UBE2M forms a positive feedback loop with estrogen receptor to drive breast cancer progression and drug resistance.

UBE2M, a NEDD8-conjugating enzyme, is dysregulated in various human cancers and promotes tumor cell proliferation. However, its role in estrogen receptor-positive (ER⁺) breast cancer remains unknown. We found that UBE2M expression was significantly higher in ER⁺ breast cancer tissues than in ER-negative (ER^-) breast cancer tissues. Higher expression of UBE2M indicated a poorer prognosis in patients with ER⁺ breast cancer but not in those with ER^- breast cancer. Of interest, a positive feedback loop was observed between UBE2M and ERα. Specifically, ERα enhanced the HIF-1α-mediated transcription of UBE2M. In turn, UBE2M maintained ERα expression by inhibiting its ubiquitination and degradation through UBE2M-CUL3/4A-E6AP-ERα axis. Functionally, silencing of UBE2M suppressed the growth of breast cancer cells by inducing cell cycle arrest and apoptosis and improved their sensitivity to fulvestrant both in vitro and in vivo. Altogether, our findings reveal that the UBE2M-ERα feedback loop drives breast cancer progression and fulvestrant resistance, suggesting UBE2M as a viable target for endocrine therapy of ER⁺ breast cancer.