PCa is a common clinical disease with a complex pathogenesis. Decreased immunity or changes in intracellular genetic material will lead to uncontrolled or abnormal cell growth(El-Amm et al. 2013; Ito 2014; Siegel et al. 2019). Although there have been some studies on circulating miRNAs as diagnostic markers for PCa, their diagnostic roles are still controversial, such as inconsistent results from different data sources(Cannistraci et al. 2014). In addition, individual differences in patients and tumor heterogeneity can affect the diagnostic efficacy of circulating miRNAs, thus hardly forming a unified conclusion(Aiso et al. 2018; Gasch et al. 2015; Hara et al. 2022; Yu et al. 2019).
The present study was based on two datasets (GSE206793 and GSE112264) expressing miRNAs in peripheral blood of PCa patients for diagnostic analysis. By setting reasonable screening thresholds, it was found that miR-455-3p co-occurred in both datasets and was highly expressed in PCa patients. In addition, miR-455-3p was highly expressed in patients with high GS, independent of T stage, age and PSA. Serum miR-455-3p was also highly expressed in other cancer patients, especially lung cancer, glioma and bladder cancer. These findings revealed a unique clinical feature of miR-455-3p in PCa. In glioma, miR-455-3p is highly expressed in patient tissues and represents an independent prognostic indicator of overall survival in patients, promising to serve as a prognostic biomarker(Wang et al. 2019). In liver cancer (LC), there was a 1.022-fold increase in the odds ratio for each unit increase in miR-455-3p, and increased serum levels of miR-122-5p and miR-455-3p were independently associated with an increased risk of incident LC in type 2 diabetes (T2D), which may be the potential biomarkers for early diagnosis of LC in T2D(Lee et al. 2021). Moreover, miR-455-3p has a potential diagnostic role in other non-cancer diseases, such as acute graft-versus-host disease, Alzheimer's disease and acute myocardial infarction(Lee et al. 2021). Consistent with these studies, ROC analysis demonstrated a favorable diagnostic efficacy of miR-455-3p in PCa patients (AUC > 0.8).
To validate the diagnostic efficacy of miR-455-3p, clinical blood samples were collected for assay. Consistent with the analysis of both datasets, miR-455-3p was highly expressed in PCa patients with GS ≥ 8, while PSA levels were not associated with GS. Among the 8 PCa patients, P1 with high GS (5 + 4) had a misdiagnosis of serum PSA < 4 ng/ml, while P6 with medium GS (3 + 3) had a serum PSA of 4.45 ng/ml, which was inconsistent with the risk degree. Clinically, serum PSA ≥ 4 ng/ml suggests a risk of developing PCa(Ito et al. 2004). However, PSA has the disadvantages of high false-positive rate, low sensitivity and inability to distinguish the malignancy degree of the tumor, failing to accurately diagnose and predict PCa development (Gupta et al. 2022; Jin et al. 2020; Schatteman et al. 2000). However, miR-455-3p was highly expressed in both P1 and P6, suggesting that it may have a superior diagnostic efficacy to PSA. Further validation using the GSE206793 dataset also revealed similar results. miR-455-3p was highly expressed in 20 misdiagnosed PCa patients (PSA < 4 ng/ml). Our study identified that miR-455-3p could be used as a novel diagnostic marker for PCa. Although miR-455-3p may have an advantage in diagnostic efficacy compared with PSA, a larger sample amount is still needed for validation.
Finally, the downstream targets of miR-455-3p were predicted by miRWalk website and 9 potential genes (PPP2R2A, ATL2, TOR1B, POFUT2, CDKN1A, GIGYF2, ITGB1, GGCX and OTULINL) were successfully screened. PPI network revealed that PPP2R2A, ITGB1 and CDKN1A were the key nodes. KEGG results indicated that they were closely related to cancer and involved in the regulation of various biological processes and molecular signals. In PCa, upregulation of miR-556-5p promoted cell proliferation by suppressing PPP2R2A expression(Zhao et al. 2015). In bladder cancer, miR-222 attenuated cisplatin-induced cell death by targeting the PPP2R2A/Akt/mTOR axis(Zeng et al. 2016). In addition, ITGB1 and CDKN1A were found to play key regulatory roles in PCa(Jain et al. 2013; Kurozumi et al. 2016; Lai et al. 2021; Pellinen et al. 2018). These results further suggest an important mediating role of miR-455-3p in PCa development.
In conclusion, miR-455-3p is highly expressed in the peripheral blood of PCa patients and correlates with GS. miR-455-3p is a novel diagnostic marker for PCa with superior diagnostic potential to PSA.