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<article article-type="research-article" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xml:lang="EN">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Pediatr.</journal-id>
<journal-title>Frontiers in Pediatrics</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Pediatr.</abbrev-journal-title>
<issn pub-type="epub">2296-2360</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fped.2023.1098999</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Pediatrics</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Hsa-miR-323a-3p functions as a tumor suppressor and targets STAT3 in neuroblastoma cells</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author"><name><surname>Bhavsar</surname><given-names>Swapnil Parashram</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/1841674/overview"/></contrib>
<contrib contrib-type="author"><name><surname>Olsen</surname><given-names>Lotte</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/2144770/overview" /></contrib>
<contrib contrib-type="author"><name><surname>L&#x00F8;kke</surname><given-names>Cecilie</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib>
<contrib contrib-type="author"><name><surname>Koster</surname><given-names>Jan</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib>
<contrib contrib-type="author"><name><surname>Fl&#x00E6;gstad</surname><given-names>Trond</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/1223365/overview" /></contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Einvik</surname><given-names>Christer</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="corresp" rid="cor1">&#x002A;</xref><uri xlink:href="https://loop.frontiersin.org/people/850030/overview" /></contrib>
</contrib-group>
<aff id="aff1"><label><sup>1</sup></label><addr-line>Pediatric Research Group, Department of Clinical Medicine, Faculty of Health Science</addr-line>, <institution>UiT&#x2014;The Arctic University of Norway</institution>, <addr-line>Troms&#x00F8;</addr-line>, <country>Norway</country></aff>
<aff id="aff2"><label><sup>2</sup></label><addr-line>Department of Oncogenomics, Center for Experimental and Molecular Medicine (CEMM)</addr-line>, <institution>Amsterdam University Medical Centers, University of Amsterdam</institution>, <addr-line>Amsterdam</addr-line>, <country>Netherlands</country></aff>
<aff id="aff3"><label><sup>3</sup></label><addr-line>Division of Child and Adolescent Health, Department of Pediatrics</addr-line>, <institution>UNN&#x2013;University Hospital of North-Norway</institution>, <addr-line>Troms&#x00F8;</addr-line>, <country>Norway</country></aff>
<author-notes>
<fn fn-type="edited-by"><p><bold>Edited by:</bold> Yi Ji, Sichuan University, China</p></fn>
<fn fn-type="edited-by"><p><bold>Reviewed by:</bold> Karina Salomao, University of S&#x00E3;o Paulo, Brazil Pablo Shimaoka Chagas, University of S&#x00E3;o Paulo, Brazil Miguel F. Segura, Vall d&#x0027;Hebron Research Institute (VHIR), Spain Graziella Ribeiro De Sousa, University of Colorado Anschutz Medical Campus, United States</p></fn>
<corresp id="cor1"><label>&#x002A;</label><bold>Correspondence:</bold> Christer Einvik <email>christer.einvik@uit.no</email></corresp>
<fn fn-type="other" id="fn001"><p><bold>Specialty Section:</bold> This article was submitted to Pediatric Oncology, a section of the journal Frontiers in Pediatrics</p></fn>
</author-notes>
<pub-date pub-type="epub"><day>24</day><month>03</month><year>2023</year></pub-date>
<pub-date pub-type="collection"><year>2023</year></pub-date>
<volume>11</volume><elocation-id>1098999</elocation-id>
<history>
<date date-type="received"><day>15</day><month>11</month><year>2022</year></date>
<date date-type="accepted"><day>06</day><month>03</month><year>2023</year></date>
</history>
<permissions>
<copyright-statement>&#x00A9; 2023 Bhavsar, Olsen, L&#x00F8;kke, Koster, Fl&#x00E6;gstad and Einvik.</copyright-statement>
<copyright-year>2023</copyright-year><copyright-holder>Bhavsar, Olsen, L&#x00F8;kke, Koster, Fl&#x00E6;gstad and Einvik</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract>
<sec><title>Background</title>
<p>Studies conducted in the last decades have revealed a role for the non-coding microRNAs (miRNAs) in cancer development and progression. Several miRNAs within the chromosome region 14q32, a region commonly deleted in cancers, are associated with poor clinical outcome in the childhood cancer neuroblastoma. We have previously identified <italic>miR-323a-3p</italic> from this region to be downregulated in chemotherapy treated neuroblastoma cells compared to pre-treatment cells from the same patients. Furthermore, in neuroblastoma tumors, this miRNA is downregulated in advanced stage 4 disease compared to stage 1&#x2013;2. In this study, we attempt to delineate the unknown functional roles of <italic>miR-323a-3p</italic> in neuroblastoma.</p>
</sec>
<sec><title>Methods</title>
<p>Synthetic miRNA mimics were used to overexpress <italic>miR-323a-3p</italic> in neuroblastoma cell lines. To investigate the functional roles of <italic>miR-323a-3p,</italic> cell viability assay, flow cytometry, reverse transcription-quantitative polymerase chain reaction, luciferase reporter assay and western blot were conducted on the neuroblastoma cell lines Kelly, SH-SY5Y and SK-N-BE(2)-C.</p>
</sec>
<sec><title>Results</title>
<p>Ectopic expression of <italic>miR-323a-3p</italic> resulted in marked reduction of cell viability in Kelly, SH-SY5Y and SK-N-BE(2)-C by causing G1-cell cycle arrest in Kelly and SH-SY5Y and apoptosis in all the cell lines tested. Furthermore, mRNA and protein levels of signal transducer and activator of transcription 3 (<italic>STAT3</italic>) were reduced upon <italic>miR-323a-3p</italic> overexpression. A direct binding of the <italic>miR-323a-3p</italic> to the 3&#x2032;UTR of <italic>STAT3</italic> was experimentally validated by luciferase reporter assay, where <italic>miR-323a-3p</italic> reduced luminescent signal from full length <italic>STAT3</italic> 3&#x2032;UTR luciferase reporter, but not from a reporter with mutation in the predicted seed sequence.</p>
</sec>
<sec><title>Conclusions</title>
<p><italic>miR-323a-3p</italic> inhibits growth of neuroblastoma cell lines through G1-cell cycle arrest and apoptosis, and the well-known oncogene <italic>STAT3</italic> is a direct target of this miRNA.</p>
</sec>
</abstract>
<kwd-group>
<kwd>non-coding</kwd>
<kwd>microRNAs</kwd>
<kwd>neuroblastoma</kwd>
<kwd>chromosome region 14q32</kwd>
<kwd>chemotherapy</kwd>
<kwd>STAT3</kwd>
</kwd-group>
<contract-num rid="cn001">210009</contract-num>
<contract-sponsor id="cn001">UiT&#x2014;The Arctic University of Norway, Barnekreftforeningen</contract-sponsor>
<counts>
<fig-count count="5"/>
<table-count count="2"/><equation-count count="0"/><ref-count count="41"/><page-count count="0"/><word-count count="0"/></counts>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro"><title>Introduction</title>
<p>Neuroblastoma is one of the most common embryonal malignancies among children and 40&#x0025; of all children diagnosed with neuroblastoma are designated as high-risk patients (<xref ref-type="bibr" rid="B1">1</xref>) with poor clinical outcome (<xref ref-type="bibr" rid="B2">2</xref>). Multiple treatment modalities are available, including intensive chemotherapy with autologous stem-cell rescue, surgery, radiation, and immunotherapy, which have improved the survival rate of high-risk neuroblastoma patients. However, many high-risk patients ultimately relapse and eventually die from disease progression. Treatment failure is mainly attributed to the development of drug resistance and is one of the major clinical obstacles in treatment of high-risk neuroblastoma (<xref ref-type="bibr" rid="B1">1</xref>, <xref ref-type="bibr" rid="B3">3</xref>). Thus, development of more effective targeted therapies is required to address this issue.</p>
<p>MicroRNAs (miRNAs) are evolutionary conserved, endogenously expressed, small non-coding RNAs (&#x223C;19&#x2013;24 nucleotides) that regulate gene expression by translation inhibition or degradation of mRNA. They are thus responsible for regulating the expression of genes involved in a myriad of cellular processes (<xref ref-type="bibr" rid="B4">4</xref>). Recently, miRNAs are shown to modulate drug resistance in multiple cancers (<xref ref-type="bibr" rid="B5">5</xref>). Some researchers have identified a differential expression of miRNAs in parental (chemo-sensitive) vs. resistant (chemo-resistant) cancer cells (<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B7">7</xref>). Interestingly, some molecular mechanisms underlying drug resistance have also been elucidated (<xref ref-type="bibr" rid="B8">8</xref>).</p>
<p>The <italic>MIR-323a</italic> gene is located on the chromosome region 14q32, a region frequently dysregulated in cancers (<xref ref-type="bibr" rid="B9">9</xref>&#x2013;<xref ref-type="bibr" rid="B12">12</xref>). Several miRNAs from this cluster have been found downregulated in neuroblastoma cells from patients with relapsed disease (<xref ref-type="bibr" rid="B7">7</xref>). An aberrant expression of <italic>miR-323a-3p</italic> is observed in multiple cancers. <italic>MiR-323a-3p</italic> was downregulated in glioblastoma (<xref ref-type="bibr" rid="B13">13</xref>), osteosarcoma (<xref ref-type="bibr" rid="B14">14</xref>), pancreatic ductal adenocarcinoma (PDAC) (<xref ref-type="bibr" rid="B15">15</xref>), breast cancer (<xref ref-type="bibr" rid="B16">16</xref>), colorectal cancer (<xref ref-type="bibr" rid="B17">17</xref>) and bladder cancer (<xref ref-type="bibr" rid="B18">18</xref>). Whereas in prostate cancer, <italic>miR-323</italic> was upregulated and promoted cell proliferation (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B19">19</xref>). The role of <italic>miR-323a-3p</italic> in neuroblastoma is unknown and investigation is warranted given the important role of this miRNA in other cancers.</p>
<p>STAT3 is one of seven members (STAT1, STAT2, STAT3, STAT4, STAT5A, STAT5B and STAT6) of the signal transducer and activator of transcription (STAT) protein family (<xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B21">21</xref>). This protein was initially shown to be activated in response to binding of cytokines and growth factors to cellular receptors, which activates membrane-associated janus kinases (JAK). JAK in turn phosphorylates STAT3 at specific residues to form homo/heterodimers and translocate to the cell nucleus. In the nucleus, STAT3 acts as a transcription factor, regulating the expression of a wide range of genes involved in survival, proliferation, invasion, metastasis, angiogenesis, and immunosuppression (<xref ref-type="bibr" rid="B22">22</xref>). Zhou C. and colleagues have shown that downregulation of STAT3 induces G1-cell cycle arrest and apoptosis in esophageal carcinoma (<xref ref-type="bibr" rid="B23">23</xref>). Accumulating evidence suggests that STAT3 is activated by numerous activators (e.g., cytokines, growth factors, toll-like receptors, etc.) (<xref ref-type="bibr" rid="B22">22</xref>). Hence, dysregulation of <italic>STAT3</italic> can lead to oncogenesis through various mechanisms. Several studies have identified different miRNAs having reciprocal interactions with JAK-STAT3 signaling pathway in different cancer types, for example, <italic>let-7</italic> (<xref ref-type="bibr" rid="B24">24</xref>), <italic>miR-9</italic> (<xref ref-type="bibr" rid="B25">25</xref>), <italic>miR-337&#x2013;3p</italic> (<xref ref-type="bibr" rid="B26">26</xref>), <italic>miR-26a</italic> (<xref ref-type="bibr" rid="B27">27</xref>) and <italic>miR-135a</italic> (<xref ref-type="bibr" rid="B28">28</xref>). However, the role of miRNA directly targeting <italic>STAT3&#x2013;3</italic>&#x2032;UTR is not yet demonstrated in neuroblastoma.</p>
<p>We have previously observed downregulation of <italic>miR-323a-3p</italic> in post-chemotherapy neuroblastoma cell lines as compared to matched pre-chemotherapy neuroblastoma cell lines (<xref ref-type="bibr" rid="B7">7</xref>). In this study, we set out to understand the functional role of <italic>miR-323a-3p</italic> in neuroblastoma. Therefore, gain-of-function studies were set up by overexpressing <italic>miR-323a-3p</italic> in neuroblastoma cell lines<italic>,</italic> which had significant effect on growth and survival by inducing G1-cell cycle arrest and apoptosis. Furthermore, we demonstrate <italic>STAT3</italic> as a novel target of <italic>miR-323a-3p</italic>.</p>
</sec>
<sec id="s2"><title>Materials and methods</title>
<sec id="s2a"><title>Cell lines and cell culture</title>
<p>The neuroblastoma cell lines Kelly, SH-SY5Y and SK-N-BE(2)-C [BE(2)-C] were all maintained at 37&#x00B0;C in RPMI-1640 medium with 2&#x2005;mM L-Glutamine (Sigma-Aldrich) supplemented with 10&#x0025; fetal bovine serum (Sigma-Aldrich), in a humidified incubator with 5&#x0025; CO<sub>2</sub> atmosphere. In collaboration with the Center of Forensic Genetics (UiT&#x2014;The Arctic University of Norway, Norway), we authenticated the cell lines using short tandem repeat (STR) profiling. We confirmed absence of mycoplasma contamination in the cell lines using MycoAlert<sup>TM</sup> Mycoplasma Detection Kit (Lonza).</p>
</sec>
<sec id="s2b"><title>Transfections</title>
<p>For ectopic expression, 25&#x2013;40&#x2009;nM of <italic>miRNA-323a-3p</italic> or negative control (NC) mirVana&#x00AE; miRNA mimics (Ambion, Thermo Fisher Scientific) were transfected using Invitrogen&#x2122; Lipofectamine&#x2122; 2000 Transfection Reagent (Fisher Scientific) in OptiMEM medium (Thermo Fisher Scientific) according to the manufacturer&#x0027;s instructions.</p>
</sec>
<sec id="s2c"><title>Cell viability</title>
<p>Cell viability was assessed using alamarBlue&#x00AE; (Thermo Fisher Scientific) cell viability assay according to the manufacturer&#x0027;s instructions. 25 nM <italic>miR-323a-3p</italic> or NC mimics were reverse transfected into Kelly, SH-SY5Y and BE(2)-C cells seeded in 24-well plates. Cell viability at 24, 48, 72 and 96&#x2005;h after transfection were measured in a CLARIOstar microplate reader (BMG LABTECH) and calculated as the percentage of NC transfected cells set to 100&#x0025;.</p>
</sec>
<sec id="s2d"><title>Flow cytometry</title>
<p>For determining the cell cycle distribution, Kelly, SH-SY5Y and BE(2)-C cells were first reverse transfected with 25 nM <italic>miR-323a-3p</italic> or NC mimics in 25 cm<sup>2</sup> culture flasks. After 72&#x2005;h, the cells were detached by trypsin, centrifuged, and washed with 1&#x2009;&#x00D7;&#x2009;phosphate-buffered saline (PBS). An overnight incubation at &#x2212;20&#x00B0;C in 70&#x0025; ethanol was performed to fixate the cells. After 10&#x2005;min centrifugation at 850&#x2005;g, and a subsequent wash with 1&#x2009;&#x00D7;&#x2009;PBS, fixated cells were added DNA-staining solution consisting of PBS with 50 &#x00B5;g/ml propidium iodide (PI) and 100 &#x00B5;g/ml RNase (Life technologies). Cells were protected from light and stored on ice during a 30&#x2005;min incubation period prior to flow cytometry measurement of PI-stained DNA in a BD LSRFortessa<sup>TM</sup> cell analyzer (BD Bioscience). The Dean-Jett-Fox model for cell cycle evaluation was used for analysis in the FlowJo 7.6.5 software.</p>
</sec>
<sec id="s2e"><title>MicroRNA target prediction</title>
<p>A computational approach with miRDB algorithm (available at <ext-link ext-link-type="uri" xlink:href="http://www.mirdb.org/">http://www.mirdb.org/</ext-link>) was used to identify <italic>miR-323a-3p</italic> targets (<xref ref-type="bibr" rid="B29">29</xref>).</p>
</sec>
</sec>
<sec id="s3"><title>RNA Extraction, Reverse Transcription and Quantitative PCR</title>
<p>Kelly, SH-SY5Y and BE(2)-C cells were transfected with 25 nM <italic>miR-323a-3p</italic> or NC mimics in 6-well plates. The QIAzol&#x00AE; Lysis Reagent (QIAGEN) was used for isolation of total RNA 24&#x2005;h later according to the manufacturer&#x0027;s instructions. Quantity and purity of total RNA was assessed with NanoDropTM 2000 spectrophotometer (Thermo Fisher Scientific).</p>
<p>For miRNA and mRNA expression analysis, complementary DNA (cDNA) synthesis from total RNA, and successive quantitative polymerase chain reaction (qPCR)-measurements, were performed as previously described (<xref ref-type="bibr" rid="B30">30</xref>). The qPCR cycling was carried out in a Light Cycler 96 SW 1.1 (Roche). For miRNA analysis the miScript primer assays Hs_miR-323&#x2013;3p_2 (cat. no MS00037219) and Hs_miR-4286_1 (cat. no MS00021371) (QIAGEN) were used for <italic>miR-323a-3p</italic> quantification and as a reference gene, respectively. Using the web-based versions of the LinRegPCR program (<ext-link ext-link-type="uri" xlink:href="https://www.gear-genomics.com/rdml-tools/">https://www.gear-genomics.com/rdml-tools/</ext-link>) (<xref ref-type="bibr" rid="B31">31</xref>), we generated mean PCR efficiency for each amplicon group. Expression of <italic>miR-323a-3p</italic> relative to <italic>miR-4286</italic> was calculated as: Expression&#x2009;&#x003D;&#x2009;E(GOI)^ -Cq(GOI)/E(REF)^ -Cq(REF) (E, PCR efficiency; GOI, gene of interest (<italic>miR-323a-3p</italic>); REF, reference gene (<italic>miR-4286</italic>)) (<xref ref-type="bibr" rid="B32">32</xref>). The following primers were used for mRNA expression analysis: <italic>STAT3</italic> (forward: 5&#x2032;-CAG CAG CTT GAC ACA CGG TA-3&#x2032;; reverse: 5&#x2032;- AAA CAC CAA AGT GGC ATG TGA -3&#x2032;), <italic>BCL2</italic> (forward: 5&#x2032;-TCG CCC TGT GGA TGA CTG A-3&#x2032;; reverse: 5&#x2032;- CAG AGA CAG CCA GGA GAA ATC AA-3&#x2032;) and <italic>SDHA</italic> (forward: 5&#x2032;-CTG ATG AGA CAA GAT GTG GTG-3&#x2032;; reverse: 5&#x2032;-CAA TCT CCC TTC AAT GTA CTC C-3&#x2032;). <italic>SDHA</italic> functioned as a reference gene. Expression of <italic>STAT3</italic> and <italic>BCL2</italic> was assessed by the <italic>&#x0394;&#x0394;</italic>Cq comparative cycle threshold method according to Taylor et al. 2019 (<xref ref-type="bibr" rid="B33">33</xref>).</p>
<p>All reverse transcription (RT)-qPCR reactions were performed in triplicates on at least three independent biological replicates. For the mRNA expression analysis, the Student&#x0027;s unpaired t-test was used to calculate statistical differences between <italic>&#x0394;</italic>Cq values of NC-treated and <italic>miR-323a-3p</italic>-treated cell lines. Values are presented as the mean normalized expression&#x2009;&#x00B1;&#x2009;standard error (SEM).</p>
<sec id="s3a"><title>Western blot analysis</title>
<p>Cells were seeded in 6-well plates, and, 72&#x2005;h later, trypsinized and lysed in 40&#x2005;&#x00B5;l RIPA buffer (50&#x2005;mM Tris-HCL pH 8, 150&#x2005;mM NaCl, 1&#x0025; NP-40, 0.5&#x0025; sodium deoxycholate, 0.1&#x0025; SDS) containing 1&#x2009;&#x00D7;&#x2009;Protein Inhibitor Cocktail (Roche) and 1&#x2005;mM dithiothreitol (DTT) (Sigma-Aldrich). For PARP-cleavage analysis, floating cells were included. Total protein concentrations were determined using DC<sup>TM</sup>Protein Assay Kit (Bio-Rad) according to the manufacturer&#x0027;s instructions, and 40&#x2005;&#x00B5;g protein was separated on a NuPAGE&#x00AE; Novex&#x2009;4&#x0025;&#x2013;12&#x0025; Bis-Tris precast polyacrylamide gel (Thermo Fisher Scientific) before blotted onto Immobilon-FL PVDF membrane (Millipore). Prior to fluorescence detection, the membrane was blocked for 1&#x2005;h at room temperature in 5&#x2005;ml Odyssey Blocking Buffer (LI-COR Biosciences) followed by overnight incubation at 4&#x00B0;C with primary antibodies: Stat3 (C-20): sc-482, rabbit, polyclonal (1:1000) (Santa Cruz Biotechnology); PARP: 9542, rabbit, polyclonal (1:1000) (Cell Signaling Technology); BCL2 (C-2): sc-7382, mouse, monoclonal (1:200) (Santa Cruz Biotechnology) and Anti-Actin antibody [ACTN05 (C4)]: ab3280, mouse, monoclonal (1:1000) (Abcam). After four (5&#x2005;min) washes with 0,1&#x0025; PBST, the membrane was incubated with secondary antibodies Rabbit IgG (H&#x0026;L) Antibody DyLight&#x2122; 800 Conjugated (1:5000) (Rockland Immunochemicals) and goat anti-mouse-Alexa Fluor 680 (1:5000) (Thermo Fisher Scientific) and scanned in the Odyssey CLx Infrared Imaging System (LI-COR Biosciences). Actin was used as loading control. For quantification of protein, the ImageJ software was used (<xref ref-type="bibr" rid="B34">34</xref>) (available on imagej.net).</p>
</sec>
<sec id="s3b"><title>Reporter constructs and dual luciferase assay</title>
<p>The cells were grown on a 12-well plate and co-transfected with 40 nM mimics, 50&#x2005;ng/ml pMIR-Report-Firefly construct (Ambion) and 100&#x2005;ng/ml mutated (pLightSwitch-STAT3&#x2013;3&#x2032;UTR-mut) or wild-type (pLightSwitch-STAT3&#x2013;3&#x2032;UTR-wt) luciferase constructs harboring full-length <italic>STAT3&#x2013;</italic>3&#x2032;UTR.</p>
<p>The pLightSwitch-STAT3&#x2013;3&#x2032;UTR-wt construct was obtained from SwitchGear Genomics (Product ID: S813664). pLightSwitch-STAT3&#x2013;3&#x2032;UTR-mut construct with a mutation in the putative <italic>miR-323a-3p</italic> seed sequence was generated using QuickChange II Site-Directed Mutagenesis kit (Agilent Technologies). The primers used for mutagenesis were: Forward: 5&#x2032;-CTG CCC AGC CTT ACT CAC TAA AAG GCC AAT AGC GGA CAA AGG AAA ATA AGT CTA TTT ATA A -3&#x2032;; reverse: 5&#x2032;-TTA TAA ATA GAC TTA TTT TCC TTT GTC CGC TAT TGG CCT TTT AGT GAG TAA GGC TGG GCA G -3&#x2032;. To confirm mutation in the seed sequence, the mutant plasmid was sequenced using sequencing primer 5&#x2032;- GAA ACG GGC TTC AGG TCA AAC CC-3&#x2032;.</p>
<p>After incubation for 24&#x2005;h at 37&#x00B0;C, luciferase activity was measured using the Dual-Luciferase Reporter Assay (Promega), according to the manufacturer&#x0027;s instructions. The renilla luciferase activity was normalized to the firefly luciferase activity.</p>
</sec>
<sec id="s3c"><title>MicroRNA expression data</title>
<p>A subset of 226 primary neuroblastoma tumors, referred to as NRC-226 dataset, from the &#x201C;Tumor Neuroblastoma NRC Compendium-NRC-364-mirg&#x201D; miRNA dataset was used to obtain miRNA expression data. <xref ref-type="table" rid="T1">Table&#x00A0;1</xref> summarizes the characteristics of the NRC-226 dataset. The dataset was generated using multiplex RT-qPCR assays and consists of tumors from the Neuroblastoma Research Consortium (NRC), a collaboration between several laboratories in Europe. The NRC-226 cohort consists of 55 tumors from Essen, 39 from Ghent, 92 from Amsterdam and 40 from Dublin. The R2: Genomics Analysis and Visualization Platform (<ext-link ext-link-type="uri" xlink:href="http://r2.amc.nl">http://r2.amc.nl</ext-link>) was used to generate Kaplan-Meier overall survival curves for patients with high and low expression of <italic>miR-323a-3p</italic>.</p>
<table-wrap id="T1" position="float"><label>Table 1</label>
<caption><p>Characteristics of primary neuroblastoma tumors from NRC-226 dataset.</p></caption>
<table frame="hsides" rules="groups">
<colgroup>
<col align="left"/>
<col align="center"/>
<col align="center"/>
</colgroup>
<thead>
<tr>
<th valign="top" align="left">Characteristics:</th>
<th valign="top" align="center">No. of tumors:</th>
<th valign="top" align="center">&#x0025;</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left"><bold>INSS tumor stage:</bold></td>
</tr>
<tr>
<td valign="top" align="left">Stage 1</td>
<td valign="top" align="center">40</td>
<td valign="top" align="center">17.7</td>
</tr>
<tr>
<td valign="top" align="left">Stage 2</td>
<td valign="top" align="center">32</td>
<td valign="top" align="center">14.2</td>
</tr>
<tr>
<td valign="top" align="left">Stage 3</td>
<td valign="top" align="center">30</td>
<td valign="top" align="center">13.3</td>
</tr>
<tr>
<td valign="top" align="left">Stage 4</td>
<td valign="top" align="center">95</td>
<td valign="top" align="center">42.0</td>
</tr>
<tr>
<td valign="top" align="left">Stage 4s</td>
<td valign="top" align="center">29</td>
<td valign="top" align="center">12.8</td>
</tr>
<tr>
<td valign="top" align="left"><bold><italic>MYCN</italic> amplification:</bold></td>
</tr>
<tr>
<td valign="top" align="left">Yes</td>
<td valign="top" align="center">40</td>
<td valign="top" align="center">17.7</td>
</tr>
<tr>
<td valign="top" align="left">No</td>
<td valign="top" align="center">186</td>
<td valign="top" align="center">83.3</td>
</tr>
<tr>
<td valign="top" align="left"><bold>Overall survival:</bold></td>
</tr>
<tr>
<td valign="top" align="left">Event</td>
<td valign="top" align="center">60</td>
<td valign="top" align="center">26.5</td>
</tr>
<tr>
<td valign="top" align="left">No event</td>
<td valign="top" align="center">166</td>
<td valign="top" align="center">73.5</td>
</tr>
<tr>
<td valign="top" align="left"><bold><italic>miR-323a</italic> expression data available:</bold></td>
</tr>
<tr>
<td valign="top" align="left">Yes</td>
<td valign="top" align="center">195</td>
<td valign="top" align="center">86.3</td>
</tr>
<tr>
<td valign="top" align="left">No</td>
<td valign="top" align="center">31</td>
<td valign="top" align="center">13.7</td>
</tr>
<tr>
<td valign="top" align="left"><bold>Age at diagnosis:</bold></td>
</tr>
<tr>
<td valign="top" align="left">&#x003C;18 months</td>
<td valign="top" align="center">112</td>
<td valign="top" align="center">49.6</td>
</tr>
<tr>
<td valign="top" align="left">&#x003E;18 months</td>
<td valign="top" align="center">114</td>
<td valign="top" align="center">50.4</td>
</tr>
<tr>
<td valign="top" align="left"><bold>Gender:</bold></td>
</tr>
<tr>
<td valign="top" align="left">Male</td>
<td valign="top" align="center">98</td>
<td valign="top" align="center">43.4</td>
</tr>
<tr>
<td valign="top" align="left">Female</td>
<td valign="top" align="center">85</td>
<td valign="top" align="center">37.6</td>
</tr>
<tr>
<td valign="top" align="left">Nd</td>
<td valign="top" align="center">40</td>
<td valign="top" align="center">17.7</td>
</tr>
<tr>
<td valign="top" align="left">Total:</td>
<td valign="top" align="center">226</td>
<td valign="top" align="center">100</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s3d"><title>Statistical analysis</title>
<p>The associations between different characteristics of the cohort, including <italic>miR-323a-3p</italic> expression, and patient overall survival were calculated using a univariable Cox model (<xref ref-type="table" rid="T2">Table&#x00A0;2</xref>). Characteristics with <italic>p</italic>-values less than 0.05 were considered statistically significant and used in a multivariable cox regression model to evaluate independent predictors of survival. <italic>MiR-323a-3p</italic> was analyzed as a continuous variable using z-scores from R2. The coxph function from the R (v. 4.2.2) package &#x201C;survival&#x201D; (v. 3.5) was used to perform the univariable and multivariable Cox regression analyses (<xref ref-type="bibr" rid="B35">35</xref>). The proportional hazard assumption was tested using the Schoenfeld residual method implemented by cox.zph function in the survival package. The variable &#x201C;Age at diagnosis&#x201D; violated this assumption (i.e., non- proportionality, <italic>p</italic>-value&#x2009;&#x003D;&#x2009;0.0067) and the final Cox model was stratified by this variable.</p>
<table-wrap id="T2" position="float"><label>Table 2</label>
<caption><p>Cox regression analysis for <italic>miR-323a-3p</italic> in neuroblastoma tumor dataset. Univariable and stratified multivariable Cox regression analysis of the correlation between <italic>miR-323a-3p</italic> expression and clinical features for overall survival in the NRC-226 dataset.</p></caption>
<table frame="hsides" rules="groups">
<colgroup>
<col align="left"/>
<col align="center"/>
<col align="center"/>
<col align="center"/>
<col align="center"/>
</colgroup>
<thead>
<tr>
<th valign="top" align="left" rowspan="2">Variable:</th>
<th valign="top" align="center" colspan="2">Univariable:</th>
<th valign="top" align="center" colspan="2">Multivariable:</th>
</tr>
<tr>
<th valign="top" align="center">HR (95&#x0025; CI)</th>
<th valign="top" align="center"><italic>p</italic> value</th>
<th valign="top" align="center">HR (95&#x0025; CI)</th>
<th valign="top" align="center"><italic>p</italic> value</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left"><bold><italic>miR-323a-3p</italic>:</bold><break/>continuous z-scores</td>
<td valign="top" align="center">0.69 (0.53&#x2013;0.88)</td>
<td valign="top" align="center">0.003<sup>&#x002A;&#x002A;</sup></td>
<td valign="top" align="center">1.00 (0.78&#x2013;1.27)</td>
<td valign="top" align="center">0.987</td>
</tr>
<tr>
<td valign="top" align="left"><bold><italic>MYCN</italic> amplification (MNA):</bold><break/>0&#x2009;&#x003D;&#x2009;non-MNA,1&#x2009;&#x003D;&#x2009;MNA</td>
<td valign="top" align="center">7.06 (4.19&#x2013;11.9)</td>
<td valign="top" align="center">1.98e&#x2013;13<sup>&#x002A;&#x002A;&#x002A;</sup></td>
<td valign="top" align="center">2.38 (1.30&#x2013;4.36)</td>
<td valign="top" align="center">0.0052<sup>&#x002A;&#x002A;</sup></td>
</tr>
<tr>
<td valign="top" align="left"><bold>Stage1/2/4s vs. Stage3/4:</bold><break/>0&#x2009;&#x003D;&#x2009;Stage1/2/4s, 1&#x2009;&#x003D;&#x2009;Stage3/4</td>
<td valign="top" align="center">24.80 (6.05&#x2013;101.8)</td>
<td valign="top" align="center">7.05e&#x2013;08<sup>&#x002A;&#x002A;&#x002A;</sup></td>
<td valign="top" align="center">14.02 (3.22&#x2013;61.05)</td>
<td valign="top" align="center">0.00043<sup>&#x002A;&#x002A;&#x002A;</sup></td>
</tr>
<tr>
<td valign="top" align="left"><bold>Age at diagnosis:</bold><break/>0&#x003D;&#x2009;&#x003C;&#x2009;18&#x2005;m, 1&#x003D;&#x2009;&#x003E;&#x2009;18&#x2005;m</td>
<td valign="top" align="center">4.94 (2.70&#x2013;9.03)</td>
<td valign="top" align="center">2.07e&#x2013;07<sup>&#x002A;&#x002A;&#x002A;</sup></td>
<td valign="top" align="center"><xref ref-type="table-fn" rid="table-fn2"><sup>a</sup></xref></td>
</tr>
<tr>
<td valign="top" align="left"><bold>Gender:</bold><break/>0&#x2009;&#x003D;&#x2009;Female, 1&#x2009;&#x003D;&#x2009;Male</td>
<td valign="top" align="center">1.10 (0.64&#x2013;1.90)</td>
<td valign="top" align="center">0.735</td>
<td valign="top" align="center"><xref ref-type="table-fn" rid="table-fn3"><sup>b</sup></xref></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="table-fn1"><p>HR, hazard ratio; CI, confidence interval.</p></fn>
<fn id="table-fn2"><label><sup>a</sup></label><p>Stratified in final model.</p></fn>
<fn id="table-fn3"><label><sup>b</sup></label><p>Not included due to non-significant in univariable analysis. Significance codes: &#x002A;&#x2009;&#x003D;&#x2009;&#x201C;&#x003C;0.05&#x2032;, &#x002A;&#x002A;&#x2009;&#x003D;&#x2009;&#x201C;&#x003C;0.01, &#x002A;&#x002A;&#x002A;&#x2009;&#x003D;&#x2009;&#x201C;&#x003C;0.001&#x2032;.</p></fn>
</table-wrap-foot>
</table-wrap>
<p>The GraphPad Prism (version 5.00) software for Windows (GraphPad Software) (available at <ext-link ext-link-type="uri" xlink:href="www.graphpad.com">www.graphpad.com</ext-link>) was used for all statistical analyses unless stated otherwise. Analyses are based on at least three independent experiments and presented as mean&#x2009;&#x00B1;&#x2009;standard deviation (SD). Student&#x0027;s t-test was used to calculate statistical differences between means (<italic>n</italic>&#x2009;&#x003D;&#x2009;3) of control and treated cells. <italic>P</italic>-values &#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.05, &#x002A;&#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.01, &#x002A;&#x002A;&#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.001 were considered to indicate statistically significant results.</p>
</sec>
</sec>
<sec id="s4" sec-type="results"><title>Results</title>
<sec id="s4a"><title>miR-323a-3p is differentially expressed in neuroblastoma cell line pairs and primary tumors</title>
<p>In our previous study, we reported a reduced expression of 22 miRNAs from the chromosome 14q32 miRNA cluster (including <italic>miR-323a</italic>) in post-chemotherapy neuroblastoma cell lines as compared to matched pre-chemotherapy neuroblastoma cell lines (<xref ref-type="sec" rid="s11">Supplementary Figure S1</xref>) (<xref ref-type="bibr" rid="B7">7</xref>). We showed that <italic>miR-323a-3p</italic> expression was reduced in advanced stage 4 tumors as compared to stage 1&#x2013;2 and in <italic>MYCN</italic>-amplified (MNA) tumors as compared to non-MNA, two well-known prognostic factors of neuroblastoma (<xref ref-type="bibr" rid="B7">7</xref>). When neuroblastoma tumor data from the Neuroblastoma Research Consortium (NRC) was analyzed using Kaplan-Meier method, we observed a significant association between low expression of <italic>miR-323a-3p</italic> and a poor overall survival (<xref ref-type="fig" rid="F1">Figure&#x00A0;1</xref>). Furthermore, we assessed the prognostic effect of <italic>miR-323a-3p</italic> expression and different clinical characteristics using a univariable Cox proportional hazards regression model. The results revealed that <italic>miR-323a-3p</italic>, <italic>MYCN</italic> amplification, age at diagnosis&#x2009;&#x003E;&#x2009;18 months, and INSS Stage1,2,4S vs. Stage 4 were associated with overall survival (<italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.05) (<xref ref-type="table" rid="T2">Table&#x00A0;2</xref>). The gender was excluded in the subsequent multivariable analysis since it was not associated with overall survival (<italic>p</italic>-value&#x2009;&#x003E;&#x2009;0.05). As expected, the multivariable cox regression analysis showed that the well-established prognostic factors <italic>MYCN</italic> amplification and INSS stage 4 were independently associated with poor survival. However, <italic>miR-323a-3p</italic> expression was not an independent prognostic factor associated with overall survival in the NRC-226 cohort (<xref ref-type="table" rid="T2">Table&#x00A0;2</xref>).</p>
<fig id="F1" position="float"><label>Figure 1</label>
<caption><p>Low expression of <italic>miR-323a-3p</italic> is associated with poor overall survival in a primary neuroblastoma tumors dataset. Kaplan-Meier overall survival curve for patients with high (blue, <italic>n</italic>&#x2009;&#x003D;&#x2009;97) and low (red, <italic>n</italic>&#x2009;&#x003D;&#x2009;98) expression of <italic>miR-323a-3p</italic>.</p></caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="fped-11-1098999-g001.tif"/>
</fig>
<p>Others have reported that <italic>miR-323a-3p</italic> is downregulated and acts as a tumor suppressor in various cancers (<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B18">18</xref>). Given these findings, we sought out to elucidate <italic>miR-323a-3p</italic> functional role in aggressive neuroblastoma.</p>
</sec>
<sec id="s4b"><title>miR-323a-3p inhibits growth and survival of neuroblastoma cells</title>
<p>To examine the relationship between reduced expression of <italic>miR-323a-3p</italic> and cell survival, we first evaluated the basic expression of <italic>miR-323a-3p</italic> relative to endogenous <italic>miR-4286</italic> in Kelly, SH-SY5Y and BE(2)-C neuroblastoma cell lines by RT-qPCR. <italic>MiR-4286</italic> is stably expressed in these neuroblastoma cell lines, as reported previously (<xref ref-type="bibr" rid="B7">7</xref>). We observed very low levels of <italic>miR-323a-3p</italic> in Kelly and SH-SY5Y as compared to BE(2)-C cell line (<xref ref-type="fig" rid="F2">Figure&#x00A0;2A</xref>).</p>
<fig id="F2" position="float"><label>Figure 2</label>
<caption><p><italic>miR-323a-3p</italic> overexpression suppressed the growth and survival of neuroblastoma cells. <bold>(A)</bold> The basic expression of <italic>miR-323a-3p</italic> with respect to stably expressed <italic>miR-4286</italic> in Kelly, SH-SY5Y and BE(2)-C cell lines were detected by RT-qPCR analysis. Data is presented as mean&#x2009;&#x00B1;&#x2009;SEM of at least three independent experiments, each repeated in triplicates. <bold>(B)</bold> Cell viability of the cell lines Kelly, SH-SY5Y and BE(2)-C at 24&#x2005;h, 48&#x2005;h, 72&#x2005;h and 96&#x2005;h post transfection with <italic>miR-323a-3p</italic>, measured with the alamarBlue cell viability assay. Data is presented as mean&#x2009;&#x00B1;&#x2009;SD of at least three independent experiments, each repeated in triplicates. &#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.05, &#x002A;&#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.01 vs. the NC. RT-qPCR, reverse transcription-quantitative polymerase chain reaction; NC, negative control; miR, microRNA; SD, standard deviation.</p></caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="fped-11-1098999-g002.tif"/>
</fig>
<p>Next, to check the transfection efficiency, we transfected Kelly, SH-SY5Y and BE(2)-C cell lines with negative control (NC) or <italic>miR-323a-3p</italic> miRNA mimics. RT-qPCR analysis demonstrated that the expression of <italic>miR-323a-3p</italic> was significantly increased in <italic>miR-323a-3p</italic> transfected cells compared to NC transfected cells (<xref ref-type="sec" rid="s11">Supplementary Figure S2</xref>). However, the BE(2)-C cell line had lower transfection efficiency than Kelly and SH-SY5Y.</p>
<p>The overexpression of <italic>miR-323a-3p</italic> in Kelly, SH-SY5Y and BE(2)-C cell lines caused markedly lower cell viability than in NC transfected cells as measured by alamarBlue cell viability assay performed at 24, 48, 72 and 96&#x2005;h post-transfection (<xref ref-type="fig" rid="F2">Figure&#x00A0;2B</xref>). Collectively, these results demonstrated that overexpression of <italic>miR-323a-3p</italic> affects the growth of neuroblastoma cells.</p>
</sec>
<sec id="s4c"><title>miR-323a-3p affects G1-cell cycle arrest and apoptosis in neuroblastoma cells</title>
<p>As cell growth is associated with the cell cycle, we analyzed the effect of <italic>miR-323a-3p</italic> overexpression on the cell cycle distribution in Kelly, SH-SY5Y and BE(2)-C by flow cytometry assay. Whereas <italic>miR-323a-3p</italic> expression did not affect cell cycle distribution in BE(2)-C, it significantly induced G1-arrest in Kelly and SH-SY5Y by 13.6&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0042) and 17.5&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0181), respectively (<xref ref-type="fig" rid="F3">Figure&#x00A0;3A</xref>).</p>
<fig id="F3" position="float"><label>Figure 3</label>
<caption><p><italic>miR-323a-3p</italic> induces G1-cell cycle arrest and apoptosis in neuroblastoma cells. <bold>(A)</bold> Kelly and SH-SY5Y cell lines were transfected with <italic>miR-323a-3p</italic> or NC mimics and cell cycle distribution was measured by flow cytometry assay. Data is presented as mean&#x2009;&#x00B1;&#x2009;SD of three independent experiments. <bold>(B)</bold> Total PARP and PARP-cleavage (represents apoptosis) was detected on western blot in Kelly, SH-SY5Y and BE(2)-C cell lines transfected with <italic>miR-323a-3p</italic>. Quantification of cleaved PARP protein levels on the western blots (<italic>n</italic>&#x2009;&#x003D;&#x2009;3). (<bold>C</bold>) <bold>(B)</bold> BCL2 was detected on western blot in Kelly, SH-SY5Y and BE(2)-C cell lines transfected with <italic>miR-323a-3p</italic>. Quantification of BCL2 protein levels on the western blots (<italic>n</italic>&#x2009;&#x003D;&#x2009;3). Data is presented as mean&#x2009;&#x00B1;&#x2009;SD of three independent experiments. &#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.05, &#x002A;&#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.01, &#x002A;&#x002A;&#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.001 vs. the NC. SD, standard deviation; NC, negative control; miR, microRNA; c-PARP, cleaved PARP.</p></caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="fped-11-1098999-g003.tif"/>
</fig>
<p>To further assess the ability of <italic>miR-323a-3p</italic> to induce apoptosis, we transfected Kelly, SH-SY5Y and BE(2)-C with NC or <italic>miR-323a-3p</italic> mimics and determined the levels of apoptotic markers PARP-cleavage and BCL2 on western blot. The western blot analysis revealed PARP-cleavage in Kelly, SH-SY5Y and BE(2)-C by 197&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0443), 671&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0365) and 175&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0079), respectively, as compared to NC transfected cells (<xref ref-type="fig" rid="F3">Figure&#x00A0;3B</xref>). Moreover, we also observed a reduction in protein levels of BCL2 in Kelly, SH-SY5Y and BE(2)-C by 72&#x0025; (<italic>p</italic>&#x2009;&#x003D;&#x2009;0.0017), 44&#x0025; (<italic>p</italic>&#x2009;&#x003D;&#x2009;0.0007) and 76&#x0025; (<italic>p</italic>&#x2009;&#x003D;&#x2009;0.0024), respectively, as compared to NC transfected cells (<xref ref-type="fig" rid="F3">Figure&#x00A0;3C</xref>). BCL2 mRNA levels were also reduced (<xref ref-type="sec" rid="s11">Supplementary Figure S3</xref>). Taken together, we show that <italic>miR-323a-3p</italic> reduces cell viability by inducing G1-cell cycle arrest and apoptosis in neuroblastoma cells.</p>
</sec>
<sec id="s4d"><title>miR-323a-3p targets STAT3 in neuroblastoma</title>
<p>We used bioinformatics target prediction algorithm miRDB to find mRNA binding sequences for <italic>miR-323a-3p.</italic> The miRDB database revealed 793 predicted targets for <italic>miR-323a-3p</italic>. Additionally, a literature search was performed to check previously validated targets of <italic>miR-323a-3p</italic> in other cancers (<xref ref-type="sec" rid="s11">Supplementary Figure S4A</xref>). We used RT-qPCR to scan through a subset of these mRNAs in Kelly cells transfected with <italic>miR-323a-3p</italic> mimics. Compared to NC mimic transfected cells, we observed several mRNAs that were downregulated. <italic>STAT3</italic>, which has not previously been validated as a direct target of <italic>miR-323a-3p</italic>, was consistently downregulated by more than 40&#x0025; (<xref ref-type="sec" rid="s11">Supplementary Figure S4B</xref>).</p>
<p>miRDB database identified a putative binding site for <italic>miR-323a-3p</italic> in the 3&#x2032;UTR of <italic>STAT3</italic> (<xref ref-type="fig" rid="F4">Figure&#x00A0;4A</xref>). Thus, to confirm that <italic>STAT3</italic> is a direct target of <italic>miR-323a-3p</italic>, we performed luciferase reporter assay by co-transfecting luciferase construct containing wild-type or mutant 3&#x2032;UTR of <italic>STAT3</italic> with <italic>miR-323a-3p</italic> or NC mimics. The results showed that overexpression of <italic>miR-323a-3p</italic> suppressed the luciferase activity of wild-type construct by 30.7&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0014), but not the mutant construct, in SH-SY5Y cells (<xref ref-type="fig" rid="F4">Figure&#x00A0;4B</xref>). Together, these data demonstrated that <italic>STAT3</italic> is a direct target of <italic>miR-323a-3p</italic> in neuroblastoma.</p>
<fig id="F4" position="float"><label>Figure 4</label>
<caption><p><italic>STAT3</italic> is a direct target of <italic>miR-323a-3p</italic> in neuroblastoma. (<bold>A)</bold> The putative binding site of <italic>miR-323a-3p</italic> (nucleotides 1,097 to 1,103) in the 3&#x2032;UTR of <italic>STAT3</italic> was mutated as shown in the figure with bold and italics. <bold>(B)</bold> Dual-luciferase reporter assay demonstrating the luciferase activity of a construct with a wild-type or a mutated 3&#x2032;UTR of <italic>STAT</italic>3 in SH-SY5Y transfected with <italic>miR-323a-3p</italic> or NC mimics. Data is presented as mean&#x2009;&#x00B1;&#x2009;SD of three independent experiments, each repeated in triplicates. &#x002A;&#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.01 vs. the NC. SD, standard deviation; miR, microRNA; NC, negative control; STAT3, signal transducer and activator of transcription; ORF, open Reading frame; UTR, untranslated region; wt, wild-type; MUT, mutated.</p></caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="fped-11-1098999-g004.tif"/>
</fig>
</sec>
<sec id="s4e"><title>STAT3 mRNA and protein levels are regulated by miR-323a-3p</title>
<p>We next investigated whether <italic>miR-323a-3p</italic> could regulate <italic>STAT3</italic> at mRNA and protein levels. The <italic>miR-323a-3p</italic> or NC mimics were transfected into neuroblastoma cell lines and the expression levels of <italic>STAT3</italic> mRNA and protein were examined by RT-qPCR and western blot analysis, respectively. Overexpression of <italic>miR-323a-3p</italic> led to significant decrease of <italic>STAT3</italic> mRNA in Kelly, SH-SY5Y and BE(2)-C by 42&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0049), 31&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0137) and 43&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0039), respectively, as compared to NC transfected cells (<xref ref-type="fig" rid="F5">Figure 5A</xref>). Moreover, STAT3 protein levels were also significantly decreased upon <italic>miR-323a-3p</italic> overexpression in Kelly, SH-SY5Y and BE(2)-C by 60&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0079), 64&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0070) and 75&#x0025; (<italic>p&#x2009;</italic>&#x003D;&#x2009;0.0023), respectively, as compared to NC transfected cells (<xref ref-type="fig" rid="F5">Figures 5B, C</xref>). Altogether, these data suggest that <italic>miR-323a-3p</italic> directly binds and inhibits the expression of <italic>STAT3</italic> mRNA and protein levels in neuroblastoma cells.</p>
<fig id="F5" position="float"><label>Figure 5</label>
<caption><p><italic>miR-323a-3p</italic> reduces mRNA and protein levels of STAT3 in neuroblastoma cells. <bold>(A)</bold> The RT-qPCR analysis of <italic>STAT3</italic> mRNA levels in Kelly, SH-SY5Y and BE(2)-C cell lines transfected with <italic>miR-323a-3p.</italic> Data is presented as mean&#x2009;&#x00B1;&#x2009;SEM of three independent experiments, each repeated in triplicates. <bold>(B)</bold> Western blot assay demonstrating STAT3 protein levels in Kelly, SH-SY5Y and BE(2)-C cell lines transfected with <italic>miR-323a-3p</italic>. <bold>(C)</bold> Quantification of STAT3 protein expression on the western blots (<italic>n</italic>&#x2009;&#x003D;&#x2009;3). Data is presented as mean&#x2009;&#x00B1;&#x2009;SD of three independent experiments. &#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.05, &#x002A;&#x002A;<italic>P</italic>&#x2009;&#x003C;&#x2009;0.01 vs. the NC. RT-qPCR, reverse transcription-quantitative polymerase chain reaction; SD, standard deviation; miR, microRNA; NC, negative control; STAT3, signal transducer and activator of transcription.</p></caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="fped-11-1098999-g005.tif"/>
</fig>
</sec>
</sec>
<sec id="s5" sec-type="discussion"><title>Discussion</title>
<p>Analyzing neuroblastoma tumor data of <italic>miR-323a-3p</italic> revealed that this miRNA is reverse correlated with MNA and high-stage disease and that there is a significant association between low <italic>miR-323a</italic> levels and poor overall survival.</p>
<p>The <italic>miR-323a-3p</italic> plays a significant role in tumorigenesis by regulating various genes, and the mechanism of action of this miRNA differs from cancer to cancer (<xref ref-type="bibr" rid="B13">13</xref>&#x2013;<xref ref-type="bibr" rid="B19">19</xref>). Observing low expression of <italic>miR-323a</italic> in neuroblastoma cell lines from patients with relapsed neuroblastoma and tumors from high-risk patients led us to hypothesize that overexpression of <italic>miR-323a-3p</italic> could have positive phenotypic effect on neuroblastoma cell lines. Indeed, cell viability was clearly reduced upon transient transfection with <italic>miR-323a-3p</italic> due to G1-arrest and apoptosis. Compared to the Kelly and SH-SY5Y cell lines, transfection with <italic>miR-323a-3p</italic> caused less reduction of cell viability in BE(2)-C, and failed to induce significant G1-cell cycle arrest in this cell line. This might be explained by lower transfection efficiency in the BE(2)-C cell line (<xref ref-type="sec" rid="s11">Supplementary Figure S2</xref>), in addition to a higher pre-existing expression level (<xref ref-type="fig" rid="F2">Figure&#x00A0;2A</xref>). Nonetheless, our study suggests a tumor suppressive role of <italic>miR-323a-3p</italic> in neuroblastoma, which coincides with most of the studies conducted in other cancer types (<xref ref-type="bibr" rid="B13">13</xref>&#x2013;<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B18">18</xref>). It is worth noting that, in contrast to these studies, <italic>miR-323</italic> was upregulated and shown to promote cell proliferation and growth of xenograft tumors by targeting <italic>p73</italic> in prostate cancer (<xref ref-type="bibr" rid="B19">19</xref>, <xref ref-type="bibr" rid="B36">36</xref>). However, the authors do not provide information on which miRNA (miR-323a or -b) or which mature miRNA (-3p or -5p) they have investigated. If they indeed investigated <italic>miR-323a-3p,</italic> the conflicting results merely demonstrate the dual roles of miRNAs. MiRNA&#x0027;s ability to regulate several targets within a cell can produce different phenotypes in different cells and diseases, and even within the same disease (<xref ref-type="bibr" rid="B7">7</xref>, <xref ref-type="bibr" rid="B37">37</xref>). Therefore, understanding the cell or disease specific mechanisms of a miRNA through functional studies is imperative to develop targeted therapies.</p>
<p>Further elucidating the role of <italic>miR-323a-3p</italic>, we searched for its unknown targets. Expression of a selection of genes involved in proliferation, cell cycle and apoptosis were screened using RT-qPCR in neuroblastoma cells transfected with either <italic>miR-323a-3p</italic> or negative control mimics. <italic>STAT3</italic>, a gene well known to function in apoptosis (<xref ref-type="bibr" rid="B22">22</xref>) and that induces G1-arrest when silenced in esophageal carcinoma (<xref ref-type="bibr" rid="B23">23</xref>), was significantly reduced by <italic>miR-323a-3p</italic> in all three cell lines, and a functional binding site for <italic>miR-323a-3p</italic> in the STAT3 3&#x00B4;UTR was confirmed by luciferase assay. Although other genes that could contribute to the observed biological effects mediated by exogenous expression of <italic>miR-323a-3p</italic> were observed downregulated (particularly <italic>SMAD2</italic>, <italic>TGFA</italic> and <italic>TGFB2</italic>), the levels of these were low (Cq-values &#x003E;31) and therefore not studied further.</p>
<p>When analyzing non-MNA neuroblastoma tumor data, we did not observe a correlation between STAT3 and <italic>miR-323a-3p</italic> expression (data not shown). This underscores the importance of conducting further investigations to establish if the phenotypic effect we observe from upregulation of <italic>miR-323a-3p</italic> is indeed functionally linked to inhibition of <italic>STAT3</italic>. There are undoubtably other mRNA targets for <italic>miR-323a-3p</italic> that can cause the loss of viability and apoptosis that we observe. Crosslink immunoprecipitation followed by high-throughput sequencing to detect miRNA-mRNA interactions could potentially have generated more targets to investigate.</p>
<p><italic>MYCN</italic> amplification is one of the most powerful biological markers indicating poor prognosis in neuroblastoma (<xref ref-type="bibr" rid="B38">38</xref>). Analyzing tumor data, we see a lower <italic>miR-323a-3p</italic> expression in MNA tumors compared to non-MNA tumors, further supporting the assumption that <italic>miR-323a-3p</italic> is a tumor suppressor in this malignancy. Basic expression of <italic>miR-323a-3p</italic> in the three cell lines we have tested do not coincide with the tumor data. Considering the heterogeneous nature of neuroblastoma, variations between single cell lines will occur. Various biological factors, like chromosomal aberrations or gene mutations can alter the miRNA expression, thus accounting for the higher expression in BE(2)-C. As the number of cell lines in this study is limited, generalization of gene expression is restricted. Furthermore, compared to its isogenic counterpart, SK-N-BE(1), expression of <italic>miR-323a-3p</italic> in BE(2)-C is indeed downregulated (<xref ref-type="bibr" rid="B7">7</xref>).</p>
<p>The documented role of miRNAs to act as either oncogenes (oncomiRs) or tumor suppressor genes in multiple cancers has led to clinical trials aiming to reconstitute downregulated tumor suppressor miRNAs or inhibit highly expressed miRNAs. <italic>MiR-34</italic> (MRX34) has been tested in a phase-I clinical trial (ClinicalTrials.gov Identifier: NCT01829971) for treating solid tumors and <italic>miR-122</italic> entered phase-II trial (ClinicalTrials.gov Identifier: NCT01200420) for treating hepatitis (<xref ref-type="bibr" rid="B39">39</xref>&#x2013;<xref ref-type="bibr" rid="B41">41</xref>). Thus, strategies involving manipulating expression of miRNAs can be an important approach in treatment of cancers or other diseases. As our study suggests a tumor suppressive function of <italic>miR-323a-3p</italic> in neuroblastoma, it is intriguing to consider it valid for further testing. Although the number of cell lines used limits our study, it is indicative of the biological functions of <italic>miR-323a-3p</italic> in neuroblastoma and provides novel knowledge about the neuroblastoma targetome.</p>
</sec>
<sec id="s6" sec-type="conclusions"><title>Conclusions</title>
<p>In conclusion, our study provides new insights into the functional roles of <italic>miR-323a-3p</italic> in neuroblastoma. We demonstrate that <italic>miR-323a-3p</italic> is downregulated in tumors with high-risk features. Moreover, ectopic expression of <italic>miR-323a-3p</italic> in neuroblastoma cell lines lead to reduced cell viability, G1-cell cycle arrest and apoptosis, and caused reduced expression of <italic>STAT3</italic> because of direct binding of <italic>miR-323a-3p</italic> to the 3&#x2032;UTR of <italic>STAT3</italic> mRNA.</p>
</sec>
</body>
<back>
<sec id="s7" sec-type="data-availability"><title>Data availability statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec id="s8"><title>Author contributions</title>
<p>SPB and CE designed the research. SPB, LO and CL performed the experiments. SPB and LO wrote the manuscript. JK contributed the NRC cohort overview, cox regression and Kaplan-Meier analyses. CE and TF reviewed the manuscript. All authors contributed to the article and approved the submitted version.</p>
</sec>
<sec id="s9" sec-type="funding-information"><title>Funding</title>
<p>This study was supported by grants from the UiT&#x2014;The Arctic University of Norway, Barnekreftforeningen (Project number: 210009), Children&#x0027;s Cancer Association Troms and Finnmark, Helse Nord and Simon Fougner Hartmanns Familiefond. The publication charges for this article have been funded by a grant from the publication fund of UiT&#x2014;The Arctic University of Norway. The funding organizations have no role in the design of the study, analysis, and interpretation of the data and in writing the manuscript.</p>
</sec>
<ack><title>Acknowledgments</title>
<p>We thank Professor Pieter Mestdagh, Ghent University, Belgium for providing us with miRNA expression data from primary neuroblastoma tumors obtained through the Neuroblastoma Research Consortium (NRC) initiative. We thank Dr. John Inge Johnsen, Childhood Cancer Research Unit, Department of Women&#x0027;s and Children&#x0027;s Health, Karolinska Institutet, 171 76 Stockholm, Sweden for providing us with SK-N-BE(2)-C, Kelly and SH-SY5Y.</p>
</ack>
<sec id="s10" sec-type="COI-statement"><title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s12" sec-type="disclaimer"><title>Publisher&#x0027;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s11" sec-type="supplementary-material"><title>Supplementary material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fped.2023.1098999/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fped.2023.1098999/full&#x0023;supplementary-material</ext-link>.</p>
<supplementary-material id="SD1" content-type="local-data">
<media mimetype="application" mime-subtype="pdf" xlink:href="Datasheet1.pdf"/>
</supplementary-material>
</sec>
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