Introduction
Cervical cancer was the fourth most common cancer among women worldwide in 2020, with 604,127 new cases and 341,831 related deaths [
1]. Cervical squamous cell carcinoma (CSCC) is one of the most common subtypes of cervical cancer, accounting for 80–85% of all cases [
2]. Cervical carcinogenesis has been described as a sequence of steps based on histopathological classifications, from high-risk human papillomavirus (HR-HPV, mostly HPV16) infection, low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and finally invasive cervical cancer [
3]. Surgery and radiotherapy are currently the main methods of treating CSCC, although their therapeutic effects are not ideal for recurrent or late-stage disease [
4,
5]. Therefore, it is imperative to discover novel molecular targets for the treatment of CSCC patients.
Circular RNAs (circRNAs) are a new type of noncoding RNA that have a continuous, covalently closed loop structure without a 3ʹ-poly A tail or 5ʹ-cap structures [
6,
7]. CircRNAs exhibit tissue-specific expression profiles and different levels of expression in varying environments, featuring stable structure and resistance to RNase R treatment compared to linear RNAs [
8,
9]. Growing evidence has suggested that circRNAs are involved in many cellular processes, and it appears that circRNAs can also act as competitive endogenous RNAs (ceRNAs) and competitive bind miRNAs to regulate the translation of downstream target genes [
10‐
12]. For example, circFBXW7 competitive binds multiple miRNAs and inhibits cell proliferation in many forms of cancer [
13,
14], and circCLK3 promotes the progression of CSCC by competitive binding miR-320a and increasing the expression of FoxM1 [
15]. Nevertheless, the specific mechanisms underlying the capability of dysregulated circRNAs to regulate the progression of CSCC remain largely unknown, and further investigations are urgently needed.
We found a novel CSCC-related circRNA (circ0001955) with tumor-promoting properties using our previous circRNA microarray data from normal cervix, HSIL and CSCC tissues and then examined its function in relation to tumor cell proliferation and metastasis [
3]. It has been reported that circ0001955 contributes to the tumorigenesis of gastric cancer by competitive binding miR-758 and regulating ZNF217 expression [
16]. Moreover, it has been demonstrated that circ0001955 contributes to the development of colorectal cancer by increasing the expression of MYO6 by competitively targeting miR-455-3p [
17]. In the present study, we discovered that circ0001955 promoted CSCC proliferation and metastasis by competitive binding miR-188-3p, resulting in the upregulation of NCAPG2 expression and further activating the AKT/mTOR signaling pathway. Collectively, our results indicate that circ0001955 could be a key driver of CSCC progression and could be a valuable marker and independent prognostic factor.
Materials and methods
Specimen collection
CSCC, HSIL tissues and normal cervical tissues were collected from patients who underwent gynecological surgery or colposcopy at the Second Hospital of Shanxi Medical University (Taiyuan, China) between 2019 and 2021. Patients in this study had not received radiotherapy or chemotherapy prior to surgery, and their FIGO (International Federation of Gynecology and Obstetrics) stages ranged from Ia2 to IIa2. All patients underwent radical hysterectomy or cervical conization. Normal cervical tissues were obtained from patients undergoing hysterectomy under nonmalignant circumstances. The tissues were first immediately frozen in liquid nitrogen and then frozen at -80 °C until RNA could be extracted. This study was approved by the Ethical Review Committee of the Second Hospital of Shanxi Medical University. The Declaration of Helsinki was followed in all patient studies.
Cell culture
The human cervical cancer cell line SiHa (HPV 16 +) and a normal cervical cell line (HcerEpic) were purchased from the American Type Culture Collection (ATCC, Manassas, VA, USA). SiHa and HcerEpic cells were cultured in DMEM (Gibco, Carlsbad, CA, USA) with 10% fetal bovine serum (FBS) (Gibco, Carlsbad, CA, USA) and 1% penicillin/streptomycin (Gibco, Carlsbad, CA, USA). Cells were cultured in a humid atmosphere with 5% CO2 at 37 °C.
RNA and gDNA extraction and cytoplasmic and nuclear RNA isolation
Total RNA was extracted from cells or tissues using TRIzol Reagent (Life Technologies, California, US) according to the manufacturer’s instructions. RNeasy Mini Kits (Qiagen, Hilden, Germany) were used to purify total RNA. gDNA was extracted using the Genome DNA Kit (Solarbio, Beijing, China). The nuclear and cytoplasmic fractions were isolated using the Cytoplasmic and Nuclear RNA Purification kit (Thermo Fisher Scientific, Waltham, MA USA). qRT‒PCR was performed on RNA extracted from the fractions to determine the level of cytoplasmic control transcript (GAPDH) and circ0001955.
RNase R treatment
The RNAs were incubated with RNase R (Geneseed; Guangzhou, China) for 15 min at 37 °C. Then, total RNA from cells was extracted, and qRT‒PCR was used to determine the stability of circ0001955.
qRT‒PCR and RT‒PCR
qRT‒PCR and RT‒PCR were performed as described previously [
3]. All primers were synthesized by Sangon Biotech (Shanghai, China), and the primer sequences are given in Additional file
1: Table S1. GAPDH or U6 was used as internal normalization for qRT‒PCR experiments in this study. Gel electrophoresis sections were observed under an optical microscope (Leica, DMI6B, Germany). Sanger sequencing of cDNA was performed by Sangon Biotech (Shanghai, China).
Plasmid construction, RNAi and cell transfection
To overexpress circ0001955, the full-length cDNA of circ0001955 was amplified in SiHa cells and then cloned into an overexpression vector (Public Protein/Plasmid Library, Nanjing, China) containing a front and back circular frame, with a mock vector containing no circ0001955 sequence serving as a control. To knock down circ0001955, three siRNAs targeting the back-splice junction site of circ0001955 and a siRNA-NC were synthesized (Public Protein/Plasmid Library, Nanjing, China). The most effective siRNA, si-circRNA2#, measured by qRT‒PCR was subcloned into the lentivirus vector to construct the sh-circ0001955 vector, while sh-NC was used as the negative control. The lentiviral vector carrying sh-circ0001955 or sh-NC (Hanbio, Shanghai, China) were transiently transfected into SiHa cells. The vectors above were verified by sequencing. MiR-188-3p mimics and inhibitor were purchased from GenePharma (Shanghai, China). miR-NC and inh-NC were used as controls. Transfections were performed using Lipofectamine 3000 (Invitrogen, Carlsbad, USA) according to the manufacturer's instructions.
Cell proliferation, cell cycle and apoptosis assays
We examined the proliferation activity of SiHa cells using Cell-Light™ EdU DNA Cell Proliferation Kit (Beyotime, Beijing, China) and Cell Counting Kit-8 (Meilunbio, Dalian, China) according to the manufacturer’s instructions. A cloning assay was performed on SiHa cells to determine their cloning capability. Cell cycle analysis was conducted with propidium iodide (PI) staining by flow cytometry (Beckman-Coulter, Hialeah, FL) and analyzed using Modfit software. The Alexa Fluor® 488 Annexin V/Dead Cell Apoptosis Kit (Thermo Fisher Scientific, Waltham, MA USA) was used to identify apoptotic cells.
Wound healing and invasion assays
At 24 h post-transfection, SiHa cells were seeded in a 6-well plate, scratched with a 10 μL pipette tip in the middle of the wells, and then cultured in serum-free medium. The wound width was evaluated in three independent wound sites per group after 24 h and normalized to the control group. The cell invasion assays were conducted with chambers (8 μm pore size, Corning) and Matrigel (BD Science, USA), while the cell migration assays were conducted with chambers without Matrigel. SiHa cells (2 × 104) were suspended in 200 μL serum-free medium and added to the upper chambers before 500 μL complete medium was added to the bottom chambers and chambers without Matrigel for cell migration. The cells in the upper chambers were removed after 24 h, and the lower chambers were fixed with ethanol, stained with crystal violet, photographed and counted under a microscope (Leica, Wetzlar, Germany).
Immunohistochemistry (IHC)
For the IHC assay, paraffin sections were incubated with primary antibodies against NCAPG2 (1:100) (Bioss ANTIBODIES, Beijing, China) and Ki67 (1:100) (Abcam, Burlingame, CA, USA) at 4 °C overnight, secondary antibodies at room temperature for 30 min and HRP-labeled streptavidin solution for 30 min and then stained with diaminobenzidine (DAB). IHC staining images were semi-quantified using Image Pro Plus (Media Cybernetics).
Hematoxylin–eosin (HE) staining
Tissues were immersed in 4% paraformaldehyde, embedded in paraffin, and sectioned into 4 mm thick transverse sections. The sections were then stained with hematoxylin and eosin.
Dual-luciferase reporter assay
psiCHECK2-circ0001955-mut and psiCHECK2-NCAPG2-mut plasmids were designed and synthesized by GenePharma (Suzhou, China). The Dual-Luciferase Assay System (Promega, Madison, WI, USA) was used to measure luciferase activity as directed by the manufacturer. Then, 5 × 103 cells per well were seeded into 96-well plates. The cells were transfected with WT- or MUT-luciferase reporter vectors and miRNA mimics after 24 h. After 48 h, the relative luciferase activity was examined by the Dual-Luciferase Assay Kit (Promega, Madison, WI, USA) in accordance with the manufacturer’s protocols.
Fluorescence in situ hybridization (FISH)
FISH assays were conducted to evaluated and recognized the expression and location of circ0001955 and miR-188-3p in cervical tissues and SiHa cells. Briefly, after prehybridization at 55 °C for 2 h, paraffin sections or cell climbing pieces were hybridized with specific Cy3-labeled circ0001955 probes and FITC-labeled miR-188-3p probes (GenePharma, Shanghai, China) at 37 °C overnight and then dyed with DAPI. Slides were photographed with a fluorescence microscope (Leica, Wetzlar, Germany).
RNA antisense purification (RAP) assays
A circ0001955 biotinylated probe was designed and synthesized by Riobio Technologies (Guangzhou, China). The RNA antisense purification assay kit from BersinBio (Guangzhou, China) was then used to verify the relationship between circ0001955 and miR-188-3p according to the manufacturer's instructions. The antibodies used for the RAP assay included anti-Argonaute2 (AGO2) and GAPDH. Briefly, crosslinked cells were lysed, sonicated and hybridized with the probes for 4 h at 37 °C. Next, the hybridization mixture was incubated with magnetic beads for 1 h. The bound RNAs and proteins were then washed and purified for RNA analysis and western blotting.
Western blot analysis
Proteins from SiHa cells were extracted using RIPA buffer, separated by 10% SDS‒PAGE, and then electrotransferred onto PVDF membranes (Millipore, Bedford, MA, USA). The membranes were blocked with 5% bovine serum albumin (BSA) and incubated with primary antibodies against NCAPG2 (1:1000) (Bioss ANTIBODIES, Beijing, China), AGO2 (1:1000), AKT (1:1000), phospho-AKT (Ser473) (ABclonal Technology, Wuhan, China), mTOR (1:1000), phospho-mTOR (Ser2448) (Cell Signaling Technology, Beverly, MA, USA) and GAPDH (1:5000) (Santa Cruz Biotechnology, CA, USA) at 4 °C overnight and then incubated with secondary antibodies (1:5000) (Santa Cruz Biotechnology, CA, USA) at room temperature for 1 h. Finally, the bands were examined using enhanced chemiluminescence (ECL) western blotting detection reagents (Beyotime, Beijing, China). The gray intensity of Western-blots data in this manuscript was quantified by ImageJ software (NIH) after normalization to corresponding loading controls.
Animal experiments
All animal experiments were approved by the Shanxi Medical University Animal Care and Use Committee and complied with the guidelines of the National Institutes of Health. SiHa cells were infected with lentiviruses (Hanbio Co. LTD, Shanghai, China) carrying sh-NC and sh-circ0001955, called LV-NC and LV-circ, respectively, and puromycin was used to select and obtain sh-circ0001955 or sh-NC stably expressed cell lines. In xenograft experiments, 2 × 106 SiHa cells suspended in 50% Martigel Matrix (Corning, USA) were subcutaneously injected into female BALB/c mice (4 weeks). The growth of the tumor was then monitored every 7 days after injection. We measured the tumor size with calipers and calculated tumor volume as length × width2 × 0.52. Mice were sacrificed 28 days after injection. Following this, the tumors were removed, weighed, and embedded in paraffin for HE and IHC.
Statistical analysis
SPSS version 21.0 and GraphPad Prism version 8.0 were used for statistical analysis. Student’s t tests were used to analyze differences between two groups. Survival rates were evaluated using the Kaplan‒Meier method and log-rank test. Pearson correlation was used to determine the correlation between groups. A receiver operating characteristic (ROC) curve was used to assess the diagnostic value. Data are presented as the mean ± standard deviation (SD) across at least three independent experiments. A value of P < 0.05 was regarded as statistically significant.
Discussion
With the development of RNA sequencing and bioinformatics technologies, a host of circRNAs have been implicated in multiple malignancies. Despite this, studies of circRNA functions are still in their infancy, and the mechanisms by which circRNAs influence the progression of CSCC have yet to be determined. In this study, we uncovered and investigated the significance of circ0001955 in CSCC tumor growth and metastasis. We found that the gain of circ0001955 expression was closely associated with the progression of CSCC. Moreover, we found that circ0001955 promoted tumor proliferation and invasion in CSCC by modulating the expression of NCAPG2. At the mechanistic level, we identified that circ0001955 restored the expression of NCAPG2 by competitive binding miR-188-3p and actives AKT/mTOR pathway. This study provides new insights into the role of circRNAs in CSCC progression and highlights the potential for therapeutic application of circ0001955 for the diagnosis and treatment of CSCC.
CircRNAs exhibit dynamic cell/tissue-specific expression and play critical roles in multiple cellular processes, functioning as miRNA competitive inhibitor, partners of RNA-binding proteins or encode polypeptides [
23‐
29]. Despite this, it is now widely accepted that circRNAs can effectively competitive inhibitor miRNAs due to the presence of high-affinity miRNA-binding sites [
30‐
32]. Previous literature has indicated that circRNAs might serve as ceRNAs to modulate the development and progression of CSCC [
33]. Based on bioinformatics analyses, we found that circ0001955 contained the MRE of miR-188-3p. FISH assays showed that circ0001955 and miR-188-3p were colocalized in the cytoplasm of SiHa cells. Therefore, we concluded that circ0001955 competitive binding miR-188-3p might play an oncogenic role in CSCC. Furthermore, dual-luciferase reporter, nucleocytoplasmic separation and RAP confirmed that circ0001955 could directly bind miR-188-3p. In addition, miR-188-3p was significantly downregulated in CSCC tissues and positively correlated with patient overall survival based on TCGA data. miR-188-3p is significantly downregulated in breast cancer [
34], colorectal cancer [
35], hepatocellular carcinoma [
36] and pancreatic cancer [
37] and negatively correlated with the degree of malignancy. Moreover, miR-188-3p suppresses proliferation, invasion, and metastasis in several cancers by targeting multiple genes [
21]. However, the function of miR-188-3p in CSCC remains unexplored. Our findings showed that circ0001955 serves as an oncogene in CSCC by competitive binding miR-188-3p and indicated the vital role of the interaction between circ0001955 and miR-188-3p in tumorigenesis and development of CSCC.
It has been hypothesized that circRNAs can act as ceRNAs to modulate the expression of miRNA target genes [
38]. It was found that NCAPG2, a mitosis and cell cycle regulator [
39], is co-overexpressed in CSCC. Interestingly, the cell cycle was the pathway most significantly enriched in both Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses, supporting the notion that the cell cycle is closely associated with CSCC tumorigenesis and progression. Furthermore, a bioinformatics analysis using miRGate and TargetScan indicated that NCAPG2 is a potential target of miR-188-3p. Then, using a dual-luciferase reporter assay, miR-188-3p was confirmed to target the 3′-untranslated region of NCAPG2. Additionally, miR-188-3p upregulation led to the downregulation of NCAPG2 mRNA and protein, whereas miR-188-3p downregulation produced the opposite effect. We found that downregulation of circ0001955 resulted in G1/S phase cell cycle arrest. NCAPG2 contributes to tumor proliferation and is associated with poor prognosis among lung adenocarcinomas [
22]. Mechanistically, NCAPG2 plays a crucial role in facilitating the kinetochore localization of PLK1 during mitosis, which in turn is essential for the proper alignment and segregation of chromosomes [
39]. Moreover, PLK1 is responsible for orchestrating the degradation of Claspin required for DNA damage checkpoint recovery, and its activation is tightly regulated by the phosphorylation status of Aurora A. In the context of HPV-induced cervical cancer, it has been observed that cells expressing HPV-16 E7 exhibit elevated levels of both Aurora A and PLK1, leading to the possibility of dysregulated regulation of these kinases and cell cycle checkpoints. Consequently, it is conceivable that dysregulation of NCAPG2 and PLK1 localization and regulation, possibly mediated by HPV-16 E7, may contribute to the pathogenesis and progression of cervical cancer [
40]. However, it remains to be determined how NCAPG2 plays a role in CSCC progression. In accordance with previous studies, we observed that NCAPG2 overexpression in CSCC tissues was associated with shorter DFS time in patients. We next examined the crosstalk between circ0001955 and NCAPG2, and we found that knockdown of circ0001955 decreased the NCAPG2 mRNA and protein levels. Moreover, these effects could be partially reversed by miR-188-3p inhibitors, which may support our hypothesis that circ0001955 acts as a ceRNA to promote NCAPG2-mediated proliferation and metastasis by acting as a decoy of miR-188-3p in CSCC.
Another significant finding in our study was that circ0001955 could activate the AKT/mTOR pathway. In CSCC, the AKT/mTOR pathway is often abnormally activated, especially in metastatic CSCC [
41]. AKT/mTOR signaling hyperactivation promotes the proliferation, metastasis, and recurrence of AKT/mTOR. While several studies have revealed sophisticated regulatory networks involving the AKT/mTOR pathway, it is unclear whether circRNAs play a role in CSCC AKT/mTOR activation. As we found, circ0001955 promoted the phosphorylation of AKT and mTOR, important components of the AKT/mTOR pathway, which resulted in the downstream EMT process. Furthermore, rapamycin, an mTOR inhibitor, inhibited the progression of CSCC induced by circ0001955. As a result of these findings, it can be concluded that circRNA functions as a key regulator of the AKT/mTOR pathway and can be used as a potential target for intervention in CSCC.
In summary, we found that circ0001955 was overexpressed in CSCC. We also demonstrated that circ0001955 promoted the proliferation and metastasis of CSCC through the miR-188-3p/NCAPG2 axis-mediated activation of the AKT/mTOR pathway. We not only provide insight into the role of circRNAs in the development and progression of CSCC, but also review circ0001955 as a potential prognostic biomarker and promising therapeutic target for CSCC.
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