Exosome-Derived Differentiation Antagonizing Non-Protein Coding RNA Promotes Tumor Recurrences in Hepatitis C-Related Hepatocellular Carcinoma

Abstract

Background & Aims: Differentiation antagonizing non-protein coding RNA (DANCR) associated with various types of neoplasms. Hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) (HCV-HCC) has a high risk of recurrence. We explored the role of DANCR in HCV-related hepatocarcinogenesis and identified potential therapeutic targets and non-invasive prognostic markers for long-term outcome of HCV-HCC after surgical resection. Methods: DANCR relevant to HCV-HCC were identified by comparative RNA-sequencing of tumor (T) and adjacent non-tumor (ANT) tissues in a screening set, validated using real-time PCR Target lncRNAs in tissues and serum exosomes were used to predict HCC recurrence of HCV-HCC after curative surgical resection in a large application cohort. Exosome-Derived DANCR was explored using JFH1-infected cells and macrophages. Results: We confirmed that DANCR was upregulated by HCV infection and identified as the lncRNA most relevant to HCV-HCC in tumor as compared to ANT tissues. In 183 HCV-HCC patients followed for 10 years after curative HCC resection, the expression level of circulating exosomal DANCR was positively associated with HCC recurrence and was the most predictive factor associated with HCC recurrence and mortality (hazard ratio/95% confidence intervals: 7.0/4.3–11.6 and 2.7/1.5–5.1, respectively). In vitro study further demonstrated that exosomal DANCR was positively associated with mesenchymal-associated β-catenin expression in HCV infectious hepatocyte and macrophages, which might consequently promote tumor cell migration and invasion abilities in the tumor microenvironment. Conclusions: The lncRNA DANCR is highly relevant to disease progression of HCV-HCC Furthermore, circulating exosomal DANCR might serve as a non-invasive prognostic biomarker for HCV-HCC. Funding Statement: This study supported by the grants from the Ministry of Science Technology (MOST) grant (108-2314-B-037-079-MY3) (106-2221-E-039-011-MY3); China medical University (CMU108-MF-93), (CMU108-Z-02), (CMU108-S-22); Kaohsiung Medical University (KMU-Q108009), (KMUQ109005), (108-CCH-KMU-001); partially by Kaohsiung Medical University Research Grant KMU-TC108A04 and KMU-TC108B06. This study was partially supported by of Liquid Biopsy and of Cancer Research, Kaohsiung Medical University, and the Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B) from The Featured Areas Research Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan. Declaration of Interests: All authors declare no support from any organization other than the below mentioned ones for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work. Hence, all authors declare themselves to be independent from funders with respect to this manuscript. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board at each hospital and the TLCN User Committee and was carried out in accordance with the Declaration of Helsinki and the guidelines of the International Conference on Harmonization for Good Clinical Practice.