Cross-Resistance to Abiraterone and Enzalutamide in Castration Resistance Prostate Cancer Cellular Models Is Mediated by AR Transcriptional Reactivation

SIMPLE SUMMARY: Prostate cancer is the second most common cancer in males. In prostate cancer cells, androgens bind and activate the intracellular mediator called Androgen Receptor that control cell proliferation and survival. Hormone deprivation therapy is administrated to reduce androgen levels and consequently tumour growth. Unfortunately, most patients develop resistance to hormone treatment over the years and novel hormonal agents, such as Abiraterone or Enzalutamide, are administered. However, many patients do not initially respond or become resistant to these drugs quickly. Firstly, we demonstrated that in hormonal sensitive human prostate cancer cells the combination therapy of Abiraterone plus Enzalutamide reduced cell growth and survival. Moreover, starting from these prostate cancer cell lines, we generated cellular models of resistance to hormonal deprivation alone or in combination with the novel hormonal agents. In all the cases, resistant cell lines restore Androgen Receptor expression, Androgen Receptor functionality, cell proliferation and migration in the absence of androgens. Importantly, these novel cellular models acquire cross-resistance to each other. These results are consistent with clinical trials in castration resistant prostate cancer patients and suggest the biological rationale to test the combination therapy of Abiraterone plus Enzalutamide as first-line treatment in hormone-sensitive prostate cancer patients before becoming hormonal resistant. ABSTRACT: Androgen deprivation therapy (ADT) and novel hormonal agents (NHAs) (Abiraterone and Enzalutamide) are the goal standard for metastatic prostate cancer (PCa) treatment. Although ADT is initially effective, a subsequent castration resistance status (CRPC) is commonly developed. The expression of androgen receptor (AR) alternative splicing isoforms (AR-V7 and AR-V9) has been associated to CRPC. However, resistance mechanisms to novel NHAs are not yet well understood. Androgen-dependent PCa cell lines were used to generate resistant models to ADT only or in combination with Abiraterone and/or Enzalutamide (concomitant models). Functional and genetic analyses were performed for each resistance model by real-time cell monitoring assays, flow cytometry and RT-qPCR. In androgen-dependent PCa cells, the administration of Abiraterone and/or Enzalutamide as first-line treatment involved a critical inhibition of AR activity associated with a significant cell growth inhibition. Genetic analyses on ADT-resistant PCa cell lines showed that the CRPC phenotype was accompanied by overexpression of AR full-length and AR target genes, but not necessarily AR-V7 and/or AR-V9 isoforms. These ADT resistant cell lines showed higher proliferation rates, migration and invasion abilities. Importantly, ADT resistance induced cross-resistance to Abiraterone and/or Enzalutamide. Similarly, concomitant models possessed an elevated expression of AR full-length and proliferation rates and acquired cross-resistance to its alternative NHA as second-line treatment.