Theranostics 2020; 10(21):9601-9618. doi:10.7150/thno.49270

Research Paper

Targeting MAD2 modulates stemness and tumorigenesis in human Gastric Cancer cell lines

Natalia Pajuelo-Lozano1,2, Sonia Alcalá1,2,3, Bruno Sainz Jr1,2,3✉, Rosario Perona2,5✉, Isabel Sanchez-Perez1,2,3,4,5✉

1. Dpto. Bioquímica. Fac. Medicina. UAM, Madrid, Spain.
2. Instituto de Investigaciones Biomédicas “Alberto Sols” CSIC-UAM, Madrid, Spain.
3. Cancer Stem Cell and Fibroinflammatory Microenvironment Group, Chronic Diseases and Cancer Area 3 - Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
4. Unidad Asociada de Biomedicina UCLM-CSIC.
5. CIBER for Rare Diseases (CIBERER); Valencia, Spain.

This is an open access article distributed under the terms of the Creative Commons Attribution License ( See for full terms and conditions.
Pajuelo-Lozano N, Alcalá S, Sainz B Jr, Perona R, Sanchez-Perez I. Targeting MAD2 modulates stemness and tumorigenesis in human Gastric Cancer cell lines. Theranostics 2020; 10(21):9601-9618. doi:10.7150/thno.49270. Available from

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Rationale: Gastric cancer (GC) is a solid tumor that contains subpopulations of cancer stem cells (CSCs), which are considered drivers of tumor initiation and metastasis; responsible for therapeutic resistance; and promoters of tumor relapse. The balance between symmetric and asymmetric division is crucial for stem cell maintenance. The objective of this study is to evaluate the role of MAD2, a key protein for proper mitotic checkpoint activity, in the tumorigenesis of GC.

Methods: Gastric cancer stem cells (GCSCs) were obtained from MKN45, SNU638 and ST2957 cell lines. Pluripotency and stemness markers were evaluated by RT-qPCR and autofluorescence and membrane markers by flow cytometry. Relevant signal transduction pathways were studied by WB. We analysed cell cycle progression, migration and invasion after modulation of MAD2 activity or protein expression levels in these in vitro models. In vivo assays were performed in a nude mouse subcutaneous xenograft model.

Results: We found that NANOG, CXCR4 and autofluorescence are common and consistent markers for the GCSCs analysed, with other markers showing more variability. The three main signalling pathways (Wnt/β-catenin; Hedgehog and Notch) were activated in GCSCs. Downregulation of MAD2 in MKN45CSCs decreased the expression of markers CXCR4, CD133, CD90, LGR5 and VIM, without affecting cell cycle profile or therapy resistance. Moreover, migration, invasion and tumor growth were clearly reduced, and accordingly, we found that metalloprotease expression decreased. These results were accompanied by a reduction in the levels of transcription factors related with epithelial-to-mesenchymal transition.

Conclusions: We can conclude that MAD2 is important for GCSCs stemness and its downregulation in MKN45CSCs plays a central role in GC tumorigenesis, likely through CXCR4-SNAI2-MMP1. Thus, its potential use in the clinical setting should be studied as its functions appear to extend beyond mitosis.

Keywords: gastric cancer stem-like cells, MAD2, EMT, MMPs, tumorigenesis