SUMMARY
Galeterone is a steroidal CYP17A1 inhibitor, androgen receptor (AR)
antagonist and AR degrader, and was under evaluation in a phase III clinical
trial for castration-resistant prostate cancer (CRPC). The A/B steroid ring
(Δ5, 3β-hydroxyl) structure of galeterone is
identical to cholesterol, which makes endogenous steroids with the same
structure (e.g., DHEA and pregnenolone) substrates for the enzyme
3β-hydroxysteroid dehydrogenase (3βHSD). We found that
galeterone is metabolized by 3βHSD to Δ4-galeterone
(D4G), which is further converted by steroid-5α-reductase (SRD5A) to
3-keto-5α-galeterone (5αG), 3α-OH-5α-galeterone,
3β-OH-5α-galeterone, and in vivo is also
converted to the 3 corresponding 5β-reduced metabolites. D4G inhibits
steroidogenesis, suppresses AR protein stability, AR target gene expression and
xenograft growth comparably to galeterone, and further conversion by SRD5A leads
to loss of several activities that inhibit the androgen axis that may compromise
clinical efficacy. Together, these findings define a critical metabolic class
effect of steroidal drugs with a Δ5, 3β-hydroxyl
structure.