Long Noncoding RNA NEAT1 Promotes Cell Proliferation And Invasion And Suppresses Apoptosis In Hepatocellular Carcinoma By Regulating miRNA-22-3p/akt2 In Vitro And In Vivo.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most aggressive cancers that is associated with cirrhosis and other chronic liver diseases. Although remarkable progress has been made in past decades, it is still necessary to continue exploring the pathology and development of HCC.
OBJECTIVE: In this study, we elucidated the effect of long noncoding RNA (lncRNA) NEAT1 on HCC development and underlying mechanisms.
METHODS: Clinicopathological features of HCC patients were collected and the correlations with NEAT1 expression were assessed. To determine cell activities, CCK-8, flow cytometry, invasion assays, and TUNEL assays were performed. Real-time PCR, Western blot, and luciferase reporter assays were performed to investigate the related mechanism of HCC.
RESULTS: The results revealed that NEAT1 expression was associated with tumor size and differentiation where NEAT1 was upregulated in both HCC tissues and cell lines. Overexpression of NEAT1 promoted proliferation and invasion while inhibited apoptosis in HCC cells, which was opposite to the effect of NEAT1 knockdown. Also, AKT2 was increased in HCC tissues. Downregulation of AKT2 was associated with reduced cell proliferation and invasion while increased apoptosis, while overexpression of AKT2 exerted opposite roles. In addition, the expression of miRNA-22-3p displayed an inverse association with NEAT1. miRNA-22-3p mimic and inhibitor suppressed and promoted HCC development, respectively. The luciferase assay revealed that both NEAT1 and AKT2 were direct target genes of miRNA-22-3p. Furthermore, knockdown and overexpression of NEAT1 suppressed and promoted tumor growth in the HCC mouse model, which were abolished by the miRNA-22-3p inhibitor and mimic, respectively.
CONCLUSION: In conclusion, the results demonstrate that NEAT1 promotes the development of HCC, both in vitro and in vivo, through regulating miRNA-22-3p/AKT2, and provides insight into developing a new strategy for HCC treatment.

Introduction

Hepatocellular carcinoma (HCC) is the most common and aggressive liver malignancy in the world and is a leading cause of tumor-associated death,1 accounting for the top seven diagnosed cancers in men and women.2 Despite remarkable progress in prevention, diagnosis and treatment, the high incidence and mortality of HCC continue to elevate.3 Thanks to high heterogeneity and barriers of symptoms, diagnosis and high frequency of metastasis or recurrence, only around 40% of patients with HCC are suitable for curative resection.3,4 Thus, it is essential to explore potential biomarkers for diagnosis and developing an HCC treatment.

Long non-coding RNAs (lncRNAs), over 200 nucleotides in length, are a class of transcripts without amino acid-coding potential.5 Moreover, lncRNAs impact molecular and cellular processes, including gene regulation, ligand-receptor activity, and cellular signaling, thereby playing fundamental roles in various physiological and pathological processes.6,7 As a multifunctional regulator, lncRNA NEAT1 participates in the regulation of various cancers, including breast cancer,8 colorectal cancer9 and gastric cancer.10 Regarding HCC, previous studies have reported that NEAT1 is associated with tumorigenesis and metastasis11–13 and sorafenib sensitivity14 in HCC cells. Therefore, further investigation is needed to better understand the role of NEAT1 as a promoting target molecule in HCC development.

In the protein kinase B family, AKT includes three isoforms, AKT1, AKT2, and AKT3.15 Increasing evidence shows that AKT signaling is important in cell growth, cell cycle, and metabolism.15 In addition, AKT2 is a target gene of miRNA-493-3p to promote apoptosis in ovarian cancer cells.16 Cyclin‐dependent kinase 9 modulates cell proliferation and apoptosis via the AKT2/p53 pathway in cervical cancer.17 The expression of AKT2, not ATK1, is found to be associated with the prognosis of HCC.18

Thus, in the present study, the objective was to further investigate the effects of NEAT1 on apoptosis, invasion and cell proliferation in HCC in vivo and in vitro and related mechanisms underlying these processes.

Materials And Methods

Ethics Statement

In the study, all subjects were informed before their inclusion and written consents were given. The study protocol was approved by the Ethics Committee of Xuzhou Medical University and the experiments were performed in accordance with the Declaration of Helsinki Principles. All animal experiments were approved by the Institutional Animal Care and Use Committee of Xuzhou Medical University and the experimental procedures were conducted according to the approved guidelines.

Patients And Samples

The clinicopathological features were assessed according to earlier studies.19,20 Forty-seven primary patients with HCC treated in Xuzhou Central Hospital between July 2016 and June 2017 were selected based on the criteria19,20 and the patient information was summarized in Table 1. All samples were evaluated by at least two professional pathologists. HCC and adjacent tissues were collected and stored at −80°C before processing.

Table 1

Correlation Between Clinicopathological Features Of Patients With HCC And NEAT1, miRNA-22-3p, And AKT2 Expressions. *P<0.05

	N	NEAT1		P value	miRNA-22-3p		P value	AKT2		P value
Low	High	Low	High	Low	High
All cases	47	24	23		22	25		24	23
Age (years)				0.385			0.411			0.401
< 65	21	11	10		10	11		12	9
≥ 65	26	14	12		13	13		14	12
Gender				0.147			0.214			0.199
Male	25	12	13		14	11		13	12
Female	22	14	8		6	16		12	10
TNM stage				0.612			0.517			0.042*
I-II	23	13	10		10	13		9	14
III-IV	24	11	13		12	12		6	18
Histological grade				0.268			0.209			0.254
Low	22	9	13		12	10		10	12
High	25	12	13		13	12		13	12
Tumor size (cm)				0.014*			0.028*			0.031*
< 3	18	8	10		9	9		8	10
≥ 3	29	9	20		19	10		10	19
Lymph node metastasis				0.089			0.103			0.112
No	22	11	11		11	11		10	12
Yes	25	12	13		14	11		12	13
Differentiation				0.023*			0.032*			0.019*
High	23	7	16		14	9		8	15
Moderate	11	5	6		5	6		4	7
Low	13	6	7		8	5		6	7
Liver cirrhosis				0.104			0.110			0.138
No	23	10	13		12	11		11	12
Yes	24	12	12		12	12		13	11
AFP				0.077			0.089			0.109
< 20 ng/mL	19	11	8		9	10		10	9
>20 ng/mL	28	13	15		15	13		14	14

Cell Culture

The human HCC cell lines (97H, Hep3B, HepG2, SMMC-7721, and SNU423) and the human normal liver cell line (L02) were obtained from the Liver Cancer Institute, Fudan University, Shanghai. The identification for cell lines was conducted by STR profiling. Cells were cultured in DMEM medium (Thermo Scientific, Madison, CA, USA) supplemented with 10% fetal bovine serum (100 μg/mL streptomycin and 100 μg/mL penicillin; Gibco, Grand Island, USA) at 37 °C with 5% CO2.

Real-Time PCR

Total RNA was extracted from the liver tissues and cell lines using TRIzol reagent (Invitrogen, CA, USA) according to the manufacturer’s instructions. cDNA was synthesized using the M-MLV Reverse Transcriptase (RNase H) kit (GeneCopoeia, MD, USA). Real-time PCR was performed using a 7500 real-time system (Applied Biosystems, CA, USA) with the recommended conditions for each reaction. The primers used were previously described and included: GAPDH,21 NEAT1,21 miRNA-22-3p,22 U6,23 and AKT2.24 Gene expression data were analyzed using the 2−ΔΔCt method25 with GAPDH as the reference gene and miRNA-154 expression was normalized to those of U6.

Cell Transfection

All siRNAs were synthesized by GenePharma Co., Ltd (Shanghai, China). The sequences of siRNA were previously described: nonsense control,19 NEAT1,26 and AKT2.27 The pLV-CMV-Not/BamHI–GFP–puro-NEAT1 (pLV-CMV-NEAT1) and pLV-CMV-AKT2 was synthesized by GenePharma Co., Ltd (Shanghai, China). The miRNA-22-3p mimic, inhibitor and negative control were purchased from Thermo Scientific Dharmacon (Lafayette, USA). The transfection of HepG2 cells were performed according to the manufacturer’s instructions of the Lipofectamine™ 3000 Transfection Reagent (Invitrogen, Waltham, USA). After 48 hrs, transfected cells were used in subsequent experiments.

Luciferase Reporter Assay

The sequences containing the predicted binding sites of miRNA-22-3p were synthesized from the 3ʹUTR of NEAT1 and AKT2, respectively, and then inserted into the firefly luciferase reporter gene in pMIR (Ambion, Austin, USA). The sequences containing mutated miRNA-22-3p binding sites was inserted into the same luciferase reporter to test binding specificity. The engineered luciferase reporter plasmids were transfected with miRNA-22-3p mimic or miRNA-control into HepG2 by using the Lipofectamine™ 3000 kit (Invitrogen, CA, USA) in accordance with the manufacturer’s instructions. After 24 hrs, relative luciferase activity was analyzed using the luciferase assay kit (Promega, Madison, WI, USA).

Flow Cytometer

HepG2 cells (1 × 105 cells/well) were used for cell cycle analysis. The detailed protocol was described in a previous study.28 The cell cycle was evaluated from the flow cytometer assay (FACSort; Becton Dickinson). The cell population in each stage was evaluated by ModFit software (Verity Software House,Top-sham, USA).

CCK-8 Assay

Cell proliferation was evaluated using CCK-8 (Dojin Laboratories, Kumamoto, Japan) according to the manufacturer’s instructions. The infected HepG2 cells were seeded (1 × 105 cells/well) in a 96-well cell culture dish. OD values were determined at 0, 24, 48, 72, and 96 h.

Transwell Invasion Assay

HepG2 cells were treated with a corresponding treatment and were subjected to the invasion assay (BD Biosciences, NJ, USA) as previously described.28,29

Western Blot

HepG2 cell protein was isolated by using the cell lysis buffer (Beyotime Institute of Biotechnology, Shanghai, China). The detailed protocol was performed as previously reported.29 The primary antibodies against AKT2 (1:1000) and GAPDH (1:1000) (Santa Cruz Biotechnology, Santa Cruz, CA) were incubated with protein samples at 4 °C overnight. Quantification of optical density was evaluated by the Uvitec Alliance software (Eppendorf, Germany).

TUNEL Assay

HepG2 cells were fixed in 4% paraformaldehyde in PBS containing 0.12 mM sucrose for 15 mins. Apoptosis was determined by the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) apoptosis detection kit (Beyotime Institute of Biotechnology, Nantong, China) according to the manufacturer’s instructions. The apoptosis level was evaluated by fluorescence microscopy (Carl Zeiss, Oberkochen, Germany).

HCC Mouse Model And In Vivo Study

Male BALB/c athymic nude mice (6 weeks old) were each inoculated with HepG2 cells (1.0 × 107) in 200 µl of PBS by subcutaneous injection into their flanks. Tumor growth was monitored daily. After 8 days, the transplanted mice were randomly divided into six groups (n=5): si-NEAT1 control, si-NEAT1, si-NEAT1+miRNA-22-3p inhibitor, plV-CMV-control, plV-CMV-NEAT1, and miRNA-22-3p mimic+plV-CMV-NEAT1. Each treatment was directly injected into the tumor in 20 ul PBS (1 nmol). The injection was performed every 4 days for a total of 7 times. Tumor volume (V) was evaluated by measuring the length (L) and width (W) with caliper and calculated with the formula V = (L × W2) × 0.5.

Statistical Analysis

Data were presented as means ± SD. Statistical analysis was performed using SPSS v.18.0 software (SPSS, IL, USA). There were at least 3 replicates in each treatment. The correlations between NEAT1 expression and clinicopathological features, NEAT1 and miRNA-22-3p, miRNA-22-3p and AKT2, as well as NEAT1 and AKT2, were analyzed with the Spearman rank correlation. OncoLnc online platform30 was used to predict overall survival rate. Differences between groups were analyzed with Student’s t-test and one-way analysis of variance. Differences were considered to be significant at P<0.05.

Results

Upregulation Of NEAT1 Is Associated With The Development Of HCC

NEAT1 expression was increased in HCC tissue (Figure 1A) and several cell lines (Figure 1C), where the greatest expression was found in the HepG2 cell line. Therefore, the HepG2 was selected for subsequent experiments. Regarding the correlation between NEAT1 and clinicopathological features in HCC, the high expression of NEAT1 was associated with larger tumor size and greater levels of differentiation and NEAT1 expression was significantly higher in HCC tissues compared with healthy tissues (Table 1) (Figure 1B). To determine the effect of upregulation of NEAT1 in HCC cells, si-NEAT1s and plV-CMV-NEAT1s were applied to knockdown and overexpress NEAT1, respectively and the efficacy was evaluated by real-time PCR (Figure 1D and E). Also, the expression level of NEAT1 was shown to be associated with the overall survival of patients with HCC (Figure 1F).

Figure 1

Involvement of NEAT1 in HCC. (A). NEAT1 expression in healthy and HCC tissues. (B). Association between NEAT1 and tumor size in HCC. (C). NEAT1 expression in several HCC cell lines. (D). Efficacy evaluation of si-NEAT1s. (E). Efficacy evaluation of pLV-CMV-NEAT1. (F). Correlation between NEAT1 expression and overall survival rate of patients with HCC (0=alive; 1=dead). Values are means ±SD. (*) denotes the difference between groups (P<0.05).

NEAT1 Is Essential For The Development Of HCC

The inhibited NEAT1 expression suppressed cell proliferation (Figure 2A), invasion (Figure 2C) and increased the number of cells in the S-phase (Figure 2B). Downregulation of NEAT1 was also associated with inhibited cell apoptosis (Figure 2D). Conversely, HepG2 cells transfected with plV-CMV-NEAT1 displayed opposite trends compared with those with downregulation of NEAT1 (Figure 3A–D).

Figure 2

Inhibition of NEAT1 suppresses HCC development. (A). OD values of HCC cells. (B). Cell cycle analysis in HCC cells. (C) Cell invasion in HCC cells. (D). Apoptosis in HCC cells. Values are means ±SD. (*) denotes the difference between groups (P<0.05).

Figure 3

Upregulation of NEAT1 promotes HCC development. (A). OD values of HCC cells. (B). Cell cycle analysis in HCC cells. (C) Cell invasion in HCC cells. (D). Apoptosis in HCC cells. Values are means ±SD. (*) denotes the difference between groups (P<0.05).

Increased AKT2 Is Involved In HCC Development

The mRNA expression of AKT2 was increased in HCC tissues compared with those in healthy tissues (Figure 4A). To investigate the function of AKT2 in HCC, si-AKT2s were applied to knockdown AKT2 and the knockdown efficiencies were evaluated by RT-PCR (Figure 4B). The downregulation of AKT2 led to the inhibitory effect on HCC development. Specifically, HepG2 cells transfected with si-AKT2 showed reduced cell proliferation (Figure 4C), the number of cells in the S-phase (Figure 4D), and invasion (Figure 4E) while elevated apoptosis levels (Figure 4F). Also, the correlation between the expression of AKT2 and the overall survival rate was demonstrated by online bioinformatics analysis (Figure 5A). Furthermore, we tested the effect of overexpression of AKT2 in the development of HCC (Figure 5B) and we found that forced AKT2 expression by plV-CMV-AKT2 further enhanced progression of HCC, that is elevated cell proliferation (Figure 5C), number of cells in the S-phase (Figure 5D), and invasion (Figure 5E) whereas downregulated apoptosis levels (Figure 5F). Moreover, the expression of AKT2 was correlated with tumor size, tumor differentiation grade, and TNM stage (Table 1). Collectively, these results demonstrated that the important effect of AKT2 in HCC.

Figure 4

Suppression of AKT2 inhibits in HCC development. (A). AKT2 expression in healthy and HCC tissues. (B). Efficacy evaluation of si-AKT2s. (C). OD values of HCC cells. (D). Cell cycle analysis in HCC cells. (E). Cell invasion in HCC cells. (F). Apoptosis in HCC cells. Values are means ±SD. (*) denotes the difference between groups (P<0.05).

Figure 5

Enhanced expression of AKT2 promotes HCC development. (A). Correlation between AKT2 expression and overall survival rate of patients with HCC (0=alive; 1=dead). (B). Efficacy evaluation of pLV-CMV-AKT2s. (C). OD values of HCC cells. (D). Cell cycle analysis in HCC cells. (E). Cell invasion in HCC cells. (F). Apoptosis in HCC cells. Values are means ±SD. (*) denotes the difference between groups (P<0.05).

NEAT1 Is Negatively Associated With miRNA-22-3p In HCC

To further determine the mechanism associated with functions of NEAT1 and AKT2 in HCC, the potential target genes of NEAT1 and AKT2 were predicted by using online databases: PicTar (), Miranda () and TargetScan (). Both NEAT1 and AKT2 contained the presumed binding site of miRNA-22-3pin 3ʹUTR and then these predictions were confirmed by results from the luciferase reporter assay (Figure 6E and F). Also, we found the decreased miRNA-22-3pexpression in HCC tissues compared with those in healthy tissues (Figure 6A) and the expression of miRNA-22-3pdisplayed inverse patterns in those treated with siRNA- NEAT1 and plV-CMV-NEAT1, respectively (Figure 6C and D), indicating NEAT1 can directly target miRNA-22-3pin HCC. Moreover, through analysis in OncoLnc, the low level of miRNA-22-3pwas associated with a poor overall survival rate in patients with HCC (Figure 6B)

Figure 6

Involvement of miRNA-22-3p in HCC. (A). miRNA-22-3p in healthy and HCC tissues. (B) Correlation between miRNA-22-3p expression and overall survival rate of patients with HCC (0=alive; 1=dead). (C). MiRNA-22-3p expression in HCC cells treated with si-NEAT1. (D). MiRNA-22-3p expression in HCC cells treated with pLV-CMV-NEAT1. (E). The predictive sequence of miRNA-22-3p binding sites in the 3ʹUTR of NEAT1 and relative luciferase activity. (F). The predictive sequence of miRNA-22-3p binding sites in the 3ʹUTR of AKT2 and relative luciferase activity. Values are means ±SD. (*) denotes the difference between groups (P<0.05).

MiRNA-22-3p Is Associated With HCC Development

Then, we further investigated the roles of miRNA-22-3pby application of mimic and inhibitor. The results showed that the upregulation of miRNA-22-3pinhibited cell proliferation (Figure 7A), number of cells in the S-phase (Figure 7B), and invasion (Figure 7C) and promoted cell apoptosis (Figure 7D), which is opposite to the effects of downregulation of miRNA-22-3pon HCC cells, indicating the essential roles of miRNA-22-3p in the development of HCC. Also, like NEAT1, the abundance of miRNA-22-3p is associated with two clinicopathological features, tumor size and differentiation grade (Table 1).

Figure 7

Roles of miRNA-22-3p in HCC development. (A). OD values of HCC cells. (B) Cell cycle analysis in HCC cells. (C). Cell invasion in HCC cells. (D). Apoptosis in HCC cells. Values are means ±SD. (*) denotes the difference between groups (P<0.05).

MiRNA-22-3p/akt2 Is Involved In The Effect Of NEAT1 On Modulating HCC Development

The knockdown of NEAT1 and the inhibition of miRNA-22-3pdecreased and increased AKT2, respectively, similarly in both mRNA and protein levels (Figure 8A and B). The combination of si-NEAT1 and miRNA-22-3pinhibitor abolished the effect of their respective roles on AKT2, showing no differences compared to the control group (Figure 8A and B). The overexpression of NEAT1 and miRNA-22-3pmimic increased and decreased AKT2, respectively, in both mRNA and protein levels (Figure 8C and D). Similarly, the combination of plV-CMV-NEAT1 and miRNA-22-3pmimic reversed their respective effects on AKT2, displaying similar expression to those of control group. Furthermore, Pearson’s correlation analysis showed that the negative correlation existed between NEAT1 and miRNA-22-3p (Figure 8E), and miRNA-22-3p and AKT2 (Figure 8F) while the positive correlation was found between NEAT1 and AKT2 (Figure 8G).

Figure 8

Involvement of AKT2 in HCC. (A, B). mRNA and protein expression of AKT2 in HCC cells transfected with si-NEAT1, miRNA-22-3p inhibitor, or both. (C, D). mRNA and protein expression of AKT2 in HCC cells transfected with pLV-CMV-NEAT1, miRNA-22-3p mimics or both. (E–G). Pearson’s correlation between NEAT1 and miRNA-22-3p, miRNA-22-3p and AKT2, and AKT2 and NEAT1. Values are means ±SD. (*) denotes the difference between groups (P<0.05).

Roles Of NEAT1in HCC In Vivo

The downregulation of NEAT1 inhibited tumor growth, which was reversed by the combination of si-NEAT1 and miRNA-22-3pinhibitor (Figure 9A–C). Meanwhile, AKT2 protein expression was reduced by si-NEAT1 treatment but was not affected by the combination of si-NEAT1 and miRNA-22-3P inhibitor (Figure 9A–C). On the other hand, overexpression of NEAT2 promoted tumor growth, which was abolished by the combination of plV-CMV-NEAT1 and miRNA-22-3P mimic. Accordingly, overexpression of NEAT1 caused elevated AKT2 protein expression (Figure 9D). while the combination of plV-CMV-NEAT1 and miRNA-22-3P mimic did not impact AKT2 abundance (Figure 9E).

Figure 9

Roles of NEAT2/miRNA-22-3p/AKT2 axis in vivo study. (A) Representative images of isolated tumors. (B) Tumor growth curve. (C) Tumor volume. (D) Protein expression of AKT2 in HCC tissues of xenograft mice model treated with pLV-CMV-NEAT1, and combination of pLV-CMV-NEAT1 and miRNA-22-3p mimics. (E) Protein expression of AKT2 in HCC tissues of xenograft mice model treated with si-NEAT1, and combination of NEAT1 and miRNA-22-3p inhibitor. Values are means ±SD. (*) denotes the difference between groups (P<0.05).

Discussion

In this study, we uncovered NEAT1 interacts with miRNA-22-3p regulate apoptosis and proliferation of HCC cells by targeting AKT2. The regulatory effect of NEAT1 and related mechanisms were demonstrated in vivo using an HCC mice model. Furthermore, NEAT1, miRNR-22-3p, and AKT2 correlated with clinicopathological features and overall survival in patients with HCC, respectively.

NEAT1 is tightly associated with HCC, such as the downregulation of NEAT1 promotes cytolysis activity to suppress cell growth in HCC mice,31 the oncogenic roles of NEAT1 in HCC are associated with its interaction with miRNA-384,12 and NEAT1 decreases the sensitivity for sorafenib, an effective drug for HCC, in HCC cells along with downregulation of miRNA-335.14 These observations together imply the critical functions of NEAT1 in the development of HCC. Consistent with these previous reports, the present study showed an increased level of NEAT1 in both HCC tissues and cell lines. Moreover, knockdown and overexpression of NEAT1 exerted opposite roles in apoptosis, cell proliferation, and invasion in HCC cells. Accordingly, the hypothesis was supported in vivo where the downregulation of NEAT1 could significantly decrease tumor growth in HCC mice. Notably, this is the first study reporting the involvement of NEAT1 in apoptosis in HCC cells, which suggests that NEAT1 may be a regulator hub mediating various cellular activities in HCC cells.

To further investigate the mechanism underlining the regulatory effect of NEAT1 in HCC, the potential microRNA (miRNA) mediating the functions of NEAT1 in HCC was determined. In this study, the expression of miRNA-22-3p was decreased in HCC tissues and negatively correlated with NEAT1 expression. Based on the predictive evidence from online databases, miRNA-22-3p was found to be a presumed miRNA functioning downstream factor of NEAT1, which was subsequently confirmed via a luciferase reporter assay. Moreover, the functional evidence revealed that inhibition and enhancement of miRNA-22-3p played opposite functions in HCC cell activities. Furthermore, Chen et al reported that berberine-induced upregulation of miRNA-22-3p inhibits HCC cell proliferation.22 Collectively, NEAT1 targets miRNA-22-3p32 and miRNA-22-3p to modulate their expressions and may function as an oncogenic regulator in HCC.

In the present study, the results also revealed that AKT2 was increased in HCC tissue and miRNA-22-3p could bind to 3ʹUTR of AKT2. Also, functional studies demonstrated that downregulation of AKT2 significantly inhibited cell proliferation and invasion as well as promoted apoptosis in HCC cells. Furthermore, there was an inverse correlation on expressions between miRNA-22-3p and AKT2. Therefore, the results together indicated that AKT2 is a direct target gene of miRNA-22-3p and that AKT2 participates in NEAT1-associated cell activities in HCC. The serine/threonine kinase AKT functions as a downstream mediator of the phosphatidylinositol 3′ kinase (PI3K) pathway and have been reported to be essential for cell growth and survival.33,34 Overexpression of AKT2 promotes cell invasion and metastasis in ovarian and breast cancer.35 Subsequently, the similar role of AKT2 is found in other cancers, such as colorectal cancer36 and lung cancer.37 Taken together, the onco-effect of AKT2 is modulated, or in part, by NEAT1/miRNA-22-3p axis in the development and progression of HCC.

In addition to evidence from molecular and cellular studies, the present study revealed that the expression of NEAT1 was positively correlated with clinicopathological features in patients with HCC, such as tumor size and differentiation. Increased expression of NEAT1 is associated with enhanced clinical features of HCC, including metastasis, vascular invasion, and the TNM stage.11 In addition, the prognostic significance of NEAT1 in HCC is observed where the upregulation of NEAT1 is tightly associated with liver cirrhosis, the TNM stage, and microvascular invasion.38 Therefore, NEAT1 may act as a favorable prognostic marker for tumorigenesis and invasion of HCC.

In conclusion, NEAT1 modulates apoptosis and cell viability in HCC cells in both in vitro and in vivo through interacting miRNA-22-3p and AKT2, suggesting the promising prognostic value of NEAT1 in patients with HCC. Our finding may provide novel evidence to support applying NEAT1 as a target for the treatment of HCC.