Background
Hepatocellular carcinoma (HCC) is one of the most prevalent malignant tumors worldwide. Although surgical techniques and adjuvant therapy have improved, long-term survival remains low due to tumor recurrence and metastasis [
1]. Early recurrence is defined as HCC that recurs within 1 year after resection, and it is most closely related to cancer metastasis spread and is the leading cause of early death in patients with HCC after liver resection [
2]. Therefore, it is critical to understand the molecular mechanism associated with HCC invasion and metastasis and identify the predictive biomarkers of HCC recurrence and prognosis to help monitor disease progression and guide diagnosis and treatment.
The Mini-chromosome maintenance protein (MCM) family is a recently reported gene family that was identified in the control of eukaryotic genome replication. In the DNA replication licensing process, the MCM2–7 complex primes chromatin for DNA replication by binding origins of DNA replication during the late M to early G1 phase of the cell cycle [
3]. Also, it is involved in the formation of replication forks and in the recruitment of other DNA-replication-related proteins. The MCM complex is a replicative helicase that is essential for DNA replication initiation and elongation in eukaryotic cells [
4].
The MCM protein family plays an important role in genome duplication of proliferating cells. It had been reported that abnormal expression of MCMs contributes to tumorigenesis. For example, a significant rise in the MCM5 level was observed in cervical epithelium squamous cancer [
5]. MCM7 expression may predict poor postoperative prognosis for HCC and promote cancer progression through cyclin-D1-dependent signaling [
6,
7]. Altered Mcm5, Mcm2 and Mcm7 were found in malignant cells in the lung, kidney and prostate [
8‐
11]. Furthermore, a rise of MCM6 has been shown to correspond with a high risk of recurrence in meningioma [
12], suggesting that the MCM proteins are promising prognostic markers for monitoring various cancers.
MCM6 is one of six members of the Mini-chromosome maintenance family. Previous studies verified the important role of MCM6 in cell proliferation and indicated its potential role in prompting tumor progression. MCM6 is up-regulated in various types of tumors [
13‐
15]. It has been reported that a high serum MCM6 level is a diagnostic biomarker for HCC [
16]. However, little is known about its relation to cancer survival or its prognostic significance in HCC. The previous studies give rise to the hypothesis that MCM6 plays an important role in HCC. In the present study, we performed a series of experiments to explore its molecular function in HCC cells and evaluate the prognostic value of both the tissue and plasma MCM6 expression level.
Methods
Tissue and serum specimens
Tumor tissue specimens, including tumor and matched adjacent non-tumor tissues, were obtained from 70 patients who had undergone curative liver resection. Detailed clinical pathological parameters were listed in Table
1. Thirty normal hepatic tissues were obtained from patients suffering from benign hepatic lesions who underwent resection. The serum samples, including 34 healthy people, 32 patients with cirrhosis, and 31 patients with HCC (obtained by collecting venous blood at the time of the primary diagnosis before operation and 8 days after surgical resection) were used in this study for measuring the serological level of MCM6 by ELISA. Serum samples were frozen and stored at −80 °C until measurement. All the selected HCC cases for serological examination had received curative hepatectomy and been provided with a uniform follow-up to the cohort. Curative hepatectomy was defined to involve (1) complete removal of all nodules with the resection margin greater than 10 mm, (2) the absence of invasion of the main trunk and first-order branches of the portal vein, common hepatic duct and its first-order branches or main trunk of the hepatic vein and inferior vena cava (3) the absence of intra- or extra-hepatic metastasis, and (4) the absence of residual tumor or portal tumor thromboses on postoperative imaging. In this study, all specimens were obtained and used under protocols approved by the Integrated Hospital of Traditional Chinese Medicine of Southern Medical University Office for Protection of Human Subjects.
Table 1
Correlation of MCM6 protein expression with clinicopathological parameters
Age (years) |
≤ 50 | 36 | 7 (19.4%) | 29 (80.6%) | 0.111 |
> 50 | 34 | 12 (35.3%) | 22 (64.7%) |
Serum AFP (μg/l) |
≤ 20 | 18 | 11 (61.1%) | 7 (38.9%) |
0.000
|
> 20 | 52 | 8 (15.4%) | 44 (84.6%) |
HBsAg |
Negative | 8 | 5 (62.5%) | 3 (37.5%) |
0.035
|
Positive | 60 | 15 (25.0%) | 45 (75.0%) |
GGT (U/I) |
≤ 50 | 28 | 8 (28.6%) | 20 (71.4%) | 0.518 |
> 50 | 42 | 11 (26.2%) | 31 (73.8%) |
Child-Pugh score |
A | 66 | 17 (25.8%) | 49 (74.2%) | 0.603 |
B | 3 | 1 (33.3%) | 2 (66.7%) |
Tumor capsule |
No/incomplete | 61 | 16 (26.2%) | 45 (73.8%) | 0.463 |
Complete | 9 | 3 (33.3%) | 6 (66.7%) |
Tumor differentiation |
I-II | 63 | 16 (25.4%) | 47 (74.6%) | 0.399 |
III-IV | 5 | 2 (40.0%) | 3 (60.0%) |
Vascular invasion |
No | 63 | 19 (30.2%) | 44 (69.8%) | 0.097 |
Yes | 7 | 0 (0%) | 7 (100%) |
Liver cirrhosis |
No | 31 | 14 (45.2%) | 17 (54.8%) |
0.003
|
Yes | 39 | 5 (12.8%) | 34 (87.2%) |
Tumor size (cm) |
≤ 5 | 34 | 11 (32.4%) | 23 (67.6%) | 0.247 |
> 5 | 36 | 8 (22.2%) | 28 (77.8%) |
Tumor number |
Solitary | 49 | 18 (36.7%) | 31 (63.3%) |
0.004
|
Multiple | 21 | 1 (4.8%) | 20 (95.2%) |
Early recurrence |
No | 36 | 15 (41.7%) | 21 (58.3%) |
0.002
|
Yes | 33 | 3 (9.1%) | 30 (90.9%) |
Patients in the TCGA database
MCM6 expression data based on RNA-Seq were extracted from The Cancer Genome Atlas (TCGA) database for 291 patients with HCC. Patients were divided into low and high expression groups, and the prognostic values of MCM6 for overall survival, cumulative recurrence, and early-recurrence were assessed.
Cell culture
HCC cell lines (HCC-LM3, SMMC7721, Huh7 and PLC/PRF/5) were obtained from the Cancer Research Institute of Southern Medical University in Guangzhou, China. HepG2 cells were purchased from the Chinese Academy of Sciences Cell Bank (Shanghai, China). All of the cells were routinely maintained in high-glucose DMEM (Life Technologies, Grand Island, NY, USA) supplemented with 10% fetal bovine serum (Life Technologies) at 37 °C with 5% CO2.
Lentivirus production and infection
Lentiviral particles expressing shRNA against MCM6 or control sequence were constructed by Cyagen Bioscience Inc. (Guangzhou, China). LM3 and SMMC-7721 cells were transfected with lentiviral vectors and selected with 750 mg/mL G418 (Gibco). MCM6 expression was confirmed by qPCR, and the levels of MCM6 protein were measured using western blotting.
RNA isolation, reverse transcription, and real-time RT-PCR
Total RNA was isolated from cells using the E.Z.N.A. Total RNA Kit I (Cat. No 66834–02 Omega). Reverse transcription was performed using the PrimeScript RT Reagent Kit (TaKaRa Biotech, Dalian, China). qRT-PCR reactions were performed using a Bio-Rad system (Bio-Rad Labs, Hercules, CA) with SYBR Green PCR Master Mix (TaKaRa Biotech). The cycling conditions were denaturation at 95 °C for 15 s, with annealing at 60 °C for 15 s and fluorescence collection at 72 °C for 10 s. The 2 − ∆∆Ct method was used for relative quantification and statistical analysis. Independent experiments were done in triplicate. The primers used in this study are listed in the Additional file
1: Table S1.
Immunohistochemistry assay
Immunohistochemical staining of tissue was performed according to the manufacturer’s instructions (DAKO, Glostrup, Denmark) on formalin-fixed, paraffin-embedded tissue sections that had been cut to 4-μm thickness. The specimens were dried at 62 °C for 2 h and then dewaxed in xylene and rehydrated using graded alcohols, followed by incubation in 3% hydrogen peroxide for 15 min to exhaust the endogenous peroxidase activity. The antigens were then retrieved in Tris-EDTA (pH 9.0)/ 0.01 M sodium citrate buffer (pH 6.0) using a microwave oven for 25 min, followed by blocking with 10% goat serum for 30 min to prevent non-specific staining. Primary antibodies were incubated overnight at 4 °C in a humidified chamber, followed by HRP-labeled anti-mouse/rabbit secondary antibody (DAKO) incubation for 1 h at room temperature. Antibody binding was detected by DAB, and the reaction was stopped by immersion in distilled water once the brown color appeared. Finally, specimens were counter-stained with hematoxylin for 3 min. Two different pathologists who specialized in liver cancer evaluated the IHC results without knowledge of the clinical data. Both the extent and intensity of immunostaining were taken into consideration when analyzing the data. The intensity of staining was scored from 0 to 3, and the extent of staining was scored from 0% to 100%. Final quantitation of staining was obtained by multiplying the two scores. The protein expression was classified as high expression if the score was higher than 1.5 and low expression if the score was 1.5 or less. The antibodies are listed below: MCM6 (1:4000; Abcam, Cambridge, UK), Ki-67 (1:200, ZSGB-BIO, China), Vimentin (1:100, ZSGB-BIO, China) and E-cadherin (1:100, ZSGB-BIO, China).
Immunofluorescence staining
Cells grown on coverslips were rinsed with phosphate-buffered saline (PBS) and fixed with cold 4% paraformaldehyde for 5 min at RT. Subsequently, the cells were blocked with Triton X-100 at a concentration of 0.2% for 30 min. Cells were then blocked for 1 h with 5% BSA and washed for 30 min, followed by incubation with primary monoclonal antibodies against MCM6 (1:500; Abcam, Cambridge, UK). Vimentin (1:100, ZSGB-BIO, China) and E-cadherin (1:50, ZSGB-BIO, China) overnight at 4 °C. The next day, the coverslips were incubated for 1 h in a dark room with Alexa Fluor 564 goat anti-rabbit IgG and Alexa Fluor 488 goat anti-mouse IgG (1:100 dilution; Bioworld Technology, Inc). Furthermore, the coverslips were stained with DAPI for 5 min at 4 °C. Finally, an LSM80 fluorescent microscope (ZESS, Germany) was used to observe the expression in cells.
Western blot
Total proteins were extracted with RIPA lysis buffer supplemented with protease inhibitors, separated by SDS-PAGE and transferred to a PVDF membrane (Millipore, Billerica, MA). The membrane was blocked with 5% non-fat milk at room temperature for 1 h and incubated with the appropriate antibody. Protein bands were visualized by the chemiluminescent HRP detection system (Millipore, Billerica, MA). The antibodies are listed below: MCM6 (1:2000, Proteintech, Chicago, IL), E-cadherin (1:1000, CST, Boston, MA), Vimentin (1:1000, CST, Boston, MA), GAPDH (1:5000, Ray antibody, China), ZO1 (1:1000, CST, Boston, MA), Fibronectin (1:1000, Wanleibio, China), p-ERK1/2 (1:300, Wanleibio, China), ERK1/2(1:500, Wanleibio, China), p-MEK1/2 (1:500, ABclonal, China), and MEK1/2 (1:1000, Wanleibio, China).
Cell viability assay
Cell viability was analyzed using the Cell Counting Kit-8 (CCK-8) (Dojindo Molecular Technologies Inc. Shanghai, China). Cells at a density of 2 × 103/well were seeded into 96-well plates and cultured in 100 μL of DMEM containing 10% FBS for 4 days. Ten microliters of CCK8 solution was added to each plate, and the cells were incubated for 3 h at 37 °C. The absorbance value (OD) of each well was measured at 450 nm.
EDU incorporation assay
For the EdU incorporation assay, proliferating cells were examined using the Cell-Light EdU Apollo 567 in vitro Imaging Kit (RiboBio, Guangzhou, China) according to the manufacturer’s protocol. Cells at a density of 5 × 103/well were seeded into 96-well plates and incubated with 10 mM EdU for 2 h, followed by fixation with 4% paraformaldehyde, permeabilization in 0.2% Triton X-100 and staining with Apollo fluorescent dyes. Next, 50 μL/well DAPI was used to stain the cell nuclei for 10 min. The number of EdU-positive cells was counted under a fluorescent microscope in five random fields.
Wound-healing assay
For the wound-healing assay, cells were grown to confluence in a six-well plate. Artificial wound tracks were created by scraping the confluent cell monolayers with a pipette tip. The cells were fed with serum-free medium. The ability of the cells to migrate into the wound area was assessed every 24 h after scratching.
Cells were plated in 6-well culture plates at 100 cells/well. After incubation for 2 weeks at 37 °C, the cells were washed twice with PBS and stained with 0.1% crystal violet solution. The number of colonies containing ≥50 cells was counted under a microscope. The colony formation efficiency was calculated as (number of colonies/number of cells inoculated) × 100%.
Cell migration and invasive assays
Cell motility was assessed by cell migration and invasion assays using transwell chambers with or without Matrigel (BD, Biosciences, CA). Approximately 6 × 104 cells in medium without FBS were seeded on transwell chambers with or without Matrigel and incubated at 37 °C for 15 h. Medium containing 10% FBS was put in the lower chamber. The invasive cells attached to the lower surface of the membrane insert were fixed, stained using Giemsa (Jiancheng, Jiangsu, China) and quantified.
Enzyme-linked immunosorbent assay (ELISA)
The serologic level of MCM6 was detected using the human MCM6 ELISA kit (Cusabio, Wuhan, CN) according to the manufacturer’s instructions. One hundred microliters of serum samples and standard proteins was added to the appropriate wells and incubated at 37 °C for 2 h. After being washed three times with washing buffer, HRP-conjugated secondary antibody (100 μL/well) was added to the cells, which were incubated at 37 °C for 1 h. The plate was washed three times, and the cells were then incubated with DAB solution for 15–30 min at 37 °C. Then, 50 μL of Stop Solution was added to each well, the optical density at 450 nm was detected, and the concentration of MCM6 was calculated from the standard curve.
Animal studies
Both subcutaneous and orthotopic models were used for animal studies. A total of 2 × 106 SMMC7721 cells transfected with MCM6 shRNA, lentiviral vectors and negative control (scramble) vector in 0.1 ml PBS medium was used in both the subcutaneous model and orthotopic model. The cells were injected into the left leg of 4–6-week-old male BALB/c nude mice. The subcutaneous tumor size was calculated and recorded every 3 days with a Vernier caliper using the following equation: tumor volume (mm3) = (L × W2)/2, where L = tumor long axis and W = short axis. The measurements were repeated three times. The mice were maintained in a barrier facility on HEPA-filtered racks and fed an autoclaved rodent diet. After 27 days, the mice were killed and the tumor tissues were surgically excised, weighed and stained with hematoxylin and eosin (H&E). For the orthotopic model, the cell suspension was injected into the left hepatic lobe of 4-week-old nude mice with a micro-syringe. Transplanted cells were allowed to grow for up to 6 weeks, when the mice were sacrificed. The livers and lungs were dissected, fixed, and paraffin-embedded. All animal handling and procedures were approved by the Animal Care and Use Committee of Southern Medical University.
Statistical analysis
All statistical analyses were performed with SPSS statistical software (version 21.0; SPSS, IBM, Armonk, NY). Survival curves were constructed using the Kaplan–Meier method and analyzed by the log-rank test. Significant prognostic factors found by univariate analysis were entered into a multivariate analysis using the Cox proportional hazard regression model. The Pearson’s chi-square test was used to analyze the association of MCM6 expression with various clinicopathologic characteristics. A paired Student’s t test or χ2 tests was used to compare the values between subgroups. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive value of the parameters, and the differences in the area under the curve (AUC) were detected. R project for Statistical Computing (R version 3.4.3) was used to calculate Harrell C-index. Data were expressed as the mean ± SD of at least three sample replicates. A value of P < 0.05 was statistically significant, and single, double, and triple asterisks indicate statistical significance of * P < 0.05, ** P < 0.01 and *** P < 0.001.
Discussion
Invasion and metastasis are responsible for the unsatisfactory long-term survival of HCC patients. An early diagnosis and aggressive intervention may offer HCC patients a significant survival benefit. Thus, the identification of new predictive biomarkers of HCC invasion and prognosis is critical. In this study, we provided evidence that MCM6 had the potential to be a novel prognostic biomarker for HCC patients. IHC assays suggested that MCM6 was highly expressed in HCC tissues. Clinical significance analysis indicated that MCM6 was associated with tumor number, liver cirrhosis and early recurrence. Also, HCC patients with increased MCM6 expression had worse over survival and higher cumulative recurrence rates. All of these results suggested that MCM6 might play an important role in HCC development. In addition, depletion of endogenous MCM6 expression in LM3 and SMMC7721 cells suppressed cell growth, migration, and invasion. Mechanical analysis indicated that MCM6 promoted EMT and activated the MEK/ERK pathway. Moreover, we found that high serum MCM6 levels significantly correlated with high early recurrence risk after hepatectomy. All of these results strongly suggest that MCM6 has the potential to be a useful prognostic biomarker for HCC.
Accumulated data show that EMT results in increasing cell migration and invasion in several cancers [
22,
23]. Functional experiments revealed that HCC invasion and metastasis were effectively inhibited by MCM6 knockdown. More significantly, we found that MCM6 knockdown increased epithelial marker expression and decreased mesenchymal marker expression. Additionally, the relationship of MCM6 and EMT markers was confirmed in xenografted tissue specimens. Therefore, our results illustrated that MCM6 promoted the EMT process. Previous reports showed that activation of the MEK/ERK signaling pathway contributed to cell growth, invasion, and EMT [
24,
25]. We showed that phosphorylation of ERK was inhibited by MCM6 silencing. This result suggests that MCM6 might affect EMT via regulation of the activation of the ERK signaling pathway. Strategies to target this pathway might be developed to inhibit HCC metastasis, although more mechanistic studies are needed.
Our study found that MCM6 was significantly upregulated in HCC tissues and predicted poor prognosis and high recurrence risk. Data from the TCGA confirmed this result. Since liquid biopsy has been widely applied in diagnostic situations and the detection of many cancers [
26,
27], serum biomarkers are also recommended to be used in surveillance for HCC early recurrence. Interestingly, our data indicated that the serum MCM6 protein level can predict early recurrence of HCC patients who accepted radical resection. Plasma analyses suggested that postoperative plasma MCM6 levels of early-recurrence patients were significantly higher than those of non-early-recurrence patients. HCC tissues are not always readily obtained during routine follow-up visits, so MCM6 has meaningful potential to be translated and applied to serum detection although further verification based on large sample tests is needed.