Anti-androgenic therapy is the mainstay for both primary and disseminated forms of prostate cancer. FDA-
approved enzalutamide (Xtandi) is at the forefront of anti-androgens with superior patient profile and is the one
most prescribed. However, enzalutamide resistant prostate cancer (ERPC) invariably develops, which is
incurable and responsible for most of the prostate cancer-related deaths, underscoring that management of
ERPC is an unmet and urgent medical need. Development of an effective therapy against ERPC is suffering
from lack of proper understanding about critical molecular targets to effectively kill ERPC cells. To identify
potential new targets, we developed an ERPC model which mimics the clinical conditions in patients undergoing
standard enzalutamide therapy. We treated androgen-sensitive prostate cancer cells with enzalutamide in long-
term culture to generate cell lines (LNCaP-ENR, PCa-2B-ENR) which are no longer sensitive to clinically relevant
doses of enzalutamide. Comprehensive gene expression analysis revealed that the ERPC cells overexpress
Tribbles 2 (Trib2), a member of the tribbles pseudokinase family. Overexpression of Trib2 was also found in PDX
and patient prostate tumors after enzalutamide treatment. Forced overexpression Trib2 results in enhanced
prostate cancer cell growth and resistance to enzalutamide, apalutamide, darolutamide and abiraterone.
Inhibition of Trib2 re-sensitizes resistant cells to enzalutamide and decreases their viability, indicating a possible
direct link between Trib2 and development of enzalutamide resistance. Interestingly, Trib2 downregulates Rb1
and p53, while induces the neuronal transcription factors (N-Myc, BRN2) and the neuroendocrine (NE) markers
(Chromogranin A, Neuron-specific enolase and Synaptophysin). Inhibition of N-Myc or BRN2 re-sensitizes
resistant cells to enzalutamide. These findings suggest that Trib2 drives cellular trans-differentiation from luminal
to NE phenotype to pose resistance to anti-androgens. Thus, Trib2 emerges as a novel, promising molecular
target for therapy of ERPC-NE. However, the mechanism and role of Trib2 in NE differentiation needs to be
determined using appropriate in vitro and in vivo models. Thus, this proposal has been designed which will
characterize how Trib2 induces NE differentiation (Aim 1), determine the impact of Trib2 inhibition in enhanced
ERPC tumor growth and distant metastasis (Aim 2), and test the impact of Trib2 gene-targeting on prostate
tumor progression and NE differentiation using transgenic Trib2 knockout mouse models (Aim 3). Accomplishing
these goals will establish Trib2 as a molecular driver for treatment-induced NE differentiation and will help
develop a new targeted therapeutic strategy for enzalutamide resistant, NE type, lethal prostate cancer.