Hypoxia is a common feature of tumors with poor clinical prognosis that have aggressive festures such as increased metabolic and migratory potential,previous studies have shown that lipid metabolism is drastically altered under hypoxic conditions[12],Hypoxia has been shown to upregulate the lipid metabolism-related gene ACSS2 in prostate and breast cancers[13].The role of hypoxia in pNENs has not yet been revealed.Therefore,our study first revealed the role played by hypoxia in pNENs,and it was found that hypoxia could promote the progression of pNENs.In order to explore the role played by hypoxia on lipid metabolism in pNENs,we found that hypoxia could up-regulate lipid metabolism-related gene ACSS2 and both of them were regulated by each other at the transcriptional level.
Studies over the past two decades have clearly established that altered lipid metabolism is an important metabolic phenotype in cancer cells. Therefore,blocking the lipid supply to cancer cells would have a dramatic impact on cancer cell bioenergetics,membrane biosynthesis and intracellular signaling processes[9].ACSS2 is a key factor in lipid metabolism that functions differently in different tumors.ACSS2 is expressed in many tumors,localized in the mammalian cytoplasm and nucleus,and is responsible for catalyzing the generation of acetyl coenzyme A,an intermediate product of metabolism from acetate[14].Under metabolic stress conditions,ACSS2 promotes the growth of cancer cells[15],and ACSS2 deficiency inhibits the growth of tumor cells and tumor formation in mice[16].Moreover,ACSS2 is upregulated in renal cell carcinoma and promotes migration and invasion of renal cancer cells[17].Our research indicated that ACSS2 was highly expressed in pNENs,Overexpression of ACSS2 promoted the proliferation,migration and invasion of pNENs,while knockdown of ACSS2 and ACSS2i treatment inhibited the proliferation of pNENs after intervention.We also found that ACSS2 regulated lipid metabolism.Therfore,ACSS2 may promote the progression of pNENs by regulating lipid metabolism.
Our study found a protein molecule HMGCS1 interacts with ACSS2, by IP assay.Moreover,WB and Co-IP analysis that ACSS2 interacted with HMGCS1 and that ACSS2 regulated the expression of HMGCS1. HMGCS1 is the first key enzyme of the mevalonate pathway that converts acetoacetyl-CoA to HMG-CoA[18].Previous studies have demonstrated that HMGCS1 expression is associated with malignant progression in colon cancer,gastric cancer,hepatocellular carcinoma,cervical cancer,and cutaneous squamous cell carcinomas[19].Recent studies demonstrated that HMGCS1 is a potential metabolic target for the treatment of cancer[20],HMGCS1 expression is upregulated in many tumors and can promote tumor progression through both metabolic and non-metabolic pathways[21].Our study indicated that overexpression of ACSS2 in pNENs promoted HMGCS1 expression,and knockdown of ACSS2 gave the opposite result.More recently we found in vivo and in vitro that overexpression of HMGCS1 reversed the oncogenic effect of ACSS2 knocked down on pNENs.Meanwhile,overexpression of HMGCS1 can reversed the regulation of lipid metabolism by ACSS2 knocked down.Our results revealed that HMGCS1 may altered the progression of pNENs through metabolic pathway.Currently,there are no reports on the roles of ACSS2 and HMGCS1 in pNENs,and only early clinical trials of ACSS2i in tumors are underway.Therefore,our results provide new therapeutic targets for pNENs.
In addition,we performed RNA-seq analysis to investigate knockdown of ACSS2 for relative biological difference analysis,the results revealed that ACSS2 may be associated with the PI3K/AKT/mTOR pathway, which was further verified by WB detection of the expression of biomarker proteins(such as PI3K、pAKT and pmTOR) related to the PI3K/AKT/mTOR pathway.The PI3K/AKT/mTOR pathway is one of the intracellular signaling pathways,which has an impact on cell metabolism, proliferation and survival[22].Numerous studies have shown it to be associated with a growing number of tumors,including colorectal,breast,prostate,and ovarian cancers[23].Abnormal activation of the PI3K/AKT/mTOR signaling pathway plays an important role in tumor cell proliferation,survival,angiogenesis,invasion,and migration[24].The PI3K/AKT/mTOR signaling pathway is an important coordinator of pNET cell growth, proliferation,angiogenesis and metabolism.Based on the efficacy shown in the phase III randomized Radiant-3 trial,the mTOR inhibitor everolimus has become a standard treatment option for advanced pNETs[25].Our study expressed that overexpression of ACSS2 activated the PI3K/AKT/mTOR pathway,whereas knockdown of ACSS2 inhibited the PI3K/AKT/mTOR pathway.Meanwhile,ACSS2 regulation of lipid metabolism can be inhibited by the mTOR inhibitor rapamycin.Moreover,HMGCS1 can reverse the inhibitory effect of knockdown of ACSS2 on the PI3K/AKT/mTOR pathway.
In conclusion,our findings indicated that hypoxia can upregulate a lipid metabolism-related gene ACSS2 in pNENs,and the upregulated ACSS2 gene in pNENs can enhance lipid metabolism reprogramming,which further regulated the expression of HMGCS1 to affect the PI3K/AKT/mTOR pathway to promote the progression of pNENs.In addition,we found that HMGCS1 can reverse the regulation of lipid metabolism exerted by ACSS2,as well as the pro-tumorigenic role of ACSS2 in pNENs,which has also been detected in vitro and in vivo(Fig. 9).Our study not only identified a potential early diagnostic biomarker for pNENs but also provided a potential therapeutic target of pNENs.