News Release

RAGE as a driver of cell plasticity in aggressive subtype of triple-negative breast cancer

Peer-Reviewed Publication

Vall d'Hebron Institute of Oncology

VHIO's Josep Villanueva, Carla Mayans and Mireia Pujals.

image: Left to right: VHIO's Josep Villanueva, Carla Mayans and Mireia Pujals. view more 

Credit: Vall d'Hebron Institute of Oncology (VHIO).

  • Triple-negative breast cancer (TNBC) is an aggressive and heterogeneous disease that represents about 15% of breast cancer cases. Classified as mesenchymal tumors, this subgroup of TNBC present the highest frequency of metastases and a poorer prognosis among these patients.


  • Directed by Josep Villanueva, results of a VHIO-led study published online ahead of print in the journal Oncogene (1) reveal that the receptor for advanced glycation end-product (RAGE) plays a key role in the cellular plasticity of mesenchymal TNBC and is a driver of cancer cell invasion and metastasis.


  • Data suggest that targeting RAGE signaling could lead to a more effective therapeutic strategy in the treatment of this TNBC subtype.


Published online ahead of print in the journal Oncogene (1), a study led by Josep Villanueva, an Investigator at the Vall d’Hebron Institute of Oncology (VHIO), shows that the receptor for advanced glycation end-product (RAGE) plays a key role in cellular mechanisms of plasticity in mesenchymal triple-negative breast cancer­ (TNBC) that transform epithelial cells into mesenchymal cells as potent drivers of cancer cell proliferation and tumor invasion. Results suggest that the therapeutic inhibition of RAGE could open a new treatment avenue for patients with this particularly aggressive TNBC subtype.

Breast cancer is the most frequent cancer among women, affecting 2 million women worldwide each year. TNBC represents about 15% of all breast cancer cases and is a particularly aggressive form of disease with a higher frequency of distant metastases than any other breast cancer subtype, with limited therapeutic options.

Triple-negative breast tumors can acquire a mesenchymal phenotype where cancer cells undergo differentiation and acquire invasive characteristics that promote disease aggressiveness and cancer cell spread.

“The regulation of cellular plasticity represents an important area of research toward  more effectively tackling these tumor cells and reduce their capacity to proliferate and spread in such an aggressive manner,” says Josep Villanueva, corresponding author of this present study.  

The role of RAGE in TNBC tumor cell plasticity

RAGE is a cell surface receptor that fuses with different types of molecules recognized by cells as foreign and has been reported to play a role in the innate immune response linked to inflammation. It is either absent or found expressed at low levels in most healthy cells. The overexpression or activation of RAGE has however been linked to different chronic inflammatory diseases including diabetes, Alzheimer’s, fibrosis, and different types of cancer.

Results of previous research led by Josep Villanueva showed an alternative extracellular function of the nuclear protein HMGA1 (2). The investigators evidenced that HMGA1 mediates the transformation of TNBC cells into a mesenchymal state by binding to the RAGE receptor expressed on the cell surface.

By studying the cellular mechanisms of plasticity, we have now shown that RAGE signaling plays a key role in maintaining the mesenchymal state of aggressive triple-negative breast cancer cells by enforcing the expression of the SNAIL1 protein, which is associated with tumor cell plasticity and a key driver of various types of cancer,” explains Mireia Pujals, a Postdoctoral Research Fellow at VHIO and first author of this present study.

The therapeutic promise of targeting RAGE

The researchers then inhibited RAGE with a pharmacological antagonist and at the same time blocked its expression in different TNBC mesenchymal cell lines.

“We observed cell plasticity in which tumor cells lost their mesenchymal characteristics, joined together in colonies and were no longer as invasive. At the molecular level, these cells recovered an epithelial state and RAGE blockade reduced SNAIL expression levels,” adds Pujals.

The researchers used xenograft mouse models to  establish if this change in cell plasticity by RAGE blockade also occurred in vivo, and observed no difference in primary tumor  growth in mice that received treatment versus those that did not.

“Mice treated with a RAGE antagonist did however survive for longer, presented fewer metastases and decreased levels of SNAIL expression. Furthermore, by losing the mesenchymal phenotype, RAGE changes its location in the cell membrane and moves close to the nucleus where it can be implicated in mechanisms of DNA repair damage,” observes Carla Mayans, a PhD Student at VHIO and co-author of this study.

Next, they assessed if these processes could also be seen in mesenchymal TNBC samples from patients who presented metastases and those who did not. They reported that the results correlated with those observed in preclinical models. In those patients with metastases, RAGE was found located in the cell membrane, coinciding with the mesenchymal characteristics, while in those who had not developed metastasis, RAGE was situated close to the cell nucleus.

“In all models, we have shown that RAGE plays a key role in the acquisition of mesenchymal characteristics mediated by overexpression of SNAIL, and that targeting RAGE signaling and tumor cell plasticity could help to develop novel, more effective therapeutic strategies against this subtype of metastatic triple-negative breast cancer,” concludes Josep Villanueva.    



  1. Pujals M, Mayans C, Bellio C, Méndez O, Greco E, Fasani R, Alemany-Chavarria M, Zamora E, Padilla L, Mitjans F, Nuciforo P, Canals F, Nonell L, Abad M, Saura C, Tabernero J, Villanueva J. RAGE/SNAIL1 signaling drives epithelial-mesenchymal plasticity in metastatic triple-negative breast cancer. Oncogene. 2023 Jul 19. doi: 10.1038/s41388-023-02778-4. Epub ahead of print. PMID: 37468678.


  1. Méndez O, Peg V, Salvans C, Pujals M, Fernández Y, Abasolo I, Pérez J, Matres A, Valeri M, Gregori J, Villarreal L, Schwartz S Jr, Ramon Y Cajal S, Tabernero J, Cortés J, Arribas J, Villanueva J. Extracellular HMGA1 Promotes Tumor Invasion and Metastasis in Triple-Negative Breast Cancer. Clin Cancer Res. 2018 Dec 15;24(24):6367-6382. 

About VHIO

The Vall d’Hebron Institute of Oncology (VHIO), established in 2006 and located within the Vall d’Hebron Barcelona Hospital Campus, is a reference comprehensive cancer center for personalized medicine in oncology. Through our purely translational and multidisciplinary research model, we aim to improve the prevention, early diagnosis and treatment of cancer by transforming the latest scientific discoveries made in the laboratory into early phase clinical trials for the development of more effective therapies to improve the quality of life and survival  of cancer patients.

VHIO forms part of the CERCA – Research Centres of Catalonia system and is accredited as a Severo Ochoa Center of Excellence.

Research at VHIO would not be possible without the support received from our patrons - Generalitat de Catalunya, Fundació Privada CELLEX, "La Caixa" Foundation, Fundación FERO, and the Fundación BBVA, the public funding it receives as well as the generous support from institutional supporters, private institutions, companies, associations, societies, and individual donors. Only with such continued support will VHIO continue to advance personalized and targeted therapies against cancer.


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