NSCLC, as the main category of lung cancer, renders the highest cancer-related mortality in many countries of the world [18]. Radiotherapy is one of the major treatments. However, in the clinical practice of radiotherapy, we have been used single-dose and segmentation mode(58-60Gy,30 times) to carry out NSCLC radiation treatment, resulting in a great difference in clinical efficacy and overall deviation in prognosis. Whether accurate individualized treatment can be determined based on the difference of tumor sensitivity is the necessity of the development of precision medicine. Is there any difference in radiosensitivity among NSCLC patients? We did experiments on fourteen consistent pathological type cell lines.Our results show that there are great differences in SF2 among fourteen lung adenocarcinoma cell lines in vitro(Table 1), and the radiosensitivity of each cell line in this study is close to the results reported in the literature, which reflects the overall reliability of the results of this study. Our observations indicate that inherent radiosensitivity differences exist in lung adenocarcinoma cells obtained from different SF2. But what causes this difference is not clear.
We primarily considered mutations in EGFR, which is a driver that can result in lung adenocarcinoma[18]. EGFR mutations are found in 47% of NSCLC patients in the Asia Pacific. NCCN guidelines recommended EGFR inhibitor oxitinib for first-line treatment of advanced EGFRm + NSCLC[19]. There is no conclusion on the combination of EGFR inhibitor and radiotherapy. It depends on whether the EGFR mutation affects the outcome of radiotherapy in vivo and whether there is a statistical correlation between the EGFR mutation and the gold standard of radiosensitivity (SF2) in vitro. A recent meta-analysis about the efficacy of definitive chemoradiotherapy in patients with locally advanced unresectable stage III non-small-cell lung cancer found that the presence of EGFR mutations may be indicative of patients overall survival(OS), but no difference in objective recurrence rate(ORR) that was more related to radiosensitivity[5]. This finding is opposed to data previously generated in preclinical studies[6][7][8]. Three articles were using statistical methods analyzed NSCLC cell lines SF2 values and EGFR mutation in the past ten years all have proved that EGFR mutation is related to radiosensitivity. Bo Xie and [8] used eight cell lines, of which three cell lines were repetitive cell-line subtypes in the mutation group. in the study of Takashi Nakano and his colleagues, the pathological types of lung cells were different[6]. The significance of pathological type consistency is that lung squamous carcinoma cell EGFR is not a key driver gene for lung squamous carcinoma, which is another type of NSCLC[20].
In this paper, we considered that there was no significant difference in SF2 between the EGFR mutant-type group and the wild-type group. NSCLC cell lines with EGFR mutation had been first proved to be associated with radiosensitivity in 2006, which is cited as the background of the three articles mentioned above[21]. In the original study, it is that just four cells were observed to have radiosensitivity difference in SF2, which explored 19 cell lines in total[21]. Instead, the effect of radiotherapy resistance was observed in the EGFR mutant cell line H1655, which was opposed to most of the mutant cell lines. The author believes that there may be a bypass basic involved in the response of EGFR and radiosensitivity[21]. Recent studies have proved that EGF modulates adhesion by redistributing focal adhesion constituents to adhesion sites. EGF response underlies an EGFR integrin cross-talk under the recruitment of receptor distal events[22]. EGFR might distinguish between radiosensitivity and radiotherapy resistance in a small number of NSCLC cell lines, but in a larger cell sample with a consistent pathological type, EGFR mutation status was insufficient to describe the difference in radiosensitivity. Our results initially raised questions about the use of a single standard of reference, EGFR mutant-or-not, for the diagnosis of radiosensitivity. However, there is no significant correlation between EGFR mutation and radiosensitivity, as expected, cause increasing evidence in cell line models suggests that the real situation may be substantially more complex. Just like organisms as a whole, individual cells can respond to radiation by the whole cell as a system, not as a part. Lung adenocarcinoma cells’ difference in radiosensitivity through changes in the activities of biomolecules that integrate signaling pathways and networks.
After the concept of proteomics has been put forward, the technology of proteomics was initially used the electrophoretic gel stained with coomassie brilliant blue, and the staining intensity was quantitatively analyzed. However, limited by staining agents and experimental techniques [23], it has now been replaced by non-gel separation techniques such as liquid chromatography. The principle of liquid chromatography-tandem mass spectrometry (Liquid chromatography coupled with tandem mass spectrometry, LC-MS/MS) is that protein samples are transformed into moving charged ion fragments, which are separated and identified according to their different mass-charge ratios. Protein and peptide mass spectrometry convert protein molecules into gas-phase ions through ionization sources. Proteins with a specific mass-charge ratio are separated in the electromagnetic field of the mass spectrometer, and unknown proteins are identified. Mass spectrometry can obtain more information, fast analysis speed, high sensitivity, and high resolution. In the further stage of data analysis, DDA and DIA are developed. In this method, the protein samples were digested into peptides and ionized for mass spectrometry analysis. Both DDA and DIA initially need full-scan mass spectra to cleave the signals of peptides that are higher than noise, but DDA is selectively cleaved, and the peptides are matched with the maps of the database to determine the types of proteins. Because most of the cleavage methods of selective random extraction tend to high abundance peptides, the information loss of low abundance peptides is large, and there are high data loss and randomness of collection [24]. DIA data-independent acquisition (Data-independent acquisition, DIA) technology divides the full scanning range into several windows, and then monitors all ions in each window, splits, and extracts all ion information in the sample without omission or difference. DIA technology realizes high data coverage and high reproducibility on this basis, improves the amount of data for a single analysis, reduces the missing and null values of each collection, and improves the reproducibility of identification,quantitative stability and accuracy. The biggest advantage of DIA compared with DDA lies in the efficient determination of extremely low abundance protein molecules in complex samples, which greatly improves the credibility of quantitative analysis and has higher quantitative accuracy and repeatability [25]. Identification of radiosensitive proteins by DIA proteomics has been used in prostate cancer tissue samples, which obtained a mean coverage of 5660 proteins from fresh tissue biopsies; with the principal, post-radiation change observed is an increase in levels amongst a total of 49 proteins exhibiting abundance changes.
We used DIA proteomics and bioinformatics analysis to explore differently express proteins (DEPs)and signal pathways, which may reveal the radiosensitivity-specific pathway maps. Our results displayed that there were a total of thirty-nine differential proteins obtained. GO and KEGG showed that signal pathways are ECM-receptor interaction, Focal adhesion, Hematopoietic cell lineage, Prion diseases. Analysis of correspondence between the signal pathway and DEPs combining with the analysis of protein-protein interaction(PPI) showed that the following proteins may play a more important role in the radiosensitivity of lung adenocarcinoma.LAMC1, ITGB4/ITGA6, and CD44 participated in multiple signaling pathways, demonstrated by a centplot. PPI founded that LAMC1, ITGB4/ITGA6, CD44, PRNP interacted more concentratedly. So it is believed that LAMC1, ITGB4/ITGA6, CD44, and PRNP may be the node proteins that weave the signal pathway into a network.(suplement Fig. 2)Among them, ITGB4/ITGA6, CD44 has been proved to be related to radiosensitivity in previous studies, and the details are shown in supplement table 4. The correlation between LAMC1 and PRNP and radiosensitivity has not been reported in previous studies.
In the KEGG signal pathway, the “ECM receptor interaction pathway” and “focal adhesion pathway” have similarities in function. Prion disease pathway and Hematopoietic cell lineage are new signal pathways in the research field of radiosensitivity. (Supplement Table 5)
To describe the radiosensitivity-specific pathway maps should optimize the DEPs integrating into the pathway networks. Differentially expressed proteins—signal pathways correspondence analysis and the PPI analysis showed that proteins, LAMC1, ITGB4/ITGA6,andCD44, not only participate in multiple signal pathways but also interact more closely with each other. Cells participate in the role of radiation as a complex system, and the signal pathways involved should also be a network of signal pathways connected in series with each other[45]. With this in mind, these proteins may be the key proteins that “weave” the network of the radiosensitivity-specific pathway, ECM-receptor interaction, Focal adhesion, Hematopoietic cell lineage, Prion diseases.
The advantages of this study are mainly reflected in three aspects. Firstly, we initially discussed the correlation between the lung adenocarcinoma mutation state of EGFR and radiosensitivity. Given the inconsistency between the results of pre-clinical research and clinical observation, we discussed the reasons for this result, that is, preclinical studies are often based on a small number of cells, and the pathological types are not consistent. Secondly, the SF2 values of fourteen lung adenocarcinoma cell lines were measured in the previous work, and each cell was repeated three times, which is a more reliable result. Therefore, we analyzed the correlation between EGFR mutation and SF2 in the lung adenocarcinoma cell line with EGFR as the driving gene. Thirdly, based on the most advanced proteomics technology, DIA-LC-MS/MS, we used a proteomic analytical method to explore the radiosensitive signal pathways of the lung adenocarcinoma cell lines. The results include not only the signal pathways that have been verified in previous studies but also the signal pathways explored for the first time. However, the deficiency of this study is that the results about proteins and signal pathways have not been verified in vivo or in vitro.