39Breast cancer is one of the leading causes of death for women worldwide. Patients whose 40 tumors express Estrogen Receptor α (ERα) account for around 70% of cases and are mostly 41 treated with targeted endocrine therapy. However, 40% of these tumors eventually relapse due 42 to resistance development and further treatment of these patients is highly ineffective. In this 43 study we profiled the early phases of the resistance development process to uncover drivers of 44 this phenomenon. Time-resolved analysis revealed that ATF3, a member of the ATF/CREB 45 family of transcription factors, acts as a novel regulator of the response to therapy via rewiring 46 of central signaling processes towards the adaptation to endocrine treatment. ATF3 was found 47 to be essential in controlling crucial processes such as proliferation, cell cycle and apoptosis 48 during the early response to treatment through the regulation of MAPK/AKT signaling 49 pathways. Its essential role was confirmed in vivo in a mouse model and elevated expression of 50 ATF3 was verified in patient datasets, adding clinical relevance to our findings. This study 51 proposes ATF3 as a novel mediator of endocrine resistance development in breast cancer and 52 elucidates its role in the regulation of downstream pathways activities. 53 54 55 56 57 Breast cancer/ endocrine therapy / drug-resistance / ATF3 / RPPA 58 4 59 60 Breast cancer is the most diagnosed type of cancer among women and the second-leading 61 cause of death after lung cancer 1 . It is a highly heterogeneous disease and the clinical sub-62 typing is based on the expression of estrogen receptor (ER), progesterone receptor (PR), HER2 63 receptor (HER2) and Ki-67 2 . Based on these markers the tumors are divided into Luminal A, 64 Luminal B, HER2 enriched and Triple negative 3 . Luminal tumors are the most abundant subtype, 65accounting for around 70% of all breast cancers, for which endocrine therapy is the standard 66 treatment 4,5 . Endocrine therapy consists of different drugs that act on ER activation, including 67 selective ER modulators (SERMs) and downregulators (SERDs), like tamoxifen and fulvestrant, 68 respectively, and aromatase inhibitors (AIs), that block the enzymes involved in the synthesis of 69 estrogens 6 . 70Despite the clear benefit of endocrine therapy for patients with ER+ breast cancer, resistance to 71 treatment is a critical clinical issue that affects approximately 10-15% of patients in the first 5 72 years 7 and up to 30-40% within 15 years from the start of the treatment 8,9 . After the failure of 73 first line endocrine therapy, recurrent ER+ breast cancer can be treated with alternative 74 strategies to target growth and survival pathways. Common strategies employ fulvestrant to 75 block and degrade the ER both in monotherapy or in combination with other approved drugs 76 for advanced breast cancer, such as CDK4/6, mTOR and PI3K inhibitors 10 . 77