Nkx2.8 inhibits epithelial-mesenchymal transition in bladder urothelial carcinoma via transcriptional repression of Twist1

Epithelial-to-mesenchymal transition (EMT) promotes metastasis which is the main cause of bladder urothelial carcinoma (UC)-related death. Loss of the candidate tumor suppressor gene Nkx2.8 has been associated with UC lymph node metastasis. Here we show that enforced expression of Nkx2.8 is sufficient to inhibit EMT, reduce motility and blunt invasiveness of UC cells. Mechanistic investigations showed that Nkx2.8 negatively regulated expression of the EMT inducer Twist1 in UC cells, at both the level of mRNA and protein accumulation. Nkx2.8 bound directly to the promoter region of this gene and transcriptionally repressed its expression. Twist1 upregulation reversed EMT inhibition by Nkx2.8, restoring the invasive phenotype of UC cells. In clinical UC specimens, expression of Nkx2.8 inversely correlated with Twist1 expression, and UC patients with Nkx2.8 positivity and low Twist1 expression displayed the best prognosis. Our findings highlight the Nkx2.8-Twist1 axis as candidate target for therapeutic intervention in advanced UC.

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