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Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor and third leading cause of cancer-related death worldwide. Most cases arise as a consequence of underlying liver disease, e.g. developed from chronic hepatitis B or C infectionsalcohol abuse or obesity, and are most often associated with liver cirrhosis. Hypoxiand the hypoxia inducible factors (HIF)-1α and -2α promote tumor progression of HCC, not only affecting tumor cell proliferation and invasion, but also angiogenesis and lymphangiogenesis and thus, increasing the risk of metastasis.
HCC is characterized as one of the most vascularized solid tumors. While HIF-1α and HIF-2α are frequently up-regulated in HCC only HIF-2α is correlated with high patientlethality. HIF-dependent regulation of HCC angiogenesis is controversially discussed.VEGFA, for example, as the most prominent factor inducing tumor angiogenesis represents not only a HIF-1 target, but also a HIF-2 target gene in HCC. This questions whether both isoforms have overlapping functions in regulating the angiogenic switch in HCC.
Besides angiogenesis also tumor-associated lymphangiogenesis significantly influences patient survival in HCC. Lymphatic spread is an important clinical determinant for the prognosis of HCC, but little is known how lymphangiogenesis is controlled in this context. To date, mainly HIF-1α was positively correlated with olymphatic invasion and metastasis in HCC, while a defined role of HIF-2α is missing. Thus, although HIF-1α and HIF-2α are structurally alike and regulate overlapping but not identical sets of target genes, they promote highly divergent outcomes in cancer progression and may even have counteracting roles. The aim of my work was to characterize the specific role of HIF-1α and HIF-2α in the angiogenic switch and lymphangiogenesis induction during HCC development.
Therefore, I created a stable knockdown of HIF-1α and HIF-2α in HepG2 cells and generated cocultures of HepG2 spheroids and embryonic bodies derived from embryonic mouse stem cells as an in vitro tumor model mimicking the cancer microenvironment to analyze which HIF isoform has key regulatory functions in HCC (lymph)angiogenesis. In cocultures with a HIF-2α knockdown angiogenesis was attenuated but lymphangiogenesis increased, while the knockdown of HIF-1α was without effect. Microarray analysis identified plasminogen activator inhibitor 1 (PAI-1)and insulin-like growth factor binding protein 1 (IGFBP1) as HIF-2 target genes.However, prominent angiogenic and lymphangiogenic factors such as VEGFs, PDGFB, ANG and their receptors were not regulated in a HIF-dependent manner. As PAI-1 was linked to angiogenesis in literature and IGF-signaling, which is negatively regulated by IGFBP-1, was correlated with lymphangiogenesis, I decided to investigate their HIF-2α-dependent influence on HCC (lymph)angiogenesis. The knockdown of PAI-1 in HepG2 cells also lowered angiogenesis in PAI-1k/d cocultures similar to the HIF-2α k/d phenotype. PAI-1 as the potent inhibitor of tPA and uPA, both inducing the conversion of plasminogen to plasmin, also inhibits plasmin directly. Therefore, I assumed an increase of plasmin in HIF-2α k/d and PAI-1 k/d cocultures as a result of the reduced PAI-1 levels. Blocking plasmin with aprotinin in HIF-2α k/d cocultures restored angioge nesis, suggesting that HIF-2α increases PAI-1 to lower concentrations of active plasmin, thereby supporting angiogenesis. In further experiments I could exclude PAI-1 to reduce angiogenesis by inducing plasmin-mediated apoptosis of differentiating stem cells in PAI-1 k/d and HIF-2α k/d cocultures, but demonstrated an increase of VEGFA165 degradation in these cocultures, suggesting plasmin-catalyzed proteolysis of VEGF as an additional layer of regulation required to explain the angiogenic phenotype. Besides the pivotal role of PAI-1 in angiogenesis I also investigated its potentialinfluence in lymphangiogenesis. Indeed, the knockdown of PAI-1 reduced lymphaticstructures and implied an important but opposing role in lymphangiogenesis comparedto induced lymphangiogenesis in HIF-2α k/d cocultures. However, blocking plasmin again with aprotinin in HIF-2α k/d cocultures restored lymphangiogenesis to the level of control virus, which indicates a divergent lymphangiogenic role of plasmin in PAI-1 k/d and HIF-2α k/d cocultures, possibly because of other essential pathways masking the lymphangiogenic effects of PAI-1 in HIF-2α k/d cocultures.
HIF-2α resulting in reduced IGFBP1 expression induced the differentiation of stem cells toward a lymphatic cell type and significantly enhanced the assembly of human dermal lymphatic endothelial cells into tubes. These data point the first time to an important impact of HIF-2 in the regulatin of lymphangiogenesis in vitro by inducing IGFBP1 and thus, scavenging IGF-1. Furthermore, matrigel plug assays to investigate the in vivorelevance of these observations confirmed HIF-2α as a crucial factor in the regulation of lymphangiogenesis in vivo
In conclusion, this work provides evidence that HIF-2α is a key regulator of angiogenesis and lymphangiogenesis in HCC by regulating PAI-1 and IGFBP1. HIF-2α positively influences the angiogenic switch via PAI-1 and negatively affects lymphangiogenesis via IGFBP1 expression. Targeting HIF-2α in HCC to reduce tumor angiogenesis should be approached carefully, as it might be overcome by induced lymphangiogenesis and metastasis.
Loss of HIF-1α in macrophages attenuates AhR/ARNT-mediated tumorigenesis in a PAH-driven tumor model
(2016)
Activation of hypoxia-inducible factor (HIF) and macrophage infiltration of solid tumors independently promote tumor progression. As little is known how myeloid HIF affects tumor development, we injected the polycyclic aromatic hydrocarbon (PAH) and procarcinogen 3-methylcholanthrene (MCA; 100 μg/100 μl) subcutaneously into myeloid-specific Hif-1α and Hif-2α knockout mice (C57BL/6J) to induce fibrosarcomas (n = 16). Deletion of Hif-1α but not Hif-2α in macrophages diminished tumor outgrowth in the MCA-model. While analysis of the tumor initiation phase showed comparable inflammation after MCA-injection, metabolism of MCA was impaired in the absence of Hif-1α. An ex vivo macrophage/fibroblast coculture recapitulated reduced DNA damage after MCA-stimulation in fibroblasts of cocultures with Hif-1α LysM-/- macrophages compared to wild type macrophages. A loss of myeloid Hif-1α decreased RNA levels of arylhydrocarbon receptor (AhR)/arylhydrocarbon receptor nuclear translocator (ARNT) targets such as Cyp1a1 because of reduced Arnt but unchanged Ahr expression. Cocultures using Hif-1α LysM-/- macrophages stimulated with the carcinogen 7,12-dimethylbenz[a]anthracene (DMBA; 2 μg/ml) also attenuated a DNA damage response in fibroblasts, while the DNA damage-inducing metabolite DMBA-trans-3,4-dihydrodiol remained effective in the absence of Hif-1α. In chemical-induced carcinogenesis, HIF-1α in macrophages maintains ARNT expression to facilitate PAH-biotransformation. This implies a metabolic activation of PAHs in stromal cells, i.e. myeloid-derived cells, to be crucial for tumor initiation.