New research from Princeton University uncovers why bone metastasis often leads to anemia

Cancer specialists have long known that anemia, caused by a lack of healthy red blood cells, often arises when cancer metastasizes to the bone, but it’s been unclear why. Now, a research team led by Princeton University researchers Yibin Kang and Yujiao Han has uncovered exactly how this happens in metastatic breast cancer, and it involves a type of cellular hijacking. The discovery aims to help slow down bone metastasis – one of cancer’s deadliest forms.

In a study forthcoming in the journal Cell on September 3, Kang and Han reveal that cancer cells effectively commandeer a specialized cell that normally recycles iron in the bone, known as an erythroblast island (EBI) macrophage. This both deprives red blood cells of necessary iron and helps the tumor continue to grow in the bone. What’s more, when the tumor takes up the iron from the macrophage, it starts to behave as if it’s the normal recipient – a red blood cell – producing hemoglobin and helping the tumor survive in the bone’s hostile oxygen-deficient environment. 

Understanding metastatic cancer – or cancer that grows and spreads in other parts of the body beyond the original tumor site – is critically important. It is one of the deadliest forms of cancer and there is no cure. Of patients who die from breast and prostate cancer, 70% have bone metastasis. 

For the past two decades, Kang and much of the cancer biology field, have focused on studying the tumor cells. With the advent of single-cell sequencing and advanced cell labeling technologies, now Kang has shifted to studying the surrounding environment that nurtures or restrains the cancer, moving from investigating the ‘seeds’ to the ‘soil.’ Although the current study focuses on metastatic breast cancer, the findings have been extended to other major cancer types and carry broad implications. By revealing how tumors manipulate their surroundings, the work opens new avenues for therapies designed to slow or stop bone metastasis and relieve the debilitating anemia that often comes with it.

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