Modifiable risk factors and skin cancers: a multi-omics Mendelian randomization study from causal inference to drug target discovery

Abstract

Introduction Recent studies have linked modifiable risk factors (RFs) to melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). This study aimed to investigate the causal relationships between 11 modifiable RFs and these skin cancers and to identify novel therapeutic targets using multi-omics approaches. Methods Exposure data were obtained from genome-wide association studies (GWAS). Mendelian randomization (MR) analyses were performed using the inverse variance weighted (IVW) method as the primary approach, and results from discovery and replication cohorts were combined by meta-analysis. Functional Mapping and Annotation (FUMA) and summary-data-based MR (SMR) were used to prioritize therapeutic targets. Drug prediction, phenome-wide association studies (PheWAS), and single-cell analyses were conducted to evaluate target druggability and biological relevance. Results Actinic keratosis (AK) was associated with an increased risk of melanoma (OR = 1.24, 95% CI 1.07-1.43, P < 0.01), whereas alcohol consumption was negatively associated with SCC risk (OR = 0.77, 95% CI 0.62-0.95, P = 0.02). No causal relationships were observed between the investigated RFs and BCC. One potential therapeutic target for melanoma (EDEM2, PSMR = 0.03) and five candidate therapeutic targets for SCC (MAPK3, PSMR = 5.30E-04; NRBP1, PSMR = 4.32E-04; ANKK1, PSMR = 1.89E-06; IL27, PSMR = 3.04E-03; ADH5, PSMR = 0.02) were identified. Drug prediction, PheWAS, and single-cell analyses further supported the therapeutic potential of these genes. Discussion AK appears to increase the risk of melanoma, whereas alcohol consumption may be protective against SCC. EDEM2 may represent a potential therapeutic target for melanoma, while MAPK3, NRBP1, ANKK1, IL27, and ADH5 are promising candidate targets for SCC. Further experimental and clinical studies are warranted to validate these findings.