Abstract

BackgroundSerum alpha-fetoprotein (AFP) is the approved serum marker for hepatocellular carcinoma (HCC) screening. However, not all HCC patients show high (≥ 20 ng/mL) serum AFP, and the molecular mechanisms of HCCs with normal (< 20 ng/mL) serum AFP remain to be elucidated. Therefore, we aimed to identify biological features of HCCs with normal serum AFP by investigating differential alternative splicing (AS) between HCCs with normal and high serum AFP.MethodsWe performed a genome-wide survey of AS events in 249 HCCs with normal (n = 131) and high (n = 118) serum AFP levels using RNA-sequencing data obtained from The Cancer Genome Atlas.ResultsIn group comparisons of RNA-seq profiles from HCCs with normal and high serum AFP levels, 161 differential AS events (125 genes; ΔPSI > 0.05, FDR < 0.05) were identified to be alternatively spliced between the two groups. Those genes were enriched in cell migration or proliferation terms such as “the cell migration and growth-cone collapse” and “regulation of insulin-like growth factor (IGF) transport and uptake by IGF binding proteins”. Most of all, two AS genes (FN1 and FAM20A) directly interact with AFP; these relate to the regulation of IGF transport and post-translational protein phosphorylation. Interestingly, 42 genes and 27 genes were associated with gender and vascular invasion (VI), respectively, but only eighteen genes were significant in survival analysis. We especially highlight that FN1 exhibited increased differential expression of AS events (ΔPSI > 0.05), in which exons 25 and 33 were more frequently skipped in HCCs with normal (low) serum AFP compared to those with high serum AFP. Moreover, these events were gender and VI dependent.ConclusionWe found that AS may influence the regulation of transcriptional differences inherent in the occurrence of HCC maintaining normal rather than elevated serum AFP levels.

Highlights

  • Serum alpha-fetoprotein (AFP) is the approved serum marker for hepatocellular carcinoma (HCC) screening

  • As FN1 is known to be overexpressed in HCC [30], we further evaluated the differential expression of FNI transcript isoforms between low and high AFP groups

  • The outcomes of this study need to be validated using a well-designed prospective study in the future. In conclusion, in this genome-wide study, we found that alternative splicing (AS) of FN1 was differently expressed in HCC with normal serum AFP compared to those with high serum AFP

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Summary

Introduction

Serum alpha-fetoprotein (AFP) is the approved serum marker for hepatocellular carcinoma (HCC) screening. Not all HCC patients show high (≥ 20 ng/mL) serum AFP, and the molecular mechanisms of HCCs with normal (< 20 ng/mL) serum AFP remain to be elucidated. It was reported that early diagnosis using liver ultrasonography (USG) and serum alpha-fetoprotein (AFP) reduced the mortality rate of HCC patients by 37% [4]. Based on this result, liver USG at 6-month intervals is generally recommended for surveillance in high-risk groups (liver cirrhosis or hepatitis B or C), either alone or in combination with serum AFP testing [5,6,7,8,9]. Given that newer biomarkers have yet to be developed that are more satisfying in HCC surveillance, it is necessary to understand the molecular biology of these HCCs with normal serum AFP levels

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