# P4HA2 Promotes Epithelial-to-Mesenchymal Transition and Glioma Malignancy through the Collagen-Dependent PI3K/AKT Pathway

Authors: Jing Lin; Lei Jiang; Xiaogang Wang; Wenxin Wei; Chaoli Song; Yong Cui; Xiaojun Wu; GuanZhong Qiu
Journal: Journal of Oncology
 (2021)

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## Abstract

Prolyl-4-hydroxylase subunit 2 (P4HA2) is a member of collagen modification enzymes involved in the remodeling of the extracellular matrix (ECM). Mounting evidence has suggested that deregulation of P4HA2 is common in cancer. However, the role of P4HA2 in glioma remains unknown. The present study aimed to elucidate the expression pattern, oncogenic functions, and molecular mechanisms of P4HA2 in glioblastoma cells. The TCGA datasets and paraffin samples were used for examining the expressions of P4HA2. P4HA2-specific lentivirus was generated to assess its oncogenic functions. A P4HA2 enzyme inhibitor (DHB) and an AKT agonist (SC79) were utilized to study the mechanisms. As a result, we demonstrated that P4HA2 is overexpressed in glioma and inversely correlates with patient survival. Knockdown of P4HA2 inhibited proliferation, migration, invasion, and epithelial-to-mesenchymal transition (EMT) like phenotype of glioma cellsin vitro and suppressed tumor xenograft growth in vivo. Mechanistically, expressions of a series of collagen genes and of phosphorylated PI3K/AKT were downregulated by either P4HA2 silencing or inhibition of its prolyl hydroxylase. Finally, the inhibitory effects on the migration, invasion, and EMT-related molecules by P4HA2 knockdown were reversed by AKT activation with SC79. Our findings for the first time reveal that P4HA2 acts as an oncogenic molecule in glioma malignancy by regulating the expressions of collagens and the downstream PI3K/AKT signaling pathway.


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## Body

## 1. Introduction

Glioma is the most common adult malignant tumor in the central nervous system with approximately 100,000 newly diagnosed cases worldwide each year [1, 2]. Despite the standard therapeutics including surgical resection, adjuvant radiotherapy, and chemotherapy, the prognosis remains poorly improved [3]. Hence, great challenges still exist in the clarification of the molecular mechanisms of glioma malignancy.Recent years have witnessed an increasing focus on the tumor microenvironment (TME) in the development of many solid tumors including glioblastoma multiform (GBM) [4]. Many malignant features of TME, including hypoxia induction and remodeling of the extracellular matrix (ECM), can correlate with reprogramming of tumor cells, lead to malignant transformation which is best represented by EMT, and result in tumor progression and therapeutic resistance [4, 5]. The oncogenic effects of TME are largely dependent on the activation of a variety of signaling networks, such as hypoxia-inducible factor (HIF), transactivating a series of downstream target genes [5].Prolyl-4-hydroxylase subunit 2 (P4HA2) is required for collagen biogenesis by catalyzing the formation of 4-hydroxyproline from proline residues of the procollagen. Previous studies, including our high-throughput microarray study, have confirmed the role of P4HA2 as the HIF target. Besides its function in hypoxic adaption, taking the fact that P4HA2 directly modifies collagen peptides to promote the maturation of collagen fibers, which constitute the main components of ECM, it is reasonable to consider P4HA2 to be an important modulator of TME [6]. Moreover, as glioma is one of the most malignant solid tumors, on which multiple players within TME exert complex influence, it is also reasonable to expect the involvement of P4HA2 in gliomagenesis. Deregulation of P4HA2 has been implicated in various pathological disorders associated with increased fibrosis [7–10] and many solid tumors such as hepatocellular carcinoma, breast cancer, papillary thyroid cancer, and oral cavity squamous cell carcinoma [11–13]. However, little is known about its expression pattern, biological functions, and oncogenic role in glioma.In this study, we analyzed the expression pattern of P4HA2 in glioma samples and TCGA database and the correlation with glioma patient survival. Then, we investigated the oncogenic functions of P4HA2 in glioma proliferation, migration, and invasion, as well as EMT, a critical aspect of cancer cells related to ECM interactions. Moreover, mechanic studies explored the regulation of P4HA2 on collagen deposition and PI3K/AKT pathway and, at last, proposed a novel regulatory axis dependent on ECM-cell signaling.


## 2. Materials and Methods

### 2.1. Clinical Samples

Fresh frozen human tissue samples of 58 WHO grades II, III, and IV primary gliomas (grade II:15; grade III 13; grade IV:30) and 5 nonneoplastic brain tissues from surgical procedures for epilepsy were obtained from General Hospital of Jinan Military Command. All procedures related to acquiring the samples from the patients were given consent by the patients and were approved by the ethics committee of General Hospital of Jinan Military Command.


### 2.2. Cell Culture and Reagents

U251 and A172 cell lines were purchased from the Chinese Academy of Sciences Cell Bank. The U87MG and LN229 cell lines were gifts from the laboratories of Dr. Hai-Zhong Feng (Renji-Med X Clinical Stem Cell Research Center, Shanghai Jiao Tong University) and Dr. Fang Wu (Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University). The authenticity of all these GBM cell lines was tested by short tandem repeat profiling. All cell lines were cultured in DMEM medium supplemented with 10% (v/v) fetal bovine serum (FBS), 100 U/ml penicillin, and 100 U/ml streptomycin from Gibco (Carlsbad, CA, USA) at 37°C in a 5% CO2 atmosphere. The P4HA2 enzymatic inhibitor ethyl 3, 4-dihydroxybenzoate (DHB, E24859) and phosphorylated AKT agonist SC79 (S7863) were purchased from Sigma-Aldrich (St Louis, MO, USA) and Selleck Chemicals (Huston, TX, USA), respectively.


### 2.3. Lentivirus Transduction

Short hairpin RNA (shRNA) against human P4HA2 (sh-P4HA2-1: CCGGGCCGAATTCTTCACCTCTATTCTCGAG AATAGAGGTGAA GAATTCGGCTTTTG; sh-P4HA2-2: CCGGGCAGTCTCTGAAAGAGTACATCT CGAGTGTACTCTTTCAGAGACTGCTTTTTG) or a nontargeting scramble shRNA (Shanghai GenePharma, China) was cloned into vector LV3 (pGLVH1/GFP + Puro) and transfected into 293T cells using Lipofectamine 3000 (Invitrogen, CA, USA) for the generation of lentiviral vectors. The complete lentiviruses containing either P4HA2-specific (sh-P4HA2) or scramble shRNA (sh-GFP) were then used to infect U251 and U87MG cell lines and selected by puromycin for 48 h after infection.


### 2.4. Proliferation Assay

Cell proliferation was detected by WST-1 assay at 24, 48, 96, and 120 h according to the manufacturer’s instructions. Briefly, cells were seeded into 96-well plates at a density of 5 × 103 cells in 200 μl medium per well. At each indicated time point, the WST-1 reagent (Roche, Basel, Switzerland) was added to each well and incubated for 1 h. The absorbance rate at 450 nm was read by using a microplate reader (Bio-Rad Laboratories, CA, USA.). All experiments were performed in triplicate and repeated at least three times.


### 2.5. Invasion Assay

Tumor invasion was determined by Boyden Chamber assay (Corning, NY, USA) with BioCoat™ Matrigel™ (BD, NY, USA). Cells were serum-starved for 24 h; 5 × 104 cells were plated into the upper well of the Boyden chambers with the serum-free medium in the top chamber and medium with 10% FBS in the lower chamber. After 24 h of incubation, cells on the top of the membrane were removed. Cells that invaded through to the bottom surface of the membrane were washed with PBS, fixed in 4% paraformaldehyde, and stained with 0.2% crystal violet. The migrated cells were observed under Leica inverted microscope (Solms, Germany). The cell number was counted in eight random fields for each condition. The experiments were performed in triplicate.


### 2.6. Migration Assay

Tumor migration was determined by wound healing assay. Cells were seeded in 6-well plates and cultured to 80–90% confluence. After serum starvation for 12 h, a wound was created by scraping the cell monolayer with a 200μl pipette tip. After washing with PBS and removing the floating cells, the cells were cultured in a serum-free medium. Cell migration into the wound was observed at the indicated times (0 h, 36 h) in marked microscopic fields and the images were captured with a DS-5M Camera System (Nikon, Tokyo, Japan). The data obtained were presented as a migration rate by calculating the ratio of premigration versus postmigration gap distance with ImageJ software.


### 2.7. Quantitative RT-PCR Analysis

Total RNA was isolated using an RNeasy® mini kit (Qiagen, Venlo, The Netherlands). The first-strand cDNA was reverse-transcribed using the SuperScript First-Strand cDNA system and amplified by Platinum SYBR Green qPCR SuperMix-UDG (Invitrogen; Thermo Fisher Scientific, Inc, CA, USA). GAPDH was used as the internal control. The gene expression was calculated using the 2−ΔΔ Ct method. All data represent the average of three replicates. The PCR primer sequences were listed as follows: P4HA2, forward 5′-CAAACTGGTGAAGCGGCTAAA-3′, reverse 5′-GCACAGAGAGGTTGGCGATA-3′; SNAI1, forward 5′-TCGGAAGCCTAACTACAGCGA-3′, reverse 5′-AGATGAGCATTGGCAGCGAG-3′; SLUG, forward 5′-CGAACTGGACACACATA CAGTG-3′, reverse 5′-CTGAGGATCTCTGGTTGTGGT-3′; TWIST1, forward 5′-GTCCGCAGTCT TACGAGGAG-3′, reverse 5′-GCTTGAGGGTCTGAATCTTGCT-3′; GAPDH, forward 5′-CACCCACTCCTCCACCTTTG-3′, reverse 5′-CCACCACCCTGTTGCTGTA G-3′.


### 2.8. Western Blot

The total cell lysates were prepared in a high KCl lysis buffer with a complete protease inhibitor cocktail (Roche, Switzerland). The protein concentration was determined using a BCA Protein Assay Kit (Pierce, Rockford, IL, USA). Equal amounts of protein samples were subjected to SDS-PAGE and transferred to polyvinylidene fluoride (PVDF) membranes (Millipore, MA, USA). The membranes were treated with 1% blocking solution in TBS for 1 h, and immunoblots were probed with the indicated primary antibodies at 4°C overnight. The primary antibodies used were P4HA2 (ab233197), Collagen I (ab34710), Collagen III (ab7778), and Collagen IV (ab6586) from Abcam (Cambridge, UK); Twist1 (25465-1-AP) from Proteintech Group (Rosemont, PA, USA); Snail (#3879), Slug (#9585), AKT (#4691), phosphor-AKT (#4060), PI3K(#4257), and phospho-PI3K(#4228) from Cell Signaling Technology (Danvers, MA, USA); and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) (sc-47724) from Santa Cruz Biotechnology (Dallas, TX, USA). Then, the membranes were washed and incubated with HRP-labeled secondary antibodies (Molecular Probes, MA, USA). The fluorescence signals were detected using a BM Chemiluminescence Western Blotting kit (Roche, Basel, Switzerland). Densitometry quantification was calculated from triplicate assays and analyzed using ImageJ software.


### 2.9. Immunohistochemistry (IHC) Staining

Clinical tumors were fixed with 10% formalin, followed by paraffin embedding and sectioning, and then stained with anti-P4HA2 antibody (Abcam, Cambridge, UK) according to the previous protocol [14]. The immunoactivities were calculated as the product of scores of the staining rate and intensity as previously described [15]. Slides were photographed using an optical or confocal microscope (Olympus, Tokyo, Japan). Two independent pathologists examined five random fields at ×100 magnification in each sample.


### 2.10. Animal Studies

The procedures of xenograft implantation and measurement had been described previously [14]. U87MG cells stably expressing sh-P4HA2 or sh-GFP were implanted in the flanks of 4-week-old female SCID mice (5 mice per group). After 4 weeks, the mice were killed, and tumors were collected. Tumor volume (V) was determined by measuring the longest diameter (a) and the shortest diameter (b) according to formula Vmm3=b2×a/2. All mouse experiments were carried out under institutional guidelines and regulations of the government. All mouse experiments were also approved by the Ethical Board at the Second Military Medical University.


### 2.11. Immunofluorescence and Hematoxylin and Eosin (H&E) Staining

The xenografts were fixed in 4% paraformaldehyde, embedded in optimal cutting temperature compound for freezing, and then cryosectioned (10μm sections). After being blocked by 15% normal donkey serum for 30 minutes, the cells were incubated at room temperature for one hour with primary antibody diluted in antibody buffer. After incubation with the Ki-67 primary antibodies (sc-56319, Santa Cuz, TX, USA), the cells were rinsed and incubated for one hour at room temperature with Alexa Fluor-labeled secondary antibodies (Molecular Probes, MA, USA). The cells were washed with PBS and the coverslips were mounted with glycerine/PBS containing 0.1 mg/mL DAPI for nuclei staining. For H&E staining, the fixed tumor was embedded in paraffin, cut into 6 μm sections, and stained with H&E reagents. Slides were analyzed by two independent pathologists with five random fields at ×100 magnification in each sample.


### 2.12. Bioinformatics

The data including P4HA2 transcriptional expression, Kaplan–Meier analysis of P4HA2 transcriptional level over the overall survival time, and the correlation of P4HA2 transcription with other genes were downloaded from the TCGA dataset including both GBM and LGG samples (The Cancer Genome Atlas). Data visualization was performed on the web server GEPIA (http://gepia.cancer-pku.cn). According to the transcriptional level of P4HA2 derived from TCGA, glioma samples were divided into two subgroups with higher or lower P4HA2 expression, respectively (50% cutoff), to acquire the differentially expressed genes (DEGs) of the two subgroups. Genes with an absolute fold change ≥2 and an adjusted p value (FDR) <0.05 in expression were considered as DEGs and were subsequently mapped onto KEGG analysis using DAVID tool (http://david.abcc.ncifcrf.gov/) and R (version 4.0.2) for visualization.


### 2.13. Statistical Analysis

All experiments were performed in triplicate and repeated at least thrice unless indicated otherwise. Statistical analysis was performed in GraphPad Prism software (Version 7, CA, USA). Experimental data were expressed as means ± standard deviation (SD). IHC staining scores were analyzed by Mann–Whitney test for two groups and Kruskal-Wallis test for multiple comparisons, respectively. Continuous data were calculated with Student’s t test for a two-group comparison and AVONA for a multiple-comparison followed by appropriate post hoc approaches. Overall survival of patients with different P4HA2 levels (using medium as cutoff) was compared with Kaplan–Meier and log-rank test. The transcriptional correlations were analyzed using Pearson correlation coefficient.p values less than 0.05 were considered significant.


## 2.1. Clinical Samples

Fresh frozen human tissue samples of 58 WHO grades II, III, and IV primary gliomas (grade II:15; grade III 13; grade IV:30) and 5 nonneoplastic brain tissues from surgical procedures for epilepsy were obtained from General Hospital of Jinan Military Command. All procedures related to acquiring the samples from the patients were given consent by the patients and were approved by the ethics committee of General Hospital of Jinan Military Command.


## 2.2. Cell Culture and Reagents

U251 and A172 cell lines were purchased from the Chinese Academy of Sciences Cell Bank. The U87MG and LN229 cell lines were gifts from the laboratories of Dr. Hai-Zhong Feng (Renji-Med X Clinical Stem Cell Research Center, Shanghai Jiao Tong University) and Dr. Fang Wu (Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University). The authenticity of all these GBM cell lines was tested by short tandem repeat profiling. All cell lines were cultured in DMEM medium supplemented with 10% (v/v) fetal bovine serum (FBS), 100 U/ml penicillin, and 100 U/ml streptomycin from Gibco (Carlsbad, CA, USA) at 37°C in a 5% CO2 atmosphere. The P4HA2 enzymatic inhibitor ethyl 3, 4-dihydroxybenzoate (DHB, E24859) and phosphorylated AKT agonist SC79 (S7863) were purchased from Sigma-Aldrich (St Louis, MO, USA) and Selleck Chemicals (Huston, TX, USA), respectively.


## 2.3. Lentivirus Transduction

Short hairpin RNA (shRNA) against human P4HA2 (sh-P4HA2-1: CCGGGCCGAATTCTTCACCTCTATTCTCGAG AATAGAGGTGAA GAATTCGGCTTTTG; sh-P4HA2-2: CCGGGCAGTCTCTGAAAGAGTACATCT CGAGTGTACTCTTTCAGAGACTGCTTTTTG) or a nontargeting scramble shRNA (Shanghai GenePharma, China) was cloned into vector LV3 (pGLVH1/GFP + Puro) and transfected into 293T cells using Lipofectamine 3000 (Invitrogen, CA, USA) for the generation of lentiviral vectors. The complete lentiviruses containing either P4HA2-specific (sh-P4HA2) or scramble shRNA (sh-GFP) were then used to infect U251 and U87MG cell lines and selected by puromycin for 48 h after infection.


## 2.4. Proliferation Assay

Cell proliferation was detected by WST-1 assay at 24, 48, 96, and 120 h according to the manufacturer’s instructions. Briefly, cells were seeded into 96-well plates at a density of 5 × 103 cells in 200 μl medium per well. At each indicated time point, the WST-1 reagent (Roche, Basel, Switzerland) was added to each well and incubated for 1 h. The absorbance rate at 450 nm was read by using a microplate reader (Bio-Rad Laboratories, CA, USA.). All experiments were performed in triplicate and repeated at least three times.


## 2.5. Invasion Assay

Tumor invasion was determined by Boyden Chamber assay (Corning, NY, USA) with BioCoat™ Matrigel™ (BD, NY, USA). Cells were serum-starved for 24 h; 5 × 104 cells were plated into the upper well of the Boyden chambers with the serum-free medium in the top chamber and medium with 10% FBS in the lower chamber. After 24 h of incubation, cells on the top of the membrane were removed. Cells that invaded through to the bottom surface of the membrane were washed with PBS, fixed in 4% paraformaldehyde, and stained with 0.2% crystal violet. The migrated cells were observed under Leica inverted microscope (Solms, Germany). The cell number was counted in eight random fields for each condition. The experiments were performed in triplicate.


## 2.6. Migration Assay

Tumor migration was determined by wound healing assay. Cells were seeded in 6-well plates and cultured to 80–90% confluence. After serum starvation for 12 h, a wound was created by scraping the cell monolayer with a 200μl pipette tip. After washing with PBS and removing the floating cells, the cells were cultured in a serum-free medium. Cell migration into the wound was observed at the indicated times (0 h, 36 h) in marked microscopic fields and the images were captured with a DS-5M Camera System (Nikon, Tokyo, Japan). The data obtained were presented as a migration rate by calculating the ratio of premigration versus postmigration gap distance with ImageJ software.


## 2.7. Quantitative RT-PCR Analysis

Total RNA was isolated using an RNeasy® mini kit (Qiagen, Venlo, The Netherlands). The first-strand cDNA was reverse-transcribed using the SuperScript First-Strand cDNA system and amplified by Platinum SYBR Green qPCR SuperMix-UDG (Invitrogen; Thermo Fisher Scientific, Inc, CA, USA). GAPDH was used as the internal control. The gene expression was calculated using the 2−ΔΔ Ct method. All data represent the average of three replicates. The PCR primer sequences were listed as follows: P4HA2, forward 5′-CAAACTGGTGAAGCGGCTAAA-3′, reverse 5′-GCACAGAGAGGTTGGCGATA-3′; SNAI1, forward 5′-TCGGAAGCCTAACTACAGCGA-3′, reverse 5′-AGATGAGCATTGGCAGCGAG-3′; SLUG, forward 5′-CGAACTGGACACACATA CAGTG-3′, reverse 5′-CTGAGGATCTCTGGTTGTGGT-3′; TWIST1, forward 5′-GTCCGCAGTCT TACGAGGAG-3′, reverse 5′-GCTTGAGGGTCTGAATCTTGCT-3′; GAPDH, forward 5′-CACCCACTCCTCCACCTTTG-3′, reverse 5′-CCACCACCCTGTTGCTGTA G-3′.


## 2.8. Western Blot

The total cell lysates were prepared in a high KCl lysis buffer with a complete protease inhibitor cocktail (Roche, Switzerland). The protein concentration was determined using a BCA Protein Assay Kit (Pierce, Rockford, IL, USA). Equal amounts of protein samples were subjected to SDS-PAGE and transferred to polyvinylidene fluoride (PVDF) membranes (Millipore, MA, USA). The membranes were treated with 1% blocking solution in TBS for 1 h, and immunoblots were probed with the indicated primary antibodies at 4°C overnight. The primary antibodies used were P4HA2 (ab233197), Collagen I (ab34710), Collagen III (ab7778), and Collagen IV (ab6586) from Abcam (Cambridge, UK); Twist1 (25465-1-AP) from Proteintech Group (Rosemont, PA, USA); Snail (#3879), Slug (#9585), AKT (#4691), phosphor-AKT (#4060), PI3K(#4257), and phospho-PI3K(#4228) from Cell Signaling Technology (Danvers, MA, USA); and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) (sc-47724) from Santa Cruz Biotechnology (Dallas, TX, USA). Then, the membranes were washed and incubated with HRP-labeled secondary antibodies (Molecular Probes, MA, USA). The fluorescence signals were detected using a BM Chemiluminescence Western Blotting kit (Roche, Basel, Switzerland). Densitometry quantification was calculated from triplicate assays and analyzed using ImageJ software.


## 2.9. Immunohistochemistry (IHC) Staining

Clinical tumors were fixed with 10% formalin, followed by paraffin embedding and sectioning, and then stained with anti-P4HA2 antibody (Abcam, Cambridge, UK) according to the previous protocol [14]. The immunoactivities were calculated as the product of scores of the staining rate and intensity as previously described [15]. Slides were photographed using an optical or confocal microscope (Olympus, Tokyo, Japan). Two independent pathologists examined five random fields at ×100 magnification in each sample.


## 2.10. Animal Studies

The procedures of xenograft implantation and measurement had been described previously [14]. U87MG cells stably expressing sh-P4HA2 or sh-GFP were implanted in the flanks of 4-week-old female SCID mice (5 mice per group). After 4 weeks, the mice were killed, and tumors were collected. Tumor volume (V) was determined by measuring the longest diameter (a) and the shortest diameter (b) according to formula Vmm3=b2×a/2. All mouse experiments were carried out under institutional guidelines and regulations of the government. All mouse experiments were also approved by the Ethical Board at the Second Military Medical University.


## 2.11. Immunofluorescence and Hematoxylin and Eosin (H&E) Staining

The xenografts were fixed in 4% paraformaldehyde, embedded in optimal cutting temperature compound for freezing, and then cryosectioned (10μm sections). After being blocked by 15% normal donkey serum for 30 minutes, the cells were incubated at room temperature for one hour with primary antibody diluted in antibody buffer. After incubation with the Ki-67 primary antibodies (sc-56319, Santa Cuz, TX, USA), the cells were rinsed and incubated for one hour at room temperature with Alexa Fluor-labeled secondary antibodies (Molecular Probes, MA, USA). The cells were washed with PBS and the coverslips were mounted with glycerine/PBS containing 0.1 mg/mL DAPI for nuclei staining. For H&E staining, the fixed tumor was embedded in paraffin, cut into 6 μm sections, and stained with H&E reagents. Slides were analyzed by two independent pathologists with five random fields at ×100 magnification in each sample.


## 2.12. Bioinformatics

The data including P4HA2 transcriptional expression, Kaplan–Meier analysis of P4HA2 transcriptional level over the overall survival time, and the correlation of P4HA2 transcription with other genes were downloaded from the TCGA dataset including both GBM and LGG samples (The Cancer Genome Atlas). Data visualization was performed on the web server GEPIA (http://gepia.cancer-pku.cn). According to the transcriptional level of P4HA2 derived from TCGA, glioma samples were divided into two subgroups with higher or lower P4HA2 expression, respectively (50% cutoff), to acquire the differentially expressed genes (DEGs) of the two subgroups. Genes with an absolute fold change ≥2 and an adjusted p value (FDR) <0.05 in expression were considered as DEGs and were subsequently mapped onto KEGG analysis using DAVID tool (http://david.abcc.ncifcrf.gov/) and R (version 4.0.2) for visualization.


## 2.13. Statistical Analysis

All experiments were performed in triplicate and repeated at least thrice unless indicated otherwise. Statistical analysis was performed in GraphPad Prism software (Version 7, CA, USA). Experimental data were expressed as means ± standard deviation (SD). IHC staining scores were analyzed by Mann–Whitney test for two groups and Kruskal-Wallis test for multiple comparisons, respectively. Continuous data were calculated with Student’s t test for a two-group comparison and AVONA for a multiple-comparison followed by appropriate post hoc approaches. Overall survival of patients with different P4HA2 levels (using medium as cutoff) was compared with Kaplan–Meier and log-rank test. The transcriptional correlations were analyzed using Pearson correlation coefficient.p values less than 0.05 were considered significant.


## 3. Results

### 3.1. P4HA2 Is Overexpressed and Correlated with Poor Prognosis in Glioma

To examine the role of P4HA2 in glioma, we first compared the tumor expression of P4HA2 with normal tissues at the transcriptional level. By interrogating the TCGA, we found the mean transcriptional level of P4HA2 in glioma samples was higher than that in normal tissues (Figure1(a), p<0.05). Next, we examined the relationship between P4HA2 transcriptional level and histologic grade in human glioma. As expected, we found the highest P4HA2 transcriptional level in the samples of WHO IV. Though the expressional difference between grades II and III is not statistically significant, it can still be seen that P4HA2 is more expressed in grade III than in grade II (Figure 1(b), p<0.001). Then, by taking advantage of the clinical data in TCGA, we revealed that the overall survival of patients with higher P4HA2 transcriptional expression was notably shorter than that of patients who have lower P4HA2 expression in glioma (Figure 1(c), p<0.001). Meanwhile, immunohistochemistry in clinical samples showed that P4HA2 was extensively expressed in the cytoplasm and the median P4HA2 posttranslational level in 58 glioma samples was significantly higher than that in 5 normal tissues. Similar to the mRNA expression, we found the expressional level of P4HA2 protein correlated with the increased pathological grade (Figures 1(d)–1(f)). At last, by log-rank test, the overall survival of patients with higher P4HA2 protein expression was found to be shorter than those expressing lower P4HA2 protein, which was consistent with the transcriptional results from TCGA, implying that either mRNA or protein expression of P4HA2 was negatively associated with the prognosis (Figure 1(g), p<0.05).Figure 1
P4HA2 is overexpressed and correlated with poor prognosis in glioma. (a) Statistical comparison of P4HA2 transcriptional expression between normal tissues and glioma tissues and (b) between glioma with different pathological grades (WHO II, III, and IV) from TCGA;p∗<0.05∗∗∗p<0.001. (c) Kaplan-Meier result showed the overall survival discrepancy between the glioma patients with high and low P4HA2 transcriptional expressions from TCGA. (d) Representative images of cytoplasmic P4HA2 expression in normal brain tissues and glioma samples by IHC staining; scale bar = 50 μm. (e) Comparison of P4HA2 IHC expression between normal and glioma tissues and (f) between glioma samples with different pathological grades; ∗∗p<0.01∗∗∗p<0.001. (g) Kaplan-Meier analysis showing the overall survival discrepancy between patients with high and low P4HA2 IHC expressions; p<0.05.
(a)(b)(c)(d)(e)(f)(g)


### 3.2. Knockdown of P4HA2 Inhibits Proliferation, Migration, and Invasion of Glioma CellsIn Vitro and Suppresses Tumorigenesis In Vivo

To explore the role of P4HA2 in glioma malignancy, the U251 and U87MG cells were chosen for the RNA interference experiment because of their relatively high P4HA2 expression levels among the four GBM cell lines (Figure2(a), left). It can be seen that both shRNAs targeting P4HA2 mRNA were effective to inhibit the expression of P4HA2 (Figure 2(a), right). To test the impact of P4HA2 interference in cell proliferation, WST-1 assay was performed. After stable P4HA2 knockdown, either U251 or U87MG cells showed an obviously reduced rate of proliferation compared to the control group at each time point (Figure 2(b), p<0.05). Notably, glioma cells transfected with sh-P4HA2-2 lentivirus had a relatively lower proliferation rate than cells with sh-P4HA2-1 transduction, thus being selected for further experiments. To clarify the role of P4HA2 in cell invasion and migration, which are the most essential aspects of glioma malignancy, Matrigel invasion assay was performed to reveal that P4HA2 knockdown significantly decreased the number of invading cells in both U251 and U87MG cells at 24 hours after serum-free culture (Figure 2(c), p<0.001). The wound healing assay showed that the migration rates of cells in both glioma cell lines were markedly reduced at 36 hours of culture (Figure 2(d), p<0.001).Figure 2
Knockdown of P4HA2 inhibits proliferation, invasion, and migration of glioma cellsin vitro. (a) P4HA2 expression level was detected by western blot in several established GBM cell lines (left). The efficiency of two P4HA2 shRNAs was validated by western blot in U251 and U87MG cells (right). (b) Cell proliferation was detected by wWST-1 assay at 0, 24, 48, and 72 h in U251 and U87MG cells; ∗p<0.05. (c) Cell invasion of both cell lines was assessed in invasion chamber by crystal violet staining (left, scale bar = 100 μm); the invaded cell number was shown in histogram on the right (∗∗∗p<0.001). (d) Cell migration was observed and photographed at 48 h (left). Data were presented as the percentage of gap distance at 0 h against 48 h and shown in histograms (right, ∗∗∗p<0.001).
(a)(b)(c)(d)Subsequently, we tried to further verify the effect of P4HA2 on tumorigenesisin vivo, where the ECM may play a more important role than in vitro. Through subcutaneous xenograft assay in a nude mouse model with U87MG cells, which was the most inhibited cell line in the in vitro experiment, we found that knockdown of P4HA2 significantly inhibited tumor growth in the observed postimplantation period (Figures 3(a) and 3(b)). Furthermore, tissue H&E staining showed that the tumor cells with characteristics of abnormal morphology were obviously decreased in the xenograft derived from P4HA2-knockdown cells (Figure 3(c)). Consistently, fluorescent staining of cell proliferation marker Ki67 merged with nucleic DAPI showed a decreased ratio of Ki-67 immunoactivity in P4HA2-knockdown xenograft compared to the control xenograft (Figure 3(d)).Figure 3
Knockdown of P4HA2 suppressed tumor xenograft growthin vivo. (a) Xenograft tumors were generated by subcutaneously implanting P4HA2 control and P4HA2 knockdown U87MG cells on either side of nude mice. (b) Photographs represented removed tumor bulks from two groups of animals (left). Tumor volume was compared between groups at indicated days (right); ∗∗∗p<0.001. (c) H&E staining of xenograft tumor tissues. Bar = 25 μm. (d) Immunoﬂuorescence images showed expression levels of Ki-67 (red) in P4HA2 control tumors and P4HA2 knockdown tumors. DAPI (blue) was used to stain nuclei (left, scale bar = 100 μm). Statistical comparison of the relative Ki-67 expression between groups was shown on the right; ∗∗∗p<0.001.
(a)(b)(c)(d)


### 3.3. Knockdown of P4HA2 Inhibits the EMT-Like Phenotype in Glioma Cells

EMT is the hallmark of malignant cells, which intensively participates in cancer invasion and metastasis [16]. By EMT transition to stromal cells, tumor cells gain misplaced stem-like properties, including the ability to aberrantly communicate with the peritumor environment (i.e., ECM) for invasive growth into adjacent tissues [17]. Thus it is reasonable to obtain insight into the role of P4HA2 in the regulation of EMT of glioma cells. We first examined the relation between P4HA2 and EMT expression using TCGA database and interestingly found a positive correlation of P4HA2 mRNA expression with a series of EMT-promoting markers (see Supplementary Figure S1). Beyond this, quantitative analysis by qRT-PCR exhibited more than a 2-fold reduction in the mRNA expression of SNAI1, SLUG, and TWIST1 in both glioma cell lines (Figures 4(a) and 4(b)). Similarly, the protein expressions of these molecules were notably reduced which were seen by qualitative immunoblotting assay (Figures 4(c)–4(e)). The results suggest that the expressions of SNAI1, SLUG, and TWIST1 are regulated by P4HA2 either at the transcriptional or at the translational level. Taken together, the data presented in Figure 2 demonstrate that P4HA2 promotes proliferation, invasion, migration, and EMT phenotype as well as in vivo tumorigenesis of glioma cells.Figure 4
Knockdown of P4HA2 downregulated the expressions of EMT-like factors. (a, b) qRT-PCR and (c–e) immunoblotting results in U251 and U87MG cell lines showed downregulation of EMT-promoting molecules after shP4HA2 transduction;p∗<0.05, ∗∗p<0.01, ∗∗∗p<0.001 compared to control.
(a)(b)(c)(d)(e)


### 3.4. P4HA2 Regulates Collagen Deposition in Glioma

Subsequently, we made further attempts to delineate the molecular underpinning of the oncogenic effect of P4HA2. By refining the gene expression profiles of glioma patients from TCGA database, the differentially expressed genes (DEGs) between two P4HA2 expressional groups were compared by KEGG pathway analysis. A few pathways tightly correlated with P4HA2 expression are exhibited in Figure5(a). Of particular interest was the finding that ECM-receptor interaction is the most enriched pathway of DEGs. Abnormal remodeling of ECM is characteristic of the tumor microenvironment [5, 6]. As the primary components of ECM fibers, collagen deposition within the tumor bulk has been proved to promote tumor invasion and metastasis. Given that P4HA2 is a collagen hydroxylase, the first step to explore the mechanisms is to find out whether P4HA2 regulates collagen expression in glioma. Through analyzing P4HA2-related DEGs, we found at least 2-fold increase in the expression of a spectrum of collagens in the high-level P4HA2 group versus the low-level group (see Supplementary Figure S2). Also, a significantly positive correlation between P4HA2 mRNA and most of the collagen genes was observed from TCGA visualization (see Supplementary Figure S3 upper, p<0.001). Next, the knockdown experiment by immunoblotting in glioma cell lines confirmed that collagens I, III, and IV, three representative collagens in the brain, are under the regulation of P4HA2 at the protein level (Figures 5(b)–5(d)).Figure 5
Knockdown of P4HA2 suppressed the gene expressions of collagens and the PI3K/AKT pathway. (a) Bubble chart of KEGG pathway analysis figured out the enriched pathways associated with P4HA2 expression, of which the ECM-receptor interaction and PI3K/AKT pathway bear the most significance. (b–d) Immunoblotting assay showed the regulation of three representative collagen types I, III, and IV by P4HA2 knockdown;p∗<0.05, ∗∗∗p<0.001 compared to control. (e–g) The effect of P4HA2 depletion and enzyme inhibition on the PI3K/AKT signaling pathway was determined by immunoblotting assay in two glioma cell lines; ∗∗∗p<0.01, ∗∗∗p<0.001 between sh-P4HA2 and control; p##<0.01, p###<0.001 between DHB and control.
(a)(b)(c)(d)(e)(f)(g)


### 3.5. P4HA2 Regulates the PI3K/AKT Pathway of Glioma Cells in a Collagen-Dependent Manner

Previous studies have determined that PI3K/AKT signaling is among the most critical pathways in the irregular molecular networks underlying the tumorigenesis of glioma [15, 18]. In the current study, bioinformatics was utilized to show that PI3K/AKT is also among the most enriched pathways associated with P4HA2 expression (Figure 5(a)). We proposed a hypothesis that P4HA2 is required for the activation of the PI3K/AKT pathway. Interestingly, though the mRNA levels PI3K and AKT were not influenced by P4HA2 knockdown (see Supplementary Figure S3 lower, p>0.05), we found by immunoblotting that P4HA2 inhibition led to reduced protein levels of phosphorylated PI3K and AKT (Figures 5(e)–5(g)). To test whether it is collagen that regulates the PI3K/AKT pathway, we utilized a P4HA2 enzyme inhibitor, DHB, to suppress the deposition of collagen in glioma cells. Similar results were observed: both phosphorylated PI3K and AKT expressions, not the total protein expressions, were significantly reduced by hydroxylase inhibition, implying that P4HA2 regulates PI3K/AKT signaling in a collagen-dependent manner (Figures 5(e)–5(g)). At this point, we were strongly inspired to find out whether PI3K/AKT activation is able to mediate the oncogenic effect of P4HA2. By employing an AKT agonist SC79, the inhibited proliferation, invasion, and migration in the P4HA2 knockdown cell line were all shown to be notably reversed (Figures 6(a)–6(c)). In particular, the EMT-related molecules, which have been downregulated by P4HA2 knockdown, were also found to increase after AKT activation, which confirms and extends the previous finding that EMT is tightly associated with AKT family (Figures 6(d)–6(e)) [19]. Taken together, this part of results indicates the transduction of collagen-PI3K/AKT, which is under the regulation of P4HA2, is possibly the underlying mechanism for the oncogenic effect of P4HA2.Figure 6
AKT activation partially reversed the antioncogenic effect of P4HA2 knockdown. The inhibitory effect on glioma proliferation (a), cell invasion (b), and migration (c) by P4HA2 depletion was partially reversed by AKT phosphorylation activator SC79;∗p<0.05, ∗∗p<0.01, ∗∗∗p<0.001. (d, e) Immunoblotting assay showed the reversed expression of previously downregulated EMT-related factors by SC79; p∗<0.05∗, ∗∗∗p<0.001 between sh-P4HA2 and control; p#<0.05, p##<0.01 between SC79 and sh-P4HA2. (f) A sketch map showing the working model of the mechanism for the oncogenic effect of P4HA2. HIF1α-induced P4HA2 promotes the malignancy of glioma cells by regulating collagen deposition and the downstream PI3K/AKT pathway, which could be targeted by DHB and SC79, respectively. P: phosphorylation; H: hydroxylation.
(a)(b)(c)(d)(e)(f)


## 3.1. P4HA2 Is Overexpressed and Correlated with Poor Prognosis in Glioma

To examine the role of P4HA2 in glioma, we first compared the tumor expression of P4HA2 with normal tissues at the transcriptional level. By interrogating the TCGA, we found the mean transcriptional level of P4HA2 in glioma samples was higher than that in normal tissues (Figure1(a), p<0.05). Next, we examined the relationship between P4HA2 transcriptional level and histologic grade in human glioma. As expected, we found the highest P4HA2 transcriptional level in the samples of WHO IV. Though the expressional difference between grades II and III is not statistically significant, it can still be seen that P4HA2 is more expressed in grade III than in grade II (Figure 1(b), p<0.001). Then, by taking advantage of the clinical data in TCGA, we revealed that the overall survival of patients with higher P4HA2 transcriptional expression was notably shorter than that of patients who have lower P4HA2 expression in glioma (Figure 1(c), p<0.001). Meanwhile, immunohistochemistry in clinical samples showed that P4HA2 was extensively expressed in the cytoplasm and the median P4HA2 posttranslational level in 58 glioma samples was significantly higher than that in 5 normal tissues. Similar to the mRNA expression, we found the expressional level of P4HA2 protein correlated with the increased pathological grade (Figures 1(d)–1(f)). At last, by log-rank test, the overall survival of patients with higher P4HA2 protein expression was found to be shorter than those expressing lower P4HA2 protein, which was consistent with the transcriptional results from TCGA, implying that either mRNA or protein expression of P4HA2 was negatively associated with the prognosis (Figure 1(g), p<0.05).Figure 1
P4HA2 is overexpressed and correlated with poor prognosis in glioma. (a) Statistical comparison of P4HA2 transcriptional expression between normal tissues and glioma tissues and (b) between glioma with different pathological grades (WHO II, III, and IV) from TCGA;p∗<0.05∗∗∗p<0.001. (c) Kaplan-Meier result showed the overall survival discrepancy between the glioma patients with high and low P4HA2 transcriptional expressions from TCGA. (d) Representative images of cytoplasmic P4HA2 expression in normal brain tissues and glioma samples by IHC staining; scale bar = 50 μm. (e) Comparison of P4HA2 IHC expression between normal and glioma tissues and (f) between glioma samples with different pathological grades; ∗∗p<0.01∗∗∗p<0.001. (g) Kaplan-Meier analysis showing the overall survival discrepancy between patients with high and low P4HA2 IHC expressions; p<0.05.
(a)(b)(c)(d)(e)(f)(g)


## 3.2. Knockdown of P4HA2 Inhibits Proliferation, Migration, and Invasion of Glioma CellsIn Vitro and Suppresses Tumorigenesis In Vivo

To explore the role of P4HA2 in glioma malignancy, the U251 and U87MG cells were chosen for the RNA interference experiment because of their relatively high P4HA2 expression levels among the four GBM cell lines (Figure2(a), left). It can be seen that both shRNAs targeting P4HA2 mRNA were effective to inhibit the expression of P4HA2 (Figure 2(a), right). To test the impact of P4HA2 interference in cell proliferation, WST-1 assay was performed. After stable P4HA2 knockdown, either U251 or U87MG cells showed an obviously reduced rate of proliferation compared to the control group at each time point (Figure 2(b), p<0.05). Notably, glioma cells transfected with sh-P4HA2-2 lentivirus had a relatively lower proliferation rate than cells with sh-P4HA2-1 transduction, thus being selected for further experiments. To clarify the role of P4HA2 in cell invasion and migration, which are the most essential aspects of glioma malignancy, Matrigel invasion assay was performed to reveal that P4HA2 knockdown significantly decreased the number of invading cells in both U251 and U87MG cells at 24 hours after serum-free culture (Figure 2(c), p<0.001). The wound healing assay showed that the migration rates of cells in both glioma cell lines were markedly reduced at 36 hours of culture (Figure 2(d), p<0.001).Figure 2
Knockdown of P4HA2 inhibits proliferation, invasion, and migration of glioma cellsin vitro. (a) P4HA2 expression level was detected by western blot in several established GBM cell lines (left). The efficiency of two P4HA2 shRNAs was validated by western blot in U251 and U87MG cells (right). (b) Cell proliferation was detected by wWST-1 assay at 0, 24, 48, and 72 h in U251 and U87MG cells; ∗p<0.05. (c) Cell invasion of both cell lines was assessed in invasion chamber by crystal violet staining (left, scale bar = 100 μm); the invaded cell number was shown in histogram on the right (∗∗∗p<0.001). (d) Cell migration was observed and photographed at 48 h (left). Data were presented as the percentage of gap distance at 0 h against 48 h and shown in histograms (right, ∗∗∗p<0.001).
(a)(b)(c)(d)Subsequently, we tried to further verify the effect of P4HA2 on tumorigenesisin vivo, where the ECM may play a more important role than in vitro. Through subcutaneous xenograft assay in a nude mouse model with U87MG cells, which was the most inhibited cell line in the in vitro experiment, we found that knockdown of P4HA2 significantly inhibited tumor growth in the observed postimplantation period (Figures 3(a) and 3(b)). Furthermore, tissue H&E staining showed that the tumor cells with characteristics of abnormal morphology were obviously decreased in the xenograft derived from P4HA2-knockdown cells (Figure 3(c)). Consistently, fluorescent staining of cell proliferation marker Ki67 merged with nucleic DAPI showed a decreased ratio of Ki-67 immunoactivity in P4HA2-knockdown xenograft compared to the control xenograft (Figure 3(d)).Figure 3
Knockdown of P4HA2 suppressed tumor xenograft growthin vivo. (a) Xenograft tumors were generated by subcutaneously implanting P4HA2 control and P4HA2 knockdown U87MG cells on either side of nude mice. (b) Photographs represented removed tumor bulks from two groups of animals (left). Tumor volume was compared between groups at indicated days (right); ∗∗∗p<0.001. (c) H&E staining of xenograft tumor tissues. Bar = 25 μm. (d) Immunoﬂuorescence images showed expression levels of Ki-67 (red) in P4HA2 control tumors and P4HA2 knockdown tumors. DAPI (blue) was used to stain nuclei (left, scale bar = 100 μm). Statistical comparison of the relative Ki-67 expression between groups was shown on the right; ∗∗∗p<0.001.
(a)(b)(c)(d)


## 3.3. Knockdown of P4HA2 Inhibits the EMT-Like Phenotype in Glioma Cells

EMT is the hallmark of malignant cells, which intensively participates in cancer invasion and metastasis [16]. By EMT transition to stromal cells, tumor cells gain misplaced stem-like properties, including the ability to aberrantly communicate with the peritumor environment (i.e., ECM) for invasive growth into adjacent tissues [17]. Thus it is reasonable to obtain insight into the role of P4HA2 in the regulation of EMT of glioma cells. We first examined the relation between P4HA2 and EMT expression using TCGA database and interestingly found a positive correlation of P4HA2 mRNA expression with a series of EMT-promoting markers (see Supplementary Figure S1). Beyond this, quantitative analysis by qRT-PCR exhibited more than a 2-fold reduction in the mRNA expression of SNAI1, SLUG, and TWIST1 in both glioma cell lines (Figures 4(a) and 4(b)). Similarly, the protein expressions of these molecules were notably reduced which were seen by qualitative immunoblotting assay (Figures 4(c)–4(e)). The results suggest that the expressions of SNAI1, SLUG, and TWIST1 are regulated by P4HA2 either at the transcriptional or at the translational level. Taken together, the data presented in Figure 2 demonstrate that P4HA2 promotes proliferation, invasion, migration, and EMT phenotype as well as in vivo tumorigenesis of glioma cells.Figure 4
Knockdown of P4HA2 downregulated the expressions of EMT-like factors. (a, b) qRT-PCR and (c–e) immunoblotting results in U251 and U87MG cell lines showed downregulation of EMT-promoting molecules after shP4HA2 transduction;p∗<0.05, ∗∗p<0.01, ∗∗∗p<0.001 compared to control.
(a)(b)(c)(d)(e)


## 3.4. P4HA2 Regulates Collagen Deposition in Glioma

Subsequently, we made further attempts to delineate the molecular underpinning of the oncogenic effect of P4HA2. By refining the gene expression profiles of glioma patients from TCGA database, the differentially expressed genes (DEGs) between two P4HA2 expressional groups were compared by KEGG pathway analysis. A few pathways tightly correlated with P4HA2 expression are exhibited in Figure5(a). Of particular interest was the finding that ECM-receptor interaction is the most enriched pathway of DEGs. Abnormal remodeling of ECM is characteristic of the tumor microenvironment [5, 6]. As the primary components of ECM fibers, collagen deposition within the tumor bulk has been proved to promote tumor invasion and metastasis. Given that P4HA2 is a collagen hydroxylase, the first step to explore the mechanisms is to find out whether P4HA2 regulates collagen expression in glioma. Through analyzing P4HA2-related DEGs, we found at least 2-fold increase in the expression of a spectrum of collagens in the high-level P4HA2 group versus the low-level group (see Supplementary Figure S2). Also, a significantly positive correlation between P4HA2 mRNA and most of the collagen genes was observed from TCGA visualization (see Supplementary Figure S3 upper, p<0.001). Next, the knockdown experiment by immunoblotting in glioma cell lines confirmed that collagens I, III, and IV, three representative collagens in the brain, are under the regulation of P4HA2 at the protein level (Figures 5(b)–5(d)).Figure 5
Knockdown of P4HA2 suppressed the gene expressions of collagens and the PI3K/AKT pathway. (a) Bubble chart of KEGG pathway analysis figured out the enriched pathways associated with P4HA2 expression, of which the ECM-receptor interaction and PI3K/AKT pathway bear the most significance. (b–d) Immunoblotting assay showed the regulation of three representative collagen types I, III, and IV by P4HA2 knockdown;p∗<0.05, ∗∗∗p<0.001 compared to control. (e–g) The effect of P4HA2 depletion and enzyme inhibition on the PI3K/AKT signaling pathway was determined by immunoblotting assay in two glioma cell lines; ∗∗∗p<0.01, ∗∗∗p<0.001 between sh-P4HA2 and control; p##<0.01, p###<0.001 between DHB and control.
(a)(b)(c)(d)(e)(f)(g)


## 3.5. P4HA2 Regulates the PI3K/AKT Pathway of Glioma Cells in a Collagen-Dependent Manner

Previous studies have determined that PI3K/AKT signaling is among the most critical pathways in the irregular molecular networks underlying the tumorigenesis of glioma [15, 18]. In the current study, bioinformatics was utilized to show that PI3K/AKT is also among the most enriched pathways associated with P4HA2 expression (Figure 5(a)). We proposed a hypothesis that P4HA2 is required for the activation of the PI3K/AKT pathway. Interestingly, though the mRNA levels PI3K and AKT were not influenced by P4HA2 knockdown (see Supplementary Figure S3 lower, p>0.05), we found by immunoblotting that P4HA2 inhibition led to reduced protein levels of phosphorylated PI3K and AKT (Figures 5(e)–5(g)). To test whether it is collagen that regulates the PI3K/AKT pathway, we utilized a P4HA2 enzyme inhibitor, DHB, to suppress the deposition of collagen in glioma cells. Similar results were observed: both phosphorylated PI3K and AKT expressions, not the total protein expressions, were significantly reduced by hydroxylase inhibition, implying that P4HA2 regulates PI3K/AKT signaling in a collagen-dependent manner (Figures 5(e)–5(g)). At this point, we were strongly inspired to find out whether PI3K/AKT activation is able to mediate the oncogenic effect of P4HA2. By employing an AKT agonist SC79, the inhibited proliferation, invasion, and migration in the P4HA2 knockdown cell line were all shown to be notably reversed (Figures 6(a)–6(c)). In particular, the EMT-related molecules, which have been downregulated by P4HA2 knockdown, were also found to increase after AKT activation, which confirms and extends the previous finding that EMT is tightly associated with AKT family (Figures 6(d)–6(e)) [19]. Taken together, this part of results indicates the transduction of collagen-PI3K/AKT, which is under the regulation of P4HA2, is possibly the underlying mechanism for the oncogenic effect of P4HA2.Figure 6
AKT activation partially reversed the antioncogenic effect of P4HA2 knockdown. The inhibitory effect on glioma proliferation (a), cell invasion (b), and migration (c) by P4HA2 depletion was partially reversed by AKT phosphorylation activator SC79;∗p<0.05, ∗∗p<0.01, ∗∗∗p<0.001. (d, e) Immunoblotting assay showed the reversed expression of previously downregulated EMT-related factors by SC79; p∗<0.05∗, ∗∗∗p<0.001 between sh-P4HA2 and control; p#<0.05, p##<0.01 between SC79 and sh-P4HA2. (f) A sketch map showing the working model of the mechanism for the oncogenic effect of P4HA2. HIF1α-induced P4HA2 promotes the malignancy of glioma cells by regulating collagen deposition and the downstream PI3K/AKT pathway, which could be targeted by DHB and SC79, respectively. P: phosphorylation; H: hydroxylation.
(a)(b)(c)(d)(e)(f)


## 4. Discussion

In this study, we found that P4HA2 was frequently upregulated in glioma and inversely correlated with patient survival, which were consistent with previous reports in other malignancies [8, 11–13]. Knockdown of P4HA2 inhibited glioma proliferation, migration, invasion, and EMT in vitro and suppressed tumor xenograft growth in vivo. Inhibiting P4HA2 downregulated collagen expressions and phosphorylated PI3K/AKT. At last, exogenously activating PI3K/AKT partially reversed the oncogenic functions of P4HA2.


### 4.1. Gliomagenesis Contributes to Collagen-Dependent ECM Remodeling

In addition to cancer cells, the tumor mass like glioblastoma consists of a variety of resident cells, secreted factors, and extracellular matrix molecules. All these factors, together with cancer cells themselves, are defined as TME. Recent evidence has demonstrated that ECM remodeling and its interaction with other components within TME not only determines the tumor progression but also shapes therapeutic responses and thus can be exploited as therapeutic targets [4–6]. Collagens are the major fibrous proteins that constitute ECM of various organs with functions of acting as a scaffold for cell adhesion and serving as a reservoir of matricellular molecules [20]. In many solid malignancies such as breast cancer, the extracellular deposition and formation of collagen fibers are promoted by HIF-1α induced P4HA2 expression by stromal cells or cancer cells themselves [6]. Moreover, collagen-dependent ECM biogenesis, which is regulated by P4HA2, can produce a stiff microenvironment for cell migration and invasion [11]. In the brain, types I, III, IV, VI, and XVI have been shown to be dysregulated and closely related to gliomagenesis [21–23], which are confirmed in our study results showing the levels of major collagens were determined by P4HA2 expression in glioma cells. Regarding that the matrix substance of the normal brain, unlike lungs, breast, or other tissues, has a unique composition containing less abundant collagens and fibronectins [24], it is reasonable to believe that the collagen-dependent matrix remodeling, which is enhanced by P4HA2 regulated collagen alignment, is possibly a consequence of gliomagenesis.


### 4.2. P4HA2-Promoted Matrix Collagen Activates PI3K/AKT Signaling

Prior studies indicated that fibrillar collagens can also act as a ligand for biochemical signaling between cells and their microenvironment [20, 25]. Coincidently, our preliminary mechanism investigation by bioinformatics analysis revealed two primary pathways in close relation with P4HA2 expression that were enriching in ECM-receptor interaction and PI3K/AKT signaling. Discoidin domain receptors (DDRs), a class of receptor tyrosine kinases, constitute one of the three types of collagen receptors (the other two are integrins and Endo 180, belonging to the transmembrane and mannose family, respectively) [26, 27]. The molecular structure of DDRs consists of an extracellular collagen-binding domain and an intracellular kinase domain within the C-terminal region. Most importantly, the tyrosine kinase domain contains a YELM binding motif which can interact with the p85 subunit of PI3K [25]. Though the crucial role of the PI3K/AKT signaling pathway in cell survival and tumorigenesis is well established in many cancer types including glioma [15, 28, 29], its involvement in cancer ECM-cell interactions has yet to be elucidated. Herein, we show for the first time that the PI3K/AKT expressions are regulated by P4HA2 in the protein level, but not the mRNA level. Further results showing PI3K/AKT can be downregulated by blocking the collagen hydroxylase of P4HA2 support our proposal that the expressional activation of PI3K/AKT is through a P4HA2 enzyme-mediated protein-protein interaction rather than a direct transcriptional activation. Moreover, by the rescue assay using an AKT agonist we demonstrate the contribution of PI3K/AKT signaling to the oncogenic effect of P4HA2. The results, taken together, illustrate a possible signal axis of the P4HA2-collagen-PI3K/AKT pathway, whereby P4HA2 promotes collagen deposition and enhances the interactions between collagens and cell receptors activating the PI3K/AKT signaling pathway, which leads to glioma malignancies (Figure 6(f)).


### 4.3. EMT Is the Critical Downstream Effect of the P4HA2-Collagen-PI3K/AKT Axis

As glioma malignancies are mostly represented by invasion into adjacent brain tissue, the last question worth clarifying is what mechanism significantly constitutes the bridge linking P4HA2 activated PI3K/AKT signaling to glioma invasion. EMT is a complex multistage process of cancer cells, which is reminiscent of how the ectoderm is programmed to form mesoderm during embryonic development as well as how the epidermal cells within the wound edge are reprogrammed to repair the skin defect [16]. By EMT transformation, cancer cells downregulate the expression of E-cadherin resulting in loss of tight junctions with adjunct cells, whereas they upregulate N-cadherin which provides weaker connections between cancer cells but has a much stronger affinity with matrix cells dominantly expressing N-cadherin molecules. Moreover, its initiation and maintenance involve activation of an orderly series of key transcription factors, matrix metalloproteinases, and Ras-like GTPases, as well as the downstream pathways, all of which contribute to the alteration of intercellular adhesion, ECM remodeling, and ultimately the invasive migration within ECM [30]. As mentioned above, PI3K/AKT pathway has been intensely studied for its role in tumorigenesis including EMT. Evidence shows that PI3K/AKT functions upstream of EMT-related factors and cytokines such as SNAI, SLUG, TWIST, and MMPs, as well as TGF-β, and thus can affect EMT in multiple ways [19]. However, previously there was insufficient evidence showing correlations between PI3K/AKT, EMT phenotype, and ECM regulators. In this study, we firstly revealed negative regulation of EMT transcription factors by P4HA2 silencing and then indicated the negative effect by P4HA2 silencing can be reversed by PI3K/AKT activation. Collectively, it can be speculated that, in glioma, P4HA2-promoted cell invasion may be attributed to EMT downstream of PI3K/AKT activation.Although our study proposes a novel signaling pathway of P4HA2-collagen-PI3K/AKT in mediating the glioma progression, some limitations need to be clarified. First, we only examined the collagen contents in the cell cultures, but it should be better to assess the collagen deposition in the tumor specimens, which could better represent the TME, from thein vivo experiment. Second, the activation of PI3K/AKT by P4HA2 is speculated to be mediated by DDRs receptors. The direct evidence could be acquired by measuring the expression of DDRs as well the interactions between DDRs and the intracellular signaling molecules using immunoblotting and immunoprecipitation assays. Third, as the antitumor effect of P4HA2 inhibition is partially reversed by exogenous PI3K/AKT activation, there could exist other mechanisms that exhibit the oncogenic effect of P4HA2. To our knowledge, the collagen-dependent regulation of focal adhesion kinase (FAK), the prostemness, and proneovascularization effect, as well as the hydroxylation of Carabin by P4HA2, have been indicated in some studies and, thus, merit further investigations [26, 31–33]. Lastly, while our study demonstrates a signaling direction from P4HA2-upregulated expression of matrix collagen to EMT genotypes, some argue that tumor cells following EMT may also reshape the ECM composition. So, whether EMT in glioma can activate P4HA2 and the collagen expression or, in other words, if there exists a feedback loop between ECM remodeling and EMT warrants deeper examination.In conclusion, we revealed that P4HA2 is a prognostic marker and exerts oncogenic functions to promote malignancy of glioma. The underlying mechanism may be regulating the collagen-dependent PI3K/AKT signaling pathway. The study opens up an avenue of targeting P4HA2 and TME related factors and developing inhibitors specific to the activity of the P4HA2 enzyme for therapeutic strategies against glioma.


## 4.1. Gliomagenesis Contributes to Collagen-Dependent ECM Remodeling

In addition to cancer cells, the tumor mass like glioblastoma consists of a variety of resident cells, secreted factors, and extracellular matrix molecules. All these factors, together with cancer cells themselves, are defined as TME. Recent evidence has demonstrated that ECM remodeling and its interaction with other components within TME not only determines the tumor progression but also shapes therapeutic responses and thus can be exploited as therapeutic targets [4–6]. Collagens are the major fibrous proteins that constitute ECM of various organs with functions of acting as a scaffold for cell adhesion and serving as a reservoir of matricellular molecules [20]. In many solid malignancies such as breast cancer, the extracellular deposition and formation of collagen fibers are promoted by HIF-1α induced P4HA2 expression by stromal cells or cancer cells themselves [6]. Moreover, collagen-dependent ECM biogenesis, which is regulated by P4HA2, can produce a stiff microenvironment for cell migration and invasion [11]. In the brain, types I, III, IV, VI, and XVI have been shown to be dysregulated and closely related to gliomagenesis [21–23], which are confirmed in our study results showing the levels of major collagens were determined by P4HA2 expression in glioma cells. Regarding that the matrix substance of the normal brain, unlike lungs, breast, or other tissues, has a unique composition containing less abundant collagens and fibronectins [24], it is reasonable to believe that the collagen-dependent matrix remodeling, which is enhanced by P4HA2 regulated collagen alignment, is possibly a consequence of gliomagenesis.


## 4.2. P4HA2-Promoted Matrix Collagen Activates PI3K/AKT Signaling

Prior studies indicated that fibrillar collagens can also act as a ligand for biochemical signaling between cells and their microenvironment [20, 25]. Coincidently, our preliminary mechanism investigation by bioinformatics analysis revealed two primary pathways in close relation with P4HA2 expression that were enriching in ECM-receptor interaction and PI3K/AKT signaling. Discoidin domain receptors (DDRs), a class of receptor tyrosine kinases, constitute one of the three types of collagen receptors (the other two are integrins and Endo 180, belonging to the transmembrane and mannose family, respectively) [26, 27]. The molecular structure of DDRs consists of an extracellular collagen-binding domain and an intracellular kinase domain within the C-terminal region. Most importantly, the tyrosine kinase domain contains a YELM binding motif which can interact with the p85 subunit of PI3K [25]. Though the crucial role of the PI3K/AKT signaling pathway in cell survival and tumorigenesis is well established in many cancer types including glioma [15, 28, 29], its involvement in cancer ECM-cell interactions has yet to be elucidated. Herein, we show for the first time that the PI3K/AKT expressions are regulated by P4HA2 in the protein level, but not the mRNA level. Further results showing PI3K/AKT can be downregulated by blocking the collagen hydroxylase of P4HA2 support our proposal that the expressional activation of PI3K/AKT is through a P4HA2 enzyme-mediated protein-protein interaction rather than a direct transcriptional activation. Moreover, by the rescue assay using an AKT agonist we demonstrate the contribution of PI3K/AKT signaling to the oncogenic effect of P4HA2. The results, taken together, illustrate a possible signal axis of the P4HA2-collagen-PI3K/AKT pathway, whereby P4HA2 promotes collagen deposition and enhances the interactions between collagens and cell receptors activating the PI3K/AKT signaling pathway, which leads to glioma malignancies (Figure 6(f)).


## 4.3. EMT Is the Critical Downstream Effect of the P4HA2-Collagen-PI3K/AKT Axis

As glioma malignancies are mostly represented by invasion into adjacent brain tissue, the last question worth clarifying is what mechanism significantly constitutes the bridge linking P4HA2 activated PI3K/AKT signaling to glioma invasion. EMT is a complex multistage process of cancer cells, which is reminiscent of how the ectoderm is programmed to form mesoderm during embryonic development as well as how the epidermal cells within the wound edge are reprogrammed to repair the skin defect [16]. By EMT transformation, cancer cells downregulate the expression of E-cadherin resulting in loss of tight junctions with adjunct cells, whereas they upregulate N-cadherin which provides weaker connections between cancer cells but has a much stronger affinity with matrix cells dominantly expressing N-cadherin molecules. Moreover, its initiation and maintenance involve activation of an orderly series of key transcription factors, matrix metalloproteinases, and Ras-like GTPases, as well as the downstream pathways, all of which contribute to the alteration of intercellular adhesion, ECM remodeling, and ultimately the invasive migration within ECM [30]. As mentioned above, PI3K/AKT pathway has been intensely studied for its role in tumorigenesis including EMT. Evidence shows that PI3K/AKT functions upstream of EMT-related factors and cytokines such as SNAI, SLUG, TWIST, and MMPs, as well as TGF-β, and thus can affect EMT in multiple ways [19]. However, previously there was insufficient evidence showing correlations between PI3K/AKT, EMT phenotype, and ECM regulators. In this study, we firstly revealed negative regulation of EMT transcription factors by P4HA2 silencing and then indicated the negative effect by P4HA2 silencing can be reversed by PI3K/AKT activation. Collectively, it can be speculated that, in glioma, P4HA2-promoted cell invasion may be attributed to EMT downstream of PI3K/AKT activation.Although our study proposes a novel signaling pathway of P4HA2-collagen-PI3K/AKT in mediating the glioma progression, some limitations need to be clarified. First, we only examined the collagen contents in the cell cultures, but it should be better to assess the collagen deposition in the tumor specimens, which could better represent the TME, from thein vivo experiment. Second, the activation of PI3K/AKT by P4HA2 is speculated to be mediated by DDRs receptors. The direct evidence could be acquired by measuring the expression of DDRs as well the interactions between DDRs and the intracellular signaling molecules using immunoblotting and immunoprecipitation assays. Third, as the antitumor effect of P4HA2 inhibition is partially reversed by exogenous PI3K/AKT activation, there could exist other mechanisms that exhibit the oncogenic effect of P4HA2. To our knowledge, the collagen-dependent regulation of focal adhesion kinase (FAK), the prostemness, and proneovascularization effect, as well as the hydroxylation of Carabin by P4HA2, have been indicated in some studies and, thus, merit further investigations [26, 31–33]. Lastly, while our study demonstrates a signaling direction from P4HA2-upregulated expression of matrix collagen to EMT genotypes, some argue that tumor cells following EMT may also reshape the ECM composition. So, whether EMT in glioma can activate P4HA2 and the collagen expression or, in other words, if there exists a feedback loop between ECM remodeling and EMT warrants deeper examination.In conclusion, we revealed that P4HA2 is a prognostic marker and exerts oncogenic functions to promote malignancy of glioma. The underlying mechanism may be regulating the collagen-dependent PI3K/AKT signaling pathway. The study opens up an avenue of targeting P4HA2 and TME related factors and developing inhibitors specific to the activity of the P4HA2 enzyme for therapeutic strategies against glioma.



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*Source: 1406853-2021-08-16.xml*