RAB34

RAB34
  • 文章类型: Journal Article
    初级纤毛是控制细胞发育和组织稳态的毛发状突起。尽管积累的研究确定了纤毛和纤毛相关疾病之间的分子联系,纤毛病的潜在病因尚未完全了解。在本文中,我们确定了Rab34的功能,一种小的GTP酶,作为控制颅面发育中纤毛发生和I型胶原蛋白运输的关键调节剂。机械上,Rab34需要形成控制成骨增殖的纤毛,生存,和通过纤毛介导的Hedgehog信号传导分化。此外,Rab34对于调节I型胶原蛋白从ER到高尔基体的运输是必不可少的。这些结果表明Rab34具有纤毛和非纤毛功能以调节成骨。我们的研究强调了Rab34的关键功能,这可能有助于理解与人类RAB34功能障碍相关的纤毛病的新病因。
    The primary cilium is a hair-like projection that controls cell development and tissue homeostasis. Although accumulated studies identify the molecular link between cilia and cilia-related diseases, the underlying etiology of ciliopathies has not been fully understood. In this paper, we determine the function of Rab34, a small GTPase, as a key regulator for controlling ciliogenesis and type I collagen trafficking in craniofacial development. Mechanistically, Rab34 is required to form cilia that control osteogenic proliferation, survival, and differentiation via cilia-mediated Hedgehog signaling. In addition, Rab34 is indispensable for regulating type I collagen trafficking from the ER to the Golgi. These results demonstrate that Rab34 has both ciliary and non-ciliary functions to regulate osteogenesis. Our study highlights the critical function of Rab34, which may contribute to understanding the novel etiology of ciliopathies that are associated with the dysfunction of RAB34 in humans.
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  • 文章类型: Journal Article
    背景:肥胖患者脂肪组织中过多的脂质积累改变了脂肪细胞的内分泌和能量储存功能。脂肪细胞脂滴代表在这些细胞中协调脂质储存和动员的关键细胞器。最近,我们发现了小的GTPase,Rab34,在脂肪细胞的脂滴卵白组中。在这里,我们对分布进行了表征,细胞内运输,以及这种GTP酶对脂肪细胞生理及其在肥胖中的调节的潜在贡献。
    方法:在体外分化3T3-L1和人原代前脂肪细胞,并使用细胞区室标记分析Rab34的分布和运输。用表达载体和/或Rab34siRNA转染3T3-L1脂肪细胞,并评估其分泌活性。脂质积累和调节脂质代谢的蛋白质的表达。蛋白质组学和蛋白质相互作用分析用于Rab34相互作用组的鉴定。这些研究与功能分析相结合,揭示了GTP酶在脂肪细胞中的作用,重点关注Rab34相互作用蛋白传达的行为。最后,还评估了响应于肥胖的Rab34调节。
    结果:我们的结果表明Rab34定位于前脂肪细胞的高尔基体。在脂滴生物生成过程中,Rab34从高尔基体转移到内质网相关区室,然后到达脂肪细胞脂滴表面。Rab34发挥与其细胞内位置相关的不同功能。因此,在高尔基,Rab34调节水箱完整性以及脂联素运输和寡聚化。在脂滴处,这种GTP酶通过与E1-泛素连接酶的相互作用来控制脂质积累和脂解,UBA1诱导脂肪酸转运蛋白和Rab34相互作用体成员的泛素化和蛋白酶体降解,FABP5.最后,脂肪组织和脂肪细胞中的Rab34水平因肥胖和相关的致病性损伤而受到调节(即,纤维化)。
    结论:Rab34在脂肪细胞分化过程中发挥相关作用,包括来自低聚的调节(即,生物活性)和分泌具有胰岛素增敏作用的主要脂肪因子,脂联素,脂质储存和从脂滴动员。肥胖中的Rab34失调可能导致脂肪因子分泌和脂质代谢的改变,这是过度肥胖条件下脂肪细胞功能障碍的特征。
    BACKGROUND: Excessive lipid accumulation in the adipose tissue in obesity alters the endocrine and energy storage functions of adipocytes. Adipocyte lipid droplets represent key organelles coordinating lipid storage and mobilization in these cells. Recently, we identified the small GTPase, Rab34, in the lipid droplet proteome of adipocytes. Herein, we have characterized the distribution, intracellular transport, and potential contribution of this GTPase to adipocyte physiology and its regulation in obesity.
    METHODS: 3T3-L1 and human primary preadipocytes were differentiated in vitro and Rab34 distribution and trafficking were analyzed using markers of cellular compartments. 3T3-L1 adipocytes were transfected with expression vectors and/or Rab34 siRNA and assessed for secretory activity, lipid accumulation and expression of proteins regulating lipid metabolism. Proteomic and protein interaction analyses were employed for the identification of the Rab34 interactome. These studies were combined with functional analysis to unveil the role played by the GTPase in adipocytes, with a focus on the actions conveyed by Rab34 interacting proteins. Finally, Rab34 regulation in response to obesity was also evaluated.
    RESULTS: Our results show that Rab34 localizes at the Golgi apparatus in preadipocytes. During lipid droplet biogenesis, Rab34 translocates from the Golgi to endoplasmic reticulum-related compartments and then reaches the surface of adipocyte lipid droplets. Rab34 exerts distinct functions related to its intracellular location. Thus, at the Golgi, Rab34 regulates cisternae integrity as well as adiponectin trafficking and oligomerization. At the lipid droplets, this GTPase controls lipid accumulation and lipolysis through its interaction with the E1-ubiquitin ligase, UBA1, which induces the ubiquitination and proteasomal degradation of the fatty acid transporter and member of Rab34 interactome, FABP5. Finally, Rab34 levels in the adipose tissue and adipocytes are regulated in response to obesity and related pathogenic insults (i.e., fibrosis).
    CONCLUSIONS: Rab34 plays relevant roles during adipocyte differentiation, including from the regulation of the oligomerization (i.e., biological activity) and secretion of a major adipokine with insulin-sensitizing actions, adiponectin, to lipid storage and mobilization from lipid droplets. Rab34 dysregulation in obesity may contribute to the altered adipokine secretion and lipid metabolism that characterize adipocyte dysfunction in conditions of excess adiposity.
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  • 文章类型: Case Reports
    骨骼纤毛病是一组异质性的先天性疾病,以多种内部异常为特征。和独特的射线照相显示。已知至少30个纤毛基因中的致病变体导致骨骼纤毛病。在这里,我们报告了具有非典型骨骼纤毛病表型和RAB34基因中复合杂合变体的胎儿。受影响的胎儿有多个畸形,包括颈后水肿,小颌畸形,低设置和小耳朵,耳廓发育不全,唇腭裂,四肢短,以及很少发生的前轴和后轴多指的组合。基因组测序确定了RAB34基因中的复合杂合变体:母体c.254T>C,p.(Ile85Thr),父系c.691C>T,p.(Arg231*)变体。未受影响的同胞中仅存在父系变体。文献中的证据表明Rab34-/-小鼠表现出left裂和多指的纤毛病表型。这些特征与在我们的患者中检测到的畸形一致,支持鉴定的RAB34变体的致病性。总的来说,该病例报告进一步扩展了人类纤毛病综合征的遗传前景,并提示RAB34是骨骼纤毛病的候选基因。
    Skeletal ciliopathies are a heterogenous group of congenital disorders characterized by multiple internal abnormalities, and distinct radiographic presentation. Pathogenic variants in at least 30 cilia genes are known to cause skeletal ciliopathies. Here we report a fetus with an atypical skeletal ciliopathy phenotype and compound heterozygous variants in the RAB34 gene. The affected fetus had multiple malformations, including posterior neck edema, micrognathia, low-set and small ears, auricular hypoplasia, cleft lip and palate, short extremities, and a combination of rarely occurring pre- and postaxial polydactyly. Genome sequencing identified compound heterozygous variants in the RAB34 gene: maternal c.254T>C, p.(Ile85Thr), and paternal c.691C>T, p.(Arg231*) variants. Only the paternal variant was present in the unaffected sibling. Evidence in the literature indicated that Rab34-/- mice displayed a ciliopathy phenotype with cleft palate and polydactyly. These features were consistent with malformations detected in our patient supporting the pathogenicity of the identified RAB34 variants. Overall, this case report further expands genetic landscape of human ciliopathy syndromes and suggests RAB34 as a candidate gene for skeletal ciliopathies.
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  • 文章类型: Journal Article
    在神经元中,树突状货物的降解需要RAB7和动力蛋白介导的向体细胞溶酶体的逆行转运。为了测试动力蛋白适配器RILP(RAB相互作用溶酶体蛋白)是否介导动力蛋白募集到晚期内体,以在树突中逆行运输,我们获得了之前在非神经元细胞中验证过的几种敲除试剂.一个shRILP质粒引起的惊人内体表型未被另一个质粒复制。此外,我们发现了两种shRILP质粒的高尔基体/TGN标记的深度耗尽。这种高尔基体破坏仅在神经元中观察到,无法通过RILP的再表达来挽救。在用siRILP或gRILP/Cas9处理的神经元中也没有发现这种高尔基体表型。最后,我们测试了与RILP相互作用的不同RAB蛋白,即与高尔基体相关的RAB34,可能是高尔基体标记物丢失的原因。显性阴性RAB34的表达确实确实引起一小部分神经元中高尔基体染色的变化,但表现为片段化,而不是染色丢失。与非神经元细胞不同,对RAB34的干扰不会导致溶酶体在神经元中的分散。基于多行实验,我们得出的结论是,用shRILP观察到的神经元高尔基体表型在这种细胞类型中可能是脱靶的。因此,任何观察到的由神经元中的shRILP引起的内体运输破坏可能是高尔基体破坏的下游。鉴定这种神经元高尔基体表型的实际靶标将是有趣的。因此,细胞类型特异性脱靶表型可能发生在神经元中,需要重新验证先前在其他细胞类型中验证的试剂。
    In neurons, degradation of dendritic cargos requires RAB7 and dynein-mediated retrograde transport to somatic lysosomes. To test if the dynein adapter RAB-interacting lysosomal protein (RILP) mediated the recruitment of dynein to late endosomes for retrograde transport in dendrites, we obtained several knockdown reagents previously validated in non-neuronal cells. Striking endosomal phenotypes elicited by one shRILP plasmid were not reproduced by another one. Furthermore, we discovered a profound depletion of Golgi/TGN markers for both shRILP plasmids. This Golgi disruption was only observed in neurons and could not be rescued by re-expression of RILP. This Golgi phenotype was also not found in neurons treated with siRILP or gRILP/Cas9. Lastly, we tested if a different RAB protein that interacts with RILP, namely the Golgi-associated RAB34, might be responsible for the loss of Golgi markers. Expression of a dominant-negative RAB34 did indeed cause changes in Golgi staining in a small subset of neurons but manifested as fragmentation rather than loss of staining. Unlike in non-neuronal cells, interference with RAB34 did not cause dispersal of lysosomes in neurons. Based on multiple lines of experimentation, we conclude that the neuronal Golgi phenotype observed with shRILP is likely off-target in this cell type specifically. Any observed disruptions of endosomal trafficking caused by shRILP in neurons might thus be downstream of Golgi disruption. It would be interesting to identify the actual target for this neuronal Golgi phenotype. Cell type-specific off-target phenotypes therefore likely occur in neurons, necessitating revalidation of reagents that were previously validated in other cell types.
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  • 文章类型: Journal Article
    RAB34(RAB34,RAS癌基因家族成员)在各种癌症中异常表达,并表现出致癌特性。然而,其在神经胶质瘤中的功能仍不清楚。在这项研究中,我们从癌症基因组图谱(TCGA)数据集中收集了697个RNA-seq数据,从中国胶质瘤基因组图谱(CGGA)数据集中收集了325个RNA-seq数据.生物信息学和PCR剖析显示RAB34表达与胶质瘤肿瘤分级呈正相干,并预测胶质瘤患者的不良预后。此外,RAB34表达在经典亚型和间充质亚型中显著上调,和IDH野生型神经胶质瘤。此外,RAB34表达与炎症活动显著相关,免疫浸润,和神经胶质瘤的免疫检查点。体外实验证明抑制RAB34的生长,迁移,以及神经胶质瘤细胞的侵袭,并逆转了上皮-间质转化(EMT)过程。我们的研究结果确立了RAB34作为一种新的进展相关的生物标志物和可能的免疫治疗目标的神经胶质瘤。
    RAB34 (RAB34, member RAS oncogene family) is aberrantly expressed in various cancers and exhibits oncogenic properties. However, its function in glioma remains largely unclear. In this study, we collected 697 RNA-seq data from The Cancer Genome Atlas (TCGA) dataset and 325 RNA-seq data from Chinese Glioma Genome Atlas (CGGA) dataset. Bioinformatics and PCR analysis showed that RAB34 expression was positively related to the glioma tumor grade, and predicted poor outcomes for glioma patients. Additionally, RAB34 expression was significantly upregulated in classical and mesenchymal subtypes, and IDH wild-type gliomas. Moreover, RAB34 expression was remarkably correlated with inflammatory activities, immune infiltration, and immune checkpoints in glioma. In vitro experiments demonstrated that inhibition of RAB34 restrained the growth, migration, as well as invasion of glioma cells, and reversed the epithelial-to-mesenchymal transition (EMT) process. Our findings established RAB34 as a novel progression-related biomarker and a possible immunotherapy target for glioma.
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  • 文章类型: Journal Article
    越来越多的证据表明,代表Ras超家族最大分支的RabGTP酶最近已成为通过调节特定亚细胞区室之间的囊泡运输来调节破骨细胞生成的核心因素。其中,Rab34GTP酶已被确定是重要的后高尔基体分泌途径和吞噬作用;然而,它在破骨细胞生成中的具体作用一直是完全模糊的。这里,在体外模型的破骨细胞形成的鼠巨噬细胞如RAW-D细胞或骨髓来源的巨噬细胞,我们揭示了Rab34双向调节破骨细胞生成。更具体地说,Rab34通过促进两种破骨细胞表面受体的溶酶体诱导的蛋白水解,充当破骨细胞分化的负调节因子。c-fms和RANK,通过早期内体-晚期内体-溶酶体的轴,导致减轻两个破骨细胞分化的主要调节因子的转录活性,c-fos和NFATc-1最终减弱破骨细胞分化和骨吸收。此外,Rab34在调节溶酶体相关蛋白酶的分泌网络中起关键作用,包括基质金属蛋白酶9和组织蛋白酶K穿过破骨细胞的褶皱边界。有助于调节骨吸收。
    Accumulating evidence suggests that Rab GTPases representing the largest branch of Ras superfamily have recently emerged as the core factors for the regulation of osteoclastogenesis through modulating vesicular transport amongst specific subcellular compartments. Among these, Rab34 GTPase has been identified to be important for the post-Golgi secretory pathway and for phagocytosis; nevertheless, its specific role in osteoclastogenesis has been completely obscure. Here, upon the in vitro model of osteoclast formation derived from murine macrophages like RAW-D cells or bone marrow-derived macrophages, we reveal that Rab34 regulates osteoclastogenesis bidirectionally. More specifically, Rab34 serves as a negative regulator of osteoclast differentiation by promoting the lysosome-induced proteolysis of two osteoclastogenic surface receptors, c-fms and RANK, via the axis of early endosomes-late endosomes-lysosomes, leading to alleviate the transcriptional activity of two of the master regulator of osteoclast differentiation, c-fos and NFATc-1, eventually attenuating osteoclast differentiation and bone resorption. Besides, Rab34 plays a crucial role in modulating the secretory network of lysosome-related proteases including matrix metalloprotease 9 and Cathepsin K across the ruffled borders of osteoclasts, contributing to the regulation of bone resorption.
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  • 文章类型: Journal Article
    背景:结直肠癌(CRC)是全球第三大常见癌症,其中RAS信号通路的异常激活经常出现。RAB蛋白(RAB)是调节胞内膜运输途径的最大的Ras小GTPases超家族。已经在包括癌症在内的各种疾病中发现了RAB的失调。与Ras家族的其他成员相比,RAB在结直肠癌中的作用尚不清楚.方法:我们使用TCGA样本的RNA测序和基因分型数据集分析了CRC中RAB的差异表达和临床病理关联。此外,在CRC细胞系和患者样本中研究了RAB17和RAB34的生物学功能.结果:我们在CRC中分析的62例RAB中,七个(RAB10,RAB11A,RAB15,RAB17,RAB19,RAB20和RAB25)显着上调,而六(RAB6B,RAB9B,与正常相比,RAB12,RAB23,RAB31和RAB34)在肿瘤组织中明显下调。我们发现上调的RAB,在代谢激活的CRC亚型(CMS3)中高表达,与细胞周期相关的通路富集相关,与CRC中的错配修复(MMR)基因呈正相关,暗示它们在调节细胞代谢和肿瘤生长中的作用。同时,下调的RAB的高表达与预后不良的CRC间质亚型(CMS4)显着相关,免疫检查点基因,和肿瘤浸润的免疫细胞,表明它们在预测预后和免疫治疗疗效中的作用。有趣的是,虽然RAB34mRNA在CRC中下调,其高表达与不良预后显著相关。体外实验表明,RAB17过表达可通过细胞周期调控促进细胞增殖。同时,RAB34过表达可以促进细胞迁移和侵袭,并与CRC细胞中PD-L1/PD-L2表达增加有关。结论:我们的研究表明,RAB可能在调节细胞周期和免疫相关通路中起重要作用。因此可能是预测CRC预后和免疫治疗反应的潜在生物标志物.
    Background: Colorectal cancer (CRC) is the third most common cancer worldwide, in which aberrant activation of the RAS signaling pathway appears frequently. RAB proteins (RABs) are the largest Ras small GTPases superfamily that regulates intracellular membrane trafficking pathways. The dysregulation of RABs have been found in various diseases including cancers. Compared with other members of Ras families, the roles of RABs in colorectal cancer are less well understood. Methods: We analyzed the differential expression and clinicopathological association of RABs in CRC using RNA sequencing and genotyping datasets from TCGA samples. Moreover, the biological function of RAB17 and RAB34 were investigated in CRC cell lines and patient samples. Results: Of the 62 RABs we analyzed in CRC, seven (RAB10, RAB11A, RAB15, RAB17, RAB19, RAB20, and RAB25) were significantly upregulated, while six (RAB6B, RAB9B, RAB12, RAB23, RAB31, and RAB34) were significantly downregulated in tumor tissues as compared to normal. We found that the upregulated-RABs, which were highly expressed in metabolic activated CRC subtype (CMS3), are associated with cell cycle related pathways enrichment and positively correlated with the mismatch repair (MMR) genes in CRC, implying their role in regulating cell metabolism and tumor growth. While, high expression of the downregulated-RABs were significantly associated with poor prognostic CRC mesenchymal subtypes (CMS4), immune checkpoint genes, and tumor infiltrating immune cells, indicating their role in predicting prognosis and immunotherapy efficacy. Interestingly, though RAB34 mRNA is downregulated in CRC, its high expression is significantly associated with poor prognosis. In vitro experiments showed that RAB17 overexpression can promote cell proliferation via cell cycle regulation. While, RAB34 overexpression can promote cell migration and invasion and is associated with PD-L1/PD-L2 expression increase in CRC cells. Conclusions: Our study showed that RABs may play important roles in regulating cell cycle and immune-related pathways, therefore might be potential biomarkers in predicting prognosis and immunotherapy response in CRC.
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  • 文章类型: Journal Article
    We have previously shown that Rab34 is an important regulator of ciliogenesis and that its unique long N-terminal region (amino acids 1-49) is essential for ciliogenesis in certain cultured mammalian cells. In the present study, we performed an in-depth deletion analysis of the N-terminal region of Rab34 together with Ala-based site-directed mutagenesis to identify the essential amino acids that are required for serum-starvation-induced ciliogenesis in hTERT-RPE1 cells. The results showed that a Rab34 mutant lacking an N-terminal 18 amino acids and a Rab34 mutant carrying an LPQ-to-AAA mutation (amino acids 16-18) failed to rescue a Rab34-KO phenotype (i.e., defect in ciliogenesis). Our findings suggest that the LPQ sequence of Rab34 is crucial for ciliogenesis in hTERT-RPE1 cells.Abbreviations: AA, amino acid(s); ac-Tub, acetylated tubulin; bsr, blasticidin S-resistant gene; HRP, horseradish peroxidase; hTERT-RPE1, human telomerase reverse transcriptase retinal pigment epithelium 1; KO, knockout; NS, not significant; PBS, phosphate-buffered saline; puro, puromycin-resistant gene.
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  • 文章类型: Journal Article
    Primary cilia are sensors of chemical and mechanical signals in the extracellular environment. The formation of primary cilia (i.e. ciliogenesis) requires dynamic membrane trafficking events, and several Rab small GTPases, key regulators of membrane trafficking, have recently been reported to participate in ciliogenesis. However, the precise mechanisms of Rab-mediated membrane trafficking during ciliogenesis remain largely unknown. In the present study, we used a collection of siRNAs against 62 human Rabs to perform a comprehensive knockdown screening for Rabs that regulate serum starvation-induced ciliogenesis in human telomerase reverse transcriptase retinal pigment epithelium 1 (hTERT-RPE1) cells and succeeded in identifying Rab34 as an essential Rab. Knockout (KO) of Rab34, but not of Rabs previously reported to regulate ciliogenesis (e.g. Rab8 and Rab10) in hTERT-RPE1 cells, drastically impaired serum starvation-induced ciliogenesis. Rab34 was also required for serum starvation-induced ciliogenesis in NIH/3T3 cells and MCF10A cells but not for ciliogenesis in Madin-Darby canine kidney (MDCK)-II cysts. We then attempted to identify a specific region(s) of Rab34 that is essential for ciliogenesis by performing deletion and mutation analyses of Rab34. Unexpectedly, instead of a specific sequence in the switch II region, which is generally important for recognizing effector proteins (e.g. Rab interacting lysosomal protein [RILP]), a unique long N-terminal region of Rab34 before the conserved GTPase domain was found to be essential. These findings suggest that Rab34 is an atypical Rab that regulates serum starvation-induced ciliogenesis through its unique N-terminal region.
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  • 文章类型: Journal Article
    目的:已经证实长链非编码RNA(lncRNAs)在人类癌症的发展中起着关键作用。越来越多的证据表明,lncRNA人浆细胞瘤变体易位1(PVT1)在非小细胞肺癌(NSCLC)中失调,这是癌症相关死亡的主要原因。然而,PVT1效应的确切机制仍然难以捉摸。我们的研究集中在NSCLC中PVT1与miR-148和RAB34的相关性。
    方法:采用实时荧光定量PCR(qRT-PCR)和免疫印迹法检测NSCLC组织和细胞中基因和蛋白的表达。CCK8,菌落形成,进行了transwell和伤口愈合试验以评估NSCLC细胞的细胞功能。进行双荧光素酶活性测定和RNA下拉测定以验证miR-148与其靶标之间的相互作用。进行异种移植试验以检测RAB34对体外肿瘤发展的影响。
    结果:在NSCLC组织和细胞中,PVT1和RAB34上调,miR-148下调。PVT1的过表达能够促进NSCLC细胞增殖和迁移,这可以通过miR-148恢复或RAB34敲低来逆转。此外,我们的数据首先确定RAB34的下调具有抑制作用,而RAB34的上调在体外和体内对肿瘤生长具有促进作用.
    结论:这些结果表明,信号通路PVT1/miR-148/RAB34在NSCLC的进展中起关键作用,可作为NSCLC的可能诊断或治疗靶点。
    OBJECTIVE: It has been verified that long non-coding RNAs (lncRNAs) play critical roles in the development of human cancers. Increasing evidence indicates that lncRNA human plasmacytoma variant translocation1 (PVT1) was dysregulated in non-small cell lung cancer (NSCLC) which is the leading cause of cancer-related death. However, the precise mechanism underlying the effect of PVT1 remains elusive. Our research focused on the correlation of PVT1 to miR-148 and RAB34 in NSCLC.
    METHODS: The quantitative real-time PCR (qRT-PCR) and western blot assay were used to detect gene and protein expression in NSCLC tissues and cells. CCK8, colony formation, transwell and wound healing assays were performed to evaluate the cell function of NSCLC cells. Dual-luciferase activity assay and RNA pull down assays were performed to verify the interaction between miR-148 and its targets. A xenograft test was conducted to detect the impact of RAB34 on tumor development in vitro.
    RESULTS: In NSCLC tissues and cells, PVT1 and RAB34 were up-regulated, and miR-148 was down-regulated. Overexpression of PVT1 was capable of promoting NSCLC cell proliferation and migration which could be reversed by miR-148 restoration or RAB34 knock down. Also, our data firstly determined that the down-regulation of RAB34 had inhibitor effects while the up-regulation of RAB34 had promotive effects on tumor growth in vitro and in vivo.
    CONCLUSIONS: Those findings indicated that the signal pathway PVT1/miR-148/RAB34 play critical roles in the progression of NSCLC could be proposed in NSCLC as a possible diagnosis or therapeutic targets.
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