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Regulation of miR-375 and Sonic hedgehog on vascular endothelial growth factor in preeclampsia rats and its effect on trophoblast cells Running title: VEGF regulated by miR-375 and SHH pathway

PURPOSE
To study the mechanism of vascular endothelial growth factor (VEGF) regulated by miR-375 and Sonic hedgehog (SHH) signaling pathways on the characteristics of trophoblast cells (TCs) in preeclampsia (PE) rats.


METHODS
Female (100) Wistar rats in rut were mated with males (50) at a ratio of 2:1, and 60 pregnant rats were assigned to a normal group (Nor, n=10) and a model group (Mod, n=50) in a random manner. Rat TCs of placental villus were isolated and were divided into 8 groups. The related indicators in each group were detected, respectively.


RESULTS
In contrast to the NC group, miR-375 expression greatly elevated in the miR-375 mimic group (mimic group); in the mimic and cyclopamine groups, VEGF, proliferating cell nuclear antigen（PCNA, N- cadherin and Bcl-2 expression, cell proliferation, S phase cells, and migration and invasion ability were significantly decreased and E-cadherin and Bax expression, G1 phase cells and apoptosis rate were increased significantly, but in Over expressing-VEGF（ov-VEGF） group, the above indicators presented contrary results (all P< 0.05). In contrast to the mimic group, the expression of SHH, VEGF, PCNA, N- cadherin and Bcl-2, cell proliferation, S phase cells and the invasion and migration activity in the miR-375 mimic + oe-VEGF group were evidently increased.


CONCLUSIONS
Over-expressing miR-375 can inhibit the expression of VEGF, thus slow down the invasion and proliferation of TCS in PE rats, which is realized by regulating SHH signal pathway.


Introduction
Preeclampsia (PE) is a malady specific to pregnant women with a prevalence rate of 7%-12% worldwide [1]. As one of the most common pathological complications of pregnancy, PE, characterized by hypertension and proteinuria, is the primary cause of pregnancy-related death, Downloaded from http://portlandpress.com/bioscirep/article-pdf/doi/10.1042/BSR20200613/879321/bsr-2020-0613.pdf by guest on 20 September 2020 Bioscience Reports. This is an Accepted Manuscript. You are encouraged to use the Version of Record that, when published, will replace this version. The most up-to-date-version is available at https://doi.org/10.1042/BSR20200613 4 increased trophoblast cell death [4]. Some studies have found increased apoptosis rate in villous trophoblast cells (TCs) in PE [5].
MicroRNAs (miRNAs) are non-coding RNAs , 22 nucleotides or so in size, which are able to negatively affect and silence target genevia binding with the 30 untranslated regions of mRNA [6]. Increasing number of reports have proved that miRNAs affect various important cellular processes s including proliferation, differentiation, and migration [7]. According to earlier studies, miRNAs affect the development of PE by regulating multiple targets or signal pathways. For example, the expression of microRNA-34a, miRNA-31-5p and miR-134 is significantly up-regulated in the placenta of preeclampsia patients [8][9][10]. Recent studies have shown that miR-375 in neuropathic mice was up regulated. [11]. However, the mechanism of miR-375 in occurrence and development of PE remains unclear. Sonic hedgehog (SHH) is a morphogen important for the development of mammalian embryos. In the post-embryonic phase, SHH is important for maintaining steady-state processes such as angiogenesis and cardiac repair [12]. SHH is secreted to ectoderm as monomer or multimer and exerts its cellular function through molecules located in the primary cilium. Once SHH binds to its 12transmembrane receptor, Patched1, it releases Smoothened (SMO), which is a 7transmembrane receptor and part of the G-protein coupled receptor superfamily. SMO will transduce the SHH signal through the cytoplasm, thereby activating the family of zinc finger transcription factor including GLI1, GLI2, and GLI3 (to a lesser extent). The GLI transcription factor recognizes the GLI binding locus in DNA and stimulates transcription of target genes such as PTCH1 and GLI1 via negative and positive feedback loops, respectively [13][14][15].
Mutations in different transcription factors of SHH signaling and dysregulation of their target genes will cause a variety of maladies including s basal cell nevus syndrome and basal cell carcinoma [16].To date, few studies have reported the function of the SHH axis in PE. Vascular endothelial growth factor (VEGF) is pivotal for networks and angiogenesis of vessels [17]. VEGF signals by its cognate receptor, and the kinase activity of VEGF receptor 2 is the key to trophoblast invasion [18]. EG-VEGF is not only an Downloaded from http://portlandpress.com/bioscirep/article-pdf/doi/10.1042/BSR20200613/879321/bsr-2020-0613.pdf by guest on 20 September 2020 Bioscience Reports. This is an Accepted Manuscript. You are encouraged to use the Version of Record that, when published, will replace this version. The most up-to-date-version is available at https://doi.org/10.1042/BSR20200613 5 important maker and protein in embryo implantation, but also a critical factor in endocrine control of placental development in the third trimester of pregnancy, moreover, VEGF is a specific gene of the SHH axis [19]. In the present research, we found a targeting relation between miR-375 and VEGF via bioinformatics prediction. Therefore, we speculate that miR-375 and SHH signaling pathway is crucial for the biological characteristics of TCs in preeclampsia rats.

Animals
Clean grade adult Wistar rats ( 200g to 225g) were fed at room temperature and they could obtain the water and food freely. Female (n=100) Wistar rats in rut were mated with males (n=50) at a ratio of 2:1. The secretions of rats are examined daily and the time of discovery of sperm was defined as the beginning of pregnancy. Sixty pregnant rats were assigned to two groups: normal group (Nor, n=10) and model group (Mod, n=50), in a random manner. Rats in the Mod were subcutaneously injected with L-nitro-arginine methyl ester at 125 mg/(kg·d) since the 15 th day of pregnancy to the 22th day, while those in the Nor were subcutaneously given with normal saline. The systolic blood pressure was measured on days 7,14,18,19, and 20 of gestation. If systolic blood pressure was significantly increased, PE rat model was successfully established.
Rats were sacrificed after childbirth, 1% pentobarbital sodium (250 mg /kg) were injected into the abdomen of rats CO2 died of euthanasia by inhalation, and the uterus placenta was taken to isolated chorionic trophoblast tissues for primary cell isolation and culture. Approval from the medical ethic committee of The First Affiliated Hospital of Xinxiang Medical University had been obtained prior to the study. This study has been approved by the animal experimental ethics committee of The First Affiliated Hospital of Xinxiang Medical University. All animal experiments were performed at laboratory of Xinxiang Medical University.

Isolation, culture and transfection of TCs from placental villus tissue
The chorionic trophoblast tissues were cut and trypsinized to obtain the cell suspension, which was then centrifuged, cleaned thrice using PBS, and resuspended by RPMI1640 culture medium (Gibco, United States) having 10% fetal bovine serum (FBS, Gibco, United States) and routine antibiotics. After being incubated in a 5% CO 2 incubator at 37 degrees centigrade , the cells were in the morphology of epithelioid-like cells and spread in a sheet-like manner under the inverted microscope. TCs grown in log phase were seeded in 6-well culture plates with serum free RPMI1640 medium at 1*10 5 /well. Then, rat TCs were assigned to the Nor (TCs from normal rat), Mod (TCs from model rat), NC group (TCs from model rats transfected with NC, 50nM), miR-375 mimic group (mimic group, TCs from model rats transfected with miR-375 overexpression vector, 50nM), cyclopamine group (TCs from model rats treated with SHH signaling pathway specific inhibitor cyclopamine, 5μM) [20], oe-VEGF Group (TCs from model rats transfected with VEGF overexpression vector, 50nM), miR-375 mimic+oe-VEGF group (mimic+oe-VEGF group, TCs from model rats treated through miR-375 overexpression vector (50nM) and VEGF overexpression vector (50nM)) and cyclopamine+oe-VEGF group (TCs from model rats treated with cyclopamine and transfected with VEGF overexpression vector).
Lipofectamine 2000 was used for the transfection of vectors according to the instructions. The medium was substituted by complete RPMI1640 after 6 hour transfection, and the cells were obtained for later study after transfection for 48h.

Dual luciferase reporter (DLR) system assay
Firstly, the binding locus was explored via the bioinformation prediction website (www.targetscan.org) between miR-375 and VEGF. The targeting correlation of miR-375 with VEGF was next investigated by the DLR system assay. The VEGF DLR vector (PGL3-VEGFwt) and the mutants (PGL3-VEGFmut) that bind to the miR-375 binding locus were constructed, respectively. The Rellina plasmid and the above two were co-injected into HEK293T cells with the miR-375 plasmid and the NC plasmid, respectively.
After 24 hours of transfection, DLR assays were performed. The cells of each group were pyrolysed, followed by1 minute centrifugation at 12,000 rpm to collect, the supernatant. The luciferase activity ((LU activity) was determined by the DLR kit (Promega, USA) according to the instruction of kit. Briefly, the lysed cell specimen (10μL) and firefly luciferase working solution (100μL) were added into EP tubes, and then the firefly LU activity was determined.
Afterwards, 100μL Renilla luciferase working solution was put in the tubes and the LU activity was detected again. Relative LU activity = firefly LU activity / renilla LU activity.

Flow cytometry
At 48 h after transfection, the cells were harvested and cleaned through PBS thrice, followed by 20 minutes of 2,000 rpm centrifugation. The supernatant was removed, and the cell concentration was changed to 1*10 5 /mL with PBS. Then, pre-cooled 75% ethanol (1mL) was put in and the specimens were stood at 4 degrees centigrade for 1 h, followed by 1,200 r/min centrifugation for 5 minutes and thrice cleaning by PBS. After then, Rnase A (120μL, Siemo, United States) was put in the samples in the dark and cultured at 37 degrees centigrade for 40 min, followed by mixing with PI dye solution (500μL, Sigma, USA) and incubating at 4 degrees centigrade in the dark for 30min. Cell cycle (red fluorescence) was determined through flow
According to the DLR system assay,the LU activity of Wt-VEGF in the mimic group was greatly weaker than that in the NC group (P<0.05). The LU activity of the Mut-VEGF presented insignificant difference between the two groups, indicating miR-375 could target the negative regulation of VEGF gene (P>0.05, Figure. 1b).

MiR-375, SHH and VEGF expression in cells from each group
To investigate how miR-375 and SHH signaling pathways affect the VEGF gene expression and play a role on the biological characteristics of TCs in preeclampsia rats, we detected the mRNA and protein levels of miR-375, SHH and VEGF by qRT-PCR and WB assays ( Figure. 2). It came out that compared with the Nor, miR-375 was up-regulated in the other groups, while SHH and VEGF were down-regulated (P>0.05);in contrast tothe Mod, no remarkable difference was seen in the gene expression in the NC group (P>0.05);the VEGF expression in the mimic group and the cyclopamine group greatly decreased, while it greatly elevated in the oe-VEGF group (P<0.05). The VEGF expression in the mimic + oe-VEGF group was much above that in the mimic group (P<0.05), and the VEGF expression in the cyclopamine+oe-VEGF group was also above that in the cyclopamine group (P<0.05). MiR-375 was remarkably up-regulated in the mimic group, and SHH was remarkably down-regulated in the cyclopamine group (both

Cell proliferation in different groups
The MTT assay showed that the cell proliferation in all groups elevated with time ( Figure. 3). In comparison with the Nor, the cell proliferation in the rest was down-regulated (P>0.05). In contrast to the Mod, the proliferation showed no remarkable difference in the NC group, but decreased in the mimic and cyclopamine groups and raised in the oe-VEGF group (P<0.05). The mimic+oe-VEGF group showed stronger proliferation of TCs than the mimic group (P<0.05), and the cyclopamine+oe-VEGF group also showed stronger proliferation of TCs than the cyclopamine group (P<0.05).

Cell cycle of cells in different groups
The cell cycle in each group was explored through flow cytometry ( Figure. 4). It came out that compared with the Nor, there were evidently more G1-phase cells in the rest groups and remarkably less S-phase cells (P<0.05). The cell phase was insignificantly different between the Mod and NC group (P >0.05); the mimic and cyclopamine groups presented much more G1phase cells and much less S-phase cells (both P <0.05), while the oe-VEGF group had contrary results. The mimic + oe-VEGF group presented remarkably less G1-phase cells and much more S-phase cell than the mimic group (both P <0.05). The cyclopamine+oe-VEGF group presented remarkably less G1-phase cells and remarkably more S-phase cells than the cyclopamine group (both P <0.05).

Apoptosis in different groups
Apoptosis was determined via flow cytometry ( Figure. 5) and it came out that the rest groups showed greatly higher apoptosis rate of TCs than the Nor (P >0.05). In contrast to the Mod, the apoptosis rate presented insignificant difference in the NC group (P >0.05), but was greatly elevated in the mimic and cyclopamine groups and remarkably lowered in the oe-VEGF group Downloaded from http://portlandpress.com/bioscirep/article-pdf/doi/10.1042/BSR20200613/879321/bsr-2020-0613.pdf by guest on 20 September 2020 Bioscience Reports. This is an Accepted Manuscript. You are encouraged to use the Version of Record that, when published, will replace this version. The most up-to-date-version is available at https://doi.org/10.1042/BSR20200613 13 (P <0.05). The mimic + oe-VEGF group presented greatly lower apoptosis rate than that the mimic group (P <0.05), and cyclopamine + oe-VEGF group showed greatly lower apoptosis rate than the cyclopamine group (P <0.05).

Cell invasion in different groups
Transwell assay was employed for cell invasion ability detection in each group ( Figure. 6). It came out that other groups showed remarkably less invasive cells than the Nor (P > 0.05). In contrast to the Mod, and the number of invasive cells presented no remarkable difference in the NC group (P >0.05), but it was greatly increased in the mimic and cyclopamine groups, and obviously increased in the oe-VEGF group (P <0.05). The mimic+oe-VEGF group showed much more invasive cells than the mimic group (P <0.05), and the cyclopamine+oe-VEGF group also showed much more invasive cells than the cyclopamine group (P <0.05).

mRNA and protein levels of PCNA, E-cadherin, N-cadherin, Bcl-2 and Bax in each group of cells
To investigate how miR-375 and SHH signaling pathways affect the VEGF gene expression and play a role on the biological characteristics of TCs in preeclampsia rats, we detected the mRNA and protein levels of PCNA, E-cadherin, N-cadherin, Bcl-2, and Bax via qRT-PCR and WB, respectively ( Figure. 7). It was turned out that in comparison with the Nor, the mRNA and protein levels of PCNA, N-cadherin, Bcl-2 decreased, while those of E-cadherin and Bax increased in other groups (P <0.05). In contrast to the Mod, no obvious difference was seen in the mRNA and protein level of each indicator in the NC group (P >0.05); the mRNA and protein levels of PCNA, N-cadherin and Bcl-2 were down-regulated, while those of E-cadherin and Bax were up-regulated in the mimic and cyclopamine groups, and these indicators showed an opposite trend in oe-VEGF group (P<0.05). The mimic+oe-VEGF group presented higher mRNA and protein levels of PCNA, N-cadherin and Bcl-2 and lower mRNA and protein levels Downloaded from http://portlandpress.com/bioscirep/article-pdf/doi/10.1042/BSR20200613/879321/bsr-2020-0613.pdf by guest on 20 September 2020 Bioscience Reports. This is an Accepted Manuscript. You are encouraged to use the Version of Record that, when published, will replace this version. The most up-to-date-version is available at https://doi.org/10.1042/BSR20200613 of E-cadherin and Bax than the mimic group (P <0.05). The cyclopamine + oe-VEGF group presented higher mRNA and protein levels of PCNA, N-cadherin and Bcl-2 and lower mRNA and protein levels of E-cadherin and Bax than the cyclopamine group(P <0.05).

Discussion
Currently, up-regulation of miR-375 has been observed in a variety of diseases such as adrenal disorders, diabetes and ionizing radiation [21,22]. The SHH pathway is strongly involved in tumor progression, metastasis, and angiogenesis. Recent reports have revealed that abnormal activation of the hedgehog axis is positively correlated with the overall survival of several clinicopathological features, lymphatic metastasis, breast carcinoma, and lung carcinoma [23].
The glycoprotein of the hedgehog family, as a signaling molecule, strongly affects the progression and cell cycle. SHH is the sole hedgehog protein with expression in the central nervous system (CNS) of adult mammals. The developmental effects of SHH signaling have been well documented, but only several reports have addressed the function of SHH in the CNS of adult mammals [24]. The disturbance of placental angiogenesis is a key feature of the pathogenesis of pre-eclampsia. The process of angiogenesis is caused by various angiogenic indicators including VEGF and placental growth factor and its membrane-bound receptors, which are the most widely studied angiogenic factors during placental development [25,26].
In our study, we found an up-regulation of miR-375 and a down-regulation of SHH and VEGF in TCs of model rats. Previously study has proved that VEGF supplementation can treat pre-eclampsia [27].
Therefore, we transfected VEGF over-expression vector to rat TCs and found that after the transfection, the proliferation-related factor (PCNA) and invasion-related factor (N-cadherin) was upregulated, cell proliferation and invasion ability was enhanced, cell cycle progression was promoted, while apoptosis rate was decreased, indicating that overexpression of VEGF could improve preeclampsia by promoting the growth of rat embryonic TCs and inhibiting its apoptosis, which was in line with the results of previously literature.
It has been uncovered that the SHH axis is abnormally activated in human lung cancer tissues, and the highly expressed SHH ligand initiates the SHH signaling pathway, leading to the transcription of Gli1 to active the target gene VEGF, so as to affect the regulation of tumorigenesis and development and Downloaded from http://portlandpress.com/bioscirep/article-pdf/doi/10.1042/BSR20200613/879321/bsr-2020-0613.pdf by guest on 20 September 2020 promote the proliferation of tumor blood vessels [28]. The SHH signaling pathway takes a part in the survival, proliferation and repair of endothelial cells [29]. We predicted that VEGF has a targeting relationship with miR-375 through the website, and the literature also showed that miR-375 has inhibitory effects in various diseases [30].Our results verified that miR-375 could negatively affect the VEGF expression and over-expressing miR-375 or inhibiting the SHH signaling pathway can inhibit trophoblast cell proliferation, invasion and promote apoptosis, but VEGF over-expression can partially reverse the inhibition effect.

Conclusion
This study has not elucidated the exact molecular mechanisms by which miR-375 and SHH signaling pathways regulate VEGF, and the related regulatory networks of miR-375 in preeclampsia. To further clarify the above issues, we will conduct in-depth research in this direction in the future.In conclusion, Over-expressing miR-375 can inhibit the expression of VEGF, thus slow down the invasionand proliferation of TCS in PE rats, which is realized by regulating SHH signal pathway,It is expected to be a potential therapeutic target. http://dx.doi.org/10.1186/s12931-017-0702-y