NRAGE Confers Radiation Resistance in 2D and 3D Cell Culture and Poor Outcome in Patients With Esophageal Squamous Cell Carcinoma

Huandi Zhou; Guohui Wang; Zhiqing Xiao; Yu Yang; Zhesen Tian; Chen Gao; Xuetao Han; Wei Sun; Liubing Hou; Junling Liu; Xiaoying Xue

doi:10.3389/fonc.2022.831506

NRAGE Confers Radiation Resistance in 2D and 3D Cell Culture and Poor Outcome in Patients With Esophageal Squamous Cell Carcinoma

Front Oncol. 2022 Apr 1:12:831506. doi: 10.3389/fonc.2022.831506. eCollection 2022.

Authors

Huandi Zhou^{1

2}, Guohui Wang¹, Zhiqing Xiao¹, Yu Yang¹, Zhesen Tian¹, Chen Gao¹, Xuetao Han¹, Wei Sun¹, Liubing Hou^{1

2}, Junling Liu¹, Xiaoying Xue¹

Affiliations

¹ Department of Radiotherapy, Second Hospital of Hebei Medical University, Shijiazhuang, China.
² Department of Central Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang, China.

Abstract

Objective: The purpose of the study is to explore the mechanism of NRAGE enhancing radioresistance of esophageal squamous cell carcinoma (ESCC) in 2D and 3D levels.

Methods: Stably NRAGE-overexpressed ESCC cells and 3D-printing models for ESCC cells were established. Then, cellular malignancy indexes, such as cell morphology, proliferation, radioresistance, motility, apoptosis, cell cycle, and proteins of the Wnt/β-catenin pathway, were compared between radioresistant and its parental cells in 2D and 3D levels. Additionally, 44 paraffin ESCC specimens with radical radiotherapy were selected to examine NRAGE and β-catenin protein expression and analyze the clinical correlation.

Results: Experiments in 2D culture showed that morphology of the Eca109/NRAGE cells was more irregular, elongated spindle-shaped and disappeared polarity. It obtained faster growth ability, stronger resistance to irradiation, enhanced motility, reduced apoptosis ratio and cell cycle rearrangement. Moreover, Western blot results showed β-catenin, p-Gsk-3β and CyclinD1 expressions were induced, while p-β-catenin and Gsk-3β expressions decreased in Eca109/NRAGE cells. Experiments in the 3D-printing model showed Eca109/NRAGE cell-laden 3D scaffolds had the advantage on growth and spheroiding according to the brightfield observation, scanning electron microscopy and Ki-67 IHC staining, and higher expression at the β-catenin protein. Clinical analysis showed that NRAGE expression was higher in tumor tissues than in control tissues of ESCC patients from the Public DataBase. Compared with radiotherapy effective group, both NRAGE total and nuclear and β-catenin nuclear expressions were significantly upregulated from ESCC specimens in invalid group. Further analysis showed a positive and linear correlation between NRAGE nuclear and β-catenin nuclear expressions. Additionally, results from univariate and multivariate analyses revealed NRAGE nuclear expression could serve as a risk factor for ESCC patients receiving radical radiotherapy.

Conclusion: ESCC cells with NRAGE nuclear accumulation demonstrated greater radioresistance, which may be related to the activation of the Wnt/β-catenin signaling pathway. It indicated that NRAGE nuclear expression was a potential biomarker for monitoring radiotherapeutic response.

Keywords: 3D bio-printing; NRAGE; Wnt/β-catenin; esophageal squamous cell carcinoma; radioresistance.