Sclerostin blockade promotes bone metastases of Wnt‐responsive breast cancer cells

The secreted protein sclerostin is primarily produced by osteocytes and suppresses osteoblast differentiation and function by inhibiting the canonical Wnt signaling pathway. Genetic and pharmacological inhibition of sclerostin has been shown to increase bone formation and an anti‐sclerostin antibody has been clinically approved for the treatment of osteoporosis. Canonical Wnt signaling is also involved in the progression of several types of cancers including breast cancer. Here, we studied the effects of sclerostin inhibition on the development of bone metastases of breast cancer using mouse models. TOPFLASH assay and real‐time PCR analysis of AXIN2, a target of canonical Wnt signaling, revealed that, among four cell lines tested, MDA‐MB‐231 human breast cancer cells responded highly to the canonical Wnt ligand Wnt3a, whereas other cell lines exhibited marginal responses. Consistent with these results, treatment with an anti‐sclerostin antibody significantly increased the bone metastases of MDA‐MB‐231 but not those of other breast cancer cells. Immunohistochemical studies demonstrated that an anti‐sclerostin antibody induced intracellular accumulation of β‐catenin in bone‐colonized MDA‐MB‐231 cells. Suspension culture assays showed that Wnt3a accelerated the tumorsphere formation of MDA‐MB‐231 cells, whereas monolayer cell proliferation and migration were not affected. Furthermore, the numbers of osteoclasts and their precursor cells in bone metastases of MDA‐MB‐231 were significantly increased in mice treated with an anti‐sclerostin antibody. These results collectively suggest that sclerostin blockade activates canonical Wnt signaling in ligand‐responsive breast cancer cells metastasized to bone, thereby increasing bone metastases, likely to have been mediated at least in part by enhancing stem cell‐like properties of cancer cells and osteoclastogenesis.