Targeting Bromodomain and Extra-Terminal (BET) Family Proteins in Castration-Resistant Prostate Cancer (CRPC)

Jonathan Welti1, Adam Sharp1,2, Wei Yuan1

  • 1The Institute for Cancer Research, London, United Kingdom.

Insights

Bromodomain and extra-terminal (BET) protein inhibitors can overcome resistance to prostate cancer therapies by blocking androgen receptor (AR) signaling. These BET inhibitors reduce AR-V7 expression and tumor growth, showing promise for clinical evaluation.

Area of Science:

  • Oncology
  • Molecular Biology
  • Genetics

Background:

  • Persistent androgen receptor (AR) signaling is a key driver of castration-resistant prostate cancer (CRPC).
  • This persistent signaling confers resistance to current AR-targeting therapies, necessitating novel treatment strategies.
  • Bromodomain and extra-terminal (BET) proteins play a role in regulating gene transcription, including AR-driven genes.

Purpose of the Study:

  • To evaluate the efficacy of BET protein inhibitors (BETi) in abrogating aberrant AR signaling in CRPC.
  • To determine the association between BET expression, AR-driven transcription, and patient outcomes in prostate cancer.
  • To elucidate the mechanism by which BETi regulate AR signaling, specifically AR-V7 expression.

Main Methods:

  • Analysis of BET expression in patient biopsies (treatment-naïve and CRPC) and correlation with patient outcomes.
  • Assessment of RNA expression of BET family proteins (BRD2, BRD3, BRD4) and their correlation with AR-driven transcription.
  • In vitro and in vivo studies using chemical BETi (JQ1, GSK1210151A; I-BET151) and BET protein knockdown to assess effects on AR-V7 expression and AR signaling in prostate cancer models.

Main Results:

  • Nuclear BRD4 protein expression was significantly increased in CRPC biopsies and associated with worse patient outcomes.
  • BET family RNA expression correlated with AR-driven transcription in CRPC.
  • Chemical BETi and BET protein knockdown reduced AR-V7 expression and AR signaling, decreased prostate cancer cell and organoid growth, and inhibited tumor growth in a patient-derived xenograft model, outperforming enzalutamide in specific contexts.

Conclusions:

  • BET inhibitors effectively reduce AR splicing and function by regulating RNA processing, leading to decreased AR-V7 expression.
  • BETi demonstrate significant anti-tumor activity against prostate cancer models with AR amplification and AR-V7 expression.
  • BET inhibitors warrant clinical evaluation for their potential to overcome resistance in CRPC by targeting AR signaling.

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