Knockdown of S100A4 impairs arecoline-induced invasiveness of oral squamous cell carcinomas

Oral Oncology 51 (2015) 690–697

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Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology

Knockdown of S100A4 impairs arecoline-induced invasiveness of oral squamous cell carcinomas Fang-Wei Hu a,b, Shiuan-Shinn Lee d,1, Li-Chiu Yang a,b,1, Chung-Hung Tsai e,f, Tong-Hong Wang g, Ming-Yung Chou a,b,c,⇑, Cheng-Chia Yu a,b,c,⇑ a

School of Dentistry, Chung Shan Medical University, Taichung, Taiwan Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan d School of Public Health, Chung Shan Medical University, Taichung, Taiwan e Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan f Department of Pathology, Chung Shan Medical University Hospital, Taichung, Taiwan g Tissue Bank, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan b c

a r t i c l e

i n f o

Article history: Received 16 October 2014 Received in revised form 2 February 2015 Accepted 4 April 2015 Available online 23 April 2015 Keywords: S100A4 Oncogenecity Invasiveness Arecoline Oral squamous cell carcinomas

s u m m a r y Objectives: Metastasis is the most common cause of oral squamous cell carcinoma (OSCC)-related death. The physiological function of S100A4 in the pathogenesis of areca quid chewing-associated OSCC has not been uncovered. Method: OSCC tissues from areca quid chewers were analyzed by immunohistochemistry for S100A4 expression. The functions of S100A4 in invasiveness of arecoline-treated oral epithelial (OE) cells were determined by loss function approaches. Results: Expression of S100A4 was positively correlated with clinical grading and lymph node metastasis of OSCC. Upregulated S100A4 is correlated with poor survival outcome of OSCC patients. Arecoline led to dose-dependent elevation of S100A4 expression in oral epithelial (OE) cells. Down-regulation of S100A4 significantly reversed arecoline-induced oncogenecity in OE cells. The additions of pharmacological agents LY294002, SP600125, and CAY10585 were found to inhibit arecoline-induced S100A4 expression in OE cells. Conclusion: Arecoline-induced S100A4 expression was down-regulated by LY294002, SP600125, or CAY10585 treatment. Targeting S100A4 might offer a new strategy for the treatment of OSCC patients with metastasis. Ó 2015 Elsevier Ltd. All rights reserved.

Introduction Oral squamous cell carcinoma (OSCC) remains one of the leading causes of cancer-related mortality worldwide despite the recent advancements in the multidisciplinary treatment [1]. Mounting epidemiological analysis has demonstrated that areca quid chewing is the main etiological factor for the development of OSCC [2,3]. However, the underlying mechanisms by which areca quid-mediated OSCC tumorigenesis have not been completely identified. S100A4 calcium-binding protein is involved in a variety of biological functions including cell motility, survival, differentiation ⇑ Corresponding authors at: School of Dentistry, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., Taichung 40201, Taiwan. Tel.: +886 4 24718668; fax: +886 4 24759065. E-mail addresses: [email protected] (M.-Y. Chou), [email protected] (C.-C. Yu). 1 Equal contribution. http://dx.doi.org/10.1016/j.oraloncology.2015.04.003 1368-8375/Ó 2015 Elsevier Ltd. All rights reserved.

and cytoskeletal organization [4]. S100A4 is also established as a regulator of cancer metastasis [5,6]. Lacking S100A4 gene suppresses the tumor development and metastasis in mice [7]. Ectopic overexpression of S100A4 enhanced metastatic phenotype [8,9]. Inhibition of S100A4 expression reduces the metastatic capacity of tumor cells [10,11]. Recent reports also suggest that expression of S100A4 in tumor tissues could serve as a prognostic indicator for tumor re-growth, malignant progression, and patient survival [12,13]. Nevertheless, the role of S100A4 in regulating tumorigenic properties in areca quid-associated OSCC is still unclear. The purpose of this study was to test whether S100A4 expression in OSCC and to further explore possible pathogenic mechanisms that may lead to enhanced expression of this molecule. Moreover, we set out to explore whether expression of S100A4 could be triggered in oral epithelial cells (SG and OECM1) by arecoline in vitro. We also demonstrated the significance of S100A4-mediated signaling on oncogenicity of arecoline-stimulated OE cells with S100A4

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knockdown in vitro. Ultimately, pharmacological inhibitors were added to search the possible signal transduction pathways of arecoline-induced S100A4 expression. Materials and methods OSCC sample collection and immunohistochemistry Formalin-fixed, paraffin-embedded specimens of OSCC specimens from areca quid chewers were drawn from the files of the Department of Pathology, Chung Shan Medical University Hospital. Patients with operable OSCC, without histories of radiation or chemotherapy, underwent surgery at the Chung Shan Medical University Hospital. Diagnosis was based on histological examination of hematoxylinand eosin-stained sections. Institutional Review Board permission at the Chung Shan Medical University Hospital was obtained for the use of discarded human tissues (CSMUH No: CSI0249). After deparaffinization and rehydration, the 5-lm tissue sections were processed with antigen retrieval by 1X Trilogy diluted in H2O and heat. The slides were immersed in 3% H2O2 for 10 min and washed with PBS 3 times. The tissue sections were then blocked with serum (Vestastain Elite ABC kit, Vector Laboratories, Burlingame, CA) for 30 min, and followed by incubating with the primary antibody and antiS100A4 (code no. A5114; Dako, Glostrup, Denmark) in phosphate buffer saline (PBS) solution at room temperature for 2 h in a container. Tissue slides were washed with PBS and incubated with biotin-labeled secondary antibody for 30 min and then incubated with streptavidin-horse radish peroxidase conjugates for 30 min and washed with PBS 3 times. Afterwards, the tissue sections were immersed with chromogen 3-30 -diaminobenzidine plus H2O2 substrate solution (VectorÒ DBA/Ni substrate kit, SK-4100, Vector Laboratories, Burlingame, CA) for 10 min. Hematoxylin was applied for counter-staining (Sigma Chemical Co., USA). Finally, the tumor sections were mounted with a cover slide with GurrÒ (BDH Laboratory Supplies, UK) and examined under a microscope. Pathologists scoring the immunohistochemistry were blinded to the clinical data. The interpretation was done in five high-power views for each slide, and 100 cells per view were counted for analysis (, 0–10% positive cells; +, more than 10% positive cells). Oral epithelial cell lines cultivation Normal human gingival epithelial cells Smulow–Glickman (SG) were cultured in Dulbecco’s modified Eagle’s medium (DMEM) supplemented with 10% fetal bovine serum (FBS) and 2 mM glutamine. OECM1 was cultured in RPMI medium with 10% FBS [14]. Quantitative real-time reverse-transcriptase (RT)-PCR Total RNA was prepared from cells or tissues using Trizol reagent according to the manufacturer’s protocol (Invitrogen). qRT–PCRs of mRNAs were reverse-transcribed using the Superscript III first-strand synthesis system for RT–PCR (Invitrogen). qRT–PCR reactions on resulting cDNAs were performed on an ABI StepOne™ Real-Time PCR Systems (Applied Biosystems).

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targets human S100A4 (oligonucleotide sequence: Sh-S100A41:50 -AAAAGGTGTCCACCTTCCACAAGTATTGGATCCAATACTTGTGG AAGGTGGACACC-30 ; Sh-S100A4-2:50 -AAAAGAAGCTGATGAGCAA CTTGGATTGGATCCAATCCAAGTTGCTCATCAGCTTC-30 ) were synthesized and cloned into pLVRNAi to generate a lentiviral expression vector. Lentivirus production was performed by transfection of plasmid DNA mixture with lentivector plus helper plasmids (VSVG and Gag-Pol) into 293T cells using Lipofectamine 2000 (Invitrogen, Calsbad, CA, USA). Supernatants were collected 48 h after transfection and then were filtered; the viral titers were then determined by FACS at 48 h post-transduction. Subconfluent cells were infected with lentivirus in the presence of 8 lg/ml polybrene (Sigma-Aldrich, St. Louis, Missouri, USA). The red fluorescence protein (RFP), which was co-expressed in lentiviral-infected cells, was served as a selection marker to indicate the successfully infected cells [15]. Stable overexpression of S100A4 The cDNA fragments encoding full-length S100A4 was amplified by RT–PCR, and purified then cloned into the pLV-EF1aMCS-IRES-GFP vector from Biosettia Inc. (Biosettia, San Diego, CA). Lentivirus production was performed as described previously [15]. Effect of arecoline on S100A4 expression in OE cells by Western blot Cells arrested in G0 by serum deprivation (0.5% FCS; 48 h) were used in the experiments. Nearly confluent monolayers of OE cells were washed with serum-free Dulbecco’s modified Eagle’s medium and immediately thereafter exposed to various concentrations (0, 5, 15, and 20 lg/mL) of arecoline after 24 h incubation period. Cells were solubilized with sodium dodecyl sulfate-solubilization buffer (5 mM EDTA, 1 mM MgCl2, 50 mM Tris–HCl, pH 7.5% and 0.5% Trition X-100, 2 mM phenylmethylsulfonyl fluoride, and 1 mM N-ethylmaleimide) for 30 min on ice. Then, cell lysates were centrifuged at 12,000g at 4 °C and the protein concentrations determined with Bradford reagent using bovine serum albumin as standards. Equivalent amounts of total protein per sample of cell extracts were run on a 10% sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immediately transferred to nitrocellulose membranes. The membranes were blocked with phosphate-buffered saline containing 3% bovine serum albumin for 2 h, rinsed, and then incubated with primary antibodies anti-S100A4 (1:500) in phosphate-buffered saline containing 0.05% Tween 20 for 2 h. After three washes with Tween 20 for 10 min, the membranes were incubated for 1 h with biotinylated secondary antibody diluted 1:1000 in the same buffer, washed again as described above and treated with 1:1000 streptavidin-peroxidase solution for 30 min. After a series of washing steps, protein expression was detected by chemiluminescence using an ECL detection kit (Amersham Biosciences UK Limited, England), and relative photographic density was quantitated by scanning the photographic negatives on a gel documentation and analysis system (AlphaImager 2000, Alpha Innotech Corp., San Leandro, CA, USA). Each densitometric value was expressed as the mean ± standard deviation (SD). In vitro cell migration and invasion Assay

S100A4 knockdown in arecoline-treated oral epithelail cells by lentiviral-mediated shRNAi The pLV-RNAi vector was purchased from Biosettia Inc. (Biosettia, San Diego, CA, USA). The method of cloning the doublestranded shRNA sequence is described in the manufacturer’s protocol. Lentiviral vectors expressing short hairpin RNA (shRNA) that

For transwell migration assays, 2  105 cells were plated into the top chamber of a transwell (Corning, Acton, MA) with a porous membrane (8.0 lm pore size). Cells were plated in medium with lower serum (0.5% FBS), and medium supplemented with higher serum (10% FBS) was used as a chemoattractant in the lower chamber. The cells were incubated for 24 h at 37 °C and cells that did not

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Fig. 1. Expression patterns of S100A4 in OSCC specimens. (A) A panel of OSCC patient samples from non-tumor and poorly differentiated tumor specimens was collected and immunohistochemically stained with anti-S100A4 antibody. (B) An overall survival correlation analysis was performed for OSCC patient samples expressing different levels of S100A4.

Table 1 Correlation with S100A4 expression and clinicopathological features. Statistic analysis using fisher’s exact test. p < 0.05 was considered statistically significant. High expression

Low expression

p-Value

Age >54 654

Multivariate analysis by Cox proportional hazards model of overall survival all patients (N = 68)

8 20

22 18

0.08

Parameters (risk factor)

HR (hazard ratio)

95% CI (confidence interval)

P value

Sex Female Male

8 20

8 32

0.562

1.562 2.572

0.823–3.129 1.583–4.061

0.125 0.023*

T category T1+2 T3+4

14 14

26 14

0.316

T category (T1+2 vs. T3+4) N category (negative vs. positive) Stage (I–II vs. III–IV) Differentiation (well vs. moderate or poor) S100A4 expression (negative vs. positive)

1.498 1.631

1.012–3.143 0.623–3.343

0.242 0.292

2.969

1.806–6.405

0.01⁄⁄

N category N0 N1-2

12 16

32 8

0.002

Stage I–II III–IV

10 18

22 18

0.143

Differentiation Well Moderate or poor ⁄

Table 2 Multivariate Cox regression analyses of S100A4 expression for overall survival of OSCC patients.

4 14

30 10

⁄⁄ *

⁄⁄⁄

0.0003

p < 0.05.

migrate through the pores were removed by a cotton swab. Cells on the lower surface of the membrane were stained with crystal violet (Sigma–Aldrich). The number of migration cells in a total of five randomly selected fields was counted. In vitro cell invasion analysis was described previously [16]. Colony-forming assay A total of 500 cells were seeded onto 6-well plates and allowed to grow for 7 days in a culture medium containing 10% FBS. The number of colonies in plates was scored by staining the cells with 0.5% crystal violet for 15 min.

p < 0.05.

top agar-medium mixture (DMEM, 10% (v/v) FCS, 0.3% (w/v) agar) containing 2  104 cells was added, and the dishes were incubated at 37 °C for 4 weeks. Plates were stained with 0.005% Crystal Violet then the colonies were counted. The number of total colonies with a diameter P100 lm was counted over five fields per well for a total of 15 fields in triplicate experiments [17]. Statistical analysis Statistical Package of Social Sciences software (version 13.0) (SPSS, Inc., Chicago, IL) was used for statistical analysis. Student’s t test was used to determine statistical significance of the differences between experimental groups; p values less than 0.05 were considered statistically significant. The level of statistical significance was set at 0.05 for all tests. Results

Anchorage-independent growth

S100A4 significantly up-regulated in OSCC specimens

Each well (35 mm) of a six-well culture dish was coated with 2 ml bottom agar (Sigma–Aldrich) mixture (DMEM, 10% (v/v) FCS, 0.6% (w/v) agar). After the bottom layer was solidified, 2 ml

To investigate whether S100A4 plays a role in tumorigenic properties of oral cancer cells, the approach of loss-of-function of S100A4 was first conducted. Immunoblotting analyses confirmed

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that lentivirus expressing both sh-S100A4-1 and sh-S100A4-2 markedly reduced the expression level of S100A4 protein in transduced OECM1 cells (Suppl. Fig. 1A). Cell proliferation (Suppl. Fig. 1B) and migration/invasion (Suppl. Fig. 1C) properties in OECM1 cells with S100A4 knockdown were also decreased in shS100A4 infected OECM1 cells. In opposite, overexpression of

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S100A4 enhanced the migration and invasion (Suppl. Fig. 1D) properties. To further thoroughly investigate the expression profile of S100A4 during the development of OSCC patients we established the ontogeny of S100A4 expression by tissue immunohistochemical staining with a panel of specimens array of 68 OSCC patients. S100A4 knockdown and overexpressing cell pellets were utilized

Fig. 2. Expression of S100A4 in arecoline-treated OE cells by western blot. (A) SG and OECM1, (B) were exposed for 24 h in medium containing various concentrations of arecoline as indicated. GAPDH was performed in order to monitor equal protein loading. Levels of S100A4 protein stimulated by arecoline were measured by densitometer. The relative level of S100A4 protein expression was normalized against GAPDH signal and the control was set as 1.0. Optical density values represent the mean ± SD. ⁄ Represents significant difference from control values with p < 0.05.

Fig. 3. Effect of arecoline on migration and invasion ability in OE cells. SG (left panel) and OECM1 (right panel) cells treated with 24 h various concentrations of arecloine as indicated were subjected to migration assay (A) and invasion assay (B). ⁄ Represents significant difference from control values with p < 0.05.

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to show IHC specificity (Suppl. Fig. 1F). Faintly S100A4 staining was observed in the cytoplasm of normal epithelium (Fig. 1A). We found more nuclear and cytoplasmic staining of S100A4 in the moderate to poor-differentiated OSCC tissues than those of welldifferentiated OSCC tissues (Fig. 1A). As shown in Table 1, elevated expression of S100A4 was highly correlated with histologic differentiation (⁄⁄⁄p < 0.001) and lymph node metastasis (⁄⁄p < 0.01) of OSCC. No significant difference in S100A4 expression was observed with respect to other factors, such as, age, sex, T category, and stage (P > 0.05). In multivariate analysis with Cox regression model, lymph node metastasis and S100A4 expression were also independent prognostic factors of overall survival (P < 0.05, Table 2). Kaplan-Meier survival analysis of OSCC patients with high levels of S100A4 had a reduced survival rate compared to their high-expression counterparts (Fig. 1B). Our data show that S100A4 is important for OSCC progression and is critical for predicting patient outcomes.

Arecoline increased S100A4 expression in a dose-dependent manner in OE cells To examine the effect of arecoline on the S100A4 expression in OE cells in vitro, SG and OECM1 cells were treated with arecoline and the levels of S100A4 protein were measured by western blotting. Arecoline was also demonstrated to elevate S100A4

expression in dose-dependent manner in SG (Fig. 2A) and OECM1 (Fig. 2B) cells. Arecoline increased migration and invasion capability of oral epithelial cells Metastasis is the most common cause of cancer-related death in OSCC patients [1]. The effect of arecoline, a major areca nut alkaloid, on metastasis capability in OSCC has never determined. Interestingly arecoline led to dose-dependent elevation of migration (Fig. 3A) and invasion (Fig. 3B) capability in SG and OECM1cells. This suggests that the induction migration/invasion ability of arecoline-treated OE cells may be the synthesis of S100A4 expression. Down-regulation of S100A4 impeded arecoline-induced migration and invasion ability in OE cells To further investigate whether S100A4 could play a modulator in oncogenicity of arecoline-treated OE cells, the approach of loss-of-function of S100A4 was first conducted. Down-regulation of S100A4 in arecoline-treated OE cells was achieved by viral transduction with lentiviral vector expressing small hairpin RNA (shRNA) targeting (sh-S100A4-1 and sh-S100A4-2). Lentiviral vector expressing shRNA against luciferase (sh-Luc) was used as control. Real-time RT–PCR and immunoblotting analyses confirmed

Fig. 4. Depletion of S100A4 reversed the phenotype of arecoline-induced migration and invasion ability in OE cells. (A) The silencing effect of S100A4 shRNA in arecloinetreated OE cells was validated transcriptionally by real-time RT–PCR analysis (left panel). Single cell suspension of OE cells was transduced with sh-Luc or sh-100A4 lentivirus, individually or concurrently, and treated with or without arecoline (20 lg/ml) as indicated. (B) Total proteins prepared from infected cells were prepared and analyzed. Single cell suspension of arecoline-treated OE cells infected with S100A4-specific shRNA or control sh-Luc lentivirus was analyzed by migration (C) and invasion assay (D). ⁄P < 0.05 Sh-Luc. + arecoline group vs. control group; #P < 0.05 Sh-S100A4-1 + arecoline or Sh-S100A4-2 + arecoline vs. Sh-Luc. + arecoline group.

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that lentivirus expressing both sh-S100A4-1 and sh-S100A4-2 markedly reduced the expression level of arecoline-induced S100A4 transcript (Fig. 4A) and protein (Fig. 4B) expression in OE cells. Of note, silencing S100A4 abrogated arecoline-induced migration (Fig. 4C) and invasion ability (Fig. 4D) in OE cells.

Silencing of S100A4 abrogates arecoline-induced colony formation ability and anchorage-independent growth in OE cells To further investigate whether the effect of arecoline-induced S100A4 plays a role in promoting tumorigenic property in OE cells, we evaluated the colony formation ability and anchorage-independent growth with arecoline-exposed treatment in OE cells. Targeting S100A4 impeded arecoline-induced colony formation ability (Fig. 5A) and anchorage-independent growth (Fig. 5B) in OE cells.

PI3K, JNK, or HIF-1a signaling pathway involved in arecoline-induced S100A4 expression in OE cells To further study the possible mechanisms involved in arecoline-induced S100A4 up-regulation in OE cells, LY294002 (PI3K inhibitor), SP600125 (JNK inhibitor), or CAY10585 (HIF-1a inhibitor) without cytotoxic concentration were added to search the possible regulatory mechanisms on arecoline-induced S100A4 expression in OE cells. Arecoline-induced S100A4 expression could be blocked by co-treatment of OE cells with LY294002, SP600125, or CAY10585 treatment (Fig. 6A). These data suggest PI3K, JNK, or HIF-1a signaling pathway involved in arecoline-induced S100A4 expression in OE cells (Fig. 6B).

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Discussion OSCC is highly associated with the habit of areca quid chewing based on the epidemiological evidences [18]. Metastasis is a major cause of OSCC-related death and is a multiple and intricate process that may complicate clinical management and may lead to poor prognosis for OSCC patients [19]. However, the exact mechanism of areca nut constituents’ action on the metastasis capability in OSCC is not fully understood. Herein, we evaluated the role of S100A4 in the maintenance of tumorigenic potential of areca quid chewing-associated OSCC. We treated OE cells with arecoline to examine its influence on S100A4 to search for the possible pathogenesis of areca quid-associated OSCC both in vitro and in vivo. To the best of our knowledge, we first found that arecoline is capable of stimulating S100A4 expression and invasiveness in human OE cells. Depletion of S100A4 by lentiviral-mediated knockdown reversed of arecoline-stimulated oncogenicity including migration, invasion, and clonogenicity of OE cells. Clinically, elevated expression of S100A4 was highly correlated with histologic differentiation (⁄⁄p = 0.001) and lymph node metastasis (⁄p < 0.05) of OSCC. Additionally, pre-treatment with pharmacologic agents markedly inhibited the arecoline-induced S100A4 expression in OE cells. Collectively, our data first demonstrated the crucial role of S100A4 in the arecoline-stimulated oncogenicity of OSCC. Epithelial-mesenchymal transition (EMT) is a process by which epithelial cells lose their polarity and later acquire a migratory mesenchymal phenotype [20]. EMT is thought to be a key step in the induction of tumor malignancy, oncogenic progression, and cancer metastasis [21]. Oral epithelial cells can acquire mesenchymal traits which facilitate migration and invasion through EMT process [22,23]. Enhanced EMT characteristic is associated with poor overall and metastasis-free survival in patients with OSCC

Fig. 5. Depletion of S100A4 reversed the phenotype of arecoline-induced colony formation ability and anchorage-independent growth in OE cells. Single cell suspension of arecoline-treated OE cells infected with S100A4-specific shRNA or control sh-Luc lentivirus was analyzed by colony formation ability (A) and anchorage-independent growth (B). ⁄P < 0.05 Sh-Luc. + arecoline group vs. control group; #P < 0.05 Sh-S100A4-1 + arecoline or Sh-S100A4-2 + arecoline vs. Sh-Luc. + arecoline group.

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Fig. 6. The regulatory effects of rapamycin, PD98059, and Bay117082 on arecoline-induced S100A4 expression in SG cells. (A) SG cells were pretreated with 4 mM NAC, 10 lM LY294002, 1 lm rapmycin, 10 lM PD98059, 1 lM Bay 117082, 10 lM CAY10585, 10 lM SB203580, or 10 lM SP600125 for 1 h before exposure to 20 lg/ml arecoline. GAPDH was performed in order to monitor equal protein loading. From the AlphaImager 2000, LY294002 (PI3K inhibitor), SP600125 (JNK inhibitor), and CAY10585 (HIF-1a inhibitor) were found to reduce the arecoline-induced S100A4 expression, respectively. ⁄ Represents significant difference from control values with p < 0.05. # represents statistically significant values between arecoline with DMSO treatment and arecoline with pharmacological agents; p < 0.05. (B) Schematic of the arecoline-activated S100A4 expression promoting the invasiveness in OSCC.

[22]. S100A4 is also a master mediator in EMT and metastasis [24]. Areca nut extract is able to activate f EMT marker in OECM1 and FaDu cells [25]. Arecoline, the major alkaloid in areca nut, could induce the expression of EMT-related molecules (vimentin and IL-6) in human buccal mucosal fibroblast [26,27]. A further understanding on the regulatory networks between S100A4-mediated EMT and arecoline-induced invasiveness may update our current knowledge on the development of therapeutic treatments for metastatic OSCC patients in the future. Hypoxia is a well-recognized tumor microenvironment/niche that is linked to tumor aggressiveness and invasive growth and malignant progression in OSCC [22]. In this study, CAY10585 (HIF1a inhibitor) was found to reduce S100A4 protein expression by arecoline in OE cells. Consistently, a mechanistic relationship between S100A4 and the hypoxia-inducible factor-1a (HIF-1a) in ovarian cancer cells has elucidated [28]. Hypoxia or hypoxia mimicking cobalt chloride (CoCl(2)) enhanced S100A4 expression in cancer cells [28,29]. These data support our findings that the activation of the HIF-1a signaling may be involved in arecoline-induced S100A4 expression and oncogenicity of OSCC. Further investigations are needed to elucidate the precise role of S100A4 and HIF in the mechanism of areca quid chewing-associated OSCC. Overall, our present research showed S100A4 up-regulation play a major role in the maintenance tumorigenicity of OSCC. Targeting S100A4 or pharmacological agents treatment might be a potential therapeutic target for areca quid chewing-associated OSCCs

Conflict of interest None declared. Acknowledgements This study was supported by grant CSH-2013-C-016 from Chung Shan Medical University Hospital and MOHW104-TDU-B212-124-005 from Health and welfare surcharge of tobacco products, Ministry of Health and Welfare, Taiwan. Appendix A. Supplementary material Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/j.oraloncology. 2015.04.003. References [1] Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin 2013;63:11–30. [2] Lee SS, Tsai CH, Ho YC, Chang YC. The upregulation of heat shock protein 70 expression in areca quid chewing-associated oral squamous cell carcinomas. Oral Oncol 2008;44:884–90. [3] Lee SS, Tsai CH, Yu CC, Chang YC. Elevated snail expression mediates tumor progression in areca quid chewing-associated oral squamous cell carcinoma via reactive oxygen species. PLoS ONE 2013;8:e67985.

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[17]

[18]

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[22] [23]

[24]

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