The present study included OSCC tissues samples from 48 patients (21 females and 27 males; age range, 35-67 years; median age, 47 years) with OSCC who underwent partial or total surgical resection at the Department of Oral and Maxillofacial Head and Neck Oncology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine (Shanghai, China) between June 2010 and July 2012. Primary cancer tissues and adjacent non-tumor tissues (>2 cm distal from the cancer area) were collected by surgical resection (no biopsy samples) and were used to investigate the clinical diagnostic and prognostic role of PLAC2. No patients were received radiotherapy or chemotherapy prior to surgical resection. Tissue samples were immediately snap-frozen in liquid nitrogen upon resection and then stored at -80°C until use. The present study was approved by Research Scientific Ethics Committee of Ninth People's Hospital, Shanghai JiaoTong University School of Medicine. All participants signed informed consent prior to using the tissues for scientific research.

A total of 2 human OSCC cell lines SCC-9 and CAL-27 were purchased from Chinese Academy of Sciences (Shanghai, China). The human normal oral epithelial keratinocytes (HOK) were purchased from ScienCell Research Laboratories, Inc. (cat. no. 2610; San Diego, CA, USA). CAL-27 and SCC-9 cells were cultured in Dulbecco's modified Eagle's medium: nutrient Mixture F-12 (DMEM/F12; Gibco; Thermo Fisher Scientific, Inc., Waltham, MA, USA) with 10% fetal bovine serum (FBS; Sigma-Aldrich; Merck KGaA, Darmstadt, Germany). HOK was cultured in DMEM supplemented with 10% FBS and penicillin-streptomycin (100 U/ml and 100 µg/ml, respectively). The culture condition was 37°C in an atmosphere containing 5% CO₂. C646 (Selleck Chemicals, Houston, TX, USA) was used at the concentration of 10 µmol/l for 24 h as required.

The synthetic silencing oligonucleotides used for interfering PLAC2 (si-PLAC2) and cAMP-response element binding protein-binding protein (CBP; si-CBP) were synthesized by Guangzhou RiboBio Co., Ltd. (Guangzhou, China). Negative control si-NC was purchased from Invitrogen (cat. no. 12935-110; Thermo Fisher Scientific, Inc.). Additionally, the overexpression plasmid containing oligonucleotides of PLAC2 (p-PLAC2) and negative control vector (p-vector) was generated by Guangzhou RiboBio Co., Ltd. and were loaded into lentivirus vectors (Lv-PLAC2 and Lv-NC, respectively). Cells were transfected with DNA plasmids using TransFast transfection reagent (Promega Corporation, Madison, WI, USA). A total of 5×10⁵ cells was seeded into each well of a 6-well plate and transfected with respective oligoribonucleotides upon reaching 70-80% confluence. For transfection, ~4 µg RNA for each well was used and the final transfection concentration was 100 nM. The transfection effects were assessed by RT-qPCR after transfection for 24 h. The cells were then subjected to further functional assays. The oligonucleotides sequences used for silencing are: si-PLAC2: 5′-UAUUCCUUCAGCCAGUACCCAGGUC-3′; and si-CBP: 5′-CGGCACAGCCTCTCAGTCA-3′.

Total RNA was extracted from OSCC cells using a RNeasy plus mini kit (Qiagen, Inc., Valencia, CA, USA), according to the manufacturer's protocol. The 20 µl RT reactions were performed using a PrimeScript^® RT reagent kit (Takara Biotechnology Co., Ltd., Dalian, China), and incubated for 30 min at 37°C and 5 sec at 85°C. For RT-qPCR, 2 µl diluted RT product was mixed with 23 µl reaction buffer from a SYBR^® Green PCR kit (Takara Biotechnology Co., Ltd.) to a final volume of 25 µl. All reactions were conducted using an Eppendorf Mastercycler EP Gradient S (Eppendorf, Hamburg, Germany) under the following conditions: 95°C for 30 sec, followed by 45 cycles of 95°C for 5 sec and 60°C for 30 sec. The expression levels of detected RNAs were normalized to GAPDH using the comparative 2^-ΔΔCq method (17). The primer sequences for RT-qPCR are as follows: PLAC2 (sense) 5′-TGT GGCCCAAACTCAGGGATACAT-3′, and (antisense) 5′-AGATGACAGTGGCTGGAGTTGTCA-3′; CBP (sense) 5′-GTGCTGGCTGAGACCCTAAC-3′, and (antisense) 5′-GGCTGTCCAAATGGACTTGT-3′; and GAPDH (sense) 5′-GCACCGTCAAGGCTGAGAAC-3′, and (antisense) 5′-ATGGTGGTGAAGACGCCAGT-3′.

The putative binding site of H3K27ac at the promoter region of PLAC2 gene was predicted by UCSC Genome Browser (http://genome.ucsc.edu/). The full sequence of PLAC2 gene can be accessed at NCBI Reference Sequence: NC_000019.10 (https://www.ncbi.nlm.nih.gov/nuccore/NC_000019.10?report=fasta&from=5558167&to=5568034&strand=true).

The altered cell proliferation following transfection with si-PLAC2 was assayed using an MTT kit (cat. no. 2348-71-2; Dojindo Molecular Technologies, Inc., Rockville, MD, USA). Cells were seeded onto 96-well plates at a density of 3×10³ cells/well and cultured in 200 µl DMEM/F12 cell culture medium followed by treatment with si-PLAC2 for 12, 24, 36 or 72 h at the concentration of 100 µM under room temperature. A total of 10 µl MTT (5 mg/ml; pH 7.4; prepared with PBS) was added to culture the cells for 2 h at 37°C in an atmosphere containing 5% CO₂. After the medium was removed, the precipitate was diluted in 100 µl dimethyl sulfoxide. An enzyme-linked immunosorbent plate reader was utilized to determine the absorbance of each well.

A wound-healing assay was used here to determine the migration ability of OSCC cells. In brief, cells were seeded at a density of 5×10⁵ cell/well onto 6-well plates. After 12 h with respective vectors, the layer of cells was scratched to form wounds using a sterile 20 µl pipette tip. The non-adherent cells were washed away with culture medium (DMEM/F12) under room temperature, and then the cells were further cultured for 48 h under room temperature followed by imaging with an inverted light confocal microscope at a ×20 magnification (Leica Microsystems GmbH, Wetzlar, Germany) to identify the gap area. Cell invasive ability was evaluated using a Matrigel invasion assay with Boyden chambers (BD Biosciences; Becton, Dickinson and Company, Franklin Lakes, NJ, USA) that had 8-μm pore size membranes with Matrigel. 1×10⁵ cells in the serum-free Opti-MEM media (Gibco; Thermo Fisher Scientific) were placed into the upper chamber of an insert. DMEM/F12 culture medium containing 10% FBS was added to the lower chamber. After 12 h of incubation, the cells that had invaded through the membrane were stained with methanol (15 min) and 0.1% crystal violet (5 min) under room temperature and imaged using an inverted light confocal microscope (Leica Microsystems GmbH).

Cells on slides were permeabilized with 0.3% Triton X-100 (Beyotime Institute of Biotechnology, Shanghai, China) for 15 min after being fixed with 4% paraformaldehyde for 15 min under room temperature. The cells were blocked using 5% goat serum (Beijing Solarbio Science & Technology Co., Ltd., Beijing, China) for 1 h at room temperature followed by incubation with anti-Ki67 antibody (cat. no. ab15580) or anti-CBP antibody (cat. no. ab2832) or anti-β-catenin (cat. no. ab32572) (all from Abcam, Cambridge, MA, USA; all 1:100) overnight at 4°C. The slides were then incubated with anti-rabbit Alexa Fluor 488 (cat. no. 111-545-003; 1:200; Jackson ImmunoResearch Laboratories, Inc., West Grove, PA, USA) for 1 h at room temperature. DAPI was used for nuclear counterstaining at room temperature for 1 h. The samples were observed under a fluorescence microscope (×40; IX73; Olympus Corporation, Tokyo, Japan).

The Cignal 45-pathway Reporter ArrayTM (Qiagen, Inc.; cat. no. CCA-901L) was used to determine the potential activity alterations of the 45 untranslated regions in response to overexpression of PLAC2, according to the manufacturer's protocols. Cells (5×10⁵) were suspended in Opti-MEM supplemented with 10% of FBS and 0.1 mM non-essential amino acids (Sigma-Aldrich; Merck KGaA), and then 50 µl of the cell suspension, equivalent to 1×10⁴ cells, was added into each plate well and mixed with DNA resident (Qiagen, Inc.; cat. no. CCA-901L). Cells were transfected with PLAC2-overexpression plasmid (Guangzhou RiboBio Co., Ltd.) for 24 h and were subsequently transfected with a mixture of a transcription factor-responsive firefly luciferase reporter and a constitutively expressing Renilla construct (Qiagen, Inc.) using the TransFast transfection reagent. The cells were incubated for 48 h at 5% CO₂ and 37°C. The relative activity of each pathway was decided by luciferase/Renilla, normalized by untreated controls and measured with a Luciferase Reporter Assay System (Promega Corporation).

The cellular fraction was isolated to locate the sublocation of PLAC2. Briefly, 1×10⁷ cells were harvested, resuspended in 1 ml ice-cold RNase-free PBS, 1 ml buffer C1 (1.28 M Sucrose, 40 mM Tris-HCl, pH 7.5, 20 mM MgCl₂ and 4% Triton X-100) and 3 ml RNase-free water, and incubated for 15 min on ice. The cells were then centrifuged for 15 min at 3,000 × g at 4°C, and the supernatant containing the cytoplasmic constituents and the nuclear pellet were retained for RNA extraction.

For RNA FISH, OSCC cells were seeded and fixed with 4% paraformaldehyde for 15 min at 4°C, treated with 0.5% Triton in PBS for 10 min at room temperature, followed by pre-hybridization. They were then hybridized with the PLAC2 probe (5 µM) overnight at 4°C. The PLAC2 probes were synthesized by Sangon (Shanghai Biotech Co., Ltd., Shanghai, China). The cells were visualized under a light confocal microscope at ×40 magnification (Leica Microsystems GmbH).

An EZ-Magna ChIP kit (EMD Millipore, Billerica, MA, USA) was used for the ChIP experiment, according to the manufacturer's protocol. OSCC cells were treated with formaldehyde and incubated for 10 min at room temperature to generate DNA-protein cross-links. Cell lysates were then sonicated to generate chromatin fragments of 200-300 bp and immunoprecipitated for 1 h at room temperature with antibodies, including anti-H3K27ac (Abcam; 1:100; cat. no. ab4729), anti-CBP (Abcam; 1:100; cat. no. ab2832) or normal mouse IgG polyclonal antibody (EMD Millipore; 1:100; cat. no. 12-371). Precipitated chromatin DNA was recovered and analyzed by RT-qPCR as aforementioned.

Radioimmunoprecipitation assay buffer (Sigma Aldrich; Merck KGaA) was used for the cell lysis to obtain total protein-containing lysates. Protein concentration was measured by using the bicinchoninic acid method (Sigma Aldrich; Merck KGaA). Subsequently, quantified protein (25 µg) was transferred onto polyvinylidene fluoride (PVDF) membranes following the separation process by performing a routine 10% gel electrophoresis. The membrane was then blocked with TBS with 10% Tween-20 solution containing 5% non-fat dry milk for 1 h at room temperature followed by treatment with respective primary antibodies (1:1,000) at 4°C overnight. Subsequently, they were incubated with a goat anti-rabbit polyclonal horseradish peroxidase-conjugated secondary antibody (1:5,000; Abcam; cat. no. ab7090) for 1 h at room temperature. The primary antibodies are as follows: anti-transcription factor 4 (TCF-4) antibody (Abcam; cat. no. ab76151), anti-matrix metallopeptidase-7 (MMP-7) antibody (Abcam; cat. no. ab205525), anti-CyclinD1 antibody (Abcam; cat. no. ab16663), anti-MMP-9 antibody (Abcam; cat. no. ab76003), anti-β-catenin antibody (Abcam; cat. no. ab8932) and anti-GAPDH antibody (Invitrogen; Thermo Fisher Scientific, Inc.; cat. no. PA1-987). Protein bands were detected using enhanced chemiluminescence reagent (GE Healthcare, Chicago, IL, USA) and exposed on an X-ray film. Gray analysis by image analysis was performed using the software Gel-Pro Analyzer version 4 (United States Biochemical, Salem, MA, USA) following scanning. The semi-quantitative analysis was performed according to the relative expression of objective protein and internal control protein GAPDH, namely the ratio of objective protein and GAPDH.

A total of 12 male BALB/c nude mice (19-22 g; 6 weeks old) were obtained from Animal Center of the Chinese Academy of Science (Shanghai, China). They were randomly divided into two groups of 6 mice and housed 3 per cage. All mice were housed and maintained under specific pathogen-free conditions at 18-22°C, with 20% humidity, a 12/12 h light/dark cycle and feeding ad libitum. The experimental protocol was approved by the Committee on the Animal Ethics of Shanghai Tenth People's Hospital (Shanghai, China). PLAC2 stably expressing cell lines were established by infecting SCC-9 cells with lentivirus as aforementioned and selected by puromycin (Sigma-Aldrich; Merck KGaA). OSCC cells were subcutaneously injected into right side of the armpit regions of mice. The mice were housed for 5 weeks, then were sacrificed and the formed tumors were stripped, and tumor mass was measured. Xenograft volumes were evaluated by caliper measurements of two perpendicular diameters and calculated as formula: Volume = a x b²/2, where ‘a’ represents the length and ‘b’ represents the width). The length of the largest subcutaneous tumor observed was 13.1 mm, and maximum tumor burden was 6.14% (tumor mass/body weight, 1.35/22.0 g). No multiple tumors were exhibited in any mouse.

Another 12 male BALB/c nude mice (19-22 g; 6 weeks old) were also obtained from Animal Center of the Chinese Academy of Science (Shanghai, China). They were randomly divided into two groups of 6 mice and housed 3 per cage with the same conditions aforementioned. Experimental lung metastases were induced by injections of a single-cell suspension (2×10⁶ cells in 100 µl) into the mouse lateral tail vein. Cells were stably infected with Lv-PLAC2 or Lv-NC as aforementioned, and all cell injections were administered in a total volume of 500 µl PBS containing 0.1% bovine serum albumin (Gibco; Thermo Fisher Scientific, Inc.) over 60 sec (18). At 5 weeks after intravenous injection into the nude mice, mice were sacrificed, then the lungs were isolated and tumor nodule numbers and areas were analyzed in a blinded fashion. For luciferase imaging, mice were injected with luciferin (25 mg/ml in 0.1 ml PBS). At 15 min after injection, animals were imaged using an IVIS-100 system at the UAB Small Animal Imaging Core Facility (Birmingham, AL, USA).

All surgeries (subcutaneous or lateral tail vein cell injection, tumor volume measurements and luciferase imaging) were performed under sodium pentobarbital anesthesia (75 mg/kg), and all efforts were made to minimize suffering. During anesthesia (15-20 min) and while recovering, mice were kept warm under a red heat lamp. To prevent the cornea from drying out, sterile eye ointment (Viscotears^®; Novartis International AG, Basel, Switzerland) was carefully applied to the eyes during all anesthesia interventions. The endpoint criteria for removing the mice before finishing the study were approved by the Committee on the Ethics of Shanghai Tenth People's Hospital. If one of the endpoint criteria was observed the mouse was sacrificed. For our experiments the following endpoint criteria was used: i) weight loss >15% from the initial weight; ii) ruffled fur, hunched back, closed eyes for more than one day; iii) immobilization/disability because of tumor size or tumor volume >2×10³ mm³; iv) breathing difficulties; v) no contact reactions; vi) no palm gripping reflex; and vii) signs of infection.

All mice were sacrificed using CO₂ euthanization methods. Briefly, the mice were placed in a transparent polycarbonate shoebox euthanasia chamber (44.0×23.5×21.0 cm). The euthanasia chamber was covered with an acrylic lid, with ports for gas inlet and outlet. Chamber air was replaced with CO₂ at a rate of 30% of the chamber volume per minute. Compressed CO₂ gas was provided from a cylinder (Weiler Welding, Moraine, OH) and controlled by a CO₂-specific regulator (Weiler Welding). A total of 3 mice were euthanized each time. The CO₂ inflation time was 6-8 min until the mice were confirmed as dead. The death of the mice was verified comprehensively by the stop of breathing and heartbeat, and the disappearance of pupil and nerve reflex.

Anti-β-catenin antibody (rabbit, polyclonal antibody, 1:100; cat. no. ab32572; Abcam) was used for the immunohistochemistry detection of protein expression in the tumor tissues from mice (4 µm) at 4°C overnight. Endogenous peroxidase was inhibited by incubation with freshly prepared 3% hydrogen peroxide with 0.1% sodium azide for 1 h at room temperature. Non-specific staining was blocked with 0.5% casein and 5% normal serum (Sigma-Aldrich; Merck KGaA) for 1 h at room temperature. The tissue samples were incubated with horseradish peroxidase goat anti-rabbit antibody (Absin, Shanghai, China; cat. no. abs957) for 1 h at room temperature. Staining was developed with diaminobenzidine substrate and the sections were counterstained with hematoxylin for 15 sec at room temperature. Images were visualized using a Nikon ECLIPSE Ti (Nikon Corporation, Tokyo, Japan) microscope system at a ×10 or ×40 magnification and processed using Nikon software version 3.0.

The Kolmogorov-Smirnov test was applied for data analysis with the distribution of each group samples. Data were presented as the median (interquartile range). Mann-Whitney U test was used for the comparison of datasets containing two groups. The Kruskal-Wallis test (post-hoc Mann-Whitney U test with Bonferroni's) was used for analyzing statistical difference among multiple groups. Receiver Operation Characteristic (ROC) analysis was used to evaluate the diagnostic performance of PLAC2. The correlations between PLAC2 and CBP expression, and PLAC2 and β-catenin expression were analyzed using Spearman's correlation test. Kaplan-Meier analysis followed by log-rank test was performed to determine the prognostic performance of PLAC2. P<0.05 was considered to indicate a statistically significant difference. Statistical analysis was performed using GraphPad Prism 5 (GraphPad Software, Inc., La Jolla, CA, USA).

The expression level of PLAC2 in OSCC was measured by RT-qPCR. Fig. 1A demonstrates that PLAC2 expression is significantly increased in OSCC cells, CAL-27 and SCC-9, compared with HOK. Additionally, PLAC2 was also significantly increased in 48 OSCC tissues, compared with the paired precancerous tissues (Fig. 1B). Recent research demonstrated that aberrant expression of lncRNAs is attributed to transcriptionally activation, including acetylation (19). To understand the cause of PLAC2 upregulation in OSCC, the probable mechanisms were investigated by genome bioinformatics analysis. Fig. 1C demonstrates that the promoter region (~1,000 bp) of PLAC2 was predicted with high density of H3K27ac enrichment. To validate the histone acetylation at the promoter region of PLAC2, ChIP assay was performed using an anti-H3K27ac antibody. As depicted in Fig. 1D, H3K27ac was enriched at the promoter region of PLAC2 in both OSCC cells and normal epithelial HOK cells. Furthermore, the enrichment level of H3K27ac was significantly increased in both OSCC cell lines, compared with HOK cells. ChIP assay was further conducted using 5 paired tissues, which were identified with significantly increased PLAC2 level in tumor tissues, compared with non-tumor tissues. As expected, the H3K27ac enrichment level was significantly upregulated in tumor tissues, compared with the paired non-tumor tissues (Fig. 1E). Furthermore, when OSCC cells were treated with histone acetyltransferase (HAT) inhibitor C646, the expression level of PLAC2 was significantly downregulated (Fig. 1F).

Subsequently, whether other key enzymes participate in the process of H3K27ac was investigated. As CBP is essential for chromatin acetylation (20), therefore it was hypothesized that CBP may be important for the enhanced acetylation. To test this hypothesis, immunofluorescence was conducted to detect the CBP expression in OSCC cells and normal HOK cells. As expected, the expression level of CBP was increased in both OSCC cell lines, compared with HOK cells (Fig. 2A). Notably, CBP protein was enriched by the PLAC2 gene and the enrichment level was increased in OSCC cells, compared with normal HOK cells (Fig. 2B). Following knockdown of the CBP gene with specific siRNA (Fig. 2C), a ChIP assay was conducted to assess the influence of CBP on H3K27ac enrichment. As expected, the enriched H3K27ac with PLAC2 gene was significantly decreased upon knockdown of CBP (Fig. 2D). Furthermore, knockdown of CBP also caused a significantly decreased expression of PLAC2 in OSCC cells (Fig. 2E). Collectively, the results indicate that upregulated PLAC2 in OSCC is attributed to the CBP-mediated H3K27ac at the promoter region of the PLAC2 gene.

As CAL-27 cells exhibited a relatively high expression of PLAC2 while SCC-9 cells exhibited a low expression level, the PLAC2-overexpression vector was built in SCC-9 cells and the PLAC2-knockdown vector in CAL-27 cells (Fig. 3A). Subsequently, an MTT assay was conducted to assess the effects of PLAC2 on cell proliferation over 6 days. As expected, knockdown of PLAC2 significantly suppressed CAL-27 cell proliferation while overexpression of PLAC2 promoted proliferation of SCC-9 cells (Fig. 3B). Additionally, an immunofluorescence assay was performed by an antibody against Ki-67 protein, which is a well-known proliferation marker (21). Fig. 3C demonstrates that knockdown of PLAC2 in CAL-27 cells suppressed the expression level of Ki-67, whereas overexpression of PLAC2 in SCC-9 cells demonstrated the opposite effect. Furthermore, a wound-healing assay indicated that knockdown of PLAC2 significantly suppressed the cell migration ability, while overexpression of PLAC2 increased cell migration (Fig. 3D). Similarly, a Matrigel assay demonstrated a decreased invasion ability caused by PLAC2 knockdown and an increased invasion ability induced by PLAC2 overexpression (Fig. 3E). These results indicate that PLAC2 may serve an oncogenic role in OSCC.

The subcellular localization of an lncRNA is associated with its biological mechanism. To verify how PLAC2 contributes to OSCC progression, a cellular fractionation assay and RNA-FISH were performed. It was demonstrated that PLAC2 was distributed primarily in the cytoplasm of SCC-9 cells (Fig. 4A and B). Subsequently, a Signal Reporter Array was conducted to simultaneously investigate the potential signaling pathways in SCC-9 cells affected by overexpression of PLAC2. Notably, the Wnt reporter pathway was reported as one of the most activated pathways upon overexpression of PLAC2 (Fig. 4C). It is previously reported that CBP could interact with Wnt/β-catenin and may serve as a co-activator of Wnt/β-catenin-mediated transcription (22). Furthermore, activation of the Wnt/β-catenin pathway could enhance the proliferation and invasion of cancer cells (23). Therefore, it was hypothesized that PLAC2 may promote malignant progression of OSCC via activating the Wnt/β-catenin signaling pathway. To test this hypothesis, western blot analysis was conducted. The results demonstrated that overexpression of PLAC2 in SCC-9 cells increased the expression of proteins in the Wnt/β-catenin pathway, including β-catenin, TCF-4, MMP-7, MMP-9 and CyclinD1, while knockdown of PLAC2 in CAL-27 cells demonstrated the opposite effect (Fig. 4D). Additionally, the results of the immunofluorescence staining demonstrated that β-catenin trans-located from the cytoplasm to the nucleus in SCC-9 cells upon overexpression of PLAC2 (Fig. 4E). Collectively, the results indicated that PLAC2 may promote OSCC malignant development through activating the Wnt/β-catenin pathway.

Subsequently, an in vivo xenograft model was constructed in male BALB/C nude mice by planting SCC-9 cells, which were stably infected with Lv-PLAC2 or Lv-NC. The mice bearing xenografts were fed for 5 weeks and then tumor xenografts were stripped from nude mice (Fig. 5A). By measuring the volume and mass of the obtained xenograft, it was verified that enhanced PLAC2 expression notably promoted the tumor growth, compared with cells infected with Lv-NC (Fig. 5B). Furthermore, a RT-qPCR assay revealed that the transcript expression of PLAC2, CBP and β-catenin in implanted OSCC tissues were significantly increased in the Lv-PLAC2 group, compared with the Lv-NC group (Fig. 5C). Immunohistochemistry analysis further revealed a significant upregulation of β-catenin in the tumor tissues from the Lv-PLAC2 group, compared with the Lv-NC group (Fig. 5D). Furthermore, a lung-metastasis model was established by injections of a single-cell suspension into the mouse lateral tail vein. As depicted in Fig. 5E and F, the luciferase flux count of lung metastases and visible number of metastases on lung surface were significantly increased in the Lv-PLAC2 group, compared with the Lv-NC group. To conclude, the results confirmed the functional role of PLAC2 in an in vivo xenograft.

Based on the aforementioned observations, the role of PLAC2 expression in the diagnosis and prognosis of OSCC was investigated. By performing Spearman's correlation test, positive correlations were identified between the transcript expression of PLAC2 and CBP, or PLAC2 and β-catenin in 48 OSCC tissues (Fig. 6A). Subsequently, the diagnostic role of PLAC2 was investigated by establishing ROC curves using the 48 paired OSCC and adjacent non-tumor tissues (Fig. 6B). The area under the curve of the ROC curve was 0.871, with a diagnostic sensitivity and specificity reaching 75.0 and 85.4% (95% confidence interval, 0.787-0.930), respectively. Analysis of association between PLAC2 expression and clinical pathological factors revealed that PLAC2 expression is positively associated with tumor size and Tumor-Node-Metastasis stage, but not with other factors, including sex, age and histological grade (Table I). By using the median value of PLAC2 as a cut-off, patients with OSCC were stratified into a high and a low PLAC2 expressing group. Kaplan-Meier analysis of the survival data demonstrated that patients with high PLAC2 expression were associated with reduced overall survival and progressive-free survival rates, compared with patients with low expression of PLAC2 (Fig. 6C and D). This indicates a potential prognostic significance of PLAC2 for patients with OSCC.

Collectively, the present study demonstrates that the H3K27ac-induced upregulation of PLAC2 promotes OSCC cell growth and metastasis via the activation of Wnt/β-catenin signaling pathway (Fig. 6E). Therefore, PLAC2 may be a potential prognostic indicator of OSCC.