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Yuan J, Liu J, Fan R, Liu Z. HECTD3 enhances cell radiation resistance and migration by regulating LKB1 mediated ZEB1 in glioma. Eur J Neurosci 2022; 56:4275-4286. [PMID: 35768187 DOI: 10.1111/ejn.15748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/31/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
Abstract
Homologous to the E6-associated protein carboxyl terminus domain containing 3 (HECTD3) has been reported to play a role in carcinogenesis. Here, we explored the role of HECTD3 in regulating the radiation resistance of glioma, and the underlying mechanism. HECTD3 expressions in glioma tissues were assessed using Western blotting, qRT-PCR and immunohistochemistry. Glioma cells were exposed to 2, 4, 6 or 8Gy X-ray to mimic the radiation treatment. CCK-8, clone formation assay, flow cytometry assay, transwell chambers and animal assay were used to test cell viability, apoptosis, migration, invasiveness and tumorigenesis, respectively. HECTD3 expression was increased in glioma tissues, especially from patients with radiation resistance. Knockdown of HECTD3 promoted cell apoptosis and inhibited cell viability under the condition of 8Gy X-ray, as well as suppressed cell migration and invasiveness. In mechanism, HECTD3 positively regulated ZEB1 expression through regulating the ubiquitination of LKB1 protein. Overexpression of ZEB2 significantly abolished the effects of HECTD3 downregulation in inhibiting the radiation resistance and migration of glioma cells. Moreover, downregulation of HECTD3 further enhanced the anti-tumor effect of X-ray on glioma growth in vivo. In conclusion, HECTD3 was overexpressed in glioma patients with radiation resistance. Knockdown of HECTD3 sensitized glioma cells to radiation and inhibited cell migration by downregulating ZEB1 expression via regulating the ubiquitination of LKB1 protein. This study reveals that HECTD3 might be a potent target to enhance the radiation sensitivity of glioma.
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Affiliation(s)
- Jinjin Yuan
- Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Junqi Liu
- Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ruitai Fan
- Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zongwen Liu
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Chen J, Zhang Q, Zhuang Y, Liu S, Zhou X, Zhang G. Molecular mechanism of GANT61 combined with doxorubicin in the treatment of gliomas based on network pharmacology. ELECTRON J BIOTECHN 2022. [DOI: 10.1016/j.ejbt.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Caja L, Dadras MS, Mezheyeuski A, Rodrigues-Junior DM, Liu S, Webb AT, Gomez-Puerto MC, Ten Dijke P, Heldin CH, Moustakas A. The protein kinase LKB1 promotes self-renewal and blocks invasiveness in glioblastoma. J Cell Physiol 2021; 237:743-762. [PMID: 34350982 DOI: 10.1002/jcp.30542] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/10/2021] [Accepted: 07/24/2021] [Indexed: 12/13/2022]
Abstract
The role of liver kinase B1 (LKB1) in glioblastoma (GBM) development remains poorly understood. LKB1 may regulate GBM cell metabolism and has been suggested to promote glioma invasiveness. After analyzing LKB1 expression in GBM patient mRNA databases and in tumor tissue via multiparametric immunohistochemistry, we observed that LKB1 was localized and enriched in GBM tumor cells that co-expressed SOX2 and NESTIN stemness markers. Thus, LKB1-specific immunohistochemistry can potentially reveal subpopulations of stem-like cells, advancing GBM patient molecular pathology. We further analyzed the functions of LKB1 in patient-derived GBM cultures under defined serum-free conditions. Silencing of endogenous LKB1 impaired 3D-gliomasphere frequency and promoted GBM cell invasion in vitro and in the zebrafish collagenous tail after extravasation of circulating GBM cells. Moreover, loss of LKB1 function revealed mitochondrial dysfunction resulting in decreased ATP levels. Treatment with the clinically used drug metformin impaired 3D-gliomasphere formation and enhanced cytotoxicity induced by temozolomide, the primary chemotherapeutic drug against GBM. The IC50 of temozolomide in the GBM cultures was significantly decreased in the presence of metformin. This combinatorial effect was further enhanced after LKB1 silencing, which at least partially, was due to increased apoptosis. The expression of genes involved in the maintenance of tumor stemness, such as growth factors and their receptors, including members of the platelet-derived growth factor (PDGF) family, was suppressed after LKB1 silencing. The defect in gliomasphere growth caused by LKB1 silencing was bypassed after supplementing the cells with exogenous PFDGF-BB. Our data support the parallel roles of LKB1 in maintaining mitochondrial homeostasis, 3D-gliomasphere survival, and hindering migration in GBM. Thus, the natural loss of, or pharmacological interference with LKB1 function, may be associated with benefits in patient survival but could result in tumor spread.
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Affiliation(s)
- Laia Caja
- Department of Medical Biochemistry and Microbiology and Ludwig Institute for Cancer Research, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
| | - Mahsa Shahidi Dadras
- Department of Medical Biochemistry and Microbiology and Ludwig Institute for Cancer Research, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden.,Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Artur Mezheyeuski
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Dorival Mendes Rodrigues-Junior
- Department of Medical Biochemistry and Microbiology and Ludwig Institute for Cancer Research, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
| | - Sijia Liu
- Department of Cell and Chemical Biology, Oncode Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna Taylor Webb
- Department of Medical Biochemistry and Microbiology and Ludwig Institute for Cancer Research, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden.,Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Catalina Gomez-Puerto
- Department of Cell and Chemical Biology, Oncode Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Ten Dijke
- Department of Cell and Chemical Biology, Oncode Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Carl-Henrik Heldin
- Department of Medical Biochemistry and Microbiology and Ludwig Institute for Cancer Research, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
| | - Aristidis Moustakas
- Department of Medical Biochemistry and Microbiology and Ludwig Institute for Cancer Research, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
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Ren YH, Zhao FJ, Mo HY, Jia RR, Tang J, Zhao XH, Wei JL, Huo RR, Li QQ, You XM. Association between LKB1 expression and prognosis of patients with solid tumours: an updated systematic review and meta-analysis. BMJ Open 2019; 9:e027185. [PMID: 31383697 PMCID: PMC6687027 DOI: 10.1136/bmjopen-2018-027185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Liver kinase B1 (LKB1) is considered a tumour suppressor that can control cell growth and metabolism. Whether LKB1 expression levels are related to clinicopathology and prognosis is controversial. This review aimed to quantitatively examine the latest evidence on this question. DESIGN An updated systematic review and meta-analysis on the association between LKB1 expression and prognosis of patients with solid tumours were performed. DATA SOURCES Eligible studies were identified through literature searches from database establishment until 15 June 2018 in the following databases: Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure and Wan Fang databases. ELIGIBILITY CRITERIA The association between LKB1 expression and clinicopathological characteristics, overall survival (OS), disease-free survival (DFS) and relapse-free survival (RFS) of patients with solid tumours were reported. Sufficient data were available to calculate the OR or HR and 95% CI. DATA EXTRACTION AND SYNTHESIS Relevant data were meta-analysed for OS, DFS, RFS and various clinical parameters. RESULTS The systematic review included 25 studies containing 6012 patients with solid tumours. Compared with patients with high LKB1 expression, patients with low expression showed significantly shorter OS in univariate analysis (HR=1.63, 95% CI 1.35 to 1.97, p<0.01) and multivariate analysis (HR=1.61, 95% CI 1.26 to 2.06, p<0.01). In contrast, the two groups showed similar DFS in univariate analysis (HR=1.49, 95% CI 0.73 to 3.01, p=0.27) as well as similar RFS in univariate analysis (HR=1.44, 95% CI 0.65 to 3.17, p=0.37) and multivariate analysis (HR=1.02, 95% CI 0.42 to 2.47, p=0.97). Patients with low LKB1 expression showed significantly worse tumour differentiation (OR=1.71, 95% CI 1.14 to 2.55, p<0.01), larger tumours (OR=1.68, 95% CI 1.24 to 2.27, p<0.01), earlier lymph node metastasis (OR=1.43, 95% CI 1.26 to 1.62, p<0.01) and more advanced tumour, node, metastases (TNM) stage (OR=1.80, 95% CI 1.56 to 2.07, p<0.01). CONCLUSION Low LKB1 expression predicts shorter OS, worse tumour differentiation, larger tumours, earlier lymph node metastasis and more advanced TNM stage. Low LKB1 expression may be a useful biomarker of poor clinicopathology and prognosis.
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Affiliation(s)
- Yun Hong Ren
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Feng Juan Zhao
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Han Yue Mo
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Rong Rong Jia
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Juan Tang
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xin Hua Zhao
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jue Ling Wei
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Rong Rui Huo
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qiu Qin Li
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xue Mei You
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, Guangxi, China
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Zhang K, Wang J, Wang J, Luh F, Liu X, Yang L, Liu YR, Su L, Yang YCSH, Chu P, Yen Y. LKB1 deficiency promotes proliferation and invasion of glioblastoma through activation of mTOR and focal adhesion kinase signaling pathways. Am J Cancer Res 2019; 9:1650-1663. [PMID: 31497348 PMCID: PMC6726989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023] Open
Abstract
Liver kinase B1 (LKB1), a serine/threonine kinase, is frequently inactivated in several types of human cancers. To date, inactivation of LKB1 tumor suppressor has rarely been reported in glioblastoma. In this study, we investigated LKB1 status, biological significance, and therapeutic implications in glioblastoma. Loss of LKB1 immunostaining was identified in 8.6% (5/58), while decrease of LKB1 immunostaining was found in 29.3% (17/58) of glioblastoma tissues. Notably, mining TCGA database of LKB1 expression in glioblastoma revealed that lower mRNA level of LKB1 was associated with shorter survival in glioblastoma. We found that knockdown of LKB1 significantly promoted in vitro proliferation, adhesion, invasion, and metformin-induced apoptosis, and simultaneously enhanced activation of ERK and mammalian-target of rapamycin (mTOR) signaling pathways in LKB1-compenent U87 and T98 glioblastoma cells. Moreover, global transcriptional profiling revealed that adhesion and cytoskeletal proteins such as Vinculin, Talin and signaling pathways including focal adhesion kinase (FAK), extracellular martrix (ECM) receptor interaction, and cellular motility were significantly enriched in U87 and T98 glioblastoma cells upon LKB1 knockdown. Additionally, we demonstrated that the enhanced activation of FAK by LKB1 knockdown was dependent on differentially expressed cytoskeletal proteins in these glioblastoma cells. Importantly, we further found that mTOR1 inhibitor rapamycin dominantly inhibited in vitro cellular proliferation, while FAK inhibitor PF-573288 drastically decreased invasion of LKB1-attenuated glioblastoma cells. Therefore, downregulation of LKB1 may contribute to the pathogenesis and malignancy of glioblastoma and may have potential implications for stratification and treatment of glioblastoma patients.
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Affiliation(s)
- Keqiang Zhang
- Department of Surgery, City of Hope National Medical CenterDuarte, CA, USA
| | - Jinghan Wang
- The First Department of Biliary Surgery, Eastern Hepatobiliary Surgical HospitalShanghai, China
| | - Jinhui Wang
- The Integrative Genomics Core Lab, City of Hope National Medical CenterDuarte, CA, USA
| | - Frank Luh
- Sino-American Cancer FoundationTemple City, CA, USA
| | - Xiyong Liu
- Sino-American Cancer FoundationTemple City, CA, USA
| | - Lu Yang
- Department of System Biology, City of Hope National Medical CenterDuarte, CA, USA
| | - Yun-Ru Liu
- Comprehensive Cancer Center, Taipei Medical UniversityTaipei, Taiwan
| | - Leila Su
- Sino-American Cancer FoundationTemple City, CA, USA
| | - Yu-Chen SH Yang
- PhD Program of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical UniversityTaipei, Taiwan
| | - Peiguo Chu
- Department of Pathology, City of Hope National Medical CenterDuarte, CA, USA
| | - Yun Yen
- Comprehensive Cancer Center, Taipei Medical UniversityTaipei, Taiwan
- PhD Program of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical UniversityTaipei, Taiwan
- Research Center of Cancer Translational Medicine, Taipei Medical UniversityTaipei, Taiwan
- Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical UniversityTaipei, Taiwan
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Zhao P, Wang M, An J, Sun H, Li T, Li D. A positive feedback loop of miR-30a-5p-WWP1-NF-κB in the regulation of glioma development. Int J Biochem Cell Biol 2019; 112:39-49. [PMID: 30978403 DOI: 10.1016/j.biocel.2019.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/22/2019] [Accepted: 04/08/2019] [Indexed: 01/08/2023]
Abstract
Previous studies demonstrated that miR-30a-5p promotes glioma cell growth and invasion. Furthermore, WWP1 (WW domain containing E3 ubiquitin protein ligase 1) inhibits NF-κB activation that is strongly correlated with gliomagenesis. Using the GEO database and bioinformatics analyses, we identified WWP1 was downregulated in glioma tissues and might be a putative target for miR-30a-5p. Hence, this study aims to explore the interaction among miR-30a-5p, WWP1, and NF-κB and their roles in the regulation of glioma development. We found decreased WWP and increased miR-30a-5p expression and p65 phosphorylation in glioma tissues. Furthermore, WWP1 mRNA level was negatively correlated with miR-30a-5p expression in glioma tissues. Interestingly, miR-30a-5p targeted WWP1 expression. Additionally, NF-κB p65 overexpression increased miR-30a-5p expression through direct binding of NF-κB RelA subunit to the promoter of miR-30a-5p. We also confirmed that WWP1 overexpression decreased phosphorylation of NF-κB p65. Importantly, miR-30a-5p promoted glioma cell proliferation, migration, and invasion via targeting WWP1. Furthermore, NF-κB p65 overexpression inhibited WWP1 expression and promoted glioma cell malignant behaviors via inducing miR-30a-5p transcription. Moreover, WWP1 overexpression decreased miR-30a-5p expression and inhibited glioma cell malignant behaviors via inhibiting NF-κB p65. Our further assay showed that WWP1 inhibited in vivo growth of xenograft tumors of glioma cells, accompanied with a decrease in miR-30-5p expression and phosphorylation of NF-κB p65. In conclusion, there is a "miR-30a-5p-WWP1-NF-κB" positive feedback loop, which plays an important role in regulating glioma development and might provide a potential therapeutic strategy for treating glioma.
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Affiliation(s)
- Peichao Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan Province, China.
| | - MengMeng Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan Province, China
| | - Jiyang An
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan Province, China
| | - Hongwei Sun
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan Province, China
| | - Tianhao Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan Province, China
| | - Dongming Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan Province, China
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Yuan Y, Li SL, Cao YL, Li JJ, Wang QP. LKB1 suppresses glioma cell invasion via NF-κB/Snail signaling repression. Onco Targets Ther 2019; 12:2451-2463. [PMID: 31040689 PMCID: PMC6452796 DOI: 10.2147/ott.s193736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Liver kinase B1 (LKB1) is involved in various human diseases. Aberrant expression of LKB1 expression is involved in glioma progression and associated with prognosis, however, the specific mechanism involving NF-κB/Snail signaling pathways remain unknown. Materials and methods In the present study, quantitative real-time PCR analysis was used to investigate the expression of LKB1 tumor tissue samples and cell lines. In glioma cell lines, CCK-8 assay, transwell invasion and migration assays were used to investigate the effects of LKB1on proliferation and invasion. Results We observed that LKB1 knockdown promoted glioma cell proliferation, migration and invasion. This effect was induced through NF-κB/Snail signaling activation. Also, LKB1 overexpression suppressed proliferation, migration, and invasion, which could be rescued by Snail overexpression. Conclusion Taken together, our results show that LKB1 knockdown promotes remarkably glioma cell proliferation, migration and invasion by regulating Snail protein expression through activating the NF-κB signaling. This may serve as a potential prognostic marker and therapeutic target for glioma.
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Affiliation(s)
- Ye Yuan
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China,
| | - Shi-Lin Li
- Department of Neurology, Qitaihe Qimei Hospital, Qitaihe 154600, People's Republic of China
| | - Yu-Lin Cao
- Department of Hematology, Wuhan General Hospital of Guangzhou Military Area Command, Wuhan 430070, People's Republic of China
| | - Jun-Jun Li
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China,
| | - Qiang-Ping Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China,
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Li N, Shi H, Zhang L, Li X, Gao L, Zhang G, Shi Y, Guo S. miR-188 Inhibits Glioma Cell Proliferation and Cell Cycle Progression Through Targeting β-Catenin. Oncol Res 2017; 26:785-794. [PMID: 29268818 PMCID: PMC7844764 DOI: 10.3727/096504017x15127309628257] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
MicroRNAs (miRNAs) play important roles in several human cancers. Although miR-188 has been suggested to function as a tumor repressor in cancers, its precise role in glioma and the molecular mechanism remain unknown. In the present study, we investigated the effect of miR-188 on glioma and explored its relevant mechanisms. We found that the expression of miR-188 is dramatically downregulated in glioma tissues and cell lines. Subsequent investigation revealed that miR-188 expression was inversely correlated with β-catenin expression in glioma tissue samples. Using a luciferase reporter assay, β-catenin was determined to be a direct target of miR-188. Overexpression of miR-188 reduced β-catenin expression at both the mRNA and protein levels, and inhibition of miR-188 increased β-catenin expression. Moreover, we found that overexpression of miR-188 suppressed glioma cell proliferation and cell cycle G1–S transition, whereas inhibition of miR-188 promoted glioma cell proliferation. Importantly, silencing β-catenin recapitulated the cellular and molecular effects seen upon miR-188 overexpression, which included inhibiting glioma cell proliferation and G1–S transition. Taken together, our results demonstrated that miR-188 inhibits glioma cell proliferation by targeting β-catenin, representing an effective therapeutic strategy for glioma.
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Affiliation(s)
- Nan Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Hangyu Shi
- Department of Neurosurgery, Xi'an Children's Hospital, Xi'an, Shaanxi, P.R. China
| | - Lu Zhang
- Department of Foreign Languages, Ming De College of Northwestern Polytechnical University, Xi'an, Shaanxi, P.R. China
| | - Xu Li
- Department of First Internal Medicine, Shaanxi Province Tumor Hospital, Xi'an, Shaanxi, P.R. China
| | - Lu Gao
- Department of Neurosurgery, Xi'an Children's Hospital, Xi'an, Shaanxi, P.R. China
| | - Gang Zhang
- Department of Neurosurgery, Xi'an Children's Hospital, Xi'an, Shaanxi, P.R. China
| | - Yongqiang Shi
- Department of Neurosurgery, Xi'an Children's Hospital, Xi'an, Shaanxi, P.R. China
| | - Shiwen Guo
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
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