Inhibition Of Dihydrotestosterone Synthesis In Prostate Cancer By Combined Frontdoor And Backdoor

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834294/
Previous work from our laboratory and others demonstrated that CaP cells use both primary and secondary backdoor pathways to synthesize DHT [5, 810]. The terminal step in the primary backdoor pathway is the conversion of DIOL to DHT [5, 10, 11] by any of the four 3α-oxidoreductases: [1] 17β-hydroxysteroid dehydrogenase (HSD) 6 (HSD17B6); [2] retinol dehydrogenase (RDH) 16 (RDH16); [3] dehydrogenase/reductase family member 9 (DHRS9, formerly RDH15); and [4] dehydrogenase/reductase family member 5 (RDH5) [5, 1113]. The secondary backdoor pathway involves the conversion of DHEA to ASD by HSD3B1 or HSD3B2. ASD is converted subsequently to 5α-dione by SRD5A1 and 5α-dione is converted to DHT by AKR1C3 or HSD17B3

Androgen metabolism inhibitors, such as the SRD5A inhibitor, dutasteride, or the CYP17A1 inhibitor, abiraterone [7, 17], have been disappointing clinically

CaP resistance to abiraterone presumably resulted from enzyme redundancy, progesterone accumulation that led to increased CYP17A1 expression and/or the generation of AR splice variants

Inhibition of the terminal steps of the frontdoor pathway using dutasteride and the primary backdoor pathway using 3α-oxidoreductase catalytic mutants lowered DHT more effectively than either alone.
 
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