Mechanistic insights into transcriptional regulation of ARHGAP36 expression identify a factor predictive of neuroblastoma survival

Reviewer #1 (Public review):

This thoughtful and thorough mechanistic and functional study reports ARHGAP36 as a direct transcriptional target of FOXC1, which regulates Hedgehog signaling (SUFU, SMO, and GLI family transcription factors) through modulation of PKAC. Clinical outcome data from patients with neuroblastoma, one of the most common extracranial solid malignancies in children, demonstrate that ARHGAP36 expression is associated with improved survival. Although this study largely represents a robust and near-comprehensive set of focused investigations on a novel target of FOXC1 activity, several significant omissions undercut the generalizability of the findings reported.

(1) It is notable that the volcano plot in Figure 1a does now show evidence of canonical Hedgehog gene regulation, even though the subsequent studies in this paper clearly demonstrate that ARHGAP36 regulates Hedgehog signal transduction. Is this because canonical Hedgehog target genes (GLI1, PTCH1, SUFU) simply weren't labeled? Or is there a technical limitation that needs to be clarified? A note about Hedgehog target genes is made in conjunction with Table S1, but the justification or basis of defining these genes as Hedgehog targets is unclear. More broadly, it would be useful to see ontology analyses from these gene expression data to understand FOXC1 target genes more broadly. Ontology analyses are included in a supplementary table, but network visualizations would be much preferred.

(2) Likewise, the ChIP-seq data in Figure 2 are under-analyzed, focusing only on the ARHGAP36 locus and not more broadly on the FOXC1 gene expression program. This is a missed opportunity that should be remedied with unbiased analyses intersecting differentially expressed FOXC1 peaks with differentially expressed genes from RNA-sequencing data displayed in Figure 1.

(3) RNA-seq and ChIP-seq data strongly suggest that FOXC1 regulates ARHGAP36 expression, and the authors convincingly identify genomic segments at the ARHGAP36 locus where FOXC1 binds, but they do not test if FOXC1 specifically activates this locus through the creation of a luciferase or similar promoter reporter. Such a reagent and associated experiments would not only strengthen the primary argument of this investigation but could serve as a valuable resource for the community of scientists investigating FOXC1, ARHGAP36, the Hedgehog pathway, and related biological processes. CRISPRi targeting of the identified regions of the ARHGAP locus is a useful step in the right direction, but these experiments are not done in a way to demonstrate FOXC1 dependency.

(4) It would be useful to see individual fluorescence channels in association with images in Figure 3b.

(5) Perhaps the most significant limitation of this study is the omission of in vivo data, a shortcoming the authors partly mitigate through the incorporation of clinical outcome data from pediatric neuroblastoma patients in the context of ARHGAP36 expression. The authors also mention that high levels of ARHGAP36 expression were also detected in "specific CNS, breast, lung, and neuroendocrine tumors," but do not provide clinical outcome data for these cohorts. Such analyses would be useful to understand the generalizability of their findings across different cancer types. More broadly, how were high, medium, and low levels of ARHGAP36 expression identified? "Terciles" are mentioned, but such an approach is not experimentally rigorous, and RPA or related approaches (nested rank statistics, etc) are recommended to find optimal cutpoints for ARHGAP36 expression in the context of neuroblastoma, "specific CNS, breast, lung, and neuroendocrine" tumor outcomes.

Reviewer #2 (Public review):

FOXC1 is a transcription factor essential for the development of neural crest-derived tissues and has been identified as a key biomarker in various cancers. However, the molecular mechanisms underlying its function remain poorly understood. In this study, the authors used RNA-seq, ChIP-seq, and FOXC1-overexpressing cell models to show that FOXC1 directly activates transcription of ARHGAP36 by binding to specific cis-regulatory elements. Elevated expression of FOXC1 or ARHGAP36 was found to enhance Hedgehog (Hh) signaling and suppress PKA activity. Notably, overexpression of either gene also conferred resistance to Smoothened (SMO) inhibitors, indicating ligand-independent activation of Hh signaling. Analysis of public gene expression datasets further revealed that ARHGAP36 expression correlates with improved 5-year overall survival in neuroblastoma patients. Together, these findings uncover a novel FOXC1-ARHGAP36 regulatory axis that modulates Hh and PKA signaling, offering new insights into both normal development and cancer progression.

The main strengths of the study are:

(1) Identification of a novel signaling pathway involving FOXC1 and ARHGAP36, which may play a critical role in both normal development and cancer biology.

(2) Mechanistic investigation using RNA-seq, ChIP-seq, and functional assays to elucidate how FOXC1 regulates ARHGAP36 and how this axis modulates Hh signaling.

(3) Clinical relevance demonstrated through analysis of neuroblastoma patient datasets, linking ARHGAP36 expression to improved 5-year overall survival.

The main weaknesses of the study are:

(1) Lack of validation in neuroblastoma models - the study does not directly test its findings in neuroblastoma cell models, limiting translational relevance.

(2) Incomplete mechanistic insight into PKA regulation - the study does not fully elucidate how FOXC1-ARHGAP36 regulates PKAC activity at the molecular level.

(3) Insufficient discussion of clinical outcome data - while ARHGAP36 expression correlates with improved survival in neuroblastoma, the manuscript lacks a clear interpretation of this unexpected finding, especially given the known oncogenic roles of FOXC1, ARHGAP36, and Hh signaling.

Reviewer #3 (Public review):

Summary:

The focus of the research is to understand how transcription factors with high expression in neural crest cell-derived cancers (e.g., neuroblastoma) and roles in neural crest cell development function to promote malignancy. The focus is on the transcription factor FOXC1 and using murine cell culture, gain- and loss-of-function approaches, and ChIP profiling, among other techniques, to place PKC inhibitor ARHGAP36 mechanistically between FOXC1 and another pathway associated with malignancy, Sonic Hedgehog (SHH).

Strengths:

Major strengths are the mechanistic approaches to identify FOXC1 direct targets, definitively showing that FOXC1 transcriptional regulation of ARHGAP36 leads to dysregulation of SHH signaling downstream of ARHGAP36 inhibition of PKC. Starting from a screen of Foxc1 OE to get to ARHGAP36 and then using genetic and pharmacological manipulation to work through the mechanism is very well done. There is data that will be of use to others studying FOXC1 in mesenchymal cell types, in particular, the FOXC1 ChIP-seq.

Weaknesses:

Work is almost all performed in NIH3T3 or similar cells (mouse cells, not patient or mouse-derived cancer cells), so the link to neuroblastoma that forms the major motivation of the work is not clear. The authors look at ARHGAP36 levels in association with the neuroblastoma patient survival; however, the finding, though interesting and quite compelling, is misaligned with what the literature shows about FOXC1 and SHH, their high expression is associated with increased malignancy (also maybe worse outcomes?). Therefore, ARHGAP36 expression may be more complicated in a tumor cell or may be unrelated to FOXC1 or SHH, leaving one to wonder what the work in NIH3T3 cells, though well done, is telling us about the mechanisms of FOXC1 as an oncogene in neuroblastoma cells or in any type of cancer cell. Does it really function as an SHH activator to drive tumor growth? The 'oncogenic relevance' and 'contribution to malignancy' claimed in the last paragraph of the introduction are currently weakly supported by the data as presented. This could be improved by studying some of these mechanisms in patient-derived neuroblastoma cells with high FOXC1 expression. Does inhibiting FOXC1 change SHH and ARHGAP36 and have any effect on cell proliferation or migration? Alternatively, does OE of FOXC1 in NIH3T3 cells increase their migration or stimulate proliferation in some way, and is this dependent on ARHGAP36 or SHH? Application of their mechanistic approaches in cancer cells or looking for hallmarks of cancer phenotypes with FOXC1 OE (and dependent on SHH or ARHGAP36) could help to make a link with cellular phenotypes of malignant cells.