eRNAs are noncoding RNAs that are transcribed from enhancers. Studies have shown that enhancers usually regulate the expression of target genes by forming a chromatin loop with the target promoter (8,24). For example, Rosenfeld et al. found that estrogen-regulated eRNAs can bind cohesin complex proteins, including RAD21 cohesin complex component (RAD21) and structural maintenance of chromosomes 3 (SMC3), and the authors proposed that eRNA/cohesin interactions serve to stabilize chromatin looping in breast cancer cells (25). Additionally, mediator complex subunit 1 (MED1) in prostate cancer cells (26), heterogeneous nuclear ribonucleoprotein U (hnRNPU) in gastric cancer cells (27), CCCTC-binding factor (CTCF) in colon cancer cells (28), and mediator complex subunit 12 (MED12) in T-cell acute lymphoblastic leukaemia cells (29) have been shown to regulate chromatin loop stability through interactions with eRNAs, thereby modulating the expression of downstream target genes. Although increasing evidence has indicated the critical roles of eRNAs in the control of gene expression, the potential role of eRNAs in LUAD remains largely unexplored.
In the present study, we obtained RNA expression profile data and clinical information for LUAD from the TCGA database and integrated these data with eRNA-related information. Using Spearman’s correlation and Kaplan–Meier analyses, we identified 76 candidate eRNAs related to the prognosis of LUAD. We further identified TBX5-AS1 as the most critical eRNA candidate sequence in LUAD, and TBX5 as its regulatory target. Clinical correlation analysis showed that TBX5 was differentially expressed according to T stage, N stage, gender, and cancer status. KEGG pathway enrichment results suggested that TBX5 may affect the survival outcome of LUAD patients through the PI3K/AKT pathway. Our pan-cancer validation results revealed that TBX5-AS1 was associated with survival in four types of tumours (ACC, LUAD, LUSC, and UCEC). Furthermore, TBX5-AS1 expression was correlated with that of its target gene, TBX5, in 26 tumour types. Finally, we validated the expression of TBX5-AS1 in surgical specimens by qRT-PCR and examined the expression levels of TBX5 in LUAD using the HPA databases. Together, our results indicated that TBX5-AS1 could be used as an independent predictor of LUAD.
Our results further suggest that TBX5-AS1 may regulate chromatin loop stability by binding to specific protein factors, which in turn promotes the expression of TBX5, its target gene. TBX5, a member of the T-box gene family, plays an important role in heart development (30-32). Members of this family are involved in a variety of processes, including cell–cell signalling, proliferation, apoptosis, and migration (33). Studies have shown that TBX5 dysregulation plays an important role in breast cancer (33), gastric cancer (34), oesophageal carcinoma (35,36), and colon cancer (37). For example, the TBX5 mRNA expression level is significantly downregulated in colorectal cancer cells; its methylation rate is significantly higher in cancer tissues than in normal tissues; and overexpressing TBX5 can inhibit the growth of colorectal cancer cells, promote the apoptosis of cancer cells, and reduce the migration rate of cancer cells (37). In this study, we found that TBX5 was highly expressed in normal paracancerous tissues and cell lines, whereas its expression was downregulated in LUAD tissue and cells. These findings revealed that the level of TBX5 is negatively correlated with lung cancer progression, which is consistent with the regulation of TBX5 in colon cancer (37). To date, whether TBX5 has a role in LUAD remains unknown. However, Ma et al. (2017) found that TBX5 may induce early and late apoptosis in NSCLC cells by activating key molecules in the apoptotic pathway, including cleaved caspase-3, cleaved caspase-8, CDKN2, and PARP. Moreover, the overexpression of TBX5 can inhibit cell proliferation, clone formation, and invasion, as well as induce apoptosis, in a NSCLC cell line (38). eRNA TBX5-AS1 might exert its antitumour effects through promoting the expression of TBX5. In summary, the present findings suggested that TBX5-AS1 has potential as a diagnostic biomarker and therapeutic target for LUAD.
Although we identified the key eRNA in LUAD and investigated its possible role in this disease, our study had several limitations. For instance, a larger clinical cohort is needed to further assess the diagnostic and prognostic potential of TBX5-AS1 in LUAD, while the potential function of TBX5-AS1 in LUAD also requires further investigation. Moreover, we demonstrated that TBX5-AS1 has roles in multiple cancer types, including ACC, LUAD, LUSC, and UCEC, and the emerging roles of TBX5-AS1 in these cancers also need to be characterized.