2.1 Low expression of PTEN in tumors, their pathological stages and subtypes
Data extracted from the TCGA showed that PTEN expression was lower in 17 tumors (ACC BLCA, BRCA, COAD, DLBC, KICH, KIRP, LUAD, LUSC OV, PRAD, SKCM, TGCT, THCA, THCA, THYM, UCEC UCS) compared with matched TCGA normal tissue and GTEx data (Fig. 1b). Then, we assessed the expression of PTEN in normal tissue by using RNA-sequencing data available from GTEx data. In particicular, we compared expression levels of PTEN between tumors with respect to normal matches, and GTEx data. We found that in terms of its expression in normal tissues, PTEN showed lower levels in these 17 cancers, and the differences between these cancers and normal samples were shown in boxplot form in Supplementary Figure S1.
Next, we evaluated PTEN expression levels with respect to tumor molecular and histological subtypes of tumors, tumor grades, and other patient conditions based on data obtained from UALCAN.
In urologic cancer, we found that the expression of the histological subtypes of BLCA was decreased in both papilloma and non-papilloma compared with normal people (Table 1 and Figure S2 Panel 1A). Regarding its molecular subtypes, the PTEN expression level in neuronal, basal squanous, luminal and luminal_papillary decreased significantly compared to normal (Table 1 and Figure S2 panel 1B). While luminal and luminal_papillary decreased most significantly, followed by neuronal and basal squamous. In KIRP tumors, the expression of PTEN was significantly decreased in both Type1 PRCC and Type2 PRCC (Table 1 and Figure S2 panel 1D), and the decrease was more significant in Type2 PRCC. In PRAD tumors, the expression of PTEN was decreased in Gleason score 9, Gleason score 6, Gleason score 7 and Gleason score 8. In their molecular subtypes, the expression of PTEN was also decreased significantly in ERG fusion, ETV1 fusion, FOXA1 mutation and SPOP mutation (Table 1 and Figure S2 Panel 1E).
Compared to normal tissue in BRCA tumors, the expression of PTEN was lower in all different molecular subtypes, including triple negative breast cancer (TNBC), HER2-amplification and luminal subtype. (Table 1 and Figure S2 Panel 2D). In terms of TNBC type in BRCA, the statistically significant changes were seen in TNBC-mesenchymal (TNBC-M), followed by TNbC-UNS, TNBC-immunomodulatory (TNBC-IM), TNbC-basal like2 (BL2) and TNBC-basal like1(BL1). (Table 1 and Figure S2 Panel 2A). PTEN expression level was decreased in pre-menopausal, peri-menopausal, and post-menopausal patients having BRCA compared with normal. However, only the difference between pre-menopausal and post-menopausal was statistically significant (Table 1 and Figure S2 Panel 2C). In addition, the expression of PTEN in BRCA was low in all histologic subtypes, most notably in invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) (Table 1 and Figure S2 Panel 2B). The expression of amplied MYC proto-oncogene (MYC), cyclin D1 (CnD1) and ERB-B2 receptor tyrosine kinase 2 (ERBB2) in metastatic breast cancer compared to conditions without amplification indicated no significand correlation with PTEN expression (Table 1 and Figure S2 panel 2E).
About digestive system tumors, COAD tumor showed increased PTEN levels in adenocarcinoma and mucinous-adenocarcinoma (Table 1 and Figure S2 panel 3A). In PAAD tumor, the reduction of PTEN expression level was statistically significant in non-drinkers and daily drinkers (Table 1 and Figure S2 panel 3E). In addition, compared with normal people, in patients with acute pancreatitis, their PTEN level decreased more significantly than patients with acute pancreatitis, but the comparison between them and patients without pancreatitis was not statistically significant (Table 1 and Figure S2 panel 3C). The reduction of PTEN in patients with diabetes was also more significant than that in normal patients (Table 1 and Figure S2 Panel 3B). In terms of tumor grade, PTEN reduction was more significant in Grade 2 and Grade 3 than in normal subjects (Table 1 and Figure S2 Panel 3D).
Regarding the expression of PTEN in LUSC tumors, we found that for LUSC patients based on smoking habits, the PTEN expression of all cancer types was decreased compared with normal people, and was more significant in smoker, reformed smoker1 and reformed smoker2 (Table 1 and Figure S2 Panel 4A). The reduction of PTEN was more obvious in LUSC NOS in terms of the histological subtypes of LUSC, followed by Lusc Mixed, Lusc SolidPatternPredominant and LUSC papillary (Table 1 and Figure S2 panel 4B).
For THYM tumor, the expression level of PTEN in THYM Type A, THYM Type B2|B3, THYM Type C, THYM Type AB and THYM Type B3 was all significantly reduced (Table 1 and Figure S2 panel 5A). In THCA tumor, the decrease of PTEN expression was most obvious in THCA Classical based on the histological subtype of THCA, followed by THCA tall and THCA follicular (Table 1 and Figure S2 panel 5B). For UCEC tumors, the expression level of PTEN decreased in UCEC endometrioid, UCEC serous and UCEC Mixed serous and endometrioid, which was statistically significant. Among them, the most significantly decrease was occurred in UCEC endometrioid. Based on the menopausal stage of UCEC patients, the expression of PTEN was significantly decreased in pre-menopausal, peri-menopausal and post-menopausal patients, which was most significant in post-menopausal patients, followed by peri-menopausal and pre-menopausal patients. However, there was no significant difference in the expression level of PTEN among pre-menopausal, peri-menopausal and post-menopausal patients.
Next, we investigated PTEN expression based on patients' pathological stage in TCGA cancer types. We found that the expression level of PTEN in BRCA, COAD, KICH, KIRP, LUAD, LUSC, THCA and UCEC was significantly lower at the early stage (Fig. 1c, p<0.05), suggesting that PTEN may be involved in the onset of cancers. In addition, compared with the early stage, the expression level of PTEN in BLCA and TGCT was lower at advanced cancer, suggesting that PTEN may play a role in cancer progression and cancer invasion (Fig. 1c, cancer without and/or small numbers of normal matches (when there is only one sample in each stage) were excluded from this analysis).
2.2 Genetic variation analysis of PTEN
We observed the genetic alteration condition of PTEN in different tumors of TCGA. As shown in Fig.2a, Endometrial cancer (in which mutation is the main change type) showed the highest mutation frequency (> 60%). The frequency of PTEN changes in prostate cancer was about 20% and deep deletion was the main type of PTEN changes. It is worth noting that in these cancers, there are almost no Fusion and Multiple Alterations among the types of PTEN gene alterations.
Fig.2b shows the type, location and the number of cases of PTEN gene change. In the 1203 group of mutation cases (including samples of single patient with double mutations), we found that the truncation mutation of PTEN was the main type of genetic changes(563 cases), followed by missense mutation (516 cases) while the number of cases with inframe mutation and fusion mutation was relatively small. In addition, the R130q /G/*/L/P/ QFS *4 mutation in DSPc domain can induce the development of a variety of cancers (uterine cancers account for the vast majority).
2.3 Role of PTEN low expression in cancer prognosis
In the Kaplan-Meier Plotter database, we compared the OS time between tumor patients with high PTEN expression level and tumor patients with low PTEN expression level, and the data showed that patients with low PTEN expression levels had a shorter OS time and worse prognosis compared with patients having high PTEN expression levels in the following cancers: KIRC, LUAD, Gastric Cancer, Liver Cancer, Lung Cancer, Breast Cancer, THYM and UCEC (Fig. 3a).
About RFS time, compared with the high PTEN expression level of the following tumor patients, the low expression level of PTEN in these tumor patients can lead to a worse prognosis (Fig. 3b). These tumors are: Liver Cancer, TGCT, UCEC, LIHC, LUAD and THCA.
In summary, the data proved that in the tumors mentioned above, lower-expressed PTEN level can lead to a worse clinical consequense.
2.4 Correlation between gene expression of PTEN and other genes in cancer
Our research showed that the expression of PTEN has a moderate to strong positive correlation with these genes in 17 cancers (Supplementary Table S1, which provides all information on coefficient correlations and p-value, using different colors to distinguish correlations as follows: Strong positive correlation in green; medium positive correlation in black; weak positive correlation in red; very weak correlation in violet and almost no correlation is indicated in light blue). As seen in Supplementary Table S1 and Table 2. Among 12 or more cancers, the following genes have a strong positive correlation with PTEN expression (R between 0.5 and 1, p-value<0.05): phosphatase and tensin homolog pseudogene 1 (PTENP1), ATPase family AAA domain containing 1 (ATAD1), wings apart-like homolog (WAPAL), tankyrase 2 (TNKS2), membrane-associated ring finger 5 (MARCH5), coiled-coil serine rich protein 2 (CCSER2), component of inhibitor of nuclear factor kappa B kinase complex (CHUK) and eukaryotic translation initiation factor 3 subunit A (EIF3A). In addition, the following genes showed a strong positive correlation with PTEN among 10 to 12 cancer types: hypoxia inducible factor 1 subunit alpha inhibitor (HIF1AN), survival motor neuron domain containing 1 (SMNDC), chromosome 10 open reading frame (C10orf12), Sp3 transcription factor (SP3), chondroitin sulfate N-acetylgalactosaminyltransferase 2 (CSGALNACT2), structural maintenance of chromosomes 3 (SMC3), NOC3 like DNA replication regulator (NOC3L), family with sequence similarity 35 member A (FAM35A), STE20 like kinase (SLK) and golgi brefeldin A resistant guanine nucleotide exchange factor 1 (GBF1). In addition, some genes showed strong positive associations with PTEN in several cancers among 17 studied cancers as indicated in the Table S1 and Table 2. For the UCEC cancer mentioned in Table S1 (shown in light blue) and Table 2, the expression of PTEN in this cancer has almost no correlation with the following genes (R<0.1) : DEAD-box helicase 46(DDX46), family with sequence similarity 160, member B1(FAM160B1), ubiquitin specific peptidase 37(USP37), nuclear receptor binding SET domain protein 1(NSD1), RIC1 homolog, RAB6A GEF complex partner 1(RIC1), golgi brefeldin A resistant guanine nucleotide exchange factor 1(GBF1), ubiquitin specific peptidase 9 X-linked(USP9X), RP11-244H3.4 and atlastin GTPase 3(ATL3).
In addition, we searched for genes with protein products that have transcription factor binding sites in the PTEN promoter region. Intersection analysis of these genes and the PTEN-related genes obtained from the GEPIA database is performed by using Venn diagram, which led to the discovery of YY1 transcription factor (YY1), and we found that among the 17 cancers we studied, YY1 has a strong positive correlation with DLBC, KIRP, THCA, THYM, ACC, KICH and BRCA (ranked from high to low).
It can be seen from Table S1 that the genes most closely correlated to PTEN are phosphatase and tensin homolog pseudogene 1 (PTENP1), tankyrase 2 (TNKS2), membrane-associated ring finger 5 (MARCH5), ATPase family AAA domain containing 1 (ATAD1), wings apart-like homolog (WAPAL), coiled-coil serine rich protein 2 (CCSER2), component of inhibitor of nuclear factor kappa B kinase complex (CHUK) and eukaryotic translation initiation factor 3 subunit A (EIF3A). It is worth noting that PTENP1 has a strong positive correlation with PTEN in all 17 cancers. In UCEC tumor, we observed that TNKS2, MARCH5, ATAD1 and CHUK all had a weak positive correlation with PTEN (0.2<R<0.4). Besides, WAPAL, CCSER2 and EIF3A had a very weak correlation with PTEN (0.1< R<0.2). In addition, we found that MARCH5, CHUK and EIF3A all had a weak correlation in LUSC tumor. In UCS tumor, WAPAL and CHUK had a weak correlation with EIF3A. In THYM tumor, ATAD1 had a weak correlation (Table S1 and Table 2). The above data was shown in Table 2. Notably, among the genes positively correlated with PTEN, some genes can be considered as targets for several types of cancers. Such as: The lncRNA of phosphatase and tensin homolog pseudogene 1 (PTENP1) can inhibit the progression of cervical cancer by inhibiting mir-106b[12]. In addition, studies have pointed out that the overexpression of lncRNA PTENP1 has been observed in vitro to successfully inhibit the proliferation and metastasis of glioma cells[13]. In gastric cancer, PTENP1 can inhibit the progression of gastric cancer by regulating the expression of PTEN protein[14]. In bladder cancer[15], breast cancer[16] and clear-cell renal cell carcinoma[17], PTENP1 also has a tumor suppressor effect. cAMP responsive element binding protein 1 (CREB1) can be used as a potential target for the treatment of hepatocellular carcinoma[18], colorectal cancer[19], gastric cancer[20] and bladder cancer[21]. Polybromo 1 (PBRM1) has clinical application value in kidney cancer[22], breast cancer[23] and cholangiocarcinoma[24]. Heterogeneous nuclear ribonucleoprotein K (HNRNPK) can be used as a potential therapeutic target for gastric cancer[25]. F-box and WD repeat domain containing 2 (FBXW2) can be used as a tumor suppressor in lung cancer to inhibit the growth of cancer cells[26]. Mutations in APC regulator of WNT signaling pathway (APC) can promote the occurrence and development of colorectal cancer[27] and bladder cancer[28]. The genes mentioned above show obvious low expression in some cancers, have abnormal expression in different pathological cancer stages and poor OS prognosis is occurred in several cancers. (Table 3 and Supplementary Figure S4).
2.5 PTEN Protein Network
We analyzed some genes, including genes that have strongly positive correlation with PTEN, genes that are closely related to PTEN and positively correlated with PTEN found in the STRING database (Analysis using Venn diagram, Fig. 4a) (Table 2 and Supplementary Table S1), and genes which have protein products that have transcription factor binding sites on the promoter regions of PTEN. Data from the STRING database showed that these proteins are in the same protein network (Fig. 4b, Some genes that have strongly positive correlation with PTEN, some genes that are closely related to PTEN, and genes that expresse PTEN transcription factor binding site proteins are shown). The proteins in this network participated in different pathways, including human papillomavirus infection, pathways in cancer, sphingolipid signaling pathway, hepatitis B, shigellosis, HTLV-1 infection, prostate cancer, TNF signaling pathway, insulin resistance, Fox0 signaling pathway, ubiquitin mediated proteolysis, osteoclast differetiation, dopaminergic synapse, PI3K-Akt signaling pathway, Cushing’s syndrome, MicroRNAs in cancer, Breast cancer, hepatocellular carcinoma and so on (Table 4 and Supplementary Table S2). All the pathways that PTEN is mainly involved in were indicated in red (Supplementary Table S2). The protein (YY1) with transcription factor binding site in the promoter region of PTEN also participated in the PTEN protein network. As shown in Supplementary Table S2, this protein was also involved in most pathways with the participation of PTEN (Supplementary Table S2). In addition, we used the RNAup webserver to analyze the RNA-RNA interaction and RNA-protein interaction between YY1 and PTEN (Fig. 4c and Fig. 4d).
2.6 Analysis of PTEN Structural Features
We analyzed the basic structure of PTEN (NM_000314.8 for mRNA and NP_000305.3 for protein) (Fig. 5a), and we analyzed the conserved domains of PTEN among different species. As shown in Fig. 5b, PTEN has conserved protein structures in different species (eg. H.sapiens, P.troglodytes, M.mulatta, C.lupus, etc) and all of these contain the PTEN_C2 domain (Fig. 5b).