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Abstract

  1. Top of page
  2. Abstract
  3. Patients and Methods
  4. Results
  5. Discussion
  6. References
  7. Supporting Information

Angiopoietin-like protein 4 (ANGPTL4) plays complex and often contradictory roles in vascular biology and tumor metastasis, but little is known about its function in hepatocellular carcinoma (HCC) metastasis. In the present study, we showed that hypoxia-inducible factor 1α (HIF-1α) directly up-regulates ANGPTL4, and its stableness positively correlates with ANGPTL4 expression in HCC tissue. Overexpression of ANGPTL4 significantly increased HCC cell transendothelial migration in vitro and intrahepatic and distal pulmonary metastasis in vivo, whereas silencing ANGPTL4 expression or treatment with a neutralizing antibody specific for ANGPTL4 protein resulted in a reduced transendothelial migration. We also found that serum ANGPTL4 is higher in HCC patients, compared to healthy control, and correlates with intrahepatic metastasis and histological grade. Further, secreted ANGPTL4 promotes transendothelial migration and metastasis of HCC cells in vitro and in vivo through the up-regulation of vascular cell adhesion molecule-1 (VCAM-1) of human umbilical vein endothelial cells and the activation of the VCAM-1/integrin β1 axis. Conclusion: ANGPTL4 is a target gene of HIF-1α and acts as an important regulator in the metastasis of HCC. Serum ANGPTL4 correlates with tumor progression and metastasis and might be used to indicate prognosis in HCC patients. (HEPATOLOGY 2011 54:910–919;)

Hepatocellular carcinoma (HCC) is one of the most common malignancies and a leading cause of cancer-related mortality in the world.1 Tumor recurrence and metastasis are the main causes of death in patients with HCC. Accumulating evidence suggests that tumor metastasis is a complex process influenced by multiple procedures and multiple mediators in human cancers2, 3; however, the biology controlling HCC metastasis remains poorly understood.

Angiopoietin-like protein 4 (ANGPTL4) is a member of the angiopoietin family and encodes a secretory glycoprotein that is highly expressed in adipose tissue, liver, and placental tissue, as well as in ischemic tissues. ANGPTL4 is also known as pp1158, peroxisome proliferator-activated receptor-gamma–induced angiopoietin-related protein, fasting-induced adipose factor, or hepatic fibrinogen/angiopoietin-related protein. ANGPTL4 plays an important role in lipid metabolism,4-7 but little is known about its role in tumor metastasis. Previous studies have suggested that the functions of ANGPTL4 in regulating angiogenesis and metastasis are diverse and often contradictory in different tissue contexts. Similar to angiopoietins and other members of the angiopoietin-like family that have been shown to regulate angiogenesis,8-10 ANGPTL4 is a proangiogenic factor in arthritis, conventional renal cell carcinoma and breast cancer, and it induces endothelial cell sprouting11-14; however, data from several independent laboratories have demonstrated that ANGPTL4 is also a potent antiangiogenic factor.15-17 ANGPTL4 remarkably prevents the metastatic process through the inhibition of vascular permeability, tumor cell motility, and invasiveness in murine Lewis lung carcinoma (3LL) and melanoma (B16F0) cells.18 Of note, a more recent report showed that ANGPTL4 promotes tumor metastasis by disrupting the integrity of vascular endothelial cell layers and facilitating the passage of breast cancer cells.19 Another study of Kaposi's sarcoma further supports the hypothesis that ANGPTL4 can promote angiogenesis and vascular permeability.20 ANGPTL4 expression, in some tissues, correlates with metastasis-related clinicopathological characteristics in human gastric cancer, esophageal squamous cell carcinoma, and colorectal cancer,21-23 indicating that ANGPTL4 might play an important role in the metastasis of human cancer.

Hypoxia is commonly associated with the environment of solid tumors and promotes invasion, metastasis, and malignancy.24 High expression of hypoxia-inducible factor 1 alpha (HIF-1α) in HCC specimens (51.39%) is found and significantly correlates with venous invasion and lymph-node invasion.25, 26 Previous studies have shown that hypoxia up-regulates ANGPTL4 in human articular chondrocytes, endothelial cells, cardiomyocytes, and certain cancer cells.13, 20, 27-30 Moreover, ANGPTL4 mRNA is expressed in the perinecrotic areas of some human tumors.13 However, it is not fully understood whether hypoxia up-regulates ANGPTL4 in HCC, and the mechanism that hypoxia regulates ANGPTL4 expression remains unclear.

In our previous study, we found that ANGPTL4 could stimulate angiogenesis in vitro and in vivo.31 Here, we evaluated, for the first time, the relationship between the expression of ANGPTL4 and HIF-1α in HCC, and demonstrated that ANGPTL4 levels positively correlated with HIF-1α expression. Moreover, ANGPTL4 is a target gene of HIF-1α. Our comprehensive investigation of the role of ANGPTL4 in HCC metastasis indicates that ANGPTL4, particularly the secreted form, is a positive regulator of HCC metastasis.

Patients and Methods

  1. Top of page
  2. Abstract
  3. Patients and Methods
  4. Results
  5. Discussion
  6. References
  7. Supporting Information

Materials and methods are outlined in Supporting Materials and Methods.

Results

  1. Top of page
  2. Abstract
  3. Patients and Methods
  4. Results
  5. Discussion
  6. References
  7. Supporting Information

ANGPTL4 Is Induced by Hypoxia in HCC Cells.

To explore the effect of hypoxia on ANGPTL4 expression, HCC cell lines were cultured under hypoxic conditions (2% O2) for 24 hours. We found that ANGPTL4 expression was significantly increased at the mRNA and protein levels in HCC cell lines under hypoxic conditions (Fig. 1A,B). Deferoxamine mesylate (DFO), a known HIF-1α activator, induced HIF-1α expression in a concentration-dependent manner and up-regulated ANGPTL4 in MHCC-97L and SMMC-7721 cells (Fig. 1C).

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Figure 1. Hypoxia induces ANGPTL4 expression in HCC cells. (A) Relative mRNA expression of ANGPTL4 was determined by quantitative polymerase chain reaction in SMMC-7721, Huh7, and MHCC-97L cells cultured under normoxic or hypoxic conditions for 24 hours. (B) Western blotting of HIF-1α and ANGPTL4 in SMMC-7721, Huh7, and MHCC-97L cells cultured under normoxia (Nor) or hypoxia (Hyp) for 24 hours. (C) Western blotting of HIF-1α and ANGPTL4 after treatment with DFO in MHCC-97L cells and SMMC-7721 cells. (D) Representative images of xenograft tumors formed by MHCC-97L cells and SMMC-7721 cells, which were immunofluorescent stained with anti-HIF-1α antibody (green), anti-ANGPTL4 antibody (red), and merge (yellow) (original magnification: 400×). White dotted line indicates the boundary of the necrotic/hypoxic area. N, necrotic area; H, hypoxic area. (E) Immunohistochemical staining of ANGPTL4 and HIF-1α in HCC tissues (original magnification: 400×). HCC-1, scores 0; HCC-2, scores 1; HCC-3, scores 2. (F) Western blotting of HIF-1α and ANGPTL4 from representative HCC tissue samples.

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To further investigate the effect of hypoxia on the induction of ANGPTL4 expression in vivo, MHCC-97L and SMMC-7721 cells were xenografted subcutaneously into BALB/c (nu/nu) mice. The xenograft tumor masses were stripped gently once a week after tumor implantation and then subjected to immunofluorescent staining. We found that ANGPTL4 was significantly up-regulated with increasing tumor size and increasing degree of hypoxia in the tumor masses, and ANGPTL4 colocalized with HIF-1α in the hypoxic areas surrounding the necrotic fields (Fig. 1D). To better understand the correlation between HIF-1α and ANGPTL4 expression in HCC tissues, immunohistochemical staining was performed. High expressions of HIF-1α and ANGPTL4 were found in tumor specimens, and ANGPTL4 protein levels in HCC tissues positively correlated with HIF-1α expression (r = 0.631, P < 0.001) (Fig. 1E,F; Table 1), suggesting that ANGPTL4 might be up-regulated by the expression of HIF-1α in HCC.

Table 1. Correlation Between HIF-1α and ANGPTL4 Expression in HCC Tissues
 ANGPTL4 Scores
0 (%)1 (%)2 (%)
  1. r = 0.631, P = 0.000.

  2. Abbreviations: HIF-1α, hypoxia-inducible factor 1α; ANGPTL4, angiopoietin-like protein 4; HCC, hepatocellular carcinoma.

HIF-1α scores029 (60.4)14 (21.5)5 (4.1)
115 (31.3)27 (41.5)20 (16.3)
24 (8.3)24 (36.9)98 (79.6)

HIF-1α Mediates Hypoxia-Induced ANGPTL4 Overexpression in HCC Cell Lines.

To further clarify the role of HIF-1α in regulating ANGPTL4 expression, we knocked down HIF-1α and HIF-2α (another alpha subunit of the HIF protein) using siRNA in MHCC-97L and SMMC-7721 cells. Under hypoxic conditions, silencing of HIF-1α significantly down-regulated ANGPTL4 (Fig. 2A; Supporting Fig. 1A), whereas silencing of HIF-2α did not affect ANGPTL4 expression (Fig. 2B; Supporting Fig. 1B). 2-methoxyestradiol (2ME2), a small molecule, has promising antitumor and antiangiogenic activity and can down-regulate HIF-1α in a number of tumors.32 We found that hypoxia-induced HIF-1α and ANGPTL4 protein levels decreased after treatment with 2ME2 under hypoxic conditions in MHCC-97L and SMMC-7721 cells (Fig. 2C; Supporting Fig. 1C).

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Figure 2. HIF-1α directly mediates hypoxia-induced ANGPTL4 expression. (A) Western blotting of HIF-1α and ANGPTL4 of MHCC-97L cells in HIF-1α siRNA experiments under hypoxia (Hyp). (B) Western blotting of HIF-2α and ANGPTL4 of MHCC-97L cells in HIF-2α siRNA experiments under hypoxia (Hyp). In (A and B), western blotting of HIF-1α, HIF-2α, and ANGPTL4 were quantified relative to β-actin. Quantifications represent the mean ± standard deviation of three independent experiments. (C) Effect of 2ME2 treatment on HIF-1α and ANGPTL4 expression in MHCC-97L cells under hypoxia (Hyp). (D) Bioinformatics analysis showed five potential HREs within the 2.2-kb region upstream of the transcriptional start site of ANGPTL4. (E) ChIP experiments were performed in MHCC-97L cells and SMMC-7721 cells grown under normoxia (Nor) or hypoxia (Hyp) for 24 hours, demonstrating that HIF-1α binds at HRE1. Genomic DNA input was 5%.

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To investigate whether the ANGPTL4 gene is a direct target of HIF-1α, chromatin immunoprecipitation (ChIP) assays were performed in MHCC-97L and SMMC-7721 cells. Bioinformatics analysis showed five potential hypoxia-responsive elements (HREs) within a 2.2-kb (kilobase) region upstream of the transcriptional start site of ANGPTL4 (Fig. 2D). ChIP assay analysis showed that the anti-HIF-1α antibody could precipitate HRE1 (−206 to −202), but not other HREs (Fig. 2E; Supporting Fig. 1D). This result indicates that hypoxia can, indeed, significantly up-regulate ANGPTL4 by promoting HIF-1α expression.

ANGPTL4 Can Promote Transendothelial Migration of HCC Cell Lines In Vitro and Increase the Metastatic Potential of HCC Cells In Vivo.

Hypoxia plays an important role in promoting metastasis and tumor progression,24, 33 and ANGPTL4 facilitates the transendothelial passage of breast cancer cells by disrupting the integrity of vascular endothelial cell layers.19 In addition, we found that ANGPTL4 expression was significantly increased in metastatic HCC cell lines MHCC-97, MHCC-97L, MHCC-97H, and MHCC-LM3 (Supporting Fig. 2). To better understand the function of ANGPTL4 in HCC metastasis, we first established two stable ANGPTL4 overexpressing cell lines, SMMC-7721-lenti-ANGPTL4 and Huh7-lenti-ANGPTL4, using a lentivirus vector (Supporting Fig. 3A-C). Transendothelial migration assays were preformed, and the results showed that SMMC-7721-lenti-ANGPTL4 and Huh7-lenti-ANGPTL4 cells traversed more efficiently through the endothelial cell monolayer into the lower chamber of the transwell, when compared with the empty vector-infected cells (P < 0.001) (Fig. 3A,B).

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Figure 3. ANGPTL4 enhances HCC cell transendothelial migration in vitro and increases the metastatic potential of HCC cells in vivo. (A) Transendothelial migration assays in stable ANGPTL4-expressing SMMC-7721 and (B) Huh7 cells. Representative images are shown, along with the quantification of six randomly selected fields (original magnification: 200×). (C) Representative images of intrahepatic and distant metastatic nodules formed by SMMC-7721-lenti-ANGPTL4 cells or vector control are shown, along with the number of metastatic nodules in the livers or lungs (n = 14 mice each group) (original magnification: a, b, e, and f, 100×; c, d, g, and h, 400×). (D) Transendothelial migration assays of MHCC-97L cells transfected with shANGPTL4, shNC, or vector. The silencing effect of shANGPTL4 was validated by western blotting. (E) Transendothelial migration assays of MHCC-97L cells treated with ANGPTL4-neutralizing antibody or rabbit immunoglobulin G (IgG) control. (F) Transendothelial migration assays of SMMC-7721 cells treated with ANGPTL4-neutralizing antibody or rabbit IgG control under normoxic (Nor) or hypoxic (Hyp) conditions. In (D-F), results are representative of three independent experiments.

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To further clarify the role of ANGPTL4 in HCC metastasis in vivo, SMMC-7721-lenti-ANGPTL4 and SMMC-7721-lenti-control cells were orthotopically inoculated in the left hepatic lobe of mice with a microsyringe. Histological examination of lung and liver tissues indicated that ANGPTL4-overexpressing tumor-bearing mice had significantly higher numbers of pulmonary and intrahepatic metastatic nodules than those bearing vector control tumors (P < 0.05) (Fig. 3C).

We also verified the effects of endogenous ANGPTL4 on the transendothelial migration of HCC cells using short-hairpin (sh)RNA knockdown. As shown in Figure 3D, knockdown of ANGPTL4 markedly inhibited the migration of MHCC-97L cells (P = 0.001). Interestingly, treatment with a neutralizing antibody specific for ANGPTL4 full-length protein could partially block the transendothelial migration of MHCC-97L cells (P < 0.001) (Fig. 3E). To determine the potential role of HIF-1α-induced ANGPTL4 expression in HCC metastasis, a transendothelial migration assay was performed under hypoxic conditions. Results showed that treatment with the ANGPTL4-neutralizing antibody could partially inhibit the transendothelial migration of SMMC-7721 cells induced by hypoxia (P < 0.001) (Fig. 3F). These results indicate that ANGPTL4 is a positive metastatic regulator of HCC.

Secreted ANGPTL4 Promotes HCC Metastasis.

Bioinformatics analysis indicates that ANGPTL4 has a secretory signal peptide sequence and encodes a secretory glycoprotein. We detected and compared serum ANGPTL4 protein levels in 90 healthy individuals, 118 chronic hepatitis B patients, and 463 HCC patients. Serum ANGPTL4 levels were significantly higher in chronic hepatitis B patients (86.0 ± 81.8 ng/mL) than in normal controls (55.6 ± 30.9 ng/mL) (P = 0.002), but lower than in HCC patients (115.0 ± 117.0 ng/mL) (P = 0.010) (Fig. 4A). Further analysis showed that ANGPTL4 levels were significantly higher in HCC patients with intrahepatic metastasis (145.8 ± 112.0 ng/mL) than in those without intrahepatic metastasis (106.5 ± 66.9 ng/mL) (P < 0.001) (Fig. 4B). In addition, ANGPTL4 levels were higher in HCC patients with macrovascular invasion (188.7 ± 203.5 ng/mL) than in those without macrovascular invasion (116.3 ± 88.3 ng/mL) (Supporting Fig. 4A), whereas ANGPTL4 levels were not elevated in HCC patients with hepatitis B virus (HBV) infection, HCC patients with cirrhosis, or HCC patients with extrahepatic metastasis (Supporting Fig. 4B-D). To determine the relationship between serum ANGPTL4 levels and clinicopathologic parameters, a cut-off value of 93.5 ng/mL was determined with a sensitivity of 44.7% and specificity of 87.4% by receiver operating characteristic analysis (Supporting Fig. 4E). With respect to clinicopathologic features, we found that high levels of serum ANGPTL4 positively correlated with intrahepatic metastasis, histological grade, and liver cirrhosis present in HCC patients (Table 2), indicating that secreted ANGPTL4 plays an important role in HCC progression.

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Figure 4. Serum ANGPTL4 was significantly increased in HCC patients, and secreted ANGPTL4 could promote lung metastasis of HCC cells. (A) Serum ANGPTL4 levels were determined by enzyme-linked immunosorbent assay in normal control (n = 90), chronic hepatitis B patients (n = 118), and HCC patients (n = 463). (B) Serum ANGPTL4 levels in HCC patients with intrahepatic metastasis (n = 47) and without intrahepatic metastasis (n = 97). (C) Numbers of mice with liver and lung metastases in CM assays are shown in the table. (D) Representative images of liver and lung metastatic nodules formed by MHCC-97L cells in conditioned medium assays (original magnification: a, b, e, and f, 50×; c, d, g, and h, 400×).

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Table 2. Correlation Between Secreted ANGPTL4 Levels in HCC Patients and Their Clinicopathologic Characteristics
Clinical PathologyANGPTL4 Negative (<93.5 ng/mL) n (%)ANGPTL4 Positive (≥93.5 ng/mL) n (%)P Value
  • P value represents the probability from a chi-square test for serum ANGPTL4 levels between variable subgroups.

  • *

    P < 0.05.

  • Abbreviations: ANGPTL4, angiopoietin-like protein 4; HCC, hepatocellular carcinoma; AFP, alpha-fetoprotein; HBV, hepatitis B virus.

Gender
 Male54 (84.4)55 (68.8)0.030*
 Female10 (15.6)25 (31.2) 
Age
 ≤5034 (53.1)31 (38.8)0.085
 >5030 (46.9)49 (61.2) 
AFP (ng/mL)
 ≤2022 (35.5)32 (40.5)0.543
 >2040 (64.5)47 (59.5) 
HBV infection
 Absent13 (20.6)13 (17.1)0.595
 Present50 (79.4)63 (82.9) 
Tumor size (cm)
 <312 (18.8)16 (20.3)0.674
 3-519 (29.7)28 (35.4) 
 >533 (51.6)35 (44.3) 
Histological grade
 I2 (3.1)4 (5.0)0.019*
 II33 (51.6)28 (35.0) 
 III20 (31.2)19 (23.8) 
 IV9 (14.1)29 (36.2) 
Intrahepatic metastasis
 Absent49 (76.6)48 (60.0)0.035*
 Present15 (23.4)32 (40.0) 
Cirrhosis
 Absent10 (15.6)4 (5.0)0.032*
 Present54 (84.4)76 (95.0) 

To evaluate the function of secreted ANGPTL4 in the metastasis of HCC cells, conditioned medium (CM) was collected from COS7-lenti-ANGPTL4 or COS7-lenti-control cells, which were established by transduction with a lentiviral vector expressing ANGPTL4 or an empty lentiviral vector (Supporting Fig. 5B). CM assays were performed, and histological analysis of lung and liver tissues showed that ANGPTL4-containing CM could significantly promote lung metastasis of MHCC-97L cells, when compared with CM from vector control cells (P < 0.05) (Fig. 4C,D).

Secreted ANGPTL4 Can Up-Regulate Vascular Cell Adhesion Molecule-1 in Human Umbilical Vein Endothelial Cells.

It has been reported that lipopolysaccharide (LPS) administration and a variety of cytokines, including tumor necrosis factor γ, interleukin-1 beta (IL-1β), and interferon up-regulate ANGPTL4,34 and some of these factors also stimulate the expression of vascular cell adhesion molecule-1 (VCAM-1) in endothelial cells.35, 36 In this context, the question arises as to whether secreted ANGPTL4 regulates VCAM-1 expression in human umbilical vein endothelial cells (HUVECs). VCAM-1, which is expressed on the surface of endothelial cells, mediates cellular adhesion via integrin α4β1.37, 38 The integrin α4β1/VCAM-1 pathway was reported to mediate the transendothelial migration of lymphoma cells.39 By western blotting, we found that integrin α4 and integrin β1 could be detected in HCC cell lines (Supporting Fig. 5C). After HUVECs were exposed to CM for 24 hours, VCAM-1 expression increased at protein level in the ANGPTL4-containing CM treatment group (Fig. 5A). When intrinsic VCAM-1 expression was knocked down in HUVECs (Fig. 5B), the transendothelial migration of SMMC-7721-lenti-ANGPTL4 cells was also significantly reduced (P < 0.05) (Fig. 5C). Consistent with these results, silencing of integrin β1 expression in SMMC-7721-lenti-ANGPTL4 cells resulted in a remarkable decrease in transendothelial migration (P < 0.05) (Fig. 5D,E). In addition, the transendothelial migration of SMMC-7721 cells was increased after treatment with ANGPTL4-containing CM (P < 0.05), but simultaneous treatment with integrin β1 antibody or ANGPTL4 antibody could reduce the transendothelial migration of SMMC-7721 cells induced by ANGPTL4-containing CM (P < 0.05) (Supporting Fig. 6A,B).

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Figure 5. Secreted ANGPTL4 up-regulates VCAM-1 in HUVECs and affects transendothelial migration through the VCAM-1/integrin β1 axis. (A) Western blotting of VCAM-1 in HUVECs after treatment with CM containing ANGPTL4 or control. (B) Silencing effect of VCAM-1 was validated by western blotting in HUVECs. (C) Transendothelial migration assays of SMMC-7721-lenti-control and SMMC-7721-lenti-ANGPTL4 cells were performed after transfection with siRNA specific for VCAM-1, negative control (NC), or MOCK in HUVECs. (D) Silencing of ITGB1 (encoding integrin β1) was validated by western blotting in SMMC-7721 cells. (E) Transendothelial migration assays of SMMC-7721-lenti-control and SMMC-7721-lenti-ANGPTL4 cells were performed after transfection with siRNA specific for ITGB1, NC, or MOCK. In (C and E), representative images are shown, along with the quantification of six randomly selected fields (original magnification: 200×).

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VCAM-1 expression in endothelial cells is usually regulated by the transcription factor, nuclear factor kappa light-chain enhancer of activated B cells (NF-κB), in a cytokine-responsive manner.35, 36 We analyzed the expression of molecules in the NF-κB-signaling pathway, and found that phosphorylation levels of p65 increased and inhibitor of nuclear factor kappa B beta (IκB-β) expression decreased in HUVECs after ANGPTL4-containing CM treatment (Supporting Fig. 6C).

Therefore, we concluded that ANGPTL4 could promote HCC cell transendothelial migration by up-regulating VCAM-1 in HUVECs.

Discussion

  1. Top of page
  2. Abstract
  3. Patients and Methods
  4. Results
  5. Discussion
  6. References
  7. Supporting Information

Metastasis and recurrence are the most important prognostic factors for HCC patients.40, 41 Therefore, it is extremely important to explore the molecular events governing the pathogenesis of cancer metastasis in HCC. Here, we show that overexpression of ectopic ANGPTL4 could significantly enhance the transendothelial migration of HCC cells in vitro and promote both intrahepatic metastasis and lung metastasis in vivo. Knockdown of ANGPTL4 or treatment with ANGPTL4-neutralizing antibody decreased the metastatic potential of HCC cells in vitro. These results strongly suggest that ANGPTL4 acts as an enhancer of HCC cell metastatic potential. The role of ANGPTL4 in HCC cells fits with the previously described roles of ANGPTL4 as an inhibitor of endothelial integrity that mediates lung metastasis seeding19 or an enhancer of cell migration during wound healing, which shares numerous characteristics during cell migration in metastasis.42, 43 In some cancers, however, several reports have indicated discordant roles for ANGPTL4 in tumor dissemination; ANGPTL4 has been shown to act as a potent antiangiogenic factor15-17 and even prevents metastasis through reduced vascular permeability.18 These diverse results suggest that ANGPTL4 may have a contextual, tissue-specific and/or tissue-associated activity. It is also possible that the function of ANGPTL4 depends on its cleavage and the context of its interaction with extracellular matrix proteins that regulate cell-matrix communication.44 More details are still needed to elucidate the mechanism of how ANGPTL4 affects metastasis in different tumors.

We demonstrated that ANGPTL4 expression significantly correlated with HIF-1α expression in HCC tissues. ANGPTL4 also colocalized with HIF-1α in hypoxic areas surrounding the necrotic fields in xenograft tumors. These data are consistent with the increased ANGPTL4 mRNA expression found in several other types of cancer, including renal cell carcinoma and glioblastomas, both of which are associated with dysregulation of HIF-1.13, 30 Our data showed that HIF-1α directly mediates hypoxia-induced ANGPTL4 expression through binding to HRE1 at −206 to −202 base pairs upstream of the transcriptional start site of ANGPTL4. HIF-1α induces the expression of many genes that lead to tumor proliferation, angiogenesis, metastasis, and progression.45 Our results showed that serum ANGPTL4 protein levels were elevated in chronic hepatitis B patients, and it was reported that ANGPTL4 could be induced by inflammation,11, 34 so we compared the roles of hypoxia and inflammation in the induction of ANGPTL4 in MHCC-97L cells. Results showed that ANGPTL4 protein levels were increased by inflammatory factors (such as IL-1β and IL-6) or hypoxia alone, whereas the role of hypoxia was more remarkable. Combined treatments with hypoxia and inflammatory factors additively increased ANGPTL4 levels (Supporting Fig. 7A,B). Although ANGPTL4 expression has been reported to correlate with venous invasion and lymphovascular invasion,21-23 our results did not identify a correlation between ANGPTL4 expression and metastatic features in primary HCC tissues (Supporting Table 1). HCC metastases are mainly intrahepatic in the clinic, and the liver tissue microenvironment plays an important role in intrahepatic metastasis.46 Furthermore, ANGPTL4 is a secreted glycoprotein. In this context, the role of secreted ANGPTL4 was investigated.

Our results showed that ANGPTL4 increased in the sera of HCC patients and correlated with the presence of macrovascular invasion, intrahepatic metastasis, and histological grade. CM containing ANGPTL4 enhanced lung metastasis of HCC cells in nude mice. In addition, we found that secreted ANGPTL4 up-regulated VCAM-1 in HUVECs and affected the transendothelial migration of HCC cells through the VCAM-1/integrin β1 axis. All of these results suggest that secreted ANGPTL4 might affect the tumor cell/endothelial cell interaction through the regulation of gene expression in endothelial cells and result in an increase in the transendothelial migration and even metastasis of HCC cells. ANGPTL4 also induces vessel permeability through a mechanism dependent on Rho and ROCK in Kaposi's sarcoma,20 which is consistent with the role of ANGPTL4 in breast cancer.19 Furthermore, ANGPTL4 expression is regulated by transforming growth factor beta19 and hypoxia, which are the main factors in the solid tumor microenvironment.45, 47 All of these studies indicate that ANGPTL4 might be a regulator of the tumor microenvironment. Although we showed ANGPTL4 is secreted and expressed consistently in HCC cells in both in vitro and in vivo experiments (Supporting Figs. 2B, 3A,C, and 5A,B), we found that serum ANGPTL4 levels are different from ANGPTL4 expression in tumor tissues in HCC patients. It is completely possible that serum ANGPTL4 is not exclusively secreted by tumor cells, because ANGPTL4 is also highly expressed in adipose tissue and ischemic tissues. This situation also occurs with serum alpha-fetoprotein (AFP) and tissue AFP in HCC.48

In conclusion, our results show that hypoxia-induced ANGPTL4 can significantly promote HCC cell invasion and metastasis in vitro and in vivo through the up-regulation of VCAM-1 in HUVECs; in addition, the ANGPTL4 gene is directly regulated by HIF-1α. These data suggest that the HIF-1α target gene, ANGPTL4, might be a potential target for cancer gene therapy, because HIF-1α has long been considered as an exceptional target for cancer therapy.49

References

  1. Top of page
  2. Abstract
  3. Patients and Methods
  4. Results
  5. Discussion
  6. References
  7. Supporting Information
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Supporting Information

  1. Top of page
  2. Abstract
  3. Patients and Methods
  4. Results
  5. Discussion
  6. References
  7. Supporting Information

Additional Supporting Information may be found in the online version of this article.

FilenameFormatSizeDescription
HEP_24479_sm_SuppInfoFigures.doc6415KSupporting Fig. 1. Hypoxia induces ANGPTL4 expression through HIF-1α but not HIF-2α. (A) Western blot analysis of HIF-1α and ANGPTL4 of SMMC-7721 cells in HIF-1α siRNA experiments under hypoxic conditions (Hyp). (B) Western blots of HIF-2α and ANGPTL4 in SMMC-7721 cells in HIF-2α siRNA experiments under hypoxic conditions (Hyp). (C) The effect of 2ME2 treatment on HIF-1α and ANGPTL4 protein levels in SMMC-7721 cells under hypoxic conditions (Hyp). (D) ChIP experiments were performed in MHCC-97L and SMMC-7721 cells grown under normoxia (Nor) or hypoxia (Hyp) for 24 h, and they demonstrated HIF-1α did not bind at HRE2, 3, 4 and 5. The genomic DNA inputs were 5%. Supporting Fig. 2. The expression of ANGPTL4 in HCC cell lines. (A) The mRNA levels of ANGPTL4 were determined by qRT-PCR analysis in 11 HCC cell lines. (B) Secreted ANGPTL4 in the cell culture supernatant was quantified by ELISA in 11 HCC cell lines. (C) The protein levels of ANGPTL4 were determined by western blotting in 11 HCC cell lines. Supporting Fig. 3. The expression levels of ANGPTL4 in the stable cell lines infected with ANGPTL4-expressing lentivirus. (A) Western blot analysis of ANGPTL4 from whole cell lysates and secreted ANGPTL4 from the conditioned medium (CM) of SMMC-7721 and Huh7 cells infected with either ANGPTL4-expressing lentivirus or control lentivirus. (B) Relative mRNA expression of ANGPTL4 was determined by qRT-PCR analysis in SMMC-7721 and Huh7 cells infected with either ANGPTL4-expressing lentivirus or control lentivirus. (C) Secreted ANGPTL4 in the culture supernatant was quantified by an ELISA in two stable ANGPTL4-overexpressing cell lines and control cell lines. (D) Validation of HUVECs used in the trans-endothelial migration assay by immunostaining with the vascular biomarkers CD31, CD34 and von Willebrand factor (vWF). The negative staining control (Ctrl) was only incubated with secondary antibody and not with primary antibodies. Original magnification: 400×. Supporting Fig. 4. (A) Serum ANGPTL4 protein levels were determined by ELISA in HCC patients with macrovascular invasion (n=29) and without macrovascular invasion (n=133). (B) Serum ANGPTL4 protein levels were determined by ELISA in HCC patients with hepatitis B infection (n=213) and without hepatitis B infection (n=33). (C) Serum ANGPTL4 protein levels were determined by ELISA in HCC patients with cirrhosis (n=130) and without cirrhosis (n=14). (D) Serum ANGPTL4 protein levels were determined by ELISA in HCC patients with extra-hepatic metastasis (n=15) and without extra-hepatic metastasis (n=395). (E) Depiction of ROC curves of serum ANGPTL4. The area under the ROC curves was 0.709 ± 0.026 (with a 95% confidence interval for the area being between 0.659 and 0.759). A cut-off point of 93.5 ng/ml discriminated between normal controls and HCC patients with a sensitivity of 44.7% and a specificity of 87.4%. The arrows indicate the cut-off point for serum ANGPTL4 at 93.5 ng/ml. Supporting Fig. 5. (A) Serum ANGPTL4 levels in tumor-bearing mice with SMMC-7721-lenti-control or MMC-7721-lenti-ANGPTL4 were determined by an ELISA. (B) Western blots of ANGPTL4 from the whole cell lysate and secreted ANGPTL4 from the CM of COS7 cells expressing ANGPTL4 or vector control. (C) The protein levels of integrin α4 and integrin β1 were determined by western blotting in SMMC-7721 and Huh7 cells. Supporting Fig. 6. Secreted ANGPTL4 enhances HCC cell trans-endothelial migration in vitro through the VCAM-1/integrin β1 pathway. (A) Trans-endothelial migration assays of SMMC-7721 cells treated with CM-control, CM-ANGPTL4, anti-integrin β1 antibody or anti-ANGPTL4 neutralizing antibody. Original magnification: 200×. (B) The quantification of six randomly selected fields is shown. (C) The protein levels of the members of NF-κB signal pathway were determined by western blotting in HUVECs treated with CM containing ANGPTL4 or control. Supporting Fig. 7. The effect of hypoxia and Inflammatory cytokines on induction of ANGPTL4 in MHCC-97L cells. (A) Secreted ANGPTL4 protein in the culture supernatant was quantified by an ELISA in MHCC-97L cells treated with interleukin 1β (0.1 ng/ml and 1 ng/ml), interleukin 6 (5 ng/ml and 50 ng/ml) or TNF α (1 ng/ml and 10 ng/ml) under normoxic (21% O2) or hypoxic (2% O2) conditions. (B) Western blot analysis of ANGPTL4 from whole cell lysates of MHCC-97L cells treated with 1 ng/ml interleukin 1β, 50 ng/ml interleukin 6 or 10 ng/ml TNF α under normoxic (21% O2) or hypoxic (2% O2) conditions.
HEP_24479_sm_SuppInfoTables.doc95KSupporting Table 1. Clinicopathologic characteristics of HCC specimens with ANGPTL4 expression and HIF-1α expression Supporting Table 2. Antibodies used in this study Supporting Table 3. The sequences of siRNA duplexes Supporting Table 4. The sequences of gene-specific primers used for qRT-PCR Supporting Table 5. Sequences of primers used for ChIP assay
HEP_24479_sm_SuppInfo.doc55KSupporting Informaion

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