<?xml version="1.0" encoding="utf-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "journalpublishing3.dtd">
<article xml:lang="en" article-type="research-article" xmlns:xlink="http://www.w3.org/1999/xlink">
<?release-delay 0|0?>
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">ETM</journal-id>
<journal-title-group>
<journal-title>Experimental and Therapeutic Medicine</journal-title>
</journal-title-group>
<issn pub-type="ppub">1792-0981</issn>
<issn pub-type="epub">1792-1015</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3892/etm.2018.6421</article-id>
<article-id pub-id-type="publisher-id">ETM-0-0-6421</article-id>
<article-categories>
<subj-group>
<subject>Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Gambogic acid regulates the migration and invasion of colorectal cancer via microRNA-21-mediated activation of phosphatase and tensin homolog</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author"><name><surname>Gao</surname><given-names>Guangyi</given-names></name>
<xref rid="af1-etm-0-0-6421" ref-type="aff">1</xref>
<xref rid="af2-etm-0-0-6421" ref-type="aff">2</xref>
<xref rid="fn1-etm-0-0-6421" ref-type="author-notes">&#x002A;</xref></contrib>
<contrib contrib-type="author"><name><surname>Bian</surname><given-names>Yinzhu</given-names></name>
<xref rid="af3-etm-0-0-6421" ref-type="aff">3</xref>
<xref rid="fn1-etm-0-0-6421" ref-type="author-notes">&#x002A;</xref></contrib>
<contrib contrib-type="author"><name><surname>Qian</surname><given-names>Hanqing</given-names></name>
<xref rid="af4-etm-0-0-6421" ref-type="aff">4</xref></contrib>
<contrib contrib-type="author"><name><surname>Yang</surname><given-names>Mi</given-names></name>
<xref rid="af4-etm-0-0-6421" ref-type="aff">4</xref></contrib>
<contrib contrib-type="author"><name><surname>Hu</surname><given-names>Jing</given-names></name>
<xref rid="af4-etm-0-0-6421" ref-type="aff">4</xref></contrib>
<contrib contrib-type="author"><name><surname>Li</surname><given-names>Li</given-names></name>
<xref rid="af1-etm-0-0-6421" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author"><name><surname>Yu</surname><given-names>Lixia</given-names></name>
<xref rid="af4-etm-0-0-6421" ref-type="aff">4</xref></contrib>
<contrib contrib-type="author"><name><surname>Liu</surname><given-names>Baorui</given-names></name>
<xref rid="af1-etm-0-0-6421" ref-type="aff">1</xref>
<xref rid="af4-etm-0-0-6421" ref-type="aff">4</xref></contrib>
<contrib contrib-type="author"><name><surname>Qian</surname><given-names>Xiaoping</given-names></name>
<xref rid="af1-etm-0-0-6421" ref-type="aff">1</xref>
<xref rid="af4-etm-0-0-6421" ref-type="aff">4</xref>
<xref rid="c1-etm-0-0-6421" ref-type="corresp"/></contrib>
</contrib-group>
<aff id="af1-etm-0-0-6421"><label>1</label>The Comprehensive Cancer Center, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210008, P.R. China</aff>
<aff id="af2-etm-0-0-6421"><label>2</label>Department of Traditional Chinese Medicine, The Affiliated Huai&#x0027;an Hospital of Xuzhou Medical University and The Second People&#x0027;s Hospital of Huai&#x0027;an, Huai&#x0027;an, Jiangsu 223002, P.R. China</aff>
<aff id="af3-etm-0-0-6421"><label>3</label>Department of Oncology, The First People&#x0027;s Hospital of Yancheng, Yancheng, Jiangsu 224005, P.R. China</aff>
<aff id="af4-etm-0-0-6421"><label>4</label>The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu 210008, P.R. China</aff>
<author-notes>
<corresp id="c1-etm-0-0-6421"><italic>Correspondence to</italic>: Dr Xiaoping Qian, The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu 210008, P.R. China, E-mail: <email>xiaopingqian1963@sina.com</email></corresp>
<fn id="fn1-etm-0-0-6421"><label>&#x002A;</label><p>Contributed equally</p></fn>
</author-notes>
<pub-date pub-type="ppub">
<month>09</month>
<year>2018</year></pub-date>
<pub-date pub-type="epub">
<day>06</day>
<month>07</month>
<year>2018</year></pub-date>
<volume>16</volume>
<issue>3</issue>
<fpage>1758</fpage>
<lpage>1765</lpage>
<history>
<date date-type="received"><day>14</day><month>01</month><year>2018</year></date>
<date date-type="accepted"><day>22</day><month>06</month><year>2018</year></date>
</history>
<permissions>
<copyright-statement>Copyright: &#x00A9; Gao et al.</copyright-statement>
<copyright-year>2018</copyright-year>
<license license-type="open-access">
<license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivs License</ext-link>, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.</license-p></license>
</permissions>
<abstract>
<p>Gambogic acid (GA) has been reported to inhibit cancer cell proliferation and migration and enhance apoptosis. Several signaling pathways were identified to be involved in GA function, including PI3K/Akt, caspase-3 apoptosis and TNF-&#x03B1;/NF-&#x03BA;B. However, to the best of our knowledge, the association between miRNA and GA has not been explored. The present study initially demonstrated that GA could inhibit HT-29 cancer cell proliferation using an MTT assay. In addition, a Transwell assay and a wound-healing assay respectively indicated that GA inhibited HT-29 cancer cell invasion and migration, which was also confirmed by the increased MMP-9 protein expression. Furthermore, GA induced the apoptosis of HT-29 cancer cells in an Annexin V and PI double staining assay. Moreover, treatment with GA significantly decreased miR-21 expression in these cells. Additionally, western blot analysis demonstrated that GA treatment enhanced the activation of phosphatase and tensin homolog (PTEN) along with the suppression of PI3K and p-Akt. Furthermore, miR-21 mimics reversed all the aforementioned activities of GA, which indicated that miR-21 was the effector of GA and blocked PI3K/Akt signaling pathway via enhancing PTEN activity. In summary, GA induced HT-29 cancer cell apoptosis via decreasing miR-21 expression and blocking PI3K/Akt, which may be a useful novel insight for future CRC treatment.</p>
</abstract>
<kwd-group>
<kwd>microRNA-21</kwd>
<kwd>gambogic acid</kwd>
<kwd>colorectal cancer</kwd>
<kwd>PTEN</kwd>
<kwd>apoptosis</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec sec-type="intro">
<title>Introduction</title>
<p>Colorectal cancer (CRC) is one of the most common types of cancer worldwide, which is comparable to lung, liver and stomach cancers (<xref rid="b1-etm-0-0-6421" ref-type="bibr">1</xref>). Each year, there are ~2 million newly diagnosed cases in China, thereby making CRC the third most common cancer and the fourth leading cause of cancer-associated death (<xref rid="b2-etm-0-0-6421" ref-type="bibr">2</xref>). In recent decades, although improvements have been made in health care and screening programs (<xref rid="b3-etm-0-0-6421" ref-type="bibr">3</xref>), the number of new cases of CRC and associated deaths is increasing. The high incidence of CRC suggests that it is urgent to investigate the mechanism of CRC in order to improve the current status of CRC therapy (<xref rid="b4-etm-0-0-6421" ref-type="bibr">4</xref>).</p>
<p>Patients with CRC are classified into four risk groups based on their tumor metastases, progression and biomarkers (<xref rid="b5-etm-0-0-6421" ref-type="bibr">5</xref>). Briefly, group 0 patients have no metastasis or lack signs of a poor prognosis. Group 1 patients exhibit borderline resectable metastasis. Group 2 patients are detected with disseminated and unresectable CRC. Patients with unresectable CRC and a lack of intensive or sequential treatment are classified as into group 3. The metastasis level and TNM stage guide the therapeutic decision and the treatment purpose along with the modified treatment strategy (<xref rid="b6-etm-0-0-6421" ref-type="bibr">6</xref>). Generally, the fist-line chemotherapy approach is a cytotoxic agent alone or in combination with a biological targeted drug, as cytotoxic agents have been shown to increase the response rate of CRC and biological targeted drugs to reduce the toxicity of the treatment (<xref rid="b7-etm-0-0-6421" ref-type="bibr">7</xref>). The most commonly used agents are fluorouracil (5-FU) alone or combined with leucovorin (LV) (<xref rid="b8-etm-0-0-6421" ref-type="bibr">8</xref>). Due to the limitations in the understanding of CRC biology, chemotherapy has been challenged with chemo-resistance.</p>
<p>Recently, a series of small non-coding RNAs, which are called microRNAs, has come to the attention of researchers. MicroRNAs are short RNAs with about 18&#x2013;24 nucleotides, which regulate translation and the stability of the target mRNA (<xref rid="b9-etm-0-0-6421" ref-type="bibr">9</xref>). Decades ago, microRNAs were first discovered in chronic lymphocytic leukemia and showed the antitumor activity (<xref rid="b10-etm-0-0-6421" ref-type="bibr">10</xref>). Since then, microRNAs have been investigated and found to be involved in the initiation, development and progression of numerous cancer types, as a tumor suppressor or oncogene (<xref rid="b11-etm-0-0-6421" ref-type="bibr">11</xref>). Extensive research is now aimed at determining if microRNAs can be used as diagnostic biomarkers and therapeutic targets for cancer. Genome-wide profiling demonstrated that miRNA expression in both CRC cell lines and CRC tumors was regulated by methylation, which might lead to a reduced expression of miRNAs in CRC, including let-7, miR-34, miR-342, miR-345, miR-9 and miR-129 (<xref rid="b12-etm-0-0-6421" ref-type="bibr">12</xref>,<xref rid="b13-etm-0-0-6421" ref-type="bibr">13</xref>). In addition, it is well known that miR-21 is commonly upregulated in a variety of cancers, including lung, gastric, breast, colorectal, esophageal, pancreas and hepatocellular carcinoma (<xref rid="b14-etm-0-0-6421" ref-type="bibr">14</xref>&#x2013;<xref rid="b22-etm-0-0-6421" ref-type="bibr">22</xref>). As the biological function of miR-21 has been well studied, it has been reported as a robust and reproducible prognostic marker of CRC (<xref rid="b17-etm-0-0-6421" ref-type="bibr">17</xref>,<xref rid="b18-etm-0-0-6421" ref-type="bibr">18</xref>). It has been reported that the potential mechanisms of miR-21 as oncogenic microRNA include downregulation of phosphatase and tensin homolog (PTEN), a decrease in Bax/Bcl-2/caspase-3 activity, repression of PDCD4 and downregulation of TIMP3 (<xref rid="b23-etm-0-0-6421" ref-type="bibr">23</xref>&#x2013;<xref rid="b25-etm-0-0-6421" ref-type="bibr">25</xref>). Additionally, in combination therapy, miR-21 inhibitors enhanced the chemo-response to 5-FU (<xref rid="b26-etm-0-0-6421" ref-type="bibr">26</xref>).</p>
<p>Gambogic acid (GA) is a naturally occurring molecule, which is commonly extracted from <italic>Garcinia hanburyi</italic> trees (<xref rid="b27-etm-0-0-6421" ref-type="bibr">27</xref>). It has been reported that GA showed numerous activities involving cell cycle arrest, programmed cell death, autophagy, anti-proliferation, antioxidant, anti-metastatic and anti-information (<xref rid="b28-etm-0-0-6421" ref-type="bibr">28</xref>). Currently, the molecular targets of GA have been well studied and numerous molecular pathways have been reported to be involved in the actions of GA, including PI3K/Akt, caspase-3 apoptosis, ATR-Chk1, TNF-&#x03B1;/NF-&#x03BA;B and MET pathways (<xref rid="b29-etm-0-0-6421" ref-type="bibr">29</xref>&#x2013;<xref rid="b32-etm-0-0-6421" ref-type="bibr">32</xref>). In addition, Huang <italic>et al</italic> (<xref rid="b33-etm-0-0-6421" ref-type="bibr">33</xref>)has reported that GA induced HT-29 cell apoptosis through the mitochondrial pathway. However, there are few reports regarding miRNA and GA, regardless of the mechanism of GA anti-CRC. The present study demonstrated that GA downregulated miR-21 in CRC and thus increased PTEN expression causing migration inhibition and resulted in CRC cell apoptosis. Taken together, these findings might provide strong evidence of GA antitumor activity and a new insight for future CRC investigation and treatment.</p>
</sec>
<sec sec-type="materials|methods">
<title>Materials and methods</title>
<sec>
<title/>
<sec>
<title>Cell culture</title>
<p>Human CRC HT-29, SW480 and HCT116 cell lines were obtained from Stem Cell Bank of Chinese Academy of Sciences (Shanghai, China) and were cultured in complete RPMI-1640 medium (Sigma-Aldrich; Merck KGaA, Darmstadt, Germany) with 10&#x0025; fetal bovine serum (Thermo Fisher Scientific, Inc., Waltham, MA, USA), penicillin (100 U/ml) and streptomycin (100 &#x00B5;g/ml; both Sigma-Aldrich; Merck KGaA). Cells were maintained at 37&#x00B0;C with 5&#x0025; CO<sub>2</sub> in a humidified cell culture incubator (Sanyo, Tokyo, Janpan). For all experiments, five biological groups were designed according to the concentrations of GA (0, 0.33, 1, 3.3 and 10 &#x00B5;M), which was purchased from Sigma-Aldrich; Merck KGaA. For each indicated time points (24, 48, and 72 h), cells were sampled for the following assay.</p>
</sec>
<sec>
<title>MTT assay of cell viability</title>
<p>An MTT assay kit (Beyotime Institute of Biotechnology, Shanghai, China) was used to measure cell growth for indicated time points following the protocol of manufacturer. Briefly, HT-29 cells at the logarithmic growth phase were seeded into 96-well plate at 5&#x00D7;10<sup>3</sup>/well. 200 &#x00B5;l GA with dose escalation (0, 0.33, 1, 3.3 and 10 &#x00B5;M) was added into each well in triplicate when cells were totally adhered at 24 h. Cells were cultured at 37&#x00B0;C (5&#x0025; CO<sub>2</sub>) and sampled at 24, 48 and 72 h. MTT (5 mg/ml, Sigma-Aldrich; Merck KGaA) solution was added (20 &#x00B5;l/well) at each sampling time point and cells were further incubated for additional 4 h in a cell incubator. At the end of incubation, the supernatants were removed with a pipette. Before reading under the microplate reader, 150 &#x00B5;l DMSO (Sigma-Aldrich; Merck KGaA) was added to each well. The proliferation rate was calculated with the absorbance value (OD) at a wavelength of 480 nm. The cell viability percentage was measured with the following formula: [(drug treated group/control group) &#x00D7;100]. Each assay was performed triplicate and the results are presented as the mean &#x00B1; SD.</p>
</sec>
<sec>
<title>Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis</title>
<p>After incubation with GA (0, 1 or 3.3 &#x00B5;M) for 24, 48 or 72 h, CRC cells were collected and total RNA was isolated from these cells using a PicoPure&#x2122; RNA Isolation kit (Arcturus, Sunnyvale, CA, USA) according to the manufacturer&#x0027;s instructions. Subsequently, 1 &#x00B5;g isolated RNA was transcribed into cDNA using SuperScript III RNase H Reverse Transcriptase (Thermo Fisher Scientific, Inc.). Following the reverse transcription reactions, amplification was performed using a Vii&#x2122; 7 system (Bio-Rad Laboratories, Hercules, CA, USA) according to the manufacturer&#x0027;s instructions. Transcript quantities were compared by relative Ct numbers, and the miR-21 expression level was normalized to an endogenous reference gene, GAPDH, and then the relative miR-21 mRNA levels to control sample was calculated using the 2<sup>&#x2212;&#x0394;&#x0394;Ct</sup> method. Both primers for miR-21and GAPDH were purchased from Thermo Fisher Scientific, Inc.</p>
</sec>
<sec>
<title>Flow cytometric analysis of cell apoptosis</title>
<p>Apoptotic cells were analyzed according to the previously described method (<xref rid="b34-etm-0-0-6421" ref-type="bibr">34</xref>). Briefly, HT-29 cells were exposed to 3.3 &#x00B5;M GA, GA combined with miR-21 mimics or vehicle for 72 h. Subsequently, these three groups of HT-29 cells were harvested and resuspended in PBS. Apoptotic cells were identified with dual-staining of Annexin V-FITC and propidium iodide (PI; Thermo Fisher Scientific, Inc.). For each group, the experiments were performed in triplicate.</p>
</sec>
<sec>
<title>Wound healing assay of cell migration</title>
<p>For the wound healing assay, the procedure was performed according to the previous reports by Ni <italic>et al</italic> (<xref rid="b35-etm-0-0-6421" ref-type="bibr">35</xref>). HT-29 cells were seeded into 6-well plates (6&#x00D7;10<sup>4</sup> cells/well) and treated with GA, GA combined with miR-21 mimics or a vehicle. When the cells grew to 90&#x0025; confluence, vertical scratches were induced down through the monolayer cell surfaces using 1,000 &#x00B5;l pipette tips. The media and cell debris were carefully aspirated before further culture with serum-free RPMI-1640 medium at 37&#x00B0;C. At 24 h, images of each sample were captured under a microscope at magnification, &#x00D7;100 (Leica DM500; Leica Buffalo Grove, IL, USA). The images were used to analyze the distance of one side of the wound to the other side using a scale bar.</p>
</sec>
<sec>
<title>Luciferase activity assay</title>
<p>MiR-21 mimics, scramble, wild-type and mutant 3&#x2032;UTR PTEN vectors were provided by Ambion (Thermo Fisher Scientific, Inc.). Vectors carried the PTEN sequence, which contained the predicted miR-21 binding sites with wild-type or mutant 3&#x2032;UTR. 5&#x00D7;10<sup>3</sup> HT-29 cells were plated into 24-well plates, which were then transfected with PTEN wild-type or mutant vector for 4 h using Lipofectamine<sup>&#x00AE;</sup> 2000 transfection reagent (Thermo Fisher Scientific, Inc.). Subsequently, the cells were treated with 100 nM miR-21 mimics or scramble miRNA. 48 h later, the cells were lysed using 0.2&#x0025; trypsin at 37&#x00B0;C and a dual luciferase assay kit was used to detect the luciferase activities (Promega Corporation, Madison, WI, USA).</p>
</sec>
<sec>
<title>Western blot analysis</title>
<p>Following treatment with GA, GA combined with miR-21 mimics or vehicle for 72 h, HT-29 cells were collected and lysed in RIPA buffer (Sigma-Aldrich; Merck KGaA). The total protein concentration was quantified using a BCA Protein Assay kit (Beyotime Institute of Biotechnology), and 20 &#x00B5;g protein from each group was separated with 10&#x0025; Tris-SDS gel. After the electrophoresis, the gel was electro-transferred onto polyvinylidene fluoride membranes (Thermo Fisher Scientific, Inc.). For the subsequent blocking, washing and antibody incubation at room temperature, an iBind kit (Thermo Fisher Scientific, Inc.) was used according the manufacturers&#x0027; instructions. The following primary antibodies were used: anti-PTEN (1:250), anti-PI3K (1:300), anti-p-Erk (1:300), anti-matrix metalloproteinase (MMP2; 1:300), anti-MMP9 (1:300; all Cell Signaling Technology, Inc., Danvers, MA, USA) and anti-GAPDH (1:1,000; Santa Cruz Biotechnology, Inc., CA, USA). Horseradish peroxidase-conjugated secondary antibodies (1:3,000; anti-rabbit or anti-goat IgG; Santa Cruz Biotechnology, Inc.) were used. The luminescent signal was detected by adding super sensitive regent (Thermo Fisher Scientific, Inc.) and quantified using the Image Lab&#x2122; system from Bio-Rad Laboratories.</p>
</sec>
<sec>
<title>Transwell assay of cell invasion</title>
<p>The online protocol published by Justus <italic>et al</italic> (<xref rid="b36-etm-0-0-6421" ref-type="bibr">36</xref>) was used in order to validate the effect of GA on HT-29 invasion. Briefly, 100 &#x00B5;l HT-29 cells (1&#x00D7;10<sup>4</sup> cells/well) mixed with 0.33 &#x00B5;M GA, GA combined with miR-21 mimics or vehicle were added to the upper chamber of Transwell chambers (Corning Life Science, Tewksbury, MA, USA) and 100 &#x00B5;l RPMI-1640 medium with 30&#x0025; FBS was added to the lower chamber. Following incubation for 72 h at 37&#x00B0;C, cells on the upper surface of the microporous membrane were carefully removed with cotton swabs, whereas cells on the lower surface of the membrane were fixed and stained with crystal violet. The cells in five selected views were counted under a microscope (Leica DM500; Leica) at magnification, &#x00D7;100. The average sum of the cells was used to calculate the invasion rate.</p>
</sec>
<sec>
<title>Statistical analysis</title>
<p>All experiments were performed in triplicate and all data are presented as the mean &#x00B1; SD. One-way ANOVA followed by Dunnett&#x0027;s test was used to determine the difference between groups with P&#x003C;0.05 being considered to indicate a statistically significant difference (&#x002A;P&#x003C;0.05, &#x002A;&#x002A;P&#x003C;0.01).</p>
</sec>
</sec>
</sec>
<sec sec-type="results">
<title>Results</title>
<sec>
<title/>
<sec>
<title>GA inhibited CRC cell proliferation and downregulated miR-21 expression</title>
<p>The viability of HT-29 cells was detected at indicated time points with dose escalation GA (<xref rid="f1-etm-0-0-6421" ref-type="fig">Fig. 1A</xref>) from 0.33 to 10 &#x00B5;M using the MTT assay. As shown in <xref rid="f1-etm-0-0-6421" ref-type="fig">Fig. 1B</xref>, GA inhibited the growth of HT-29 cells in a time- and dose-dependent manner. GA at all doses significantly inhibited HT-29 cell proliferation compared with vehicle at 72 h (P&#x003C;0.01). miR-21 was mostly found to be overexpressed in CRC. In order to explore the effect of GA on miR-21 expression, the cells treated with 1 or 3.3 &#x00B5;M GA for 24, 48 and 72 h were subject to qPCR. The results indicated that GA downregulated miR-21 RNA expression at both doses, even at 24 h (<xref rid="f1-etm-0-0-6421" ref-type="fig">Fig. 1C</xref>; P&#x003C;0.05). Moreover, we used the other two CRC cell lines, SW480 and HCT116, to investigate the involvement of miR-21 on the effects of GA. The results were consistent with the data obtained using HT-29 cells (<xref rid="f1-etm-0-0-6421" ref-type="fig">Fig. 1D-F</xref>). All these results indicated that GA exerted anti-proliferation effects on HT-29 cancer cells through downregulation of miR-21 expression.</p>
</sec>
<sec>
<title>GA induced apoptosis of HT-29 cancer cells</title>
<p>To further investigate how GA inhibited HT-29 cancer cell growth and whether miR-21 was the effector of GA, apoptotic cells were detected with FACS by double staining with Annexin V and PI. In addition to the vehicle and GA (3.3 &#x00B5;M) treatment groups, the GA with miR-21 mimics group was added to determine whether miR-21mimics could interfere with the antitumor effect of GA. The results in <xref rid="f2-etm-0-0-6421" ref-type="fig">Fig. 2A and B</xref> demonstrated that the majority of HT-29 cells were subject to apoptosis following GA treatment compared with the control group (P&#x003C;0.01). Moreover, when miR-21 mimics were added to the GA 3.3 &#x00B5;M group, the apoptotic rate of the HT-29 cells was reduced to a lower level, which was similar to that of the control group and was significantly less than that of the GA 3.3 &#x00B5;M group (<xref rid="f2-etm-0-0-6421" ref-type="fig">Fig. 2B</xref>; P&#x003C;0.01). These results indicated that GA inhibited HT-29 cancer cell growth by inducing cell apoptosis via downregulation of miR-21 expression.</p>
</sec>
<sec>
<title>GA inhibited HT-29 cancer cell migration</title>
<p>In order to validate the effect of GA on HT-29 cell migration, a wound healing assay was performed. The results in <xref rid="f3-etm-0-0-6421" ref-type="fig">Fig. 3A</xref> indicated that cell migration was significantly inhibited by 0.33 &#x00B5;M GA compared with control group. Additionally, in the miR-21 mimics treated group, the wound was similar to that in the control group, which further confirmed that the anti-migration effect of GA was exerted through miR-21. Quantification of the migration activity revealed significant differences among the control, GA and GA with miR-21 groups (<xref rid="f3-etm-0-0-6421" ref-type="fig">Fig. 3B</xref>, P&#x003C;0.01, P&#x003C;0.05). Thus, this result suggested that GA inhibited HT-29 cell migration via blocking miR-21 activity.</p>
</sec>
<sec>
<title>GA enhanced PTEN expression and blocked the PI3K/Akt pathway</title>
<p>In the present study, miR-21 gene expression was inhibited by GA (<xref rid="f1-etm-0-0-6421" ref-type="fig">Fig. 1B</xref>) and, as Zhang <italic>et al</italic> (<xref rid="b15-etm-0-0-6421" ref-type="bibr">15</xref>) had previously reported that miR-21 was an onco-miRNA that downregulated the tumor suppressor gene, PTEN in gastric cancer, we needed to determine whether GA could affect PTEN expression in CRC. From the luciferase assay, we found a statistically significant decrease in firefly luciferase activity in the cells transfected with miR-21 mimics and wild-type 3&#x2032;UTR PTEN vectors (<xref rid="f4-etm-0-0-6421" ref-type="fig">Fig. 4A</xref>). In addition, GA-induced cell growth inhibition was reversed by miR-21 mimics (<xref rid="f4-etm-0-0-6421" ref-type="fig">Fig. 4B</xref>). The western blot results further confirmed that GA significantly increased the PTEN protein level and miR-21 mimics suppressed the enhancement induced by GA (<xref rid="f4-etm-0-0-6421" ref-type="fig">Fig. 4C and D</xref>). Moreover, PTEN is a suppressor of the PI3K/Akt pathway and therefore, the enhanced expression of PTEN induced by GA would have definitely blocked the PI3K/Akt signaling pathway. The western blot results shown in <xref rid="f4-etm-0-0-6421" ref-type="fig">Fig. 4C, E and F</xref> indicated that GA significantly decreased PI3K and p-Akt protein expression (P&#x003C;0.01). All these findings demonstrated that GA showed antitumor activity through targeting miR-21 and, in turn, blocking of the PI3K/Akt signaling pathway.</p>
</sec>
<sec>
<title>GA inhibited the invasion of HT-29 cells</title>
<p>A Transwell assay was used in order to further investigate the biological function of GA on HT-29 cell invasion. The invasion of HT-29 cells treated with 0.33 &#x00B5;M GA was markedly less than that in the control group under the microscope view (<xref rid="f5-etm-0-0-6421" ref-type="fig">Fig. 5A</xref>). The invaded cell number was quantified and is shown in <xref rid="f5-etm-0-0-6421" ref-type="fig">Fig. 5B</xref>, which reveals a significantly smaller number of invading cells compared with the vehicle group. Moreover, in the GA and miR-21 mimics treated group, the cell number was comparable with that in the control group (<xref rid="f5-etm-0-0-6421" ref-type="fig">Fig. 5B</xref>). As MMP2 and MMP-9 are closely associated with cell migration and invasion, the expression of these factors was also detected. The results revealed that MMP-2 and MMP-9 expression was significantly decreased following treatment with GA (<xref rid="f5-etm-0-0-6421" ref-type="fig">Fig. 5C-E</xref>). These results indicated that GA inhibited the activity of MMP2 and MMP-9 and thus showed its anti-invasion activity in HT-29 cancer cells.</p>
</sec>
</sec>
</sec>
<sec sec-type="discussion">
<title>Discussion</title>
<p>CRC has become a global public health problem with its high incidence and mortality rate worldwide (<xref rid="b4-etm-0-0-6421" ref-type="bibr">4</xref>). One review published recently has summarized discoveries and newest findings in CRC diagnosis and treatment (<xref rid="b5-etm-0-0-6421" ref-type="bibr">5</xref>). Based on genetic screening tests, most of the major cancer genes involved in CRC have been well characterized, such as APC, KRAS, PI3K and TP53 (<xref rid="b37-etm-0-0-6421" ref-type="bibr">37</xref>&#x2013;<xref rid="b39-etm-0-0-6421" ref-type="bibr">39</xref>). Epigenetic instability, mainly with respect to CpG island methylation, was also a common feature in CRC (<xref rid="b38-etm-0-0-6421" ref-type="bibr">38</xref>). Non-coding RNAs (ncRNA) are RNA molecules without an open reading frame and are not translated into proteins. This results in the deregulation of miRNAs associated with CRC. Previously, researchers have reported that miRNAs function as potential diagnostic and prognostic biomarkers in CRC (<xref rid="b9-etm-0-0-6421" ref-type="bibr">9</xref>). For instance, 12 miRNAs showed higher expression levels in CRC patient samples than in those from healthy controls, such as miR-7, &#x2212;17, &#x2212;20a, &#x2212;21, &#x2212;92a, &#x2212;96, &#x2212;106a, &#x2212;134, &#x2212;183, &#x2212;196a, &#x2212;199a-3p and &#x2212;214. Meanwhile, 8 miRNAs were shown to be downregulated, including miR-9, &#x2212;29b, &#x2212;127-5p, &#x2212;138, &#x2212;143, &#x2212;146a, &#x2212;222 and &#x2212;938 (<xref rid="b40-etm-0-0-6421" ref-type="bibr">40</xref>). At present, an extensive amount of research regarding CRC is focused on the development of new less aggressive and more effective therapies than conventional ones.</p>
<p>It has been shown that GA inhibited the growth of a wide variety of cancers, including hepatocarcinoma, gastric carcinoma, lung cancer and breast cancer (<xref rid="b41-etm-0-0-6421" ref-type="bibr">41</xref>&#x2013;<xref rid="b45-etm-0-0-6421" ref-type="bibr">45</xref>). The mechanisms of GA antitumor activity have been well studied. However, few studies about the effect of GA on miRNA expression have been reported. In this article, we not only validated the antitumor effect of GA via MTT assay for proliferation, wound healing assay for migration, Transwell assay for invasion and FACS for cell apoptosis, but we also first demonstrated that miR-21 was down regulated by GA in CRC. In addition, miR-21 expression was suppressed by GA in HT-29 cells, as determined by RT-qPCR. Based on this knowledge, we proposed that miR-21 might be an effector of GA in HT-29 cells. For the potential mechanisms of miR-21 as an onco-miRNA, several reports have been published. Meng <italic>et al</italic> (<xref rid="b46-etm-0-0-6421" ref-type="bibr">46</xref>) has found that PTEN was regulated by miR-21 in hepatocellular carcinoma. Similarly, PTEN was repressed by miR-21 in non-small cell lung cancer (<xref rid="b47-etm-0-0-6421" ref-type="bibr">47</xref>).</p>
<p>PTEN was revealed to be an essential tumor suppressor and modulator of cell growth and proliferation (<xref rid="b48-etm-0-0-6421" ref-type="bibr">48</xref>). PTEN was reported to be under the control of various transcription factors involving EGR-1, p53, ATF2 and PPAR&#x03B3; (<xref rid="b48-etm-0-0-6421" ref-type="bibr">48</xref>). miRNA-guided degradation would control the process of PTEN mRNA splicing, which is translocated to the cytosol (<xref rid="b48-etm-0-0-6421" ref-type="bibr">48</xref>). The prominent miRNAs of PTEN-targeting included miR-19, miR-21 and miR-221 (<xref rid="b46-etm-0-0-6421" ref-type="bibr">46</xref>). Based on these, we investigated the protein expression level of PTEN, PI3K and p-Akt in GA-treated HT-29 cells. As expected, PTEN was increased by GA, while PI3K and p-AKT proteins were decreased in HT-29 cells.</p>
<p>Taken together, the anti-proliferation effect of GA on HT-29 cancer cells may be mediated via decreasing miR-21 expression and blocking the PI3K/Akt pathway. Therefore, our article might open up a new pathway toward CRC pharmacological intervention.</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgements</title>
<p>Not applicable.</p>
</ack>
<sec>
<title>Funding</title>
<p>No funding was received.</p>
</sec>
<sec>
<title>Availability of data and materials</title>
<p>The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.</p>
</sec>
<sec>
<title>Authors&#x0027; contributions</title>
<p>GG, YB, HQ, MY, JH and LL collaborated in the experiment design, sample collection and experiments execution. GG, LY and BL analyzed and interpreted the patient data and were the major contributors in developing the first draft of the manuscript. BL reviewed and edited the manuscript. XQ analyzed and interpreted the data and reviewed and approved the final draft of the manuscript.</p>
</sec>
<sec>
<title>Ethics approval and consent to participate</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Patient consent for publication</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Competing interests</title>
<p>The authors declare that they have no competing interests.</p>
</sec>
<ref-list>
<title>References</title>
<ref id="b1-etm-0-0-6421"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Haggar</surname><given-names>FA</given-names></name><name><surname>Boushey</surname><given-names>RP</given-names></name></person-group><article-title>Colorectal cancer epidemiology: Incidence, mortality, survival, and risk factors</article-title><source>Clin Colon Rectal Surg</source><volume>22</volume><fpage>191</fpage><lpage>197</lpage><year>2009</year><pub-id pub-id-type="doi">10.1055/s-0029-1242458</pub-id><pub-id pub-id-type="pmid">21037809</pub-id></element-citation></ref>
<ref id="b2-etm-0-0-6421"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Connell</surname><given-names>O JB</given-names></name><name><surname>Maggard</surname><given-names>MA</given-names></name><name><surname>Ko</surname><given-names>CY</given-names></name></person-group><article-title>Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging</article-title><source>J Natl Cancer Inst</source><volume>96</volume><fpage>1420</fpage><lpage>1425</lpage><year>2004</year><pub-id pub-id-type="doi">10.1093/jnci/djh275</pub-id><pub-id pub-id-type="pmid">15467030</pub-id></element-citation></ref>
<ref id="b3-etm-0-0-6421"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kraus</surname><given-names>S</given-names></name><name><surname>Nabiochtchikov</surname><given-names>I</given-names></name><name><surname>Shapira</surname><given-names>S</given-names></name><name><surname>Arber</surname><given-names>N</given-names></name></person-group><article-title>Recent advances in personalized colorectal cancer research</article-title><source>Cancer Lett</source><volume>347</volume><fpage>15</fpage><lpage>21</lpage><year>2014</year><pub-id pub-id-type="doi">10.1016/j.canlet.2014.01.025</pub-id><pub-id pub-id-type="pmid">24491406</pub-id></element-citation></ref>
<ref id="b4-etm-0-0-6421"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ferlay</surname><given-names>J</given-names></name><name><surname>Shin</surname><given-names>HR</given-names></name><name><surname>Bray</surname><given-names>F</given-names></name><name><surname>Forman</surname><given-names>D</given-names></name><name><surname>Mathers</surname><given-names>C</given-names></name><name><surname>Parkin</surname><given-names>DM</given-names></name></person-group><article-title>Estimates of worldwide burden of cancer in 2008: GLOBOCAN, 2008</article-title><source>Int J Cancer</source><volume>127</volume><fpage>2893</fpage><lpage>2917</lpage><year>2010</year><pub-id pub-id-type="doi">10.1002/ijc.25516</pub-id><pub-id pub-id-type="pmid">21351269</pub-id></element-citation></ref>
<ref id="b5-etm-0-0-6421"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>M&#x00E1;rmol</surname><given-names>I</given-names></name><name><surname>S&#x00E1;nchez-de-Diego</surname><given-names>C</given-names></name><name><surname>Dieste</surname><given-names>Pradilla A</given-names></name><name><surname>Cerrada</surname><given-names>E</given-names></name><name><surname>Yoldi</surname><given-names>Rodriguez MJ</given-names></name></person-group><article-title>Colorectal carcinoma: A general overview and future perspectives in colorectal cancer</article-title><source>Int J Mol Sci</source><volume>18</volume><comment>pii: E197</comment><year>2017</year><pub-id pub-id-type="doi">10.3390/ijms18010197</pub-id></element-citation></ref>
<ref id="b6-etm-0-0-6421"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Venook</surname><given-names>A</given-names></name></person-group><article-title>Critical evaluation of current treatments in metastatic colorectal cancer</article-title><source>Oncologist</source><volume>10</volume><fpage>250</fpage><lpage>261</lpage><year>2005</year><pub-id pub-id-type="doi">10.1634/theoncologist.10-4-250</pub-id><pub-id pub-id-type="pmid">15821245</pub-id></element-citation></ref>
<ref id="b7-etm-0-0-6421"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Van Cutsem</surname><given-names>E</given-names></name><name><surname>Cervantes</surname><given-names>A</given-names></name><name><surname>Nordlinger</surname><given-names>B</given-names></name><name><surname>Arnold</surname><given-names>D</given-names></name></person-group><article-title>ESMO guidelines working group: Metastatic colorectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up</article-title><source>Ann Oncol</source><volume>3</volume><supplement>25 Suppl</supplement><fpage>iii1</fpage><lpage>iii9</lpage><year>2014</year><pub-id pub-id-type="doi">10.1093/annonc/mdu260</pub-id></element-citation></ref>
<ref id="b8-etm-0-0-6421"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lee</surname><given-names>JJ</given-names></name><name><surname>Beumer</surname><given-names>JH</given-names></name><name><surname>Chu</surname><given-names>E</given-names></name></person-group><article-title>Therapeutic drug monitoring of 5-fluorouracil</article-title><source>Cancer Chemother Pharmacol</source><volume>78</volume><fpage>447</fpage><lpage>464</lpage><year>2016</year><pub-id pub-id-type="doi">10.1007/s00280-016-3054-2</pub-id><pub-id pub-id-type="pmid">27217046</pub-id></element-citation></ref>
<ref id="b9-etm-0-0-6421"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liu</surname><given-names>M</given-names></name><name><surname>Chen</surname><given-names>H</given-names></name></person-group><article-title>The role of microRNAs in colorectal cancer</article-title><source>J Genet Genomics</source><volume>37</volume><fpage>347</fpage><lpage>358</lpage><year>2010</year><pub-id pub-id-type="doi">10.1016/S1673-8527(09)60053-9</pub-id><pub-id pub-id-type="pmid">20621017</pub-id></element-citation></ref>
<ref id="b10-etm-0-0-6421"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kempin</surname><given-names>S</given-names></name></person-group><article-title>Update on chronic lymphocytic leukemia: Overview of new agents and comparative analysis</article-title><source>Curr Treat Options Oncol</source><volume>14</volume><fpage>144</fpage><lpage>155</lpage><year>2013</year><pub-id pub-id-type="doi">10.1007/s11864-013-0229-5</pub-id><pub-id pub-id-type="pmid">23494726</pub-id></element-citation></ref>
<ref id="b11-etm-0-0-6421"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Di Leva</surname><given-names>G</given-names></name><name><surname>Cheung</surname><given-names>DG</given-names></name><name><surname>Croce</surname><given-names>CM</given-names></name></person-group><article-title>miRNA clusters as therapeutic targets for hormone-resistant breast cancer</article-title><source>Expert Rev Endocrinol Metab</source><volume>10</volume><fpage>607</fpage><lpage>617</lpage><year>2015</year><pub-id pub-id-type="doi">10.1586/17446651.2015.1099430</pub-id><pub-id pub-id-type="pmid">27721895</pub-id></element-citation></ref>
<ref id="b12-etm-0-0-6421"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Grady</surname><given-names>WM</given-names></name><name><surname>Carethers</surname><given-names>JM</given-names></name></person-group><article-title>Genomic and epigenetic instability in colorectal cancer pathogenesis</article-title><source>Gastroenterology</source><volume>135</volume><fpage>1079</fpage><lpage>1099</lpage><year>2008</year><pub-id pub-id-type="doi">10.1053/j.gastro.2008.07.076</pub-id><pub-id pub-id-type="pmid">18773902</pub-id></element-citation></ref>
<ref id="b13-etm-0-0-6421"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Karakatsanis</surname><given-names>A</given-names></name><name><surname>Papaconstantinou</surname><given-names>I</given-names></name><name><surname>Gazouli</surname><given-names>M</given-names></name><name><surname>Lyberopoulou</surname><given-names>A</given-names></name><name><surname>Polymeneas</surname><given-names>G</given-names></name><name><surname>Voros</surname><given-names>D</given-names></name></person-group><article-title>Expression of microRNAs, miR-21, miR-31, miR-122, miR-145, miR-146a, miR-200c, miR-221, miR-222, and miR-223 in patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma and its prognostic significance</article-title><source>Mol Carcinog</source><volume>52</volume><fpage>297</fpage><lpage>303</lpage><year>2013</year><pub-id pub-id-type="doi">10.1002/mc.21864</pub-id><pub-id pub-id-type="pmid">22213236</pub-id></element-citation></ref>
<ref id="b14-etm-0-0-6421"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Li</surname><given-names>Y</given-names></name><name><surname>Li</surname><given-names>W</given-names></name><name><surname>Ouyang</surname><given-names>Q</given-names></name><name><surname>Hu</surname><given-names>S</given-names></name><name><surname>Tang</surname><given-names>J</given-names></name></person-group><article-title>Detection of lung cancer with blood microRNA-21 expression levels in Chinese population</article-title><source>Oncol Lett</source><volume>2</volume><fpage>991</fpage><lpage>994</lpage><year>2011</year><pub-id pub-id-type="pmid">22866162</pub-id></element-citation></ref>
<ref id="b15-etm-0-0-6421"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhang</surname><given-names>BG</given-names></name><name><surname>Li</surname><given-names>JF</given-names></name><name><surname>Yu</surname><given-names>BQ</given-names></name><name><surname>Zhu</surname><given-names>ZG</given-names></name><name><surname>Liu</surname><given-names>BY</given-names></name><name><surname>Yan</surname><given-names>M</given-names></name></person-group><article-title>microRNA-21 promotes tumor proliferation and invasion in gastric cancer by targeting PTEN</article-title><source>Oncol Rep</source><volume>27</volume><fpage>1019</fpage><lpage>1026</lpage><year>2012</year><pub-id pub-id-type="doi">10.3892/or.2012.1645</pub-id><pub-id pub-id-type="pmid">22267008</pub-id></element-citation></ref>
<ref id="b16-etm-0-0-6421"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Papagiannakopoulos</surname><given-names>T</given-names></name><name><surname>Shapiro</surname><given-names>A</given-names></name><name><surname>Kosik</surname><given-names>KS</given-names></name></person-group><article-title>MicroRNA-21 targets a network of key tumor-suppressive pathways in glioblastoma cells</article-title><source>Cancer Res</source><volume>68</volume><fpage>8164</fpage><lpage>8172</lpage><year>2008</year><pub-id pub-id-type="doi">10.1158/0008-5472.CAN-08-1305</pub-id><pub-id pub-id-type="pmid">18829576</pub-id></element-citation></ref>
<ref id="b17-etm-0-0-6421"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liu</surname><given-names>GH</given-names></name><name><surname>Zhou</surname><given-names>ZG</given-names></name><name><surname>Chen</surname><given-names>R</given-names></name><name><surname>Wang</surname><given-names>MJ</given-names></name><name><surname>Zhou</surname><given-names>B</given-names></name><name><surname>Li</surname><given-names>Y</given-names></name><name><surname>Sun</surname><given-names>XF</given-names></name></person-group><article-title>Serum miR-21 and miR-92a as biomarkers in the diagnosis and prognosis of colorectal cancer</article-title><source>Tumour Biol</source><volume>34</volume><fpage>2175</fpage><lpage>2181</lpage><year>2013</year><pub-id pub-id-type="doi">10.1007/s13277-013-0753-8</pub-id><pub-id pub-id-type="pmid">23625654</pub-id></element-citation></ref>
<ref id="b18-etm-0-0-6421"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Asangani</surname><given-names>IA</given-names></name><name><surname>Rasheed</surname><given-names>SA</given-names></name><name><surname>Nikolova</surname><given-names>DA</given-names></name><name><surname>Leupold</surname><given-names>JH</given-names></name><name><surname>Colburn</surname><given-names>NH</given-names></name><name><surname>Post</surname><given-names>S</given-names></name><name><surname>Allgayer</surname><given-names>H</given-names></name></person-group><article-title>MicroRNA-21 (miR-21) post-transcriptionally downregulates tumor suppressor Pdcd4 and stimulates invasion, intravasation and metastasis in colorectal cancer</article-title><source>Oncogene</source><volume>27</volume><fpage>2128</fpage><lpage>2136</lpage><year>2008</year><pub-id pub-id-type="doi">10.1038/sj.onc.1210856</pub-id><pub-id pub-id-type="pmid">17968323</pub-id></element-citation></ref>
<ref id="b19-etm-0-0-6421"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhang</surname><given-names>HL</given-names></name><name><surname>Yang</surname><given-names>LF</given-names></name><name><surname>Zhu</surname><given-names>Y</given-names></name><name><surname>Yao</surname><given-names>XD</given-names></name><name><surname>Zhang</surname><given-names>SL</given-names></name><name><surname>Dai</surname><given-names>B</given-names></name><name><surname>Zhu</surname><given-names>YP</given-names></name><name><surname>Shen</surname><given-names>YJ</given-names></name><name><surname>Shi</surname><given-names>GH</given-names></name><name><surname>Ye</surname><given-names>DW</given-names></name></person-group><article-title>Serum miRNA-21: Elevated levels in patients with metastatic hormone-refractory prostate cancer and potential predictive factor for the efficacy of docetaxel-based chemotherapy</article-title><source>Prostate</source><volume>71</volume><fpage>326</fpage><lpage>331</lpage><year>2011</year><pub-id pub-id-type="doi">10.1002/pros.21246</pub-id><pub-id pub-id-type="pmid">20842666</pub-id></element-citation></ref>
<ref id="b20-etm-0-0-6421"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dillhoff</surname><given-names>M</given-names></name><name><surname>Liu</surname><given-names>J</given-names></name><name><surname>Frankel</surname><given-names>W</given-names></name><name><surname>Croce</surname><given-names>C</given-names></name><name><surname>Bloomston</surname><given-names>M</given-names></name></person-group><article-title>MicroRNA-21 is overexpressed in pancreatic cancer and a potential predictor of survival</article-title><source>J Gastrointest Surg</source><volume>12</volume><fpage>2171</fpage><lpage>2176</lpage><year>2008</year><pub-id pub-id-type="doi">10.1007/s11605-008-0584-x</pub-id><pub-id pub-id-type="pmid">18642050</pub-id></element-citation></ref>
<ref id="b21-etm-0-0-6421"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Faragalla</surname><given-names>H</given-names></name><name><surname>Youssef</surname><given-names>YM</given-names></name><name><surname>Scorilas</surname><given-names>A</given-names></name><name><surname>Khalil</surname><given-names>B</given-names></name><name><surname>White</surname><given-names>NM</given-names></name><name><surname>Mejia-Guerrero</surname><given-names>S</given-names></name><name><surname>Khella</surname><given-names>H</given-names></name><name><surname>Jewett</surname><given-names>MA</given-names></name><name><surname>Evans</surname><given-names>A</given-names></name><name><surname>Lichner</surname><given-names>Z</given-names></name><etal/></person-group><article-title>The clinical utility of miR-21 as a diagnostic and prognostic marker for renal cell carcinoma</article-title><source>J Mol Diagn</source><volume>14</volume><fpage>385</fpage><lpage>392</lpage><year>2012</year><pub-id pub-id-type="doi">10.1016/j.jmoldx.2012.02.003</pub-id><pub-id pub-id-type="pmid">22580180</pub-id></element-citation></ref>
<ref id="b22-etm-0-0-6421"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kumar</surname><given-names>S</given-names></name><name><surname>Keerthana</surname><given-names>R</given-names></name><name><surname>Pazhanimuthu</surname><given-names>A</given-names></name><name><surname>Perumal</surname><given-names>P</given-names></name></person-group><article-title>Overexpression of circulating miRNA-21 and miRNA-146a in plasma samples of breast cancer patients</article-title><source>Indian J Biochem Biophys</source><volume>50</volume><fpage>210</fpage><lpage>214</lpage><year>2013</year><pub-id pub-id-type="pmid">23898484</pub-id></element-citation></ref>
<ref id="b23-etm-0-0-6421"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhu</surname><given-names>Q</given-names></name><name><surname>Wang</surname><given-names>Z</given-names></name><name><surname>Hu</surname><given-names>Y</given-names></name><name><surname>Li</surname><given-names>J</given-names></name><name><surname>Li</surname><given-names>X</given-names></name><name><surname>Zhou</surname><given-names>L</given-names></name><name><surname>Huang</surname><given-names>Y</given-names></name></person-group><article-title>miR-21 promotes migration and invasion by the miR-21-PDCD4-AP-1 feedback loop in human hepatocellular carcinoma</article-title><source>Oncol Rep</source><volume>27</volume><fpage>1660</fpage><lpage>1668</lpage><year>2012</year><pub-id pub-id-type="pmid">22322403</pub-id></element-citation></ref>
<ref id="b24-etm-0-0-6421"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liu</surname><given-names>CZ</given-names></name><name><surname>Liu</surname><given-names>W</given-names></name><name><surname>Zheng</surname><given-names>Y</given-names></name><name><surname>Su</surname><given-names>JM</given-names></name><name><surname>Li</surname><given-names>JJ</given-names></name><name><surname>Yu</surname><given-names>L</given-names></name><name><surname>He</surname><given-names>XD</given-names></name><name><surname>Chen</surname><given-names>SS</given-names></name></person-group><article-title>PTEN and PDCD4 are bona fide targets of microRNA-21 in human cholangiocarcinoma</article-title><source>Chin Med Sci J</source><volume>27</volume><fpage>65</fpage><lpage>72</lpage><year>2012</year><pub-id pub-id-type="pmid">22770403</pub-id></element-citation></ref>
<ref id="b25-etm-0-0-6421"><label>25</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>N</given-names></name><name><surname>Zhang</surname><given-names>CQ</given-names></name><name><surname>He</surname><given-names>JH</given-names></name><name><surname>Duan</surname><given-names>XF</given-names></name><name><surname>Wang</surname><given-names>YY</given-names></name><name><surname>Ji</surname><given-names>X</given-names></name><name><surname>Zang</surname><given-names>WQ</given-names></name><name><surname>Li</surname><given-names>M</given-names></name><name><surname>Ma</surname><given-names>YY</given-names></name><name><surname>Wang</surname><given-names>T</given-names></name><name><surname>Zhao</surname><given-names>GQ</given-names></name></person-group><article-title>MiR-21 down-regulation suppresses cell growth, invasion and induces cell apoptosis by targeting FASL, TIMP3, and RECK genes in esophageal carcinoma</article-title><source>Dig Dis Sci</source><volume>58</volume><fpage>1863</fpage><lpage>1870</lpage><year>2013</year><pub-id pub-id-type="doi">10.1007/s10620-013-2612-2</pub-id><pub-id pub-id-type="pmid">23504349</pub-id></element-citation></ref>
<ref id="b26-etm-0-0-6421"><label>26</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Feng</surname><given-names>YH</given-names></name><name><surname>Wu</surname><given-names>CL</given-names></name><name><surname>Shiau</surname><given-names>AL</given-names></name><name><surname>Lee</surname><given-names>JC</given-names></name><name><surname>Chang</surname><given-names>JG</given-names></name><name><surname>Lu</surname><given-names>PJ</given-names></name><name><surname>Tung</surname><given-names>CL</given-names></name><name><surname>Feng</surname><given-names>LY</given-names></name><name><surname>Huang</surname><given-names>WT</given-names></name><name><surname>Tsao</surname><given-names>CJ</given-names></name></person-group><article-title>MicroRNA-21-mediated regulation of Sprouty2 protein expression enhances the cytotoxic effect of 5-fluorouracil and metformin in colon cancer cells</article-title><source>Int J Mol Med</source><volume>29</volume><fpage>920</fpage><lpage>926</lpage><year>2012</year><pub-id pub-id-type="pmid">22322462</pub-id></element-citation></ref>
<ref id="b27-etm-0-0-6421"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhang</surname><given-names>HZ</given-names></name><name><surname>Kasibhatla</surname><given-names>S</given-names></name><name><surname>Wang</surname><given-names>Y</given-names></name><name><surname>Herich</surname><given-names>J</given-names></name><name><surname>Guastella</surname><given-names>J</given-names></name><name><surname>Tseng</surname><given-names>B</given-names></name><name><surname>Drewe</surname><given-names>J</given-names></name><name><surname>Cai</surname><given-names>SX</given-names></name></person-group><article-title>Discovery, characterization and SAR of gambogic acid as a potent apoptosis inducer by a HTS assay</article-title><source>Bioorg Med Chem</source><volume>12</volume><fpage>309</fpage><lpage>317</lpage><year>2004</year><pub-id pub-id-type="doi">10.1016/j.bmc.2003.11.013</pub-id><pub-id pub-id-type="pmid">14723951</pub-id></element-citation></ref>
<ref id="b28-etm-0-0-6421"><label>28</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>X</given-names></name><name><surname>Chen</surname><given-names>W</given-names></name></person-group><article-title>Gambogic acid is a novel anti-cancer agent that inhibits cell proliferation, angiogenesis and metastasis</article-title><source>Anticancer Agents Med Chem</source><volume>12</volume><fpage>994</fpage><lpage>1000</lpage><year>2012</year><pub-id pub-id-type="doi">10.2174/187152012802650066</pub-id><pub-id pub-id-type="pmid">22339063</pub-id></element-citation></ref>
<ref id="b29-etm-0-0-6421"><label>29</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ishaq</surname><given-names>M</given-names></name><name><surname>Khan</surname><given-names>MA</given-names></name><name><surname>Sharma</surname><given-names>K</given-names></name><name><surname>Sharma</surname><given-names>G</given-names></name><name><surname>Dutta</surname><given-names>RK</given-names></name><name><surname>Majumdar</surname><given-names>S</given-names></name></person-group><article-title>Gambogic acid induced oxidative stress dependent caspase activation regulates both apoptosis and autophagy by targeting various key molecules (NF-&#x03BA;B, Beclin-1, p62 and NBR1) in human bladder cancer cells</article-title><source>Biochim Biophys Acta</source><volume>1840</volume><fpage>3374</fpage><lpage>3384</lpage><year>2014</year><pub-id pub-id-type="doi">10.1016/j.bbagen.2014.08.019</pub-id><pub-id pub-id-type="pmid">25218692</pub-id></element-citation></ref>
<ref id="b30-etm-0-0-6421"><label>30</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>L&#x00FC;</surname><given-names>L</given-names></name><name><surname>Tang</surname><given-names>D</given-names></name><name><surname>Wang</surname><given-names>L</given-names></name><name><surname>Huang</surname><given-names>LQ</given-names></name><name><surname>Jiang</surname><given-names>GS</given-names></name><name><surname>Xiao</surname><given-names>XY</given-names></name><name><surname>Zeng</surname><given-names>FQ</given-names></name></person-group><article-title>Gambogic acid inhibits TNF-&#x03B1;-induced invasion of human prostate cancer PC3 cells in vitro through PI3K/Akt and NF-&#x03BA;B signaling pathways</article-title><source>Acta Pharmacol Sin</source><volume>33</volume><fpage>531</fpage><lpage>541</lpage><year>2012</year><pub-id pub-id-type="doi">10.1038/aps.2011.180</pub-id><pub-id pub-id-type="pmid">22426696</pub-id></element-citation></ref>
<ref id="b31-etm-0-0-6421"><label>31</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>LH</given-names></name><name><surname>Li</surname><given-names>Y</given-names></name><name><surname>Yang</surname><given-names>SN</given-names></name><name><surname>Wang</surname><given-names>FY</given-names></name><name><surname>Hou</surname><given-names>Y</given-names></name><name><surname>Cui</surname><given-names>W</given-names></name><name><surname>Chen</surname><given-names>K</given-names></name><name><surname>Cao</surname><given-names>Q</given-names></name><name><surname>Wang</surname><given-names>S</given-names></name><name><surname>Zhang</surname><given-names>TY</given-names></name><etal/></person-group><article-title>Gambogic acid synergistically potentiates cisplatin-induced apoptosis in non-small-cell lung cancer through suppressing NF-&#x03BA;B and MAPK/HO-1 signalling</article-title><source>Br J Cancer</source><volume>110</volume><fpage>341</fpage><lpage>352</lpage><year>2014</year><pub-id pub-id-type="doi">10.1038/bjc.2013.752</pub-id><pub-id pub-id-type="pmid">24300974</pub-id></element-citation></ref>
<ref id="b32-etm-0-0-6421"><label>32</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhang</surname><given-names>H</given-names></name><name><surname>Lei</surname><given-names>Y</given-names></name><name><surname>Yuan</surname><given-names>P</given-names></name><name><surname>Li</surname><given-names>L</given-names></name><name><surname>Luo</surname><given-names>C</given-names></name><name><surname>Gao</surname><given-names>R</given-names></name><name><surname>Tian</surname><given-names>J</given-names></name><name><surname>Feng</surname><given-names>Z</given-names></name><name><surname>Nice</surname><given-names>EC</given-names></name><name><surname>Sun</surname><given-names>J</given-names></name></person-group><article-title>ROS-mediated autophagy induced by dysregulation of lipid metabolism plays a protective role in colorectal cancer cells treated with gambogic acid</article-title><source>PLoS One</source><volume>9</volume><fpage>e96418</fpage><year>2014</year><pub-id pub-id-type="doi">10.1371/journal.pone.0096418</pub-id><pub-id pub-id-type="pmid">24810758</pub-id></element-citation></ref>
<ref id="b33-etm-0-0-6421"><label>33</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>GM</given-names></name><name><surname>Sun</surname><given-names>Y</given-names></name><name><surname>Ge</surname><given-names>X</given-names></name><name><surname>Wan</surname><given-names>X</given-names></name><name><surname>Li</surname><given-names>CB</given-names></name></person-group><article-title>Gambogic acid induces apoptosis and inhibits colorectal tumor growth via mitochondrial pathways</article-title><source>World J Gastroenterol</source><volume>21</volume><fpage>6194</fpage><lpage>6205</lpage><year>2015</year><pub-id pub-id-type="doi">10.3748/wjg.v21.i20.6194</pub-id><pub-id pub-id-type="pmid">26034354</pub-id></element-citation></ref>
<ref id="b34-etm-0-0-6421"><label>34</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hu</surname><given-names>Y</given-names></name><name><surname>Yang</surname><given-names>Y</given-names></name><name><surname>You</surname><given-names>QD</given-names></name><name><surname>Liu</surname><given-names>W</given-names></name><name><surname>Gu</surname><given-names>HY</given-names></name><name><surname>Zhao</surname><given-names>L</given-names></name><name><surname>Zhang</surname><given-names>K</given-names></name><name><surname>Wang</surname><given-names>W</given-names></name><name><surname>Wang</surname><given-names>XT</given-names></name><name><surname>Guo</surname><given-names>QL</given-names></name></person-group><article-title>Oroxylin A induced apoptosis of human hepatocellular carcinoma cell line HepG2 was involved in its antitumor activity</article-title><source>Biochem Biophys Res Commun</source><volume>351</volume><fpage>521</fpage><lpage>527</lpage><year>2006</year><pub-id pub-id-type="doi">10.1016/j.bbrc.2006.10.064</pub-id><pub-id pub-id-type="pmid">17069758</pub-id></element-citation></ref>
<ref id="b35-etm-0-0-6421"><label>35</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ni</surname><given-names>W</given-names></name><name><surname>Fang</surname><given-names>Y</given-names></name><name><surname>Tong</surname><given-names>L</given-names></name><name><surname>Tong</surname><given-names>Z</given-names></name><name><surname>Yi</surname><given-names>F</given-names></name><name><surname>Qiu</surname><given-names>J</given-names></name><name><surname>Wang</surname><given-names>R</given-names></name><name><surname>Tong</surname><given-names>X</given-names></name></person-group><article-title>Girdin regulates the migration and invasion of glioma cells via the PI3K-Akt signaling pathway</article-title><source>Mol Med Rep</source><volume>12</volume><fpage>5086</fpage><lpage>5092</lpage><year>2015</year><pub-id pub-id-type="doi">10.3892/mmr.2015.4049</pub-id><pub-id pub-id-type="pmid">26151295</pub-id></element-citation></ref>
<ref id="b36-etm-0-0-6421"><label>36</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Justus</surname><given-names>CR</given-names></name><name><surname>Leffler</surname><given-names>N</given-names></name><name><surname>Ruiz-Echevarria</surname><given-names>M</given-names></name><name><surname>Yang</surname><given-names>LV</given-names></name></person-group><article-title>In vitro cell migration and invasion assay</article-title><source>J Vis Exp</source><volume>88</volume><year>2014</year></element-citation></ref>
<ref id="b37-etm-0-0-6421"><label>37</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Li</surname><given-names>W</given-names></name><name><surname>Qiu</surname><given-names>T</given-names></name><name><surname>Zhi</surname><given-names>W</given-names></name><name><surname>Shi</surname><given-names>S</given-names></name><name><surname>Zou</surname><given-names>S</given-names></name><name><surname>Ling</surname><given-names>Y</given-names></name><name><surname>Shan</surname><given-names>L</given-names></name><name><surname>Ying</surname><given-names>J</given-names></name><name><surname>Lu</surname><given-names>N</given-names></name></person-group><article-title>Colorectal carcinomas with KRAS codon 12 mutation are associated with more advanced tumor stages</article-title><source>BMC Cancer</source><volume>15</volume><fpage>340</fpage><year>2015</year><pub-id pub-id-type="doi">10.1186/s12885-015-1345-3</pub-id><pub-id pub-id-type="pmid">25929517</pub-id></element-citation></ref>
<ref id="b38-etm-0-0-6421"><label>38</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ogino</surname><given-names>S</given-names></name><name><surname>Nosho</surname><given-names>K</given-names></name><name><surname>Kirkner</surname><given-names>GJ</given-names></name><name><surname>Kawasaki</surname><given-names>T</given-names></name><name><surname>Meyerhardt</surname><given-names>JA</given-names></name><name><surname>Loda</surname><given-names>M</given-names></name><name><surname>Giovannucci</surname><given-names>EL</given-names></name><name><surname>Fuchs</surname><given-names>CS</given-names></name></person-group><article-title>CpG island methylator phenotype, microsatellite instability, BRAF mutation and clinical outcome in colon cancer</article-title><source>Gut</source><volume>58</volume><fpage>90</fpage><lpage>96</lpage><year>2009</year><pub-id pub-id-type="doi">10.1136/gut.2008.155473</pub-id><pub-id pub-id-type="pmid">18832519</pub-id></element-citation></ref>
<ref id="b39-etm-0-0-6421"><label>39</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Munro</surname><given-names>AJ</given-names></name><name><surname>Lain</surname><given-names>S</given-names></name><name><surname>Lane</surname><given-names>DP</given-names></name></person-group><article-title>P53 abnormalities and outcomes in colorectal cancer: A systematic review</article-title><source>Br J Cancer</source><volume>92</volume><fpage>434</fpage><lpage>444</lpage><year>2005</year><pub-id pub-id-type="doi">10.1038/sj.bjc.6602358</pub-id><pub-id pub-id-type="pmid">15668707</pub-id></element-citation></ref>
<ref id="b40-etm-0-0-6421"><label>40</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ahmed</surname><given-names>FE</given-names></name><name><surname>Ahmed</surname><given-names>NC</given-names></name><name><surname>Vos</surname><given-names>PW</given-names></name><name><surname>Bonnerup</surname><given-names>C</given-names></name><name><surname>Atkins</surname><given-names>JN</given-names></name><name><surname>Casey</surname><given-names>M</given-names></name><name><surname>Nuovo</surname><given-names>GJ</given-names></name><name><surname>Naziri</surname><given-names>W</given-names></name><name><surname>Wiley</surname><given-names>JE</given-names></name><name><surname>Mota</surname><given-names>H</given-names></name><name><surname>Allison</surname><given-names>RR</given-names></name></person-group><article-title>Diagnostic microRNA markers to screen for sporadic human colon cancer in stool: I. Proof of principle</article-title><source>Cancer Genomics Proteomics</source><volume>10</volume><fpage>93</fpage><lpage>113</lpage><year>2013</year><pub-id pub-id-type="pmid">23741026</pub-id></element-citation></ref>
<ref id="b41-etm-0-0-6421"><label>41</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kashyap</surname><given-names>D</given-names></name><name><surname>Mondal</surname><given-names>R</given-names></name><name><surname>Tuli</surname><given-names>HS</given-names></name><name><surname>Kumar</surname><given-names>G</given-names></name><name><surname>Sharma</surname><given-names>AK</given-names></name></person-group><article-title>Molecular targets of gambogic acid in cancer: Recent trends and advancements</article-title><source>Tumor Biol</source><volume>37</volume><fpage>12915</fpage><lpage>12925</lpage><year>2016</year><pub-id pub-id-type="doi">10.1007/s13277-016-5194-8</pub-id></element-citation></ref>
<ref id="b42-etm-0-0-6421"><label>42</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yang</surname><given-names>Y</given-names></name><name><surname>Sun</surname><given-names>X</given-names></name><name><surname>Yang</surname><given-names>Y</given-names></name><name><surname>Yang</surname><given-names>X</given-names></name><name><surname>Zhu</surname><given-names>H</given-names></name><name><surname>Dai</surname><given-names>S</given-names></name><name><surname>Chen</surname><given-names>X</given-names></name><name><surname>Zhang</surname><given-names>H</given-names></name><name><surname>Guo</surname><given-names>Q</given-names></name><name><surname>Song</surname><given-names>Y</given-names></name><etal/></person-group><article-title>Gambogic acid enhances the radiosensitivity of human esophageal cancer cells by inducing reactive oxygen species via targeting Akt/mTOR pathway</article-title><source>Tumor Biol</source><volume>37</volume><fpage>1853</fpage><lpage>1862</lpage><year>2016</year><pub-id pub-id-type="doi">10.1007/s13277-015-3974-1</pub-id></element-citation></ref>
<ref id="b43-etm-0-0-6421"><label>43</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yu</surname><given-names>J</given-names></name><name><surname>Guo</surname><given-names>QL</given-names></name><name><surname>You</surname><given-names>QD</given-names></name><name><surname>Zhao</surname><given-names>L</given-names></name><name><surname>Gu</surname><given-names>HY</given-names></name><name><surname>Yang</surname><given-names>Y</given-names></name><name><surname>Zhang</surname><given-names>HW</given-names></name><name><surname>Tan</surname><given-names>Z</given-names></name><name><surname>Wang</surname><given-names>X</given-names></name></person-group><article-title>Gambogic acid-induced G2/M phase cell-cycle arrest via disturbing CDK7-mediated phosphorylation of CDC2/p34 in human gastric carcinoma BGC-823 cells</article-title><source>Carcinogenesis</source><volume>28</volume><fpage>632</fpage><lpage>638</lpage><year>2007</year><pub-id pub-id-type="doi">10.1093/carcin/bgl168</pub-id><pub-id pub-id-type="pmid">17012222</pub-id></element-citation></ref>
<ref id="b44-etm-0-0-6421"><label>44</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yu</surname><given-names>J</given-names></name><name><surname>Guo</surname><given-names>QL</given-names></name><name><surname>You</surname><given-names>QD</given-names></name><name><surname>Lin</surname><given-names>SS</given-names></name><name><surname>Li</surname><given-names>Z</given-names></name><name><surname>Gu</surname><given-names>HY</given-names></name><name><surname>Zhang</surname><given-names>HW</given-names></name><name><surname>Tan</surname><given-names>Z</given-names></name><name><surname>Wang</surname><given-names>X</given-names></name></person-group><article-title>Repression of telomerase reverse transcriptase mRNA and hTERT promoter by gambogic acid in human gastric carcinoma cells</article-title><source>Cancer Chemother Pharmacol</source><volume>58</volume><fpage>434</fpage><lpage>443</lpage><year>2006</year><pub-id pub-id-type="doi">10.1007/s00280-005-0177-2</pub-id><pub-id pub-id-type="pmid">16470410</pub-id></element-citation></ref>
<ref id="b45-etm-0-0-6421"><label>45</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Felth</surname><given-names>J</given-names></name><name><surname>Lesiak-Mieczkowska</surname><given-names>K</given-names></name><name><surname>D&#x0027;Arcy</surname><given-names>P</given-names></name><name><surname>Haglund</surname><given-names>C</given-names></name><name><surname>Gullbo</surname><given-names>J</given-names></name><name><surname>Larsson</surname><given-names>R</given-names></name><name><surname>Linder</surname><given-names>S</given-names></name><name><surname>Bohlin</surname><given-names>L</given-names></name><name><surname>Frykn&#x00E4;s</surname><given-names>M</given-names></name><name><surname>Rickardson</surname><given-names>L</given-names></name></person-group><article-title>Gambogic acid is cytotoxic to cancer cells through inhibition of the ubiquitin-proteasome system</article-title><source>Invest New Drugs</source><volume>31</volume><fpage>587</fpage><lpage>598</lpage><year>2013</year><pub-id pub-id-type="doi">10.1007/s10637-012-9902-y</pub-id><pub-id pub-id-type="pmid">23179339</pub-id></element-citation></ref>
<ref id="b46-etm-0-0-6421"><label>46</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Meng</surname><given-names>F</given-names></name><name><surname>Henson</surname><given-names>R</given-names></name><name><surname>Wehbe-Janek</surname><given-names>H</given-names></name><name><surname>Ghoshal</surname><given-names>K</given-names></name><name><surname>Jacob</surname><given-names>ST</given-names></name><name><surname>Patel</surname><given-names>T</given-names></name></person-group><article-title>MicroRNA-21 regulates expression of the PTEN tumor suppressor gene in human hepatocellular cancer</article-title><source>Gastroenterology</source><volume>133</volume><fpage>647</fpage><lpage>658</lpage><year>2007</year><pub-id pub-id-type="doi">10.1053/j.gastro.2007.05.022</pub-id><pub-id pub-id-type="pmid">17681183</pub-id></element-citation></ref>
<ref id="b47-etm-0-0-6421"><label>47</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cao</surname><given-names>L</given-names></name><name><surname>Chen</surname><given-names>J</given-names></name><name><surname>Ou</surname><given-names>B</given-names></name><name><surname>Liu</surname><given-names>C</given-names></name><name><surname>Zou</surname><given-names>Y</given-names></name><name><surname>Chen</surname><given-names>Q</given-names></name></person-group><article-title>GAS5 knockdown reduces the chemo-sensitivity of non-small cell lung cancer (NSCLC) cell to cisplatin (DDP) through regulating miR-21/PTEN axis</article-title><source>Biomed Pharmacother</source><volume>93</volume><fpage>570</fpage><lpage>579</lpage><year>2017</year><pub-id pub-id-type="doi">10.1016/j.biopha.2017.06.089</pub-id><pub-id pub-id-type="pmid">28686971</pub-id></element-citation></ref>
<ref id="b48-etm-0-0-6421"><label>48</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Salmena</surname><given-names>L</given-names></name></person-group><article-title>PTEN: History of a tumor suppressor</article-title><source>Methods Mol Biol</source><volume>1388</volume><fpage>3</fpage><lpage>11</lpage><year>2016</year><pub-id pub-id-type="doi">10.1007/978-1-4939-3299-3_1</pub-id><pub-id pub-id-type="pmid">27033066</pub-id></element-citation></ref>
</ref-list>
</back>
<floats-group>
<fig id="f1-etm-0-0-6421" position="float">
<label>Figure 1.</label>
<caption><p>Gambogic acid decreased CRC viability and miR-21 expression. (A) The structure of GA. (B) Cell viability was determined using an MTT assay in HT-29 cells treated with GA (0, 0.33, 1, 3.3 or 10 &#x00B5;M) for 24, 48 or 72 h (&#x002A;&#x002A;P&#x003C;0.01 compared with the 0 &#x00B5;M GA groups). (C) Expression of miR-21 in HT-29 cells treated with GA (0, 1 or 3.3 &#x00B5;M) at the indicated time points was determined by qPCR. The miR-21 expression level was normalizing to the GAPDH level (&#x002A;P&#x003C;0.05, &#x002A;&#x002A;P&#x003C;0.01 compared with the 0 &#x00B5;M GA groups. Cell viability was determined using an MTT assay in (D) SW480 and (E) HCT116 cells treated with GA (0, 0.33, 1, 3.3 or 10 &#x00B5;M) for 72 h (&#x002A;P&#x003C;0.05, &#x002A;&#x002A;P&#x003C;0.01 compared with the 0 &#x00B5;M GA group). (F) Expression of miR-21 in SW480 and HCT116 cells treated with GA (0, 1 or 3.3 &#x00B5;M) at 72 h was determined by RT-qPCR (&#x002A;P&#x003C;0.05 &#x002A;&#x002A;P&#x003C;0.01 compared with the 0 &#x00B5;M GA group). CRC, colorectal cancer; GA, gambogic acid.</p></caption>
<graphic xlink:href="etm-16-03-1758-g00.jpg"/>
</fig>
<fig id="f2-etm-0-0-6421" position="float">
<label>Figure 2.</label>
<caption><p>GA induced cell apoptosis by Annexin V/PI dual staining assay. (A) HT-29 cells were exposed to 3.3 &#x00B5;M GA or GA combined with miR-21 mimics for 72 h. Apoptotic cells were indicated with Annexin V and PI double staining. (B) The apoptosis cell rates were calculated (&#x002A;&#x002A;P&#x003C;0.01 as indicated). GA, gambogic acid; PI, propidium iodide.</p></caption>
<graphic xlink:href="etm-16-03-1758-g01.jpg"/>
</fig>
<fig id="f3-etm-0-0-6421" position="float">
<label>Figure 3.</label>
<caption><p>GA inhibited CRC migration. (A) Images of wound at the magnification, &#x00D7;100 in the HT-29 cell monolayers treated with vehicle, 0.33 &#x00B5;M of GA or GA combined with miR-21 mimics for 24 h. (B) The migration index indicated as a percentage of the control group (&#x002A;P&#x003C;0.05, &#x002A;&#x002A;P&#x003C;0.01 as indicated). GA, gambogic acid; CRC, colorectal cancer.</p></caption>
<graphic xlink:href="etm-16-03-1758-g02.jpg"/>
</fig>
<fig id="f4-etm-0-0-6421" position="float">
<label>Figure 4.</label>
<caption><p>GA downregulated PI3K and p-Akt, and enhanced PTEN protein expression. (A) HT-29 cells were transfected with PTEN wild-type or mutant vector for 4 h. Later on, the cells were treated with 100 nM miR-21 mimics or scramble. (B) Cell viability was determined using an MTT assay in HT-29 cells treated with 3.3 &#x00B5;M GA or GA plus miR-21 mimics for 72 h (&#x002A;&#x002A;P&#x003C;0.01 as indicated). (C) PTEN, PI3K and p-Akt protein expression was detected by western blot analysis in HT-29 cells treated with vehicle, 3.3 &#x00B5;M GA or GA combined with miR-21 mimics for 72 h. Quantification of the (D) PTEN, (E) PI3K and (F) p-AKT protein expression level was determined by normalizing to the internal reference protein, GAPDH (&#x002A;&#x002A;P&#x003C;0.01 as indicated). GA, gambogic acid; CRC, colorectal cancer; PTEN, phosphatase and tensin homolog.</p></caption>
<graphic xlink:href="etm-16-03-1758-g03.jpg"/>
</fig>
<fig id="f5-etm-0-0-6421" position="float">
<label>Figure 5.</label>
<caption><p>GA inhibited CRC invasion and the expression of MMP-9. (A) Images of the HT-29 cells stained with crystal violet in a Transwell invasion assay (magnification, &#x00D7;100). (B) Quantification of invasive cells (&#x002A;P&#x003C;0.05 as indicated). (C) MMP2 and MMP9 expression was detected by western blot analysis Quantification of (D) MMP2 and (E) MMP9 protein levels via normalizing to the endogenous protein, GAPDH (&#x002A;P&#x003C;0.05 and &#x002A;&#x002A;P&#x003C;0.01 as indicated). MMP, anti-matrix metalloproteinase; GA, gambogic acid; CRC, colorectal cancer.</p></caption>
<graphic xlink:href="etm-16-03-1758-g04.jpg"/>
</fig>
</floats-group>
</article>
