Colorectal cancer is a major health challenge globally. Though there have been improvements of early detection and systemic treatment, some CRC patients still succumb to distant metastasis and recurrence due to limited treatment options [14, 15]. The majority of CRC are adenocarcinomas originating from colonic epithelial tissue which is the result of genetic mutations [6]. The extreme heterogeneity of CRC in histological subtyping, TNM staging and molecular subtypes brings certain differences in tumor biology, therapeutic effect and prognosis. There are four major types of CRC therapy according to different stages: surgery, radiotherapy, chemotherapy and immunotherapy. Recently, immunotherapy strategy against CRC being tested in a number of human clinical trials [16]. Tumor heterogeneity and its interaction with immune microenvironment remains a formidable challenge for CRC immunotherapy [17].
N6-methyladenosine (m6A), one such RNA modification is the N6-methylation found on adenosine (m6A) and 2'-O-methyladenosine (m6Am) regulated at post-transcriptionally level. It imposes a series of influence for RNA metabolism, such as splicing, translation, export and decay [18]. The variety of functionality played by this modification illustrates why m6A regulation correlated with various human cancer. Regulators of m6A are associated with tumor proliferation, angiogenesis and migration among different cancer types including papillary thyroid cancer, hepatocellular carcinoma, gastric cancer and colorectal cancer [19–21]. For instance, m6A related regulator, YTH m6A RNA-binding protein 1 (YTHDF1), plays important role in gastric carcinogenesis by controlling translation of FZD7 [22]. Aberrant expression of YTHDF1 correlated with more aggressive tumor phenotype and poor clinical prognosis. Overexpression of WTAP related to m6A methylation promotes hepatocellular carcinoma progression via the HuR-ETS1-p21/p27 axis [23]. WTAP serves as a potential therapeutic target of hepatocellular carcinoma therapy. These studies indicated the occurrence of m6A, a well-known modification with new epigenetic functions, perform regulatory mechanism in tumorigenesis.
There has been considerable research in the past years on the relationship between m6A and CRC [24]. As far as we're concerned, the function of m6A related prognostic biomarkers and regulatory mechanism in colorectal cancer, by far, has not been fully elucidated. It is highly necessary to clarify the prognostic value of m6A related regulators and its immune infiltration, a benefit for personalized immunotherapy in CRC.
In this work, to identify effective prognostic biomarkers and study the malignant biological properties of CRC, gene expression profile and clinical information of 536 CRC sample from TCGA dataset were evaluated by a series of bioinformatics analyses. First, we identified 25 differential expression levels of m6A regulators in CRC patients, the majority of m6A regulators were significantly different between CRC and normal group. Obviously, these candidate molecule plays important role in the progression of CRC. Furthermore, we analyzed the somatic mutations in CRC patients from the cBioPortal database. In terms of mutation data, 178 of 536 CRC patients contained mutated m6A related genes. To some extent, it suggests a role of m6A methylated modification in colorectal cancer susceptibility. Several cases of m6A methylated modification in cancer have been reported in the literature, and it is clear that the variant rs8100241 located in ANKLE1 was significantly associated with susceptibility of BRCA1 mutation triple negative breast cancer [25]. Besides, the association between m6A regulators aberrations and survival time in CRC obtained from TCGA was determined to further evaluate the prognostic value. Cox regression identified 8 m6A regulators related with CRC prognosis and patients with high expressions of FMR1, LRPPRC, METTL14, RBMX, YTHDC2, YTHDF2, YTHDF contribute to the poor prognosis of CRC patients. Moreover, low expression of IGF2BP1 possess poor prognosis in CRC patients. After further screening, we evaluated the relationship between expression of FMR1, LRPPRC, RBMX, YTHDC2, IGF2BP1 and clinical parameters, including stage, T (tumor infiltrating), N (lymphatic metastasis) and M (distant metastasis) in CRC. Obviously, we found that there was significant difference between normal group and four stages for FMR1, IGF2BP1, LRPPRC and RBMX. Nevertheless, there was no significant correlation between YTHDC2 and clinical stage of CRC patients. These m6A regulators may closely related to CRC severity. We all know that biomarkers can also reveal changes in a biological pathway that relate to disease progression. To further clarify the role of above five m6A regulators, we analyzed the mRNA expression patterns in human CRC samples. The results showed conspicuously higher RBMX, FMR1 and IGF2BP1 expression in tumor tissues, especially RBMX. These candidates can be regarded as potential therapeutic targets in CRC. RBMX is a ubiquitously expressed nuclear RNA binding protein which plays vital role in binding and stabilizing many proteins [26]. Some reports showed RBMX implicated in viral infection and cancer [27, 28]. RBMX serves as therapeutic target for hepatocellular carcinoma, because it promotes hepatocellular carcinoma development and reduce sorafenib sensitivity by targeting BLACAT1 [29]. RBMX plays tumor suppressor role in bladder cancer [30]. Neither is it clear what roles of RBMX played in CRC, it certainly looks worthy of further investigation.
As we know, colorectal cancer is highly heterogeneous at the genetic and molecular level, which has major repercussions on the efficacy of immunotherapy [31]. Hence, there is a strong relativity of prognosis and immune infiltration in CRC patients. In this study, we explored the roles of five m6A regulators and immune cell infiltration level in CRC. Primarily, we found that RBMX, FMR1, LRPPRC, YTHDC2 and HNRNPC expression significantly associated with immune cell, IGF2BP1 expression only correlated with T cells, CD4, memory cell. Considering the adaptive immune response influences the behavior of human cancer, we figured the tumor-infiltrating immune cells may therefore be a valuable prognostic tool in the therapy of CRC. The majority of CRC patients are microsatellite-stable genetic subtype, a molecular indicator of proficient DNA mismatch repair. Compared with microsatellite-stable genetic subtype, high tumor mutational burden and neoantigen load in microsatellite instability tumors favors the infiltration of immune effector cells [32]. It is reported that RBMX and HNRNPC can predict the prognosis of head and neck squamous cell carcinoma and are related to immune infiltration [33]. Additionally, YTHDC2 was significantly associated with tumor immune infiltration in skin cutaneous melanoma and brain lower grade glioma [34]. we arrived at the same general conclusion that YTHDC2 was positively correlated with immune cells.
Immunotherapy is the most exciting and most promising development in cancer research [35]. M6A modification is heavily involved in modulation of immune responses, and how immune responses regulate m6A modification remains elusive in CRC. We hold opinion that immune cell infiltration of primary non-metastatic tumors is a strong prognostic factor for survival in CRC patients. Hence, we examined the correlation between m6A regulatory factor and immune regulatory factor. We found that FMR1, IGF2BP1, LRPPRC, RBMX was negatively correlated with immunosuppressants, YTHDC2 was positively correlated with immunosuppressants. IGF2BP1, LRPPRC, RBMX was negatively correlated with immunostimulators, FMR1 and YTHDC2 was positively correlated with immunostimulators. FMR1, IGF2BP1, LRPPRC, RBMX was negatively correlated with MHC molecules, YTHDC2 positively correlated with MHC molecule. Immune cells means a large fraction of the tumor microenvironment which plays crucial role in mediating pro-tumor and anti-tumor immune responses. There are some studies suggesting the same theoretical for immunomodulation in different cancer types [36, 37]. It follows that immunomodulation is closely linked with tumor relapse and prognosis in CRC. Collectively, the mechanism of above m6A related regulators with immune microenvironment has not been elucidated thoroughly now. Some of these regulators play important role in epigenetic modification and immune infiltration, which may serves as potential biomarker for prognosis in CRC patients.