SOX2 is highly expressed in A549/CDDP cisplatin-resistant cells
To investigate the underlying mechanism of cisplatin resistance and the related signaling molecules, we successfully cultivated A549/CDDP cells with acquired cisplatin resistance and the parental A549 cells [3]. Compared with A549 cells, A549/CDDP cells had stronger cisplatin resistance and colony formation ability (Fig 1A&B). SOX2, a stemness biomarker, is related to drug resistance in many cancers [18, 19]. First, we assessed the protein and mRNA expression levels of SOX2 between A549/CDDP and A549 cells via western blotting and qRT-PCR, respectively. As shown in Fig 1C and 1D, SOX2 expression was higher in A549/CDDP cells than in A549 cells at both the protein and mRNA levels. All these data suggest that cisplatin resistance may be correlated with SOX2 overexpression in NSCLC.
Inhibition of SOX2 decreases colony formation and viability and increases apoptosis in A549/CDDP cells.
SOX2 is highly expressed in A549/CDDP cells. We wondered what would happen if we knocked down SOX2 by transducing the cells with lentivirus expressing siSOX2. Through colony formation assays, we found that A549/CDDP cells in the siSOX2 group formed fewer colonies than those in the control group (Fig 2A, 2B&2C). Then, we carried out CCK-8 assays to analyze cellular viability. The data showed that, upon cisplatin treatment, compared with the control group, the siSOX2 group of A549/CDDP cells had lower viability at both 24 h and 48 h (Fig 2D). Furthermore, we found that apoptosis was obviously increased in the siRNA treatment group compared with the control group (Fig 2E). This suggests that suppression of SOX2 decreases colony formation and viability and increases apoptosis in A549/CDDP cells.
Lentivirus-mediated overexpression of SOX2 increases colony formation and viability and inhibits apoptosis in NCI-H460 cells
SOX2 overexpression induces tumor progression, recurrence and metastasis in many cancers, including NSCLC [7]. We applied another cell line, NCI-H460, to carry out lentivirus-mediated overexpression of SOX2 (OE-SOX2). As expected, compared with the control group, the OE-SOX2 group of NCI-H460 cells had decreased colony formation ability (Fig 3A, 3B & 3C) and reduced cellular viability with cisplatin treatment (Fig 3D). Furthermore, flow cytometry was used to evaluate apoptosis, and NCI-H460 cells in the OE-SOX2 group had a lower apoptosis rate than those in the control group (Fig 3E). Together, these findings show that high SOX2 expression can inhibit apoptosis by enhancing cell proliferation and viability, suggesting that SOX2 is related to cisplatin resistance.
SOX2 regulates APE1 signaling, which is directly involved in cisplatin resistance in NSCLC
Emerging data have revealed that SOX2 is involved in many molecular events and has a key role in cancer [5]. We first used Genomatix (version 3.4) to predict the possible mechanism by which SOX2 regulates cisplatin resistance. Interestingly, the APE1 promoter had some SOX2 binding sites, but the SOX2 promoter had no APE1 binding sites (Fig 4A). Next, we used dual-luciferase reporter assays to verify whether APE1 is a direct target of SOX2 in 293T cells. As expected, OE-SOX2 dramatically enhanced the luciferase activities of wild-type APE1 reporters, while it markedly decreased those of the mutant reporter and blank vector reporter (Fig 4B). Moreover, we assessed whether APE1 affects SOX2 expression. As shown in Fig 4C, SOX2 protein expression hardly changed in A549/CDDP cells with lentivirus-mediated transduction of a small hairpin RNA targeting APE1 (shAPE1) that we successfully designed (Fig 4D). These data suggest that APE1 is a direct target of SOX2 involved in cisplatin resistance in NSCLC.
siSOX2 reverses cisplatin resistance in A549/CDDP cells
Next, we wanted to see whether siSOX2 could reverse cisplatin resistance in A549/CDDP cells. First, we used a colony formation assay to test the effect on cell proliferation ability. Inspiringly, the number of colonies formed in the combined siRNA and 20 μM cisplatin treatment group was less than that in the control or siRNA treatment group (Fig 5A & B). More importantly, apoptosis was strongly enhanced in the combined siRNA and 20 μM cisplatin treatment group compared with the control or cisplatin treatment group (Fig 5C & D). All these data suggest that siSOX2 rescues resistance to cisplatin in NSCLC, which makes SOX2 a new target for sensitizing NSCLC tumor cells to cisplatin.
NSCLC patients with SOX2 overexpression had good survival
We also collected 45 samples from stage IIA and IIIA-IIIB NSCLC patients who underwent surgery in our hospital from January 2018 to December 2019. The follow-up time was 15 months. These patients received at least four cycles of adjuvant chemotherapy with a cisplatin regimen. We further investigated the expression of SOX2 by IHC. As shown in Fig 6A, SOX2 expression was variable, 60.0% (27/45) of samples had high expression, and 40.0% (18/45) of samples had low expression. Next, we applied Kaplan-Meier survival analysis and the log-rank test to analyze whether SOX2 expression affects NSCLC patient survival. The results showed that patients with high SOX2 expression survived longer than patients with low SOX2 expression, the median overall survival times were 15 months vs 25 months, respectively (Fig 6B). Taken together, these findings indicate that SOX2 expression is correlated with NSCLC patient prognosis and has bright anticancer prospects.