Ovarian clear cell carcinoma (OCCCa) shows chemoresistance and clinical outcomes at advanced stages are generally unfavorable. To identify proteins involved in OCCCa, shotgun proteomics analysis was applied using formalin-fixed and paraffin-embedded samples. Analysis of 1521 proteins revealed that 52 were differentially expressed between four OCCCa and 12 non-OCCCa samples. Of the highly expressed proteins in OCCCa, we focused on left-right determination factor (LEFTY). In 143 cases of ovarian epithelial carcinoma, LEFTY expression at both mRNA and protein levels was significantly higher in OCCCas compared with non-OCCCas.
Since there is a close relationship between epithelial-mesencymal transition (EMT)/cancer stem cell (CSC) features and chemoresistance in OCCCas, we next examined a link between LEFTY expression and EMT/CSC properties. OCCCa cell lines that were treated with TGF-β, underwent morphological changes toward an EMT appearance, along with increased expression of LEFTY and Snail. The cells also showed CSC properties, as demonstrated by increases in the aldehyde dehydrogenase (ALDH)1high activity population, number of spheroid formation, and expression of several CSC markers. Inhibition of LEFTY expression induced decreases in the number of spindle-shaped cells and CSC features, while cells stably overexpressing LEFTY exhibited enhancement of such EMT/CSC properties. Finally, treatment of cells with TGF-β led to increased LEFTY expression and activation of Akt, which subsequently induced inactivation of GSK-3β, while inhibition of GSK-3β resulted in increased expression of both LEFTY and Snail. In conclusion, we reported the first time that LEFTY may be an excellent OCCCa-specific molecular marker and the functional rule may be the establishment and maintenance of phenotypic characteristics of OCCCas through modulation of EMT/CSC properties mediated LEFTY/Akt/GSK-3β/Snail axis.
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