4-Hydroxytamoxifen enhances sensitivity of estrogen receptor α-positive breast cancer to docetaxel in an estrogen and ZNF423 SNP-dependent fashion

  • Gen Wang
  • Sisi Qin
  • Jacqueline Zayas
  • James N. Ingle
  • Mohan Liu
  • Richard M. Weinshilboum
  • Kunwei ShenEmail author
  • Liewei WangEmail author
Preclinical study



In early stage, ERα-positive breast cancer, concurrent use of endocrine therapy and chemotherapy has not been shown to be superior to sequential use. We hypothesized that genetic biomarkers can aid in selecting patients who would benefit from chemo-endocrine therapy. Our previous studies revealed that ZNF423 is a transcription factor for BRCA1 and an intronic single nucleotide polymorphism (SNP) in ZNF423, rs9940645, determines tamoxifen response. Here, we identified mitosis-related genes that are regulated by ZNF423 which led us to investigate taxane response in a rs9940645 SNP- and tamoxifen-dependent fashion.


The Cancer Genome Atlas (TCGA) breast cancer dataset was used to identify genes correlated with ZNF423. Quantitative reverse transcription PCR, chromatin immunoprecipitation, and luciferase reporter assays were used to validate the gene regulation. We used CRISPR/Cas9 to engineer paired ZR-75-1 cells which differ only in ZNF423 rs9940645 SNP genotype to test SNP-dependent phenotypes including cell cycle and cell viability. We validated our findings in an additional two breast cancer cell lines, Hs578T-ERα and HCC1500.


Mitosis-related genes VRK1 and PBK, which encode histone H3 kinases, were experimentally validated to be regulated by ZNF423. ZNF423 knockdown decreased VRK1 and PBK expression and activity. Additionally, ZNF423 knockdown enhanced docetaxel-induced G2/M arrest and cytotoxicity through VRK1 or PBK regulation. Lastly, cells carrying the rs9940645 variant genotype had increased G2/M arrest and decreased cell viability when treated with docetaxel in combination with estradiol and 4-OH-TAM.


We identified ZNF423 regulated genes involved in the G2/M phase of the cell cycle. 4-OH-TAM sensitized ERα-positive breast cancer cells to docetaxel in a ZNF423 SNP-dependent manner. Our findings suggest that patients with rs9940645 variant genotype may benefit from concurrent tamoxifen and docetaxel. This would impact a substantial proportion of patients because this SNP has a minor allele frequency of 0.47.


Breast cancer ZNF423 rs9940645 Chemo-endocrine therapy Single nucleotide polymorphism Precision medicine 





Calmodulin-like protein 3


Clustered, regularly interspaced short palindromic repeats






Estrogen receptor


Estrogen response element


Gene ontology


Genome-wide association study


Lymphoblastoid cell line


National surgical adjuvant breast and bowel project




Poly(ADP-ribose) polymerase


PDZ binding kinas


Quantitative reverse transcription polymerase chain reaction


Selective estrogen receptor modulator


Single nucleotide polymorphism


The Cancer Genome Atlas


Wild type


Vaccinia-related kinase 1


Zinc finger protein 423



We would like to acknowledge Thomas Spelsberg, Ph.D. for providing the Hs578T-ERα cell line.

Author contributions

GW, SQ, and JZ participated in data acquisition, data analysis, and manuscript writing. GW designed the study and drafted the manuscript. SQ generated the ZR75-1 CRISPR Cas9 genome edited cell line. ML carried out the ZNF423 and 4-OH-TAM screens. JNI provided invaluable clinical expertise and assisted in manuscript preparation. RMW conceived the study, participated in the study design, and provided guidance in data interpretation. KS provided clinical advice and helped apply for the ChuYing Charity Foundation support. LW conceived the study, participated in the study design, coordinated the study, and is responsible for all data as described. All authors approved the final manuscript.


This work was supported by The Breast Cancer Research Foundation (BCRF-18-076) and Eisenberg Foundation. GW was supported by ChuYing Charity Foundation. JZ was supported by the Mayo Clinic Medical Scientist Training Program (T32 GM065841) and Initiative for Maximizing Student Development (R25 GM055252).

Compliance with ethical standards

Conflict of interest

ML is currently affiliated with AbbVie and, however, was not at the time of involvement in this study. LW and RMW are co-founders and stockholders in OneOme, LLC, a pharmacogenomic decision support company.

Ethical approval

All experiments performed in this publication comply with US laws. There were no human participants or animals used in this study.

Supplementary material

10549_2019_5194_MOESM1_ESM.xlsx (9 kb)
Supplementary material 1. Online Resource 1: Table S1 Primers sequences for luciferase and ChIP assay are provided 5’ to 3’. Catalog numbers for predesigned qRT-PCR primers are also listed. (XLSX 9 KB)
10549_2019_5194_MOESM2_ESM.xlsx (13 kb)
Supplementary material 2. Online Resource 2: Table S2 Hs578T-ERα cells were transiently transfected with siRNA targeting each of the 368 candidate genes and an siRNA control (siControl). Gene expression was measured by by real-time quantitative reverse transcription-PCR (qRT-PCR) and normalized to housekeeping genes. There were 109 genes with at least a twofold change in gene expression upon ZNF423 knockdown; 99 downregulated and 10 upregulated genes. (XLSX 12 KB)
10549_2019_5194_MOESM3_ESM.xlsx (21 kb)
Supplementary material 3. Online Resource 3: Table S3 Lymphoblastoid cell lines (LCLs) overexpressing ERα with known rs9940645 genotypes were treated with vehicle control, E2, or E2 plus 4-OH-TAM. We used at least 7 different LCLs per genotype for each treatment. Gene expression of the 368 genes was measured by quantitative reverse transcription-PCR (qRT-PCR). There were 119 genes that displayed SNP-dependent expression pattern changes in the E2 plus 4-OH-TAM treatment compared to E2 alone. Eighty-two of the 119 genes had decreased expression in wild-type cells treated with 4-OH-TAM and increased expression in variant cells treated with 4-OH-TAM, which is the same direction of change that we observed previously with ZNF423 and BRCA1. (XLSX 20 KB)
10549_2019_5194_MOESM4_ESM.pptx (981 kb)
Supplementary material 4. Online Resource 4: Figure S1 GO Analysis was performed by inputting genes identified from the ZNF423 knockdown or 4-OH-TAM screen into the Cluego plugin of the Cytoscape software. Depicted is the GO analysis for the 4-OH-TAM screen. (A) GO terms are visualized as nodes and grouped into a network based on function (kappa score level ≥ 0.4). The size of each node represents the enrichment significance. (B-C) Each functional group (GO group) is labeled with a unique color and named using the most significant GO term within the group. Some GO terms were shared by different GO groups. (B) The pie chart illustrates the proportion by which each GO group was represented among the GO terms. Mitotic nuclear division was the most abundant GO group. (C) The significance of GO groups is shown ranked by Bonferroni-corrected p value. (PPTX 981 KB)
10549_2019_5194_MOESM5_ESM.xlsx (20 kb)
Supplementary material 5. Online Resource 5: Table S4 Results from gene ontology analysis of the 109 genes which had at least a twofold change in gene expression upon ZNF423 knockdown. (XLSX 20 KB)
10549_2019_5194_MOESM6_ESM.xls (64 kb)
Supplementary material 6. Online Resource 6: Table S5 Results from gene ontology analysis of the 119 genes that displayed SNP-dependent expression pattern changes in the E2 plus 4-OH-TAM treatment compared to E2 alone. (XLS 64 KB)
10549_2019_5194_MOESM7_ESM.xls (28 kb)
Supplementary material 7. Online Resource 7: Table S6 Comparison of genes within the most significant GO term from each screen. There were 7 overlapping genes from top GO terms, including VRK1 and PBK. (XLS 28 KB)
10549_2019_5194_MOESM8_ESM.pptx (359 kb)
Supplementary material 8. Online Resource 8: Figure S2 ZR-75-1 cells with WT or variant SNP genotype were transiently (A) knocked down with the indicated siRNA or (B) overexpressed with the indicated plasmids. Then, qRT-PCR was performed to determine the gene expression of ZNF423, VRK1, and PBK relative to control. Data shown as mean ± SEM. *p < 0.05, **p < 0.01, ***p < 0.001. (PPTX 359 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Comprehensive Breast Health Center, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiPeople’s Republic of China
  2. 2.Department of Molecular Pharmacology and Experimental TherapeuticsMayo ClinicRochesterUSA
  3. 3.Mayo Clinic Graduate School of Biomedical SciencesMayo Clinic School of Medicine and the Mayo Clinic Medical Scientist Training ProgramRochesterUSA
  4. 4.Department of OncologyMayo ClinicRochesterUSA
  5. 5.Pharmacogenetics and Human Genetics, Genomics Research CenterAbbVie Inc.North ChicagoUSA

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