Abstract
HER2-positive breast cancer is an aggressive subtype of breast cancer, characterized by high malignancy and poor prognosis. Trastuzumab, the first HER2-targeted monoclonal antibody therapy, has a crucial role in a curative setting in HER2-positive breast cancer. However, frequent drug resistance inhibits its clinical efficacy. Herein, by performing circular RNA (circRNA) profiling, we identified a novel circRNA, circ-BGN, as a key contributor in trastuzumab resistance. Circ-BGN was evidently increased in trastuzumab-resistant breast cancer cells and tissues, linking to poor overall survival. Knockdown of circ-BGN inhibited breast cancer cell viability and notably restored its sensitivity to trastuzumab. Further, we found that circ-BGN could directly bind to OTUB1 and SLC7A11, enhancing OTUB1-mediated SLC7A11 deubiquitination and thereby inhibiting ferroptosis, a newly recognized form of cell death that is distinct from apoptosis, necrosis, and autophagy. Moreover, erastin, a small-molecule ferroptosis inducer, could effectively restore the anti-tumor effect of trastuzumab. Pre-clinically, the orthotopic tumor model showed that erastin significantly reduced tumor volume generated by trastuzumab-resistant breast cancer cells, which was more pronounced after combined circ-BGN knockdown. Collectively, our data reveal a novel circRNA controlling trastuzumab resistance via regulation of ferroptosis, providing a promising therapeutic strategy for trastuzumab-resistant breast cancer patients.