1. Introduction
PPARs are members of a large family of related ligand-activated nuclear receptors that bind to a common consensus recognition sequence in the promoters of target genes, the peroxisome proliferators response element (PPRE). Ligand-induced activation of PPARs bound to the PPRE subsequently induce target gene transcription (for review, see [
1]). Three different PPAR proteins have been identified (PPARα, PPARδ and PPARγ), all of which require heterodimerization with the retinoid X receptor α (RXRα) for PPRE binding and transcriptional activity [
1]. Endogenous PPAR ligands include unsaturated and saturated fatty acids and fatty acid metabolites [
2,
3]. While the three different PPAR receptors exhibit differences in tissue distribution, all three PPARs are known to be expressed in human and mouse skin [
4]. In addition, all three PPAR subtypes play key roles as homeostatic regulators of lipid metabolism, energy balance, and cellular differentiation [
2,
3].
In addition to their role as direct transcriptional regulators of genes involved in energy balance and lipid metabolism, PPARγ acts through mechanistically distinct transrepressive signaling pathways to suppress the activities of other transcription factors, such as NF-κB, activator protein 1 (AP-1), and nuclear factor of activated T cells (NFAT) [
5]. Using whole transcriptomic analysis of differentially expressed genes in
Pparg-/-epi relative to wildtype control mice, we showed that
Pparg-/-epi mice exhibit a marked increase in inflammatory mediators and gene products associated with inflammasome activation, indicating a key role for PPARγ as an important immune modulator [
6]. The mice also developed spontaneous inflammatory skin lesions [
6]. A role for PPARγ as a suppressor of cutaneous inflammation is seen in studies of inflammatory dermatoses. Relative to normal human control skin, PPARγ transcripts in psoriatic and atopic lesions are reduced 8- and 3.3-fold, respectively [
7]. Another study demonstrated that
PPARG mRNA is significantly decreased in human lichen planopilaris, a form of scarring (cicatricial) alopecia [
8].
PPARs have also received interest for their potential role in neoplastic development. Keratinocyte-specific loss of
Pparg in mice
(Pparg-/-epi mice
) results in increased photocarcinogenesis and photoinflammation [
9], as well as a severe defect in normal contact hypersensitivity (CHS) responses [
10]. Similarly, epidermal-specific loss of either
Pparg or it’s heterodimeric partner RXRα in mice resulted in an approximately 2-fold increase in DMBA/PMA-induced tumors [
11]. DMBA treatment of mice with hemizygous germline loss of
Pparg resulted in a cancer incidence increase of over 3-fold, while metastatic disease increased 4.6-fold [
12]. The increase in cancers included a 1.7-fold increase in cutaneous papilloma multiplicity.
In addition to these loss of function models, pharmacologic gain of function studies also indicate a potential role for PPARγ agonists in cutaneous malignancy. Treatment of mice with rosiglitazone was shown to suppress chemical carcinogenesis by approximately 70% [
13]. Rosiglitazone also blocks the ability of ultraviolet light to suppress both CHS responses and anti-tumor immunity [
10]. In addition, rosiglitazone promotes anti-tumor immune reactions in a mouse immunogenic cutaneous SCC tumor model [
14]. In yet another study, the anti-neoplastic efficacy of immune therapy consisting of CTLA4 blockade and a cancer vaccine was enhanced by the addition of rosiglitazone treatment [
15]. C0llectively, these data indicate a potential tumor suppressor role for PPARγ that is mediated by its effects on inflammation and anti-tumor immune responses.
Chronic inflammation and immunosuppression are hallmarks of the tumor microenvironment [
16,
17]. While malignant tumors orchestrate changes to the stromal microenvironment to promote tumor growth and escape from immune surveillance, it is unclear how this process is regulated. Mice lacking epidermal
Pparg (
Pparg-/-
epi mice) also exhibit immune suppression, chronic inflammation and increased chemical and photocarcinogenesis. We were therefore interested in determining whether the transcriptomic changes observed in
Pparg-/-
epi mice exhibit any overlap with non-melanoma skin cancer (NMSC). We utilized transcriptomic analysis and single cell RNA sequencing (scRNAseq) to provide evidence that PPAR signaling is the top inhibited canonical signaling pathway in NMSC and that this loss correlates with significant reductions in PPARγ expression and activity, increased cytokine & chemokine signaling. Smaller but significant reductions in PPARα mRNA expression and activity were also seen, suggesting a potential tumor suppressor role for PPARα as well. In
Pparg-/-
epi mice, scRNAseq further indicated that epidermal
Pparg is a key epidermal regulator that modulates the recruitment of stromal myeloid, lymphoid and fibroblast populations.
4. Discussion
In this report, we show that loss of epidermal
Pparg is sufficient to induce transcriptomic changes that mimic those observed in actinic disease and SCCs. These changes include multiple changes in inflammatory signaling, chemokine expression and immune cell recruitment. Gene set enrichment analysis revealed largely similar activation and inhibition profiles for canonical signaling pathways and diseases and biofunctions. A surprising and informative finding is that there is a switch from increased PPAR signaling in normal sun-exposed skin (SES) to a loss of PPAR signaling in AKs and cutaneous SCCs. This PPAR signaling switch correlates with a similar switch between increased
PPARG expression in SES skin to reduced
PPARG expression in malignant AK and cutaneous SCC lesions. A similar but less intense change in the pattern of
PPARA expression was also observed. In contrast,
PPARD expression was increased in both AKs and cutaneous SCCs. This indicates that loss of overall PPAR signaling and an associated loss of
PPARG and
PPARA expression are important features that distinguish NMSC from sun-damaged skin. To our knowledge, this report is the first to demonstrate that PPAR Signaling the top commonly inhibited canonical signaling pathway in SCC development. We and others have shown that loss of epidermal
Pparg promotes both chemical and photocarcinogenesis in mice [
9,
11,
12]. Thus, our data further supports a key role for PPARγ as a tumor suppressor in both human and murine cutaneous SCC formation.
There are multiple potential mechanisms through which PPARγ activity could be lost in cutaneous neoplasia. This includes genetic deletions or inactivating mutations. Since germline loss of one
Pparg allele in mice results in an increased susceptibility to chemical carcinogenesis [
12], complete loss of PPARγ activity is likely not necessary for increased tumorigenesis. The human
PPARG gene is located at the 3p25 chromosomal locus [
42]. It is therefore of interest that loss of heterozygosity (LOH) of large portions of 3p were observed in 25% of AKs and 53% of cutaneous SCCs [
43]. Another study showed that chromosomal loss of 3p is seen in 53% of SCC and 60% of SCC
in situ [
44]. LOH for 3p has also been described in 2 of 5 human SCC cell lines (SCC-12 and MET-1, but not SCC-13, SCL-I, or SCL-II) [
45]. In addition, LOH of chromosomal locus 3p25 is common in related head & neck SCCs (54%)[
46] and laryngeal SCC (60%) [
47]. Interestingly, LOH of 3p25 was not seen in any of 10 cases of non-malignant laryngeal squamous metaplasia [
47]. As we found that
PPARG expression was not reduced in sun-exposed skin, this supports the idea that loss of PPARγ expression and activity is a tumor-specific event. In contrast to
PPARG, LOH at chromosomal loci for the
PPARA gene (22q) or the
PPARD gene (6p) are infrequent (<5%) in cutaneous SCC [
43,
45,
48,
49].
Loss of function somatic missense mutations of
PPARG have also been described in cancer but are not particularly common [
50]. However, as UV is a potent mutagen and UV-induced tumors have the highest reported mutation burden of human cancers [
51], it is possible that somatic LOF mutations are more frequent in cutaneous SCC.
An additional potential mechanism for loss of PPARγ signaling in AK and SCCs includes alternative splice variants with dominant negative (dnPPARγ) activity. A number of dnPPARγ splice variants have been shown to be increased in cancer (γORF4 [
52], hPPARγ1
tr [
53], and PPARγΔ5 [
54]). In mice, both TNF and LPS suppress
Pparg expression and induce
PpargΔ5 splice variant expression, providing a mechanism for loss of PPARγ activity through alternative splicing [
33]. In the case of hPPARγ1
tr, the expression of this splice variant was identified in lung SCC but not adjacent normal tissue [
53]. Thus, upregulation of dnPPARγ variants specifically in tumors could also account for reduced PPARγ activity.
Reduced PPARG and PPARA expression have also been documented in some cancers through micro RNAs (miRNAs), long non-coding RNAs (lncRNAs) and promoter hypermethylation.
Using Targetscan 8.0 [
55,
56], 274 or 502 distinct miRNAs are predicted to target human
PPARG or mouse
Pparg respectively. While a role for miRNAs in suppressing
PPARG expression has not been adequately studied in NMSC, one study demonstrated that miR-27b, miR-130b and miR-138 are all upregulated in colon cancer and correlated negatively with
PPARG mRNA and protein expression [
57]. In addition, elevation of miR-374a/-128/-130b were seen in 7 cases of human cutaneous SCC relative to non-lesional skin [
58]. All three of these miRNAs are predicted to bind to the human PPARG 3’-UTR, although a role in regulating
PPARG expression was not addressed.
Like miRNAs, a number of lncRNAs have validated ability to alter PPAR expression [
59]. MALAT1 is a known lncRNA regulator of tumor development and is overexpressed in cutaneous SCC [
60,
61]. MALAT1 is also thought to target
PPARG [
59]. In competing endogenous RNA networks (ceRNA networks), sequence homology between lncRNAs and miRNAs competes for miRNA target binding to suppress the regulatory function of miRNAs. A study of human cutaneous SCCs examined correlations between 3221 differentially expressed transcripts and 24 differentially expressed lncRNAs (DElncRNA). By incorporating known miRNA targets of the lncRNAs, they were able to predict ceRNA networks that are operational in cutaneous SCC [
62]. Of the 24 DElncRNAs that were identified, five were predicted to target
PPARG (HCG18, LINC00342, HLA-F-AS1, SNX29P2, POLR214) [
62]. In addition, all 5 were down-regulated. Thus, loss of these lncRNAs could in turn promote miRNA-induced suppression of
PPARG expression. Consistent with this idea,
PPARG expression was decreased in their dataset (Log2FC of -0.91071; FDR 1.73E-07).
Another epigenetic mechanism for potential loss of
PPARG expression in skin cancer is promoter hypermethylation. Promoter hypermethylation of the
PPARG gene is strongly correlated with a lack of
PPARG expression in 30% of primary colorectal cancers as well as poor prognosis [
63]. However, it has yet to be determined whether promoter methylation and silencing of
PPARG gene expression occurs in NMSC.
Finally, recent studies indicate that PPARγ and NF-κB signaling have a complex and mutually antagonistic relationship. Studies in adipocytes, mesenchymal stem cells and macrophages show that stimulation with LPS or TNFα act to suppress overall
PPARG/Pparg transcript expression and target gene expression [
33]. Constitutive activation of NF-κB has been described as a common feature of malignancy due to activating mutations of NF-κB transcription factors themselves or upstream regulators [
64]. It is possible that loss of
PPARG exprersion or activity through any of these epigenetic or genetic mechanisms could result in a self-sustaining negative feedback cycle whereby the initial loss of PPARγ anti-inflammatory a ctivity results in increased inflammatory cytokine production that results in a further degradation of PPARγ signaling within the tumor cells themselves or surrounding stromal cells.
The decrease in PPARα expression suggests that this transcription factor may also play a tumor suppressor role, particularly in mouse SCC. Further studies are needed to clarify the degree to which PPARγ and PPARα activity are suppressed in NMSC and the mechanisms through which this occurs. It would therefore be of interest to determine the degree to which mice lacking epidermal Ppara exhibit transcriptomic changes that mirror those observed in AKs, SCCs, and Pparg-/-epi mice.
Given that PPARγ has an important anti-inflammatory role, it is not surprising that another key finding from our analysis is that inflammatory signaling and immune cell activation are a common feature of
Pparg-/-
epi mice, AKs and SCCs. This suggests that loss of PPARγ activity acts to promote neoplasia through its ability to induce stromal changes associated with tumorigenesis. This included a prominent accumulation of neutrophils and macrophage cells. It might be noted that mice expressing dominant negative
Pparg (dn
Pparg) in type II pulmonary alveolar cells stimulate the mobilization and recruitment of myeloid cells with MDSC activity [
65]. Given that
Pparg-/-
epi mice have a marked defect in CHS responses, it is tempting to speculate that the myeloid cell infiltrate that we observe exhibits MDSC activity. However, additional functional studies are needed to verify whether these myeloid cells represent MDSCs and contribute to the immune suppression seen in
Pparg-/-
epi mice.
An interesting feature of our analysis is the increase in
PPARD/Ppard during malignant progression. It is possible that whatever mechanism is involved in down-regulating PPARγ and PPARα expression fails to elicit downregulation of PPARδ. Alternatively, since PPAR isoforms have overlapping functions, particularly in cellular energy production [
66], the increase in
PPARD/Ppard may also serve a compensatory function to mitigate the changes that are caused by loss of the other isoforms in human and mouse tumors. The increase in PPARδ may also promote tumor angiogenesis and progression through its effects on endothelial cells [
67].
Another potential explanation for the increase in PPARδ transcripts in AKs and SCCs might be implied by our scRNAseq data from
Pparg-/-
epi mice. We found that
Ppard expression was increased in
Pparg-/-
epi mice, particularly in fibroblasts expressing myofibroblast markers. It has been reported that PPARδ mediates fibroblast differentiation to profibrotic myofibroblasts by inducing the expression of TGFβ, which in turn induces the expression of alpha smooth muscle actin [
68]. While the significance of this finding requires further studies, the presence of myofibroblasts is associated with chronic inflammation, fibrosis, wound healing [
69]. Myofibroblast markers are also associated with cancer associated fibroblasts (CAFs) [
70]. Thus, the observed increase in
PPARD/
Ppard expression in the tumor datasets may simply reflect an increase in myofibroblasts that are characteristic of the tumor stroma. Moreover, as PPARγ activation suppresses TGFβ expression and myofibroblast differentiation [
71], this may also indicate that PPARγ & PPARδ have opposing actions in myofibroblast differentiation and fibrosis.
A weakness of our studies is that our mouse model results in embryonic loss of Pparg. Thus, our studies done in adult mice would suffer from long-standing dermal inflammatory changes that would create a new normal homeostatic state. Thus, the proximal events that are first initiated by loss of epidermal PPARγ cannot be assessed. If loss of PPARG is a defining feature of NMSC tumor-stromal interactions, then it would be important to determine the nature of these early signals to identify potential interventional targets. While this would be difficult to do in our current Pparg-/-epi mice, these studies could be performed in floxed Pparg mice crossed with a tamoxifen-inducible Krt14-Cre transgene.
In conclusion, loss of PPARγ expression and activity is a top feature of both Pparg-/-epi mouse skin and AK and SCC transcriptomic datasets. A more modest reduction in PPARα expression and activity is also observed. Single cell analysis also reveals that Pparg-/-epi mouse skin exhibits immune cell infiltrates and myofibroblast differentiation that is indicative of a chronic inflammatory state. This non-biased genomic approach supports previous studies indicating that PPARγ is an important tumor suppressor in cutaneous carcinogenesis leading to actinic disease and squamous cell carcinoma. Specifically, loss of tumor cell-specific PPARγ activity may be necessary for the establishment of the stromal inflammatory microenvironment that is a hallmark of neoplastic disease in the skin.