HMGCR and pachyonychia congenita: Another study found that 3-hydroxy-3-methyl-glutaryl–CoA reductase (HMGCR), a key enzyme in the cholesterol synthesis pathway, was elevated in enzalutamide-resistant PC cell lines and that simvastatin, a HMGCR inhibitor, blocked AR synthesis and inhibited growth in vitro and in vivo [29].