Receptor Polymorphisms before Starting Therapy with Androgen Receptor Inhibitors: A Study of a Patient Who Developed Toxic Myocarditis after Enzalutamide Treatment.
Fecha
2022Resumen
Enzalutamide is a nonsteroidal inhibitor of the androgen receptor (AR) signaling pathway
and is used to treat patients with metastatic castration-resistant prostate cancer. However, the risk
of cardiovascular-related hospitalization in patients with no contraindications for the use of enzalutamide is about 1–2%. To date, the underlying molecular basis of this has not been established. The
androgen receptor, glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) are nuclear receptors that share structural similarities and have closely related DNA-binding sites and coregulators.
In non-epithelial cells, a fine balance of the activities of these receptors is essential to ensure correct
cellular function. In this study, we present a molecular characterization of these nuclear receptors
in a prostate cancer patient who developed congestive heart failure after enzalutamide treatment.
White cell RNAseq revealed a homozygous rs5522 MR polymorphism and both the rs143711342 and
rs56149945 GR polymorphisms, carried in different alleles. No different specific splice isoforms were
detected. Recent research suggests that AR inhibition by enzalutamide makes available a coregulator
that specifically interacts with the rs5522-mutated MR, increasing its activity and producing adverse
effects on cardiovascular health. We suggest an evaluation of the MR rs5522 polymorphism before
starting therapy with AR inhibitors.