{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:52:19Z","timestamp":1791291139693,"version":"4.3.0"},"reference-count":45,"publisher":"American Association for Cancer Research (AACR)","issue":"2","content-domain":{"domain":["aacrjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Inhibitor of apoptosis (IAP) proteins play a central role in many types of cancer, and IAP antagonists are in development as anticancer agents. IAP antagonists cause apoptosis in many cells, but they also activate alternative NF-\u03baB signaling through NF-\u03baB\u2013inducing kinase (NIK), which regulates osteoclasts. In bone metastasis, a positive feedback loop between tumors and osteoclasts promotes tumor growth and osteolysis. We therefore tested the effect of IAP antagonists on the bone microenvironment for metastasis. In both drug-sensitive and drug-resistant tumors, growth in bone was favored, as compared with other sites during IAP antagonist treatment. These drugs also caused osteoporosis and increased osteoclastogenesis, mediated by NIK, and enhanced tumor-associated osteolysis. Cotreatment with zoledronic acid, a potent osteoclast inhibitor, reduced IAP antagonist\u2013enhanced tumor growth in bone and osteolysis. Thus, IAP antagonist\u2013based cancer treatment may be compromised by osteoporosis and enhanced skeletal metastasis, which may be prevented by antiresorptive agents.<\/jats:p>\n                  <jats:p>Significance: Although IAP antagonists are a class of anticancer agents with proven efficacy in multiple cancers, we show that these agents can paradoxically increase tumor growth and metastasis in the bone by stabilizing NIK and activating the alternative NF-\u03baB pathway in osteoclasts. Future clinical trials of IAP antagonist\u2013based therapy may require detailed examination of this potential for enhanced bone metastasis and osteoporosis, as well as possible combination with antiresorptive agents. Cancer Discov; 3(2); 212\u201323. \u00a92012 AACR.<\/jats:p>\n                  <jats:p>This article is highlighted in the In This Issue feature, p. 125<\/jats:p>","DOI":"10.1158\/2159-8290.cd-12-0271","type":"journal-article","created":{"date-parts":[[2012,12,26]],"date-time":"2012-12-26T20:47:16Z","timestamp":1356554836000},"page":"212-223","update-policy":"https:\/\/doi.org\/10.1158\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Antagonism of Inhibitor of Apoptosis Proteins Increases Bone Metastasis via Unexpected Osteoclast Activation"],"prefix":"10.1158","volume":"3","author":[{"given":"Chang","family":"Yang","sequence":"first","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Davis","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Zeng","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paras","family":"Vora","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinming","family":"Su","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne I.","family":"Collins","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suwanna","family":"Vangveravong","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H.","family":"Mach","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Piwnica-Worms","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"},{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine N.","family":"Weilbaecher","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Faccio","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Veis Novack","sequence":"additional","affiliation":[{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 6Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri"},{"name":"Authors' Affiliations: Divisions of 1Bone and Mineral Diseases and 2Mole\u00adcular Oncology, Department of Medicine; 3Mallinckrodt Institute of Radiology; Departments of 4Cell Biology and Physiology\/BRIGHT Institute, 5Orthopedic Surgery, and 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