Steinkamp Mara P, O'Mahony Orla A, Brogley Michele, Rehman Haniya, Lapensee Elizabeth W, Dhanasekaran Saravana, Hofer Matthias D, Kuefer Rainer, Chinnaiyan Arul, Rubin Mark A, Pienta Kenneth J, Robins Diane M
Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109-5618, USA.
Cancer Res. 2009 May 15;69(10):4434-42. doi: 10.1158/0008-5472.CAN-08-3605. Epub 2009 Apr 14.
Mutations in the androgen receptor (AR) that enable activation by antiandrogens occur in hormone-refractory prostate cancer, suggesting that mutant ARs are selected by treatment. To validate this hypothesis, we compared AR variants in metastases obtained by rapid autopsy of patients treated with flutamide or bicalutamide, or by excision of lymph node metastases from hormone-naïve patients. AR mutations occurred at low levels in all specimens, reflecting genetic heterogeneity of prostate cancer. Base changes recurring in multiple samples or multiple times per sample were considered putative selected mutations. Of 26 recurring missense mutations, most in the NH(2)-terminal domain (NTD) occurred in multiple tumors, whereas those in the ligand binding domain (LBD) were case specific. Hormone-naïve tumors had few recurring mutations and none in the LBD. Several AR variants were assessed for mechanisms that might underlie treatment resistance. Selection was evident for the promiscuous receptor AR-V716M, which dominated three metastases from one flutamide-treated patient. For the inactive cytoplasmically restricted splice variant AR23, coexpression with AR enhanced ligand response, supporting a decoy function. A novel NTD mutation, W435L, in a motif involved in intramolecular interaction influenced promoter-selective, cell-dependent transactivation. AR-E255K, mutated in a domain that interacts with an E3 ubiquitin ligase, led to increased protein stability and nuclear localization in the absence of ligand. Thus, treatment with antiandrogens selects for gain-of-function AR mutations with altered stability, promoter preference, or ligand specificity. These processes reveal multiple targets for effective therapies regardless of AR mutation.
雄激素受体(AR)的突变可使抗雄激素激活,这种突变发生在激素难治性前列腺癌中,这表明突变型AR是通过治疗被选择出来的。为了验证这一假设,我们比较了接受氟他胺或比卡鲁胺治疗的患者经快速尸检获得的转移灶中的AR变体,或从未接受过激素治疗的患者切除的淋巴结转移灶中的AR变体。所有标本中AR突变的发生率都很低,这反映了前列腺癌的基因异质性。在多个样本中反复出现或在每个样本中多次出现的碱基变化被认为是假定的选择突变。在26个反复出现的错义突变中,大多数位于氨基末端结构域(NTD),在多个肿瘤中出现,而位于配体结合结构域(LBD)的突变则具有病例特异性。未接受过激素治疗的肿瘤几乎没有反复出现的突变,且LBD中没有突变。我们评估了几种AR变体可能导致治疗抵抗的机制。对于混杂受体AR-V716M,选择现象明显,它在一名接受氟他胺治疗的患者的三个转移灶中占主导地位。对于无活性的胞质受限剪接变体AR23,与AR共表达增强了配体反应,支持其诱饵功能。一个参与分子内相互作用的基序中的新NTD突变W435L影响了启动子选择性、细胞依赖性反式激活。在与E3泛素连接酶相互作用的结构域中发生突变的AR-E255K,在没有配体的情况下导致蛋白质稳定性增加和核定位。因此,抗雄激素治疗会选择功能获得性AR突变,这些突变具有改变的稳定性、启动子偏好或配体特异性。这些过程揭示了有效治疗的多个靶点,而与AR突变无关。