As mentioned earlier, Cdc37 is an overexpressed oncogene. Indeed, under forced
Cdc37 expression cells become transformed, proliferate and tumors arise. When Cdc37 is overexpressed along with the proto-oncogene c-Myc, the effects of both agents become amplified and more and larger tumors arise in transgenic mice
15,8,14. Indeed, Cdc37 levels are elevated in many clinical cancers
8. Although Cdc37 may be regarded as a specialized partner of Hsp90, dealing with structurally compromised kinase clients, it may also offer a preferable target for cancer therapy. Hsp90 is expressed with similar abundance in normal and malignant cells and includes among its clientele proteins required for the viability of normal cells
26. In its favor as a therapeutic target, some studies indicate that tumor Hsp90 is selectively vulnerable due to the proliferation of its oncogenic clients and the formation of mature Hsp90/client/co-chaperone complexes that bind Hsp90 drugs with increased affinity
27. However this phenomenon is not universally observed
28. Cdc37, by contrast is increased in proliferating tissues, and is heavily expressed in certain cancers including prostate carcinoma, anaplastic large cell lymphoma, acute myelocytic leukemia, hepatocellular carcinoma and multiple myeloma
29–32. As most normal tissues do not proliferate or appear to require Cdc37, a potential therapeutic window is available, which is not as obvious in the case of Hsp90.
The mechanisms underlying increased Cdc37 expression in malignant cells are not known. The Cdc37 promoter contains multiple binding sites for transcription factor Mzf1, implicated in myeloid tumorigenesis, although evidence for a dynamic role in Cdc37 expression is not available
33. The
addicted to chaperones hypothesis might predict that chaperone levels should increase as clients proliferate. Indeed, there is a clear rationale for this mechanism in the case of Hsp90 whose transcription is activated by the factor HSF1 which undergoes induction by increased accumulation of unfolded proteins
34. However, the Cdc37 promoter is devoid of canonical HSF1 binding elements and does not respond to HSF1 activation. A further clue that warrants exploration is that Cdc37 is overexpressed in prostate cancer and such cancers are induced by the forced expression of Cdc37
8,14. As AR is one of the rare non-kinase clients for Cdc37, and is essential for proliferation and differentiation of prostatic epithelium, a role for AR would fit the profile
8.
Recent studies address the feasibility of targeting Cdc37 in prostate carcinoma
15,35. Indeed, depletion of Cdc37 in prostate cancer cell lines by RNA interference techniques leads to permanent growth inhibition both in androgen-dependent and androgen-independent cell lines
35. Growth inhibition was correlated with decreased signaling through the anabolic ERK and Akt kinase cascades as well as reduced AR-dependent transcriptional signaling
35 (). In addition, Cdc37 targeting inhibits HSF1 activity and Hsp70 expression, components of a common resistance pathway that mediates insensitivity to therapeutics such as Hsp90 inhibitors and proteasomal targeting agents
35,36 (). Inactivation of Cdc37 may thus decrease cell survival through a range of pathways, permitting effective inhibition of anabolic signaling and breaking resistance to cytotoxic therapy. It is significant that the consequences of Cdc37 depletion and Hsp90 inhibition are divergent at the molecular level, with Hsp90 inactivation triggering degradation of the abandoned clients while Cdc37 depletion does not
35 (). Cdc37 knockdown instead causes profound inhibition of the activities of multiple kinase cascades and loss of the transcriptional activity of AR
35. These data suggest intrinsic differences in the relationships between Hsp90, Cdc37 and their clients that become unmasked during therapy. Cdc37 is evidently not essential for the intracellular survival of its clients while functional Hsp90 is required to prevent degradation
37 (). However, in order for protein kinases to transfer phosphate to their substrates or for AR to interact productively with its ligand, Cdc37 is indispensable. Further underlining the contrasting mechanisms of Hsp90- and Cdc37-dependent prostate cancer growth, functional inhibition of both proteins in tumor cells is supra-additive
35. The question of independent, non-Hsp90 requiring interactions for Cdc37 observed in recent studies also arises
20.
Recent work also shows that depletion of another Hsp90 co-chaperone AHA1 leads to a similar reduction in activity of Hsp90 client kinases without marked increases in degradation of such proteins. These findings suggest that degradation of clients may require direct interaction between drugged, inactive Hsp90 and its bound clients and cannot be mimicked by the inactivation of co-chaperones
38. Targeting Hsp90 co-chaperones may therefore lead to radically different consequences compared to the direct inhibition of Hsp90. Future strategies for Cdc37 drug design and selection would likely aim at the inhibition of either: (1) the Cdc37-client interaction or (2) Cdc37-Hsp90 association (). Indeed recent studies using the triterpine drug celastrol indicate cancer cell growth reduction through mechanism (2) the inhibition of Hsp90-Cdc37 interaction
39. These natural plant products cause pleiotropic changes in cancer cells and can lead to tumor regression
39. However, the cellular responses to celastrol resemble those provoked by Hsp90 inhibitors, and include client protein destruction and HSF1 activation and may not provide a radical departure from current treatments. Further studies might concentrate on agents with more novel mechanisms of action such as Cdc37-client interaction.
In conclusion, inhibition of Cdc37 activity is a promising new approach to the treatment of cancer due to its multi-targeting nature, the elevated expression of Cdc37 in dividing cells and the ability of Cdc37 depletion to arrest growth in both AR+ and AR− prostate cancer. Cdc37 targeting also has the potential ability to deter the evolution of new traits that depend on kinase mutation and such a block on adaptation might limit the ability of tumors to respond to therapy and a deteriorating microenvironment. Such effects are proposed to occur in tumors treated with Hsp90-targetting drugs
5. As to the ultimate selectivity of Cdc37 inhibition for treating malignant cells, this chaperone is not expressed in quiescent cells but appears necessary for the growth of normal epithelial cells. Therefore treating prostate cancer through the inhibition of Cdc37 might involve sacrificing this non-essential population
15. However, this drawback would not differ markedly from current therapies used to treat prostate cancer, which also focus on eradicating normal prostate tissue as well as cancer. One potential concern with this therapy could however be the unknown potential for effects on other normally proliferating epithelium including that in the GI tract and skin.