The Role of Androgens and Androgen Receptor in Human Bladder Cancer
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biomolecules Review The Role of Androgens and Androgen Receptor in Human Bladder Cancer Elizabeth Martínez-Rojo, Laura Cristina Berumen , Guadalupe García-Alcocer and Jesica Escobar-Cabrera * Unidad de Investigación Genética, Posgrado en Ciencias Químico Biológicas, Facultad de Química, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico; [email protected] (E.M.-R.); [email protected] (L.C.B.); [email protected] (G.G.-A.) * Correspondence: [email protected]; Tel.: +55-4421287051 Abstract: Bladder cancer (urothelial carcinoma) is one of the most frequently diagnosed neoplasms, with an estimated half a million new cases and 200,000 deaths per year worldwide. This pathol- ogy mainly affects men. Men have a higher risk (4:1) of developing bladder cancer than women. Cigarette smoking and exposure to chemicals such as aromatic amines, and aniline dyes have been established as risk factors for bladder cancer and may contribute to the sex disparity. Male internal genitalia, including the urothelium and prostate, are derived from urothelial sinus endoderm; both tissues express the androgen receptor (AR). Several investigations have shown evidence that the AR plays an important role in the initiation and development of different types of cancer including bladder cancer. In this article, we summarize the available data that help to explain the role of the AR in the development and progression of bladder cancer, as well as the therapies used for its treatment. Keywords: androgens; androgen receptor; bladder cancer; signaling pathways; therapies Citation: Martínez-Rojo, E.; Berumen, L.C.; García-Alcocer, G.; Escobar-Cabrera, J. The Role of 1. Introduction Androgens and Androgen Receptor Bladder cancer has high incidence and mortality around the world. Approximately, in Human Bladder Cancer. half a million new cases and 200,000 deaths have been reported worldwide per year [1]. Biomolecules 2021, 11, 594. https:// In the United States, it is the fourth leading cause of death in men. About 83,730 new cases doi.org/10.3390/biom11040594 and 17,200 deaths from this pathology among men and women have been estimated [2]. Most of the people affected by this pathology are men over 65 years of age and, to a Academic Editor: Alessandro Alaimo lesser extent, women. The main risk factors are smoking, exposure to chemicals, radiation therapy, and chemotherapy [3]. Androgens are classically known for their role in the male Received: 1 March 2021 reproductive system. Androgens and their receptors control the transcription of genes Accepted: 15 April 2021 Published: 18 April 2021 associated with processes such as cell cycle, survival, and differentiation; thus, the study of their influence on the development, progression, and diagnosis in different types of cancer is very important [4]. Different studies have shown that the presence of androgens and Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in their receptor is strongly associated with bladder cancer [5]. published maps and institutional affil- The aim of this review is to collect the most recent information on the role of androgens iations. and the AR in the development and progression of bladder cancer, as well as the signaling pathways involved and new therapies. 2. Structure of Androgens and Androgen Receptors Androgens are a group of steroid hormones that include mainly testosterone, which is Copyright: © 2021 by the authors. α Licensee MDPI, Basel, Switzerland. converted to 5 -dihydrotestosterone (DHT, its active metabolite which shows a 2–5 times This article is an open access article higher binding affinity to the AR than that of testosterone) through the action of the en- distributed under the terms and zyme 5α-reductase [4]. Androgens are produced from the transformation of cholesterol conditions of the Creative Commons in the testes (Leydig cells), ovaries, adrenal gland [4,6] muscles, fat tissue, skin, and en- Attribution (CC BY) license (https:// dometrium [7]. creativecommons.org/licenses/by/ The AR belongs to the steroid receptor family (NR3C4 of the 3-ketosteroid receptors, 4.0/). family III), one of the subtypes of the nuclear receptor superfamily, the latter composed Biomolecules 2021, 11, 594. https://doi.org/10.3390/biom11040594 https://www.mdpi.com/journal/biomolecules Biomolecules 2021, 11, x 2 of 16 in the testes (Leydig cells), ovaries, adrenal gland [4,6] muscles, fat tissue, skin, and endo- Biomolecules 2021, 11metrium, 594 [7]. 2 of 16 The AR belongs to the steroid receptor family (NR3C4 of the 3-ketosteroid receptors, family III), one of the subtypes of the nuclear receptor superfamily, the latter composed of more than 500 transcription factors modulating gene expression [8–10]. The AR is com- of more than 500 transcription factors modulating gene expression [8–10]. The AR is posed of four different domains; an N-terminal domain (NTD), which contains the activa- composed of four different domains; an N-terminal domain (NTD), which contains the tion function-1 (AF-1) domain, which contains essential sites of phosphorylation; a DNA- activation function-1 (AF-1) domain, which contains essential sites of phosphorylation; a binding domain (DBD) that has two zinc fingers, and its function is the recognition, di- DNA-binding domain (DBD) that has two zinc fingers, and its function is the recognition, merization, and binding to the DNA in androgen responsive elements (ARE); a hinge, a dimerization, and binding to the DNA in androgen responsive elements (ARE); a hinge, a lysine rich region that is important for nuclear receptor localization; and a ligand-binding lysine rich region that is important for nuclear receptor localization; and a ligand-binding domain (LBD) that contains the AF-2 [6,11]. The AR gene is located on the long arm of the domain (LBD) that contains the AF-2 [6,11]. The AR gene is located on the long arm of the X-chromosomeX-chromosome and is expressed and in is several expressed tissues in several, including tissues, the includingprostate, breast, the prostate, testes, breast, testes, skeletal muscle,skeletal uterus muscle,, and bladder uterus, [11]. and The bladder AR belongs [11]. The to AR the belongs family of to transcription the family of transcription factors that homodimerizefactors that homodimerize after ligand-binding, after ligand-binding, while RXR receptors while RXR may receptors heterodimer- may heterodimerize, ize, and monomericand monomeric orphan receptors orphan do receptors not require do not dimerization require dimerization [12,13]. [12,13]. 3. Activation of3. Androgen Activation Receptor of Androgen and ReceptorCofactorsand Cofactors In the absenceIn of the a ligand, absence the of AR a ligand, is bound the to AR heat is bound shock toproteins heat shock that prevent proteins the that prevent the translocation totranslocation the nucleus to and the protect nucleus the and receptors protect thefrom receptors degradation from (and degradation from the (and from the generation of toxicgeneration AR aggregates) of toxic AR and aggregates) remains in the and cytoplasm; remains in after the ligand cytoplasm; binding, after the ligand binding, AR dissociatesthe from AR the dissociates heat shock from proteins the heat and shock transloc proteinsates and to the translocates nucleus. toIn thethe nucleus. nu- In the nu- cleus, the AR bindscleus, to the ARE AR located binds to on ARE the DNA located promoter on the DNA via zinc promoter finger viabinding zinc fingerdomains. binding domains. Once the AR dimerOnce theis bound AR dimer to the is boundDNA, it to forms the DNA, complexes it forms with complexes transcriptional with transcriptional coacti- coactiva- vators and co-regulatorstors and co-regulators for the regulation for the of regulation target gene of expression target gene (Figure expression 1) [4,6,14 (Figure–18].1)[ 4,6,14–18]. Figure 1. Genomic androgenFigure receptor 1. Genomic pathway androgen. receptor pathway. Coregulators areCoregulators not DNA- arebinding not DNA-binding proteins, but proteins, are recruited but are to recruitedtranscription to transcription fac- factors, tors, such as thesuch AR, as and the have AR, anddifferent have differentactivities activitiesinvolved involvedin the regulation in the regulation of gene ex- of gene expres- pression; somesion; of them some cause of them chromatin cause reconfiguration chromatin reconfiguration or are needed or to are bind needed some toother bind some other cofactors [19]. cofactors [19]. Liu et al., 2017Liu studied et al., the 2017 AR studiedcoregulators the ARin association coregulators with in prostate association cancer; with they prostate cancer; worked with 181they coregulators worked with interacting 181 coregulators physically interacting and functionally physically, with and ARfunctionally, 51 of them with AR 51 associated withof prostate them associated cancer and with 22 prostatecorrelated cancer with andthe most 22 correlated aggressive with characteristics the most aggressive char- (Figure 2). Theyacteristics managed (Figure the knockout2). They of managed the 22 coregulators the knockout and of identified the 22 coregulators four of them and identified that decreasedfour AR ofprotein them thatexpression decreased (GAK, AR proteinHIP1, RAD9A expression, and (GAK, SMAD3). HIP1, They RAD9A, con- and SMAD3). firmed the participationThey confirmed of the the other participation 18 coregulators of the other, silencing 18 coregulators, each factor silencing individually each factor individ- with specific siRNuallyA, with with