Introduction
Breast cancer (BC) has exceeded lung cancer to become the most common cancer in women worldwide [
1]. Male BC is becoming more common worldwide, despite its rarity [
2]. Genetics is the most important risk factor for BC [
3]. Despite various treatments including immunotherapy, targeted therapy, chemotherapy, radiation therapy, and surgery, BC patients are prone to developing drug resistance [
3]. Since BC is a heterogeneous disease with different molecular subtypes and biological characteristics, treatment should be tailored to each patient based on molecular features [
4]. Therefore, innovating reliable and effective prognostic biomarkers is urgently needed in order to identify different subgroups of BC patients and instruct precise and personalized treatment.
One of the significant hallmarks of cancer is Metabolic reprogramming. Recently, Liu et al. [
5] revealed disulfidptosis, a metabolism-related form of regulated cell death (RCD). Differing from conventional forms of programmed cell death such as apoptosis, ferroptosis, and necroptosis, disulfidptosis is a novel form of programmed cell death triggered by disulfide stress. It is featured by the collapse of cellular cytoskeleton proteins and F-actin due to the intracellular accumulation of disulfide bonds [
6]. Liu et al. [
5] also identified four genes as promoters of disulfidptosis: solute carrier family 7 member 11 (SLC7A11), solute carrier family 3 member 2 (SLC3A2), recombinant ribophorin 1 (RPN1), and NCK-associated protein 1 (NCKAP1),. Among these four genes, SLC7A11 has received a lot of attention. When glucose is limited, tumor cells overexpressing SLC7A11 rapidly deplete NADPH and accumulate disulfides abnormally, inducing disulfidptosis [
6]. Inducing cell death is well-known to be a potential therapeutic approach for cancer treatment. Understanding the mechanisms of cell death and their application in the treatment of cancer patients is therefore of great significance. Several studies have demonstrated the significant role of disulfidptosis in the prognosis and immune response of various cancers, including bladder cancer [
7], renal cell carcinoma [
8], lung adenocarcinoma [
9], and cervical cancer [
10]. However, limited research has been conducted on the impact mechanism of disulfidptosis on the prognostic survival and immune infiltration features of BC.
In this study, we intended to identify different subtypes of BC based on disulfidptosis-related genes (DRGs) and analyze the characteristics of disulfidptosis-related BC subtypes from the perspectives of tumor mutation, immune infiltration, immunotherapy response prediction, and targeted small molecule prediction. Through enrichment analyses, we analyzed the biological functions of differentially expressed genes (DEGs) related to disulfidptosis-related BC subtypes. Our findings provide valuable insights for future investigations of disulfidptosis in BC.
Discussion
Disulfide compounds are important for maintaining protein stability, and disulfidptosis is a type of cell death in tumor cells [
6]. There are four genes related to disulfidptosis, including SLC7A11, SLC3A2, RPN1, and NCKAP1
15. SLC7A11 and SLC3A2 are subunits of the cystine/glutamate antiporter xCT, and the expression of GPX4 driven by xCT determines the sensitivity of BC cells to ferroptosis inducers [
16]. The anti-diabetic drug metformin induces ferroptosis in BC cells by suppressing the UFMylation of SLC7A11
17. Obesity-associated protein (FTO) prevents thyroid cancer progression by SLC7A11 m6A methylation in a ferroptosis-dependent manner [
18]. By targeting SLC7A11, miR-5096 can inhibit the development of BC [
19]. RPN1 is a ribonucleoprotein, and upregulation of RPN1 expression in BC is related to poor prognosis [
20]. NCKAP1, as a tumor inhibitor gene in hepatocellular carcinoma, can improve the prognosis of liver cancer patients by targeting Rb1/p53
21. Ma et al. [
22] reported that miR-140-5p inhibits the proliferation, migration, and invasion of vascular smooth muscle cells by targeting and suppressing the expression of NCKAP1. In this study, based on the classification of SLC7A11, SLC3A2, RPN1, and NCKAP1, the association between disulfidptosis and patient survival was demonstrated. Furthermore, differential gene classification was performed between two subtypes, and survival analysis and expression analysis further elucidated the correlation between Disulfidptosis-related genes and patient survival. Additionally, both the first and second clustering analyses indicated that patients with higher survival rates corresponded to higher immunogenicity (IPS score) or immune levels (expression of immune checkpoints). Overall, the second clustering analysis validated the results obtained from the first analysis effectively.
In this study, we observed that patients (cluster 1 and cluster B) with higher survival rates exhibited higher immune levels. This suggests a potential relationship between patient survival and immunity in BC. It is well-known that the infiltration of immune cells in the tumor microenvironment (TME) influences tumor development. Interestingly, our study found higher levels of immune-related cell infiltration, including aDCs, DCs, NK cells, Th2 cells, and Treg cells, in cluster1. Dendritic cells are typical antigen-presenting cells in the immune system that regulate T cell responses [
23]. NK cells are the major effector cell type in innate immunity, and they can autonomously kill target cells during tumor initiation. However, long-term exposure to the TME leads to NK cells being in an immunosuppressive state, promoting tumor immune evasion and metastasis [
24]. The higher proportion of NK cell infiltration in cluster2 with poorer prognosis may be one of the reasons for promoting tumor immune escape. Th2 cells are a type of helper T cell that can regulate tumor immunity, and targeting Th2 with montelukast, a drug that blocks Th2, effectively improves the response of BC patients to immune checkpoint blockade (ICB) therapy [
25]. Treg cells enhance BC immune escape by integrating integrin αvβ8-mediated TGF-β activation [
26], which is consistent with the results of this study showing a higher proportion of Treg cell infiltration in cluster2 with poorer prognosis. Therefore, differences in the infiltration proportions of dendritic cells, NK_cells, Th2_cells, and Treg cells may affect the prognosis of different BC subtypes.
In this study, we observed higher expression levels of immune checkpoints in cluster B, which was associated with higher survival rates. ICI therapy in immunotherapy blocks checkpoints to alleviate their inhibitory effects on immune cells, activate T cells, destroy cancer cells, and restore the body’s ability to resist tumors [
27]. A clinical trial showed that pembrolizumab, an anti-PD-1 drug, effectively improved the efficacy of paclitaxel in BC patient treatment, but not all BC patients benefited from ICI therapy [
28]. This study found that the likelihood of benefiting from ICI therapy was greater in cluster1 of BC subtypes, indicating that the disulfidptosis-related BC subtype was helpful in predicting the efficacy of ICI therapy in patients.
Our study indicated that clofazimine, lenalidomide, and epigallocatechin had good therapeutic effects on cluster2 BC patients. Clofazimine is a targeted inhibitor of the Wnt signaling pathway, which has clinical value for triple-negative breast cancer with over-activated Wnt signaling pathway [
29,
30]. Lenalidomide is an immunomodulatory drug that has been validated in the treatment of lymphoma and multiple myeloma [
31,
32]. Epigallocatechin is a derivative of green tea catechins, and current studies have pointed out that epigallocatechin-3-gallate has application value in the prevention and treatment of BC [
33]. Therefore, clofazimine and epigallocatechin have application values in the treatment of BC, while lenalidomide has not yet been validated for BC treatment.
The DEGs between the two BC subtypes are enriched in steroid hormone biosynthesis and ovarian steroidogenesis signaling pathways. Steroid hormones can regulate cellular, tissue, and organ functions throughout the human lifespan [
34]. Postmenopausal women are more likely to develop BC when sex steroid hormones such as dehydroepiandrosterone sulfate, estradiol, and testosterone increase [
35]. The ovarian steroid 17β-estradiol (E2) is an effective growth promoter for BC [
36]. In addition, the DEGs between the two BC subtypes are related to the signaling pathway of neutrophil extracellular trap formation. Neutrophil extracellular traps take a pivotal part in BC invasion, evasion, and metastasis [
37,
38]. We speculated that the different prognostic survival characteristics exhibited by the two BC subtypes might be related to steroid hormone biosynthesis, ovarian steroidogenesis, and neutrophil extracellular trap formation signaling pathways.
Although our study results were based on the analysis of DRGs to identify the potential subtypes of BC patients and reveal the characteristics of each subtype, changes in gene expression might not necessarily be genetically driven and they might be influenced by environmental factors. In addition, we obtained our results through bioinformatics analysis, and these results needed further experimental validations.
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