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8 Prostate Cancer andPTEN/PI3K/AKT/mTOR Signaling
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mTOR inhibitor) on the promotion of bone metastases, activation of osteoclasts, and function of osteoblasts both in cell lines and in xenograft models of prostate cancer bone metastases. It is worth noting that the inhibition of PI3K/mTOR led to a declination in tumor development in both primary and bone metastatic locations, as well as a substantial increase in survival rates with prostate cancer [50].
8.5 Perspectives andConclusion
The PI3K/AKT/mTOR signaling has been widely acknowledged as one of the pri­mary pathways in tumor progression, playing a crucial role in cancer cell prolifera­tion, growth, migration, and survival. Extensive research has been devoted to developing specic inhibitors through the design and implementation of preclinical and clinical studies. However, the increasing complexity of this pathway continues to present challenges in effectively targeting it for therapeutic purposes. Despite the existence of many powerful and selective drugs, the progress in targeting PI3K sig­naling therapeutically for cancer has been disheartening, with the majority of com­pounds failing to advance beyond phase II trials. Over the last decade, preclinical investigations have elucidated the underlying factors contributing to this lack of success, therefore offering a justication for the development of future pharmaceu­tical agents. The PI3K/AKT/mTOR pathway is commonly depicted as a sequential series of events in which each component transmits the signal to downstream fac­tors. However, recent evidence has revealed that this pathway exhibits extensive network divergence and signicant intercommunication with other signaling cycles. Consequently, the inhibitory effects of drugs on this pathway can be overridden, leading to the restoration of active signaling through various mechanisms. These factors encompass a range of mechanisms, including, but not limited to, the increased expression of RTKs [51, 52], signaling redundancies, excessive inhibi­tion, loss of function deletions of PTEN, activating point mutations in PI3K includ­ing the PIK3CA H1047RK, and interruption of inhibitory feedback loops that restrict the effectiveness of treatments like the AKT activation triggered by rapamy­cin [53].
Consequently, it is unsurprising that the clinical efcacy of medications that spe­cically target PI3K signaling as a standalone treatment for prostate cancer has so far shown poor results. In spite of the existence of several active-site inhibitors or allosteric inhibitors, as well as dual kinase and pan- or isoform-specic inhibitors, the number of medicines authorized by the FDA and EMA remains limited, with none specically indicated for prostate cancer treatment. On the other hand, the use of additional substances in combination shows more potential as a strategy. However, caution must be exercised when adding medications that have comparable bad effects, as this might result in heightened toxicity. An example of this is the interac­tion between mTOR and PI3K inhibitors with traditional chemotherapy. Nevertheless, promising results have been observed in a phase Ib/II clinical trial evaluating the efcacy of GDC-0068 (ipatasertib), an ATP-competitive AKT
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inhibitor, in combination with abiraterone acetate for the treatment of metastatic CRPC [54]. CRCP patients under consideration exhibit a state of constitutive acti­vation in the PI3K/AKT/mTOR and AR signaling pathways, which is closely linked to a very worse prognosis. Despite the generally favorable outcomes seen in this trial, it is noteworthy that patients with PTEN loss exhibited a notable deceleration in disease progression and a higher level of treatment tolerance. These encouraging ndings have prompted the initiation of a subsequent randomized phase III research focused on PTEN-null CRPC.While the outcomes of the aforementioned phase III clinical trial are currently unavailable, the potential combination of GDC-0068/ipa­tasertib with abiraterone acetate has the potential to be a signicant study in the treatment of PTEN-null CRPC patients. Furthermore, it may have implications for the treatment of prostate cancer patients with a similar genetic prole during the early stages of their disease. Hence, it is essential to comprehensively analyze the genetic background and signaling circuitry in order to effectively devise therapeutic interventions for prostate cancer.

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Chapter 9
Prostate Cancer andNoncoding RNAs: AFocus onmiRNAs, lncRNAs, andcircRNAs
AhmadNazari, ParisaOsati, SiavashSeifollahyFakhr, MahnazAkhound­Attar, NazaninPazhouheshFar, MortezaRajabi, MahshidSeyed Karimi, NasimEbrahimi, MostafaHaji-Fatahaliha, andAmirRezaAref
Abstract Noncoding RNAs (ncRNAs) are a class of regulatory transcripts that
play important functions in the pathogenesis of several cancer types, including pros­tate cancer (PCa). Within the framework of prostate cancer, non-coding RNAs have the capacity to function as either oncogenic or tumor-suppressive agents. ncRNAs have the potential to participate in the prostate cancer progression by inuencing the signaling of the androgen receptor (AR), the degradation process of AR via
A. Nazari Tehran University of Medical Science, Tehran, Iran
P. Osati Department of Chemical Engineering, Fouman Faculty of Engineering, College of Engineering, University of Tehran, Tehran, Iran
S. S. Fakhr Department of Biotechnology, Faculty of Applied Ecology, Agricultural Science and Biotechnology, Campus Hamar, Inland Norway University of Applied Sciences, Hamar, Norway
M. Akhound-Attar Department of Biology, Faculty of Sciences, Yazd University, Yazd, Iran
N. P. Far Department of Microbiology, Faculty of Advanced Science and Technology, Tehran Medical Science, Islamic Azad University, Tehran, Iran
M. Rajabi Department of Genetics, Faculty of Basic Science, Central Tehran Branch, Islamic Azad University, Tehran, Iran
M. Seyed Karimi (*) Department of Surgery and Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
N. Ebrahimi (*) Division of Genetics, Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
Ltd. 2024 G. Sethi et al. (eds.), Prostate Cancer: Molecular Events and Therapeutic Modalities, https://doi.org/10.1007/978-981-97-4612-5_9
183© The Author(s), under exclusive license to Springer Nature Singapore Pte
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ubiquitin- proteasome pathways, or other critical signaling pathways. This chapter provides a detailed review of the involvement of ncRNAs in the evolutionary pro­cesses of PCa, with a particular emphasis on their signicance in the development of innovative biomarker proles and targets for cancer treatment.
Keywords Androgen receptor (AR) · Double-stranded RNAs (dsRNAs) · RNA interference (RNAi) · Prostate cancer · CRISPR-Cas9

9.1 Introduction

The rst investigations into carcinogenesis mostly focused on genes that encode proteins, since proteins are regarded as fundamental components of molecular biol­ogy [1]. The discovery of several noncoding RNA (ncRNAs) species has been facil­itated by advancements in transcriptional sequencing methods. Furthermore, extensive evidence has shown the involvement of several noncoding RNAs in vari­ous essential cellular processes and pathological conditions, particularly in cancer [2]. ncRNAs may be classied into some distinct categories considering their sequence length. The rst category comprises short noncoding RNAs (sncRNAs), which are featured by their size being fewer than 200 nucleotides (nt). Examples of sncRNAs include microRNAs (miRNAs) and Piwi-interacting RNAs (piRNAs). The second group consists of long noncoding RNAs (lncRNAs), which include cir­cular RNAs (circRNAs) and pseudogenes [2, 3]. miRNAs and lncRNAs have gar­nered signicant interest among the many types of ncRNAs [4–6].
miRNAs as a category of short ncRNAs are typically composed of 18–22 nt. These molecules have a pivotal function in the regulation of several developmental and physiological processes. Extensive research conducted over the last 20 years has provided substantial evidence supporting the involvement of miRNAs in numer­ous health conditions [7–9]. A considerable count of miRNAs has been found in more advanced eukaryotes, and research has shown that they exhibit a high degree of conservation across different species. Their primary role is to negatively control the expression of coding and noncoding genes at the post-transcriptional stage [7]. The discovery of lin-4 miRNA occurred in 1993, marking the rst identication of a microRNA. The coming to light of the regulatory role of the short
M. Haji-Fatahaliha Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
A. R. Aref (*) Mass General Cancer Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Broad Institute of MIT and Harvard, Harvard Medical School, Cambridge, MA, USA e-mail: aaref@mgh.harvard.edu
9 Prostate Cancer andNoncoding RNAs: AFocus onmiRNAs, lncRNAs, andcircRNAs
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non-protein- coding RNA lin-4in the transcription of the lin-4 gene via its 3′-UTR (untranslated region)was reported separately by two research teams [9, 10]. In a subsequent study conducted by Fire and colleagues, the elucidation of the RNA interference (RNAi) process in the worm Caenorhabditis elegans was revealed. This was achieved by the observation of the impact of double-stranded RNAs (dsR­NAs) on the RNAi activation mechanism and subsequent suppressing messenger RNAs (mRNAs) [11]. Based on the data gathered subsequent to the identication of this mechanism and the subsequent discovery of let-7, the rst mammalian miRNA, it is now postulated that RNA interference (RNAi) is present in all animal species [12, 13].
The early indication of the involvement of miRNAs in tumorigenesis was pre­sented by Croce and his collaborators, who discovered a tumor-suppressive sequence located at chromosome 13q14 [14]. The research conducted has shown a high fre­quency of deletions in the area indicated above among individuals diagnosed with chronic lymphocytic leukemia. Additionally, it has been observed that this sequence encodes two distinct miRNA genes, namely miR-16a and miR-15a. The miRNA genes in question exhibit deletions or experience transcriptional downregulation in blood-related tumors, such as chronic lymphocytic leukemia [14]. Subsequent investigations have provided additional evidence indicating that both miR-15a and miR-16a serve as tumor-suppressive miRNAs by promoting cell death via the repression of an anti-apoptotic protein known as B-cell lymphoma 2 (Bcl-2). Notably, Bcl-2 is found to be excessively expressed in blood-related tumors [15,
16]. These data were reafrmed by experimental studies, which demonstrated that
the removal of a cluster of tumors suppressive miRNAs in animal models replicated the phenotypes associated with B-cell malignancies seen in humans. This nding offers compelling support for the tumor-suppressor roles of these miRNAs [17, 18]. The invitro and invivo functional validation of miRNAs has contributed to a deeper understanding of pathophysiological and physiological mechanisms in both regular growth and pathological conditions in humans [19–21]. The aforementioned research has shown a novel method of post-transcriptional regulation that exhibits signicant dysregulation in cancerous cells [22, 23]. The dysregulation of miRNAs in a spectrum of disorders, including infectious afictions, cardiovascular diseases, and different types of human cancer, including prostate cancer (PCa), has been dem­onstrated using advanced high-throughput techniques like single-cell analysis, next­generation sequencing (NGS), and expression microarrays along with clustered regularly interspaced short palindromic repeats (CRISPR) approaches [24–28]. The prognostic, diagnostic, or theragnostic consequences of improperly expressed miR­NAs may be determined using their expression proles [29]. The comprehensive analysis of the miRNome at the genomic level enabled the precise differentiation of various cancer types and the identication of the tissue from which poorly differen­tiated cancers originated [25, 30].
In contrast to miRNAs and other tiny ncRNAs, which typically consist of less than 200 ribonucleotides, lncRNAs exhibit more heterogeneity in terms of length, spanning from 200 to several thousand ribonucleotides [31, 32]. In contemporary times, there is a growing acknowledgment that lncRNAs exhibit a higher degree of
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regulation and are more precisely conned to certain cellular contexts as compared to messenger RNAs (mRNAs) [33]. Despite little overall sequence similarity, these elements exhibit frequent and evolutionarily conserved activities, secondary struc­tures, and microhomology areas [34]. There is a growing body of data that supports the participation of lncRNAs in the control of transcription and translation pro­cesses, as well as their association with many human disorders [35]. Notably, lncRNAs have undergone thorough investigation within the realm of cancer [36].
This chapter aims to explain the distinctive attributes and signicant implications of ncRNAs, including miRNA, lncRNA, and circRNA, in relation to prostate cancer progression and its related mechanism in therapy resistance. The noncoding RNAs mentioned have the capacity to serve as therapeutic targets in the treatment of medi­cation resistance in prostate cancer (Fig.9.1).
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9.2 miRNAs inProstate Cancer
The evidence has clearly demonstrated that any disruption in the expression level of miRNAs, including the upregulation of oncogenic miRNAs and the downregulation of tumor-suppressive miRNAs, can be associated with the initiation and progression of prostate tumors [38]. Multiple studies have conrmed the correlation between dysregulation in miRNA expression and the onset and development of metastatic phenotype in prostate cancer. These miRNAs regulate key processes including epithelial- to-mesenchymal transition (EMT), tumor proliferation, AR signaling, metastasis, and apoptosis [39].
9.3 miRNAs andProstate Cancer Progression andInvasion
One of the miRNAs that has been investigated and shows promise is miR-18a, which is a member of the miR-17–92 cluster. It is increased in PCa and acts as a promoter of tumor growth [40, 41]. The miR-18a-5p overexpression induces the prostate cancer cell growth via targeting solute carrier family 40 member 1 (SLC40A1), which is an iron transporter [42]. Furthermore, miR-18a-5p has the ability to decrease the tran­scription of a pro-apoptotic protein known as serine/threonine kinase 4 (STK4), lead­ing to an elevation in phosphorylated-protein kinase b (AKT) levels and ultimately promoting the survival of tumor cells [43]. Additionally, it has been shown that the miR-221/miR-222 oncogenic cluster is present at elevated levels in prostate cancer. A suggested mechanism of miR-221/miR-222 action includes the reduction of p27kip1 expression, which then impacts the transcription of many genes contributed to the progression of cell cycle and cell proliferation, including cyclin D1, cyclin A, and S-phase kinase-associated protein 2 (Skp2) [44]. Additionally, it has been shown that miR-122 has a role as a tumor-suppressor microRNA in the prostate cancer progres­sion. The downregulation of this entity has been associated with overexpression of ROCK2 protein [45]. In a separate investigation, it was revealed that reduced
9 Prostate Cancer andNoncoding RNAs: AFocus onmiRNAs, lncRNAs, andcircRNAs
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Fig. 9.1 The biogenesis of several noncoding RNAs. The regulation of miRNA transcription is controlled by RNA polymerase II. a)The primary microRNAs (pri-miRNAs) undergo a series of sequential cleavage events to generate mature microRNAs (miRNAs) due to their transcriptional origin. Ultimately, fully developed microRNAs (miRNAs) are integrated into the Argonaute pro­tein, resulting in the formation of the miRNA-induced silencing complex (RISC). b)Based on the information provided by diverse origin transcription sites, lncRNAs may be categorized into many distinct categories, including intronic lncRNAs, exonic lncRNAs, promoter-associated lncRNAs, and enhancer-associated lncRNAs.c) The majority of circRNAs originate from precursor mRNA (pre-mRNA). CircRNAs are categorized into many categories based on their distinct composi­tions [37]
transcription of miR-122 was concomitant with heightened proliferation, suppressed apoptosis, and enhanced resistance of prostate cancer to docetaxel. This effect was presumably mediated via the regulation of pyruvate kinase M2 (PKM2) enzyme expression [46]. Furthermore, it has been shown that the absence of the tumor-sup­pressor cluster (miR-16-1 and -15a) has a signicant impact on the prostate cancer cell’s growth and survival. This effect is achieved via the regulation of many genes, including CDK6, cyclin D1, cyclin E1, and BCL2 [47]. miR-204-5p has been exten­sively studied as a tumor suppressor that exerts its inuence on the formation of PCa prostate cancer by regulating the levels of BCL2, Meis Homeobox 1 (MEIS1), and Homeobox A10 (HOXA10) expression [48, 49].
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In addition, it is noteworthy that a tumor-suppressive family of miRNAs, known as miR-200, plays a pivotal role in EMT regulation. The family comprises miR-200a/ b/c, -141, and -429. Research was conducted to examine the impact of miR-200c-3p on the invasiveness of prostate cancer cells. The ndings revealed a considerable downregulation of miR-200c-3p in human prostate cancer cell lines, such as PC3 and DU145, in comparison to the normal prostatic epithelial cell line (RWPE1). The inhibitory effects of miR-200c-3p on cell motility, cell migration, and cell invasion have been suggested to occur via its targeting of zinc nger E-box binding homeobox 2 (ZEB2), which acts as a repressor of E-cadherin and a promoter of EMT [50]. The inhibition of miR-200b in prostate cancer has been shown to downregulate epithelial­mesenchymal transition, hinder growth, and impede metastasis via a route mediated by ZEB1, which is comparable to previous ndings [51]. In a study, it was observed that the downregulation of miR-141-3p plays a role in the metastasis and invasiveness of prostate cancer by activating the nuclear factor kappa b (NF- κB) signaling pathway [52]. Moreover, miR-141-3p enrichment enhances the stemness features in prostate cancer stem cells (PCSCs) by inhibiting a group of genes associated with promoting metastasis, such as Ras homologous (Rho) GTPases, EZH2, and CD44 [53]. Furthermore, the reduced expression of miR-204 5p was linked with disease progres­sion and metastasis, in addition to its established function in regulating cell prolifera­tion and cell death through the apoptosis pathway. Wa and colleagues demonstrated that miR-204-5p exerts inhibitory effects on invasion, migration, and bone metastasis. These effects are achieved through the suppression of NF-κB signaling, which is accomplished by targeting three key proteins at the same time: tumor necrosis factor receptor-associated factor 1 (TRAF1), TGF-β activated kinase 1 (MAP3K7) binding protein 3 (TAB3), and mitogen- activated protein kinase kinase kinase 3 (MAP3K3) [54]. Furthermore, many studies have provided insights into the signicant incorpora- tion of the miR-34a tumor suppressor in the invasiveness of prostate cancer, with a noticeable decrease in its expression reported in prostate tumors [55]. The study con­ducted by Liang and coworkers demonstrated the inhibitory impact of miR-34a on the Wnt signaling pathway, leading to the suppression of migration and invasion associ­ated with EMT in prostate tumors [56]. Liu’s team showed that miR-34a has a role in the development of resistance to paclitaxel-based chemotherapy in prostate cancer cells. This resistance is achieved by the direct inhibition of the JAG1/Notch1 axis [57]. Furthermore, Yan and coworkers (2015) provided evidence for the engagement of miR-34a in the regulation of PCSCs and the process of metastasis by its direct repres­sion of CD44 expression. In addition, a comprehensive analysis was conducted in a recent study to thoroughly examine the participation of many microRNAs, such as miR-185, miR-148, and miR-145in the regulation of the phenotype of PCSCs and their contribution to the invasive and metastatic properties of prostate cancer [58, 59].
Zhiping and colleagues showed that miR-181a expression was signicantly ele­vated in metastatic prostate tumors in comparison to native prostate cancers. The miR-181a upregulation has been seen to have a role in the acquisition of the EMT phenotype. This is achieved by the increased levels of E-cadherin and other epithe­lial markers, in contrast to elevated levels of vimentin, N-cadherin, and Snail expres­sion, which are mesenchymal indicators. The upregulation of miR-181 has been