Background: Glycogen synthase kinase-3β (GSK-3β) is recently demonstrated to be a tumor promoter and a potential drug target in several tumors. However, the implication and mechanism of GSK-3β in hepatocellular carcinoma (HCC) remain unexplored. Methods: We firstly clarified the expression of GSK-3β in human HCC samples. Given that deviated retinoid signalling is critical for HCC development, we investigated where GSK-3β could be involved in the regulation. Since sorafenib is currently used to treat HCC, the involvement of GSK-3β in sorafenib treatment response was determined. Coimmunoprecipitation, GST pull down, in vitro kinase assay, luciferase reporter and chromatin immunoprecipitation were used to study the molecular mechanism. The biological readouts were examined with MTT, flow cytometry and animal experiments. Findings: We demonstrated that GSK-3β is highly expressed in HCC and associated with shorter overall survival (OS). Tumor-associated GSK-3β is correlated with reduced expression of retinoic acid receptor-β (RARβ), which is caused by GSK-3β-mediated phosphorylation and heterodimerization abrogation of retinoid X receptor (RXRα) with RARα on RARβ promoter. Overexpression of functional GSK-3β impairs retinoid response and represses sorafenib anti-HCC effect. Inactivation of GSK-3β by tideglusib can potentiate 9-cis-RA enhancement of sorafenib sensitivity (tumor inhibition: from 48.3% to 93.4%). Efficient induction of RARβ by tideglusib/9-cis-RA is required for enhanced therapeutic outcome of sorafenib, which effect is greatly inhibited by knocking down RARβ. Interpretation: Our findings suggest that overexpression of GSK-3β may confer HCC growth through interfering retinoid signalling. Targeting GSK3β can be a promising strategy for designing improved treatment of sorafenib in HCC. Funding Statement: This work is supported by grants from Natural Science Foundation of China (No. 81673467, 31471273, 31461163002/RGC N_HKU 740/14), the 10th Singapore-China Joint Research Program (S2014GR0448), Natural Science Foundation of Fujian Province (2019I0002) and Leading Talents in Scientific and Technological Innovation, Double Hundred Talents Program of Fujian Province. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: All the use of human samples and study protocols were approved by the Hospital Ethics Committee. All patients signed an informed consent form in prior to sample collection.
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