Most sporadically occurring renal tumors include a functional loss of the tumor suppressor von Hippel Lindau (VHL). Development of VHL-deficient renal cell carcinoma (RCC) relies upon activation of the hypoxia-inducible factor-2α (HIF2α), a master transcriptional regulator of genes that drive diverse processes, including angiogenesis, proliferation, and anaerobic metabolism. In determining the critical functions for HIF2α expression in RCC cells, the NADPH oxidase NOX4 has been identified, but the pathogenic contributions of NOX4 to RCC have not been evaluated directly. Here, we report that NOX4 silencing in VHL-deficient RCC cells abrogates cell branching, invasion, colony formation, and growth in a murine xenograft model RCC. These alterations were phenocopied by treatment of the superoxide scavenger, TEMPOL, or by overexpression of manganese superoxide dismutase or catalase. Notably, NOX4 silencing or superoxide scavenging was sufficient to block nuclear accumulation of HIF2α in RCC cells. Our results offer direct evidence that NOX4 is critical for renal tumorigenesis and they show how NOX4 suppression and VHL re-expression in VHL-deficient RCC cells are genetically synonymous, supporting development of therapeutic regimens aimed at NOX4 blockade. Cancer Res; 74(13); 3501–11. ©2014 AACR.

Renal cell carcinoma (RCC) is a common adult malignancy with an estimated 65,150 new cases and 13,680 deaths in the United States in 2013 (1). Localized disease can be treated by surgical resection alone, but advanced RCC is notoriously resistant to cytotoxic therapy or radiation. Immunotherapy, the mainstay of treatment for several decades, is curative in fewer than 15% (2). Advances in the molecular genetics of kidney cancer have led to FDA-approval of targeted agents with good clinical response rates (3). However, complete, durable responses are rare, and novel therapeutic approaches are still desperately needed.

More than 80% of clear cell RCCs have lost or mutated both alleles of the von Hippel Lindau (VHL) tumor suppressor. VHL is the binding subunit of an E3 ubiquitin ligase complex that targets the α subunits of hypoxia-inducible transcription factors 1 and 2 (HIFα) for ubiquitin-mediated, proteasomal degradation. In the absence of VHL, HIFα accumulate in the cell, leading to increased transcription of more than 100 HIF-regulated genes involved in angiogenesis, anaerobic metabolism, proliferation, and other cell survival pathways. We and others have shown that HIF2α is the relevant oncogenic target of VHL degradation. Forced accumulation of HIF2α is sufficient to support xenograft growth of RCC cells despite reintroduction of wild-type VHL, (4, 5) and specific HIF2α inhibition suppresses tumor growth (6). In contrast, forced expression of HIF1α suppresses xenograft growth, (4, 7), and specific HIF1α shRNA enhances xenograft growth (8). HIF1α and HIF2α have unique, nonoverlapping regulatory profiles suggesting a more proapoptotic rather than proproliferative role for the former (7, 9). In short, specific activation of HIF2α seems to be critical for renal tumorigenesis.

We previously reported that HIF2α expression and transactivation are dependent upon expression of the NADPH oxidase 4 (Nox4; ref. 10). In the adult human, Nox4 is most highly expressed in the distal renal tubule where it generates intracellular superoxide and is implicated in oxygen sensing for regulation of erythropoietin, a HIF-dependent gene (11). In contrast to other Nox isoforms, Nox4 requires only p22phox for coactivation (12). In renal cancer cells, Nox4 is a major source of intracellular reactive oxygen species (ROS; ref. 13). We hypothesized that this heightened oxidative state might promote HIF2α transactivation under normal oxygen conditions. Consistent with this hypothesis, Nox4 silencing inhibits transactivation of VEGF, Glut-1, and erythropoietin by greater than 80% in 786-0 RCC cells. Furthermore, Nox4 siRNA suppresses HIF2α and VHL at the mRNA and protein levels (10). Nox4-dependent expression of HIF2α protein has been confirmed by others (14, 15).

Thus, HIF2α is an established oncogene for clear cell kidney cancer, and Nox4 is critical for its expression and transactivation in RCC. However, the contribution of Nox4 to renal tumorigenesis is not known. We report that in vitro branching morphogenesis and invasion are abrogated by Nox4 silencing and enhanced by Nox4 overexpression via generation of ROS and that in vivo RCC xenograft growth is suppressed by Nox4 silencing. Further, we report that Nox4 regulates the intracellular distribution of HIF2α with abrogation of nuclear accumulation under both hypoxic and normal oxygen conditions.

Cell lines and cultures

Established human conventional RCC lines, 786-0, RCC4, and Caki-1, were maintained in DMEM supplemented with 10% FBS, penicillin, and streptomycin. 786-0 (WT) and 786-0 (pRC), created by stable transfection of with wild-type VHL or empty pRC vector, respectively, were a gift from W. Kaelin, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA (16). They were selected with G418 (500 μg/mL) every sixth passage. RCC4 was generously provided by M.C. Simon (Abramson Family Cancer Institute, University of Pennsylvania, Philadelphia, PA), and Caki1 cells were obtained from ATCC. Cell lines were routinely authenticated by DNA fingerprinting at the start and twice annually for the duration of these studies by the core University of Pittsburgh Cancer Institute Cell Culture and Cytogenetics Facility.

Stable Nox4 knockdown was achieved for each cell line by expressing two Nox4 shRNAs or a nontargeting shRNA in pSilencer 4.1-CMV puro (Ambion) as previously described (10). Stable transfectants were maintained in puromycin (1 μg/mL). RT-PCR for Nox1–5, p22phox, p47phox, and p67phox was performed as described (17). Adenoviral vectors Ad-EGFP, Ad-MnSOD, and Ad-catalase were a generous gift of Dr. Yong Lee, Department of Surgery, University of Pittsburgh, Pittsburgh, PA (18).

Adenoviral transduction was performed as previously described (19). Briefly, cells were infected at 100 or 200 multiplicity of infection for 1.5 hours in DMEM. Assays were performed 48 hours after transduction. To overexpress Nox4, parental 786-0 cells were transfected with a pcDNA vector expressing the complete human Nox4 cDNA, and antibiotic selection of stable clones was performed. Cells were pretreated for 4 hours with indicated concentrations of DL-Dithiothreitol (DTT; Promega) or 4-hydroxy-TEMPOL (Sigma-Aldrich) before fixation or live cell assay. Drug was maintained in the media throughout live cell assays.

Quantitative RT-PCR

Total RNA was extracted from 786-O, RCC4, and LNCap cells with TRIzol reagent and RNeasy Mini Kit (Qiagen). First strand cDNA was synthesized using the iScript cDNA synthesis Kit (BIO-RAD). Gene-specific TaqMan Gene Expression Assays primer sets and Master Mix were used for quantitative PCR of NOX4 (Hs00418356), NOX1 (Hs00246589), and GAPDH (Hs99999905). Samples were then subjected to real-time PCR analysis using the ABI StepOnePlus real-Time PCR System (Applied Biosystems). Relative mRNA expression of each transcript was normalized against GAPDH.

Western blot

Protein was extracted as previously described (4). Equal amounts of protein were subjected to separation in a 4.5% to 15% Tris-HCl gel, and the resolved proteins were transferred to polyvinylidene difluoride membrane. The blots were probed with anti-Nox4 rabbit monoclonal Ab (1:2,000; Abcam) or β-actin Ab (1:1,000; Santa Cruz Biotechnology), followed by horseradish peroxidase–conjugated secondary Ab. Bands were visualized using SuperSignal West Femto Maximum Sensitivity Substrate (Thermo Scientific).

Measurement of NAD(P)H oxidase activity

Superoxide production from membrane fraction was determined by lucigenin chemiluminescence as described (20). Briefly, 20-μg protein was added to 200 μL of 50 mmol/L phosphate buffer with 1 mmol/L ethylene glycol tetra acetic acid, 150 mmol/L sucrose, and 100 μmol/L NADPH. Lucigenin was added, and chemiluminescence read every 30 seconds for 20 minutes (SpectraMax Plus 384) and expressed as relative light units (RLU)/mg protein. Alternatively, ROSs were measured using 2′7′-dichlorofluorescin diacetate (Sigma-Aldrich) as described (21). Fluorescence at 530 nm was measured using a Wallac Victor 1420 multilabel counter (Wallac Oy).

Branching and invasion assays

Branching morphogenesis assays were performed as previously described (22). Briefly, 60-μL cells at 3.5 × 105 cells/mL media were mixed 1:1 with Matrigel in six flat-bottomed 96-well plates. After 30 minutes at 37°C, 120-μL DMEM with 10% FBS and 40 ng recombinant hepatocyte growth factor (HGF; Sigma-Aldrich) was added, and cells were incubated an additional 72 hours before determining the percentage of branched cells per well. Invasion assays were done in 8-μ Matrigel 24-well invasion chambers (BD). In the top chambers, 1.5 × 104 cells were plated in 200-μL media in five replicate wells. The bottom wells contained 750 μL media with 20 ng/mL HGF. After 24 hours at 37°C, Matrigel and cells were removed from the top of the filter with a cotton swab, and the filter bottom was fixed and stained with Diff-Quick (IMEB Inc.). Stained cells were photographed at ×100 magnification and counted. Significance was determined by the Student t test.

Immunofluorescence and confocal microscopy

A total of 5 × 104 cells were plated on cover-glass in 24-well plates for 12 hours. They were then incubated 4 hours with indicated media at 21% O2 or 1% O2. Cells were then fixed in 4% paraformaldehyde for 15 minutes, washed three times with PBS, then permeabilized with 0.1% Triton X-100 in PBS solution for 15 minutes. Cover slides were blocked with 2% BSA for 45 minutes and stained by primary antibodies for 60 minutes. After five washes with 0.5% BSA, secondary antibody was applied for 60 minutes, slides were counterstained with DAPI for 30 seconds and mounted with gelvatol. Images were taken with a FluoroView 1000 II confocal microscope.

Soft agar colony formation

Cells were grown in 0.3% bacto-agar (BD) on a cushion of 0.6% agar, in triplicate. Fresh 0.3% agar was applied weekly. After 30 days, colonies were photographed and counted at ×40 magnification.

Mouse xenograft assay

One million viable cells as determined by trypan blue exclusion were suspended in 100-μL Hank's buffered saline and injected subcutaneously per flank of four 6-week female SCID beige mice (Charles River Laboratories). Tumors were measured twice weekly with digital calipers (VWR) in the two largest dimensions by a technician blinded to the genotype. Mice were euthanized at 14 weeks and tumors harvested.

Immunohistochemistry

Paraffin slides were deparaffinized and hydrated to deionized water before heat-induced epitope retrieval by Diva antigen retrieval buffer (Biocare Medical). Endogenous peroxidase was quenched with 3% hydrogen peroxide for 10 minutes followed by TBS buffer for 5 minutes. In an Dako Autostainer Plus Stainer, slides were blocked 10 minutes with CAS block (Invitrogen) and incubated 60 minutes with anti-HIF2α mouse monoclonal Ab 1:500 (Novus Biologicals) or anti-Nox4 rabbit polyclonal Ab 1:100 (Abcam). Slides were then rinsed twice with TBS buffer and incubated with Dako Envision Dual Link HRP (Dako North America) for 30 minutes followed by Dako + Chromagen for 10 minutes. After several rinses with deionized water, slides were counterstained with Harris Hematoxylin for 10 seconds, rinsed with tap water, dehydrated, cleared, and coverslipped. All incubations were performed at room temperature.

Statistical analysis

Data were expressed as the mean ± SE for at least three independent experiments from separate harvests. Statistical analysis was performed using the Student t test. P values of <0.05 versus control group were considered significant.

Nox4 shRNA selectively suppressed Nox4 mRNA and protein expression and abrogated NADPH-dependent superoxide generation

We first assessed endogenous expression of Nox 1–5 and coactivators in three human clear cell RCC cell lines, RCC4, 786-0, and Caki1. RCC4 and 786-0 lack functional pVHL due to a mutation in the VHL gene, whereas Caki1 cells express wild-type VHL. By semiquantitative RT-PCR, all three lines abundantly expressed Nox4 and the cofactor p22phox (Fig. 1). Nox2 was detectable in RCC4 and Caki1 cells but Nox3 was seen only in Caki1 cells. In contrast to a prior report (14), we did not detect Nox1 in any of our cell lines (Supplementary Fig. S1).

Figure 1.

Semiquantitative RT-PCR for NADPH oxidase family members and cofactors was performed in three human clear cell renal cancer cell lines, 786-0, RCC4, and Caki-1. The anticipated band sizes for Nox1–5 are 247, 413, 458, 286, and 630 bp, respectively, and cofactors p22phox, p47phox, and p67phox are 320, 771, and 760 bp, respectively. β-Actin served as an internal control.

Figure 1.

Semiquantitative RT-PCR for NADPH oxidase family members and cofactors was performed in three human clear cell renal cancer cell lines, 786-0, RCC4, and Caki-1. The anticipated band sizes for Nox1–5 are 247, 413, 458, 286, and 630 bp, respectively, and cofactors p22phox, p47phox, and p67phox are 320, 771, and 760 bp, respectively. β-Actin served as an internal control.

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Silencing of Nox4 mRNA and protein by specific shRNA (KD) relative to scramble control shRNA (NS) was confirmed by quantitative RT-PCR and Western blot, respectively. Although Nox4 expression was decreased by greater than 70%, Nox2 was not affected by silencing (Fig. 2A–C). A corresponding loss of NADPH-dependent superoxide generation from the cell membrane fraction was measured by lucigenin assay following Nox4 silencing (Fig. 2D), consistent with its role as the major source of superoxide in these cells. Similar superoxide suppression was demonstrated by lucigenin in RCC4 and Caki-1 following Nox4 knockdown. Membrane fraction from both 786-0 and RCC4 demonstrated the highest superoxide generation (Supplementary Fig. S3). In summary, Nox4 was the dominant NADPH oxidase in three RCC cell lines. Nox4 shRNA silencing effectively and selectively silenced Nox4 expression, leading to abrogation of NADPH-dependent superoxide generation.

Figure 2.

A, semiquantitative RT-PCR for Nox isoforms 2–4 in 786-0, RCC4, and Caki-1 cells transfected with Nox4-specific siRNA (KD) or nontargeting siRNA (NS). β-Actin served as an internal control. B, representative quantitative RT-PCR for Nox4 mRNA relative to β-actin in RCC4 cells expressing Nox4 shRNA2 (KD) or scramble (NS). Columns, mean; bars, ±SE; *, P < 0.01 relative to NS. C, Western blot analysis for Nox4 protein in three RCC cell lines. 786-0 indicates parental 786-0 cells (ATCC) in contrast to the 786-0 pRC (16) cells used for NS/KD. The upper band runs at the predicted 67 kD for full-length Nox4. D, lucigenin chemiluminescent assay for NADP(H)-dependent superoxide generation from isolated cell membranes of 786-0 NS and KD cells. Luminescence following addition of lucinigen is measured every 20 seconds for 20 minutes and expressed as RLU.

Figure 2.

A, semiquantitative RT-PCR for Nox isoforms 2–4 in 786-0, RCC4, and Caki-1 cells transfected with Nox4-specific siRNA (KD) or nontargeting siRNA (NS). β-Actin served as an internal control. B, representative quantitative RT-PCR for Nox4 mRNA relative to β-actin in RCC4 cells expressing Nox4 shRNA2 (KD) or scramble (NS). Columns, mean; bars, ±SE; *, P < 0.01 relative to NS. C, Western blot analysis for Nox4 protein in three RCC cell lines. 786-0 indicates parental 786-0 cells (ATCC) in contrast to the 786-0 pRC (16) cells used for NS/KD. The upper band runs at the predicted 67 kD for full-length Nox4. D, lucigenin chemiluminescent assay for NADP(H)-dependent superoxide generation from isolated cell membranes of 786-0 NS and KD cells. Luminescence following addition of lucinigen is measured every 20 seconds for 20 minutes and expressed as RLU.

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Nox4 silencing inhibited branching morphogenesis and invasion by VHL-deficient cells

We have reported that Nox4 is critical for expression and transactivation of HIF2α in VHL-deficient RCC cells, suggesting that Nox4 silencing might phenocopy VHL reintroduction in these cells. To explore the impact of Nox4 expression on renal tumorigenesis, we first assayed two established phenotypes of VHL-deficient renal cells: branching morphogenesis and invasion across a basement membrane. RCC cells demonstrate exuberant branching following exposure to HGF and will migrate through a Matrigel-coated filter membrane toward an hepatocyte growth factor/scatter factor gradient. These behaviors are believed to reflect invasive and metastatic potential and are completely abrogated by reintroduction of a wild-type copy of the VHL tumor suppressor (22). To test our hypothesis that Nox4 expression is required to support branching and invasion, we assayed VHL-deficient 786-0 and RCC4 cells expressing KD or NS. Nox4 knockdown decreased the fraction of branching cells by 83% (P < 0.001) and 93% (P < 0.01) relative to NS cells in 786-0 and RCC4 cells, respectively (Fig. 3A–C), consistent with a critical requirement for Nox4 expression. Similarly, Nox4 silencing decreased the number of invasive cells by 70% (P < 0.001) and 82% (P < 0.05) relative to NS in 786-0 and RCC4 cells, respectively (Fig. 3D–F). Again, Nox4 silencing recapitulated the wild-type VHL phenotype.

Figure 3.

A–C, branching assays. VHL-deficient cells (786-0 or RCC4) expressing control vector (NS; A) or Nox4 shRNA (KD; B), cultured 72 hours in Matrigel with HGF (0.33 μg/mL). Bar graph (C) depicts the mean percentage of branched cells. D–F, invasion assays. VHL-deficient cells expressing control vector (NS; D) or Nox4-specific shRNA (KD; E) that have crossed a Matrigel-coated, 8-μ pore filter toward an HGF gradient (magnification, ×100). Small circles, pores. Bar graph (F) shows mean crossing cells. G–J, exogenous Nox4 overexpression: Western blot for Nox4 expression in lysates of parental 786-0 stably transfected with pcDNA-Nox4 or empty vector. β-Actin served as an internal loading control. Invasion assays were performed as described above using pcDNA empty vector (H) or pcDNA-Nox4–transfected (I) cells. J, bar graph shows percentage of branching cells. Columns, mean; bars, ± SE; *, P < 0.05; **, P < 0.01.

Figure 3.

A–C, branching assays. VHL-deficient cells (786-0 or RCC4) expressing control vector (NS; A) or Nox4 shRNA (KD; B), cultured 72 hours in Matrigel with HGF (0.33 μg/mL). Bar graph (C) depicts the mean percentage of branched cells. D–F, invasion assays. VHL-deficient cells expressing control vector (NS; D) or Nox4-specific shRNA (KD; E) that have crossed a Matrigel-coated, 8-μ pore filter toward an HGF gradient (magnification, ×100). Small circles, pores. Bar graph (F) shows mean crossing cells. G–J, exogenous Nox4 overexpression: Western blot for Nox4 expression in lysates of parental 786-0 stably transfected with pcDNA-Nox4 or empty vector. β-Actin served as an internal loading control. Invasion assays were performed as described above using pcDNA empty vector (H) or pcDNA-Nox4–transfected (I) cells. J, bar graph shows percentage of branching cells. Columns, mean; bars, ± SE; *, P < 0.05; **, P < 0.01.

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To determine if overexpression of exogenous Nox4 could conversely enhance branching and invasion, we transfected parental 786-0 cells with a pcDNA vector expressing the complete human Nox4 cDNA. Following selection, cells demonstrated altered morphology with smaller, rounded cells, but similar growth kinetics (Supplementary Fig. S2A and S2B). Although these changes may reflect effects of oxidative signaling on multiple pathways, they may also be attributed to increased oxidative stress. Quantitative RT-PCR confirmed a marked increase in Nox4 mRNA expression (data not shown), which was confirmed at the protein level by Western blot (Fig. 3G). Invasive cells increased nearly 2-fold (P < 0.05) following expression of pcDNA-Nox4 relative to empty vector (Fig. 3H–J). We did not observe increased branching in the Nox4-overexpressed cells, likely due to the overall morphologic changes noted above. Taken together, these results indicate a regulatory role for Nox4 on the invasive phenotype of RCC.

Superoxide scavenging with TEMPOL treatment or expression of adenoviral-SOD recapitulated the effect of Nox4 silencing on branching and invasion

To determine if the impact of Nox4 on RCC behavior is mediated by generation of superoxide, we used two parallel strategies. TEMPOL (4-hydroxy-2,2,6,6-tetramethylpiperidin-1-oxyl) is a heterocyclic chemical oxidant that reacts with intracellular superoxide anion to form hydrogen peroxide. Treatment with TEMPOL has been shown to increase detectable hydrogen peroxide (23) and thus, although it decreases intracellular superoxide, it does not necessarily decrease the overall oxidative status of the cell. TEMPOL exposure (0.125–10 mmol/L) did not impact 786-0 or RCC4 cell viability by Cell Titre Blue assay. When we treated parental 786-0 and RCC4 cells, we observed suppression of branching comparable with Nox4 silencing (P < 0.01; Fig. 4A). Similarly, treatment with TEMPOL decreased invasion in a dose-dependent manner (P < 0.01; Fig. 4B).

Figure 4.

Effects of ROS scavengers and DTT on RCC cell branching and invasion. A and B, branching assays were performed as in Fig. 3. Cells were treated with the indicated concentrations of TEMPOL or DTT (A) or transduced with adenoviral vectors expressing GFP (control), SOD, or catalase before Matrigel culture (B). C and D, invasion assays demonstrate the number of cells crossing a transwell membrane in the presence of TEMPOL or DTT (C), or after transduction of Ad-GFP, Ad-SOD, or Ad-catalase (D). Dichlorofluorescein assay (E) measures ROS produced by parental 786-0, 786-0 scramble (NS) or 786-0 expressing Nox4 shRNA (KD) cells transduced with adenoviral vectors expressing GFP (control), SOD, catalase, or both SOD and catalase. F, lucigenin chemiluminescent assay for superoxide on isolated cell membrane fraction of parental 786-0 cells with or without addition of TEMPOL. Columns, mean; bars, ± SE; *, P < 0.02 relative to untreated or GFP controls.

Figure 4.

Effects of ROS scavengers and DTT on RCC cell branching and invasion. A and B, branching assays were performed as in Fig. 3. Cells were treated with the indicated concentrations of TEMPOL or DTT (A) or transduced with adenoviral vectors expressing GFP (control), SOD, or catalase before Matrigel culture (B). C and D, invasion assays demonstrate the number of cells crossing a transwell membrane in the presence of TEMPOL or DTT (C), or after transduction of Ad-GFP, Ad-SOD, or Ad-catalase (D). Dichlorofluorescein assay (E) measures ROS produced by parental 786-0, 786-0 scramble (NS) or 786-0 expressing Nox4 shRNA (KD) cells transduced with adenoviral vectors expressing GFP (control), SOD, catalase, or both SOD and catalase. F, lucigenin chemiluminescent assay for superoxide on isolated cell membrane fraction of parental 786-0 cells with or without addition of TEMPOL. Columns, mean; bars, ± SE; *, P < 0.02 relative to untreated or GFP controls.

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Although the major biologic functions of TEMPOL have been attributed to its ability to scavenge superoxide anion, it is not a specific SOD mimetic. It also has catalase-like activity and can inhibit hydroxide generation via the Fenton reaction, making it a general purpose redox cycling agent. To reduce these off-target effects, we also examined branching and invasion after transducing RCC4 and 786-0 cells with adenoviral vectors expressing the ROS scavengers, manganese superoxide dismutase (Ad-SOD), or catalase (Ad-catalase). Nox4-generated superoxide cannot cross cell membranes, but is rapidly dismutated by SOD to hydrogen peroxide, which freely diffuses through the cell (24). Hydrogen peroxide is in turn reduced by catalase to water and oxygen. Ad-SOD alone markedly suppressed branching by 77% (P < 0.01) and 96% (P < 0.01) relative to Ad-GFP in 786-0 and RCC4 cells, respectively. Comparable suppression was seen with cotransduction of Ad-catalase, or with Ad-catalase alone (Fig. 4C). Invasion assays (Fig. 4D) again revealed suppression of invasion by Ad-SOD relative to Ad-GFP in both 786-0 and RCC4 cells (P < 0.01 for both). Cotransduction with Ad-catalase further decreased invasion in both cell lines (P < 0.01).

By 2′,7′-dichlorofluorescein (DCF) assay, Ad-SOD expression alone had minimal impact on detectable ROS relative to Ad-GFP–transduced controls (Fig. 4E). This likely reflects the fact that DCF predominantly measures hydrogen peroxide, which is increased by the antioxidant activity of manganese superoxide dismutase (MnSOD). Thus, DCF will underestimate the impact of specific superoxide suppression. In contrast, catalase is specific for scavenging hydrogen peroxide and it is notable that transduction with Ad-catalase alone or in combination leads to ROS levels comparable with those observed with Nox4-silenced KD cells, again demonstrating that Nox4 is a major source of ROS in these cells (Fig. 4E). Suppression of the superoxide burst following exposure to TEMPOL was confirmed using a lucigenin chemiluminescent assay for NADP(H)-dependent superoxide generation from isolated cell membranes (Fig. 4F).

To summarize, scavenging of intracellular superoxide by either TEMPOL or expression of exogenous superoxide dismutase mimics Nox4 silencing with respect to suppression of branching and invasion of RCC cells. Further suppression by catalase suggests that hydrogen peroxide may be an equally important mediator of Nox4 signaling for branching and invasion.

DTT induction of superoxide promoted cell branching

DTT is a strong antioxidant. However, under physiologic conditions, the thiol-mediated antioxidant reaction results in intracellular generation of superoxide (25). We treated our cells with DTT to determine if further induction of superoxide could enhance branching and invasion relative to parental 786-0 and RCC cells. DTT treatment proved to be quite toxic, resulting in high cell death (Supplementary Fig. S4). The number of invasive cells was decreased in a dose-dependent fashion, likely due to overall cell attrition. Despite this, we observed a nearly 2-fold increase in the percentage of branching cells in both 786-0 and RCC4 cells (P = 0.03 and P = 0.017, respectively; Fig. 4A), consistent with our hypothesis that superoxide mediates branching morphogenesis.

Nox4 silencing blocked nuclear accumulation of HIF2α

We have reported that expression of HIF2α at the mRNA and protein level is suppressed by Nox4 silencing (10). Others have confirmed that HIF2α protein expression is dependent upon Nox4 expression (14, 15). However, we have observed suppression in HIF2α transactivation even at high HIF2α protein levels with Nox4 silencing. To test our hypothesis that Nox4 further contributes to activation of HIF2α, we used confocal microscopy to examine HIF2α cellular localization in our Nox4-silenced 786-0 and RCC4 cells. Activation is a multistep process that requires binding to the aryl hydrocarbon receptor nuclear translocator, nuclear translocation, binding to CBP/p300 and other cofactors, and binding to promoter DNA. Under hypoxic conditions, this requires factor-inhibiting HIF (FIH)-mediated hydroxylation of asparagine residues. As HIF2α has been shown to be less dependent upon FIH than HIF1α for activation (26), we hypothesize that Nox4 provides an alternate activating signal for HIF2α.

Figure 5A shows representative confocal images of HIF2α localization. We observed a Nox4-dependent distribution of endogenous HIF2α protein. 786-0 and RCC4 NS cells showed diffuse staining throughout the cytoplasm and nucleus under normal oxygen conditions. As expected, culture at 1% oxygen resulted in nuclear concentration of HIF2α. However, Nox4 KD cells showed a striking nuclear exclusion of HIF2α with granular perinuclear enhancement. Notably, this nuclear exclusion was seen under both normal oxygen (Supplementary Fig. S5A–S5D) and hypoxic conditions, suggesting that for HIF2α, there may be a superoxide requirement even for hypoxic activation. Consistent with superoxide as a signaling intermediary, pretreatment with TEMPOL or transduction with Ad-SOD in NS cells mimicked the HIF2α distribution observed with Nox4 silencing. Conversely, superoxide induction with DTT rescued nuclear accumulation despite Nox4 silencing. Western blot analysis of isolated nuclear fractions confirmed a dose-dependent decrease in nuclear HIF2α expression following TEMPOL treatment, whereas nuclear HIF2α expression increased with DTT treatment (Fig. 5B and C). These findings support a role for Nox4-generated superoxide in nuclear accumulation of HIF2α.

Figure 5.

Cellular distribution of HIF2α. A, representative confocal microscopy images (magnification, ×400) showing HIF2α immunofluorescence, DAPI nuclear staining, or merged images. Cultures were grown in 1% oxygen for 8 hours before fixation and staining. Control (NS) or Nox4 shRNA (KD) cells were imaged following exposure to TEMPOL (0.25 mmol/L), DTT (1 mmol/L), or transduction with Ad-SOD. B and C, Western blots for HIF2α protein expression in isolated nuclear fractions of 786-0 NS cells grown under normal oxygen conditions with serial dilutions of TEMPOL (B) or 786-0 KD cell grown under normoxic conditions with serial dilutions of DTT (C). TATA binding protein (TBP) served as an internal control for total loaded protein.

Figure 5.

Cellular distribution of HIF2α. A, representative confocal microscopy images (magnification, ×400) showing HIF2α immunofluorescence, DAPI nuclear staining, or merged images. Cultures were grown in 1% oxygen for 8 hours before fixation and staining. Control (NS) or Nox4 shRNA (KD) cells were imaged following exposure to TEMPOL (0.25 mmol/L), DTT (1 mmol/L), or transduction with Ad-SOD. B and C, Western blots for HIF2α protein expression in isolated nuclear fractions of 786-0 NS cells grown under normal oxygen conditions with serial dilutions of TEMPOL (B) or 786-0 KD cell grown under normoxic conditions with serial dilutions of DTT (C). TATA binding protein (TBP) served as an internal control for total loaded protein.

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Nox4 silencing inhibits colony formation and xenograft tumor growth

We next sought to determine if Nox4 silencing would be sufficient to prevent tumor growth. Neoplastic cells exhibit anchorage-independent growth and can proliferate in the absence of exogenous growth factors. This classic behavior, measured by the ability to form colonies in soft agar, was decreased by 94% (P = 0.008) in 786-0 KD cells relative to NS (Fig. 6A). To determine if Nox4 expression is similarly required to support in vivo tumor growth, we established xenografts of our 786-0 KD and control cells in SCID beige mice. 786-0 cells form tumors in immunocompromised mice that are abrogated by reintroduction of wild-type VHL (16). Attempts to establish subcutaneous xenografts with RCC4 were unsuccessful. Tumor growth curves are presented in Fig. 6B. Mice injected with VHL-deficient 786-0 cells expressing control shRNA (NS) developed palpable tumors by week 5, whereas Nox4 knockdown (KD) tumors were not detected before week 9. Further, KD tumors were significantly smaller at 14 weeks than NS (mean cross sectional area, 35 mm2 vs. 105 mm2; P < 0.01). Metastases to the brain, lungs, or abdominal organs were not observed in any mice. Interestingly, despite clear inhibition of tumor growth, KD tumors demonstrated similar growth kinetics to NS once established. We postulate that the delayed tumors represent selection and enrichment of a subpopulation of cells that have escaped silencing—an effect that would lead to underestimation of tumor inhibition. Consistent with this, immunohistochemical evaluation of the 14-week tumor explants revealed that protein expression of Nox4 and HIF2α was as high in the KD tumors as control (Supplementary Fig. S6). Regardless, this intermediate phenotype is consistent with our hypothesis that Nox4 silencing suppresses RCC tumor growth, and suggests that therapies designed to target Nox4 or intracellular superoxide may have efficacy in RCC.

Figure 6.

Nox4 expression is required for RCC cell colony formation and xenograft tumor growth. A, soft agar colony formation in 786-0 cells with Nox4 shRNA silencing (KD) or nonspecific control shRNA (NS). Colonies larger than 20 μm were counted. B, mean cross-sectional area of tumor xenografts from four SCID beige mice per cohort injected subcutaneously with 786-0 NS or KD cells with or without reexpression of VHL. Tumor take rates were 100% for the 786-0 NS cohort and 75% for the KD cohort. Columns, mean; bars, ± SE; *, P < 0.008.

Figure 6.

Nox4 expression is required for RCC cell colony formation and xenograft tumor growth. A, soft agar colony formation in 786-0 cells with Nox4 shRNA silencing (KD) or nonspecific control shRNA (NS). Colonies larger than 20 μm were counted. B, mean cross-sectional area of tumor xenografts from four SCID beige mice per cohort injected subcutaneously with 786-0 NS or KD cells with or without reexpression of VHL. Tumor take rates were 100% for the 786-0 NS cohort and 75% for the KD cohort. Columns, mean; bars, ± SE; *, P < 0.008.

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Loss of the VHL tumor suppressor, resulting in abundant HIFα protein and increased expression of HIF transcription targets, occurs commonly in sporadic clear cell RCC. We previously reported that expression and transactivation of HIF2α in VHL-deficient RCC cells is critically dependent upon expression of Nox4 (10). In the present study, we show that Nox4 silencing inhibits morphogenesis, invasive potential, colony formation, and xenograft tumor growth of VHL-deficient human RCC cells. Superoxide scavenging by treatment with TEMPOL or overexpression of superoxide dismutase or catalase mimicked the effects of Nox4 silencing, indicating a role for generation of superoxide and hydrogen peroxide in the tumorigenic RCC phenotype. Furthermore, Nox4 silencing abrogated nuclear accumulation of HIF2α under both normal and hypoxic oxygen conditions demonstrating that Nox4 is an alternative activating signal for HIF2α translocation. To our knowledge, these data provide the first evidence that renal Nox4 expression is critical to support the renal tumorigenic phenotype, suggesting that it may function as a renal oncogene.

HIF1α and HIF2α are both subject to VHL-mediated oxygen-dependent degradation and recognize the same DNA response element. However, they have differential effects on gene expression such that a shift in balance toward HIF2α predominance promotes cell survival, whereas HIF1α predominance favors apoptosis (27). In kidney cancer, HIFα expression is biased toward HIF2α, and inhibition of HIF2α suppresses VHL −/− tumor growth (6, 28). We speculate that heightened HIF2α transcriptional activity is due in part to constitutive, isoform-specific induction by highly expressed renal Nox4. In renal cells, HIF2α activity is held in check only by VHL-mediated protein degradation, leading to catastrophic proliferation and tumor formation following the loss of VHL. Consistent with this hypothesis, Nox4 silencing in our VHL-deficient RCC cells phenocopied reexpression of wild-type VHL.

Our results are consistent with other reports indicating that Nox4 modulates cellular phenotypic changes, including migration, invasion, and the epithelia-to-mesenchymal transition. A recent report by Boudreau and colleagues found that inhibition of Nox4, either by shRNA knockdown or expression of a dominant-negative form, abrogated wound healing and cell migration in breast cancer epithelia (29). Similar to the results from this study, Yamaura and colleagues demonstrated that inhibition of Nox4 by siRNAs in melanoma cells decreased anchorage-independent growth and xenograft tumor growth in vivo (30). In keratinocytes, cell migration was inhibited by both diphenyliodonium, a nonspecific flavoprotein inhibitor of Nox enzymes, and Nox4 silencing (31). Nox4 has been implicated in the regulation of cell migration in nontumorigenic cell types as well including myofibroblasts, endothelia, and vascular smooth muscle cells (32–34).

Although several sources of intracellular ROS exist, we and others have shown that Nox4 is a major producer of ROS in renal tumors (13). Importantly, there is growing evidence to suggest that ROS, in conjunction with Nox expression, can induce the tumorigenic phenotype via heightened oxidative stress. For example, ROS, as well as Nox4, is required for invadopodia formation, an important step in invasion and metastasis that acts as a catalyst for extracellular matrix degradation (35, 36). Furthermore, ROSs have been shown to regulate the production of matrix metalloproteinases, critical proteolytic enzymes of tumorigenic invasion, in several tumor types including tumors of the pancreas and breast (37, 38) and glioblastomas (39).

ROS-induced stabilization and induction of HIFα has been described in a number of systems. Exogenous hydrogen peroxide stabilizes HIF1 α protein in normoxia (40). Expression of exogenous MnSOD in MCF-7 cells suppresses hypoxic accumulation of HIF1 α protein (41). MnSOD siRNA in these cells increases both detectable superoxide and HIF1 α accumulation, whereas TEMPOL decreased accumulation, implicating superoxide as the molecular effector (42). Quercertin, a potent flavonoid antioxidant, induces normoxic accumulation of HIF1 α that is reversed by iron chelation, leading investigators to conclude that it inhibited HIFα ubiquitination by inactivating the HIF prolyl hydroxylase (PHD) and preventing binding of pVHL (43). Redox-mediated inactivation of PHD was also described in pulmonary artery smooth muscle cells where overexpression or induction of Nox4 stabilized HIF2 α in the setting of decreased HIFα hydroxylation and pVHL binding (15).

The mechanism of Nox4 regulation of HIF2α in VHL-deficient RCC cells, however, remains unclear. Block and colleagues describe increased expression p22(phox), leading to inactivation of tuberin and downstream ribosomal activation consistent with a translational pathway to increased HIF2 α accumulation (44). Our finding of altered nuclear expression of HIF2α with Nox4 silencing or treatment with superoxide scavengers suggests an additional role for redox signaling on nuclear translocation or DNA binding. We speculate that redox signaling may alter the HIF2α transcriptional complex and subsequent transactivation of target genes. Our study is limited by dependence upon established RCC cell lines and by potential off-target effects of shRNA. However, suppression of the cancer phenotype was reproducible in two VHL-deficient lines with independent shRNA sequences supporting our conclusion that experimental effects were due to specific Nox4 knockdown. Although we demonstrate that Nox4 silencing and TEMPOL treatment lead to specific superoxide suppression, our results cannot exclude the possibility that Nox4 signaling is also mediated by direct generation of hydrogen peroxide.

In summary, we show that Nox4 plays a crucial permissive role in the tumorigenic phenotype of VHL-deficient, human RCC cells and that specific Nox4 suppression inhibits intracellular superoxide generation, prevents nuclear accumulation of HIF2α, and phenocopies reexpression of wild-type VHL. Furthermore, Nox4 silencing is mimicked by superoxide scavengers, TEMPOL or MnSOD, or by catalase, implicating superoxide anion and hydrogen peroxide as mediators of Nox4 regulation of HIF2α. Taken together, these support an oncogenic role for Nox4 in conventional RCC and suggest that agents designed to target Nox4 might have clinical efficacy against kidney cancer.

No potential conflicts of interest were disclosed.

Conception and design: G. Chang, J.K. Maranchie

Development of methodology: G. Chang, D. Joshi, L. Chen, J.K. Maranchie

Acquisition of data (provided animals, acquired and managed patients, provided facilities, etc.): R.M. Turner II, G. Chang, D. Joshi, L. Chen

Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis): J.L. Gregg, R.M. Turner II, G. Chang, D. Joshi, L. Chen, J.K. Maranchie

Writing, review, and/or revision of the manuscript: J.L. Gregg, R.M. Turner II, J.K. Maranchie

Administrative, technical, or material support (i.e., reporting or organizing data, constructing databases): J.L. Gregg, D. Joshi, L. Chen

Study supervision: J.K. Maranchie

The authors thank Dr. Simon Watkins for his assistance with confocal microscopy imaging and Dr. Julie Eisemann for her invaluable assistance with mouse experiments and interpretation of the data.

This work was supported by NIH grant DK064887 and American Cancer Society grant 116627-RSG-09-023-01-CNE (J.K. Maranchie).

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

1.
Siegel
R
,
Naishadham
D
,
Jemal
A
. 
Cancer statistics, 2013
.
CA Cancer J Clin
2013
;
63
:
11
30
.
2.
McDermott
DF
. 
Immunotherapy of metastatic renal cell carcinoma
.
Cancer
2009
;
115
:
2298
305
.
3.
Singer
EA
,
Gupta
GN
,
Srinivasan
R
. 
Update on targeted therapies for clear cell renal cell carcinoma
.
Current opinion in oncology
2011
;
23
:
283
9
.
4.
Maranchie
JK
,
Vasselli
JR
,
Riss
J
,
Bonifacino
JS
,
Linehan
WM
,
Klausner
RD
. 
The contribution of VHL substrate binding and HIF1-alpha to the phenotype of VHL loss in renal cell carcinoma
.
Cancer Cell
2002
;
1
:
247
55
.
5.
Kondo
K
,
Klco
J
,
Nakamura
E
,
Lechpammer
M
,
Kaelin
WG
 Jr.
Inhibition of HIF is necessary for tumor suppression by the von Hippel-Lindau protein
.
Cancer Cell
2002
;
1
:
237
46
.
6.
Kondo
K
,
Kim
WY
,
Lechpammer
M
,
Kaelin
WG
 Jr.
Inhibition of HIF2alpha is sufficient to suppress pVHL-defective tumor growth
.
PLoS Biol
2003
;
1
:
E83
.
7.
Raval
RR
,
Lau
KW
,
Tran
MG
,
Sowter
HM
,
Mandriota
SJ
,
Li
JL
, et al
Contrasting properties of hypoxia-inducible factor 1 (HIF-1) and HIF-2 in von Hippel-Lindau-associated renal cell carcinoma
.
Mol Cell Biol
2005
;
25
:
5675
86
.
8.
Shen
C
,
Beroukhim
R
,
Schumacher
SE
,
Zhou
J
,
Chang
M
,
Signoretti
S
, et al
Genetic and functional studies implicate HIF1alpha as a 14q kidney cancer suppressor gene
.
Cancer discovery
2011
;
1
:
222
35
.
9.
Hu
CJ
,
Wang
LY
,
Chodosh
LA
,
Keith
B
,
Simon
MC
. 
Differential roles of hypoxia-inducible factor 1alpha (HIF-1alpha) and HIF-2alpha in hypoxic gene regulation
.
Mol Cell Biol
2003
;
23
:
9361
74
.
10.
Maranchie
JK
,
Zhan
Y
. 
Nox4 is critical for hypoxia-inducible factor 2-alpha transcriptional activity in von Hippel-Lindau-deficient renal cell carcinoma
.
Cancer Res
2005
;
65
:
9190
3
.
11.
Geiszt
M
,
Kopp
JB
,
Varnai
P
,
Leto
TL
. 
Identification of renox, an NAD(P)H oxidase in kidney
.
Proc Natl Acad Sci U S A
2000
;
97
:
8010
4
.
12.
Martyn
KD
,
Frederick
LM
,
von Loehneysen
K
,
Dinauer
MC
,
Knaus
UG
. 
Functional analysis of Nox4 reveals unique characteristics compared to other NADPH oxidases
.
Cell Signal
2006
;
18
:
69
82
.
13.
Fitzgerald
JP
,
Nayak
B
,
Shanmugasundaram
K
,
Friedrichs
W
,
Sudarshan
S
,
Eid
AA
, et al
Nox4 mediates renal cell carcinoma cell invasion through hypoxia-induced interleukin 6- and 8- production
.
PloS one
2012
;
7
:
e30712
.
14.
Block
K
,
Gorin
Y
,
Hoover
P
,
Williams
P
,
Chelmicki
T
,
Clark
RA
, et al
NAD(P)H oxidases regulate HIF-2alpha protein expression
.
J Biol Chem
2007
;
282
:
8019
26
.
15.
Diebold
I
,
Flugel
D
,
Becht
S
,
Belaiba
RS
,
Bonello
S
,
Hess
J
, et al
The hypoxia-inducible factor-2alpha is stabilized by oxidative stress involving NOX4
.
Antioxid Redox Signal
2010
;
13
:
425
36
.
16.
Iliopoulos
O
,
Kibel
A
,
Gray
S
,
Kaelin
WG
 Jr.
Tumour suppression by the human von Hippel-Lindau gene product
.
Nat Med
1995
;
1
:
822
6
.
17.
Vaquero
EC
,
Edderkaoui
M
,
Pandol
SJ
,
Gukovsky
I
,
Gukovskaya
AS
. 
Reactive oxygen species produced by NAD(P)H oxidase inhibit apoptosis in pancreatic cancer cells
.
J Biol Chem
2004
;
279
:
34643
54
.
18.
Song
JJ
,
Lee
YJ
. 
Catalase, but not MnSOD, inhibits glucose deprivation-activated ASK1-MEK-MAPK signal transduction pathway and prevents relocalization of Daxx: hydrogen peroxide as a major second messenger of metabolic oxidative stress
.
J Cell Biochem
2003
;
90
:
304
14
.
19.
Steiner
MS
,
Zhang
X
,
Wang
Y
,
Lu
Y
. 
Growth inhibition of prostate cancer by an adenovirus expressing a novel tumor suppressor gene, pHyde
.
Cancer Res
2000
;
60
:
4419
25
.
20.
Mohazzab
KM
,
Wolin
MS
. 
Sites of superoxide anion production detected by lucigenin in calf pulmonary artery smooth muscle
.
Am J Physiol
1994
;
267
:
L815
22
.
21.
Goyal
P
,
Weissmann
N
,
Grimminger
F
,
Hegel
C
,
Bader
L
,
Rose
F
, et al
Upregulation of NAD(P)H oxidase 1 in hypoxia activates hypoxia-inducible factor 1 via increase in reactive oxygen species
.
Free Radic Biol Med
2004
;
36
:
1279
88
.
22.
Koochekpour
S
,
Jeffers
M
,
Wang
PH
,
Gong
C
,
Taylor
GA
,
Roessler
LM
, et al
The von Hippel-Lindau tumor suppressor gene inhibits hepatocyte growth factor/scatter factor-induced invasion and branching morphogenesis in renal carcinoma cells
.
Mol Cell Biol
1999
;
19
:
5902
12
.
23.
Chen
Y
,
Pearlman
A
,
Luo
Z
,
Wilcox
CS
. 
Hydrogen peroxide mediates a transient vasorelaxation with tempol during oxidative stress
.
Am J Physiol Heart Circ Physiol
2007
;
293
:
H2085
92
.
24.
Brown
DI
,
Griendling
KK
. 
Nox proteins in signal transduction
.
Free Radic Biol Med
2009
;
47
:
1239
53
.
25.
Clement
MV
,
Sivarajah
S
,
Pervaiz
S
. 
Production of intracellular superoxide mediates dithiothreitol-dependent inhibition of apoptotic cell death
.
Antioxid Redox Signal
2005
;
7
:
456
64
.
26.
Bracken
CP
,
Fedele
AO
,
Linke
S
,
Balrak
W
,
Lisy
K
,
Whitelaw
ML
, et al
Cell-specific regulation of hypoxia-inducible factor (HIF)-1alpha and HIF-2alpha stabilization and transactivation in a graded oxygen environment
.
J Biol Chem
2006
;
281
:
22575
85
.
27.
Loboda
A
,
Jozkowicz
A
,
Dulak
J
. 
HIF-1 versus HIF-2–is one more important than the other?
Vascul Pharmacol
2012
;
56
:
245
51
.
28.
Turner
KJ
,
Moore
JW
,
Jones
A
,
Taylor
CF
,
Cuthbert-Heavens
D
,
Han
C
, et al
Expression of hypoxia-inducible factors in human renal cancer: relationship to angiogenesis and to the von Hippel-Lindau gene mutation
.
Cancer Res
2002
;
62
:
2957
61
.
29.
Boudreau
HE
,
Casterline
BW
,
Rada
B
,
Korzeniowska
A
,
Leto
TL
. 
Nox4 involvement in TGF-beta and SMAD3-driven induction of the epithelial-to-mesenchymal transition and migration of breast epithelial cells
.
Free Radic Biol Med
2012
;
53
:
1489
99
.
30.
Yamaura
M
,
Mitsushita
J
,
Furuta
S
,
Kiniwa
Y
,
Ashida
A
,
Goto
Y
, et al
NADPH oxidase 4 contributes to transformation phenotype of melanoma cells by regulating G2-M cell cycle progression
.
Cancer Res
2009
;
69
:
2647
54
.
31.
Nam
HJ
,
Park
YY
,
Yoon
G
,
Cho
H
,
Lee
JH
. 
Co-treatment with hepatocyte growth factor and TGF-beta1 enhances migration of HaCaT cells through NADPH oxidase-dependent ROS generation
.
Exp Mol Med
2010
;
42
:
270
9
.
32.
Haurani
MJ
,
Cifuentes
ME
,
Shepard
AD
,
Pagano
PJ
. 
Nox4 oxidase overexpression specifically decreases endogenous Nox4 mRNA and inhibits angiotensin II-induced adventitial myofibroblast migration
.
Hypertension
2008
;
52
:
143
9
.
33.
Pendyala
S
,
Gorshkova
IA
,
Usatyuk
PV
,
He
D
,
Pennathur
A
,
Lambeth
JD
, et al
Role of Nox4 and Nox2 in hyperoxia-induced reactive oxygen species generation and migration of human lung endothelial cells
.
Antioxid Redox Signal
2009
;
11
:
747
64
.
34.
Meng
D
,
Lv
DD
,
Fang
J
. 
Insulin-like growth factor-I induces reactive oxygen species production and cell migration through Nox4 and Rac1 in vascular smooth muscle cells
.
Cardiovasc Res
2008
;
80
:
299
308
.
35.
Hilenski
LL
,
Clempus
RE
,
Quinn
MT
,
Lambeth
JD
,
Griendling
KK
. 
Distinct subcellular localizations of Nox1 and Nox4 in vascular smooth muscle cells
.
Arterioscler Thromb Vasc Biol
2004
;
24
:
677
83
.
36.
Diaz
B
,
Shani
G
,
Pass
I
,
Anderson
D
,
Quintavalle
M
,
Courtneidge
SA
. 
Tks5-dependent, nox-mediated generation of reactive oxygen species is necessary for invadopodia formation
.
Sci Signal
2009
;
2
:
ra53
.
37.
Binker
MG
,
Binker-Cosen
AA
,
Richards
D
,
Oliver
B
,
Cosen-Binker
LI
. 
EGF promotes invasion by PANC-1 cells through Rac1/ROS-dependent secretion and activation of MMP-2
.
Biochem Biophys Res Commun
2009
;
379
:
445
50
.
38.
Pelicano
H
,
Lu
W
,
Zhou
Y
,
Zhang
W
,
Chen
Z
,
Hu
Y
, et al
Mitochondrial dysfunction and reactive oxygen species imbalance promote breast cancer cell motility through a CXCL14-mediated mechanism
.
Cancer Res
2009
;
69
:
2375
83
.
39.
Chiu
WT
,
Shen
SC
,
Chow
JM
,
Lin
CW
,
Shia
LT
,
Chen
YC
. 
Contribution of reactive oxygen species to migration/invasion of human glioblastoma cells U87 via ERK-dependent COX-2/PGE(2) activation
.
Neurobiol Dis
2010
;
37
:
118
29
.
40.
Chandel
NS
,
McClintock
DS
,
Feliciano
CE
,
Wood
TM
,
Melendez
JA
,
Rodriguez
AM
, et al
Reactive oxygen species generated at mitochondrial complex III stabilize hypoxia-inducible factor-1alpha during hypoxia: a mechanism of O2 sensing
.
J Biol Chem
2000
;
275
:
25130
8
.
41.
Wang
M
,
Kirk
JS
,
Venkataraman
S
,
Domann
FE
,
Zhang
HJ
,
Schafer
FQ
, et al
Manganese superoxide dismutase suppresses hypoxic induction of hypoxia-inducible factor-1alpha and vascular endothelial growth factor
.
Oncogene
2005
;
24
:
8154
66
.
42.
Kaewpila
S
,
Venkataraman
S
,
Buettner
GR
,
Oberley
LW
. 
Manganese superoxide dismutase modulates hypoxia-inducible factor-1 alpha induction via superoxide
.
Cancer Res
2008
;
68
:
2781
8
.
43.
Park
SS
,
Bae
I
,
Lee
YJ
. 
Flavonoids-induced accumulation of hypoxia-inducible factor (HIF)-1alpha/2alpha is mediated through chelation of iron
.
J Cell Biochem
2008
;
103
:
1989
98
.
44.
Block
K
,
Gorin
Y
,
New
DD
,
Eid
A
,
Chelmicki
T
,
Reed
A
, et al
The NADPH oxidase subunit p22phox inhibits the function of the tumor suppressor protein tuberin
.
Am J Pathol
2010
;
176
:
2447
55
.

Supplementary data