Breast cancer metastasis to bone: it is not all about PTHrP

Breast cancer shows a predilection for metastasis to bone. Interestingly, approximately 80% of patients with breast cancer also have bone metastases develop at some point during the course of their disease. Osteolytic breast cancer induces bonedestruction via the stimulation of osteoclasts. Breast cancer cells produce many known stimulators of bone resorption with significant research effort focused on the role of parathyroid hormone-related protein (PTHrP). However, a recent prospective clinical trial has questioned the primary role of PTHrP in this process. The overexpression of interleukin-8 (IL-8) in metastatic breast cancer cells prompted additional investigation of the role of IL-8 in osteolysis. Recombinant IL-8 induces the expression of RANKL mRNA and protein in osteoblastic cells and stimulates formation of bone resorbing osteoclasts, even in the absence of RANKL. The ability of IL-8 to directly stimulate osteoclastogenesis via RANKL dependent and independent mechanisms suggests it may play an important role in the process of osteoclast formation and function. Therefore, we propose that cytokines such as IL-8 are involved in the early stages of breast cancer metastasis and initiate the process of osteoclastic bone resorption. In this modified model of breast cancer metastasis to bone, PTHrP expression is induced later to stimulate the vicious cycle of bone destruction.