For example, TWIST could transcriptionally upregulate the expression of AKT2, which induced paclitaxel resistance in breast cancer, and this resistance was reduced with the silence of AKT2;188 TWIST could also repress the expression of estrogen receptor-α (ER) together with histone deacetylase 1 in breast tumors, which might contribute to the hormone-resistance in ER-negative breast cancer.189. This evidence concerns the gene TWIST1 and breast carcinoma.