In the quest to enhance therapeutic strategies for Estrogen Receptor-Positive (ER+) breast cancer, an innovative study by a team of researchers from the University of Illinois Urbana-Champaign marks a significant milestone. Published on January 14, 2024, in the reputable journal ‘Trends in Endocrinology and Metabolism’, the article penned by Heath Hannah H, Mogol Ayca Nazli AN, Santaliz Casiano Ashlie A, Zuo Qianying Q, and Madak-Erdogan Zeynep Z, sheds light on the potential of modifying systemic and gut microbial metabolism as a promising treatment pathway. This article provides an in-depth analysis of the study and explores the implications of the findings.

DOI: 10.1016/j.tem.2023.12.008


1. ER+ breast cancer treatment
2. Systemic metabolism in cancer
3. Gut microbiome and cancer
4. Estrogen receptor targeting
5. Breast cancer therapy resistance


Breast cancer remains the second most common cancer worldwide among women, with Estrogen Receptor-Positive (ER+) variants constituting a significant proportion of these cases. These cancer cells grow in response to the hormone estrogen. Conventional treatments targeting ER+ breast cancer often lead to therapy resistance, a major challenge in the clinical management of the disease. Addressing this concern, the research conducted by Hannah and colleagues put forth an innovative approach—targeting both systemic and gut microbial metabolism—to overcome resistance and improve therapeutic outcomes for patients with ER+ breast cancer.

Systemic and Gut Microbial Metabolism in ER+ Breast Cancer

The critical role of metabolism in cancer growth and progression has been well-documented in recent years. In the context of ER+ breast cancer, the systemic metabolism, which includes the entirety of biochemical processes within the body, and the gut microbiome, a key component in the regulation of metabolic processes, play pivotal roles. Metabolic pathways, influenced by factors such as diet and gut bacteria, can modulate the availability of estrogen and other metabolites that may either facilitate or impede breast cancer pathogenesis.

Targeting Metabolic Pathways

The approach advocated by the researchers hinges on therapeutic interventions designed to disrupt the metabolic pathways that enable cancer cells to proliferate. It involves manipulating diet, utilizing specific drugs that alter metabolism, and engineering gut microbiota—all aimed at changing the metabolic milieu of ER+ breast cancer.

Diet, a malleable determinant of metabolism, can influence the effectiveness of breast cancer therapies. Drawing associations between dietary patterns and cancer treatment outcomes alludes to the potential of diet as an adjuvant therapy. Modulating the gut microbiome—an intricate community of microbes in the gastrointestinal tract—has also shown promise in affecting cancer progression.

Therapy Resistance

ER+ breast cancer displays a propensity to develop resistance to conventional hormone therapies. This resistance often creates a significant treatment barrier leading to disease recurrence. By altering metabolic processes that contribute to this resistance, it may be possible to potentiate the effectiveness of existing therapies, delay or prevent resistance, and ultimately improve patient outcomes.

Study Insights and Methodologies

The team’s research review encompasses a holistic approach to understanding the intricacies of metabolic processes and their interactions with ER+ breast cancer. They employ comprehensive methods, including genetic, biochemical, and microbial analyses, to dissect the interplay between systemic and gut microbial metabolism with cancer progression and treatment responses.

Discussion and Potential Therapeutics

The findings published by Hannah and colleagues provide a unique perspective on metabolic manipulation as a cancer treatment strategy. By targeting the metabolic dependencies of breast cancer cells, as well as the wider metabolic environment influenced by the gut microbiome, it may be possible to devise new therapeutic approaches with more sustained and effective outcomes.

One potential area of interest lies in the design of specific diets or nutritional interventions tailored to the metabolic profiles of ER+ breast cancer patients. Additionally, the selective modulation of gut microbiota could be achieved through prebiotics, probiotics, fecal transplants, or microbial metabolite supplementation.

Implications for Future Research and Clinical Practice

The exploration into metabolic targeting for ER+ breast cancer opens several avenues for future research. Clinical trials that investigate dietary interventions, gut microbiome modulation, and metabolism-specific drugs are needed to substantiate the potential of these approaches. Additionally, a deeper understanding of the molecular mechanisms underlying therapy resistance will be instrumental in developing comprehensive, personalized cancer therapies.


The study by Hannah H and colleagues represents a paradigm shift in breast cancer treatment. By focusing on the systemic and gut microbial metabolism, researchers may unlock new, more effective means of combating ER+ breast cancer and overcoming therapy resistance. As research continues to evolve, a future where metabolic targeting stands at the forefront of cancer treatment is on the horizon.


1. Hannah, H. H., Mogol, A. N., Santaliz Casiano, A. A., Zuo, Q., & Madak-Erdogan, Z. (2024). Targeting systemic and gut microbial metabolism in ER+. Trends in Endocrinology and Metabolism, DOI: 10.1016/j.tem.2023.12.008

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3. Cho, E., Spiegelman, D., Hunter, D. J., Chen, W. Y., Colditz, G. A., & Willett, W. C. (2003). Premenopausal fat intake and risk of breast cancer. Journal of the National Cancer Institute, 95(14), 1079-1085.

4. O’Keefe, S. J. D. (2016). Diet, microorganisms, and their metabolites, and colon cancer. Nature Reviews Gastroenterology & Hepatology, 13(12), 691-706.

5. Sonnenburg, J. L., & Bäckhed, F. (2016). Diet-microbiota interactions as moderators of human metabolism. Nature, 535(7610), 56-64.

Declaration of Interests

The authors have declared that they have no competing interests to disclose.