1 Up-Regulation of Rac Gtpase Activating Protein 1 Is Significantly
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Author Manuscript Published OnlineFirst on August 8, 2011; DOI: 10.1158/1078-0432.CCR-11-0557 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. RACGAP1 and HCC recurrence Up-regulation of Rac GTPase activating protein 1 is significantly associated with the early recurrence of human hepatocellular carcinoma Suk Mei Wang1, London Lucien P.J. Ooi2, and Kam M. Hui1,3 Authors' Affiliations: 1Bek Chai Heah Laboratory of Cancer Genomics, Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore; 2Department of Surgical Oncology, National Cancer Centre, Singapore and 3Cancer and Stem Cell Biology Program, Duke-NUS Graduate Medical School, Singapore. Corresponding Author: Kam M. Hui, Division of Cellular and Molecular Research, National Cancer Centre, 11 Hospital Drive, Singapore 169610; Phone: (65) 6436-8337; Fax: (65) 6226-3843; E-mail: [email protected]. Running title: RACGAP1 and HCC recurrence Key words: human hepatocellular carcinoma; interactome; oligonucleotide gene arrays; prediction of recurrent HCC disease; RACGAP1. Abbreviations: RACGAP1, Rac GTPase activating protein 1; HCC, hepatocellular carcinoma; HBV, Hepatitis B virus; HCV, Hepatitis C virus; AFP, alpha-fetoprotein. Grant support: This work was supported by grants from the National Medical Research Council, Biomedical Research Council of Singapore and The Singapore Millennium Foundation. 1 Downloaded from clincancerres.aacrjournals.org on September 24, 2021. © 2011 American Association for Cancer Research. Author Manuscript Published OnlineFirst on August 8, 2011; DOI: 10.1158/1078-0432.CCR-11-0557 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. RACGAP1 and HCC recurrence Translational Relevance Hepatocellular carcinoma (HCC) is the world’s third commonest cause of cancer-related deaths. Surgery currently offers the only possibility of long-term survival for these patients. Unfortunately, recurrences occur in more than two thirds of these patients and confer a dismal prognosis. In this study, we have systematically presented molecular evidence and provided clinical corroboration of these data to demonstrate that, independently from clinical risk factors, aggressive early recurrent HCC tumors have their Rac GTPase-activating protein 1 (RACGAP1) expression significantly up-regulated. For the first time, our data provides clinical support for possible drug developments targeting the various important oncogenic signaling molecules in an interactome clinically relevant to early HCC recurrence. Our results also suggest the importance of RACGAP1 as a stratification factor for the design of future comparative therapeutic trials which is especially important for early recurrent HCC tumors. 2 Downloaded from clincancerres.aacrjournals.org on September 24, 2021. © 2011 American Association for Cancer Research. Author Manuscript Published OnlineFirst on August 8, 2011; DOI: 10.1158/1078-0432.CCR-11-0557 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. RACGAP1 and HCC recurrence Abstract Purpose: To assess the significance of Rac GTPase-activating protein 1 (RACGAP1) expression in identifying HBV-positive human hepatocellular carcinoma (HCC) patients who are at high risk for recurrent disease. Experimental Design: The prognostic significance of RACGAP1 was compared with clinicopathologic parameters available at diagnosis using multivariate and log rank test. RACGAP1 expression and outcome in recurrence was compared between 35 patients with recurrence and 41 patients without recurrence using Kaplan-Meier analysis. RACGAP1 targeted molecules and pathways were identified and characterized by inhibition with siRNA duplexes. Results: Kaplan-Meier analysis demonstrated that the level of RACGAP1 expression is sufficient to predict the early recurrence of HCC: high RACGAP1 expression correlates with high risk of post-resection recurrent HCC (p<0.0005). Silencing of RACGAP1 in Hep3B and MHCC97-H HCC cells with high endogenous RACGAP1 expression inhibited cell migration and invasion. Using IPA, the target molecules silenced in the RACGAP1 interactome were mostly genes related to the mitotic roles of the polo-like kinases. These included PRC1, AURKB, CDC2, ECT2, KIF23, PAK1 and PPP2R5E. In providing clinical corroboration of these results, when expression of these transcripts were analyzed in an expression database that we have established previously for HBV-positive HCC patients, these genes was mostly up-regulated in patients who exhibited early recurrent disease and hence provided important corroboration of these results. Conclusions: siRNA silencing RACGAP1 mainly targeted genes in an interactome clinically relevant to early HCC recurrence. Besides being an independent informative prognostic biomarker, RACGAP1 could also be a potential molecular target for designing therapeutic strategies for HCC. 3 Downloaded from clincancerres.aacrjournals.org on September 24, 2021. © 2011 American Association for Cancer Research. Author Manuscript Published OnlineFirst on August 8, 2011; DOI: 10.1158/1078-0432.CCR-11-0557 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. RACGAP1 and HCC recurrence Introduction Hepatocellular carcinoma (HCC) is the commonest primary cancer of the liver and is the world’s third most frequent cause of cancer-related deaths, with more than 660,000 deaths per annum (1-5). The major etiological factors of HCC are hepatitis B virus (HBV) and hepatitis C virus infection (HCV), and various other non-viral related causes such as aflatoxins, alcohol intake and other causes of liver cirrhosis including non-alcoholic steatohepatitis (NASH). The prevalence of HCC in Europe and the US is increasing and is currently the leading cause of death in patients with cirrhosis, possibly resulting from the transmission of HCV by intravenous drug abuse and a rising prevalence of obesity and diabetes (6, 7). Surgery currently offers the only possibility of prolonged survival for HCC patients. Unfortunately, recurrence occurs in more than two-thirds of these patients despite initial curative intent and converts the situation to a dismal prognosis (8, 9). It is presently a challenge to identify patients who are at high risk for early recurrence after undergoing potentially curative treatment for HCC and various surrogate clinicopathological features like lymphovascular invasion, capsular invasion, satellite lesions and tumour numbers are often used with varying reliability. Such high risk patients could potentially benefit from closer surveillance or receive adjuvant novel interventional measures if they could be accurately identified. DNA microarrays have been widely applied to the study of human cancer and comprehensive and systematic functional analyses of large number of genetic and epigenetic alterations provide unbiased analytical approaches to decipher the molecular heterogeneity of cancer (10, 11). Through these strategies, distinct subclasses of HCC patients based on their differing gene expression patterns, which were also associated with patient survival, were identified, indicating the 4 Downloaded from clincancerres.aacrjournals.org on September 24, 2021. © 2011 American Association for Cancer Research. Author Manuscript Published OnlineFirst on August 8, 2011; DOI: 10.1158/1078-0432.CCR-11-0557 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. RACGAP1 and HCC recurrence presence of distinct molecular subtypes of HCC (12-14). However, the identification of the early recurrence of HCC remains a major challenge and the development of new prognostic markers are urgently needed to identify HCC patients who are at higher risk of having recurrence. Previous studies by our group and others have successfully shown that specific gene expression signatures can be established from frozen and formalin-fixed cancerous tissues to accurately predict early recurrent disease following curative hepatic surgery (15-19). In this context, we have reported a 57-member gene signature earlier for selecting HCC patients who are at higher risk of having recurrent disease (18). While a number of options for gene set analysis exist, we have chosen to investigate the prognostic significance of individual members of the gene set using multivariate and log rank test and observed that RACGAP1, a member of this 57-member gene signature, gave the best ability to predict early recurrent disease and survival outcome. In this study, we report the identification and molecular characterization of RACGAP1 as a clinically relevant prognostic predictor for recurrent HCC disease. Materials and Methods Patient samples All tissue samples employed in this study were approved and provided by the Tissue Repository of the National Cancer Centre Singapore and conducted in accordance with the policies of its Ethics Committee. Informed consent was obtained from all participating patients and all clinical and histopathological data provided to the researchers were rendered anonymous. Cancerous and some of the corresponding distant 5 Downloaded from clincancerres.aacrjournals.org on September 24, 2021. © 2011 American Association for Cancer Research. Author Manuscript Published OnlineFirst on August 8, 2011; DOI: 10.1158/1078-0432.CCR-11-0557 Author manuscripts have been peer reviewed and accepted for publication