Exercise suppresses breast cancer and reprograms the immune tumor microenvironment, cancer cell intrinsic features, and their interaction

BACKGROUND: Exercise links with improved cancer outcomes following a diagnosis of primary breast cancer but experimental evidence and molecular mechanistic interrogation from preclinical studies are limited. The purpose of this study was to evaluate the effects, and dose‒response, of exercise in mouse models of breast cancer, as well as elucidate cancer cell extrinsic and intrinsic responses. METHODS: Independent in vivo modeling was used to investigate the effects of exercise across distinct breast cancer models. Unbiased transcriptomic and metabolomic analyses, alongside cellular and proteomic interrogation, were used to determine tumor microenvironment (TME)- and cancer cell-specific effects. RESULTS: Exercise inhibited breast cancer growth and metastasis across multiple syngeneic mouse models compared to sham control. Tumor growth inhibition was independent of estrogen receptor status, and in the 4T1 model, exercise exerted non-dose-dependent effects. In the Met1 model, exercise decreased TME immune cell content, particularly tumor-associated macrophages, while promoting an activated anticancer innate immune cell gene signature. Concurrent in vivo cancer cell-intrinsic effects were characterized by broad transcriptomic reprogramming including downregulation of metabolic pathways and upregulation of pathways regulating proliferation and apoptosis. Whole tumor metabolomic analyses unveiled broad shifts including decreased nicotinamide adenine dinucleotide (NAD+) and lactate, as well as availability of biosynthetic precursors. Finally, in silico analyses identified TME ligands, such as High Mobility Group Box 2 (HMGB2) and Cardiotrophin-1 (CTF1) as candidate drivers of downstream gene expression changes in cancer cells. CONCLUSION: Exercise suppresses breast cancer progression, which occurs in conjunction with broad reprogramming of immune TME-cancer processes and their interaction.