Necrosis is a hallmark of glioblastoma (GBM) and is responsible for poor prognosis and resistance to conventional therapies. However, the molecular mechanisms underlying necrotic microenvironment-induced malignancy of GBM have not been elucidated. Here
, we report that transglutaminase 2 (TGM2) is upregulated in the perinecrotic region of GBM and triggered mesenchymal (MES) transdifferentiation of glioma stem cells (GSC) by regulating master transcription factors (TF), such as C/EBPβ, TAZ, and STAT3. TGM2 expression was induced by macrophages/microglia-derived cytokines via NF-κB activation and further degraded DNA damage–inducible transcript 3 (GADD153) to induce C/EBPβ expression, resulting in expression of the MES transcriptome. Downregulation of TGM2 decreased sphere-forming ability, tumor size, and radioresistance and survival in a xenograft mouse model through a loss of the MES signature. A TGM2-specific inhibitor GK921 blocked MES transdifferentiation and showed significant therapeutic efficacy in mouse models of GSC. Moreover, TGM2 expression was significantly increased in recurrent MES patients and inversely correlated with patient prognosis. Collectively, our results indicate that TGM2 is a key molecular switch of necrosis-induced MES transdifferentiation and an important therapeutic target for MES GBM. Cancer Res; 77(18); 4973–84. ©2017 AACR.
Glioblastoma multiforme (GBM) is the most malignant glial tumor and is associated with extremely poor survival (1). Current standard treatments, radiotherapy and chemotherapy have not improved the poor prognosis of GBM, which has a median overall survival of approximately 14 months and a 2-year survival rate of less than 10% (2). Analysis of large-scale gene expression and genomic datasets segregated GBM into four groups—proneural (PN), neural, classical (CL), and mesenchymal (MES; ref. 3). Notably, the MES subtype of GBM is associated with relatively poor prognosis compared with that of the other subtypes and shows resistance to conventional therapy (4). Moreover, several reports have suggested that MES transdifferentiation from other subtypes occurs during GBM progression due to the microenvironment or therapeutic stimuli (4–8). Therefore, it is very important to elucidate the detailed molecular mechanisms of MES transdifferentiation during GBM tumor progression to develop future therapeutics.
Necrosis, a hallmark of GBM, has been suggested to be responsible for the poor prognosis and resistance to conventional therapies (9, 10). The necrotic microenvironment contains infiltrating macrophages/microglia and glioma stem cells (GSC), and hypoxia-associated genes are expressed (11–14). Interestingly, patients with the MES subtype showed a high level of necrosis (3), and transcriptome analysis of the perinecrotic regions also showed high MES activity (15). Moreover, analysis of The Cancer Genome Atlas (TCGA) data set showed that non-MES GBMs became transcriptionally similar to the MES subtype with increasing levels of necrosis (15). Collectively, these results indicate that the necrotic microenvironment may be involved in MES transdifferentiation during GBM progression. A recent analysis of longitudinal genomic and transcriptomic data showed that expression-based subtype change is a major event of GBM recurrence (16). Because subtype transdifferentiation is affected by therapy-induced necrosis, we hypothesized that therapy-induced MES subtype change due to the necrotic microenvironment is the major cause of acquired resistance to conventional therapy and recurrence.
To test our hypothesis, we identified the molecular mechanisms underlying MES transdifferentiation in the necrotic regions of GBM. We analyzed common population of genes between necrosis-associated genes and MES GSC-enriched genes. Here, we showed that perinecrotic areas highly expressed transglutaminase 2 (TGM2), which contributed to the MES transdifferentiation of GSC via regulation of master transcription factors (TF) of MES GBM.
Materials and Methods
Astrocyte and 293T cells were maintained in DMEM supplemented with 10% FBS (HyClone). Human NSCs were purchased from Millipore and cultured according to the manufacturer's instructions. Patient-derived GBM stem cells (83NS, 131, 528NS, 84NS, 047T, and 352T2) were maintained in DMEM/F-12 supplemented with B27 (Invitrogen), EGF (10 ng/mL; R&D Systems), and bFGF (5 ng/mL; R&D Systems). Astrocyte was obtained from ScienCell Research Laboratories. 293T was obtained from ATCC. 83NS, 528NS, and 84NS were obtained from Dr. Ichiro Nakano (University of Alabama at Birmingham, Birmingham, AL). 131, 047T, and 352T2 were obtained from Dr. Do-Hyun Nam (Samsung Medical Center, Korea). All experiments using GSC were performed on cells in passages 5-30 (2015-2016). The cell cultures have not been authenticated but all cells were repeatedly screened for mycoplasma (e-Myco Mycoplasma PCR Detection Kit, iNtRON) and maintained in culture for less than 6 months after receipt.
Plasmids, transfection, and lentivirus production and infection
Lentivirus production was performed as previously reported (17). Briefly, 3 to 4 × 106 293T cells were plated on 100 mm culture dish 24 hours before transfection. Then, 4.5 μg of lentiviral construct (pHRST-IRES-TGM2, pLL3.7-shTGM2-B, and pLL3.7-shTGM2-C), 3 μg of psPAX2 (Addgene), and 1.5 μg of pMD2.G (Addgene) were cotransfected into 293T cells using 27 μL of Lipofectamine 2000 (Invitrogen). The medium was changed 6 hours after transfection. The medium containing lentivirus was harvested 48 hours after transfection. Viral particles were concentrated and purified using a Lenti-X concentrator (Clontech). Cells were infected with lentivirus in the presence of 6 μg/mL polybrene. siRNAs against human C/EBPβ, GADD153 and negative control siRNA (Genolution) were transfected in GSC using Lipofectamine 2000 (Invitrogen). The nucleotide sequences used for target-specific siRNA or shRNA are as follows: anti-GADD153 siRNA, 5′-GAAAGAACAGGAGAAUGAAUU-3′; shTGM2-B, 5′-GCCTCGTGGTTATTAGCAAGG-3′; and shTGM2-C, 5′-GCCATTGACCACCCACCATAT-3′.
Semiquantitative RT-PCR was performed as previously described (17, 18). Total RNA was isolated from cells using Trizol reagent (Invitrogen) according to the manufacturer's instructions. Total RNA (1 μg) was used as a template to synthesize cDNA using M-MLV reverse transcriptase (Invitrogen). The PCR primers are shown as follows: TGM2, sense 5′-AACATGGGCAGTGACTTTGA-3′ and antisense 5′-AGAGAAAGGCTCCAGGTTGA-3′; C/EBPβ, sense 5′-GACAAGCACAGCGACGAGTA-3′ and antisense 5′-CAGCTGCTCCACCTTCTTCT-3′; TNFα, sense 5′-ACGGCATGGATCTCAAAGAC-3′ and antisense 5′-GTGGGTGAGGAGCACGTAGT-3′; GADD153, sense 5′-AGATGGCAGCTGAGTCATTG-3′ and antisense 5′-GTTCTGGCTCCTCCTCAGTC-3′; and GAPDH, sense 5′-GGAGTCCACTGGCGTCTTCAC-3′ and antisense 5′-GAGGCATTGCTGATGATCTTGAGG-3′. The PCR products were analyzed on a 1% agarose gel.
Limiting dilution assay
For in vitro limiting dilution assays (LDA), GSC with decreasing numbers of cells (200, 100, 50, and 10 or 100, 50, 25, and 5) per well were plated in 96-well plates containing DMEM/F-12 with B27, EGF (10 ng/mL), and bFGF (5 ng/mL). Extreme limiting dilution analysis was performed using software available at http://bioinf.wehi.edu.au/software/elda/.
Proteins were extracted with RIPA buffer with complete protease inhibitors (Roche), separated by electrophoresis, transferred to PVDF membranes (Millipore), and blocked with 5% skim milk (BD Biosciences). Primary antibodies against TGM2 (Chemicon), CD44 (R&D Systems), Sox2 (R&D Systems), TAZ (Cell Signaling Technology), C/EBPβ (Santa Cruz Biotechnology), p-STAT3 (Cell Signaling Technology), STAT3 (Santa Cruz Biotechnology), IκBα (Santa Cruz Biotechnology), GADD153 (Santa Cruz Biotechnology), and α-tubulin (Santa Cruz Biotechnology) were incubated overnight at 4°C. Immunoreactive bands were visualized using peroxidase-labeled affinity purified secondary antibodies (KPL) and the Amersham ECL prime Western blotting detection reagent (GE Healthcare).
Polymerization of GADD153 by TGM2
Purified guinea pig liver transglutaminase (Zedira) was diluted in buffer containing 10 mmol/L Tris-HCl (pH 8.0), 1 mmol/L EDTA (pH 8.0), and 0.1 mol/L NaCl. The TGM2 2 was incubated in 40 μL of reaction buffer [50 mmol/L Tris-HCl (pH 8.0), 50 mmol/L NaCl, 0.5 mmol/L EDTA, 1 mmol/L MgCl2, 5 mmol/L DTT, 10 mmol/L CaCl2] with human GADD153 (Biosource) at 37°C for 10 minutes. The reaction mixture was separated using 4% to 12% Tris-glycine gels (Invitrogen).
In vivo study
All animal experiments were conducted in accordance with protocols approved by the Institutional Animal Care and Use Committee at the National Cancer Center, Republic of Korea. For the orthotopic mouse model (19, 20), cells were transplanted following resuspension in DMEM/F-12 with B27, EGF (10 ng/mL), and bFGF (5 ng/mL). Cells were injected stereotactically into the left striatum of 5-week-old female BALB/c nude mice. The injection coordinates were 2.2 mm to the left of the midline and 0.2 mm posterior to the bregma at a depth of 3.5 mm. The brain of each mouse was harvested and fixed in 4% paraformaldehyde. For the subcutaneous mouse model, cells were injected into the hip area on both sides of each mouse. Tumor growth was measured two times a week using electronic caliper to measure two diameters using the following formula: length × width2 × 0.5. The mean tumor volume at the start of the experiment was approximately 200 mm3. Mice were sacrificed 4 weeks after the cell injections. The tumors were extracted, pooled for each experimental group, and mechanically disaggregated using steel operating scissors. GK921 (2 mg/kg; MedChem Express) was orally administered daily and radiation treatment was administered at a dose of 2.5 Gy for 4 days. Survival and tumor size were analyzed using GraphPad PRISM software (version 7).
Histology and IHC staining
For observation of the histologic features, the brains were removed, fixed with 4% paraformaldehyde for 24 hours at 4°C, and stained with hematoxylin (DaKo) and 0.25% eosin (Merck). For IHC staining of cancer stem cell markers and TGM2-associated genes [CD44 (Cell Signaling Technology), Sox2 (R&D Systems), TGM2 (Cell Signaling Technology), C/EBPβ (Santa Cruz Biotechnology), GADD153 (Santa Cruz Biotechnology)], after the antigen retrieval process with citrate buffer (pH 6.0) and endogenous peroxidase blocking with 3% hydrogen peroxide, tissue sections were incubated in primary antibody overnight at 4°C in a humidified chamber with IHC world antibody diluent buffer. We developed samples using 3,3′-diaminobenzidine (DAB, Vector Laboratories) as the chromogen. To quantify the IHC staining, immunostained cells were analyzed using a Tissue FAXS system (Tissue Gnostics). The scanned images were quantified using the HistoQuest cytometry software in the Tissue FAXS system. The cut-off threshold was determined by the stained density of the negative control. For patient tissue staining, GBM specimens were obtained from patients undergoing surgery with the approval of the Institutional Review Board of the Samsung Medical Center (No. 2010-04-004) and with informed consent. This Institutional Review Board follows the guidelines of Declaration of Helsinki and Belmont Report.
Genomic data and clinicopathologic data for GBM samples were downloaded from TCGA data portal (http://cancergenome.nih.gov/). For TCGA RNA sequencing data analysis, BAM files were available from the Cancer Genomics Hub (http:/cghub.ucsc.edu). The expression measurements, RPKM values were estimated using R package DEGseq. The nearest template prediction algorithm was used to predict the MES activity of a given TCGA samples with statistical significance using a predefined set of markers that are specific to MES subtype (21, 22). We also analyzed clinical information for the patients with untreated GBM who had survival information available.
As shown in Fig. 1A, to reanalyze the molecular characteristics of cancer stem cells in our study, we acquired microarray data in raw form from the Gene Expression Omnibus (GEO) database (GEO number, GSE67089), published at Ichiro Nagano Laboratory (7). Affymetrix Human U219 CEL files (GSE67089) were normalized using the robust multiarray average method from the Affy packages (23). For unbiased analysis, unspecific filtering was performed with the SD filter (24), and genes that were not changed or were expressed at a very low level at all microarrays were removed by the cut-off value (SD less than 2). The Hopkins statistic (25) was used to assess the clustering tendency of the filtered dataset. The filtered dataset was highly clusterable (H value, 0.1900499). The Elbow method (26) was used to determine the optimal number of the clusters and four clusters were suggested. All samples from the dataset were grouped into four subgroups (astrocytes, glioma cell lines, cancer stem cells of two subtypes, PN and MES) using the filtered genes (total 901 genes) through principle component analysis (PCA), K-means (27), PAM (28), and hierarchical clustering.
A web tool for Venn diagrams (bioinformatics.psb.ugent.be/webtools/Venn/) was used to select common genes between the above 919 genes (unique gene, 561 genes) and 1,150 positive necrosis-related genes (unique gene, 864 genes). The tool identified 90 common genes and the variable factors and separated all samples into four groups using PCA. Through this analysis, the 90 genes were revealed to be important variables associated with each group (astrocytes, glioma cell lines, and PN and MES subtypes). Next, due to the association between the MES subtype and necrotic characteristics of GBM, significant analysis of microarray (SAM) was performed using the freely available MeV software (version 4.9.0, http://mev.tm4.org) to determine whether there were differentially expressed genes in MES subtype cancer stem cells compared to PN subtype. Twenty-seven genes were found to be statistically significant in the analysis, and the order of genes was ranked by fold change. This analysis was performed by R and MeV software in all bioinformatics analyses.
All the data are expressed as the mean ± SEM from at least three independent experiments. For survival curve analysis, the Kaplan–Meier method was used. In the case of patients who were alive at the time of last follow-up, the survival records were censored in our analysis. Statistical Package for the Social Sciences software, version 16 (SPSS) was used for statistical analysis. Spearman's correlation coefficients and significance (two-tailed) were calculated using SPSS software for each pair of genes. In the case of the mouse experiments, results of the multi-dataset were compared by analysis of variance using the log-rank (Mantel–Cox) test. The results of the two-dataset experiments were compared using a two-tailed Student t test. The level of statistical significance stated in the text is based on the P values. *, P < 0.05 or **, P < 0.01 was considered statistically significant.
TGM2 is upregulated in MES GBM
Given that patients with the MES subtype exhibit a high degree of tumor necrosis, we compared the gene signature between the tumor necrotic regions and MES GSC (3, 7). TGM2 was selected as a strong candidate because of its important role in tumorigenesis (Fig. 1A). By using tissue microarray (TMA) analysis, we confirmed that TGM2 was upregulated in MES GBM samples and enriched in the perinecrotic regions of human GBM tissues (Supplementary Fig. S1A–C and Fig. 1B). Furthermore, recurrent MES patient samples showed significant increases in TGM2 expression compared to initial MES samples (Fig. 1C). Our results raised possibility that TGM2 might play an important role for the MES transdifferentiation in recurrent MES GBM.
Among the members of the transglutaminase family, TGM2 is expressed in various cancer cell types and associated with poor patient survival (29–34). However, the functions of TGM2 in GBM, especially in the MES transdifferentiation of GSC, are unclear. To analyze clinical importance of TGM2 expression in GBM, we carried out an expression analysis from TCGA data set. TGM2 was highly expressed in the MES subtype (Fig. 1D) and showed strong MES activity in the MES samples (Fig. 1E). Furthermore, the prognosis for GBM patients with high TGM2 expression was poor (Fig. 1F).
Taken together, the results showed that TGM2 can be used as a prognostic marker for GBM, because of the markedly higher expression of TGM2 in GBM patients with the malignant MES subtype and a poor prognosis.
TGM2 regulates the transdifferentiation of MES GSC
To address functional significances of TGM2, we first confirmed TGM2 expression in subtypes of GSC. In immunoblot analysis, TGM2 was detected in the MES GSC but not in astrocytes, neural stem cells (NSC), or PN and CL GSC (Fig. 2A). The expression of CD44, a MES subtype marker, was similar to that of TGM2, whereas Sox2, a marker of the PN subtype, was inversely related to the expression of TGM2 (Fig. 2A; refs. 35–37). Similar patterns were also observed in an IHC analysis of a GSC-injected orthotopic mouse model (Fig. 2B).
To determine the role of TGM2 in transdifferentiation of MES, we silenced TGM2 in MES GSC (83NS and 131) using shRNA, examined the levels of master TF, including C/EBPβ, TAZ, and STAT3, and performed LDAs. When TGM2 was silenced in MES GSC, both the MES marker CD44 and master TF decreased (Fig. 2C and Supplementary Fig. S2A). The sphere-forming ability was decreased when TGM2 was suppressed in MES subtype cells, as shown in LDAs measuring the sphere-forming ability of cancer stem cells (Fig. 2D and Supplementary Fig. S2B; ref. 38). Next, we overexpressed TGM2 in PN 528NS and 84NS GSC (7). The results showed that overexpression of TGM2 increased the MES marker CD44 and master TF (Fig. 2E and Supplementary Fig. S2C). Similarly, the GSC sphere-forming ability was enhanced as TGM2 expression increased (Fig. 2F and Supplementary Fig. S2D). We obtained similar results using 047T and 352T2 cells, CL subtype cells (Supplementary Fig. S2E–H). These results indicate that TGM2 regulate self-renewal activity of MES GSC by modulation of master TF, which is critical for maintaining the transcriptome profiling of the MES subtype.
TGM2 regulates tumor progression in vivo
To further analyze the functional significance of TGM2 in vivo, we generated an orthotopic mouse model using TGM2-silenced 83NS cells. Depletion of TGM2 in MES GSC significantly increased mouse survival and reduced tumor size compared to that of the control GSC (Fig. 3A and B). In addition, the expression levels of TGM2 and the MES marker CD44 were specifically decreased in 83NS cells with TGM2 knockdown as determined by IHC (Fig. 3B). Moreover, overexpression of TGM2 in PN GSC significantly decreased mouse survival and increased tumor size and the level of TGM2 and CD44 compared to those of the control GSC (Fig. 3C and D). Taken together, these results suggest TGM2 to be an important therapeutic target in MES GBM.
TGM2 regulates C/EBPβ expression directly by polymerization of GADD153
To determine whether TGM2 is the key molecular switch of MES transdifferentiation, we first analyzed the correlation between TGM2 and the master TF using TCGA dataset. Because C/EBPβ was most strongly correlated with TGM2 expression among MES master TF (Fig. 4A and Supplementary Fig. S3A), we assessed the effect of TGM2 on the regulation of C/EBPβ. Previous reports demonstrated that TGM2 degrades target proteins by crosslinking; therefore, we speculated that there must be a negative upstream regulator of C/EBPβ as a TGM2 substrate, and this protein may be degraded by TGM2-mediated crosslinking (31, 32). GADD153, a nuclear protein that avidly dimerizes with C/EBP isoforms α and β, is a transcriptional inhibitor of C/EBPβ signaling (39, 40). Moreover, induction of GADD153 was also associated with decreased expression of C/EBPβ (40). As GADD153 expression showed anticorrelation with C/EBPβ in TCGA dataset (Fig. 4B), we hypothesized that TGM2-mediated GADD153 crosslinking may induce C/EBPβ expression. When TGM2 was overexpressed in 528NS cells, the expression of C/EBPβ increased, and GADD153 expression decreased (Fig. 4C). In contrast, suppressing TGM2 expression in 83NS cells led to an increase in GADD153 (Fig. 4D). More importantly, silencing of GADD153 in 528NS cells strongly induced C/EBPβ expression, suggesting that GADD153 is a negative regulator of C/EBPβ (Fig. 4E). To confirm the degradation of GADD153, we added proteasome inhibitors to MES subtype cells and found that the expression of GADD153 was augmented (Fig. 4F and Supplementary Fig. S3B and C). To further determine whether GADD153 is a direct substrate of TGM2, we incubated recombinant human GADD153 with purified TGM2 in vitro. TGM2 induced the polymerization of GADD153 in a Ca2+ -dependent manner (Fig. 4G and H).
These collective data indicate that increased expression of TGM2 in MES subtype cells leads to the direct degradation of GADD153 and thus induces C/EBPβ expression.
Radiation-induced TGM2 regulates MES transdifferentiation
Among the current therapeutic interventions for GBM, radiotherapy often leads to recurrence, largely due to the survival of radioresistant GSC (41, 42). Following radiotherapy, GSC shift from the PN to the MES subtype, mainly due to the secretion of TNFα by infiltrating macrophages/microglia (4). However, the molecular link between macrophages/microglia-secreted cytokines and MES transdifferentiation has not been clearly demonstrated. To determine the possible role of TGM2 in radiation-induced MES transdifferentiation by macrophages/microglia infiltration, we analyzed macrophages/microglia infiltration and TGM2 expression in 83NS-derived xenograft tumors with or without radiation treatment. As expected, radiation treatment induced TGM2 expression and macrophages/microglia infiltration (IBA1 staining) in the perinecrotic regions (Fig. 5A). Furthermore, in response to irradiation treatment on 528NS cells, the expression of TGM2 was increased and, consequently, the expression of master TF (Fig. 5B) and sphere forming ability was also enhanced (Fig. 5C). More importantly, we confirmed that radiation induced TGM2 and TNFα expression in 528NS-derived xenograft tumor (Fig. 5D). When the recombinant TNFα was applied, the expression of TGM2, CD44, and master TF increased in a dose-dependent manner (Fig. 5E). In contrast, expression of Iκ-Bα, a negative regulator of NF-κB, decreased (Fig. 5E). To demonstrate the molecular link between NF-κB and this event, we treated Bay 11-7085, an irreversible inhibitor of Iκ-Bα phosphorylation, to PN GSC and found that the decreased expression of Iκ-Bα by TNFα treatment was rescued, and TGM2 expression was downregulated (Fig. 5F). Moreover, downstream targets of TGM2, CD44, and master TF were also downregulated (Fig. 5F). Furthermore, we investigated whether master TF were regulated by TGM2 following NF-κB activation. As shown in Fig. 5G, TNFα induced master TF expression was blocked by TGM2 silencing. Taken together, the results indicate that after irradiation of PN GSC, TGM2 is upregulated via NFκB signaling to enhance transdifferentiation to MES subtype and acquire radioresistance.
Knockdown of TGM2 suppresses radiation-induced MES transdifferentiation in vivo
To interrogate the functional relations of TGM2 in radio-resistance, we confirmed the combined effect of TGM2 knockdown and radiation treatment in the orthotopic mouse model. A combination of TGM2 silencing and radiation treatment further prolonged mouse survival, and decreased in tumor size of an 83NS-derived model (Fig. 6A and B). Notably, IHC analysis showed that TGM2, CD44, and IBA1 expression further increased after radiation treatment and blocked by TGM2 silencing (Fig. 6B). These results suggest that TGM2 induction by radiation may play a critical role in radioresistance of MES GSC.
In previous results, we demonstrated that PN to MES transition was mediated by TGM2 expression; thus, we postulated that TGM2 expression may increase during irradiation of PN GSC to induce recurrence and radioresistance via MES subtype change. To verify this hypothesis, we measured the expression of TGM2 in a 528NS animal model after irradiation. As expected, TGM2 expression was increased in the irradiated tissues of the 528NS-injected mouse model (Fig. 6C and D). These results suggest that PN subtype patients may express TGM2 during irradiation to promote the MES subtype change. Thus, inhibition of TGM2 to block PN to MES transition could be a good therapeutic strategy. To assess this hypothesis, we analyzed the combination treatment of irradiation and TGM2 silencing using the 528NS animal model; survival of the 528NS-injected mice was prolonged in the radiation treatment group, but this group eventually showed radioresistance due to TGM2 induction, as expected (Fig. 6C and D). TGM2 silencing in the radiation combined group substantially increased survival of the 528NS-injected mice (Fig. 6C). Taken together, our results strongly suggest that a combination of TGM2-specific suppression and conventional radiotherapy may be effective not only in MES GBM but also non-MES GBM patients.
The TGM2 inhibitor GK921 specifically induces cell death and reduces the MES signature and tumorigenesis of MES GSC
To explore possible clinical application, we evaluated the effects of blocking TGM2 using GK921, a TGM2-specific inhibitor (43, 44). When GK921 was applied, cell growth of the astrocytes and PN subtype cells was not significantly affected, whereas in MES subtype cells, cell viability was reduced even at a low concentration of 0.5 μmol/L (Fig. 7A). In addition, CD44 and master TF were reduced following treatment with GK921 (Fig. 7B and C). To further confirm in vivo efficacy of its treatment, we generated an orthotopic xenograft mouse model using MES GSC (83NS) and orally administered GK921. The results showed that the median survival increased, and the tumor size was also reduced by GK921 treatment (Fig. 7D and E). Notably, IHC analysis demonstrated that CD44 and C/EBPβ expression was reduced, and GADD153 expression increased in the GK921 treatment group (Fig. 7E). Because we suggested significant therapeutic benefit of radiation therapy and TGM2 inhibition in non-MES GSC by blocking non-MES to MES subtype change, we tested GK921 drug effect combined with irradiation in 528NS-derived subcutaneous mouse model. Although GK921 or irradiation treatment partially reduced tumor volume compared with vehicle group, but these groups showed relapse of tumor growth (Fig. 7F). However, combined treatment of GK921 and irradiation significantly decreased tumor size and prolonged duration of treatment response (Fig. 7F).
On the basis of these results, we concluded that GK921 increased response to radiation therapy of GSC by blocking MES transdifferentiation. Our results strongly support the therapeutic potential of TGM2 inhibition in GBM patients.
Subtype changes of GBM are strongly associated with acquisition of resistance to conventional therapy and poor prognosis. Because MES transdifferentiation leads to recurrence and resistance to conventional therapies, the underlying mechanisms of this shift require elucidation for therapeutic improvement (4, 7). Our study demonstrated TGM2 as a key molecular switch for the necrosis-induced MES transdifferentiation. TGM2 modulates this process by inducing proteasomal degradation through the polymerization of GADD153 and by modulating C/EBPβ. Silencing and pharmacologic inhibition of TGM2 significantly increased survival rate and therapeutic efficacy of irradiation in mouse models. In addition to extensive in vivo data, clinical relevance of our findings was supported by in silico analysis of TGM2 expression in a large glioma genomic dataset and IHC analysis of patient-derived specimens. Especially, TGM2 expression was highly upregulated in recurrent MES patient samples compared to that of non-MES and initial GBM samples, and correlated with poor prognosis. These results suggested that TGM2 might play an important role for the recurrence and radioresistance of GBM by inducing MES transdifferentiation and could be an important therapeutic target for the recurrent GBM.
Infiltrating macrophages/microglia in necrotic regions have been linked to poor prognosis via secretion of cytokines (45–48). TNFα, one of the major cytokines secreted by infiltrating macrophages/microglia in the perinecrotic region, induced master TF of the MES transition and promoted conversion from a PN subtype to a MES subtype in an NF-κB signaling-dependent manner (4). However, the molecular link between NF-κB and master TF was unclear. Here, we demonstrated that TNFα-induced NF-κB activation was responsible for the TGM2 expression, and this event ultimately led to MES differentiation via regulation of master TF. Therefore, our results indicate that TGM2 is a molecular mediator between NF-κB and master TF for the necrosis-induced MES transdifferentiation.
Recent studies have introduced an algorithm to identify transcriptional interactions based on GBM expression classes (16). From the transcriptomic findings, several TF, including C/EBPβ, C/EBPδ, TAZ, STAT3, FOSL2, bHLHE40, and RUNX1, were shown to be regulators of the transition to the MES subtype (15, 49). Of these TF, C/EBPβ, TAZ, and STAT3 were identified as master transcriptional regulators. These TF regulate expression of key factors and downstream signaling, including the MES gene signature (15). A high degree of necrosis is observed in the MES class of GBM, and master TF were strongly correlated with the degree of necrosis (3, 15). All three TF are closely involved in self-renewal of MES GSC and maintenance of MES characteristics (49, 50). By blocking TGM2, we effectively downregulated the master TF. Interestingly, TGM2 directly targeted GADD153, a negative regulator of C/EBPβ, to induce protein degradation (40). Our results suggest that TGM2 is a key molecular switch for MES subtype change by regulating master TF.
Radiation-induced necrosis has long been considered a major cause of radioresistance (9, 51). However, there are no clear molecular explanations for this event. In this paper, we demonstrated that irradiation induced TGM2 expression in perinecrotic regions is responsible for the radioresistance by triggering MES subtype change. TGM2 can be a therapeutic biomarker for not only the MES subtype but also non-MES subtypes because therapy-induced necrosis can easily convert non-MES to MES patients. When we compared therapeutic efficacy between MES GSC and non-MES GSC using a combination of radiation and TGM2 silencing, non-MES GSC-injected mice showed better therapeutic benefit following the combination treatment despite their initial low level of TGM2 compared to that of MES GSC. Our results strongly indicate that TGM2 is a therapeutic target that can be used to improve the response to radiotherapy not only MES GBM patients but also for non-MES GBM patients by preventing non-MES to MES transition.
In conclusion, we demonstrated that TGM2 as a key therapeutic target in GBM by regulating the master TF of the MES subtype to increase radioresistance and recurrence. Therefore, our results will provide important therapeutic implication for recurrent GBM.
Disclosure of Potential Conflicts of Interest
No potential conflicts of interest were disclosed.
Conception and design: J. Yin, Y.T. Oh, H.-S. Gwak, H. Yoo, S.-H. Lee, J.H. Kim, S.-Y. Kim, D.-H. Nam, J.B. Park
Development of methodology: Y.T. Oh, J.-Y. Kim, S.S. Kim, E. Choi, J.H. Hong, N. Chang, H.J. Kwon, W. Lin, J.H. Kim, S.-Y. Kim, J.B. Park
Acquisition of data (provided animals, acquired and managed patients, provided facilities, etc.): N. Chang, S. Park, H.-S. Gwak, D.-H. Nam, M.-J. Park, J.B. Park
Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis): T.H. Kim, N. Chang, H.J. Cho, J.K. Sa, H.-S. Gwak, S.-H. Lee, J.H. Kim, S.-Y. Kim, D.-H. Nam, J.B. Park
Writing, review, and/or revision of the manuscript: J. Yin, Y.T. Oh, J.-Y. Kim, E. Choi, T.H. Kim, H.-S. Gwak, J.H. Kim, M.-J. Park, J.B. Park
Administrative, technical, or material support (i.e., reporting or organizing data, constructing databases): J. Yin, I. Nakano, J. Lee, J.H. Kim, S.-Y. Kim, D.-H. Nam, J.B. Park
Study supervision: J.H. Kim, S.-Y. Kim, D.-H. Nam, J.B. Park
This research was supported by grants from the National Cancer Center, Republic of Korea (NCC-1410290, NCC-1510061), Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2015H1D3A1036090, NRF-2015R1A2A1A15054865, NRF-2015M3A9D9067485, NRF-2017R1A2B4011741, and NRF-2015R1C1A1A01054963), the Korea Institute of Radiological and Medical Science (KIRAMS), funded by the Ministry of Science, ICT and Future Planning, Republic of Korea (1711045557, 1711045538, 1711045554/50531-2017), and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea, HI14C3418.
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.