
Follistatin expression is also controlled by additional layer(s) of regulatory control outside of the basal TGF-β-Smad autoregulatory feedback circuit often disrupted in cancer. Follistatin upregulation in head and neck squamous cell carcinoma (HNSCC) arises through MAPK signaling mediated by EGFR and TP63 amplification, likely at super-enhancers reprogramming the epigenetic landscape. Inactivating mutations of FAT1 also impair Hippo pathway signaling allowing YAP1 translocation to the nucleus where it forms a complex with TEAD and BRD4 that binds to the follistatin promoter to drive tumorigenesis and immune evasion. Pharmacologic inhibition of BRD4 (i.e. BET inhibitors like JQ1) blocks YAP-mediated follistatin upregulation. Follistatin also functions as a transcriptional coregulator of TEAD/p63-mediated immune evasion programs contributing to an immunosuppressive TME. Taken together, oncogenic dependency on follistatin links epithelial-stromal communication with immune-cold, therapeutic drug-resistant tumor microenvironments in squamous cancers.
Fig. 1 Signaling pathways driving follistatin in cancer. (Sosa J, et al. 2024)
References
A therapy to silence activin A (ActA) due to its overexpression was created by loading LNPs with follistatin (FST) mRNA. In vivo studies of the murine model of head and neck squamous cell carcinoma (HNSCC) showed LNPs delivering FST mRNA resulted in local and systemic downregulation of ActA expression which decreased tumor burden and metastasis to the lungs, as well as inhibited cachexia-related loss of muscle and adipose tissue mass. mRNA LNPs encoding FST were based on ALC-0315 and utilized mRNA modified with pseudouridine to ensure a safety profile conducive to effective FST expression. ActA overexpression is implicated in the formation of metastasis as well as cachexia in multiple cancers, so both routes of administration were effective including IP delivery and localized transfection of tumors when administered SC.
Fig. 2 Inhibition of head and neck squamous cell carcinoma metastasis using follistatin mRNA lipid nanoparticles. (Grigoriev V, et al. 2024)
References
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