Overexpression of Muscarinic Receptor 3 Promotes Metastasis and Predicts Poor Prognosis in Non–Small-Cell Lung Cancer  Gengpeng Lin, MD, Longhua Sun,

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Overexpression of Muscarinic Receptor 3 Promotes Metastasis and Predicts Poor Prognosis in Non–Small-Cell Lung Cancer  Gengpeng Lin, MD, Longhua Sun,
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Overexpression of Muscarinic Receptor 3 Promotes Metastasis and Predicts Poor Prognosis in Non–Small-Cell Lung Cancer  Gengpeng Lin, MD, Longhua Sun, PhD, Ran Wang, PhD, Yubiao Guo, MD, Canmao Xie, MD, PhD  Journal of Thoracic Oncology  Volume 9, Issue 2, Pages 170-178 (February 2014) DOI: 10.1097/JTO.0000000000000066 Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 M3R is overexpressed in both NSCLC cell lines and tissues. A Western blot analysis of M3R expression in NSCLC cell lines (GLC82, PC9, SPC-A1, A549, and L78) and HLF. B, Western blot analysis of M3R protein level in 10 pairs of tissues (T: tumor, N: adjacent noncancerous lung tissue). β-actin was used as a loading control. M3R, muscarinic receptor 3; NSCLC, non–small-cell lung cancer; and HLF. Journal of Thoracic Oncology 2014 9, 170-178DOI: (10.1097/JTO.0000000000000066) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Overexpression of M3R correlates with poor prognosis and metastasis in NSCLC patients. A, Representative immunohistochemistry pictures of M3R expression in different NSCLC subtypes and normal lung tissues. B, Survival curves of NSCLC patients with high or low M3R expression (n =148, p < 0.0001; left panel). Differences within subgroups of NSCLC with COPD (n = 60, p = 0.0003; middle panel) and NSCLC without COPD (n = 88, p = 0.0222; right panel). M3R, muscarinic receptor; 3 NSCLC, non–small-cell lung cancer; COPD, chronic obstructive pulmonary disease. Journal of Thoracic Oncology 2014 9, 170-178DOI: (10.1097/JTO.0000000000000066) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Expression of M3R in NSCLC is associated with airway obstruction and smoking. A, Differences in M3R expression in NSCLC tissues between patients with and without COPD. B, Inverse correlation between M3R expression and FEV1/FVC (r = 0.5057, p < 0.0001). C, Inverse correlation between M3R expression and %FEV1 (r = 0.7017, p < 0.0001). D, M3R expression levels in NSCLC patients with and without a smoking history. E, Correlation between M3R expression and smoking (pack-years) (r = 0.3169, p = 0.0014). M3R, muscarinic receptor 3; NSCLC, non–small-cell lung cancer; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; COPD, chronic obstructive pulmonary disease. Journal of Thoracic Oncology 2014 9, 170-178DOI: (10.1097/JTO.0000000000000066) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 M3R promotes proliferation, migration, and invasion of non–small-cell lung cancer cell lines. A, Knockdown efficiency of M3R siRNA in A549 and L78 cells. B, Growth curves of L78 and A549 after M3R siRNA treatment. A small reduction of absorbance was observed after siRNA treatment (p < 0.01). C, Wound-healing assay to analyze cell migration after M3R siRNA treatment. D, Migration and invasion assay using a transwell system (representative images of migration chambers; average counts from 5 random microscopic fields). M3R siRNA inhibited the migration and invasion ability of L78 and A549. M3R, muscarinic receptor 3. Journal of Thoracic Oncology 2014 9, 170-178DOI: (10.1097/JTO.0000000000000066) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5 M3R promotes the migration and invasion of non–small-cell lung cancer cell lines through the PI3K/Akt/MMP9 pathway. A, Zymography of MMP9 in conditioned medium of cells treated with M3R siRNA. B and D, Western bot assay of p-Akt, Akt, E-cadherin, and MMP9 in indicated cells. B, Knockdown of M3R results in the reduced expression of p-Akt and MMP9, but elevated expression of E-cadherin. D, Activation of M3R by Ach induces expression of MMP9 and p-Akt, but reduces expression of E-cadherin. PI3K inhibitor abolishes the effect of Ach. C, Zymography of MMP9 using conditioned medium from cells treated with Ach and LY294002. E, Wound-healing assay for cells migration ability after Ach and LY294002 treatment. A concentration of 10−4M Ach promotes migration, but migration is abolished by LY294002. F, Migration and invasion assay using a transwell system (representative images of migration chambers; average counts from 5 random microscopic fields). Cells were treated with 10-4M Ach with and without 20μM LY294002, respectively. A concentration of 10-4M Ach promotes migration while LY294002 treatment inhibits it. M3R, muscarinic receptor 3, Ach, acetylcholine; MMP9, matrix metalloproteinase 9; NC, negative control; pAKT, phosphor-AKT. Journal of Thoracic Oncology 2014 9, 170-178DOI: (10.1097/JTO.0000000000000066) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions