Inhibition of HIF1A-AS1 promoted starvation-induced hepatocellular carcinoma cells apoptosis by reducing HIF-1α/mTOR mediated autophagy



Background: Hepatocellular carcinoma (HCC) is still a major health burden in China considering its high incidence and mortality. Long non-coding RNAs (lncRNAs) were found playing vital roles in tumor progression, suggesting a new way of diagnosis and prognosis prediction, or treatment of HCC. This study was designed to investigate the role of HIF1A-AS1 during the progression of HCC, and to explore its related mechanisms.

Methods: The expression of HIF1A-AS1 was detected in 50 paired carcinoma tissues and adjacent normal tissues by quantitative real-time PCR assay. HCC cells apoptosis was induced by nutrient-deficient culture medium, and detected by Cell Counting Kit‐8 and flow cytometer assays. HIF1A-AS1 inhibition in HCC cells was accomplished by small interfering RNA transfection.

Results: HIF1A-AS1 was overexpressed in HCC tissues and was associated with tumor size, TNM stage and lymph node metastasis. Compared with low HIF1A-AS1 group, high HIF1A-AS1 group had a shorter overall survival and a worse disease-free survival. HIF1A-AS1 expression was significantly higher in HCC cell lines (7721 and Huh7) than that in normal hepatocyte cell line L02 under normal culture condition. However, under nutrient-deficient condition, HIF1A-AS1 expression was significantly increased in both HCC and normal hepatocyte cell lines, and was increased with the prolongation of nutrient-free culture. inhibition of HIF1A-AS1 promoted starvation-induced HCC cells apoptosis. Furthermore, inhibition of HIF1A-AS1 could also reduce starvation-induced HCC cells autophagy. The expression of HIF-1α and phosphorylated mTOR was significantly decreased in HCC cells after HIF1A-AS1 inhibition.

Conclusions: HIF1A-AS1, overexpressed in HCC and associated with HCC prognosis, could regulate starvation-induced HCC cells apoptosis by reducing HIF-1α/mTOR mediated autophagy, promoting HCC cell progression.

Trial registration: This research is retrospectively registered.


Hepatocellular carcinoma (HCC) is the most common primary liver cancer in the world, and it is one of the most common causes of tumor-related deaths due to the high incidence of tumor recurrence and metastasis worldwide [1]. Although interventional therapy, liver transplantation, chemotherapy and surgery are available to treat HCC, the 5-year survival rate remains unsatisfactory [2]. In general, the process of HCC involves multiple steps, including a large number of genetic or epigenetic changes [3], which ultimately lead to the transformation of hepatocellular malignancies. Therefore, in order to improve the diagnosis and management strategies for HCC, it is urgent to find new hepatocellular carcinoma biomarkers and to understand the molecular mechanism of HCC in more detail.

Autophagy is a highly conserved and widespread mechanism of lysosome-dependent self-digestion and intracellular recycling in the evolutionary process, which is essential for the maintenance of cellular homeostasis [4]. The self-protection mechanism of autophagy occurs in unfavorable environment, which is closely related to the occurrence and development of tumor [5]. For instance,autophagy can affect the progression of HCC by regulating the expression of other factors or signaling pathways, such as RAC1, NF-κB, and PI3K pathways [68]. However, the specific molecular mechanism between HCC and autophagy remains unclear.

Long non-coding RNAs (lncRNAs) is one of the most important regulatory factors in medical research in recent years, which play a complex and precise regulatory function in the development of organism and disease [9]. Recently, it has been reported that several lncRNAs are frequently regulated in HCC, including HOTAIR, MALAT1, UCA1, HULC, DBH-AS1, and PTV1 [1015]. Some of these lncRNAs include HOTAIR, HULC, PTV1 and MALAT1, which are also involved in the regulation of autophagy in hepatoma cells [1619]. LncRNA HIF1A-AS1 is located on the antisense strand of hypoxia inducible factor 1α (HIF-1α) of human chromosome 14, and the length of mature body is 652 nt. Zhang et al found that the activation of hepatic stellate cells mediated by TET3 may be mediated by regulating the HIF1A-AS1 expression [20]. The expression of HIF1A-AS1 is closely related to the proliferation and apoptosis of hepatic stellate cells [21]. However, the specific downstream regulation mechanism of HIF1A-AS1 has not been reported.

In our study, we aimed to identify the relationship between HIF1A-AS1 expression and clinical characteristic of HCC, and explore the role and mechanism of HIF1A-AS1 on nutrient-deficient induced HCC cell apoptosis and autophagy. The results would bring potential research directions for HCC treatment in future.


Patients and specimens

This study was carried out in accordance to the principles of the Declaration of Helsinki and approved by the Medical Ethics Committee in Ningbo University Medical College. All clinical HCC tissues and matched adjacent normal tissues were obtained from Yinzhou Hospital between 2015 and 2017. Written informed consent was obtained from all the participants prior to enrollment. All patients recruited in this study were diagnosed with HCC based on histopathological evaluation, and were not received any chemotherapy or radiotherapy before surgical operation. All collected tissues were immediately stored at liquid nitrogen until further analysis. TNM staging of HCC samples were performed according to 7th edition AJCC/UICC TNM staging systems. Clinicopathological characteristics analyses of all the specimens were provided in Tables 1.

Table 1
Correlation between HIF1A-AS1 levels and clinical features of HCC patients
clinical features
HIF1A-AS1 expression
High (n = 25)
Low (n = 25)
≤ 50
> 50
Tumor size
≤ 5 cm
> 5 cm
TNM stage
Lymph node metastasis
*P < 0.05

Cell lines and culture

The human HCC cell lines (7721 and Huh7) were obtained from Chinese Academy of Sciences, the normal hepatocyte cell line (L02) was presented by Department of General Surgery of Changhai Hospital. Cells were cultured in Dulbecco’s modified Eagle’s medium (Gibco) containing 10% fetal bovine serum (Gibco) in a humidified atmosphere of 5% CO2 at 37 °C. The nutrient-deficient induction was established by Earle’s Balanced Salt Solution (EBSS. Gibco).

RNA extraction and quantitative real-time PCR (qRT-PCR)

Total RNA was extracted from tissue and cell samples using Trizol reagent (Invitrogen) according to the manufacturer’s protocol. Reverse transcription was performed using PrimeScript RT Reagent Kit (TaKaRa). The diluted cDNAs were amplified using SYBR Premix Ex Taq (TaKaRa). Three independent biological replicates were set at least for the cell experiments. β-actin was used as a loading control.

Western blot analysis

Total cell lysates were subjected to 10% SDS-PAGE and the proteins were transferred to nitrocellulose filter membranes, followed by blocking for 1 hour in 5% non-fat dry milk. The membranes were incubated with primary antibodies at 4 °C overnight, and then with secondary antibodies at room temperature for 1 hours. Proteins were visualized by ECL Plus Western Blotting Substrate (Thermo Scientific) on ChemiDoc MP system (Bio-Rad). β-actin was used as a gel loading control.

Small interfering RNA (siRNA) and transient transfection

SiRNA targeting HIF1A-AS1 (si-HIF1A-AS1) and scrambled control (si-NC) were designed and synthesized by Shanghai GenePharma company. When the confluence of cells reached to 70–80%, siRNAs were transfected at a final concentration of 100 nmol/L with Lipofectamine 2000 (Invitrogen) according to the manufacturer’s protocol. Knockdown levels of the siRNA were determined by RT-PCR.

Cell viability analysis

The HCC cells vitality were identified by Cell Counting Kit-8 assay (CCK-8. Beyotime). Briefly, HCC cells were seeded in a 96-well plate (6 wells per group) and incubated overnight, followed by siRNA transfection and nutrient-deficient induction for 24 h. After adding 10 µL CCK‐8 solution, the relative growth vitality was detected on a microplate reader (BioTek) according to the manual.

Cell apoptosis analysis

The cell apoptosis was determined using Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) double staining (BD Biosciences). After treatment for 48 h, cells were harvested and resuspended in 200 µL Annexin-binding buffer. Then, the cells were incubated with 10 µL Annexin V-FITC and 5 µL PI for 30 min in the dark. The stained cells were examined by a FACScan flow cytometer (BD Biosciences).

Statistical analysis

The statistical analysis was carried out by SPSS 22.0 software. The qualitative data was analyzed by Chi-Square test or Fisher’s exact test when necessary. The quantitative data were expressed as the means ± standard deviations, and analyzed by t-test for 2 groups, and one-way ANOVA test for multiple groups. The survival curves were analyzed by Kaplan-Meier test. A P value less than 0.05 was considered statistically significant.


The elevated HIF1A-AS1 levels was directly proportional to HCC prognosis

We first detected the expression of HIF1A-AS1 in 50 pairs of HCC specimens and corresponding adjacent normal tissues by qRT-PCR. The results showed that HIF1A-AS1 expression was obviously up-regulated in HCC specimens when compared with that in matched normal tissues (P < 0.01. Figure 1A). Additionally, we analyzed the correlation between HIF1A-AS1 expression and clinicopathological characteristics in HCC patients, which were divided into high HIF1A-AS1 group (n = 25) and low HIF1A-AS1 group (n = 25) with the median value of HIF1A-AS1 expression as a cutoff point. Statistical analysis revealed that high level of HIF1A-AS1 was significantly correlated with tumor size (P = 0.023), TNM stage (P = 0.024) and lymph node metastasis (P = 0.047. Table 1). There was no significant correlation between HIF1A-AS1 expression and other clinicopathological features including age, gender (P > 0.05). Furthermore, patients in the high HIF1A-AS1 group had a shorter overall survival (P = 0.0225. Figure 1B) and a worse disease-free survival (P = 0.017. Figure 1C) than low HIF1A-AS1 group. Together, these results demonstrated that HIF1A-AS1 expression might be associated with the HCC progression and prognosis.

HIF1A-AS1 expression was increased in HCC cells exposed to starvation

To clarify the potential function of HIF1A-AS1 on HCC development, we first detected HIF1A-AS1 expression levels in different HCC cells. On normal culture condition, the expression level of HIF1A-AS1 was significantly higher in HCC cell lines (7721 and Huh7) than that in normal hepatocyte cell line L02 (Fig. 2A). Under nutrient-deficient condition, HIF1A-AS1 expression was significantly increased in both HCC and normal hepatocyte cell lines (Fig. 2B). Furthermore, we analyzed the relationship between HIF1A-AS1 expression and the nutrient-deficient time in 2 HCC cell lines. QRT-PCR assay confirmed that the expression of HIF1A-AS1 was increased with the prolongation of nutrient-free culture in both 7721 and Huh7 cell lines (Fig. 2C-2D). These results indicated that the HIF1A-AS1 might be correlated with nutrient-deficient induced HCC cells behaviors.

Inhibition of HIF1A-AS1 promoted starvation-induced HCC cells apoptosis

In order to further explore the role of HIF1A-AS1 on nutrient-deficient induced HCC cells behaviors, siRNAs targeting HIF1A-AS1 (si-HIF1A-AS1) and negative control (si-NC) were synthesized and transfected into HCC cells respectively. The inhibition efficiency of si-HIF1A-AS1 was verified by qRT-PCR assay. Si-HIF1A-AS1 transfection could significantly reduce the HIF1A-AS1 level in 7721 and Huh7 HCC cell lines (Fig. 3A-3B). The result from CCK-8 assay showed that the viability of HCC cells transfected with si-HIF1A-AS1 was significantly lower than that of si-NC group under nutrient-deficient condition (Fig. 3C). Flow cytometry assay confirmed that inhibition of HIF1A-AS1 could enhance nutrient-deficient induced HCC cells apoptosis (Fig. 3D).

Inhibition of HIF1A-AS1 reduced starvation-induced HCC cells autophagy

Autophagy is an important mechanism for cells to survive and resist apoptosis in extreme environments, such as nutrient deficiency and hypoxia. Western blot assay showed that the expression of autophagic marker (BECN1 and LC3) was significantly increased in 7721 and Huh7 cell lines after 12 h-nutrient-deficient culture (Fig. 4A-4B). Subsequently, we explored the role of HIF1A-AS1 on HCC cells autophagy induced by nutrient-deficient. After 12 h-nutrient-deficient induction, the increased expression of BECN1 and the conversion of LC3I to LC3II (LC3 II/I) was significantly reduced in both 7721 and Huh7 cell lines transfected with si-HIF1A-AS1 (Fig. 4C-4D). Then, we further detected the effect of HIF1A-AS1 on HIF-1α and mTOR expression under normal and nutrient-deficient condition. The results showed that the expression of HIF-1α and phosphorylated mTOR was significantly reduced in 7721 and Huh7 HCC cell lines after HIF1A-AS1 inhibition (Fig. 4E-4F). These results suggested that HIF1A-AS1 might regulate starvation-induced HCC cells autophagy through HIF-1α and mTOR pathways.


In the present study, we found that HIF1A-AS1 was highly expressed in HCC tissues, and associated with poor HCC prognosis. Inhibition of HIF1A-AS1 could promote starvation-induced HCC cells apoptosis, which might be mediated by HIF-1α pathway-related autophagy. Our results suggested that inhibition of HIF1A-AS1 might be a potential strategy for HCC treatment.

Many studies have shown that lots of differentially expressed lncRNAs are involved in regulation of HCC cells proliferation, migration, and invasion [22]. LncRNA TUG1, highly expressed in HCC cells, could promote proliferation and apoptosis of HCC cells through epigenetic silencing of KLF2 [23]. Wang et al found that lncRNA PVT1 can stabilize NOP, thereby promoting HCC cells growth and maintaining stem cell-like properties [24]. LncRNA Magic2-AS3 could inhibit HCC progression by targeting the miR-374b-5p/SMG1 pathway [25]. Our work confirmed that inhibition of HIF1A-AS1 could promote starvation-induced HCC cells apoptosis. Based on the limited protein-coding potential of lncRNAs, overexpression or inhibition of lncRNAs would be a more feasible strategy for gene therapy in HCC.

HIF1A-AS1, located in the antisense strand of human HIF-1α gene, was recognized as an oncogene in non-small cell lung cancer and colorectal cancer [26, 27]. In addition, studies have shown that HIF1A-AS1 was involved in the regulation of proliferation of vascular smooth muscle cells, which may be related to the pathogenesis of aneurysms [2830]. However, the role of HIF1A-AS1 in HCC remains unclear. In our study, the elevated expression of HIF1A-AS1 was associated with tumor size, TNM stage, lymph node metastasis and prognosis. These evidences suggested that HIF1A-AS1 played an important role during the progression of HCC.

Autophagic cell death is a process of programmed cell death that is different from apoptosis and does not depend on the Caspase pathway. The autophagic activity would be increased in the harsh environments, including nutritional deprivation, peroxidative damage, and DNA damage. During the development of HCC, in order to adapt to nutrient deficiencies and hypoxia, cells would initiate autophagy to protect themselves [31]. Therefore, inhibition of tumor cell autophagy is an important part of anti-tumor drug development. To date, there have been some studies on the relationship between lncRNA and HCC cells autophagy. Yang et al. found that HOTAIR activated autophagy by increasing the expression of ATG3 and ATG7 [16]. Xiong et al. found that HULC triggered protective autophagy by stabilizing SIRT1 [17]. Yuan et al. found that MALAT1 could inhibit HCC cells apoptosis and reduce chemosensitivity by promoting autophagy [18]. In our experiments, it was found that in the starved state of HCC cells, the highly expressed HIF1A-AS1 is involved in autophagy activation and reduces the HCC cells apoptosis.

mTOR is a mammalian target of rapamycin, an atypical serine/threonine protein kinase. As a key regulator of the autophagy initiation phase, inhibition of mTOR complex 1 (MTORC1) in autophagy has been demonstrated [32]. Li et al found that DCST1-AS1 accelerates proliferation, metastasis and autophagy of HCC cells through the Akt/mTOR signaling pathway [33]. Zhang et al found that SOCS5 promotes HCC cell metastasis via PI3K/Akt/mTOR-mediated autophagy pathway [25]. In our study, we found that inhibition of HIF1A-AS1 induced decreased expression of HIF-1α, suggesting that the role of HIF1A-AS1 on HCC cells autophagy might be mediated by HIF-1α/mTOR pathway.


In conclusion, our results suggest that HIF1A-AS1 promotes hepatocarcinogenesis through activation of autophagy via the HIF-1α/mTOR signaling pathway, and reveal that HIF1A-AS1 is involved in a new pathway to regulate HCC progression and provides a potential direction for future HCC treatment strategies.

List Of Abbreviations

HCC, hepatocellular carcinoma cells; lncRNAs, long non-coding RNAs; HIF-1α, hypoxia inducible factor 1α; siRNA, Small interfering RNA; CCK-8, Cell Counting Kit-8; FITC, fluorescein isothiocyanate; PI, propidium iodide.


Ethics approval and consent to participate

This study was carried out in accordance to the principles of the Declaration of Helsinki and approved by the Medical Ethics Committee in Ningbo University Medical College. All clinical HCC tissues and matched adjacent normal tissues were obtained from Yinzhou Hospital between 2015 and 2017. Written informed consent was obtained from all the participants prior to enrollment.

Competing interests

The authors declare that they have no competing interests.


This work was supported in part by Zhejiang Provincial Natural Science Foundation of China (LY16H160004), Shanghai Municipal Population and Family Planning Commission (201540304), Natural Science Foundation of Shanghai (17ZR1422500 and 19ZR1456300), and Interdisciplinary Program of Shanghai Jiao Tong University (YG2016MS26).

Authors’ contributions

X. L. and F. X: conception and design of the work. F. H., Y. L. and Y. G: acquisition, and interpretation of data. L. Z.: statistical analysis of the data. X. L. and F. H.: writing of the draft.


We thank all members of the laboratory for helpful discussions and comments on the manuscript.


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