With the development and application of targeted therapy and immunotherapy, the use of traditional chemotherapy is increasingly restricted and denounced in NSCLC. Even so, platinum is still administered widely for the treatment of NSCLC [20, 21]. However, long-term survival in patients with NSCLC remains poor largely due to the emergence of resistance prior to and during the course of treatment. [2–4]. Thus, the exploration of novel driver oncogenes is urgently needed in order to identify targets for reversing drug resistance in NSCLC.
In this report, we found that the SOX2 protein or mRNA expression in A549/CDDP cells was higher than that in A549 cells [19]. Knockdown of SOX2 in A549/CDDP cells induced apoptosis by inhibiting colony formation and decreasing cell viability [22], but overexpression of SOX2 reversed these effects [22]. This suggests that SOX2 promotes cell growth in NSCLC, but Koki Takeda et al. thought that SOX2 may suppress cell proliferation in colorectal cancer [23]. SOX2, as a putative marker of undifferentiated cells [23, 24], has additional roles in adult tissue homeostasis and regeneration [25]. Recently, aberrant expression of SOX2 has been demonstrated in various types of cancers, including NSCLC [18, 22, 23, 26, 27]. Additionally, studies found that SOX2 regulates the stem cell properties and drug resistance of cancer cells [10], which was consistent with our previous findings for the role of SOX2 in NSCLC A549/CDDP cells [28].The mechanisms of resistance to cisplatin among different cell types are different and complicated [19]. Notably, SOX2 is involved in cisplatin resistance events [19, 29, 30]. Emerging downstream targets regulating SOX2, such as cyclin D1, Nanog, SKIL, and PI3K, have been found [5, 31, 32]. However, to date, the downstream targets are not fully understood. On the other hand, studies aimed at functional depletion, for example, by siRNA knockdown, are difficult to translate into clinical settings. Alternatively, the identification of upstream or downstream regulators of SOX2 that are easier to target is of utmost importance [31].
Interestingly, Genomatix software [33] predicted that the APE1 promoter has some SOX2 binding sites but that the SOX2 promoter has no APE1 binding sites. Further, APE1 was highly expressed in A549/CDDP cells compared with A549 cells, suggesting that it may benefit cisplatin resistance [34]. APE1 expression was decreased or increased with knockdown or overexpression of SOX2 in NCI-H460 cells, respectively. We also found that SOX2 expression was not affected by shAPE1 in A549/CDDP cells in vitro. Furthermore, luciferase reporter assays further proved that SOX2 could bind the promoter of APE1 in 293T cells. All these data suggest that SOX2 induces cisplatin resistance in NSCLC by regulating APE1. In addition, this is the first report indicating that APE1 is a direct downstream target of SOX2.
As expected, colony formation was obviously inhibited and apoptosis was strongly enhanced in A549/CDDP cells treated with siSOX2 alone or combined with CDDP compared with the control cells [11]. Finally, we found that SOX2 expression was different in 45 advanced NSCLC patients and that patients with high expression of SOX2 survived longer than those with low expression of SOX2, which was consistent with some previous reports [35, 36]; however, some studies reported that SOX2 is a predictor of poor survival in upper tract urothelial carcinoma, breast cancer and small cell lung cancer [37–39].
In conclusion, we found that SOX2 was overexpressed in A549/CDDP cells with acquired resistance versus parental A549 cells. Further study revealed that siSOX2 overcomes cisplatin resistance in NSCLC by regulating APE1 signaling, providing a new therapeutic target for NSCLC patients.