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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">IJO</journal-id>
<journal-title-group>
<journal-title>International Journal of Oncology</journal-title></journal-title-group>
<issn pub-type="ppub">1019-6439</issn>
<issn pub-type="epub">1791-2423</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name></publisher></journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3892/ijo.2012.1559</article-id>
<article-id pub-id-type="publisher-id">ijo-41-04-1337</article-id>
<article-categories>
<subj-group>
<subject>Articles</subject></subj-group></article-categories>
<title-group>
<article-title>The BHLH transcription factor DEC1 plays an important role in the epithelial-mesenchymal transition of pancreatic cancer</article-title></title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>WU</surname><given-names>YUNYAN</given-names></name><xref rid="af1-ijo-41-04-1337" ref-type="aff"><sup>1</sup></xref><xref rid="af2-ijo-41-04-1337" ref-type="aff"><sup>2</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>SATO</surname><given-names>FUYUKI</given-names></name><xref ref-type="corresp" rid="c1-ijo-41-04-1337"/><xref rid="af1-ijo-41-04-1337" ref-type="aff"><sup>1</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>YAMADA</surname><given-names>TOSHIYUKI</given-names></name><xref rid="af3-ijo-41-04-1337" ref-type="aff"><sup>3</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>BHAWAL</surname><given-names>UJJAL KUMAR</given-names></name><xref rid="af4-ijo-41-04-1337" ref-type="aff"><sup>4</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>KAWAMOTO</surname><given-names>TAKESHI</given-names></name><xref rid="af5-ijo-41-04-1337" ref-type="aff"><sup>5</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>FUJIMOTO</surname><given-names>KATSUMI</given-names></name><xref rid="af5-ijo-41-04-1337" ref-type="aff"><sup>5</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>NOSHIRO</surname><given-names>MITSUHIDE</given-names></name><xref rid="af5-ijo-41-04-1337" ref-type="aff"><sup>5</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>SEINO</surname><given-names>HIROKO</given-names></name><xref rid="af1-ijo-41-04-1337" ref-type="aff"><sup>1</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>MOROHASHI</surname><given-names>SATOKO</given-names></name><xref rid="af1-ijo-41-04-1337" ref-type="aff"><sup>1</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>HAKAMADA</surname><given-names>KENICHI</given-names></name><xref rid="af6-ijo-41-04-1337" ref-type="aff"><sup>6</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>ABIKO</surname><given-names>YOSHIMITSU</given-names></name><xref rid="af4-ijo-41-04-1337" ref-type="aff"><sup>4</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>KATO</surname><given-names>YUKIO</given-names></name><xref rid="af5-ijo-41-04-1337" ref-type="aff"><sup>5</sup></xref></contrib>
<contrib contrib-type="author">
<name><surname>KIJIMA</surname><given-names>HIROSHI</given-names></name><xref rid="af1-ijo-41-04-1337" ref-type="aff"><sup>1</sup></xref></contrib></contrib-group>
<aff id="af1-ijo-41-04-1337">
<label>1</label>Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, 
<country>Japan</country>;</aff>
<aff id="af2-ijo-41-04-1337">
<label>2</label>Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences of China Medical University, Shenyang 110001, 
<country>P.R. China</country>;</aff>
<aff id="af3-ijo-41-04-1337">
<label>3</label>Department of Biochemistry and Genome Biology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562;</aff>
<aff id="af4-ijo-41-04-1337">
<label>4</label>Department of Biochemistry and Molecular Biology Nihon University School of Dentistry at Matsudo, Chiba 271-8587;</aff>
<aff id="af5-ijo-41-04-1337">
<label>5</label>Department of Dental and Medical Biochemistry, Hiroshima University Graduate School of Biomedical Science, Hiroshima 734-8553;</aff>
<aff id="af6-ijo-41-04-1337">
<label>6</label>Department of Gastrointestinal Surgery, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, 
<country>Japan</country></aff>
<author-notes>
<corresp id="c1-ijo-41-04-1337">Correspondence to: Dr Fuyuki Sato, Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan, E-mail: <email>fsatodec1dec2@yahoo.co.jp</email></corresp></author-notes>
<pub-date pub-type="ppub">
<month>10</month>
<year>2012</year></pub-date>
<pub-date pub-type="epub">
<day>18</day>
<month>07</month>
<year>2012</year></pub-date>
<volume>41</volume>
<issue>4</issue>
<fpage>1337</fpage>
<lpage>1346</lpage>
<history>
<date date-type="received">
<day>03</day>
<month>02</month>
<year>2012</year></date>
<date date-type="accepted">
<day>23</day>
<month>04</month>
<year>2012</year></date></history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2012, Spandidos Publications</copyright-statement>
<copyright-year>2012</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0">
<license-p>This is an open-access article licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. The article may be redistributed, reproduced, and reused for non-commercial purposes, provided the original source is properly cited.</license-p></license></permissions>
<abstract>
<p>DEC1 (BHLHE40/Stra13/Sharp2) is a basic helix-loop-helix (bHLH) transcription factor that is involved in the regulation of apoptosis and cell proliferation and the response to hypoxia. Epithelial-mesenchymal transition (EMT) is an important step leading to invasion and migration of various tumor cells, and TGF-&#x003B2; treatment has been shown to induce cancer cells to undergo EMT. However, the significance of DEC1 in TGF-&#x003B2;-induced EMT remains unknown. We examined the role of DEC1 in EMT of PANC-1 cells, a human pancreatic cancer cell line. As a result, we found that DEC1 was upregulated by TGF-&#x003B2; in PANC-1 cells, and regulated the expression and the levels of nuclear, cytoplasmic or membrane localization of EMT-related factors, including phosphorylated Smad3 (pSmad3), snail, claudin-4 and N-cadherin. In the presence of TGF-&#x003B2;, DEC1 knockdown by siRNA inhibited morphological changes during EMT processes, while TGF-&#x003B2; induced PANC-1 cells to taken on a spindle-shaped morphology. Furthermore, a combination treatment of DEC1 expression with TGF-&#x003B2; was closely linked to the migration and invasion of PANC-1 cells. Immunohistochemically, DEC1 and pSmad3 were detected within pancreatic cancer tissues, whereas claudin-4 expression was weaker in the cancer tissues compared with the adjacent non-cancer pancreatic tissues. These findings suggest that DEC1 plays an important role in the regulation of these EMT-related factors in pancreatic cancer.</p></abstract>
<kwd-group>
<kwd>differentiated embryonic chondrocyte gene 1</kwd>
<kwd>epithelial-mesenchymal transition</kwd>
<kwd>transforming growth factor-&#x003B2;</kwd>
<kwd>human pancreatic cancer</kwd></kwd-group></article-meta></front>
<body>
<sec sec-type="intro">
<title>Introduction</title>
<p>Epithelial-mesenchymal transition (EMT) is a dynamic process that occurs during the tumor progression of various cancers. It is characterized by the loss of epithelial factors, including E-cadherin, claudins, and cytokeratins, and the upregulated expression of mesenchymal markers, including N-cadherin, vimentin and fibronectin. Cancer cells that have undergone EMT are thought to acquire a fibroblast-like motile and an invasive phenotype (<xref rid="b1-ijo-41-04-1337" ref-type="bibr">1</xref>,<xref rid="b2-ijo-41-04-1337" ref-type="bibr">2</xref>).</p>
<p>Transforming growth factor (TGF)-&#x003B2; one of the most potent inducers of EMT, induces spindle-shaped cell morphology, inhibits cell proliferation, and promotes tumor cell motility and invasion (<xref rid="b2-ijo-41-04-1337" ref-type="bibr">2</xref>&#x02013;<xref rid="b4-ijo-41-04-1337" ref-type="bibr">4</xref>). TGF-&#x003B2; binds to two different serine/threonine kinase receptors; type I (TGF-&#x003B2;RI) and type II receptors (TGF-&#x003B2;RII). The formation of hetero-dimers of TGF-&#x003B2;RI and TGF-&#x003B2;RII leads to the activation of the signaling pathways mediated by TGF-&#x003B2; (<xref rid="b5-ijo-41-04-1337" ref-type="bibr">5</xref>). Human pancreatic cancer (PANC-1) cells express both TGF-&#x003B2;RI and TGF-&#x003B2;RII, whereas MIA PaCa-2 pancreatic cancer cells do not express either of them (<xref rid="b6-ijo-41-04-1337" ref-type="bibr">6</xref>). Smads are key intracellular mediators of the transcriptional responses to TGF-&#x003B2;, and Smad4 mutations are known to be present in more than 50&#x00025; of pancreatic cancer cases (<xref rid="b7-ijo-41-04-1337" ref-type="bibr">7</xref>,<xref rid="b8-ijo-41-04-1337" ref-type="bibr">8</xref>). In addition, the activation of other Smads plays important roles in the tumor progression of pancreatic cancer. The phosphorylation of Smad2 and Smad3 causes them to translocate from the cytoplasm to the nucleus and associate with Smad4. In the nucleus, the activated Smad complex binds to target gene promoters and regulates the transcriptional responses to TGF-&#x003B2; (<xref rid="b5-ijo-41-04-1337" ref-type="bibr">5</xref>,<xref rid="b9-ijo-41-04-1337" ref-type="bibr">9</xref>,<xref rid="b10-ijo-41-04-1337" ref-type="bibr">10</xref>).</p>
<p>There are several EMT inducing transcription factors, such as snail, slug, twist and ZEB1 (<xref rid="b11-ijo-41-04-1337" ref-type="bibr">11</xref>&#x02013;<xref rid="b14-ijo-41-04-1337" ref-type="bibr">14</xref>). Since there were some reports on the roles of snail in PANC-1, we selected snail as a marker of positive control during EMT. Snail is expressed in various tumor cells and regulates the expression of E-cadherin, claudins, and some mesenchymal markers, which are involved in tumor invasion, metastasis, and cell motility (<xref rid="b1-ijo-41-04-1337" ref-type="bibr">1</xref>,<xref rid="b15-ijo-41-04-1337" ref-type="bibr">15</xref>,<xref rid="b16-ijo-41-04-1337" ref-type="bibr">16</xref>). Furthermore, TGF-&#x003B2; directly activates snail transcription through the Smad3 phosphorylation (<xref rid="b17-ijo-41-04-1337" ref-type="bibr">17</xref>).</p>
<p>We have shown that DEC1 (BHLHE40/Stra13/Sharp2) is involved in the regulation of apoptosis and the cell cycle in human breast and oral cancer cells (<xref rid="b18-ijo-41-04-1337" ref-type="bibr">18</xref>&#x02013;<xref rid="b20-ijo-41-04-1337" ref-type="bibr">20</xref>). DEC1 is also highly expressed in various tumors (<xref rid="b20-ijo-41-04-1337" ref-type="bibr">20</xref>&#x02013;<xref rid="b24-ijo-41-04-1337" ref-type="bibr">24</xref>). However, the role of DEC1 in EMT is still unknown. In this study, we focused on the role of DEC1 in EMT of pancreatic cancer cells during TGF-&#x003B2; treatment and demonstrated that DEC1 plays important roles in EMT of pancreatic cancer cells.</p></sec>
<sec sec-type="methods">
<title>Materials and methods</title>
<sec>
<title>Cell culture and treatment</title>
<p>Human pancreatic cancer PANC-1 and MIA PaCa-2 cells were cultured as described previously (<xref rid="b25-ijo-41-04-1337" ref-type="bibr">25</xref>,<xref rid="b26-ijo-41-04-1337" ref-type="bibr">26</xref>). These cells were incubated with recombinant human TGF-&#x003B2; (R&#x00026;D Systems, Minneapolis, MN, USA) or A-83-01 (Takara, Shiga, Japan) at various concentrations and periods.</p></sec>
<sec>
<title>Knockdown of DEC1 by RNA interference</title>
<p>Short interference RNA (siRNA) against DEC1 was synthesized by Qiagen (Hilden, Germany). The sequences of the sense and anti-sense DEC1 siRNA and the negative control (scrambled) siRNA, and the siRNA transfection were performed as described previously (<xref rid="b18-ijo-41-04-1337" ref-type="bibr">18</xref>).</p></sec>
<sec>
<title>DEC1 overexpression</title>
<p>DEC1 overexpression was induced using pcDNA vector as described previously (<xref rid="b19-ijo-41-04-1337" ref-type="bibr">19</xref>). After transfection, the cells were incubated for 24 h and subjected to the invasion assay.</p></sec>
<sec>
<title>Western blotting</title>
<p>Cells were lysed using M-PER lysis buffer (Thermo Scientific, Rockford, IL, USA) and their protein concentration was determined using the bicinchoninic acid (BCA) assay. Their lysates were subjected to SDS-PAGE and detected the protein expression as described previously (<xref rid="b18-ijo-41-04-1337" ref-type="bibr">18</xref>,<xref rid="b19-ijo-41-04-1337" ref-type="bibr">19</xref>).</p></sec>
<sec>
<title>Antibodies</title>
<p>The membranes for western blotting were incubated with antibodies specific to DEC1 (1:10,000; Novus Biologicals Inc., Littleton, CO, USA), Smad3 (1:1,000; Epitomics Inc., Burlingame, CA, USA), pSmad3 (1:6,000; Epitomics), phospho extracellular signal-related kinases (p-ERK)&#x000BD; (1:1,000; Epitomics), pSmad2 (1:5,000; Invitrogen, Carlsbad, CA, USA), slug (1:3,000; Cell Signaling Technology Inc.), snail (1:3,000; Cell Signaling Technology Inc., Danvers, MA, USA), ERK1/2 (1:30,000; Cell Signaling Technology Inc.), &#x003B1;-smooth muscle actin (&#x003B1;-SMA) (1:20,000; Sigma Chemical Co., St. Louis, MO, USA), vimentin (1:10,000; Epitomics), N-cadherin (1:10,000; ECM Biosciences, Versailles, KY, USA), E-cadherin (1:1000; Takara), claudin-1 (1:10,000; Invitrogen), claudin-4 (1:20,000; Invitrogen), claudin-7 (1:1,000; Invitrogen), and actin (1:30,000; Sigma), followed by horseradish peroxidase-conjugated secondary antibody (Immuno-Biological Laboratories, Fujioka, Japan). Can Get Signal immunoreaction enhancer solution (Toyobo Co. Ltd., Osaka, Japan) or Immunoshot immunoreaction enhancer solution (Cosmobio Co. Ltd., Tokyo, Japan) was used to dilute the primary antibody.</p></sec>
<sec>
<title>Real-time polymerase chain reaction (PCR)</title>
<p>We prepared three independent RNA samples (n&#x0003D;3). Total-RNA was isolated and first-strand cDNA was synthesized as described previously (<xref rid="b19-ijo-41-04-1337" ref-type="bibr">19</xref>). The real-time PCR was performed using SYBR-Green Master Mix (Life Technologies, Carlsbad, CA, USA). The sequences of the primers and the sizes of products are shown in <xref rid="t1-ijo-41-04-1337" ref-type="table">Table I</xref>.</p></sec>
<sec>
<title>Immunofluorescent staining</title>
<p>Immunofluorescent staining was performed as described previously (<xref rid="b18-ijo-41-04-1337" ref-type="bibr">18</xref>). The permeabilized cells were incubated with anti-DEC1 (1:300), pSmad3 (1:300), snail (1:300), N-cadherin (1:300), E-cadherin (1:300), claudin-1 (1:300), claudin-4 (1:300), or claudin-7 (1:300) antibodies at 4&#x000B0;C overnight. The cells were then incubated for 1 h with goat anti-rabbit IgG antibody conjugated to Alexa 488 dye (Molecular Probes Inc., Tokyo, Japan), while nuclear staining was performed using 4&#x02032;,6-diamidino-2-phenylindole (DAPI). These cells were visualized using confocal laser scanning microscopy LSM 710 (Zeiss, Wetzlar, Germany).</p>
<p>Cell stain was carried out using the CnT-ST-100 stain kit (CellnTEC Advanced Cell Systems AG, Bern, Switzerland), in accordance with the manufacturer&#x02019;s instructions.</p></sec>
<sec>
<title>Invasion assay and migration assay</title>
<p>The invasion assay was performed using a BD BioCoat Matrigel invasion chamber kit (Becton Dickinson, Franklin Lakes, NJ, USA). PANC-1 cells were separated using cell dissociation solution (Sigma) and then (5&#x000D7;10<sup>4</sup> cells/600 &#x003BC;l) were added to the top chamber of a cell culture insert in a 24-well companion plate. After overnight incubation, the cells that had invaded the lower surface of the membrane were fixed with methanol and subjected to Giemsa staining. The number of cells that had migrated was quantified by counting them in ten random distinct fields using a light microscope.</p>
<p>For the migration assay, PANC-1 cells were seeded in a 4-chamber slide glass, and an artificial &#x02018;wound&#x02019; was carefully created at 0 h by scratching the confluent cell monolayer with the tip of a P-200 pipette. Microphotographs were taken at 0, 24 and 48 h.</p></sec>
<sec>
<title>Human pancreatic tissues</title>
<p>We examined immunohistochemical analyses of surgically resected pancreatic cancers (n&#x0003D;17), which have been filed in Hirosaki University Hospital, Japan (<xref rid="t2-ijo-41-04-1337" ref-type="table">Table II</xref>). All of the 17 cases examined were invasive ductal carcinoma of pancreas. Histological specimens were retrieved from the archives of our hospital according to the guidelines produced by the Japanese Society of Pathology.</p></sec>
<sec>
<title>Immunohistochemistry</title>
<p>Immunohistochemistry was performed as described previously (<xref rid="b27-ijo-41-04-1337" ref-type="bibr">27</xref>). The sections were incubated overnight at 4&#x000B0;C with anti-DEC1 (1:100), pSmad3 (1:200), or claudin-4 (1:400) antibodies diluted in Can Get Signal Immunostain Solution (Toyobo Co.). Finally, the sections were counterstained with Mayer&#x02019;s hematoxylin.</p></sec></sec>
<sec sec-type="results">
<title>Results</title>
<sec>
<title>DEC1 expression was induced by TGF-&#x003B2; in PANC-1 cells</title>
<p>TGF-&#x003B2; treatment induced Smad3 phosphorylation, and upregulated the expression of DEC1, snail, &#x003B1;-SMA, vimentin and N-cadherin, whereas it downregulated E-cadherin, claudin-1 and claudin-4 in PANC-1 cells (<xref rid="f1-ijo-41-04-1337" ref-type="fig">Fig. 1A and B</xref>). The highest level of DEC1 expression was observed in the cells treated with 2 ng/ml of TGF-&#x003B2; for 24 h. TGF-&#x003B2; had little effect on the Smad2 phosphorylation and the expression of Smad3, slug and claudin-7 in PANC-1 cells. On the other hand, no apparent effects were observed on the expression of the aforementioned molecules after TGF-&#x003B2; treatment in MIA PaCa-2 cells. Next, we investigated the endogenous mRNA expression of these proteins in PANC-1 cells treated with TGF-&#x003B2;. The expression of DEC1, snail and N-cadherin was upregulated by TGF-&#x003B2;, whereas the expression of E-cadherin and claudin-4 was downregulated (<xref rid="f1-ijo-41-04-1337" ref-type="fig">Fig. 1C</xref>). A-83-01-an inhibitor of the TGF-&#x003B2; signaling pathway prevents Smad2/3 phosphorylation. We therefore investigated whether A-83-01 affects the Smad3 phosphorylation and DEC1 expression induced by TGF-&#x003B2; in PANC-1 cells. A-83-01 suppressed the Smad3 phosphorylation, and the expression of DEC1 and snail. On the other hand, claudin-4 expression was upregulated by A-83-01 (<xref rid="f1-ijo-41-04-1337" ref-type="fig">Fig. 1D</xref>).</p></sec>
<sec>
<title>DEC1 knockdown suppressed EMT induced by TGF-&#x003B2;</title>
<p>The cells that were transfected with the control siRNA showed a spindle-shaped morphology after 24 h treatment with TGF-&#x003B2;, while the cells transfected with DEC1 siRNA displayed no morphological changes after the same treatment (<xref rid="f2-ijo-41-04-1337" ref-type="fig">Fig. 2A</xref>). As shown in <xref rid="f2-ijo-41-04-1337" ref-type="fig">Fig. 2B</xref>, in the absence of TGF-&#x003B2;, DEC1 siRNA upregulated the expression of claudin-4, claudin-7 and E-cadherin, and downregulated the expression of N-cadherin, whereas it had little effect on the Smad3 phosphorylation, and the expression of snail and claudin-1. In the presence of TGF-&#x003B2;, DEC1 siRNA decreased the Smad3 phosphorylation, and the expression of snail and N-cadherin, whereas it upregulated the expression of claudin-1, claudin-4, claudin-7, and E-cadherin. In the presence or absence of TGF-&#x003B2;, DEC1 siRNA had little effect on the ERK1/2 phosphorylation, and the expression of total-ERK1/2, &#x003B1;-SMA and vimentin. Another DEC1 siRNA oligonucleotide yielded similar results (data not shown). In order to examine whether DEC1 regulates EMT-related factors at the transcriptional level, we performed real-time PCR analysis. The altered mRNA expression patterns of snail, E-cadherin, claudin-4 and N-cadherin were compatible with the above protein results (<xref rid="f2-ijo-41-04-1337" ref-type="fig">Fig. 2C</xref>). In the presence of TGF-&#x003B2;, DEC1 siRNA also significantly decreased the expression of TGF-&#x003B2;RI, although DEC1 siRNA without TGF-&#x003B2; slightly decreased the expression of TGF-&#x003B2;RI. DEC1 siRNA regardless of TGF-&#x003B2; had little effect on the expression of TGF-&#x003B2;RII (data not shown).</p></sec>
<sec>
<title>Effects of DEC1 knockdown on the amounts of nuclear/cytoplasmic EMT-related factors</title>
<p>As shown in <xref rid="f2-ijo-41-04-1337" ref-type="fig">Fig. 2D</xref>, DEC1 siRNA without TGF-&#x003B2; decreased the amount of N-cadherin in the cell membrane, while it increased the cell membrane levels of E-cadherin, claudin-4 and claudin-7. On the other hand, DEC1 siRNA without TGF-&#x003B2; had little effect on the amounts of nuclear/cytoplasmic pSmad3, snail and claudin-1. In the presence of TGF-&#x003B2;, control siRNA increased the levels of pSmad3 and snail in the nucleus compared with the absence of TGF-&#x003B2;, and slightly increased the level of N-cadherin in the cell membrane, whereas it decreased the amounts of E-cadherin and claudin-1 in the cell membrane, and decreased the amount of claudin-4 in the cytoplasm. However, it had little effect on the amount of claudin-7 in the cytoplasm or membrane. In the presence of TGF-&#x003B2;, DEC1 siRNA decreased the levels of pSmad3 and snail in the nucleus compared with control siRNA, and it also decreased the amount of N-cadherin in the cell membrane. On the other hand, a combination treatment of DEC1 siRNA with TGF-&#x003B2; significantly increased the levels of E-cadherin, claudin-1 and claudin-4 in the cell membrane compared with control siRNA. A combination treatment of DEC1 siRNA with TGF-&#x003B2; also slightly increased the amount of claudin-7 in the cell membrane. These findings demonstrated that DEC1 has inducible effects on EMT in PANC-1 cells during TGF-&#x003B2; treatment, which involved alterations in the cellular amounts of EMT-related factors.</p></sec>
<sec>
<title>In the presence of TGF-&#x003B2;, DEC1 expression was closely involved in the migration and invasion</title>
<p>We examined whether DEC1 expression was involved in the migration and invasion of PANC-1 cells. In the presence of TGF-&#x003B2;, DEC1 siRNA delayed cell migration for 24&#x02013;48 h in comparison with those transfected with the control siRNA (<xref rid="f3-ijo-41-04-1337" ref-type="fig">Fig. 3</xref>). We performed an invasion assay in which we transiently transfected the cells with a DEC1 expressing plasmid. As a result, the number of invasive PANC-1 cells with a spindle-shaped morphology was increased in the presence of TGF-&#x003B2; (<xref rid="f4-ijo-41-04-1337" ref-type="fig">Fig. 4</xref>). The invasion assay also demonstrated that there were significantly more invasive spindle-shaped cells among the cells transfected with DEC1 than among those transfected with the control pcDNA vector.</p></sec>
<sec>
<title>DEC1, pSmad3 and claudin-4 protein expression in human pancreatic cancer tissues and the adjacent non-cancerous pancreatic tissues</title>
<p>We examined the immunohistochemical expression of DEC1, pSmad3 and claudin-4 in human pancreatic cancer tissues. Photographs of DEC1, pSmad3 and claudin-4 expression in representative cases are shown in <xref rid="f5-ijo-41-04-1337" ref-type="fig">Fig. 5</xref>. Significant DEC1 immunoreactivity was detected in the cancer tissues (100&#x00025;, 17/17 cases) compared with the adjacent non-cancerous pancreatic tissues, and it was predominantly located within the cytoplasm of the cancer cells, although very weak DEC1 immunoreactivity was found in the non-cancerous pancreatic ductal cells of all cases. DEC1 immunoreactivity was detected in parts of the adjacent non-cancerous tissues (17&#x00025;, 3/17 cases).</p>
<p>It is often difficult to distinguish between spindle-shaped cells of the cancer invasive front and fibroblasts in stroma. We distinguish them by dyskaryosis and size. Firstly, dyskaryosis was shown in spindle-shaped cells, whereas it was not shown in fibroblasts in stroma. Secondary, the sizes of spindle-shaped cells were larger than fibroblasts. The spindle-shaped cells of the cancer invasive front showed strong DEC1 immunoreactivity similar to that seen in the other cancer regions (case 9, right panel). Marked claudin-4 immunoreactivity was detected in the membrane and/or cytoplasm of non-cancerous pancreatic ductal cells, whereas that in the cancer cells was weak, except for 4 cases in which strong claudin-4 expression was detected in cancer cells. Significant pSmad3 expression was found in the nucleus of spindle-shaped cancer cells, whereas it was detected in non-cancerous ductal cells in 3 cases. The changes in the immunohistochemical expression of DEC1, pSmad3, and claudin-4 were found to be independent of the cancer grade and the patient&#x02019;s age and gender.</p></sec></sec>
<sec sec-type="discussion">
<title>Discussion</title>
<p>DEC1 is expressed in various tumors and regulates the responses to hypoxia, apoptosis and the cell cycle (<xref rid="b19-ijo-41-04-1337" ref-type="bibr">19</xref>,<xref rid="b20-ijo-41-04-1337" ref-type="bibr">20</xref>,<xref rid="b23-ijo-41-04-1337" ref-type="bibr">23</xref>,<xref rid="b24-ijo-41-04-1337" ref-type="bibr">24</xref>,<xref rid="b28-ijo-41-04-1337" ref-type="bibr">28</xref>). Recent studies have shown that the expression of DEC1 is related to apoptosis resistance in pancreatic cancer cells (<xref rid="b29-ijo-41-04-1337" ref-type="bibr">29</xref>). However, the significance of DEC1 in pancreatic cancer is poorly understood. In the present study, we showed that DEC1 was upregulated by TGF-&#x003B2; in PANC-1 cells. DEC1 expression was highest in the cells cultured in the presence of TGF-&#x003B2; for 24 h, whereas snail expression was highest in the cells cultured in the presence of TGF-&#x003B2; for 48 h. PANC-1 cells showed the highest level of Smad3 phosphorylation when cultured in the presence of TGF-&#x003B2; for 24&#x02013;48 h, which also induced a spindle-shaped morphology and enhanced migration and invasiveness. These findings indicate that EMT of PANC-1 is induced by 24 h TGF-&#x003B2; treatment and that TGF-&#x003B2;-induced DEC1 expression is closely related to EMT phenomena. Previous studies have reported that TGF-&#x003B2; affects circadian phase shifts in rat fibroblasts, as well as the immediate-early induction of DEC1, and Smad binding sites (SBE) were presented in the DEC1 promoter (<xref rid="b30-ijo-41-04-1337" ref-type="bibr">30</xref>). The differences in DEC1 induction time between the previous report and our present study are probably related to cell type. It was reported that TGF-&#x003B2; increased the protein expression of Smad4 in PANC-1 cells (<xref rid="b31-ijo-41-04-1337" ref-type="bibr">31</xref>). We performed a chip assay whether Smad3 or Smad4 bound to the DEC1 promoter in PANC-1 cells, and found that in the presence of TGF-&#x003B2;, Smad3 or Smad4 bound to the SBE in the DEC1 promoter (data not shown). Thus, we thought, at least, Smad3 or Smad4 might have activities for binding to the DEC1 promoter in PANC-1 cells.</p>
<p>We demonstrated that a combination treatment of DEC1 siRNA with TGF-&#x003B2; downregulated the Smad3 phosphorylation, and the expression of TGF-&#x003B2;RI and snail, and it also decreased the amounts of pSmad3 and snail in the nucleus. These findings suggest that DEC1 is an upstream factor of these genes. It has been reported that DEC1 upregulates and downregulates target genes by binding to sp1 and E-box sites, respectively (<xref rid="b21-ijo-41-04-1337" ref-type="bibr">21</xref>,<xref rid="b32-ijo-41-04-1337" ref-type="bibr">32</xref>,<xref rid="b33-ijo-41-04-1337" ref-type="bibr">33</xref>). The promoter region of TGF-&#x003B2;RI contains sp1 sites (<xref rid="b34-ijo-41-04-1337" ref-type="bibr">34</xref>). Therefore, we speculate that DEC1 binds to sp1 sites of the TGF-&#x003B2;RI promoter and regulates EMT-related factors through pSmad3/snail signaling. TGF-&#x003B2; also affects the ERK1/2 phosphorylation independent of Smad pathway (<xref rid="b35-ijo-41-04-1337" ref-type="bibr">35</xref>). However, DEC1 siRNA regardless of TGF-&#x003B2; had little effect on the ERK1/2 phosphorylation. These results suggest that DEC1 specifically regulates the pSmad3/snail pathway induced by TGF-&#x003B2;. In MIA PaCa-2 cells lacking the TGF-&#x003B2; receptor, TGF-&#x003B2; treatment had little effect on the expression of DEC1 and snail, and the Smad3 phosphorylation, and cell morphology. These findings suggest that DEC1 regulates pSmad3 by positive and negative feedback systems during EMT of pancreatic cancer.</p>
<p>Claudin-4 expression has been shown to decrease the invasiveness and metastatic potential of pancreatic cancer (<xref rid="b36-ijo-41-04-1337" ref-type="bibr">36</xref>). Claudin and E-cadherin expression were found to be down-regulated in breast, esophageal, and head and neck cancer tissue (<xref rid="b37-ijo-41-04-1337" ref-type="bibr">37</xref>&#x02013;<xref rid="b39-ijo-41-04-1337" ref-type="bibr">39</xref>). The promoter regions of claudins and E-cadherin contain E-boxes (<xref rid="b15-ijo-41-04-1337" ref-type="bibr">15</xref>,<xref rid="b40-ijo-41-04-1337" ref-type="bibr">40</xref>,<xref rid="b41-ijo-41-04-1337" ref-type="bibr">41</xref>). We showed that DEC1 had effect on the expression and the amounts of claudin-4, claudin-7, and E-cadherin in the cell membrane, while DEC1 and claudin-4 were immunohistochemically detected in cancer tissues and non-cancerous ducts, respectively. Based on the above findings, DEC1 is considered to negatively regulate the expression of E-cadherin and claudins.</p>
<p>Our study is the first report to demonstrate marked pSmad3 immunoreactivity in pancreatic cancer cells compared with that in the adjacent non-cancerous pancreatic tissues. In particular, strong pSmad3 immunoreactivity was found in the nucleus of the spindle-shaped cancer cells, which were located at the cancer invasive front. A recent study reported that Smad3, but not Smad2, increased the expression of matrix metalloproteinase-9 in lung cancer cells and contributed to EMT through TGF-&#x003B2; (<xref rid="b42-ijo-41-04-1337" ref-type="bibr">42</xref>) which suggests that pSmad3 expression is closely involved in EMT of cancer cells.</p>
<p>In the present study, we demonstrated that DEC1 has inducible effects on EMT, which are mediated through the Smad3 phosphorylation, and plays an important role in EMT of pancreatic cancer; i.e., it alters the expression of EMT-related factors and affects the morphology, migration, and invasion of cancer cells.</p></sec></body>
<back>
<glossary>
<title>Abbreviations:</title>
<def-list>
<def-item>
<term>DEC1</term>
<def>
<p>differentiated embryonic chondrocyte gene 1</p></def></def-item>
<def-item>
<term>TGF-&#x003B2;</term>
<def>
<p>transforming growth factor-&#x003B2;</p></def></def-item>
<def-item>
<term>EMT</term>
<def>
<p>epithelial-mesenchymal transition</p></def></def-item>
<def-item>
<term>PANC-1</term>
<def>
<p>human pancreatic cancer</p></def></def-item></def-list></glossary>
<ack>
<p>This study was supported by Grants-in-Aid for Science from the Ministry of Education, Culture, Sports, Science, and Technology of Japan; a Grant for Hirosaki University Institutional Research; and the Fund for the Promotion of International Scientific Research.</p></ack>
<ref-list>
<title>References</title>
<ref id="b1-ijo-41-04-1337"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Thiery</surname><given-names>JP</given-names></name><name><surname>Sleeman</surname><given-names>JP</given-names></name></person-group><article-title>Complex networks orchestrate epithelial-mesenchymal transitions</article-title><source>Nat Rev Mol Cell Biol</source><volume>7</volume><fpage>131</fpage><lpage>142</lpage><year>2006</year></element-citation></ref>
<ref id="b2-ijo-41-04-1337"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zavadil</surname><given-names>J</given-names></name><name><surname>B&#x000F6;ttinger</surname><given-names>EP</given-names></name></person-group><article-title>TGF-beta and epithelial-to-mesenchymal transitions</article-title><source>Oncogene</source><volume>24</volume><fpage>5764</fpage><lpage>5774</lpage><year>2005</year></element-citation></ref>
<ref id="b3-ijo-41-04-1337"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Miettinen</surname><given-names>PJ</given-names></name><name><surname>Ebner</surname><given-names>R</given-names></name><name><surname>Lopez</surname><given-names>AR</given-names></name><name><surname>Derynck</surname><given-names>R</given-names></name></person-group><article-title>TGF-beta induced transdifferentiation of mammary epithelial cells to mesenchymal cells: involvement of type I receptors</article-title><source>J Cell Biol</source><volume>127</volume><fpage>2021</fpage><lpage>2036</lpage><year>1994</year></element-citation></ref>
<ref id="b4-ijo-41-04-1337"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moustakas</surname><given-names>A</given-names></name><name><surname>Heldin</surname><given-names>CH</given-names></name></person-group><article-title>Signaling networks guiding epithelial-mesenchymal transitions during embryogenesis and cancer progression</article-title><source>Cancer Sci</source><volume>98</volume><fpage>1512</fpage><lpage>1520</lpage><year>2007</year></element-citation></ref>
<ref id="b5-ijo-41-04-1337"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Miyazawa</surname><given-names>K</given-names></name><name><surname>Shinozaki</surname><given-names>M</given-names></name><name><surname>Hara</surname><given-names>T</given-names></name><etal/></person-group><article-title>Two major Smad pathways in TGF-beta superfamily signalling</article-title><source>Genes Cells</source><volume>7</volume><fpage>1191</fpage><lpage>1204</lpage><year>2002</year></element-citation></ref>
<ref id="b6-ijo-41-04-1337"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Giehl</surname><given-names>K</given-names></name><name><surname>Seidel</surname><given-names>B</given-names></name><name><surname>Gierschik</surname><given-names>P</given-names></name><etal/></person-group><article-title>TGFbeta1 represses proliferation of pancreatic carcinoma cells which correlates with Smad4-independent inhibition of ERK activation</article-title><source>Oncogene</source><volume>19</volume><fpage>4531</fpage><lpage>4541</lpage><year>2000</year></element-citation></ref>
<ref id="b7-ijo-41-04-1337"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hahn</surname><given-names>SA</given-names></name><name><surname>Schutte</surname><given-names>M</given-names></name><name><surname>Hoque</surname><given-names>AT</given-names></name><etal/></person-group><article-title>DPC4, a candidate tumor suppressor gene at human chromosome 18q21.1</article-title><source>Science</source><volume>271</volume><fpage>350</fpage><lpage>353</lpage><year>1996</year></element-citation></ref>
<ref id="b8-ijo-41-04-1337"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bartsch</surname><given-names>D</given-names></name><name><surname>Hahn</surname><given-names>SA</given-names></name><name><surname>Danichevski</surname><given-names>KD</given-names></name><etal/></person-group><article-title>Mutations of the DPC4/Smad4 gene in neuroendocrine pancreatic tumors</article-title><source>Oncogene</source><volume>18</volume><fpage>2367</fpage><lpage>2371</lpage><year>1999</year></element-citation></ref>
<ref id="b9-ijo-41-04-1337"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Massagu&#x000E9;</surname><given-names>J</given-names></name></person-group><article-title>How cells read TGF-beta signals</article-title><source>Nat Rev Mol Cell Biol</source><volume>1</volume><fpage>169</fpage><lpage>178</lpage><year>2000</year></element-citation></ref>
<ref id="b10-ijo-41-04-1337"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zawel</surname><given-names>L</given-names></name><name><surname>Dai</surname><given-names>JL</given-names></name><name><surname>Buckhaults</surname><given-names>P</given-names></name><etal/></person-group><article-title>Human Smad3 and Smad4 are sequence-specific transcription activators</article-title><source>Mol Cell</source><volume>1</volume><fpage>611</fpage><lpage>617</lpage><year>1998</year></element-citation></ref>
<ref id="b11-ijo-41-04-1337"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ohashi</surname><given-names>S</given-names></name><name><surname>Natsuizaka</surname><given-names>M</given-names></name><name><surname>Naganuma</surname><given-names>S</given-names></name><etal/></person-group><article-title>A NOTCH3-mediated squamous cell differentiation program limits expansion of EMT-competent cells that express the ZEB transcription factors</article-title><source>Cancer Res</source><volume>71</volume><fpage>6836</fpage><lpage>6847</lpage><year>2011</year></element-citation></ref>
<ref id="b12-ijo-41-04-1337"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dave</surname><given-names>N</given-names></name><name><surname>Guaita-Esteruelas</surname><given-names>S</given-names></name><name><surname>Gutarra</surname><given-names>S</given-names></name><etal/></person-group><article-title>Functional cooperation between Snail1 and twist in the regulation of ZEB1 expression during epithelial to mesenchymal transition</article-title><source>J Biol Chem</source><volume>286</volume><fpage>12024</fpage><lpage>12032</lpage><year>2011</year></element-citation></ref>
<ref id="b13-ijo-41-04-1337"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gregory</surname><given-names>PA</given-names></name><name><surname>Bracken</surname><given-names>CP</given-names></name><name><surname>Smith</surname><given-names>E</given-names></name><etal/></person-group><article-title>An autocrine TGF-beta/ ZEB/miR-200 signaling network regulates establishment and maintenance of epithelial-mesenchymal transition</article-title><source>Mol Biol Cell</source><volume>22</volume><fpage>1686</fpage><lpage>1698</lpage><year>2011</year></element-citation></ref>
<ref id="b14-ijo-41-04-1337"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hong</surname><given-names>J</given-names></name><name><surname>Zhou</surname><given-names>J</given-names></name><name><surname>Fu</surname><given-names>J</given-names></name><etal/></person-group><article-title>Phosphorylation of serine 68 of Twist1 by MAPKs stabilizes Twist1 protein and promotes breast cancer cell invasiveness</article-title><source>Cancer Res</source><volume>71</volume><fpage>3980</fpage><lpage>3990</lpage><year>2011</year></element-citation></ref>
<ref id="b15-ijo-41-04-1337"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ikenouchi</surname><given-names>J</given-names></name><name><surname>Matsuda</surname><given-names>M</given-names></name><name><surname>Furuse</surname><given-names>M</given-names></name><name><surname>Tsukita</surname><given-names>S</given-names></name></person-group><article-title>Regulation of tight junctions during the epithelium-mesenchyme transition: direct repression of the gene expression of claudins/occludin by Snail</article-title><source>J Cell Sci</source><volume>116</volume><fpage>1959</fpage><lpage>1967</lpage><year>2003</year></element-citation></ref>
<ref id="b16-ijo-41-04-1337"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ohkubo</surname><given-names>T</given-names></name><name><surname>Ozawa</surname><given-names>M</given-names></name></person-group><article-title>The transcription factor Snail downregulates the tight junction components independently of E-cadherin downregulation</article-title><source>J Cell Sci</source><volume>117</volume><fpage>1675</fpage><lpage>1685</lpage><year>2004</year></element-citation></ref>
<ref id="b17-ijo-41-04-1337"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zavadil</surname><given-names>J</given-names></name><name><surname>Cermak</surname><given-names>L</given-names></name><name><surname>Soto-Nieves</surname><given-names>N</given-names></name><etal/></person-group><article-title>Integration of TGF-beta/Smad and Jagged1/Notch signalling in epithelial-to-mesenchymal transition</article-title><source>EMBO J</source><volume>23</volume><fpage>1155</fpage><lpage>1165</lpage><year>2004</year></element-citation></ref>
<ref id="b18-ijo-41-04-1337"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wu</surname><given-names>Y</given-names></name><name><surname>Sato</surname><given-names>F</given-names></name><name><surname>Bhawal</surname><given-names>UK</given-names></name><etal/></person-group><article-title>Basic helix-loop-helix transcription factors DEC1 and DEC2 regulate the paclitaxel-induced apoptotic pathway of MCF-7 human breast cancer cells</article-title><source>Int J Mol Med</source><volume>27</volume><fpage>491</fpage><lpage>495</lpage><year>2011</year></element-citation></ref>
<ref id="b19-ijo-41-04-1337"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liu</surname><given-names>Y</given-names></name><name><surname>Sato</surname><given-names>F</given-names></name><name><surname>Kawamoto</surname><given-names>T</given-names></name><etal/></person-group><article-title>Anti-apoptotic effect of the basic helix-loop-helix (bHLH) transcription factor DEC2 in human breast cancer cells</article-title><source>Genes Cells</source><volume>15</volume><fpage>315</fpage><lpage>325</lpage><year>2010</year></element-citation></ref>
<ref id="b20-ijo-41-04-1337"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bhawal</surname><given-names>UK</given-names></name><name><surname>Sato</surname><given-names>F</given-names></name><name><surname>Arakawa</surname><given-names>Y</given-names></name><etal/></person-group><article-title>Basic helix-loop-helix transcription factor DEC1 negatively regulates cyclin D1</article-title><source>J Pathol</source><volume>224</volume><fpage>420</fpage><lpage>429</lpage><year>2011</year></element-citation></ref>
<ref id="b21-ijo-41-04-1337"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Li</surname><given-names>Y</given-names></name><name><surname>Xie</surname><given-names>M</given-names></name><name><surname>Yang</surname><given-names>J</given-names></name><etal/></person-group><article-title>The expression of antiapoptotic protein survivin is transcriptionally upregulated by DEC1 primarily through multiple sp1 binding sites in the proximal promoter</article-title><source>Oncogene</source><volume>25</volume><fpage>3296</fpage><lpage>3306</lpage><year>2006</year></element-citation></ref>
<ref id="b22-ijo-41-04-1337"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Turley</surname><given-names>H</given-names></name><name><surname>Wykoff</surname><given-names>CC</given-names></name><name><surname>Troup</surname><given-names>S</given-names></name><etal/></person-group><article-title>The hypoxia-regulated transcription factor DEC1 (Stra13, SHARP-2) and its expression in human tissues and tumours</article-title><source>J Pathol</source><volume>203</volume><fpage>808</fpage><lpage>813</lpage><year>2004</year></element-citation></ref>
<ref id="b23-ijo-41-04-1337"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chakrabarti</surname><given-names>J</given-names></name><name><surname>Turley</surname><given-names>H</given-names></name><name><surname>Campo</surname><given-names>L</given-names></name><etal/></person-group><article-title>The transcription factor DEC1 (stra13, SHARP2) is associated with the hypoxic response and high tumour grade in human breast cancers</article-title><source>Br J Cancer</source><volume>91</volume><fpage>954</fpage><lpage>958</lpage><year>2004</year></element-citation></ref>
<ref id="b24-ijo-41-04-1337"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Giatromanolaki</surname><given-names>A</given-names></name><name><surname>Koukourakis</surname><given-names>MI</given-names></name><name><surname>Sivridis</surname><given-names>E</given-names></name><etal/></person-group><article-title>DEC1 (STRA13) protein expression relates to hypoxia- inducible factor 1-alpha and carbonic anhydrase-9 overexpression in non-small cell lung cancer</article-title><source>J Pathol</source><volume>200</volume><fpage>222</fpage><lpage>228</lpage><year>2003</year></element-citation></ref>
<ref id="b25-ijo-41-04-1337"><label>25</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kondo</surname><given-names>J</given-names></name><name><surname>Sato</surname><given-names>F</given-names></name><name><surname>Kusumi</surname><given-names>T</given-names></name><etal/></person-group><article-title>Claudin-1 expression is induced by tumor necrosis factor-&#x003B1; in human pancreatic cancer cells</article-title><source>Int J Mol Med</source><volume>22</volume><fpage>645</fpage><lpage>649</lpage><year>2008</year></element-citation></ref>
<ref id="b26-ijo-41-04-1337"><label>26</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Suzuki</surname><given-names>T</given-names></name><name><surname>Sato</surname><given-names>F</given-names></name><name><surname>Kondo</surname><given-names>J</given-names></name><etal/></person-group><article-title>Period is involved in the proliferation of human pancreatic MIA-PaCa2 cancer cells by TNF-alpha</article-title><source>Biomed Res</source><volume>29</volume><fpage>99</fpage><lpage>103</lpage><year>2008</year></element-citation></ref>
<ref id="b27-ijo-41-04-1337"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sato</surname><given-names>F</given-names></name><name><surname>Wu</surname><given-names>Y</given-names></name><name><surname>Bhawal</surname><given-names>UK</given-names></name><name><surname>Liu</surname><given-names>Y</given-names></name><etal/></person-group><article-title>PERIOD1 (PER1) has anti-apoptotic effects, and PER3 has pro-apoptotic effects during cisplatin (CDDP) treatment in human gingival cancer CA9-22 cells</article-title><source>Eur J Cancer</source><volume>47</volume><fpage>1747</fpage><lpage>1758</lpage><year>2011</year></element-citation></ref>
<ref id="b28-ijo-41-04-1337"><label>28</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Li</surname><given-names>Y</given-names></name><name><surname>Zhang</surname><given-names>H</given-names></name><name><surname>Xie</surname><given-names>M</given-names></name><etal/></person-group><article-title>Abundant expression of Dec1/stra13/sharp2 in colon carcinoma: its antagonizing role in serum deprivation-induced apoptosis and selective inhibition of procaspase activation</article-title><source>Biochem J</source><volume>367</volume><fpage>413</fpage><lpage>422</lpage><year>2002</year></element-citation></ref>
<ref id="b29-ijo-41-04-1337"><label>29</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>W</given-names></name><name><surname>Reiser-Erkan</surname><given-names>C</given-names></name><name><surname>Michalski</surname><given-names>CW</given-names></name><etal/></person-group><article-title>Hypoxia inducible BHLHB2 is a novel and independent prognostic marker in pancreatic ductal adenocarcinoma</article-title><source>Biochem Biophys Res Commun</source><volume>401</volume><fpage>422</fpage><lpage>428</lpage><year>2010</year></element-citation></ref>
<ref id="b30-ijo-41-04-1337"><label>30</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kon</surname><given-names>N</given-names></name><name><surname>Hirota</surname><given-names>T</given-names></name><name><surname>Kawamoto</surname><given-names>T</given-names></name><etal/></person-group><article-title>Activation of TGF-beta/ activin signalling resets the circadian clock through rapid induction of Dec1 transcripts</article-title><source>Nat Cell Biol</source><volume>10</volume><fpage>1463</fpage><lpage>1469</lpage><year>2008</year></element-citation></ref>
<ref id="b31-ijo-41-04-1337"><label>31</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nicol&#x000E1;s</surname><given-names>FJ</given-names></name><name><surname>Hill</surname><given-names>CS</given-names></name></person-group><article-title>Attenuation of the TGF-beta-Smad signaling pathway in pancreatic tumor cells confers resistance to TGF-beta-induced growth arrest</article-title><source>Oncogene</source><volume>22</volume><fpage>3698</fpage><lpage>3711</lpage><year>2003</year></element-citation></ref>
<ref id="b32-ijo-41-04-1337"><label>32</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sato</surname><given-names>F</given-names></name><name><surname>Kawamoto</surname><given-names>T</given-names></name><name><surname>Fujimoto</surname><given-names>K</given-names></name><etal/></person-group><article-title>Functional analysis of the basic helix-loop-helix transcription factor DEC1 in circadian regulation. Interaction with BMAL1</article-title><source>Eur J Biochem</source><volume>271</volume><fpage>4409</fpage><lpage>4419</lpage><year>2004</year></element-citation></ref>
<ref id="b33-ijo-41-04-1337"><label>33</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kawamoto</surname><given-names>T</given-names></name><name><surname>Noshiro</surname><given-names>M</given-names></name><name><surname>Sato</surname><given-names>F</given-names></name><etal/></person-group><article-title>A novel autofeedback loop of Dec1 transcription involved in circadian rhythm regulation</article-title><source>Biochem Biophys Res Commun</source><volume>313</volume><fpage>117</fpage><lpage>124</lpage><year>2004</year></element-citation></ref>
<ref id="b34-ijo-41-04-1337"><label>34</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bloom</surname><given-names>BB</given-names></name><name><surname>Humphries</surname><given-names>DE</given-names></name><name><surname>Kuang</surname><given-names>PP</given-names></name><etal/></person-group><article-title>Structure and expression of the promoter for the R4/ALK5 human type I transforming growth factor-beta receptor: regulation by TGF-beta</article-title><source>Biochim Biophys Acta</source><volume>1312</volume><fpage>243</fpage><lpage>248</lpage><year>1996</year></element-citation></ref>
<ref id="b35-ijo-41-04-1337"><label>35</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mulder</surname><given-names>KM</given-names></name></person-group><article-title>Role of ras and Mapks in TGF-beta signaling</article-title><source>Cytokine Growth Factor Rev</source><volume>11</volume><fpage>23</fpage><lpage>35</lpage><year>2000</year></element-citation></ref>
<ref id="b36-ijo-41-04-1337"><label>36</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Michl</surname><given-names>P</given-names></name><name><surname>Barth</surname><given-names>C</given-names></name><name><surname>Buchholz</surname><given-names>M</given-names></name><etal/></person-group><article-title>Claudin-4 expression decreases invasiveness and metastatic potential of pancreatic cancer</article-title><source>Cancer Res</source><volume>63</volume><fpage>6265</fpage><lpage>6271</lpage><year>2003</year></element-citation></ref>
<ref id="b37-ijo-41-04-1337"><label>37</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Turksen</surname><given-names>K</given-names></name><name><surname>Troy</surname><given-names>TC</given-names></name></person-group><article-title>Junctions gone bad: Claudins and loss of the barrier in cancer</article-title><source>Biochim Biophys Acta</source><volume>1816</volume><fpage>73</fpage><lpage>79</lpage><year>2011</year></element-citation></ref>
<ref id="b38-ijo-41-04-1337"><label>38</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Berx</surname><given-names>G</given-names></name><name><surname>Van Roy</surname><given-names>F</given-names></name></person-group><article-title>The E-cadherin/catenin complex: an important gatekeeper in breast cancer tumorigenesis and malignant progression</article-title><source>Breast Cancer Res</source><volume>3</volume><fpage>289</fpage><lpage>293</lpage><year>2001</year></element-citation></ref>
<ref id="b39-ijo-41-04-1337"><label>39</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wells</surname><given-names>A</given-names></name><name><surname>Yates</surname><given-names>C</given-names></name><name><surname>Shepard</surname><given-names>CR</given-names></name></person-group><article-title>E-cadherin as an indicator of mesenchymal to epithelial reverting transitions during the metastatic seeding of disseminated carcinomas</article-title><source>Clin Exp Metastasis</source><volume>25</volume><fpage>621</fpage><lpage>628</lpage><year>2008</year></element-citation></ref>
<ref id="b40-ijo-41-04-1337"><label>40</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mart&#x000ED;nez-Estrada</surname><given-names>OM</given-names></name><name><surname>Culler&#x000E9;s</surname><given-names>A</given-names></name><name><surname>Soriano</surname><given-names>FX</given-names></name><etal/></person-group><article-title>The transcription factors Slug and Snail act as repressors of Claudin-1 expression in epithelial cells</article-title><source>Biochem J</source><volume>394</volume><fpage>449</fpage><lpage>457</lpage><year>2006</year></element-citation></ref>
<ref id="b41-ijo-41-04-1337"><label>41</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Batlle</surname><given-names>E</given-names></name><name><surname>Sancho</surname><given-names>E</given-names></name><name><surname>Franc&#x000ED;</surname><given-names>C</given-names></name><etal/></person-group><article-title>The transcription factor snail is a repressor of E-cadherin gene expression in epithelial tumour cells</article-title><source>Nat Cell Biol</source><volume>2</volume><fpage>84</fpage><lpage>89</lpage><year>2002</year></element-citation></ref>
<ref id="b42-ijo-41-04-1337"><label>42</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Reka</surname><given-names>AK</given-names></name><name><surname>Kurapati</surname><given-names>H</given-names></name><name><surname>Narala</surname><given-names>VR</given-names></name><etal/></person-group><article-title>Peroxisome proliferator-activated receptor-gamma activation inhibits tumor metastasis by antagonizing Smad3-mediated epithelial-mesenchymal transition</article-title><source>Mol Cancer Ther</source><volume>9</volume><fpage>3221</fpage><lpage>3232</lpage><year>2010</year></element-citation></ref></ref-list>
<sec sec-type="display-objects">
<title>Figures and Tables</title>
<fig id="f1-ijo-41-04-1337" position="float">
<label>Figure 1</label>
<caption>
<p>DEC1 expression is upregulated by TGF-&#x003B2; in human pancreatic cancer PANC-1 cells. (A) PANC-1 and MIA PaCa-2 cells were treated with various concentrations of TGF-&#x003B2; for 24 h. The control cells (mock) were treated with TGF-&#x003B2;-diluted buffer. These cells were then lysed and the lysates were subjected to western blot analyses of pSmad3, Smad3, pSmad2, DEC1, slug, snail, &#x003B1;-SMA, vimentin, N-cadherin, E-cadherin, claudin-1, claudin-4, claudin-7 and actin. One representative of at least three independent experiments with similar results is shown. (B) PANC-1 and MIA PaCa-2 cells were treated with TGF-&#x003B2; (2 ng/ml) for various periods. The cells were lysed, and the lysates were subjected to western blot analyses of pSmad3, Smad3, DEC1, snail, claudin-4 and actin. One representative of at least three independent experiments with similar results is shown. (C) PANC-1 cells were treated as above, and total-RNA was prepared and subjected to real-time PCR of DEC1, snail, E-cadherin, claudin-4 and N-cadherin. Each value represents the mean &#x000B1; SE (bars) of three independent experiments <sup>&#x0002A;</sup>p&#x0003C;0.05, according to the t-test. (D) PANC-1 cells were treated with the TGF-&#x003B2; inhibitor A-83-01 (1 or 10 &#x000B5;M) for 90 min before being treated with or without TGF-&#x003B2; (2 ng/ml) for 24 h, and the lysates were subjected to western blot analyses of pSmad3, Smad3, DEC1, snail, claudin-4 and actin. One representative of at least two independent experiments with similar results is shown.</p></caption>
<graphic xlink:href="IJO-41-04-1337-g00.gif"/>
<graphic xlink:href="IJO-41-04-1337-g01.gif"/>
<graphic xlink:href="IJO-41-04-1337-g02.gif"/></fig>
<fig id="f2-ijo-41-04-1337" position="float">
<label>Figure 2</label>
<caption>
<p>DEC1 knockdown inhibits TGF-&#x003B2;-induced EMT in PANC-1 cells. (A) PANC-1 cells were transfected with control siRNA or siRNA against DEC1. At 24 h post-transfection, the cells were treated with or without TGF-&#x003B2; (2 ng/ml) and incubated for 24 h. The cells were then fixed, stained and observed in bright field. The black arrows show spindle-shaped cancer cells. One representative of at least two independent experiments with similar results is shown. (B) PANC-1 cells were treated with control siRNA or DEC1 siRNA in the presence or absence of TGF-&#x003B2; (2 ng/ml) for 24 h, and the lysates were subjected to western blot analyses of DEC1, pSmad3, Smad3, snail, claudin-1, claudin-4, claudin-7, E-cadherin, N-cadherin, &#x003B1;-SMA, vimentin, pERK1/2, total-ERK1/2 and actin. One representative of at least three independent experiments with similar results is shown. (C) PANC-1 cells were treated as above, and total-RNA was prepared and subjected to real-time PCR of DEC1, snail, E-cadherin, claudin-4, N-cadherin, and TGF-&#x003B2;RI. Each value represents the mean &#x000B1; SE (bars) of three independent experiments <sup>&#x0002A;</sup>p&#x0003C;0.05, according to the t-test. (D) PANC-1 cells were transfected with control siRNA or siRNA against DEC1. At 24 h post-transfection, the cells were treated with or without TGF-&#x003B2; (2 ng/ml) and incubated for 24 h. The cells were then fixed, incubated with anti-pSmad3, snail, N-cadherin, E-cadherin, claudin-1, claudin-4, or claudin-7 antibodies, and visualized using Alexa488-conjugated secondary antibody (green). The cells were also counterstained with DAPI (blue) in order to detect their nucleus. A merged image that is representative of at least two independent experiments with similar results is shown.</p></caption>
<graphic xlink:href="IJO-41-04-1337-g03.gif"/>
<graphic xlink:href="IJO-41-04-1337-g04.gif"/>
<graphic xlink:href="IJO-41-04-1337-g05.gif"/>
<graphic xlink:href="IJO-41-04-1337-g06.gif"/></fig>
<fig id="f3-ijo-41-04-1337" position="float">
<label>Figure 3</label>
<caption>
<p>In the presence of TGF-&#x003B2;, DEC1 siRNA decreased the migration of PANC-1 cells. PANC-1 cells were transfected with control siRNA or siRNA against DEC1. After 24 h transfection, a wound was made with a pipette tip and photographs of the wounded area were taken periodically.</p></caption>
<graphic xlink:href="IJO-41-04-1337-g07.gif"/></fig>
<fig id="f4-ijo-41-04-1337" position="float">
<label>Figure 4</label>
<caption>
<p>DEC1 overexpression increased the invasion induced by TGF-&#x003B2; in PANC-1 cells. PANC-1 cells were transfected with pcDNA or DEC1 pcDNA. At 24 h post-transfection, the cells were treated with or without TGF-&#x003B2; (2 ng/ ml) for 24 h and 5&#x000D7;10<sup>4</sup> cells each were seeded in the invasion chamber. At 24 h after cell seeding, the chambers were stained and the numbers of invasive cells was counted. The top panel shows a representative photograph. The black arrows show spindle-shaped cancer cells. The bottom panel shows the quantitative data. Each value represents the mean &#x000B1; SE (bars) of three independent experiments <sup>&#x0002A;</sup>p&#x0003C;0.05, according to the t-test.</p></caption>
<graphic xlink:href="IJO-41-04-1337-g08.gif"/></fig>
<fig id="f5-ijo-41-04-1337" position="float">
<label>Figure 5</label>
<caption>
<p>DEC1 and pSmad3 expression were increased in human pancreatic cancer tissues. Significant DEC1 immunoreactivity was detected in the pancreatic cancer tissues (case 2 involved moderately differentiated adenocarcinoma; right panel, labeled T), while it was weak in the non-cancerous pancreatic tissues (N, left panel). Strong DEC1 and pSmad3 immunoreactivities ware found in the spindle-shaped cancer cells (case 9 involved moderately differentiated adenocarcinoma; the black arrows show spindle-shaped cancer cells, whereas the gray arrows show fibroblasts; right panel, labeled T). Claudin-4 expression was strongly detected in the cytoplasm and the membrane of non-cancerous pancreatic ductal cells, while it was weak in the cancer tissues (case 4).</p></caption>
<graphic xlink:href="IJO-41-04-1337-g09.gif"/></fig>
<table-wrap id="t1-ijo-41-04-1337" position="float">
<label>Table I</label>
<caption>
<p>Sequences of the primer sets and the product sizes of real-time PCR.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="middle">Gene</th>
<th align="center" valign="middle">Product size (bp)</th>
<th align="center" valign="middle">Primer sequences</th></tr></thead>
<tbody>
<tr>
<td align="left" valign="bottom"><italic>DEC1</italic></td>
<td align="right" valign="bottom">76</td>
<td align="left" valign="middle">F: 5&#x02032;-GAAAGGATCGGCGCAATTAA-3&#x02032;<break/>R: 5&#x02032;-CATCATCCGAAAGCTGCATC-3&#x02032;</td></tr>
<tr>
<td align="left" valign="bottom"><italic>Snail</italic></td>
<td align="right" valign="bottom">73</td>
<td align="left" valign="middle">F: 5&#x02032;-CTTCAACTGCAAATACTGCAACAAG-3&#x02032;<break/>R: 5&#x02032;-GCGTGTGGCTTCGGATGT-3&#x02032;</td></tr>
<tr>
<td align="left" valign="bottom"><italic>E-cadherin</italic></td>
<td align="right" valign="bottom">75</td>
<td align="left" valign="middle">F: 5&#x02032;-ACAGTCACTGACACCAACGATAATC-3&#x02032;<break/>R: 5&#x02032;-ACTGCTGCTTGGCCTCAAA-3&#x02032;</td></tr>
<tr>
<td align="left" valign="bottom"><italic>Claudin-4</italic></td>
<td align="right" valign="bottom">64</td>
<td align="left" valign="middle">F: 5&#x02032;-TGGGAGGGCCTATGGATGA-3&#x02032;<break/>R: 5&#x02032;-TCGTACACCTTGCACTGCATCT-3&#x02032;</td></tr>
<tr>
<td align="left" valign="bottom"><italic>N-cadherin</italic></td>
<td align="right" valign="bottom">77</td>
<td align="left" valign="middle">F: 5&#x02032;-TGATCGAGAAAAAGTGCAACAGTAT-3&#x02032;<break/>R: 5&#x02032;-GGCTGTGTTTGAAAGGCCATA-3&#x02032;</td></tr>
<tr>
<td align="left" valign="bottom"><italic>TGF-&#x003B2;RI</italic></td>
<td align="right" valign="bottom">105</td>
<td align="left" valign="middle">F: 5&#x02032;-CTGAAGTTCTCGATGATTCCATAAATAT-3&#x02032;<break/>R: 5&#x02032;-GAACATCGTCGAGCAATTTCC-3&#x02032;</td></tr>
<tr>
<td align="left" valign="bottom"><italic>18S rRNA</italic></td>
<td align="right" valign="bottom">150</td>
<td align="left" valign="middle">F: 5&#x02032;-GTAACCCGTTGAACCCCATT-3&#x02032;<break/>R: 5&#x02032;-CCATCCAATCGGTAGTAGCG-3&#x02032;</td></tr></tbody></table>
<table-wrap-foot><fn id="tfn1-ijo-41-04-1337">
<p>F, forward primer; R, reverse primer.</p></fn></table-wrap-foot></table-wrap>
<table-wrap id="t2-ijo-41-04-1337" position="float">
<label>Table II</label>
<caption>
<p>Immunohistochemical expression of DEC1, pSmad3, and claudin-4 proteins in human pancreatic cancer tissues.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="middle"/>
<th align="center" valign="middle"/>
<th align="center" valign="middle"/>
<th colspan="2" align="center" valign="middle">DEC1
<hr/></th>
<th colspan="2" align="center" valign="middle">pSmad3
<hr/></th>
<th colspan="2" align="center" valign="middle">claudin-4
<hr/></th></tr>
<tr>
<th align="left" valign="middle">C</th>
<th align="center" valign="middle">A/S</th>
<th align="center" valign="middle">D</th>
<th align="center" valign="middle">T</th>
<th align="center" valign="middle">N</th>
<th align="center" valign="middle">T</th>
<th align="center" valign="middle">N</th>
<th align="center" valign="middle">T</th>
<th align="center" valign="middle">N</th></tr></thead>
<tbody>
<tr>
<td align="right" valign="middle">1</td>
<td align="left" valign="middle">66/F</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">2</td>
<td align="left" valign="middle">62/M</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td></tr>
<tr>
<td align="right" valign="middle">3</td>
<td align="left" valign="middle">66/F</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">4</td>
<td align="left" valign="middle">66/M</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">5</td>
<td align="left" valign="middle">67/F</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">6</td>
<td align="left" valign="middle">62/F</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">7</td>
<td align="left" valign="middle">75/M</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">8</td>
<td align="left" valign="middle">58/M</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Strong</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">9</td>
<td align="left" valign="middle">65/M</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">10</td>
<td align="left" valign="middle">72/F</td>
<td align="left" valign="middle">Well</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td></tr>
<tr>
<td align="right" valign="middle">11</td>
<td align="left" valign="middle">67/M</td>
<td align="left" valign="middle">Poorly</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">12</td>
<td align="left" valign="middle">71/F</td>
<td align="left" valign="middle">Well</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td></tr>
<tr>
<td align="right" valign="middle">13</td>
<td align="left" valign="middle">74/M</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Strong</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">14</td>
<td align="left" valign="middle">72/M</td>
<td align="left" valign="middle">Poorly</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td></tr>
<tr>
<td align="right" valign="middle">15</td>
<td align="left" valign="middle">55/M</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Weak</td></tr>
<tr>
<td align="right" valign="middle">16</td>
<td align="left" valign="middle">61/F</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Strong</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td></tr>
<tr>
<td align="right" valign="middle">17</td>
<td align="left" valign="middle">50/F</td>
<td align="left" valign="middle">Moderately</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="center" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td>
<td align="left" valign="middle">Strong</td>
<td align="left" valign="middle">Weak</td></tr></tbody></table>
<table-wrap-foot><fn id="tfn2-ijo-41-04-1337">
<p>C, cases; A/S, age (yr)/sex; D, differentiation of pancreatic cancer; T, tumor cells; N, Adjacent non-tumor cells.</p></fn></table-wrap-foot></table-wrap></sec></back></article>
