Abstract 466: microRNA regulators of neuroendocrine differentiation in metastatic castration-resistant prostate cancer

Abstract Therapy-induced neuroendocrine prostate cancer (NEPC), an extremely aggressive variant of castration-resistant prostate cancer (CRPC), is increasing in incidence with the widespread use of highly potent androgen receptor (AR) -pathway inhibitors (APIs) via a reversible trans-differentiation process, referred to as neuroendocrine differentiation (NED). The molecular basis of NED is not completely understood leading to a lack of effective molecular markers for its diagnosis. We hypothesized that alterations in key miRNAs drive NED, leading to lineage switching and emergence of NEPC. The aims of our study are: (i) identify key miRNA alterations that occur as PCa cells undergo neuroendocrine differentiation; (ii) develop a miRNA-based classifier for predicting/diagnosing NEPC; (iii) understand the functional role of key miRNA alterations. To systematically investigate the key miRNAs alterations driving therapy induced NED, we performed small RNA-NGS in a retrospective cohort of human metastatic CRPC clinical samples + PDX models with adenocarcinoma features (CRPC-adeno) vs those with neuroendocrine features (CRPC-NE). Further, with the application of machine learning algorithms to sequencing data, we trained a ‘miRNA classifier’ that could robustly classify ‘CRPC-NE’ from ‘CRPC-Adeno’ cases. The performance of classifier was validated in additional cohorts of mCRPC patients acquired from independent sites by employing single model prediction algorithm. We further sought to understand the functional role of these miRNAs by overexpessing in PCa cell lines followed by functional assays. In vivo xenograft studies were performed using PC3 cells overexpressing miR-28/control miRNA. We demonstrate for the first time, that lineage switching to NE states is accompanied by key miRNA alterations. Our analysis, measured using receiver operating characteristic (ROC) curves, demonstrated an area under the curve (AUC) value of 0. 8318, confirming the robustness of our classifier in distinguishing CRPC-NE from CRPC-Adeno. Furthermore, we identified a select group of 5 miRNAs that were pivotal in distinguishing between these two prostate cancer subtypes. We focused on miR-28-3p, little studied miRNA in prostate cancer. Our in vitro and in vivo data with prostate cancer cell lines and xenograft model suggests that miR-28-3p acts as a tumor suppressor miRNA in advanced stage prostate cancer. We further found mesenchymal gene Vimentin to be a direct miR-28-3p target. We propose that loss of miR-28-3p promotes epithelial-to-mesenchymal transition (EMT), thereby favoring NED. Our study has important clinical implications and transformative potential as our 'miRNA classifier' can be used as a molecular tool to stratify mCRPC patients into those with/without NED and guide treatment decisions. Further, we identify novel miRNA NED drivers that can be exploited for NEPC therapeutic targeting. Citation Format: Diana Asante, Sandip Nathani, Tae Jin Lee, Ashok Sharma, Sharanjot Saini. microRNA regulators of neuroendocrine differentiation in metastatic castration-resistant prostate cancer abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts) ; 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84 (6Suppl): Abstract nr 466.