Knowing that metabolic dysregulations and hypoxic involvements are strongly introduced as one of the main factors of TMX resistance11, this study aimed at exploring the possible role of the metabolic/hypoxial axis TUG-1/miR-186/SIRT3, PPAR-1α, HIF-1α in TMX sensitive and resistant BC patients as it might be a crucial link in understanding metabolic rewiring on TMX resistance and might be used as a future biomarker. The gene discussed is SIRT3; the disease is breast cancer.