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Peroxisome Proliferator-activated Receptor Modulators As Potential Chemopreventive Agents
National Cancer Institute, Division of Cancer Prevention, Bethesda, Maryland 20892-7322 [L. K., J. R. F., J. A. C.] Department of Pharmacology, Georgetown University School of Medicine, Washington, D.C. 20057 [R. I. G.]
| Abstract |
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and PPAR
, and inhibition of PPAR
, may prevent cancer. PPAR
agonists induce differentiation, inhibit the growth of established tumor cells in vitro and in vivo, and have chemopreventive effects in animal models. PPAR
has anti-inflammatory and differentiating activity and protects against the oxidative damage associated with aging. In contrast, PPAR
expression may be a factor in colorectal carcinogenesis. PPAR
is normally repressed by the adenomatous polyposis coli tumor suppressor gene, and impaired adenomatous polyposis coli is strongly associated with human colorectal cancer risk. This review presents a rationale for using PPAR modulators as cancer chemopreventive drugs. | Introduction |
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,
, and
), each exhibiting distinct patterns of tissue distribution and ligand specificity. PPAR
regulates numerous aspects of fatty acid catabolism, whereas PPAR
controls adipocyte differentiation, systemic glucose levels, and lipid homeostasis (reviewed in Refs. 1 and 2). PPAR
is involved in development, embryo implantation, myelination of the corpus callosum, lipid metabolism, and epidermal cell proliferation (3, 4). Significant species differences in response to PPAR
, but not PPAR
, have been noted. Specifically relevant to cancer, PPAR
agonists increase peroxisomes and induce hepatomegaly and liver cancer in rodents. However, humans are refractory to the hepatotoxic actions of these drugs (reviewed in Ref. 5). In the following sections, evidence is presented for each PPAR class and the specific PPAR agonists that may play a role in cancer chemoprevention.
PPAR and Cancer
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stimulates adipose differentiation in cultured mouse fibroblasts generated interest in the receptors potential anticancer effects (6). Subsequent studies showed that activation of the receptor inhibits proliferation, and in some cases induces differentiation and/or apoptosis, in a variety of tumor cell lines (Table 1). Some of the most extensive work has been conducted in the colon, where PPAR
is expressed at high levels in normal tissue (7), and in both well- and poorly differentiated colon cancers (8). PPAR
-selective ligands inhibit proliferation and induce differentiation in colon cancer cell lines (8, 9) and diminish growth of human colon tumor xenografts (Ref. 8; Table 2). Importantly, for the purposes of chemoprevention, these ligands prevent the development of carcinogen-induced preneoplastic aberrant crypt foci in rats (10). Loss-of-function somatic mutations in the PPAR
gene are found in sporadic human colon cancers, suggesting that PPAR
may function directly as a tumor suppressor (11). PPAR
agonists also suppress macrophage activation and inflammatory cytokine production in vitro (12, 13) and reduce inflammation (10, 14) and neoplastic lesion development (10) in rodent models of inflammatory bowel disease. The latter finding is particularly relevant to chemoprevention, because the risk of colorectal cancer is increased in patients with this disease (reviewed in Ref. 15).
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activation promotes colon cancer in mice carrying a nonsense mutation in the APC tumor suppressor gene; defective APC is highly associated with human colorectal cancer risk (16). The TZDs troglitazone and rosiglitazone enhance colon tumorigenicity in these genetically predisposed mice; the more potent PPAR
agonist rosiglitazone induces more malignant tumors. However, pharmacological doses of troglitazone are not tumorigenic in wild-type mice, suggesting that increased risk is limited to animals harboring a mutant APC gene (17, 18).
Data available from other target sites suggest that PPAR
activation has chemopreventive potential. The receptor is expressed in human breast cancer cell lines and breast adenocarcinomas, and TZDs inhibit growth of breast cancer cells in vitro and in vivo, inducing differentiation in some cases (19, 20). However, cell lines expressing the highest levels of PPAR
are relatively unresponsive to TZD treatment. Adding a mitogen-activated protein kinase inhibitor overcomes this insensitivity, suggesting that phosphorylation prevents PPAR
activation (19).
The relevance of PPAR
activation for chemoprevention has been demonstrated in rodent mammary cancer models. The highly potent and specific PPAR
ligand GW 7845 significantly reduces tumor incidence, number, and weight in estrogen receptor-positive mammary tumors when fed to rats after carcinogen administration. Additive effects are observed on coadministration with suboptimal doses of the antiestrogen tamoxifen (21). Likewise, troglitazone prevents development of carcinogen-induced early neoplastic lesions in mouse mammary gland organ culture when administered during initiation or promotion stages. Synergism was noted with RXR-selective ligands (22), although similar effects were not observed in human breast cancer cell lines induced to differentiate in response to PPAR
activation (19). PPAR
ligands also diminish expression of aromatase (23), the rate-limiting enzyme in estrogen biosynthesis, which may contribute to chemopreventive effects in estrogen-responsive tissues.
In the prostate, PPAR
is expressed in primary cancers and cell lines, and receptor agonists display antiproliferative effects in vitro (2426) and in xenografts in nude mice (24); effects in vivo are associated with necrotic, as well as apoptotic changes (24). Additionally, a subset of human prostate tumors carry hemizygous deletions of the PPAR
gene (25). In preliminary clinical studies, 20% (8 of 41) of prostate cancer patients treated with troglitazone showed decreased serum prostate-specific antigen levels, and 39% showed prolonged stabilization (25). Consistent with these findings, troglitazone decreases prostate-specific antigen levels in prostate cancer cell lines (24, 25). The actions of PPAR
ligands in the prostate may be associated with decreased activation of the androgen receptor (27) or a reduction in circulating estrogens (reviewed in Ref. 28), secondary to reduced aromatase expression (23).
PPAR
ligands also inhibit proliferation of human lung, urinary bladder, pancreatic, neuroblastoma, gastric, and liposarcoma cell lines (Table 1) and induce differentiation and inhibit growth of liposarcomas in patients (29). The activated form of matrix metalloproteinase-2, strongly associated with tumor growth, metastasis, and angiogenesis (30), markedly decreases in lung cancer cells treated with PPAR
agonists (31). Furthermore, PPAR
activators are direct inhibitors of angiogenesis both in vitro and in vivo (32, 33). A role for PPAR
in thyroid follicular carcinoma is suggested by the presence in these tumors of a PAX8-PPAR
1 fusion oncoprotein, which functions as a dominant negative suppressor of wild-type PPAR
(34).
Recent investigations have provided clues about the signaling pathways used by PPAR
agonists to suppress neoplasia. Inhibition of tumor cell growth has been associated with G1 cell cycle arrest (9, 35, 36), which in some cases is linked to loss of DNA binding activity of the transcriptional regulator E2F/DP (37). Other mechanisms that may be involved include upregulation of the cyclin-dependent kinase inhibitors p18 INK4c and p21 Waf1/Cip1 and reduced expression of cyclin D1 (31, 3840). Recent studies showed that the antiproliferative and anti-inflammatory activities of PPAR
ligands are mechanistically distinct. PPAR
-dependent antiproliferative effects involve repression of cyclin D1 via sequestration of p300 and interference with c-fos-directed transcription. Anti-inflammatory effects, independent of this receptor, are mediated via inhibition of the intracellular kinase intracellular
B kinase, involved in nuclear factor
B activation (40). Additionally, PPAR
agonists up-regulate the phosphatase and tension homologue (PTEN) tumor suppressor, suggesting that phosphoinositide signaling pathways are also associated with PPAR
-mediated growth suppression (41).
PPAR and Cancer
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activation and epidermal differentiation. Fibrates, which are PPAR
ligands, induce differentiation and inhibit proliferation of human keratinocytes in vitro (42), and in normal (43) and hyperproliferating (44) mouse skin in vivo, but are inactive in PPAR
-deficient mice (43). Farnesol also stimulates PPAR
-dependent differentiation in epidermal keratinocytes (45). Topical PPAR
agonists have weak preventive effects on tumor promotion in mouse skin, despite up-regulation of PPAR
in untreated tumors compared with normal epidermis (46). In this regard, PPAR
expression is also up-regulated in human prostate adenocarcinomas (47). The significance of this observation is as of yet unknown.
Some anticancer actions of phenylacetate may be mediated by PPAR
activation. The relative potencies of phenylacetate and its analogues as PPAR
activators correlate strongly to their growth inhibitory effects in human cancer cell lines (48). Phenylacetate also activates PPAR
(49), making it difficult to ascribe growth-inhibitory effects specifically to activation of the
isoform. It is important to note that PPAR
ligands are inactive in tumor cell lines in which PPAR
ligands are effective antiproliferative agents (8, 9, 25); however, the status of PPAR
expression in these tumor cell lines is unknown.
In rodents, PPAR
activation has been associated with both anti- (50, 51) and proinflammatory (52) actions. Opposing effects have also been described in humans. PPAR
agonists diminish expression of inflammatory markers in human cells and patients treated with fibrates (53, 54). In contrast, expression of the inflammatory mediator COX-2 in human breast and colon cancer cells is up-regulated by PPAR
agonists (55). The latter finding is particularly troublesome, given that increased COX-2 expression has been specifically linked to enhanced colon cancer risk (reviewed in Ref. 28).
Other possible connections between PPAR
and cancer prevention come from the inverse association of PPAR
activation with decreased oxidative stress and aging, both linked with tumorigenesis (reviewed in Ref. 56). PPAR
agonists administered to aged PPAR
-replete, but not aged PPAR
-null mice, decreased tissue levels of lipid peroxides and the oxidant-stress-activated transcription factor nuclear factor
B (51). Additionally, reduced expression of PPAR
and peroxisome-associated genes is observed in aged mice; PPAR
agonists restore expression to levels seen in young animals (57).
PPAR and Cancer
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and
isoforms, activation of PPAR
is associated positively with tumorigenesis. PPAR
transcription is normally suppressed by wild-type APC but is up-regulated in colorectal cancer cells, which have an inactivating APC mutation through enhanced ß-catenin/Tcf-4 binding to TCF-4-responsive elements in the PPAR
promoter (58). Xenografts of PPAR
-null colon cancer cell lines display decreased tumorigenicity in nude mice (59). Consistent with these findings, PPAR
is overexpressed in human and rodent colorectal tumors, as well as preneoplastic colonic mucosa (58, 60, 61). Although initial experiments suggested that nonsteroidal anti-inflammatory drug-induced apoptosis is mediated in part by PPAR
inhibition (58), this was not confirmed in additional studies (59). However, additional experiments in PPAR
-null mice indicate that nonsteroidal anti-inflammatory drug-mediated anti-inflammatory response, which may also be chemopreventive, is at least partially dependent on PPAR
(3). | PPAR Modulators |
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and PPAR
, and antagonists of PPAR
, may find utility as chemopreventive agents. Although no selective PPAR
inhibitors have been identified, a number of agonists for these isoforms has been described. Selective PPAR
agonists include classic TZDs (troglitazone, rosiglitazone, pioglitazone, and ciglitizone; Refs. 62 and 63) and non-TZD-type agonists. Representatives of the latter include N-(2-benzoylphenyl)-L-tyrosine derivatives, such as GW 1929, GI 262570, and GW 7845, which are among the most potent and selective PPAR
agonists identified to date (64, 65). GW 0207, a 2,3-disubstituted indole-5-carboxylic acid, is also a potent and selective PPAR
agonist (66).
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agonists used to treat hyperlipidemia (2). Newer PPAR
agonists, such as the ureidofibrate GW 9578, are significantly more potent (67) and can be used to study the effects of PPAR
in neoplasia. If both PPAR
and PPAR
are involved in tumorigenesis, dual receptor agonists, such as the TZD KRP-297 (68) and the related isoxazolidinedione derivative JTT-501 (69), may also find utility as chemopreventive agents.
The following compounds can act as partial PPAR
agonists/antagonists. Although TZD MCC-555 is a low-affinity PPAR
ligand, it is an effective PPAR
activator in animals (70). L-764406, a sulfonyl quinoxaline derivative, is a potent and specific PPAR
ligand and partial agonist that covalently modifies the receptor (71). The thiazolidine acetamide GW 0072 is a high-affinity PPAR
ligand and weak partial transcriptional activator of the receptor; it is also a potent inhibitor of rosiglitazone-induced adipocyte differentiation (72).
These partial agonists/antagonists display unique biological properties that may translate to distinct therapeutic and/or toxicological profiles, similar to selective estrogen receptor modulators (partial estrogen receptor agonists/antagonists; reviewed in Ref. 28). This is significant, because the selective PPAR
agonist troglitazone can have rare but serious hepatotoxic consequences (73). Moreover, it is possible that the cancer-promoting effects of PPAR
ligands, as observed in animals predisposed to colon cancer, can be mitigated using partial agonists.
| Conclusions |
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| Footnotes |
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2 The abbreviations used are: PPAR, peroxisome proliferator-activated receptor; AOM, azoxymethane; APC, adenomatous polyposis coli; COX, cyclooxygenase; RXR, retinoic X receptor; TZD, thiazolidinedione. ![]()
Received 11/26/01; revised 1/24/02; accepted 1/24/02.
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A. I. Neugut, B. Lebwohl, and D. L. Hershman Cancer Chemoprevention: How Do We Know What Works? J. Clin. Oncol., April 20, 2007; 25(12): 1461 - 1462. [Full Text] [PDF] |
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L. Xu, C. Han, K. Lim, and T. Wu Cross-talk between Peroxisome Proliferator-Activated Receptor {delta} and Cytosolic Phospholipase A2{alpha}/Cyclooxygenase-2/Prostaglandin E2 Signaling Pathways in Human Hepatocellular Carcinoma Cells Cancer Res., December 15, 2006; 66(24): 11859 - 11868. [Abstract] [Full Text] [PDF] |
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L. Xu, C. Han, and T. Wu A Novel Positive Feedback Loop between Peroxisome Proliferator-activated Receptor-{delta} and Prostaglandin E2 Signaling Pathways for Human Cholangiocarcinoma Cell Growth J. Biol. Chem., November 10, 2006; 281(45): 33982 - 33996. [Abstract] [Full Text] [PDF] |
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J-R Weng, C-Y Chen, J J Pinzone, M D Ringel, and C-S Chen Beyond peroxisome proliferator-activated receptor {gamma} signaling: the multi-facets of the antitumor effect of thiazolidinediones. Endocr. Relat. Cancer, June 1, 2006; 13(2): 401 - 413. [Abstract] [Full Text] [PDF] |
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K. Yamaguchi, S.-H. Lee, T. E. Eling, and S. J. Baek A novel peroxisome proliferator-activated receptor {gamma} ligand, MCC-555, induces apoptosis via posttranscriptional regulation of NAG-1 in colorectal cancer cells Mol. Cancer Ther., May 1, 2006; 5(5): 1352 - 1361. [Abstract] [Full Text] [PDF] |
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Y. Yin, H. Yuan, C. Wang, N. Pattabiraman, M. Rao, R. G. Pestell, and R. I. Glazer 3-Phosphoinositide-Dependent Protein Kinase-1 Activates the Peroxisome Proliferator-Activated Receptor-{gamma} and Promotes Adipocyte Differentiation Mol. Endocrinol., February 1, 2006; 20(2): 268 - 278. [Abstract] [Full Text] [PDF] |
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J. Lu, K. Imamura, S. Nomura, K.-i. Mafune, A. Nakajima, T. Kadowaki, N. Kubota, Y. Terauchi, G. Ishii, A. Ochiai, et al. Chemopreventive Effect of Peroxisome Proliferator-Activated Receptor {gamma} on Gastric Carcinogenesis in Mice Cancer Res., June 1, 2005; 65(11): 4769 - 4774. [Abstract] [Full Text] [PDF] |
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Y. Yin, R. G. Russell, L. E. Dettin, R. Bai, Z.-L. Wei, A. P. Kozikowski, L. Kopleovich, and R. I. Glazer Peroxisome Proliferator-Activated Receptor {delta} and {gamma} Agonists Differentially Alter Tumor Differentiation and Progression during Mammary Carcinogenesis Cancer Res., May 1, 2005; 65(9): 3950 - 3957. [Abstract] [Full Text] [PDF] |
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