Evidence mapPaperPMID 41484064Full record

ArticleCell death & disease2026

SOX4-STAT6-MTHFD2 axis drives hepatocellular carcinoma progression and treatment resistance.

Chia-Lung Tsai, Ming-Chin Yu, Cheng-Lung Hsu, Hsiang-Yu Tang, Yun-Shien Lee, Lang-Ming Chi, Sey-En Lin, Mei-Ling Cheng, Heng-Yuan Hsu, Chi-Neu Tsai

Abstract read
In one paragraph

Article in Cell death & disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Chia-Lung Tsai *Genomic Medicine Core Laboratory, Linkou Chang-Gung Memorial Hospital, Taoyuan City, 33305, Taiwan.ORCID http://orcid.org/0000-0002-7895-909X
Ming-Chin Yu *Department of Surgery, New Taipei Municipal Tucheng Hospital (Built and operated by Chang-Gung Medical Foundation), New Taipei City, 23652, Taiwan.ORCID http://orcid.org/0000-0002-6980-7123
Cheng-Lung HsuSchool of Medicine, College of Medicine, Chang-Gung University, Taoyuan City, 33302, Taiwan.ORCID http://orcid.org/0000-0002-8197-3079
Hsiang-Yu TangMetabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Taoyuan, 33302, Taiwan.ORCID http://orcid.org/0000-0002-2536-6370
Yun-Shien LeeDepartment of Biotechnology, Ming Chuan University, Taoyuan, 33348, Taiwan.ORCID http://orcid.org/0000-0001-9617-335X
Lang-Ming ChiMolecular Medicine Research Center, Chang-Gung University, Taoyuan City, 33302, Taiwan.ORCID http://orcid.org/0000-0002-6461-2239
Sey-En LinDepartment of Anatomical Pathology, Taipei Institute of Pathology, Taipei City, 10372, Taiwan.ORCID http://orcid.org/0000-0002-8994-9452
Mei-Ling ChengMetabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Taoyuan, 33302, Taiwan.ORCID http://orcid.org/0000-0003-2006-133X
Heng-Yuan HsuDepartment of Surgery, New Taipei Municipal Tucheng Hospital (Built and operated by Chang-Gung Medical Foundation), New Taipei City, 23652, Taiwan.ORCID http://orcid.org/0000-0002-9342-8772
Chi-Neu TsaiDepartment of Surgery, New Taipei Municipal Tucheng Hospital (Built and operated by Chang-Gung Medical Foundation), New Taipei City, 23652, Taiwan. pink7@mail.cgu.edu.tw.ORCID http://orcid.org/0000-0002-5940-0696

Funding

Chang Gung Medical Foundation CMRPD1K0711, CMRPD1M0611/2Chang Gung Medical Foundation CMRPG3M1291/2/3Chang Gung Medical Foundation CMRPVVM0093
6 · The paper itself

Abstract

Hepatocellular carcinoma (HCC) is a major global health burden. Despite recent advances in immunotherapy, tyrosine kinase inhibitors (TKIs) treatment or combined therapies, therapeutic resistance and disease progression remain significant challenges. SOX4, a transcription factor frequently overexpressed in HCC and other cancers, has been linked to drug resistance and poor prognosis; however, the underlying molecular mechanisms remain unexplored. In this study, we identify STAT6 as a novel transcriptional target and interacting partner of SOX4 in HCC cells. Genetic ablation or knockdown of SOX4 induced hypermethylation of the STAT6 promoter, suppressing its expression, while treatment with the DNA methyltransferase inhibitor 5-Aza-2'-deoxycytidine restored STAT6 levels, indicating an epigenetic mechanism of regulation. In addition, SOX4 is physically associated with STAT6, as confirmed by co-immunoprecipitation and immunofluorescence. SOX4 depletion impaired interleukin-4 (IL-4)-induced phosphorylation of STAT6 at tyrosine residue 641 (Y641), implicating SOX4 in IL-4-mediated STAT6 activation. Chromatin immunoprecipitation (ChIP) assays demonstrated that SOX4 and STAT6 co-occupy the promoter of MTHFD2, a key enzyme in folate metabolism, regulating NADH/NADPH production and nucleotide biosynthesis. Knockdown of SOX4 or STAT6, or mutation of their binding sites within the MTHFD2 promoter, reduced MTHFD2 expression, NADPH levels, and nucleotide synthesis. Transcriptomic analyses from TCGA-LIHC and our independent cohort revealed a strong positive correlation between SOX4, STAT6, and MTHFD2, with MTHFD2 overexpression linked to poor overall survival. Clinically, elevated SOX4/STAT6/MTHFD2 axis activity was associated with resistance to immunotherapy or TKIs, either in our enrolled cohort or transcriptome data obtained from GSE109211. Metabolomic profiling further revealed increased NADPH and nucleotide biosynthesis in tumors with high SOX4/STAT6/MTHFD2 expression. Targeting STAT6 or MTHFD2 suppressed tumor growth in TKIs-resistant patient-derived xenograft models. Collectively, our findings identify the SOX4-STAT6-MTHFD2 axis as a critical driver of HCC progression and therapeutic resistance, offering a promising target for intervention in refractory HCC.

Indexed as

Carcinoma, HepatocellularDrug Resistance, NeoplasmLiver NeoplasmsMethylenetetrahydrofolate Dehydrogenase (NADP)SOXC Transcription FactorsSTAT6 Transcription FactorAnimalsCell Line, TumorDisease ProgressionGene Expression Regulation, NeoplasticHumansMiceMice, NudePromoter Regions, GeneticMethylenetetrahydrofolate Dehydrogenase (NADP)SOX4 protein, humanSOXC Transcription FactorsSTAT6 protein, humanSTAT6 Transcription Factor

Identifiers

PMID41484064
PMCPMC12858837

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.