Upregulation of Serine Proteinase Inhibitor Clade B Member 3 (SERPINB3) Expression by Stromal Cell-Derived Factor (SDF-1)/CXCR4/Nuclear Factor kappa B (NF-κB) Promotes Migration and Invasion of Gastric Cancer Cells.

BACKGROUND Serine proteinase inhibitor clade B member 3 (SERPINB3) is a neutral glycoprotein. Its overexpression is related to the promotion of cell proliferation and activation via the nuclear factor kappa B (NF-kappaB) pathway in several tumors. Whether it can participate in stromal cell-derived factor (SDF-1)/NF-kappaB-induced metastasis of gastric cancer has not been reported. MATERIAL AND METHODS We analyzed the ability of SDF-1 to induce migration and invasion in vitro by knocking down the expression of SERPINB3 with siRNAs in gastric cancer cells. We also explored the effects of a CXCR4 antagonist and NF-kappaB inhibitor on SERPINB3 expression. We verified the effect of SERPINB3 on prognosis in gastric cancer specimens by immunohistochemistry. RESULTS In vitro experiments confirmed that SDF-1 upregulated the expression of SERPINB3 and promoted metastasis in gastric cancer cells. This phenomenon was reversed by knockdown of SERPINB3, a chemokine receptor 4 (CXCR4) antagonist, and an NF-kappaB inhibitor, which downregulated the expression of SERPINB3. In patients with gastric cancer, a significant positive correlation was observed between CXCR4 and SERPINB3 expression (r=0.222, P=0.029). Moreover, double positivity for SERPINB3 and CXCR4 was certified to be an independent prognostic factor (HR=3.332, P<0.001). CXCR4-positive patients who also expressed SERPINB3 were inclined to suffer from lymph node metastasis, confirming that SERPINB3 is a downstream molecule of CXCR4. CONCLUSIONS In vitro and pathological results showed that SDF-1/CXCR4 activated the NF-kappaB pathway and upregulated SERPINB3 to facilitate the migration and invasion of gastric cancer cells.

Background

Gastric cancer (GC) is the fourth most common malignant tumor in the world and has an extremely high fatality rate. Despite a decline in its incidence in developed countries, about 8% of all newly diagnosed cancers worldwide are GC, resulting in more than 700,000 deaths per year [1]. The overall survival (OS) of patients with advanced gastric cancer is only 4–13 months, although a variety of therapies, including surgery, chemoradiotherapy, and targeted therapy, have been widely attempted [2]. Metastasis remains the most important prognostic factor in gastric cancer patients [3]. SDF-1 is a key member of the chemokine CXC family, acting with CXCR4 on the surface of cell membranes. It may be related to the occurrence, proliferation, invasion, and metastasis of cancer [4]. The 2 most pivotal downstream pathways of the SDF-1/CXCR4 axis in gastric cancer are mitogen-activated protein kinase (MAPK)/extracellular signal–regulated kinase (ERK) and phosphoinositide-3-kinase (PI3K) signaling [5]. Mammalian target of rapamycin (mTOR) regulates the proliferation, survival, and migration of cancer cells as a key molecule in the PI3K pathway [6]. The interaction between CXCR4 and c-MET signaling partially contributes to the epithelial-mesenchymal transition (EMT) induced by SDF-1 [7]. However, the mechanism by which SDF-1 promotes the invasion and metastasis of gastric cancer is still unclear.

SERPINB3 is a neutral glycoprotein that acts as a serine protein kinase inhibitor. It was first discovered in cervical squamous cell carcinoma. Elevated serum SERPINB3 levels may be associated with disease progression [8], indicating that SERPINB3 can be a prognostic marker [9]. Its prognostic value has also been established in cancers originating in the epithelium or endoderm. High expression of SERPINB3 has been associated with high-grade breast cancer, tumors negative for estrogen and progesterone receptors, and breast cancer patients with poor prognosis [10]. The NF-κB pathway has been associated with SERPINB3 expression [11]. Studies on thyroid cancer have confirmed that the SDF-1/CXCR4 axis can promote the invasion and metastasis of B-CPAP cells by activating the NF-κB pathway [12]. The reciprocal regulation of NF-κB and CXCR4 has also been verified in gastric cancer [13,14]. However, whether SERPINB3 participates in SDF-1/CXCR4/NF-κB-induced gastric cancer cell migration and invasion is not known.

The present study indicated that SDF-1/CXCR4 upregulated SERPINB3 to promote the migration and invasion of gastric cancer cells by activating the NF-κB pathway. Tissue samples from cancer patients also verified that the expression of SERPINB3 and CXCR4 was an independent prognostic factor. Therefore, SERPINB3 may be a prognostic biomarker and potential target of anti-SDF-1/CXCR4 treatment.

Material and Methods

Bioinformatics analysis

Expression data from normal tissue and GC tissue datasets were downloaded from The Cancer Genome Atlas (TCGA) (). Kaplan-Meier Plotter () was used to draw Kaplan-Meier survival curves for patients with different expression levels of SERPINB3.

Cells and cell culture

The human gastric cell lines MGC803 and BGC823 were obtained from the Type Culture Collection of the Chinese Academy of Sciences (Shanghai, China). The cells were cultured in RPMI-1640 medium (Gibco; Thermo Fisher Scientific, Inc., Waltham, MA, USA) containing 10% fetal bovine serum (FBS; Gibco; Thermo Fisher Scientific, Inc., Waltham, MA, USA) and 1% penicillin–streptomycin in a humidified atmosphere of 95% air and 5% CO2 at 37°C.

Reagents and antibodies

Recombinant SDF-1 was purchased from PeproTech (Rocky Hill, NJ, USA). The CXCR4 antagonist AMD3100 (cat. no. A5602) and the NF-κB inhibitor BAY117082 (cat. no. b5556) were obtained from Sigma-Aldrich (Merck KGaA, Darmstadt, Germany). The SERPINB3 antibody (cat. no. Ab55733; dilution: 1: 1000) was obtained from Abcam (Cambridge, UK). P65 (cat. no. 8242; dilution: 1: 1000), p-P65 (cat. no. 3033; dilution: 1: 1000), IκB (cat. no. 4814; dilution: 1: 1000), and p-IκB (cat. no. 2859; dilution: 1: 1000) antibodies were purchased from Cell Signaling Technology, Inc. (Beverly, MA, USA). The GAPDH antibody was obtained from Santa Cruz Biotechnology, Inc. (Dallas, TX, USA).

Small interfering RNA (siRNA) transfection

The MGC803 cells and the BGC823 cells were seeded at a density of 1.5×105 cells/well and 2.0×105 cells/well, respectively, on 6-well plates, and were incubated overnight at 37°C. The cells were transfected with siRNA using Lipofectamine 2000 (Invitrogen, Carlsbad, CA, USA; Thermo Fisher Scientific, Inc., Waltham, MA, USA) according to the manufacturer’s protocol. The siRNA sequences (GenePharma, Inc., Sunnyvale, CA, USA) for SERPINB3 were 5′-CCUGGAAAUACCAUACAAATT-3′ for MGC803 and 5′-CCAGAAGCUUGAAGAGAAATT-3′ for BGC823. The control sequence was: 5′-AAT TCT CCG AAC GTG TCA CGT-3′.

After 72 h of transient transfection at 37°C, the cells were analyzed using western blot analysis to examine the effect of the siRNA.

Western blot analysis

The cells were seeded at a density of 2×105 cells/well on 6-well plates and incubated overnight at 37°C. They were treated with SDF-1 (100 ng/mL) for 15 min, 30 min, 60 min, 120 min, and 24 h. Then, they were lysed in lysis buffer (1% Triton X-100; 50 mM Tris-HCl, pH 7.4; 150 mM NaCl; 10 mM EDTA; 100 mM NaF; 1 mM Na3VO4; 1 mM PMSF; and 2 μg/mL aprotinin) on ice. Western blot analysis was performed as previously described [15].

In vitro migration and invasion assays

The migration and invasion assays were performed using 8-μm Transwell chambers (Corning Life Science, Tewksbury, MA, USA). The cells (1×104 cells/well) were pretreated with BAY117082 (15 μM) and were loaded onto the upper chamber with 200 μL of serum-free RPMI 1640 medium. The lower chambers contained 500 μL of RPMI 1640 with 2.5% FBS, with or without 100 ng/mL SDF-1. The cells in the chambers were incubated for 24 h at 37°C. The cells could migrate through the membrane for the migration assay and through a matrigel-coated membrane for the invasion assay (Corning Life Science, Tewksbury, MA, USA). Nonmigrated cells were removed from the upper surface of the chamber with a wet cotton swab, and the cells on the lower surface of the chamber were stained using the Wright-Giemsa method as described previously [16]. At least 4 randomly selected fields were counted, and the average number from these 4 counts is presented.

Quantitative real-time polymerase chain reaction

Total RNA was extracted with TRIzol (Invitrogen, Carlsbad, CA, USA) reagent. For mRNA detection, reverse transcription was performed using the PrimeScript real-time reagent kit with a gDNA Eraser (TaKaRa, Shiga, Japan). The cDNA was generated from 1000 ng total RNA using SYBR Premix Ex Taq II (Tli RNaseH Plus, TaKaRa, Shiga, Japan). Quantitative real-time polymerase chain reaction (qRT-PCR) was run on Applied Biosystems 7500 Real-Time PCR Systems (Thermo Fisher Scientific, Waltham, MA, USA). The PCR conditions were 30 s at 95°C, followed by 45 cycles of 95°C for 5 s followed by 58°C for 34 s. Data were analyzed using the Applied Biosystems 7500 software program (Version 2.3) with the automatic Ct setting for adapting baseline and threshold for Ct determination. The threshold cycle and 2−ΔΔCt method were used for calculating the relative amount of target RNA. Transcripts of 18 S in the same incubations were used as internal controls. The primer sequences for SERPINB3 were as follows:

forward (5′-TGCAGGCCAAGATGGTGGAA-3′) and

reverse (5′-TCCACGCTAGCAACGTGTCA-3′);

18S: forward (5′-CCCGGGGAGGTAGTGACGAAAAAT-3′) and

reverse (5′-CGCCCGCCCGCTCCCAAGAT-3′).

Immunofluorescence microscopy

MGC803 cells were fixed in 3.3% paraformaldehyde and then blocked using 5% bovine serum albumin. Staining was performed using an anti-human NF-κB monoclonal antibody (cat. no. 8242; dilution: 1: 200) to detect the position of NF-κB. The slides were overlaid with DAPI before the images were captured using confocal fluorescence microscopy (FV1000SSIM/IX81, Olympus, Tokyo, Japan).

Patients and tissue samples

From 2007 to 2011, 96 patients who underwent curative gastrectomy for adenocarcinoma at the First Hospital of China Medical University were recruited into this study. The Tumor, Node, Metastases (TNM) stage was examined according to the American Joint Committee on Cancer staging system (seventh edition). Lauren grading was performed according to World Health Organization classification. None of these patients had undergone chemotherapy or radiotherapy before surgery.

Immunohistochemistry

Immunohistochemical staining was performed as previously described [17]. Positive immunohistochemical expression was defined as the product of positive cells in the field (accounting for the percentage of tumor cells) and positive cell-staining intensity [18].

Statistical analysis

SPSS 18.0 (IBM, Armonk, NY, USA) computer software was used for statistical analysis. All data were obtained by 3 independent experiments. The differences between groups were compared using t test. A P value less than 0.05 was considered statistically significant.

The research was finished in the Department of Medical Oncology, Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, Liaoning Province Clinical Research Center for Cancer, the First Hospital of China Medical University, Shenyang 110001, China.

Results

SDF-1 promotes the migration and invasion of gastric cancer cells by upregulating SERPINB3 expression

SDF-1 treatment (100 ng/mL) was previously shown to induce CXCR4 and c-MET expression, cooperatively, to promote epithelial-mesenchymal transition in gastric cancer cells [7] and migration via SRC-mediated CXCR4-EGFR cross-talk [19]. After 100 ng/mL SDF-1 treatment, the migration and invasion of gastric cancer cells was significantly enhanced compared with the control group (Figure 1A, 1B). The expression microarray result for MGC803 found that SERPINB3 mRNA expression in the SDF-1 group was 1.73 times that of the control group (Figure 2A, Supplementary Table 1). SERPINB3 was expressed in a variety of gastric cancer cell lines (Figure 2B). After treatment with SDF-1, SERPINB3 protein (Figure 2C) and mRNA (Figure 2D) levels increased significantly. TCGA data suggested that the mRNA level of SERPINB3 was higher in tumor tissues than in normal tissues of the stomach (Figure 2E). KMplot database () 209719 dataset results suggested that the OS of patients with gastric cancer was shortened in the SERPINB3 high-expression group (P=0.0018) (Figure 2F). This is in accordance with expectations based on our findings that the knockdown of SERPINB3 (Figure 3A) substantially decreased SDF-1-induced migration and invasion of gastric cancer cells in vitro (Figure 3B, 3C).

Figure 1

SDF-1 induced migration and invasion of gastric cancer cells. (A) MGC803 and (B) BGC823 cells were treated with SDF-1 (100 ng/mL); the cell migration and invasion were assessed using a Transwell assay (magnification, ×200). The cells were stained using the Wright-Giemsa method. Data are presented as the mean±standard deviation of the results from 3 independent experiments. * P<0.05.

Figure 2

SDF-1 upregulated SERPINB3 protein expression in gastric cancer cells. (A) Expression microarray results showed that mRNA levels of SERPINB3 were elevated in MGC803 cells. (B) CXCR4 and SERPINB3 were expressed in a variety of gastric cancer cell lines. (C) MGC803 and BGC823 cells were treated with SDF-1 (100 ng/mL), and SERPINB3 protein expression increased, as detected by western blot analysis. (D) RT-PCR showed that the mRNA level also increased after treatment with SDF-1. (E) Increased mRNA level was also verified in the TCGA database. (F) KMplot database () 209 719 dataset results suggested that elevated SERPINB3 expression (probe expression greater than 107) in patients with gastric cancer indicated short overall survival and poor prognosis (P=0.0018).

Figure 3

Effects of SERPINB3 expression on gastric cancer cells in vitro. (A) Knockdown effect of SERPINB3. (B, C) MGC803 (B) and BGC823 (C) cells with SERPINB3 knockdown were cultured in the upper chamber with serum-free medium for 24 h and subjected to migration and invasion, respectively, using Transwell assays.

Antagonism of CXCR4 and inhibition of the NF-κB pathway reduced SERPINB3 protein expression and inhibited cell migration and invasion

To explore the upstream pathway of SERPINB3, the PROMO database () was used to predict the transcription factor, and NF-κB (P65) was predicted. P65 and NF-κB inhibitor protein (IκB) were phosphorylated (Figure 4A) and P65 nuclear translocation was increased in SDF-1-treated gastric cancer cells (Figure 4B, 4C). When SDF-1 was added after pretreatment of gastric cancer cells with the NF-κB pathway inhibitor BAY117082, phosphorylation of P65 and IκB was inhibited (Figure 4D). SERPINB3 protein expression was also inhibited (Figure 4E). With the inhibition of SERPINB3, the migration and invasion abilities induced by SDF-1 were depressed (Figure 4F). Moreover, the CXCR4 antagonist AMD3100 had been previously shown to significantly reduce SDF-1-induced cell migration in gastric cancer cells [19], at a concentration of 10 μg/mL. In the present study, we found that, at the same concentration, AMD3100 was able to inhibit the NF-κB pathway (Figure 5A) as well as nuclear translocation (Figure 5B), and was also able to downregulate SERPINB3 expression (Figure 5C). As a result, the migration and invasion of gastric cancer cells were suppressed (Figure 5D).

Figure 4

NF-κB was involved in SDF-1-induced elevated SERPINB3 expression during gastric cancer cell migration and invasion. (A) Serum-starved MGC803 and BGC823 cells were treated with SDF-1 (100 ng/mL) for 15 min, 30 min, 1 h, or 2 h, and the total protein levels of P65, p-P65, IκB, and p-IκB were detected using western blot analysis. (B, C) P65 was transported to the nuclei of MGC803 cells after SDF-1 (100 ng/ml) treatment by the method of nuclear pulp separation and immunofluorescence. (D) With or without 6-hours Bay117082 (15 μM) pretreatment, the activation of the NF-κB pathway (E) and the increased SERPINB3 level were evaluated by western blot analysis. (F) Migration and invasion abilities were assessed using a Transwell assay with or without the inhibition of NF-κB. Data are presented as the mean±standard deviation of the results from 3 independent experiments. * P<0.05.

Figure 5

CXCR4 was involved in SDF-1-induced activation of NF-κB and elevated SERPINB3 levels, which resulted in the migration and invasion of gastric cancer cells. (A) Serum-starved MGC803 and BGC823 cells were treated with SDF-1 (100 ng/mL) with or without pretreatment with AMD3100 (10 μg/mL) and activation of the NF-κB pathway. (B) Nuclear translocation of P65 was also inhibited by AMD3100 in MGC803 cells. (C) With or without 2 hours of AMD3100 pretreatment, the increased SERPINB3 level was evaluated by western blot analysis. (D) Migration and invasion abilities were assessed using a Transwell assay with or without the inhibition of AMD3100. Data are presented as the mean±standard deviation of the results from 3 independent experiments. * P<0.05.

Expression of CXCR4 and SERPINB3 in tissue specimens from patients with gastric cancer and its influence on prognosis

Regarding the expression of SDF-1 in gastric cancer tissues, Wang [20] demonstrated the expression of SDF-1 in both peritumor and intratumor tissues. In addition, Zheng [21] reported that expression of SDF-1 in gastric adenocarcinoma tissue was remarkably higher than that in the nonneoplastic adjacent gastric tissue, and the level of expression was correlated with metastasis to lymph nodes. Therefore, we did not test for expression of SDF-1 in our study. Instead, we next examined CXCR4 and SERPINB3 levels in 96 histologically confirmed resected gastric cancer tissue samples embedded in paraffin (Figure 6A). The positivity rate for CXCR4 and SERPINB3 in the 96 patients with gastric cancer was 66/96 (68.7%) and 51/96 (53.2%), respectively. Lymph node metastasis significantly increased in patients with positive CXCR4 and SERPINB3 expression (P=0.003 and P=0.001, respectively) (Table 1). The expression of CXCR4 was significantly and positively correlated with the expression of SERPINB3 (r=0.222, P=0.029) (Table 2). The univariate analysis showed that the positive expression of SERPINB3 was associated with shortened OS (HR=3.539, 95% CI 1.876–6.675) (P<0.001) (Figure 6B). CXCR4 positivity was also a poor prognostic factor for OS (HR=2.171, 95% CI 1.051–4.483, P=0.036) (Figure 6C). The multivariate analysis showed that CXCR4/SERPINB3 double positivity (HR=3.332, 95% CI 1.787–6.212, P<0.001) was a negative independent prognostic factor for patients (Figure 6D) (Table 3). Among the CXCR4-positive patients, the prognosis for SERPINB3-positive patients was significantly worse (P<0.001) (Figure 6E). However, no difference in prognosis was observed for CXCR4-negative patients (P=0.102) (Figure 6F). That is to say, patients with positive SERPINB3 expression were more likely to have lymph node metastasis (P=0.041) (Table 4) in CXCR4-positive patients, but not in CXCR4-negative patients (Table 5). The above pathological and in vitro results indicated that SERPINB3 was an important downstream molecule in SDF-1/CXCR4-induced metastasis in GC patients (Figure 7).

Figure 6

Representative images for CXCR4 and SERPINB3 immunohistochemical staining in gastric cancer tissues along with overall survival. (A) H&E staining of GC tissue, with negative control and positive expression shown by immunohistochemistry (×200). CXCR4-positive staining was observed in the cell membrane and cytoplasm (in brown). SERPINB3-positive staining was observed in cell nuclei and cytoplasm (in brown). (B) Overall survival (OS) of SERPINB3-positive or SERPINB3-negative patients with gastric cancer was estimated by the Kaplan-Meier method and log-rank test (n=96, P<0.05). (C) OS of CXCR4-positive or CXCR4-negative patients with gastric cancer was estimated by the Kaplan-Meier method and log-rank test (n=96, P=0.036). (D) OS of CXCR4-positive and SERPINB3-positive patients with gastric cancer was estimated by the Kaplan-Meier method and log-rank test (n=96, P<0.05). (E) Among the CXCR4-positive patients, the OS of SERPINB3-positive patients was estimated by the Kaplan-Meier method and log-rank test (P<0.001). (F) Among the CXCR4-negative patients, the OS of SERPINB3-positive patients was estimated by the Kaplan-Meier method and log-rank test (P=0.102).

Table 1

Correlation between CXCR4/SERPINB3 levels and clinicopathological factors in patients with primary GC.

Factors	Cases	CXCR4				SERPINB3
		Neg (%)	Pos (%)	χ2	P value	Neg (%)	Pos (%)	χ2	P value
Sex
Male	73	24 (25.0)	49 (51.0)			33 (34.4)	40 (41.7)
Female	23	6 (6.3)	17 (17.7)	0.375	0.54	12 (12.5)	11 (11.5)	0.341	0.559
Age
<60	46	15 (15.6)	31 (32.3)			23 (24.0)	23 (24.0)
≥60	50	15 (15.6)	35 (36.5)	0.076	0.783	22 (22.9)	28 (29.2)	0.346	0.556
T stage
T1+T2+T3	28	11 (11.5)	17 (17.7)			14 (14.6)	14 (14.6)
T4	68	19 (19.8)	49 (51.0)	1.188	0.276	31 (32.3)	37 (38.5)	0.155	0.694
LN metastasis
N0	23	13 (13.5)	10 (10.4)			18 (18.8)	5 (5.2)
N1–N3	73	17 (17.7)	56 (58.3)	8.991	0.003*	27 (28.1)	46 (47.9)	11.965	0.001*
Lauren classification
Intestinal	43	12 (12.5)	31 (32.3)			19 (19.8)	24 (25.0)
Others	53	18 (18.8)	35 (36.5)	0.405	0.524	26 (27.1)	27 (28.1)	0.226	0.634

LN – lymph node.

P<0.05.

Table 2

Correlations between CXCR4 expression and SERPINB3 levels in patients with primary gastric cancer.

CXCR4	Cases (%)	SERPINB3
		Neg (%)	Pos (%)	R value	P value
Neg (%)	30 (31.3)	19 (19.8)	11 (11.5)	0.222	0.029*
Pos (%)	66 (68.8)	26 (11.5)	40 (41.7)
Cases (%)	96 (100.0)	45 (46.9)	51 (53.1)

Table 3

Univariate and multivariate analysis of OS in GC patients with different characteristics.

Variable	Univariate			Multivariate
	HR	95% CI	P value	HR	95% CI	P value
Age (<60 vs. ≥60)	1.247	0.705–2.206	0.448
Gender (Male vs. Female)	0.781	0.389–1.568	0.487
Lauren classification (others vs. intestinal)	2.145	1.164–3.953	0.014*	2.743	1.454–5.176	0.002*
LN (positive vs. negative)	4.704	1.686–13.128	0.003*	2.933	1.027–8.382	0.045*
T Stage (T4 vs. T1/T2/T3)	1.893	0.941–3.810	0.074
CXCR4 (positive vs. negative)	2.171	1.051–4.483	0.036*
CXCR4 and SERPINB3 (positive vs. other)	3.259	1.812–5.860	0.000*	3.332	1.787–6.212	0.000*
SERPINB3 (positive vs. negative)	3.539	1.876–6.675	0.000*

OS – overall survival; GC – gastric cancer; LN – lymph node metastasis.

P<0.05.

Table 4

Correlation between SERPINB3 levels and clinicopathological factors in CXCR- positive patients with GC.

Factors	Cases	SERPINB3
		Neg (%)	Pos (%)	χ2	P value
Sex
Male	49	20 (30.3)	29 (43.9)
Female	17	6 (9.1)	11 (16.7)	0.161	0.688
Age
<60	31	13 (19.7)	18 (27.3)
≥60	35	13 (19.7)	22 (33.3)	0.158	0.691
T stage
T1+T2+T3	17	6 (9.1)	11 (16.7)
T4	49	20 (30.3)	29 (43.9)	0.161	0.688
LN metastasis
N0	10	7 (10.6)	3 (4.5)
N1–3	56	19 (28.8)	37 (56.1)	4.624	0.041*
Lauren classification
Intestinal	31	10 (15.2)	21 (31.8)
Others	35	16 (14.2)	19 (28.8)	1.247	0.264

GC – gastric cancer; LN – lymph node.

P<0.05.

Table 5

Correlation between SERPINB3 levels and clinicopathological factors in CXCR4 negative patients with GC.

Factors	Cases	SERPINB3
		Neg (%)	Pos (%)	χ2	P value
Sex
Male	24	13 (43.3)	11 (36.7)
Female	6	6 (20)	0 (0)	4.342	0.061
Age
<60	15	10 (33.3)	5 (16.7)
≥60	15	9 (30)	6 (20)	0.144	0.705
T stage
T1+T2+T3	11	8 (26.7)	3 (10)
T4	19	11 (36.7)	8 (26.7)	0.660	0.466
LN metastasis
N0	13	11 (36.7)	2 (6.7)
N1–3	17	8 (26.7)	9 (30.0)	4.474	0.057
Lauren classification
Intestinal	12	9 (30)	3 (10)
Others	18	10 (33.3)	8 (26.7)	1.172	0.442

GC – gastric cancer; LN – lymph node.

Figure 7

Working model for SDF-1/CXCR4-induced migration and invasion in gastric cancer cells. SDF-1/CXCR4 induced the activation of the NF-κB pathway, which led to upregulated expression of SERPINB3, which resulted in tumor metastasis.

Discussion

SERPINB3 is a neutral glycoprotein belonging to the superfamily of serine protein kinase inhibitors. It is highly expressed in squamous cell carcinoma; for instance, esophageal cancer [22] and cervical cancer [23], and can both promote cell proliferation and inhibit apoptosis. However, in a previous study of lung squamous cell carcinoma, high expression of SERPINB3 meant a good prognosis, yielding a conflicting result with those of our present study [24]. Recent evidence has shown that SERPINB3 is also expressed in adenocarcinoma, and that this expression predicted poor prognosis in hepatocellular carcinoma [25] and colorectal cancer [26]. In epithelial cells of the breast and pancreas, RAS (rat sarcoma; including KrasG12D, HrasG12V, and NrasQ61R) and BRAF (V-raf murine sarcoma viral oncogene homolog B1) V600E mutations can induce SERPINB3 expression [27]. The increased SERPINB3 expression originated from the binding of its promoter with the ETS (E-26) family transcription factor PEA3 (polyomavirus enhancer activator3). However, PEA3 was activated by the MAPK/ERK pathway via ubiquitination driven by RAS mutation [28,29]. RAS is part of the classical downstream pathway of SDF-1 [30,31]. The aforementioned studies may explain another mechanism by which SDF-1 increased SERPINB3 protein expression in gastric cancer cells. Some studies have shown that ectopic expression of SERPINB3 can lead to epithelial stroma transformation. This was confirmed by morphological and molecular changes in the hepatocellular carcinoma cell line HepG2 and the epithelial cell line MCF10A breast and infant mouse kidney (BMK) cell lines [11,32,33], which resulted in an increase in cell migration ability. In the present study, upregulation of SERPINB3 by SDF-1 promoted migration and invasion in gastric cancer cells. This might provide new ideas for blocking invasion and metastasis of gastric cancer caused by SDF-1.

SERPINB3 localizes in lysosomes and inhibits lysosomal protease and lysosomal damage [32]. Furthermore, SERPINB3 may cause a chronic unfolded protein response (UPR) status by inhibiting lysosomal proteases [11]. Because of upregulated UPR, SERPINB3 activates the NF-κB pathway, which induces IL-6 expression and finally leads to EMT-like phenotypic changes and tumorigenicity in mammary epithelial MCF10A cells. This indicates that SERPINB3 activates the NF-κB pathway as an upstream factor, which contradicts the results of our study. In the present study, NF-κB acted as an upstream molecule to regulate the SERPINB3 protein. This might present a new proposed mode of action: the SDF-1 axis might regulate the SERPINB3 protein by activating the NF-κB pathway to promote the invasion and metastasis of gastric cancer cells. SERPINB3 may become an important target for blocking the invasion and metastasis of malignant tumors in the SDF-1 signaling axis.

NF-κB has been increasingly recognized as a key participant in many steps of tumorigenesis and development. In breast cancer, SDF-1 can promote breast cancer invasion and metastasis by activating the NF-κB pathway [34,35]. In thyroid cancer, studies have confirmed that the SDF-1/CXCR4 axis can promote the invasion and metastasis of B-CPAP cells by activating the NF-κB pathway [12]. In pancreatic cancer, studies have also confirmed that NF-κB is in the downstream signaling pathway of the SDF-1/CXCR4 axis [36], but in gastric cancer, studies have only confirmed the interaction between NF-κB and CXCR4 [13,37,38]. Since CXCR4 is the classic receptor of SDF-1, we have reason to speculate that SDF-1 can activate the NF-κB pathway through CXCR4 in gastric cancer, and this deduction has also been supported by our research.

The present study found that SERPINB3 acted as a major effector molecule downstream of SDF-1/CXCR4 to promote the invasion and metastasis of gastric cancer cells. Therefore, we further investigated the relationship between clinicopathological parameters and SERPINB3 expression in human tumor tissues. Patients with positive SERPINB3 expression were found to be inclined to lymph node metastasis and with shorter survival. Turato found that patients with high mRNA expression of SERPINB3 in hepatocellular carcinoma had a worse prognosis than those with low expression, and were more likely to relapse [39]. In colorectal cancer, SERPINB3 is associated with a higher likelihood of lymph node metastasis and vascular invasion [26]. Moreover, elevated SERPINB3 expression is an independent prognostic factor in breast cancer [40]. In addition, SERPINB3 level is related to poor prognosis in cervical and esophageal carcinoma, and is associated with tumor invasion and lymph node metastasis [22,23,41]. The multivariate analysis showed that SERPINB3 and CXCR4 double positivity was an independent factor for poor prognosis. One reason for this trend was that patients who were either SERPINB3- or CXCR4-positive tended to suffer from lymph node metastasis. Moreover, the study analyzed the effect of SERPINB3 on patients with different CXCR4 status. The analysis showed that SERPINB3 could affect the prognosis in CXCR4-positive patients, while this trend was absent in CXCR4-negative patients. These results confirmed the speculation that SERPINB3 is downstream of CXCR4 and might be used as a biomarker for the prognosis of the CXCR4-positive population.

Conclusions

The present study indicated that SERPINB3 mediated the migration and invasion of gastric cancer induced by the SDF-1/CXCR4/NF-κB pathway. SERPINB3 and CXCR4 double positivity was an independent factor for poor prognosis due to the promotion of lymph node metastasis. The study elucidated a new mechanism for gastric cancer metastasis. The findings might aid in the search for new therapeutic targets for gastric cancer.