Abstract
   Alternative splicing alterations can contribute to human disease. The
   ability of an RNA-binding protein to regulate alternative splicing
   outcomes can be modulated by a variety of genetic and epigenetic
   mechanisms. In this study, we use a computational framework to
   investigate the roles of certain genes, termed modulators, on changing
   RBPs’ effect on splicing regulation. A total of 1,040,254
   modulator-mediated RBP-splicing interactions were identified, including
   137 RBPs, 4,309 splicing events and 2,905 modulator candidates from
   TCGA-KIRC RNA sequencing data. Modulators function categories were
   defined according to the correlation changes between RBPs expression
   and their targets splicing outcomes. QKI, as one of the RBPs
   influencing the most splicing events, attracted our attention in this
   study: 2,014 changing triplets were identified, including 1,101
   modulators and 187 splicing events. Pathway enrichment analysis showed
   that QKI splicing targets were enriched in tight junction pathway,
   endocytosis and MAPK signaling pathways, all of which are highly
   associated with cancer development and progression. This is the first
   instance of a comprehensive study on how alternative splicing outcomes
   changes are associated with different expression level of certain
   proteins, even though they were regulated by the same RBP. Our work may
   provide a novel view on understanding alternative splicing mechanisms
   in kidney cancer.
   Keywords: alternative splicing, RNA-binding protein, modulation,
   cancer, dysregulation
Introduction
   Renal cell carcinoma (RCC) is a common malignancy, representing 4.2% of
   all new cancer cases, with about 73,820 new cases and 14,770 deaths
   estimated for 2019 in the United States ([29]Siegel et al., 2019). RCC
   is radiotherapy- and chemotherapy-resistant, and surgery remains
   first-line therapy ([30]Hsieh et al., 2017; [31]Yin et al., 2019).
   Despite early surgical treatment, 30% of patients with a localized
   tumor eventually develop metastases, and 2 years survival rate of
   patients with metastatic kidney renal clear cell carcinoma (KIRC) is
   less than 20% ([32]Mickisch, 2002; [33]Janzen et al., 2003). Therefore,
   identification of underlying molecular mechanisms and metastatic
   potential of KIRC are essential for improvements in early diagnosis and
   treatment.
   Dysregulation of alternative splicing (AS) is widely considered a new
   hallmark of cancer and its products are acknowledged as potentially
   useful biomarkers ([34]Ladomery, 2013). Recent estimates indicate that
   nine out of every 10 human genes undergo AS in a cell type- or
   condition-specific manner to create distinct RNA transcripts from the
   same pre-mRNA molecule ([35]Wang et al., 2008). The key role of AS is
   further confirmed by the linkage of splicing regulation to numerous
   human diseases, including neurological disorders and many types of
   cancer ([36]Scotti and Swanson, 2016). Regulation of AS is a
   complicated process in which numerous interacting components are at
   work, including cis-acting elements and trans-acting factors,
   complicated by the functional coupling between transcription and
   splicing ([37]Wang et al., 2015). Corruption of the process may lead to
   disruption of normal cellular function and eventually disease. Thus,
   understanding the regulatory patterns that control AS events has the
   potential not only to give valuable molecular insights but also to
   provide solutions for various diseases.
   AS events are largely controlled by RNA-binding proteins (RBPs) that
   recognize specific regulatory sequences embedded in the pre-mRNA
   transcripts ([38]Gerstberger et al., 2014). However, splicing complexes
   are intricate molecular machines that process tens to hundreds of RNA
   target genes. At any given time, depending on the context and cellular
   stimuli, an RBP will affect only a subset of its RNA target genes. This
   specificity is often provided by a certain factors we named as
   “modulators,” such as signaling proteins, microRNAs, lncRNAs that
   control RBPs activity through several different mechanisms, including:
   expression level ([39]Payne et al., 2018), protein stability and
   turnover ([40]Garcia-Maurino et al., 2017), nuclear/cytoplasmic
   localization ([41]Di Liegro et al., 2014), altered protein interactions
   ([42]Jankowsky and Harris, 2015), and co-transcriptional regulation
   ([43]Shukla and Oberdoerffer, 2012). Modulators help a cell combine
   different external signals and make complex downstream decisions.
   Elucidating their function is necessary for understanding and
   controlling cell’s response to external stimuli at transcriptional
   level.
   With the increased availability of large data sets derived from
   high-throughput experiments and computer algorithms, investigating
   complex transcriptional dysregulation between RBPs and AS events in
   complex diseases is now possible. Recently, the ENCODE project
   published eCLIP data sets for 150 RBPs across K562 and HepG2 cell types
   ([44]Van Nostrand et al., 2016; [45]Yee et al., 2019). Technological
   advances have made it possible to define the comprehensive target
   networks of individual RBPs with high accuracy by integrating global
   splicing profiles upon depletion of each RBP and genome-wide maps of in
   vivo, direct protein-RNA interactions ([46]Zhang et al., 2010;
   [47]Weyn-Vanhentenryck et al., 2014).
   In this study, we established a computational method for dissecting the
   relationship among RBPs, alternatives splicing events and a kind of
   proteins that may influenced the splicing regulation effect of RBPs.
   Our method is unique in its ability to discover how alternative
   splicing outcomes is changing when modulator expression is different,
   even though they were regulated by the same RBP. It is the first time
   in which a triplet describing the relationships among modulators, RBPs
   and the outcomes of their alternative splicing targets is reported. The
   triplet contains three objects: a specific RBP, a splicing target
   regulated by RBP, and a modulator candidate that may change splicing
   regulation of the RBP. This method was applied to RCC using TCGA-KIRC
   dataset to identify modulator-dependent RBPs and their targets splicing
   outcomes in kidney cancer. QKI, as one of the key RBPs in this study,
   has the greatest number of influenced splicing events. Functional
   enrichment analysis showed that the inferred QKI modulators were highly
   associated with regulation progress of some hallmark cancer genes,
   including ARMH4, LINC01268, PDP2, LAPTM4B, and CD7. The results showed
   that different expression of modulators was associated with the
   changing roles of RBPs on regulating their targets alternative splicing
   outcomes. We expect that such integrated analysis could reveal the
   roles of RBPs and provide novel insights into understanding alternative
   splicing mechanisms in kidney cancer.
Materials and Methods
Identify Alternative Splicing Events and Gene Expression
   Paired-end RNA sequencing data from 480 RCC patients was downloaded
   from The Cancer Genome Atlas Kidney Renal Clear Cell Carcinoma
   (TCGA-KIRC). The percentage of inclusion (PSI) of spliced events were
   derived using Mixture of Isoforms (MISO) ([48]Lee et al., 2013). A PSI
   value was computed for every identified event in each sample, and the
   original AS events were further processed to generate high-confidence
   events by retaining events with a PSI value greater than 0.1 in at
   least 100 samples from 480 (∼21% samples in total). Then, events that
   occurred in both the curated and TCGA datasets were retained to form
   the final set of AS events. In this study, we only focused on skipped
   exon (SE) alternative splicing events. We defined an altered skipped
   exon as any exon of a transcript excluding the first and the last
   exons. Finally, we only kept the events that at least 100 patients’
   have PSI value and coefficient of variation (CV) of PSI was larger than
   0.1. Gene differential expression analysis was performed using edgeR
   ([49]Robinson et al., 2010), and CPM was used to estimated gene
   expression.
Identify RBPs Targets Using eCLIP Data
   We used crosslinking immunoprecipitation (CLIP) data for 150 RBPs
   profiled in eCLIP peaks ([50]Van Nostrand et al., 2016) downloaded from
   ENCODE in bed format ([51]Consortium Encode Project, 2012). The peaks
   in two immortalized human cell types, K562 and HepG2, were filtered by
   peak enrichment larger than 8 (log[2]FC ≥ 3) and p < 10^–5 as
   recommended ([52]Van Nostrand et al., 2016). Since the agreement
   between peaks in two replicates was moderate (the median Jaccard
   distance 25 and 28% in K562 and HepG2, respectively), we took the union
   of peaks between the two replicates in both cell lines and then pooled
   the resulting peaks. We defined an RBP-binding splicing event as the
   region upstream 300 base pairs of the exon to downstream 300 base pairs
   of the exon.
Genomes and Transcript Annotations
   February 2009 assembly of the human genome (hg19, GRCh37) was download
   from Genome Reference Consortium ([53]Church et al., 2011). The
   respective transcript annotation v19 was download from GENCODE website
   ([54]Harrow et al., 2012). Transcript annotations were parsed to
   extract positions of introns and exons.
Gene Function and Categories Analysis
   Functional enrichment analysis was carried out via the hypergeometric
   test using the clusterProfiler R package. We used Human Gene Ontology
   annotation provided by Gene Ontology (GO) Consortium ([55]Ashburner et
   al., 2000; [56]The Gene Ontology Consortium, 2017). GO terms enrichment
   with adjusted p < 0.01 and KEGG pathway enrichment with adjusted p <
   0.05. The gene types we discussed in this study including immune
   related genes, which were download from IMMPORT database^[57]1 and
   TRRUST v2 database.^[58]2 The lncRNA gene type annotation was based on
   biomaRt software suite in R.
Construction Modulator-RBP-Splicing Triplets in KIRC
   The probabilistic model is similar to [59]Li et al. (2017) as follows:
   [MATH:
   Ytarget=β0+β1X<
   mrow>rbp
   mrow>+β2X<
   mi>m+β3X<
   mrow>rbpXm+ε :MATH]
   (1)
   where, the X[rbp], X[m], and Y[target] are the gene expression of RBP
   and its modulator, and the splicing outcomes of the affected target
   gene, respectively. X[rbp] and X[m] represent the effect of RBP and
   modulator, respectively, on target by themselves alone (main effects),
   while β[3] represents the effect of their interaction. If an RBP and
   modulator interaction influences target splicing outcomes, we expect
   β[3] to be non-zero.
   We divide rank-ordered expression values of a gene by tertiles and
   further discretize the triplets using:
   [MATH:
   x′={1 ifxisinup<
   /mi>perte<
   /mi>rti
   mo>leNU
   LL ifxisinmi<
   /mi>ddl
   mo>ete<
   /mi>rti
   mo>le0 ifxisinlo<
   /mi>werte<
   /mi>rti
   mo>le<
   /mrow> :MATH]
   (2)
   Values are ranked and transformed by tertials as follows, and
   coefficients are estimated from the differences in observed proportions
   of frequencies:
     * (1)
       Splice events are ranked according to PSI.
     * (2)
       RBP is ranked by its expression.
     * (3)
       Each modulator is ranked by their expression.
   After discretization, we only consider the eight bins, where none of
   the genes has “NULL” value, covering ∼33% of the samples. This simple
   strategy has been shown to maximize entropy among groups and the
   selection of significant triplets’ method can be found in [60]Babur et
   al. (2010).
Statistical Analysis and Software
   The data were analyzed and visualized using R statistics software
   version 3.4.1 and ggplot2 package. Correlations were assessed using
   Pearson correlation test. Survival curves were generated by the Kaplan
   Meier method using the median H-score as the cutoff, and differences
   were analyzed with the log-rank test.
Results
Category of Modulator Action
   We developed a framework to infer the modulators of RBPs whose
   expression strongly correlates with changes of a RBP’s effect on
   regulating targets splicing outcomes. Here, the transcriptional
   activity of a RBP was evaluated by the Pearson correlation between the
   expression level of RBPs and its target splicing outcomes. A schematic
   diagram of work-flow is provided in [61]Figure 1.
FIGURE 1.
   [62]FIGURE 1
   [63]Open in a new tab
   A schematic diagram of workflow. Briefly, the dataset in this study
   derived from TCGA-KIRC and ENCODE ECLIP-Seq, hg19 was used as reference
   gene annotation from Ensemble. Each triplet contains three object: RBP,
   target and a modulator. Gene expression level is the input of RBP and
   modulator candidates, splicing outcomes (PSI value) is used to estimate
   the splicing level of target. Data filtering criteria as follows: (1)
   log2 (CPM) ≥ 1 (2) remove events with “NA” samples > 100 (3) CV(PSI) >
   0.1. Then using the linear regression model to predict triplets. Only
   the triplets with significant β[3] p-value will be considered and
   selected to the following analysis. Finally, for each triplet, we group
   the samples into “low” and “high” groups based on the expression level
   of modulator (bottom/top 33% samples) in the specific triplet, and we
   compare the Pearson correlation coefficient values of RBP expression
   and target PSI value in two groups, identify the modulator function
   categories.
   The proposed method takes five inputs: gene expression profiles, an RBP
   of interest, a list of modulator candidates, splicing profiles, and
   RBPs’ binding information. Candidate modulators may include all genes
   satisfying the criteria. In addition, the expression of the modulator
   candidates and RBPs were required to be statistically independent. Each
   possible triplet was then independently tested using the PCCs (Pearson
   correlation coefficients) estimator, and by comparing ΔPCCs we defined
   the subtype of modulation categories. False positives were controlled
   using appropriate statistical thresholds. Three possible modes of
   modulator action were identified, depending on whether RBP-splicing
   correlation increased or decreased as a function of the modulator
   abundance.
Category of Modulator Action
   For each triplet, three possible modes of modulator action were
   identified depending on whether RBP-splicing correlation increased or
   decreased as a function of the modulator abundance. The three models
   are “attenuates splicing,” “enhances splicing,” and “‘inverts
   splicing.” Among them, attenuates/enhances splicing modes including two
   sub-types: attenuates/enhances exon exclusion and attenuates/enhances
   exon inclusion; inverts splicing mode means that the mode of modulator
   switches from exon inclusion to exon exclusion or from exon exclusion
   to exon inclusion. These cases and details interpretations are listed
   in [64]Table 1.
TABLE 1.
   Categories of modulator mediated RBP regulations on splicing targets.
   Modulation category PCC[low] PCC[high] ΔPCCs Subtype mode
   Attenuates splicing – (EE) – (EE) | PCC[low]| > | PCC[high] | or
   p-value.high > 0.05 Attenuates exon exclusion (AEE)
   Enhances splicing – (EE) – (EE) | PCC[low]| < | PCC[high]| or
   p-value.low > 0.05 Enhances Exon exclusion (EEE)
   Inverts splicing + (EI) – (EE) Exon inclusion to exclusion (ExonIE)
   Inverts splicing – (EE) + (EI) Exon exclusion to inclusion (ExonEI)
   Enhances splicing + (EI) ++(EI) | PCC[low]| < | PCC[high]| or p-value.
   Low > 0.05 Enhances EI (EEI)
   Attenuates splicing + +(EI) +(EI) | PCC[low]| > | PCC[high]| or
   p-value.high > 0.05 Attenuates EI (AEI)
   [65]Open in a new tab
   “+” and “−” signs in the columns indicate positive and negative values
   of Pearson correlation coefficient. “EE” represents exon exclusion, and
   “EI” means exon inclusion. The modulation categories of “attenuates
   splicing.” “enhances splicing” or “inverts splicing” only refer to the
   roles of RBP on specific alternative spliced exon.
Identify Modulators of QKI in Kidney Cancer
   We applied the proposed method for identifying modulators for 150 RBPs.
   14,707 exons were selected from 42,485 annotated skipped exons that are
   derived using the gene structures of ENSEMBL database. We identified
   1,040,254 significant modulator-mediated triplets from 40,623,520
   potential modulator-RBP-splicing interactions at FDR ≤ 0.01 using
   TCGA-KIRC data. The potential interactions consisted of 137 RBPs, 4,309
   splicing events, and 2,905 modulator candidates. Among these RBPs, 13
   RBPs were filtered out as the PSI distribution among 480 patients did
   not meet our criteria (the PSI coefficient of variation should be
   larger than 0.1). RNA-binding protein Quaking (QKI) had the greatest
   number (68.9%, 199 out of 289) of modulated spliced exons.
   We identified 2,014 Modulator-QKI-Splicing triplets. The triplets
   include 1,101 modulators and 187 splicing events corresponding to 130
   genes. According to the correlation between QKI expression and its
   target splicing outcomes, six modulator sub-categories were identified,
   including 450 triplets in “Attenuates_Exon_Exclusion,” 226 triplets in
   “Attenuates_Exon_Inclusion,” 517 triplets in “Enhances_Exon_Exclusion,”
   406 triplets in “Enhances_Exon_Inclusion,” 218 triplets in
   “Exon_Exclusion_to_Inclusion,” and 197 triplets in
   “Exon_Inclusion_to_Exclusion” ([66]Figure 2A).
FIGURE 2.
   [67]FIGURE 2
   [68]Open in a new tab
   Identify modulators of QKI in KIRC. (A) Six mode sub-categories
   according to the correlation between QKI expression and its target
   splicing outcomes. The number in the pie chart means the percentage of
   each sub-categories. AEI indicates attenuates the exon inclusion, AEE
   indicates attenuates exon exclusion, EEI indicates enhances exon
   inclusion, EEE indicates enhances exon exclusion, ExonIE indicates
   reverses exon inclusion to exon exclusion, ExonEI indicates reverse
   exon exclusion to inclusion. (B) Modulators clusters by their
   regulation patterns. Six clusters were grouped according to modulator
   sub-categories. (C) Correlation heatmap of QKI modulators. The redder
   the color the higher correlation between two modulators. The values in
   the matrix were the normalized gene expression of modulators. (D) KEGG
   enrichment analysis of QKI modulators. (E) Modulators categories
   according to gene biotypes and features, including immune genes,
   transcription factors and lncRNAs.
   Furthermore, we observed that most modulators affected multiple
   splicing targets were multimodal, and the same modulator may play
   opposite roles on different QKI targets. For example, ARMH4 inverts the
   splicing activity of QKI on its target CLTC: the inclusion of CLTC’s
   spliced exon was correlated with increasing expression of QKI when
   ARMH4 is lowly expressed, while such association was inversed when
   ARMH4 is highly expressed. However, ARMH4 played enhanced exon
   inclusion role on QKI-STIM1 pair when its expression level changed from
   low to high. In another case, while the modulator KRT17 influenced 11
   splicing targets of QKI, the role of KRT17 on these splicing outcomes
   changed among EEE, ExonIE, and ExonEI. The observation indicated that
   the distinct modulation patterns were triplets dependent rather than
   depending on specific RBPs or target genes. Our findings support this
   complexity in modulators typically had many target-specific effects.
   These findings suggested that more complex models are needed to better
   elucidate that how splicing is regulated.
   Hence, we clustered modulators by their regulation patterns, yielding
   distinct groups of modulators that mediated splicing dysregulation in
   specific patterns ([69]Figure 2B). For instance, the modulators in
   cluster 1–2 tend to reverse the QKI activity on regulating splicing
   targets’ outcomes, whereas those modulators in cluster 4 and cluster 6
   tend to enhance QKI splicing activity. In conclusion, these modulators
   may work as antagonistic or coactivators to mediate QKI splicing
   activity.
   Among these modulator-mediated triplets, we noticed that many
   modulators regulate the same QKI splicing targets, this may be because
   some of the modulators co-express or play similar functions in related
   pathways. As the result showed in [70]Figure 2C, modulators were
   grouped into several clusters according to their expression’s
   correlation. This may be a potential reason why the spliced outcome of
   same target could be influenced by many modulators. In addition, the
   pathway enrichment results shown that these modulators were highly
   enriched in categories which were known to be associated with cancer
   development and progression, including cytokine-cytokine receptor
   interaction, Th1 and Th2 cell differentiation, and cell adhesion
   molecules ([71]Figure 2D).
   Furthermore, we classified the modulators of QKI according to gene
   biotypes and features, including immune related genes, transcription
   factors and lncRNAs ([72]Figure 2E). The types of categories provide a
   framework for understanding many types of dysregulation on splicing.
Functional Analysis of QKI Modulators
   To confirm the QKI-splicing-modulator triplet signatures as independent
   predictors, we selected six inferred modulator-influenced triplets to
   compare the association among QKI-splicing-modulators. The modulators
   we focused on were obtained from the analysis result 3.3, including
   immune genes (CCL3, HLA-F, AGER), transcription factors (ARMH4, STAT4),
   and lncRNAs (LINC01268).
   As an example, immune gene AGER as a modulator of QKI, who shown
   differentially expressed level between cohort and normal samples in
   KIRC, played inverts exon exclusion role on regulating the splicing
   outcomes of GABRE. Comparing the two patterns in different groups, when
   the expression of modulator AGER is low, the PCCs between QKI
   expression and GABRE splicing level (PSI) is −0.1, while such
   correlation inverts to 0.32 in another group whose AGER expression
   high. Similar pattern we found that the correlation between QKI and its
   splicing target STIM1 was lost from 0.45 to no significant correlation
   when the modulator immune gene HLA-F expression differentially in two
   groups. Meanwhile, LINC01268 as modulator played attenuated effect on
   regulating QKI splicing activity. The correlation between QKI and
   target CTNND1 was −0.54 in LINC01268 expressed low group, while such
   correlation gone when LINC01268 expression becomes high ([73]Figure 3).
FIGURE 3.
   [74]FIGURE 3
   [75]Open in a new tab
   Relationships among QKI-modulator-target. The blue means the samples in
   modulator expression low group (expression in bottom 33%), the red
   means the samples in modulator expression high group (expression in top
   33%). The correlation value is the Pearson correlation between
   expression level of QKI and the splicing outcomes of its targets. No
   correlation means the statistical p-value of correlation is not
   significant (p-value cutoff setup as 0.01).
   To investigate the association between dysregulated target splicing
   outcomes and kidney cancer, we performed survival analysis and compared
   the expression level of these modulators in kidney tumor samples and
   normal samples based on TCGA-KIRC dataset. Results shown that most of
   the modulators were differentially expressed between tumor and normal
   samples and overall survival associated. Although KRT17 as one of the
   modulators we inferred did not show too much differentially expressed,
   the clinical information obtained from TCGA indicated that gene
   expression in kidney cancer was significantly associated with overall
   survival outcomes. The gene expression levels and survival analysis of
   top 10 modulators who has the most influenced targets of QKI were
   compared ([76]Figures 4A,B).
FIGURE 4.
   [77]FIGURE 4
   [78]Open in a new tab
   Functional analysis of QKI modulators. (A) Expression levels of top10
   modulators in KIRC tumor tissues (red boxes) compared with normal
   tissues (gray boxes). (B) survival analysis of top10 modulators. The
   red line means the modulator expression is high, the green line means
   the modulator is expression low. Modulator is grouped according to the
   median value of its expression level. (C–F) KEGG pathway and GO
   enrichment analysis, including biological process (BP), cellular
   component (CC) and molecular function (MF). (G) Cancer-relevant
   modulators identification according to Network of Cancer genes (NCG)
   and Tumor suppressor gene (TSGene) database. (*The top10 modulators
   were selected based on the number of their influenced splicing
   targets).
   KEGG enrichment analysis revealed that these target genes were enriched
   in categories known to be related to cancer development and progression
   ([79]Figure 4C), such as tight junction pathway, transcriptional
   mis-regulation in cancer, endocytosis, and MAPK signaling pathway. The
   top enriched GO terms of these influenced target genes were associated
   with transcriptional regulation progress, including RNA splicing, cell
   growth and protein binding ([80]Figures 4D–F). The results were
   reasonable as QKI regulated its target mainly on splicing level, once
   the expression of QKI was perturbed by the modulators, the roles of QKI
   on its targets, including binding, splicing, cellular development and
   transcriptional regulation would be influenced consequently.
   In addition, cancer-relevant modulators were identified though tumor
   associated gene list from the Network of Cancer Genes (NCG, v6.0)
   database ([81]Repana et al., 2019) and Tumor suppressor gene database
   (TSGene v2.0) ([82]Zhao et al., 2016), separately ([83]Figure 4G). The
   2,372 tumor diver genes obtained from NCG including 711 known cancer
   genes and 1,661 candidate cancer genes. Among them, 149 genes
   overlapped with tumor diver genes, almost reaching 13% (149/1,179) of
   total numbers of modulators we inferred in this study. Meanwhile,
   approximately 7% (77/1,179) modulators were tumor suppressor genes, and
   the gene type was protein coding gene.
Analysis the Splicing Outcomes of CTNND1 Influenced by Modulators in Kidney
Cancer
   In this study, we found that the spliced outcome of the 20th exon of
   CTNND1 has the most inferred modulators, including 30 lncRNAs and 80
   protein coding RNAs. The corresponding AS event is “chr11:57582866:
   57582972: + @ chr11: 57583387: 57583473: + @ chr11:57583769:
   57586652:+.” Previously study reported that CTNND1 encodes a member of
   the Armadillo protein family, which function in adhesion between cells
   and signal transduction ([84]Zhu et al., 2012), multiple CTNND1
   isoforms are expressed in cells via alternative splicing, only
   full-length CTNND1 promotes invasiveness ([85]Yanagisawa et al., 2008).
   Two modulation categories were identified including 107 attenuates exon
   exclusion (AEE), 7 enhances exon exclusion (EEE). The alternative
   spliced exon of CTNND1 and some of it’s in each category are shown in
   [86]Figure 5A.
FIGURE 5.
   [87]FIGURE 5
   [88]Open in a new tab
   CTNND1 splicing outcomes influenced by modulator expression in KIRC.
   (A) Examples of modulators in each mode sub-categories, including exon
   exclusion to inclusion (ExonEI), exon inclusion to exclusion (ExonIE),
   enhances exon exclusion (EEE) and attenuates exon exclusion (AEE). (B)
   Four modulators influence splicing outcomes of CTNND1, including
   TNFRSF14, ARMH4, LAPTM4B, and ODF3B. The red means the samples in
   modulator expression high group (top 33%), the blue means the samples
   in modulator expression low group (bottom 33%). The x-axis is the
   expression level of QKI, y-axis is splicing outcome (PSI value) of
   CTNND1.
   For example, TNFRSF14 as one of modulators of QKI attenuates the
   splicing regulation on the 20th exon exclusion of CTNND1. We found
   that, in TNFRSF14 expression low group, the correlation between QKI
   expression and CTNND1 PSI is −0.38 (p = 1.7e−05), while such
   correlation is lost when in TNFRSF14 expression high group (correlation
   = 0.001, p = 0.98). This indicated that high expression of modulator
   TNFRSF14 may play negative effect on changing the splicing activity of
   QKI. In addition, we found that LAPTM4B, as another modulator of QKI,
   played enhanced exon exclusion role on regulating the 20th exon
   splicing outcome when it expression is high ([89]Figure 5B). Thus, the
   results showed that differentially expressed modulators indeed changed
   the role of QKI on regulating CTNND1’s splicing outcomes, and we
   believed that this kind of regulation may provide important insights
   for study dysregulation of splicing outcomes associated with various
   diseases.
Discussion
   Alternative splicing alterations may confer a selective advantage to
   the tumor, such as angiogenesis ([90]Amin et al., 2011), proliferation
   ([91]Bechara et al., 2013), cell invasion ([92]Venables et al., 2013),
   and avoidance of apoptosis ([93]Izquierdo et al., 2005). Some splicing
   mRNA isoforms could change the reading frame, resulting in the
   generation of different protein isoforms with diverse functions and/or
   localizations ([94]Sutandy et al., 2018). One of the traditional
   methods to estimate the functions of mRNAs or protein is comparing the
   difference of gene expression level ([95]Kim et al., 2014;
   [96]Lorthongpanich et al., 2019; [97]Xu et al., 2019).
   However, not all detected alternative splicing events might necessarily
   result in mRNAs or proteins expression level changing. In addition,
   global description of alternative splicing networks and demonstration
   of their functional consequences have now emerged as one of the biggest
   challenges of the field ([98]Baralle and Giudice, 2017). By integrating
   gene expression profile with splicing outcomes of alternative splicing
   events may be one of the possible ways to study the functional
   consequences for most of the identified splicing events.
   In this study, we established a computational method for identification
   the modulators whose expression is associated with changing the targets
   splicing outcomes of RBPs in KIRC. Previously, several computational
   methods have been developed to identify modulators associated with
   transcription factors (TFs) regulation activity on expression level
   ([99]Wang et al., 2009; [100]Babur et al., 2010; [101]Li et al., 2016,
   [102]2017), these studies discussed the transcriptional activities of
   TFs can be influenced by the expression level of modulators. Our method
   is unique in its ability to discover how alternative splicing outcomes
   is changing when modulator expression is different, even though they
   were regulated by the same RBP. And the method aimed at dissecting the
   effects of disruption in RBPs and hopefully it could provide insight
   into studying alternative splicing networks during development, cell
   differentiation, and in disease.
   During tissue development and cell differentiation specific RBPs are
   finely regulated at their expression levels, localization, their own
   splicing, mRNA stability, and translation efficiency ([103]Baralle and
   Giudice, 2017). RBPs bind to cis-elements promoting or inhibiting
   splice site recognition, hence RBP expression coordinates alternative
   splicing networks during development. We focused on 150 RBPs in this
   study, and only 137 RBPs remained in the final analysis due to there
   was no splicing targets of them within our criteria. Three possible
   modes of modulator actions were defined in this study, depending on the
   correlation changes between RBP and its target splicing outcomes when
   modulator expression is different. Among these RBPs, we found that QKI
   had the greatest number of influenced spliced exons (68.9%, 199 out of
   289), and 2,014 Modulator-QKI-Splicing triplets were finally identified
   focused on QKI. Results showed that most modulators affected multiple
   splicing targets were multimodal, and the same modulator may play
   opposite roles on different QKI targets.
   For example, high expression level of modulator ADAM8 enhanced QKI role
   on regulating ACSF2 exon exclusion, while it enhanced target FMNL2 exon
   inclusion in regulating splicing outcomes. Another example, low
   expression level of AJM1 modulated QKI attenuated exon exclusion on
   regulating CTNND1 splicing outcomes, while such modulation role changed
   into enhanced exon inclusion when the target became ATF2. The detailed
   information about the modulators roles in the triples could be found in
   [104]Supplementary Table S1.
   Pathway enrichment results showed that all these influenced splicing
   target events of QKI were enrolled in cancer development and
   progression related pathways, including tight junction pathway,
   transcriptional mis-regulation in cancer, endocytosis, and MAPK
   signaling pathways. This evidence indicated that these alternative
   spliced events played crucial roles in kidney cancer, and changes the
   splicing outcomes of them may result in dysregulation in alternative
   splicing networks.
   Among all these influenced splicing events, CTNND1 attracted more
   attention as the splicing outcomes of the 20th exon has the most
   inferred modulators. Previously study reported that CTNND1 was a
   tumor-driver gene, whose alternative splicing was related to cell
   invasion and metastasis ([105]Yanagisawa et al., 2008). In addition,
   CTNND1 (p120) consists of central ARM domain flanked by the N-terminal
   regulatory (NTR) and C-terminal tail region (CTR) ([106]Ishiyama et
   al., 2010), and the 20th exon of CTNND1 is in CTR region. Thus,
   different splicing outcomes of CTNND1 may influence the domain
   function, resulting in the generation of different protein isoforms
   with diverse functions.
   We identified 114 inferred modulators of QKI-CTNND1 pair, including 30
   lncRNAs and 80 protein-coding RNAs. [107]Han et al. (2016) reported
   that MALAT1 may play as a tumor-suppressor gene in gliomas, and high
   MALAT1 expression linked to cell proliferation and metastasis. In our
   results, we noticed that high expression of modulator MALAT1 tended to
   attenuate QKI regulation role on splicing the 20th exon exclusion in
   CTNND1. The correlation between QKI expression and CTNND1 PSI was −0.51
   (p = 4.3e−09) in MALAT1 expression low group, and such correlation
   changed into −0.20 (p = 0.02) in MALAT1 expression high group.
   LINC00174 as another inferred modulator had been reported that it
   exerted a tumorigenesis role in glioma. LINC00174 knockdown inhibited
   cell proliferation, migration, invasion and glycolysis ([108]Shi et
   al., 2019). We found that, when LINC00174 expression is low, the
   correlation between QKI expression and splicing outcomes of CTNND1 is
   −0.37 (p = 2.6e−05), while such correlation was lost (r = −0.07, p =
   0.44) when LINC00174 expression became high. These evidences showed
   that regulation of alternative splicing outcomes is a complex progress,
   it different splicing consequence not only associated with RBP but also
   associated with other proteins expression.
   Although the established model in this study and the corresponding
   results appear helpful for understanding the alternative splicing
   regulation, there are some limitations. First, many proteins tended to
   show similar expression pattern, certain RBP-target pairs may have more
   than two inferred modulators, these results may contain certain false
   positive modulators. In addition, the function and mechanism of how
   modulator changes the RBPs regulation on their target splicing outcomes
   need to be further studied by experiments, for example, modulator
   co-expressed or physically interacted with RBPs, and this is a long way
   for us to go. Finally, we expect that our study could provide novel
   insights for understanding the dysregulation of alternative splicing in
   cancer.
Data Availability Statement
   Paired-end RNA sequencing data from 480 RCC patients was downloaded
   from the Cancer Genome Atlas Kidney Renal Clear Cell Carcinoma
   (TCGA-KIRC).
Author Contributions
   YL and YW designed the study. YW and SC wrote the code, analyzed data,
   and wrote the manuscript. XR calculated the alternative splicing events
   in KIRC. All authors read and approved the final manuscript.
Conflict of Interest
   The authors declare that the research was conducted in the absence of
   any commercial or financial relationships that could be construed as a
   potential conflict of interest.
Acknowledgments