Abstract SerpinA6 is a major cortisol binding transport protein, which helps in cortisol tissue delivery particularly at inflammatory sites. Moreover, SerpinA6 has been reported to participate in stress response by releasing cortisol specifically at inflammatory sites upon cleavage by human neutrophil elastase between residues 344 and 345. In castrate resistant prostate cancer (CRPC) patients, reports suggest castration induces inflammation in the prostate, which increases glucocorticoids (GCs) levels and elevates pro-inflammatory cytokine IL-6 levels. We propose declining SerpinA6 levels in the prostate may play a role in prostate cancer disease progression. This could be due to increasing IL-6 levels after castration, which may inhibit or degrade SerpinA6. Deficient SerpinA6 may not be sufficient to keep steroids inactive, due to the increasing GCs. Our data suggests IL-6 treatment of androgen independent prostate cancer (PC-3) cells decreases SerpinA6 level and conversely increases glucocorticoid receptor (GR) expression in a dose (1-10ng/ml) and time (30-180 minutes) dependent fashion. Moreover, IL-6 dose dependent treatment in PC-3 cells decreases FOXO3a expression, a major apoptotic protein dysregulated in prostate cancer. Next, we determine the role of SerpinA6 (30µg/ml) and IL-6(5ng/ml) independently and in combination to PC-3 cells. We observed IL-6 and SerpinA6 co-treatment to PC-3 cells (charcoal stripped FBS media) for 6 hours reduced Neutrophil elastase levels significantly. Additionally we observed increased FOXO3a and SerpinA6 expression, whereas decreased GR and HNF3α levels. However, silencing IL-6 in PC-3 cells increased SerpinA6 expression. To further support our findings, silencing SerpinA6 in metastatic variant of PC-3 cells increased phosphor-Akt-(ser-473), glucocorticoid receptor and increased apoptotic protein FOXO3a expressions. Using dexamethasone (15µM), which is known to suppress PC-3 cell migration, we found increased expression of SerpinA6. Conversely, Mifepristone (15µM), which inhibits PC-3 cell growth, deceases SerpinA6 expression after 24 hours of treatment. In humans the normal range of circulatory SerpinA6 level are 19-45ug/ml. We treated normal prostate epithelial cells (RWPE1) and prostate cancer (PC-3) cells with human recombinant protein 18 and 36ug/ml of doses for 24 hours; RWPE1 cells represented a SerpinA6 dose dependent increase in cellular viability, whereas PC-3 cells demonstrated no change in the viability after a dose response treatment with SerpinA6 for 24 hours. These findings suggest the SerpinA6 context dependent role. We suggest that decreasing levels of SerpinA6 and FOXO3a expressions in the prostate cancer patients may have potential role in disease progression. Moreover, we need to have an effective agent, which could prevent the decreasing levels of SerpinA6 and FOXO3a in prostate to inhibit the progression of prostate cancer. Citation Format: Carlos Riveros, Victor Chalfant, Jatinder Kumar, Sanjeev Shukla. Dysregulated SerpinA6 levels and progression of prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3983.