1
Publication statusPublished - 14 Feb 2014

External IDs

Scopus 84896878302
researchoutputwizard legacy.publication#61016
PubMed 24528599
PubMedCentral PMC3979025
researchoutputwizard legacy.publication#61416
ORCID /0000-0001-9345-026X/work/150883240
ORCID /0000-0002-8691-8423/work/150882245


Sustainable Development Goals


  • Animals, Anticholesteremic Agents/pharmacology, Atorvastatin, Bone Density Conservation Agents/pharmacology, Bone Neoplasms/prevention & control, Cell Line, Tumor, Diphosphonates/pharmacology, Female, Gene Expression Regulation, Neoplastic, Heptanoic Acids/pharmacology, Humans, Imidazoles/pharmacology, Intercellular Signaling Peptides and Proteins/biosynthesis, L Cells, Lymphocyte Activation, MCF-7 Cells, Mevalonic Acid/metabolism, Mice, Osteoblasts/cytology, Osteogenesis, Osteoprotegerin/biosynthesis, Prenylation, Pyrroles/pharmacology, RNA Interference, RNA, Small Interfering, Rho Factor/metabolism, Triple Negative Breast Neoplasms/pathology, Wnt3A Protein/antagonists & inhibitors, Zoledronic Acid, cdc42 GTP-Binding Protein/metabolism