VSX1 was identified as a novel prognostic biomarker of ccRCC
To search for novel prognostic biomarkers of ccRCC, the survival prognosis, including OS, DSS, and PFI, of related genes was investigated for patients with ccRCC. Differentially expressed target genes were identified between ccRCC and peritumoral tissues. A four-way Venn diagram showed there were 131 DEGs in ccRCC tissues compared with peritumoral tissues (Fig. 1a and Additional file 2: Table S2). Among these genes, 80 were potential protein-coding genes. A total of 56 candidate upregulated genes were identified and were listed in Additional file 2: Table S2. However, some of these genes, such as RNASET2, TF, and ZIC2, were already known to have an oncogenic role in the tumorigenesis, progression, and metastasis of renal cancer [24,25,26]. Among these candidate upregulated genes, VSX1 was selected and further analysis focused on the oncogenic role of VSX1 in ccRCC. Figure 1b showed that VSX1 mRNA was not only upregulated in cancerous tissues of ccRCC, but was also upregulated in pan-cancer tissues. In addition, the expression level of VSX1 in ccRCC tissues was higher than that in the matched normal adjacent tissues (Fig. 1c). Clinical correlation studies of data revealed that upregulated VSX1 mRNA was strongly associated with advanced T stages, distant metastasis, and high pathological stages. However, no such correlation was found with lymphatic metastasis (Fig. 1d). Similarly, the VSX1 mRNA level and an advanced T stage or a high pathological stage were associated with papillary RCC (pRCC) (Fig. 1d). Additionally, the survival analyses revealed that OS, DSS, and PFS were shortened for ccRCC patients with a high expression of VSX1 (Fig. 2a). However, no prognostic difference was observed in pRCC patients (Fig. 2b). These data implied that the upregulation of VSX1 might play an essential role in the progression of ccRCC.
The upregulation of VSX1 was validated in ccRCC clinical samples and cell lines
After screening VSX1 as a potential prognostic biomarker by using bioinformatics methods, VSX1 mRNA levels were detected in 20 pairs of ccRCC tissues and adjacent nontumoral tissues by qRT-PCR. Of the 20 cancerous samples, 19 (95%) had upregulated VSX1 mRNA levels compared with adjacent noncancerous tissues (P = 0.0278, Fig. 3a and b). The upregulation of VSX1 was consistently confirmed between the adjacent and tumoral tissues based on dataset GSE40435 from the GEO database (P = 0.0023, Fig. 3c). Furthermore, the upregulation of VSX1 was also confirmed in cancerous tissues by the IHC assay. IHC scoring showed that the expression of VSX1 increased in cancerous tissues compared with normal kidney tissues (Fig. 3d and e).
The expression of VSX1 was further detected in HEK-293 T cells, the immortal kidney cortex/proximal tubule cell line HK-2, and a panel of human RCC cell lines by qRT-PCR. Human RCC cells (786-O, 769-P, ACHN, A498, and Caki-1) exhibited higher expression of VSX1 compared with HEK-293 T and HK-2 cells, with A498 and Caki-1 cells showing the highest expression (Fig. 3f). The Caki-1 cell line was acquired from metastatic sites of the skin, while the A498 cell line was initially obtained from the primary tumor of a female patient.
Knockdown or overexpression of VSX1 affected ccRCC aggressiveness in vitro
To reveal the oncogenic role of VSX1 upregulation in ccRCC progression, VSX1 was overexpressed in the ccRCC cell line 786-O and knocked down in the Caki-1 cell line. Stable VSX1 overexpression or knockdown cell lines were constructed using a lentivirus system and confirmed by qRT-PCR and western blotting analyses (Fig. 3g and h).
In the CCK-8 assay, 786-O cells with stable VSX1 overexpression displayed significantly enhanced growth compared with that in the empty vector control group (Fig. 3i). In contrast, VSX1 knockdown in Caki-1 cells markedly suppressed cell proliferation compared with the shRNA negative control (shNC) group. Moreover, colony formation assays indicated that VSX1 knockdown in Caki-1 cells inhibited colony formation; the opposite results were revealed in 786-O cells overexpressing VSX1 compared with the empty vector control group (Fig. 3j). Furthermore, a cell cycle assay showed a marked reduction of cell populations in the S phase induced by the knockdown of VSX1 in Caki-1 cells, and the opposite results were obtained in 786-O cells with overexpression of VSX1 in comparison with the shNC group (Fig. 3k). This result was also confirmed by the CCK-8 assay.
Flow cytometry analyses implied that the knockdown of VSX1 expression significantly increased the apoptosis rate in ccRCC cells (Fig. 3l), and opposing results were obtained in 786-O cells overexpressing VSX1 compared with the empty vector control group. Moreover, the tumor sphere formation assay revealed that knockdown of VSX1 expression in Caki-1 cells significantly inhibited the tumor sphere formation capacity of the cells compared with that of the shNC group (Additional file 3: Fig. S1a). Conversely, compared with the empty vector control group, the overexpression of VSX1 in 786-O cells markedly enhanced tumor sphere formation ability of the cells (Additional file 3: Fig. S1b). The Transwell assay, performed to evaluate the migration and invasion abilities of ccRCC cells, revealed that upregulation of VSX1 promoted the migration and invasion abilities of Caki-1 cells and 786-O cells, and vice versa (Additional file 3: Fig. S1c and d). Collectively, these findings suggested that VSX1 acted as a tumor activator gene in ccRCC.
Gene correlation analyses revealed VSX1 was an essential upstream transcriptional regulator
Gene correlation analyses were performed between VSX1 and other DEGs in ccRCC from TCGA using the Spearman’s correlation coefficient. As shown in Fig. 4a, many upregulated or downregulated genes in ccRCC were correlated with the expression of VSX1. KEGG analysis via a bubble chart of the top 100 up- or down-regulated genes indicated that these genes showed good correlation with VSX1 and might play a leading role in the transcriptional misregulation of cancer and organic acid transmembrane transporter activity (Fig. 4b).
Since VSX1 is essentially a transcription factor [27], we focused on the top upregulated genes relevant to transcriptional dysregulation, such as BEST4, LMO1, ARID3C, TMEM44, FKBP10, and TRIB3. Pearson’s correlation analyses suggested that the expression levels of BEST4, LMO1, ARID3C, TMEM44, FKBP10, and TRIB3 were positively correlated with upregulated VSX1, which was also observed in the heatmap analysis (Fig. 4c and d). Examination of the expression of these genes in ccRCC samples revealed that mRNA expression of these genes was higher in cancerous tissues than in the normal adjacent tissues, and this finding was confirmed in the matched normal and cancerous tissues (Fig. 4e and f).
The expression of these genes in ccRCC samples was further investigated in relation to the T stage, N stage, M stage, and pathological stage. As shown in Fig. 4g–j, upregulated mRNA levels of BEST4, LMO1, and ARID3C were associated with an advanced T stage and a high pathological stage; however, the association was not found in the N stage and M stage. In addition, upregulated mRNA levels of TMEM44, FKBP10, and TRIB3 were strongly associated with advanced T stage, lymphatic metastasis, distant metastasis, and a high pathological stage. Survival analyses implied that OS, DSS, and PFI were shortened for ccRCC patients with high expression of these genes (Fig. 5a). Moreover, high expression of TMEM44, FKBP10, and TRIB3 was an unfavorable prognostic risk factor for ccRCC patients in advanced T and high pathological stages (Fig. 5b). These genes might therefore have potential as diagnostic biological markers for ccRCC (Fig. 5c). These data led to the reasonable assumption that VSX1 might transcriptionally regulate these tumor-related genes either directly or indirectly, and this hypothesis warranted further experimental verification.
VSX1 affected ccRCC invasiveness through transcriptionally regulating FKBP10
The upregulation of TMEM44, FKBP10, and TRIB3 was confirmed between the adjacent and tumoral tissues based on dataset GSE40435 from the GEO database (Fig. 6a). Gene correlation analyses between VSX1 and TMEM44, FKBP10, or TRIB3 were also performed based on dataset GSE40435. TMEM44, FKBP10, and TRIB3 were positively correlated with VSX1 (Fig. 6b). Next, the expression of these genes was detected by qRT-PCR in 20 pairs of ccRCC tissues and adjacent nontumoral tissues. There was no significant difference in the expression of TMEM44 between cancerous samples and adjacent noncancerous tissues (Fig. 6c), but both FKBP10 and TRIB3 mRNA were upreglated in most cancerous samples (Fig. 6d and e).
The dual-luciferase reporter gene assay revealed that the knockdown of VSX1 expression significantly decreased the relative luciferase activities of TMEM44, FKBP10, and TRIB3 (Fig. 6g), while the overexpression of VSX1 increased the relative luciferase activities of these genes (Fig. 6h). Next, VSX1 protein levels were changed by either knockdown or overexpression in vitro, and the expression levels of TMEM44, FKBP10, and TRIB3 in Caki-1 and 786-O cells were analyzed via qRT-PCR, respectively. The expression of TMEM44, FKBP10, and TRIB3 was downregulated by the knockdown of VSX1 compared with the negative control in Caki-1 cells (Fig. 6i), and similar results were confirmed in 786-O cells (Fig. 6j). The CCK-8 assay showed that significantly enhanced growth in 786-O cells with stable VSX1 overexpression was almost restored to normal by the knockdown of FKBP10 (Fig. 6k).
The CCK-8 assay showed significantly inhibited growth in Caki-1 cells with stable FKBP10 knockdown (Additional file 4: Fig. S2a), while the Transwell assay demonstrated that the knockdown of FKBP10 inhibited the migration and invasion abilities of Caki-1 cells (Additional file 4: Fig. S2b and c). Colony formation assays revealed that FKBP10 knockdown in 786-O cells inhibited colony formation (Fig. 6l and Additional file 4: Fig. S2d). In addition, the tumor sphere formation assay indicated that the ability to inhibit the tumor sphere formation in 786-O cells with the knockdown of FKBP10 after stable VSX1 overexpression was stronger than that in the shNC group (Additional file 4: Fig. S2e and f). A Transwell assay was performed to illuminate the impact of FKBP10 on the behavior of 786-O cells and showed that downregulation of FKBP10 inhibited the migration and invasion ability of the cells compared with the shNC group (Additional file 4: Fig. S2g and h). These findings suggested that VSX1 affected tumor invasiveness via transcriptionally regulating FKBP10.