Skip to main content

Advertisement

Log in

RANK Ligand: Effects of Inhibition

  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Receptor activator of nuclear factor κ-light-chain-enhancer of activated B-cells (RANK) and its ligand (RANKL) belong to the tumor necrosis factor (TNF) superfamily. RANK mRNA is expressed widely in bone and bone marrow. It has a significant role in stimulating osteoclast differentiation and maturation, and also in preventing apoptosis. Because osteoclast activity is an important aspect of bone resorption in malignancy, targeting these cells is a good rationale for preventing skeletal-related events in malignancies. Preclinical studies have demonstrated the efficacy of denosumab in preventing bone loss in mice and improving bone mineral density. Denosumab is a fully human monoclonal antibody against RANKL, which has been shown to be effective in reducing signaling via RANK and thus osteoclast activity. It has been demonstrated in large, randomized, phase 3 studies to be effective in preventing fractures and bone loss, and improving the bone mineral density in various cancerous and noncancerous settings. This article reviews the latest evidence of RANKL inhibition and its clinical implications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently have been highlighted as: • Of importance •• Of major importance

  1. Coleman RE: Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 2001, 27:165–176

    Article  CAS  PubMed  Google Scholar 

  2. Carlin BI, Andriole GL: The natural history, skeletal complications, and management of bone metastases in patients with prostate carcinoma. Cancer 2000, 88:2989–2994.

    Article  CAS  PubMed  Google Scholar 

  3. Nakagawa N, Kinosaki M, Yamaguchi K, et al.: RANK is the essential signaling receptor for osteoclast differentiation factor in osteoclastogenesis. Biochem Biophys Res Commun 1998, 253:395–400.

    Article  CAS  PubMed  Google Scholar 

  4. Kim H, Choi HK, Shin JH, et al.: Selective inhibition of RANK blocks osteoclast maturation and function and prevents bone loss in mice. J Clin Invest 2009, 119:813–815.

    Article  CAS  PubMed  Google Scholar 

  5. Asagiri M, Takayanagi H: The molecular understanding of osteoclast differentiation. Bone 2007, 40:251–264.

    Article  CAS  PubMed  Google Scholar 

  6. Wong BR, Josien R, Lee SY, et al.: The TRAF family of signal transducers mediates NF-kappaB activation by the TRANCE receptor. J Biol Chem 1998, 273:28355–28359.

    Article  CAS  PubMed  Google Scholar 

  7. Ghosh S, May MJ, Kopp EB: NF-kappa B and Rel proteins: evolutionarily conserved mediators of immune responses. Annu Rev Immunol 1998, 16:225–260.

    Article  CAS  PubMed  Google Scholar 

  8. Bonizzi G, Karin M: The two NF-kappaB activation pathways and their role in innate and adaptive immunity. Trends Immunol 2004, 25:280–288.

    Article  CAS  PubMed  Google Scholar 

  9. Memet S: NF-kappaB functions in the nervous system: from development to disease. Biochem Pharmacol 2006, 72:1180–1195.

    Article  CAS  PubMed  Google Scholar 

  10. Lacey DL, Timms E, Tan HL, et al.: Osteoprotegerin ligand is a cytokine that regulates osteoclast differentiation and activation. Cell 1998, 93:165–176.

    Article  CAS  PubMed  Google Scholar 

  11. Anderson DM, Maraskovsky E, Billingsley WL, et al.: A homologue of the TNF receptor and its ligand enhance T-cell growth and dendritic-cell function. Nature 1997, 390:175–179.

    Article  CAS  PubMed  Google Scholar 

  12. • Fouque-Aubert A, Chapurlat R: Influence of RANKL inhibition on immune system in the treatment of bone diseases. Joint Bone Spine 2008, 75:5–10. This article provides a very good review of the influence of RANKL inhibition on immune system.

    Article  CAS  PubMed  Google Scholar 

  13. Li P, Schwarz EM, O’Keefe RJ, et al.: RANK signaling is not required for TNFalpha-mediated increase in CD11(hi) osteoclast precursors but is essential for mature osteoclast formation in TNFalpha-mediated inflammatory arthritis. J Bone Miner Res 2004, 19:207–213.

    Article  CAS  PubMed  Google Scholar 

  14. Seshasayee D, Wang H, Lee WP, et al.: A novel in vivo role for osteoprotegerin ligand in activation of monocyte effector function and inflammatory response. J Biol Chem 2004, 279:30202–30209.

    Article  CAS  PubMed  Google Scholar 

  15. Wong BR, Josien R, Lee SY, et al.: TRANCE (tumor necrosis factor [TNF]-related activation-induced cytokine), a new TNF family member predominantly expressed in T cells, is a dendritic cell-specific survival factor. J Exp Med 1997, 186:2075–2080.

    Article  CAS  PubMed  Google Scholar 

  16. Bachmann MF, Wong BR, Josien R, et al.: TRANCE, a tumor necrosis factor family member critical for CD40 ligand-independent T helper cell activation. J Exp Med 1999, 189:1025–1031.

    Article  CAS  PubMed  Google Scholar 

  17. Kitazawa S, Kitazawa R: RANK ligand is a prerequisite for cancer-associated osteolytic lesions. J Pathol 2002, 198:228–236.

    Article  CAS  PubMed  Google Scholar 

  18. Croucher PI, Shipman CM, Lippitt J, et al.: Osteoprotegerin inhibits the development of osteolytic bone disease in multiple myeloma. Blood 2001, 98:3534–3540.

    Article  CAS  PubMed  Google Scholar 

  19. Canon JR, Roudier M, Bryant R, et al.: Inhibition of RANKL blocks skeletal tumor progression and improves survival in a mouse model of breast cancer bone metastasis. Clin Exp Metastasis 2008, 25:119–126.

    Article  CAS  PubMed  Google Scholar 

  20. Zhang J, Dai J, Qi Y, et al.: Osteoprotegerin inhibits prostate cancer-induced osteoclastogenesis and prevents prostate tumor growth in the bone. J Clin Invest 2001, 107:1235–1244.

    Article  CAS  PubMed  Google Scholar 

  21. Eastell R, Hannon R: Long-term effects of aromatase inhibitors on bone. J Steroid Biochem Mol Biol 2005, 95:151–154.

    Article  CAS  PubMed  Google Scholar 

  22. Baum M, Buzdar A, Cuzick J, et al.: Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early-stage breast cancer: results of the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial efficacy and safety update analyses. Cancer 2003, 98:1802–1810.

    Article  CAS  PubMed  Google Scholar 

  23. Coombes RC, Hall E, Gibson LJ, et al.: A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 2004, 350:1081–1092.

    Article  CAS  PubMed  Google Scholar 

  24. Goss PE, Ingle JN, Martino S, et al.: A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med 2003, 349:1793–1802.

    Article  CAS  PubMed  Google Scholar 

  25. • Ellis GK, Bone HG, Chlebowski R, et al.: Randomized trial of denosumab in patients receiving adjuvant aromatase inhibitors for nonmetastatic breast cancer. J Clin Oncol 2008, 26:4875–4882. This article demonstrates how denosumab resulted in a statistically significant increase in BMD at 12 and 24 months in estrogen receptor–positive metastatic breast cancer patients receiving AI therapy.

    Article  CAS  PubMed  Google Scholar 

  26. Lipton A, Steger GG, Figueroa J, et al.: Extended efficacy and safety of denosumab in breast cancer patients with bone metastases not receiving prior bisphosphonate therapy. Clin Cancer Res 2008, 14:6690–6696.

    Article  CAS  PubMed  Google Scholar 

  27. Lipton A, Steger GG, Figueroa J, et al.: Randomized active-controlled phase II study of denosumab efficacy and safety in patients with breast cancer-related bone metastases. J Clin Oncol 2007, 25:4431–4437.

    Article  CAS  PubMed  Google Scholar 

  28. Stopeck A: A comparison of denosumab versus zoledronic acid on the incidence of skeletal-related events in breast cancer patients with bone metastases [abstract 22]. Presented at the 32nd Cancer Therapy and Research Center–American Association for Cancer Research San Antonio Breast Cancer Symposium. San Antonio, TX; December 9–13, 2009.

  29. Stopeck, A, Body, JJ, Fujiwara Y, et al.: Denosumab versus zoledronic acid for the treatment of breast cancer patients with bone metastases: results of a randomized phase 3 study. In European Society for Medical Oncology, Berlin 2009. Presented at the European Society for Medical Oncology. Berlin, Germany; September 20–24, 2009.

  30. •• Smith MR, Egerdie B, Hernandez Toriz N, et al.: Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med 2009, 361:745–755. This study showed that denosumab statistically increased BMD and decreased vertebral fractures in patients with nonmetastatic prostate cancer receiving ADT.

    Article  CAS  PubMed  Google Scholar 

  31. Fizazi K, Lipton A, Mariette X, et al.: Randomized phase II trial of denosumab in patients with bone metastases from prostate cancer, breast cancer, or other neoplasms after intravenous bisphosphonates. J Clin Oncol 2009, 27:1564–1571.

    Article  CAS  PubMed  Google Scholar 

  32. Fizazi K, Bosserman L, Gao G, et al.: Denosumab in patients with bone metastases from castration-resistant prostate cancer and elevated bone resorption despite intraenous bisphosphonate (IV BP) therapy: analysis of a randomized phase II trial. Presented at the European Society for Medical Oncology. Berlin, Germany; September 20–24, 2009.

  33. Henry DR: A double-blind, randomized study of denosumab versus zoledronic acid for the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. Presented at the European Society for Medical Oncology. Berlin, Germany; September 20–24, 2009.

  34. Cummings SR, San Martin J, McClung MR, et al.: Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009, 361:756–765. This large randomized study showed that fractures were significantly decreased (HR, 0.32) in osteoporotic postmenopausal women when treated with denosumab twice yearly for 36 months.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

Dr. Bukowski has been a consultant for Novartis and Amgen. He has also been a speaker for and received honoraria from Novartis.

No further potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Saby George.

Rights and permissions

Reprints and permissions

About this article

Cite this article

George, S., Brenner, A., Sarantopoulos, J. et al. RANK Ligand: Effects of Inhibition. Curr Oncol Rep 12, 80–86 (2010). https://doi.org/10.1007/s11912-010-0088-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-010-0088-1

Keywords

Navigation