Background/Aim: We aimed to evaluate the changes of androgen receptor (AR) signaling-related long non-coding RNAs (lncRNAs) in serum extracellular vesicles (EVs) from prostate cancer (PC) patients, in order to identify novel biomarkers for AR axis-targeted therapy (ARAT)resistance among castration-resistant PC (CRPC) patients. Patients and Methods: EVs were isolated from 2 patients before and after acquiring ARAT-resistance. RNA profiling of EVs was performed by RNA-sequencing. The expression levels of selected lncRNAs in EVs were analyzed by digital droplet PCR (ddPCR) in 58 localized and 14 metastatic PC patients at diagnosis, 7 ARAT-naïve and 6 ARAT-resistant CRPC patients. LncRNA H19 expression in PC tissue was examined using published data. In order to analyze the role of H19, the prognosis was analyzed in PC patients and proteomic analysis was performed in 22Rv1 PC cells. Results: RNA-sequencing revealed that AR-regulated RNAs were most enriched in EVs after acquiring ARAT-resistance. Among them, up-regulation of AR signaling-related lncRNAs (PCAT1, H19, HOXA-11AS, ZEB1-AS1, ARLNC1, PART1, CTBP1-AS and PCA3) was confirmed by ddPCR. H19 contained in EVs (EV-H19) was significantly increased among ARAT-resistant patients compared to ARAT-naïve CRPC or metastatic PC patients. In PC tissue, H19 was negatively correlated with AR protein and AR-activity score and up-regulated in neuroendocrine CRPC tissue with low AR expression. Furthermore, EV-H19 expression was significantly associated with worse outcome to androgendeprivation therapy. Proteomic analysis demonstrated that H19 knockdown enhanced PC-related protein expression.
Conclusion: EV-H19 may negatively correlate with ARsignaling activity and could be a marker to diagnose ARATresistance among CRPC patients.Prostate cancer (PC) is the most commonly diagnosed male malignancy in the United States, with 268,490 new cases and the second leading cause of death with 34,500 deaths in 2022 (1). The five-year overall survival rate among localized and regional PC patients is over 99%, however, and it decreases to 31% among metastatic PC patients (1). Androgen receptor (AR)-signaling is a central axis in PC pathogenesis and androgen-deprivation therapy (ADT) is a common treatment for metastatic PC patients. ADT is temporarily effective; however, PC develops castration-resistant PC (CRPC) following ADT. It has been reported that AR-signaling is still activated in CRPC (2). For this reason, second generation androgen receptor axis-targeted therapy (ARAT; Abiraterone, Enzalutamide, Apalutamide and Darolutamide) is strongly recommended for CRPC patients by the National Comprehensive Cancer Network (NCCN) guidelines (3). Although ARAT improves the prognosis of CRPC, it has limited effect and CRPC patients develop ARAT-resistance (4). Prostate-specific antigen (PSA) is a reliable tumor monitoring marker for PC; however, it sometimes deviates from the disease state in CRPC patients who are receiving ARAT (5). Therefore, it is of great importance to identify novel biomarkers t...