{'fraction_non_alphanumeric': 0.03171044202434337, 'fraction_numerical': 0.03193923309234008, 'mean_word_length': 4.92436974789916, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Identification of a Functional Variant in the MICA Promoter Which Regulates MICA Expression and Increases HCV-Related Hepatocellular Carcinoma Risk

Hepatitis C virus (HCV) infection is the major cause of hepatocellular carcinoma (HCC) in Japan. We previously identified the association of SNP rs2596542 in the 5' flanking region of the MHC class I polypeptide-related sequence A (MICA) gene with the risk of HCV-induced HCC. In the current study, we performed detailed functional analysis of 12 candidate SNPs in the promoter region and found that a SNP rs2596538 located at 2.8 kb upstream of the MICA gene affected the binding of a nuclear protein(s) to the genomic segment including this SNP. By electrophoretic mobility shift assay (EMSA) and chromatin immunoprecipitation (ChIP) assay, we identified that transcription factor Specificity Protein 1 (SP1) can bind to the protective G allele, but not to the risk A allele. In addition, reporter construct containing the G allele was found to exhibit higher transcriptional activity than that containing the A allele. Moreover, SNP rs2596538 showed stronger association with HCV-induced HCC (P = 1.82×10−5 and OR = 1.34) than the previously identified SNP rs2596542. We also found significantly higher serum level of soluble MICA (sMICA) in HCV-induced HCC patients carrying the G allele than those carrying the A allele (P = 0.00616). In summary, we have identified a functional SNP that is associated with the expression of MICA and the risk for HCV-induced HCC.


Introduction
Hepatocellular carcinoma (HCC) is one of the common cancers in the world. It is well-known to be associated with the chronic infection of Hepatitis B (HBV) and Hepatitis C (HCV) viruses. In Japan, nearly 70% of HCC patients are infected with HCV [1]. The annual rate of developing HCC among patients with HCVrelated liver cirrhosis in Japan is estimated to be about 4-8 percent [2]. Recent analyses have identified various genetic factors that are related with viral induced liver diseases [3][4][5]. In our previous twostage genome-wide association study (GWAS) using a total number of 1,394 cases and 5,486 controls, a SNP rs2596542 located on chromosome 6p21.33 was shown to be significantly associated with HCV-induced HCC (P = 4.21610 213 and OR = 1.39) [6]. This SNP is located within the class I major histocompatibility complex (MHC) region and is at about 4.8 kb upstream of MHC class I polypeptide-related sequence A (MICA) gene. We also identified that the risk A allele of SNP rs2596542 was strongly associated with the low expression of soluble MICA (sMICA) in the serum of HCV-related HCC patients [6].
MICA is a membrane protein which is up-regulated in various tumor cells and also induced in response to various cellular stresses such as infection, hypoxia, and heat shock [7]. It is an important component of the innate immune response, as MICA can bind to the NKG2D receptor and subsequently activate natural killer (NK) cells, CD8+ cells, and cd T cells [8,9]. Moreover, membrane MICA can be shed by metalloproteinases, including MMP9, ADAM10, and ADAM17, and secreted into serum as a soluble form [10,11]. Since these metalloproteinases are often activated in HCC, the expressions of both membrane-bound MICA and sMICA are increased [12,13]. SNP rs2596542 was found to be associated with the progression from chronic hepatitis C (CHC) to HCC and also with serum sMICA level. Hence, both rs2596542 and sMICA would be possible prognostic biomarkers for CHC patients. However, their underlying molecular mechanisms were not fully elucidated so far.
We hypothesize that MICA variations could affect sMICA level by either one or both of the following two possible mechanisms: (1) the genetic variation(s) in the coding region affecting the protein stability and (2) the transcriptional regulation. Previously, variable numbers of tandem repeats (VNTRs) in exon 5 of MICA were identified to affect MICA subcellular localization and serum MICA level [14]. The exon 5 of MICA encodes the transmembrane domain and the insertion of an extra G nucleotide in the domain would result in a premature stop codon that would generate MICA protein without a transmembrane domain and subsequently affect sMICA level [14]. However, our previous results indicated that MICA VNTR was not significantly associated with the sMICA level or HCC risk [6]. Therefore, in the current study, we have tried to investigate whether the MICA variations would affect the MICA transcription in the liver cancer cells. Through the functional analysis of genetic variations in the MICA promoter region, we here report a causative SNP rs2596538 that increases the binding affinity of the transcription factor Specificity Protein 1 (SP1) and the risk of progression of the disease.

Samples and genotyping
DNA samples for direct sequencing (50 HCV-related HCC cases), imputation analysis (721 HCV-related HCC cases and 5,486 HCV-negative controls), and serum samples for sMICA ELISA (246 HCV-related HCC) were obtained from BioBank Japan [15,16]. Genotyping of SNPs from 1,394 HCC patients and measurement of sMICA expression by ELISA were performed in the previous study [6]. Genotyping of SNP rs2596542 in 1,043 CHC was performed previously in RIKEN using Illumina HumanHap610-Quad BeadChip [17]. All CHC subjects had abnormal levels of serum alanine transaminase for more than 6 months and were positive for both HCV antibody and serum HCV RNA. The SNP rs2596542 in liver cirrhosis samples without hepatocellular carcinoma from BioBank Japan (n = 420) and the University of Tokyo (n = 166) were genotyped using Illumina HumanHap610-Quad BeadChip or invader assay [18]. All subjects were either subjected to liver biopsy or diagnosed by non-invasive methods including hepatic imaging, biochemical data, and the presence/absence of clinical manifestations of portal hypertension [18]. The samples used in the current project were listed in Table S1. Case samples with HBV co-infection were excluded from this study. The subjects with cancers, chronic hepatitis B, diabetes or tuberculosis were excluded from non-HCV controls. All subjects were Japanese origin and provided written informed consent. This research project was approved by the ethical committees of the University of Tokyo and RIKEN.

Imputation study
The imputation study was performed by using a hidden Markov model programmed in MACH [19] and haplotype information from 1000 genomes database [20]. The imputation results were confirmed by direct DNA sequencing in 50 randomly selected samples.

Cell culture
Human liver cancer cell lines HLE and HepG2 were purchased from JHSF (Osaka, Japan) and ATCC. These cells were grown in Dulbecco's modified Eagle's medium (Invitrogen) with 10% fetal bovine serum. Cells were cultured at 37uC with 5% CO 2 .
EMSA HLE cells were grown in 15 cm culture plate until they reached 95% confluency. The plate was then sealed with parafilm and immersed in a water bath at 42.5uC for 1.5 hours [21]. Nuclear extracts from these cells were prepared according to the standard protocol [22]. EMSA was carried out using DIG Gel Shift Kit, 2 nd Generation (Roche) according to the manufacturer's instructions. The sequences of the 12 probes were listed in the Table S2. In brief, 30 fmol of labeled probes were hybridized with 5 mg nuclear extract for 15 minutes at room temperature. The mixtures were then loaded into a 6% TBE gel, separated by electrophoresis at 4uC and transferred onto a nylon membrane. The membrane was then hybridized with anti-digoxigenin-AP antibody and developed by CSPD solution. For competition study, nuclear extracts were incubated with non-labeled oligonucleotides first before adding labeled probe. For supershift assay, SP1 antibody (SC-59X, Santa Cruz Biotechnology) was added into the nuclear extract and incubated on ice for 30 minutes first before adding labeled probe. The mixtures were then separated by electrophoresis using 4% TBE gel. All EMSAs were repeated twice for reconfirmation of the results.

ChIP
The HLE cells (G allele homozygote) and HepG2 cells (heterozygote) were used in the ChIP assay. The plasmid pCAGGS-SP1 was transfected into both cells by using FuGENE6 Transfection Reagent (Roche). The ChIP assays were carried out using Chromatin Immunoprecipitation Assay Kit (Millipore) according to the manufacturer's protocol. In brief, the cells were treated with formaldehyde to crosslink DNA-protein complexes at 48 hours post-transfection. DNA-protein complexes were then sheared by sonication and immunoprecipitated by rabbit polyclonal anti-SP1 antibody (SC-59X, Santa Cruz Biotechnology). The resulting DNAs were analyzed by PCR (Table S2). In order to determine the binding specificity of SP1 to the SNP rs2596538 allele, the PCR products from HepG2 cells were further subcloned into pCR 2.1 vector and sequenced to assess G to A ratio in both input DNA and immunoprecipitant.

Dual luciferase reporter assay
Three copies of 31 bp DNA fragments equivalent to the EMSA oligonucleotides of SNP rs2596538 were cloned into pGL3promoter vector (Promega). The plasmids were co-transfected with pCAGGS-SP1 and pRL-TK plasmids (Promega) into HLE cells by FuGENE6 Transfection Reagent (Roche). The pCAGGS-SP1 plasmid provided the expression of transcription factor SP1, and pRL-TK plasmid served as internal control for transfection efficiency [23]. The cells were lysed at 48 hours post-transfection, and relative luciferase activities were measured by Dual Luciferase Assay System (Toyo B-Net).

Western blotting
Cancer cell lysates were prepared by using pre-chilled RIPA buffer, and 25 mg of each lysate was loaded into the gel and separated by SDS-PAGE. Western blotting was performed according to the standard protocol. Rabbit anti-MICA antibody (ab63709, abcam: 1/1000) and rabbit anti-SP1 antibody (17-601, Upstate Biotechnology: 1/500) were used in the experiment.

Statistical analysis
The case-control association was analyzed by Student's t-test and Fisher's exact test as appropriate. The association of allele dependent sMICA expression was studied by Kruskal-Wallis test using R statistical environment version 2.8.1. The LD and coefficients (D' and r 2 ) were calculated by Haploview version 4.2 [24].

Analyses of SNP rs2596542 in HCV-infected patients at different disease stages
Since the development of HCC consists of multiple steps, we investigated the role of SNP rs2596542 with disease progression. SNP rs2596542 was genotyped in patients at three different disease categories of CHC (chronic hepatitis C) without liver cirrhosis (LC) or HCC, LC without HCC, and HCC. The statistical analysis indicated that SNP rs2596542 was significantly associated with disease progression from CHC to LC with P-value of 0.048 and odds ratio of 1.17 ( Table 1). The risk allele frequency among HCC patients (40.1%) was higher than that among LC patients (38.0%), but the association was not statistically significant (P-value of 0.203 and odds ratio of 1.09). These results suggested the involvement of MICA with both liver fibrosis and hepatocellular carcinogenesis.

HCV-HCC risk is not associated with MICA copy number variation
A previous report has indicated the deletion of the entire MICA locus in 3.2% of Japanese population [25] and this deletion was shown to be associated with the risk of nasopharyngeal carcinoma (NPC), especially in male [26]. To identify the functional SNP that may affect MICA mRNA expression, we analyzed the relation between the MICA copy number variation (CNV) and the HCC susceptibility. We quantified this CNV by real-time PCR in 375 HCV-related HCC patients and 350 HCV-negative controls. As shown in Table S3, we found no difference in the copy numbers between HCC cases and controls, indicating that this CNV is unlikely to be causative genetic variation for the risk of HCC.

Direct sequencing of 5' flanking region of MICA
We then focused on the variations in the 5' flanking region of the MICA gene which may be associated with its promoter activity. We had conducted direct DNA sequencing of the 5-kb promoter region which included the marker SNP rs2596542 using genomic DNAs of 50 HCC subjects and identified 11 SNPs showing strong linkage disequilibrium with the marker SNP rs2596542 (D'.0.953 and r 2 .0.832) (Fig. S1, Table 2).
Allele specific binding of nuclear protein to genomic region including SNP rs2596538 To investigate whether these genetic variations would affect the binding affinity of some transcription factors, we had conducted the electrophoretic mobility shift assay (EMSA) using the nuclear extract of HLE human hepatocellular carcinoma cells. Since MICA is a stress-inducible protein [21], we first treated the cells with heat shock treatment at 42uC for 90 minutes and confirmed significant induction of MICA expression as shown in Fig. 1a. Then we performed EMSA using 24 labeled-oligonucleotides corresponding to each allele of the 12 candidates' SNPs. The results of EMSA demonstrated that an oligonucleotide corresponding to a G allele of SNP rs2596538 exhibited stronger binding affinity to a nuclear protein(s) than that to an A allele (Fig. 1b). We then confirmed the specific binding of nuclear proteins to the G allele by competitor assay using non-labeled oligonucleotides (Fig. 1c). The self (G allele) oligonucleotides inhibited the formation of DNA-protein complex in a dosedependent manner, but the non-self (A allele) oligonucleotides showed no inhibition effect. Taken together, some nuclear protein(s) in hepatocellular carcinoma cells would interact with a DNA fragment including the G allele of SNP rs2596538.  Since in silico analysis identified a putative GC box in a protective G allele but not in a risk A allele (Fig. 2a), the transcription factor SP1 might preferentially bind to the G allele. Base on this information, we further performed competitor assay using non-labeled oligonucleotides (Table S2) and found that among seven tested oligonucleotides, only SP1-consensus oligonucleotides could effectively inhibit the binding of the nuclear protein(s) to the labeled G allele (Fig. 2b). In addition, we identified that the addition of anti-SP1 antibody caused a supershift of a band corresponding to the DNA-protein complex while control IgG did not cause the band shift (Fig. 2c). This result clearly indicated that the SP1 protein is very likely to be a component of the DNA-protein complex.
Furthermore, we performed chromatin immunoprecipitation (ChIP) assay to confirm the binding of SP1 to this genomic region in vivo. We had used two cell lines with different genetic backgrounds at SNP rs2596538 locus: HLE cells carrying the only G allele, while HepG2 cells harboring both A and G alleles. After the introduction of SP1 expression vector (pCAGGS-SP1) into these cell lines, the cell extracts were subjected to ChIP assay using anti-SP1 antibody (Fig. 2d). Subsequent PCR experiments indicated that SP1 bound to a genomic fragment containing the G allele of SNP rs2596538 in vivo, while 3' UTR region of MICA (negative control) was not immunoprecipitated with anti-SP1 antibody. To further evaluate the binding ability of SP1 to each allele in vivo, we sub-cloned the DNA fragment that amplified from genomic DNA of HepG2 cells before and after immunoprecipitation by anti-SP1 antibody. The subsequent sequencing results showed that 26 out of 29 tested clones contained the G allele, demonstrating the preferential binding of SP1 to the G allele (Fig. 2e).

SP1 over-expression preferentially up-regulates MICA expression at G allele
To further investigate the physiological role of the interaction between SP1 and this genomic region, we performed reporter gene assay. Three copies of 31-bp DNA fragments flanking the candidate functional SNP rs2596538 were subcloned into the multiple cloning sites of the pGL3 promoter vector. The relative luciferase activity of the plasmid including the G allele was significantly higher than that including the A allele (Fig. 3a). Furthermore, over-expression of SP1 in the cells could significantly enhance the luciferase activity of the G-allele vector, while the enhancement of the A-allele vector was relatively modest (Fig. 3a). We also evaluated the effect of ectopically expressed SP1 on the MICA expression in HLE cells. Western-blot analysis showed that MICA protein expression was significantly increased after the SP1 over-expression (Fig. 3b). These results provided a strong evidence that the G allele has higher transcriptional potential that can be inducible by SP1.

Association of SNP rs2596538 with HCC risk and sMICA level in HCV-induced HCC patients
To further investigate the role of SNP rs2596538 in human carcinogenesis, we investigated the association of SNP rs2596538 with HCV-induced HCC in 721 HCV-HCC cases and 5,486 HCV-negative controls that had been genotyped using Illumina HumanHap610-Quad Genotyping BeadChip in our previous study [6]. We performed imputation analysis by using haplotype data from 1000 genome database [20] and found that an A allele of SNP rs2596538 was considered to be a risk allele for HCVrelated HCC (Table 3, odds ratio = 1.343, P = 1.82610 25 ). The functional SNP rs2596538 exhibited a stronger association with the HCC risk than the marker SNP rs2596542 (2.46610 25 ). We also analyzed the relationship between the SNP rs2596538 and the sMICA level among 246 HCV-induced HCC patients and found a significant association with the P-value of 0.00616 (Fig. 4). These results were concordant with our functional analyses in which the G allele exhibited a higher affinity to SP1 and revealed a higher transcriptional activity.

Discussion
Approximately 160 million people (2.35% of the worldwide population) are estimated to have HCV infection [27]. Since HCV carriers have an increased risk to develop liver cirrhosis and subsequent HCC [28,29], the prediction of cancer risk is especially important for CHC patients. In our previous study, we have identified that SNP rs2596542 located in the upstream of MICA gene was significantly associated with the risk of HCC development among CHC patients as well as the serum level of sMICA [6]. In this study, we found that the genetic variant at SNP rs2596538 strongly affected the binding affinity of SP1. Overexpression of SP1 remarkably induced MICA expression in cells carrying the G allele that has a higher affinity to the SP1 binding. These findings are concordant with higher serum sMICA level among HCC patients with the G allele at SNP rs2596538. SP1 is a  ubiquitously expressed transcription factor which binds to the GCrich decanucleotide sequence (GC box) and activates the transcription of various viral and cellular genes [30,31]. Phosphorylation of SP1 was shown to be induced by HCV core protein and exhibited higher binding affinity to the promoter region of its downstream targets [32]. From our previous study, we showed a significant difference of sMICA expression between non-HCV individuals and CHC patients. This indicated that sMICA expression was induced after HCV infection [6]. Hence, we here propose the following hypothesis. After HCV infection, the virus core protein enhances the SP1 phosphorylation in hepatocytes, and the phosphorylated SP1 binds to the DNA segment corresponding to the G allele of SNP rs2596538 and then induces MICA expression. The membrane-bound MICA (mMICA) serves as a ligand for NKG2D to activate the immune system and results in the elimination of viral-infected cells by NK cells and CD8+ T cells [8,9]. Eventually, HCV-infected individuals with higher MICA level may cause stronger immune response to the infected cells and hence result in a reduced risk for HCC progression. Moreover, the mMICA is then shed by metalloproteinases that are often over-expressed in cancer tissues and convert mMICA to sMICA. This resulted in a significantly increase of sMICA level in the serum of HCV infected patients.
In contrast to HCV-induced HCC, our group had previously identified that higher sMICA level was associated with poor prognosis in HBV-induced HCC patients [33]. Such an opposite effect of MICA would be attributable to the difference in downstream pathway between HBV and HCV. HBV virus encodes hepatitis B virus X protein (HBx) that is pathogenic and promotes tumor formation. It had been reported that HBx protein was associated with an elevated expression of MT1-MMP, MMP2, and MMP3 [34,35]. HBx was also shown to transactivate MMP9 through ERKs and PI-3K-AKT/PKB pathway and suppress TIMP1 and TIMP3 activities [36,37]. The activation of metalloproteinases would induce the shedding of mMICA into sMICA, which promotes the tumor formation through the inhibitory effect of sMICA on NK cells. This can explain why high sMICA expression is a marker of poor prognosis for HBVinduced HCC. On the other hand, HCV infection was not associated with metalloproteinases activation, although the expression of sMICA was shown to be proportional to mMICA level. Therefore individuals with high MICA expression are likely to activate natural killer cells and CD8+ T cells to eliminate virus infected cells. SP1 was previously identified as a transcriptional regulator of both MICA and MICB [7,9,38]. A polymorphism in the MICB promoter region was found to be associated with MICB transcription level [7]. To our knowledge, this is the first report showing that MICA transcription is directly influenced by functional variant. Moreover, this functional SNP is significantly associated with HCV-induced HCC. Our findings provide an insight that MICA genetic variation is a promising prognostic biomarker for CHC patients. Figure S1 Pairwise LD map between marker SNP and 11 candidates SNP. Black color boxes represent regions of high pairwise r 2 value. The LD was determined by direct DNA