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Therapeutic implications of peroxisome proliferator-activated receptors in non-small cell lung cancer
Li Nie1, Xinliang Zou2,3,4, Huaxi Liu5
1School of Medicine, Chongqing University, Chongqing, 400030, China.
Abstract:
Lung cancer remains the leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for approximately 80-85% of cases. Despite therapeutic advances, drug resistance and suboptimal outcomes persist, underscoring the need for novel molecular targets. Peroxisome proliferator-activated receptors (PPARα, PPARβ/δ, PPARγ) are ligand-activated transcription factors that regulate lipid metabolism and inflammation. Their expression is dysregulated in NSCLC, but functional studies have yielded conflicting results: all three isoforms can exert either tumor-suppressive or tumor-promoting effects depending on cellular context, metabolic state, and genetic background. This context-dependent duality has created uncertainty in the field, even as the intersection of metabolism and anti-tumor immunity becomes increasingly recognized as a driver of NSCLC progression. PPARs sit at this intersection, integrating metabolic, inflammatory, and immune signals, which has renewed interest in their therapeutic potential. Clinically available PPAR agonists (e.g., fibrates, thiazolidinediones) are being investigated in exploratory combinations with immune checkpoint or targeted therapies, though their success may depend on biomarker-guided patient selection. This review critically discusses the isoform-specific functions and molecular mechanisms of PPARs in NSCLC, summarizes preclinical and clinical advances in PPAR-targeted strategies for prevention and treatment, and highlights key translational gaps. We aim to provide a conceptual framework for developing precision therapies that account for the context-dependent nature of PPAR signaling.
Insights
Peroxisome proliferator-activated receptors (PPARs) show dual roles in non-small cell lung cancer (NSCLC), acting as either tumor suppressors or promoters. Understanding their context-dependent functions is key for developing targeted NSCLC therapies.
Area of Science:
- Oncology
- Molecular Biology
- Metabolism
Background:
- Non-small cell lung cancer (NSCLC) is a leading cause of cancer mortality, with persistent challenges in drug resistance and treatment outcomes.
- Peroxisome proliferator-activated receptors (PPARs), including PPARα, PPARβ/δ, and PPARγ, are transcription factors regulating lipid metabolism and inflammation, with dysregulated expression in NSCLC.
- The dual role of PPAR isoforms in NSCLC (tumor-suppressive vs. tumor-promoting) creates complexity, influenced by cellular context, metabolic state, and genetic background.
Purpose of the Study:
- To critically review the isoform-specific functions and molecular mechanisms of PPARs in NSCLC.
- To summarize preclinical and clinical advances in PPAR-targeted strategies for NSCLC prevention and treatment.
- To provide a framework for developing precision therapies that address the context-dependent nature of PPAR signaling in NSCLC.
Main Methods:
- Literature review of preclinical and clinical studies on PPARs in NSCLC.
- Analysis of molecular mechanisms underlying PPAR isoform functions in different NSCLC contexts.
- Evaluation of current and emerging PPAR-targeted therapeutic strategies, including combinations with immunotherapy.
Main Results:
- PPARs integrate metabolic, inflammatory, and immune signals, highlighting their role at the intersection of metabolism and anti-tumor immunity in NSCLC.
- Conflicting evidence exists regarding PPAR isoform functions, with all three potentially exerting tumor-suppressive or tumor-promoting effects.
- Clinically available PPAR agonists are under investigation in combination therapies, emphasizing the need for biomarker-guided patient selection.
Conclusions:
- The context-dependent duality of PPAR signaling in NSCLC necessitates a nuanced approach for therapeutic development.
- Understanding PPAR isoform-specific functions and mechanisms is crucial for advancing precision medicine in NSCLC.
- Further research is needed to bridge translational gaps and optimize PPAR-targeted strategies for NSCLC treatment and prevention.
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