Annals of Surgical Oncology

, Volume 25, Issue 12, pp 3728–3737 | Cite as

Hypoxia-Induced PLOD2 is a Key Regulator in Epithelial-Mesenchymal Transition and Chemoresistance in Biliary Tract Cancer

  • Yuichiro Okumura
  • Takehiro Noda
  • Hidetoshi EguchiEmail author
  • Takuya Sakamoto
  • Yoshifumi Iwagami
  • Daisaku Yamada
  • Tadafumi Asaoka
  • Hiroshi Wada
  • Koichi Kawamoto
  • Kunihito Gotoh
  • Shogo Kobayashi
  • Yutaka Takeda
  • Masahiro Tanemura
  • Koji Umeshita
  • Yuichiro Doki
  • Masaki Mori
Translational Research and Biomarkers



The prognosis of biliary tract cancer (BTC) is unfavorable due to its chemoresistance. Hypoxia triggers epithelial-to-mesenchymal transition (EMT), which is closely related to drug resistance. In this study, we focused on the functional roles of procollagen-lysine, 2-oxoglutarate 5-dioxygenase 2 (PLOD2), a hypoxia-induced gene, in BTC, and assessed the clinical significance of PLOD2.


The expression of PLOD2 under hypoxia was assessed in BTC cell lines. Gemcitabine-resistant (GR) BTC cell lines were transfected with small interfering RNA (siRNA) against PLOD2, and EMT markers and chemoresistance were evaluated. PLOD2 expression was also characterized using immunohistochemistry in BTC clinical specimens following resection. Patient survival was analyzed and the role of PLOD2 expression was examined.


The expression of PLOD2 was induced by hypoxia in vitro and was upregulated in BTC-GR cell lines, which had low expression of epithelial markers and high expression of mesenchymal markers. Downregulation of PLOD2 by siRNA resulted in improved chemoresistance, recovery of epithelial markers, and reduction of mesenchymal markers. In the resected BTC samples, PLOD2 expression was significantly correlated with lymph node metastasis (p = 0.037) and stage (p = 0.001). Recurrence-free survival (p = 0.011) and overall survival (p < 0.001) rates were significantly lower in patients with high expression of PLOD2. PLOD2 expression was an independent prognostic factor for overall survival (p = 0.019).


The expression of PLOD2 influenced chemoresistance through EMT, and high expression of PLOD2 was a significant unfavorable prognostic factor in BTC patients. PLOD2 might be a potential therapeutic target for overcoming chemoresistance.



This work was supported in part by grants from Grant-in-Aid for Scientific Research of the Japan Society for the Promotion of Science (JSPS) [(C) 16K10572], Grant-in-Aid for Young Scientists of the JSPS [(B) 17K16543], and the Suzuken Memorial Foundation. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors thank the members of their laboratory for technical advice and helpful discussions.

Conflicts of interest

The authors declare no conflicts of interest associated with this manuscript.

Supplementary material

10434_2018_6670_MOESM1_ESM.docx (1.7 mb)
Supplementary material 1 (DOCX 50 kb)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Yuichiro Okumura
    • 1
  • Takehiro Noda
    • 1
  • Hidetoshi Eguchi
    • 1
    Email author
  • Takuya Sakamoto
    • 1
  • Yoshifumi Iwagami
    • 1
  • Daisaku Yamada
    • 1
  • Tadafumi Asaoka
    • 1
  • Hiroshi Wada
    • 1
  • Koichi Kawamoto
    • 1
  • Kunihito Gotoh
    • 1
  • Shogo Kobayashi
    • 1
  • Yutaka Takeda
    • 1
    • 2
  • Masahiro Tanemura
    • 1
    • 3
  • Koji Umeshita
    • 4
  • Yuichiro Doki
    • 1
  • Masaki Mori
    • 1
  1. 1.Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversityOsakaJapan
  2. 2.Department of SurgeryKansai Rosai HospitalHyogoJapan
  3. 3.Department of SurgeryOsaka Police HospitalOsakaJapan
  4. 4.Division of Health Science, Graduate School of MedicineOsaka UniversityOsakaJapan

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