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Cancer-associated fibroblast-derived protein S100-A11 influences the response to anti-HER2 therapies in HER2-positive breast cancer
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DOI：10.1016/j.neo.2026.101318.png)
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Abstract
En 中文
Breast cancer is the most commonly diagnosed cancer worldwide and includes the HER2-positive (HER2+) subtype, characterised by HER2 overexpression. HER2+ breast cancer is treated with neoadjuvant anti-HER2 therapy combined with taxane-based chemotherapy, yet a substantial proportion of patients fail to achieve pathological complete response. Increasing evidence indicates that the tumour microenvironment (TME), particularly cancer-associated fibroblasts (CAFs), contributes to therapy resistance through paracrine signalling. In this study, we investigated the role of stromal/CAF-derived S100-A11 in the response to trastuzumab, pertuzumab, and docetaxel (TPD) therapy. Proteomic analysis and ELISA confirmed increased S100-A11 secretion by TPD-treated CAF-200 fibroblasts. Recombinant S100-A11 reduced sensitivity to TPD in multiple HER2+ breast cancer cell lines, whereas S100A11 silencing in CAF-200 attenuated the resistance-promoting effect of CAF-conditioned medium in BT-474 and EFM-192A cells. Mechanistically, S100-A11 exposure was associated with increased STAT3 phosphorylation, and pharmacological inhibition of STAT3 or RAGE partially reversed the S100-A11-associated resistance phenotype. In a reductionist xenograft model, RAGE inhibition with azeliragon attenuated the effect of exogenous S100-A11 on tumour response to TPD. In a retrospective cohort of early-stage HER2+ breast cancer, high stromal S100-A11 expression was associated with residual disease after neoadjuvant therapy and with increased tumour p-STAT3 levels. Dual staining for S100-A11 and α-SMA further supported the presence of S100-A11-expressing CAFs in patient tumours. Together, these findings support a role for stromal S100-A11 in modulating response to anti-HER2 therapy and suggest that the S100-A11/RAGE/STAT3 axis may represent a therapeutically relevant stromal signalling pathway. Further validation in independent clinical cohorts and more physiologically representative models is required.
Keywords:
Breast cancer
HER2-positive
Trastuzumab
Pertuzumab
Resistance
Tumour microenvironment
Cancer-associated fibroblasts
S100-A11
STAT3 signalling
RAGE receptor
Azeliragon
Stattic
Preclinical models
Biomarkers
Therapy-response biomarker potential
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