Estrogen promotes the survival and pulmonary metastasis of tuberin-null cells

Lymphangioleiomyomatosis (LAM) is an often fatal disease primarily affecting young women in which tuberin (TSC2)-null cells metastasize to the lungs. The mechanisms underlying the striking female predominance of LAM are unknown. We report here that 17-β-estradiol (E ₂) causes a 3- to 5-fold increase in pulmonary metastases in male and female mice, respectively, and a striking increase in circulating tumor cells in mice bearing tuberin-null xenograft tumors. E ₂-induced metastasis is associated with activation of p42/44 MARK and is completely inhibited by treatment with the MEK1/2 inhibitor, CI-1040. In vitro, E ₂ inhibits anoikis of tuberin-null cells. Finally, using a bioluminescence approach, we found that E ₂ enhances the survival and lung colonization of intravenously injected tuberin-null cells by 3-fold, which is blocked by treatment with CI-1040. Taken together these results reveal a new model for LAM pathogenesis in which activation of MEK-dependent pathways by E ₂ leads to pulmonary metastasis via enhanced survival of detached tuberin-null cells.