Serum Nardilysin, a Surrogate Marker for Epithelial-Mesenchymal Transition, Predicts Prognosis of Intrahepatic Cholangiocarcinoma After Surgical Resection
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Author Manuscript Published OnlineFirst on October 23, 2018; DOI: 10.1158/1078-0432.CCR-18-0124 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Title Page Serum nardilysin, a surrogate marker for epithelial-mesenchymal transition, predicts prognosis of intrahepatic cholangiocarcinoma after surgical resection 5 Authors Tomoaki Yoh1), Etsuro Hatano2), Yosuke Kasai1), Hiroaki Fuji1), Kiyoto Nishi3), Kan Toriguchi2), Hideaki Sueoka2), Mikiko Ohno4), Satoru Seo1), Keiko Iwaisako5), Kojiro Taura1), Rina Yamaguchi6), Masato Kurokawa6), Jiro Fujimoto2), Takeshi Kimura3), Shinji Uemoto1), Eiichiro 10 Nishi4) Affiliations 1) Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan 2) Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan 15 3) Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan 4) Department of Pharmacology, Shiga University of Medical Science, Otsu, Japan 5) Department of Medical Life Systems, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan 20 6) Sanyo Chemical Industries Ltd., Kyoto, Japan Corresponding author: Eiichiro Nishi, MD, PhD Department of Pharmacology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, 25 520-2192, Japan Tel.: +81-77-548-2181, Fax: +81-77-548-2183, E-mail: [email protected] 1 Downloaded from clincancerres.aacrjournals.org on September 23, 2021. © 2018 American Association for Cancer Research. Author Manuscript Published OnlineFirst on October 23, 2018; DOI: 10.1158/1078-0432.CCR-18-0124 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Etsuro Hatano, MD, PhD Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan Tel.: +81-798-45-6582, Fax: +81-798-45-6581, E-mail: [email protected] 5 Running title: Nardilysin is a novel prognostic biomarker for ICC Key words: 10 Intrahepatic cholangiocarcinoma, nardilysin, epithelial-mesenchymal transition, biomarker, surgery Conflicts of Interest: The authors declare no conflict of interest. 15 Abbreviations ICC: intrahepatic cholangiocarcinoma HCC: hepatocellular carcinoma OS: overall survival NRDC: nardilysin (N-arginine dibasic convertase) 20 HB-EGF: heparin-binding epidermal growth factor TNF-α: tumor necrosis factor-α ADAM: a disintegrin and metalloproteinase HDAC3: Histone deacetylase 3 PGC-1α: peroxisome proliferator-activated receptor gamma coactivator 1-alpha 25 IHC: immunohistochemistry AJCC: American Joint Committee on Cancer 2 Downloaded from clincancerres.aacrjournals.org on September 23, 2021. © 2018 American Association for Cancer Research. Author Manuscript Published OnlineFirst on October 23, 2018; DOI: 10.1158/1078-0432.CCR-18-0124 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. ELISA: enzyme-linked immunosorbent assay CM: condition medium FBS: fetal bovine serum 5 KD: knockdown NC: negative control qRT-PCR: quantitative real-time polymerase chain reaction WST-8: tetrazolium salt-based proliferation assay CCK8: Cell Counting Kit-8 10 PBS: Phosphate-buffered saline GAPDH: glyceraldehyde-3-phosphate dehydrogenase DFS: disease-free survival ROC: receiver operating characteristic AUC: area under the curve 15 SD: standard deviation HC: healthy controls LN: lymph node CEA: Carcinoembryonic antigen CA19-9: carbohydrate antigen 19-9 20 EMT: epithelial-mesenchymal transition ZEB1: zinc finger E-box binding homeobox 1 EMT-TFs: EMT-inducing transcription factors SOX2: sex-determining region Y-box 2 CSC: cancer stem cell 25 HIF-1α: hypoxia-inducible factor-1α IGF-1: insulin-like growth factors-1 3 Downloaded from clincancerres.aacrjournals.org on September 23, 2021. © 2018 American Association for Cancer Research. Author Manuscript Published OnlineFirst on October 23, 2018; DOI: 10.1158/1078-0432.CCR-18-0124 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. TGF-β: transforming growth factor-β EGF: epidermal growth factor 4 Downloaded from clincancerres.aacrjournals.org on September 23, 2021. © 2018 American Association for Cancer Research. Author Manuscript Published OnlineFirst on October 23, 2018; DOI: 10.1158/1078-0432.CCR-18-0124 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Abstract Purpose: Few studies have investigated prognostic biomarkers in patients with intrahepatic 5 cholangiocarcinoma (ICC). Nardilysin (NRDC), a metalloendopeptidase of the M16 family, has been suggested to play important roles in inflammation and several cancer types. We herein examined the clinical significance and biological function of NRDC in ICC. Experimental Design: We measured serum NRDC levels in 98 ICC patients who underwent surgical resection in two 10 independent cohorts to assess its prognostic impact. We also analyzed NRDC mRNA levels in cancerous tissue specimens from 43 ICC patients. We investigated the roles of NRDC in cell proliferation, migration, gemcitabine sensitivity, and gene expression in ICC cell lines using gene silencing. Results: 15 High serum NRDC levels were associated with shorter overall survival and disease-free survival in the primary (n=79) and validation (n=19) cohorts. A correlation was observed between serum protein levels and cancerous tissue mRNA levels of NRDC (Spearman’s ρ=0.413, p=0.006). The gene knockdown of NRDC in ICC cell lines attenuated cell proliferation, migration, and tumor growth in xenografts, and increased sensitivity to gemcitabine. The gene knockdown of NRDC was 20 also accompanied by significant changes in the expression of several epithelial-mesenchymal transition (EMT)-related genes. Strong correlations were observed between the mRNA levels of NRDC and EMT-inducing transcription factors, ZEB1 and SNAI1, in surgical specimens from ICC patients. Conclusions: 25 Serum NRDC, a possible surrogate marker reflecting the EMT state in primary tumors, predicts the outcome of ICC after surgical resection. 5 Downloaded from clincancerres.aacrjournals.org on September 23, 2021. © 2018 American Association for Cancer Research. Author Manuscript Published OnlineFirst on October 23, 2018; DOI: 10.1158/1078-0432.CCR-18-0124 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Translational Relevance Few studies have investigated prognostic biomarkers in intrahepatic cholangiocarcinoma (ICC) that 5 may contribute to establishing adjuvant strategies. Nardilysin (NRDC), a metalloendopeptidase of the M16 family, has been suggested to play important roles in inflammation and several cancer types. The present results revealed 1) a correlation between serum NRDC levels and cancerous tissue mRNA levels of NRDC, 2) that preoperative serum NRDC levels were associated with survival and recurrence, and 3) strong correlations between the mRNA levels of NRDC and EMT- 10 inducing transcription factors, ZEB1 and SNAI1, in ICC cell lines and cancerous tissue. Based on the potential relationship between NRDC and EMT, the preoperative evaluation of serum NRDC has potential as a clinical tool for predicting the postoperative outcomes of ICC patients undergoing surgical resection. 6 Downloaded from clincancerres.aacrjournals.org on September 23, 2021. © 2018 American Association for Cancer Research. Author Manuscript Published OnlineFirst on October 23, 2018; DOI: 10.1158/1078-0432.CCR-18-0124 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Introduction Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer following hepatocellular carcinoma (HCC), accounting for 5-15% of all primary liver cancers [1-3]. There are marked geographic variations in the incidence of ICC, with a higher incidence in East Asia, while 5 the number of ICC patients has been reported to be increasing worldwide [3, 4]. The survival rate of ICC patients is poor because of the late presentation of the disease and limited therapies. Although surgical resection is the only curative treatment, 30-40% of ICC patients have surgical indications [3]. Moreover, the recurrence rate after surgical resection is 50–60% and the 5-year overall survival (OS) rate after surgical resection is only 25–31% [3, 5, 6], highlighting the need to optimize 10 adjuvant strategies. Recent evidence has suggested that adjuvant chemotherapy is associated with prolonged survival, particularly in some advanced cases [7, 8]. However, there are no established methods to define patient subgroups that need adjuvant strategies. The preoperative measurement of serum tumor markers may identify high-risk patients; however, few studies have investigated biomarkers in ICC patients possibly due to the difficulties associated with collecting large numbers 15 of serum samples from ICC patients [9-11]. Nardilysin (N-arginine dibasic convertase, NRDC) is a zinc peptidase of the M16 family that selectively cleaves dibasic sites [12, 13]. NRDC exhibits widespread expression throughout the body, and regulates multiple biological processes, such as myelination [14], body temperature homeostasis [15], and insulin secretion [16]. Although NRDC is a soluble cytosolic protein without 20 an obvious signal peptide or nuclear localization signal, it shuttles between the cytoplasm and nucleus and is secreted via an as yet unknown mechanism [17]. We