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Dickkopf-related protein 1 (DKK1) belongs to the DKK family and inhibits the Wnt/β-catenin signaling pathway. The DKK1 gene is found on human chromosome 10q11.2 and encodes a secretory glycoprotein weighing about 28.7 kDa and containing 266 amino acids. The molecular structure of DKK1 is complicated, including an N-terminal signal sequence, two cysteine-rich conserved regions (Dkk_N and an auxiliary lipase fold area), and a C-terminal glycosylation site. The N-terminal signal sequence largely drives DKK1 to the endoplasmic reticulum (ER). It regulates secretion, whereas the cysteine-rich sections stabilize the protein via disulfide bonds and bind to the Wnt receptors LRP5/6 and Kremen1/2. DKK1 regulates intracellular and extracellular signal transduction via these structural properties.
Figure 1. DKK1 plays a versatile role in cell signaling by inhibiting Wnt signaling and promoting alternative pathways that influence cell proliferation and differentiation. (Jiang H, et al., 2022)
The Wnt/β-catenin signaling system regulates cell proliferation, differentiation, and survival. Wnt proteins activate Dishevelled (Dvl) by binding to Frizzled (Fz) and LRP5/6 receptors, blocking the formation of the destruction complex. This stabilizes β-catenin and allows it to translocate to the nucleus to control transcription of downstream target genes. However, as an antagonist of Wnt signaling, DKK1 suppresses this pathway via two mechanisms:
1. Competitive Binding to the LRP5/6 Receptor: DKK1 competes with Wnt proteins for binding sites on LRP5/6, limiting the beginning of Wnt signaling.
2. Induction of LRP5/6 Endocytosis: By establishing a complex with Kremen1/2, DKK1 increases LRP5/6 endocytosis and degradation, decreasing signal transmission.
DKK1 inhibits β-catenin stability and nuclear translocation, affecting downstream gene expression and biological processes such as cell proliferation, differentiation, and death.
DKK1 is present in a broad range of tissues and cell types, including bone tissue, the placenta, skin, the prostate, and the kidney. DKK1 suppresses bone formation in osteoblasts and osteocytes while activating bone resorption via the Wnt/β-catenin signaling pathway. In recent years, the involvement of DKK1 in cancers, aberrant growth and development, and different disorders has received a lot of attention. According to research, DKK1 expression and activity vary depending on the cellular environment and pathological state, functioning as an oncogene in certain cancers while inhibiting malignancies in others.
In multiple myeloma, increased DKK1 expression is associated with bone damage. It suppresses the development of bone marrow stem cells into osteoblasts, hence boosting bone resorption. The development of anti-DKK1 antibodies and vaccines has shown promise for treating multiple myeloma. Anti-DKK1 vaccinations, for example, may stimulate particular T-cell responses that suppress myeloma cell proliferation and bone damage.
DKK1 is abundantly expressed in gastric cancer cells and has been associated with enhanced invasiveness and tumor spread. Clinical studies show that Sirexatamab, a targeted medication against DKK1, may block angiogenesis while activating immune-related proteins such IFNγ, IL-15, and IL-33. This enhances tumor cell killing and improves patient prognosis.
In colorectal cancer, DKK1 suppresses the creation of vasculogenic mimicry (VM), which prevents the tumor blood supply from expanding. VM is a pseudo-vascular structure generated by tumor cells under appropriate circumstances that provides nutrition while also encouraging invasion and metastasis. DKK1 overexpression dramatically inhibits colorectal cancer cells' capacity to produce VM, indicating that it might be a therapeutic target in cancer.
In breast cancer, DKK1 may control the disease by regulating bone metastases or accelerate tumor growth by increasing angiogenesis and cell migration. Similarly, in pancreatic cancer, detecting both DKK1 and the serum tumor marker CA19-9 may increase diagnostic accuracy and act as a specific signal for disease progression.
Beyond its role in tumors, DKK1 is involved in the pathophysiology of various non-tumorous diseases. In Parkinson's disease models, DKK1 knockdown significantly reduces neuronal apoptosis and improves neuronal survival. Additionally, in osteoporosis and ankylosing spondylitis, DKK1 exacerbates the disruption of bone homeostasis by inhibiting osteoblast differentiation and activating osteoclast activity.
Given DKK1's crucial role in various diseases, targeting this protein has become a focal point in drug development. BHQ-880 and Sirexatamab, as DKK1 inhibitors, have entered clinical trials for multiple myeloma and gastric cancer. Furthermore, DKK1-related vaccines and monoclonal antibodies are under exploration. Sirexatamab, for example, has shown strong therapeutic results in clinical trials of gastric cancer, with effectiveness closely related to DKK1 expression levels in patient tumors. These developments not only open up new avenues for targeted therapeutics against DKK1, but also set the basis for a better understanding of DKK1's mechanisms of action.
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