Introduction
Gastric cancer is one of the most common cancers and the second leading cause of cancer-related death worldwide [
1,
2]. Due to atypical early symptoms, the majority of gastric cancer patients are diagnosed with advanced-cancer stage, decreasing the chance of resection and resulting in a poor 5-year survival rate [
3]. Although the therapeutic effect of gastric cancer has been greatly improved [
4], the 5-year survival rate is still not satisfactory [
5]. As a result, there is an urgent need for additional research on the pathogenesis of gastric cancer to develop new biomarkers and therapeutic targets, which can help for better diagnosis and treatment.
Tumor blood vessels deliver oxygen and nutrients to tumor tissue, allowing it to grow rapidly and spread to distant locations [
6]. Recently, inhibiting cancer angiogenesis has been developed as a new anti-tumor strategy [
7]. VEGFs were first identified as vascular permeability factors, which are essential for vessel formation in both physiological and pathological conditions [
8]. VEGFs are released by tumor cells and promote vascular leakage [
8]. Mammalian VEGF-A, -B, and -C are required for blood vessel formation, whereas VEGF-C and -D regulate lymphatic vessel formation [
9,
10].
Spalt-like transcription factor 4 (SALL4) encodes a zinc finger transcription factor that is essential for maintaining embryonic stem cell pluripotency and self-renewal [
11]. Overexpression of SALL4 has been reported in a variety of cancers including gastric cancer [
12‐
14]. Numerous studies demonstrate that SALL4 plays a key role in carcinogenesis, cancer metastasis, and cancer therapy resistance [
15,
16]. SALL4 is required for embryogenesis but is rarely found in adult tissues [
17]. It is well known that vasculogenesis and angiogenesis are required for embryogenesis and play a critical role in the regulation of multiple physiological processes during embryonic development. Furthermore, increased cancer vascularization has been linked to a poor prognosis, and a high proliferative, and metastatic potential [
18].
Targeting SALL4 has a promising therapeutic effect on cancer and has the potential to become an effective therapeutic strategy. Previous research has linked high SALL4 expression to a more sensitive response to entinostat treatment in human lung cancer cells [
19]. Also, SALL4 knockdown is an important mechanism for cisplatin-induced apoptosis and may restore cisplatin sensitivity in acquired resistant lung cancer cells [
20].
In this study, we investigated the biological roles and mechanisms of SALL4 in the pathogenesis of gastric cancer. We found that the upregulation of SALL4 in STAD was positively correlated with tumor progression. Also, we found that SALL4-B downregulation inhibited, while overexpression enhanced, the pro-angiogenic effect of gastric cancer cells. In addition, we also discovered that SALL4 promoted angiogenesis via the regulation of the VEGF gene. Furthermore, we used exosomes as a nanocarrier vesicle to deliver SALL4-B-targeting siRNA and the chemotherapeutic drug thalidomide for the suppression of gastric cancer angiogenesis by inhibiting the SALL4/VEGF pathway. Thus, our findings suggest that SALL4 is critically involved in gastric cancer progression by regulating VEGF and angiogenesis, thus providing a potential target for cancer therapy.
Materials and methods
Cell culture
Human gastric cancer cell lines (MKN-45, MGC-803, and HGC-27) and HUVECs were purchased from the Chinese Academy of Sciences’ Institutes for Biological Sciences (Shanghai, China) and maintained in Gibco Roswell Park Memorial Institute (RPMI-1640) or Dulbecco’s modified Eagle (DMEM) medium supplemented with 10% fetal bovine serum (FBS) and 1% penicillin-streptomycin (Gibco, Invitrogen Life Technologies, Carlsbad, CA, USA). All the cell lines were grown in an incubator (37 °C) with 5% CO2.
Chemicals
Thalidomide (CSN12073) and Puromycin (CSN23421) were purchased from CSNpharm (Illinois, USA).
Gene transfection
In 6-well plates, the cells were seeded at a density of 2 × 10
5 cells/well and cultured overnight in a 37 °C incubator. The over-expressing plasmid and silencing siRNAs (Gene Chem, Shanghai, China) were transfected into the cells using Lipofectamine 2000 transfection reagent (Invitrogen; Thermo Fisher Scientific Inc. USA) in a serum-free medium. The cells were switched to a complete medium 6 h after transfection and cultured for another 36 h. The target sequences of siRNAs are shown in (Additional file 1 Table
S1).
CRISPR/Cas9 SALL4 knockout
CRISPR/Cas9 technology was used to create MGC-803 SALL4 knockout cells. SALL4 CRISPR/Cas9 knockout (KO) plasmid (h) (sc-401,033, Santa Cruz Biotechnology, Inc. USA) is a pool of three plasmids, each encoding the Cas9 nuclease and a SALL4-specific 20 nt guide RNA (gRNA) sequence for maximum knockout efficiency. The GeCKO (v2) library is used to generate gRNA sequences that direct the Cas9 protein to induce a site-specific double-strand break (DSB) in the genomic DNA. After incubation, successful transfection of CRISPR/Cas9 KO plasmid may be visually confirmed by detection of the green fluorescent protein (GFP) via Western blot or immunofluorescence (GFP-tag Antibody, T0005, Affinity Biosciences, USA). Co-transfection with SALL4 HDR Plasmid (h) (sc-401,033-HDR, Santa Cruz Biotechnology, Inc. USA) is recommended for Puromycin (10 µg/mL) selection of cells containing a successful Cas9-induced DSB.
Western blotting
A RIPA buffer containing 1% protease inhibitors was used to lyse the cells. SDS-PAGE was used to separate the protein sample, followed by the transfer to PVDF membranes. The membrane was blocked with 5% bovine serum albumin and then incubated overnight with specific antibodies against SALL4 (ab29112, Abcam), VEGF-A (66828-1-Ig, Proteintech), VEGF-B (YT4871, Immunoway), VEGF-C (22601-1-AP, Proteintech), and GAPDH (MB001; Bioworld Technology, St. Louis Park, MN, USA). After 2 h of incubation with the secondary antibodies (Bioworld Technology) at room temperature, the bands were visualized with a chemiluminescent detection system.
RNA extraction and quantitative real-time PCR (qRT-PCR)
Total RNA was isolated using Trizol (Invitrogen Life Technologies) reagent from gastric cancer cells according to the manufacturer’s instructions. For cDNA synthesis, the isolated RNA was reverse-transcribed using the HiScript reverse transcription kit (R312-01/02, Vazyme Biotech, Nanjing, China). The cDNA was then subjected to qRT-PCR analyses using SYBR green on a Bio-Rad CFX96 system. The 2
−ΔΔCt method was used to determine mRNA fold changes. β-actin served as a normalization control. The primer sequences are listed in (Additional file 1 Table
S2).
Conditioned medium (CM) collection
The transfected and treated cells were cultured in RPMI-1640 containing 10% FBS and plated on a 6-well plate (2 × 105 cells/dish). The cells were washed after 24 h and changed from normal growth medium to serum-free medium. After 48 h of incubation, cell culture supernatants were collected and centrifuged at 2000 rpm to remove cell debris.
Cell counting Kit-8 (CCK-8) assay
Cells were seeded in 96-well plates (2000 cells/well), and cultured for the indicated time. Cell growth was measured by incubating cells with CCK-8 solution according to the manufacturer’s instructions (A311-01, Vazyme Biotech). The absorbance at 450 nm was then measured using a microplate reader. The experiment was done in triplicate.
The 96-well plates were coated with Matrigel (60 µl/well). HUVECs (4 × 104 cells/well) were resuspended with the indicated CMs and plated onto the Matrigel (356,234, Corning, USA) after solidification for 1 h at 37 °C. Tubes were observed and pictures were taken after 6-hour incubation at 37 °C for tube formation. The formed tubes were analyzed using ImageJ software.
Cell migration assay
Transwell assays were used to assess the effect of the indicated CMs on HUVEC migration. Briefly, HUVECs were resuspended in a serum-free medium and placed in the upper chamber (4 × 104 cells/well). The lower chamber was then incubated with the indicated CMs for 24 h. Penetrated cells were stained with crystal violet, and images were taken under a microscope to count the cells.
Enzyme-linked immunosorbent assay (ELISA)
The level of VEGF-A, B, and C in si-SALL4-B, P-SALL4-B, CRISPR/Cas9-KO-SALL4, MGC-803-Thalidomide or engineered exosomes cells’ conditioned medium were determined using an ELISA kit according to the manufacturer’s protocol (Jiangsu Jingmei Biological Technology co., LTD.). The absorbance at 450 nm was measured using a microplate reader (FLX800, USA).
Immunofluorescence staining
Cells were plated and grown on coverslips overnight. After being fixed in 4% paraformaldehyde, cells were treated with 0.5% Triton X-100 for cell permeabilization. The coverslips were then immersed in blocking solution for 1 h, followed by incubation with anti-GFP (T0005, Affinity Biosciences) overnight. Coverslips were washed twice with PBS. Cells were observed and pictures were acquired by fluorescence microscope (Delta Vision OMX SR; GE Healthcare Bio-Sciences, Piscataway, NJ, USA).
Chromatin immunoprecipitation assay (ChIP)
According to the manufacturer’s instructions (ab500, Abcam), the chromatin immunoprecipitation assay was performed on MGC-803 cells. Cells were collected in SDS lysis buffer after 10 min of cross-linking with 1% formaldehyde at 37 °C, and the DNA was sonicated to 200 bp fragments. The precleared chromatin was incubated overnight with SALL4 (15H26L3, Thermofisher Scientific) or nonspecific IgG antibodies. Protein A agarose beads were added, and the mixture was incubated at 4 °C for 1 h. Following the reverse of the cross-links, the DNA was isolated and used for PCR. (Additional file 1 Table
S3) shows the specific primers for detecting the responsive element in the promoter of VEGF-A, B, and C genes.
Electrophoretic mobility shift assay (EMSA)
Nuclear extracts were prepared from MGC-803 cells 48 h after transfection with the SALL4-overexpressing plasmid. Nuclear proteins were extracted using a protein extraction kit according to the manufacturer’s instructions (OP-0002, EpiQuick™ Nuclear Extraction Kit 1). A BCA assay (P0011, Beyotime Biotechnology, China) was used to determine nuclear protein concentrations. EMSA kit (E33075, Invitrogen™) was used to investigate the interaction between SALL4 in the nuclear protein extract and the DNA probe. SYBR Green EMSA stain (green) was applied to the gel, followed by SYPRO Ruby EMSA stain (red). The image was documented using a laser-based scanner after each staining (iBright™ 1500 Imagers-Invitrogen™, USA), and the digital images were pseudocolored and overlaid. Yellow bands indicate areas that have been stained with both stains. The probe sequences are listed in (Additional file 1 Table
S3).
Exosomes isolation
Serial centrifugation was used to separate exosomes from the cell culture medium. Cells were cultured in exosome-free FBS for 48 h before the medium was collected. Cell debris is removed by centrifugation at 300 g for 20 min and 2000 g for another 20 min, followed by 30 min of secondary centrifugation at 10,000 g to remove larger vesicles. The medium was then ultracentrifuged at 100,000 g for 3 h, washed with PBS, and centrifuged for another 3 h at 100,000 g. The exosome pellet was resuspended in a suitable volume of PBS. The concentration of exosome suspension was determined using a BCA protein assay kit (P0011, Beyotime Biotechnology, China). Exosomal markers CD63 (ab271286, Abcam), CD9, HSP-70, TSG-101(Cell Signaling Technology, USA), and the ER marker Calnexin (Abcam, UK) were determined.
Nanoparticle tracking analysis (NTA)
The number and size distribution of isolated exosomes were measured using a ZetaView PMX120 instrument (Particle Metrix, Bavaria, Germany) via a 1-ml syringe. The results were calculated three times on average using the corresponding software, ZetaView 8.02.28.
Transmission electron microscopy (TEM)
The isolated exosomes were fixed for 5 min in 2% paraformaldehyde before being dropped onto a Formvar copper carbonate grid with glow discharge for 1 min. The cells were then negatively stained for 1 min with 2% uranyl acetate. After drying the sample, the photograph was taken with an electron microscope (Philips, Netherlands) at an acceleration voltage of 80 kV.
Statistical analysis
Group differences were determined using GraphPad Prism 7.00 software and IBM SPSS 23.0 software. Experimental values are represented as means ± SEM. A two-tailed Student’s t-test (two groups) and a one- and two-way ANOVA test (three or more groups) were conducted as appropriate for differences comparison. The Kaplan-Meier method was employed to analyze patient survival, and Spearman correlation analysis was applied for gene expression correlation analysis. The difference was considered significant as indicated (*P < 0.05, **P < 0.01, and ***P < 0.001).
Discussion
Here, we investigated the potential role of SALL4 in gastric cancer angiogenesis. We found that SALL4 is frequently overexpressed in STAD patients and positively correlated with tumor progression. Also, SALL4-B downregulation suppressed, whereas overexpression increased the proliferation, migration, and tube formation of HUVECs. Furthermore, SALL4-B expression was positively correlated with that of VEGF family genes in gastric cancer cells. More importantly, SALL4 bound to the promoter regions of VEGF family genes and initiated histone modifications to activate their expression, suggesting that SALL4 plays an important role in gastric cancer progression by regulating VEGF.
SALL4 (sal-like 4) is a transcription factor that is abundantly expressed in fetal tissues [
22]. Restored SALL4 expression has been found in various tumors and linked to cancer progression. VEGF is the primary regulator of pro-angiogenic factors, inducing endothelial cell sprouting and proliferation [
23]. The secretion of VEGF by tumor cells contributes to neovascularization, which in turn helps cancer development and progression [
24,
25]. Recent studies indicated that SALL4 downregulation inhibits endothelial cell proliferation, cell cycle progression, migration, and tube formation in HUVEC [
26]. Additionally, VHL mutation-mediated SALL4 overexpression promoted clear cell renal cell carcinoma (ccRCC) cell proliferation, colony formation, cell cycle progression, migration, invasion, tumorigenicity, and tumor vascularization through modulating Akt/GSK-3β axis and VEGF-A expression [
27]. In accordance with previous studies, we revealed that SALL4 knockdown by si-SALL4-B or knockout by CRISPR/Csa9 decreased, while SALL4 overexpression by P-SALL4-B increased the levels of VEGF-A, B, and C, which indicates that SALL4/VEGF axis may be a common regulatory mechanism for cancer angiogenesis.
Several studies have revealed that SALL4 could bind to different gene promoters and activate their expressions. For example, SALL4 promoted EMT and antineoplastic drug resistance by regulating c-Myc [
15]. SALL4 induced epithelial-mesenchymal transition and promoted tumor progression in breast cancer by directly binding to the vimentin promoter [
28]. Also, SALL4 bound to the TGF-β1 promoter and promoted gastric cancer metastasis by upregulating TGF-β1 and activating the SMAD signaling pathway [
14]. In addition, SALL4 bound to the CD44 promoter region and activated its transcription, and CD44 overexpression reversed the inhibition of gastric cancer cell proliferation, migration, and invasion caused by SALL4 knockdown [
29]. The oncogene Bmi-1 is a direct target gene of SALL4, and the SALL4/Bmi-1 network plays a key role in leukemogenesis [
30]. Furthermore, SALL4 bound specifically to the HOXA9 promoter and promoted human myeloid leukemogenesis [
31]. In agreement with the previous findings, our results showed that SALL4 could bind to the (-601 to -711), (-690 to -822), (-852 to -1080) regions of the promoter of VEGF-A, B, and C genes, respectively, and activate their expression in gastric cancer cells. Histone methylation at H3-K4 and H3-K79 sites is associated with the SALL4 binding region of the Bmi-1 promoter and increased in the presence of SALL4 [
30]. The epigenetic activation markers H3-K4 and H3-K79 are also found to be enriched in the same HOXA9-I region bound by SALL4 [
31]. By physically interacting with DOT1-like histone H3-K79 methyltransferase (DOT1l) and LSD1/KDM1A, SALL4 enhances the levels of H3K79me2/3 and H3K4me3 at target gene promoters and thus activates transcription [
32]. In another study, it was confirmed that treatment with a hypomethylating agent led to demethylation of the CpG region and up-regulation of SALL4 expression [
33]. Here, our findings indicate that the SALL4 binding regions of the VEGF-A, B, and C promoters are hypermethylated at H3–K4 and H3–K79 histones in the presence of SALL4.
Thalidomide was developed in 1954 and was first used to treat respiratory infections in 1967. When reports from various countries revealed that the drug was teratogenic, it was withdrawn. It was known that the teratogenic effects of thalidomide are caused by the protein cereblon, which is found in both embryonic and adult tissues. Cereblon is necessary for normal morphogenesis [
34]. Thalidomide has wide anti-cancer and antiangiogenic properties [
35,
36]. Thalidomide can control biological features that are crucial in the context of tumor development and secondary spread. It is capable of inhibiting angiogenesis and cell proliferation, as well as the promotion of apoptosis. In previous studies, it was discovered that thalidomide causes CRBN-dependent degradation of SALL4 [
21,
37]. Thalidomide’s antiangiogenic activity is related to its inhibitory action on VEGF secretion and microvessel formation by human endothelial cells [
38]. In advanced esophageal cancer, thalidomide in combination with TP (pacilitaxel plus cisplatin) chemotherapy inhibits tumor angiogenesis by lowering serum VEGF levels [
39]. Thalidomide also inhibits VEGF-A expression in colorectal cancer cells in a dose and time-dependent manner [
40]. Transcatheter arterial chemoembolization (TACE) in combination with thalidomide-mediated adjuvant treatment has demonstrated a promising clinical outcome in hepatocellular carcinoma (HCC) patients by lowering VEGF levels [
41]. We found that gastric cancer cells treated with different concentrations of thalidomide expressed lower levels of VEGF-A, B, and C at both mRNA and protein levels. Furthermore, the CM from thalidomide-treated gastric cancer cells displayed an impaired effect to promote the proliferation, migration, and tube formation of HUVECs, indicating that thalidomide may target SALL4 to inhibit VEGF signaling.
Recent advances in drug delivery biomaterials have enabled remarkable progress in disease treatment [
42,
43]. This discovery enabled the biomaterial-based drug delivery strategies to be a novel method for cancer inhibition. Exosomes have been considered as promising drug delivery vehicles that can deliver chemotherapeutics, proteins, or genes against tumors and have unique advantages such as nanosized, biodegradability, and tumor-homing function [
44‐
46]. Exosomes also have improved stability, enhanced endocytosis, and lower toxicity in vivo [
44]. This evidence suggests that exosomes may be a novel nanosized drug delivery system for cancer treatment. Recent studies indicate that cisplatin encapsulated in M1 macrophage exosomes effectively inhibits lung cancer cell proliferation and induces apoptosis. The simultaneous delivery of miR-21i and 5-FU via exosomes significantly increases cytotoxicity in 5-FU-resistant colon cancer cells [
47]. A functionalized macrophage exosome-based nano-drug delivery system loaded with Panobinostat and PPM1D siRNA effectively kills Pontine Gliomas (DIPG) tumor cells in vitro and achieves significant tumor growth inhibition and prolonged survival time in orthotopic DIPG-bearing mice [
48]. In addition, mesenchymal stem cell (MSC)-derived exosomes can transfer miR-15a to HCC cells to inhibit proliferation, migration, and invasion by negatively regulating SALL4 [
49]. Also, SALL4 could bind to the promoter of miR-146a-5p and directly influence its expression in exosomes. In DEN/CCL4-induced HCC mice, blocking the interaction between SALL4 and miR-146a-5p lowered inhibitory receptor expression on T cells, reversed T cell exhaustion, and delayed HCC progression [
50]. Based on the above studies, it is plausible that an exosome-based nano-drug delivery system loaded with thalidomide and SALL4-B siRNA inhibited SALL4-B and VEGF family gene expression in gastric cancer cells. After treatment with engineered exosomes, the CM from gastric cancer cells had a remarkably decreased ability to promote HUVEC cell proliferation, migration, and tube formation, indicating that this strategy may represent a new regimen for cancer therapy by suppressing SALL4/VEGF pathway via exosome-mediated drug delivery.
In conclusion, our study suggests that SALL4 plays a critical role in gastric cancer angiogenesis by modulating VEGF expression, and targeting SALL4 may be an effective strategy for anti-angiogenic therapy of gastric cancer.
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