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Archive for the ‘Inflammasome’ Category

Cytokines in IBD

Curators: Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN

 

Revised 2/14/2016

 

The following presentation explores the application of antisense oligonucleotide agents that modulate the activity of Il17 and Il23 signaling activity in the cell.

IL 17 & 23

United States Patent 9,238,042
Schnell ,   et al. January 19, 2016

Antisense modulation of interleukins 17 and 23 signaling
Provided are antisense oligonucleotides and other agents that target and modulate IL-17 and/or IL-23 signaling activity in a cell, compositions that comprise the same, and methods of use thereof. Also provided are animal models for identifying agents that modulate 17 and/or IL-23 signaling activity.

Abes et al., “Arginine-rich cell penetrating peptides: Design, structure-activity, and applications to alter pre-mRNA splicing by steric-block oligonucleotides,” J Pept Sci 14: 455-460, 2008. cited by applicant .
Abes et al., “Delivery of steric block morpholino oligomers by (R-X-R).sub.4 peptides: structure-activity studies,” Nucleic Acids Research 36(20): 6343-6354, Sep. 16, 2008. cited by applicant .
Abes et al., “Vectorization of morpholino oligomers by the (R-Ahx-R).sub.4 peptide allows efficient splicing correction in the absence of endosomolytic agents,” Journal of Controlled Release 116: 304-313, 2006. cited by applicant .
Lebleu et al., “Cell penetrating peptide conjugates of steric block oligonucleotides,” Advanced Drug Delivery Reviews 60: 517-529, 2008. cited by applicant .
Marshall et al., “Arginine-rich cell-penetrating peptides facilitate delivery of antisense oligomers into murine leukocytes and alter pre-mRNA splicing,” Journal of Immunological Methods 325: 114-126, 2007. cited by applicant .
Moulton et al., “Cellular Uptake of Antisense Morpholino Oligomers Conjugated to Arginine-Rich Peptides,” Bioconjugate Chem 15: 290-299, 2004. cited by applicant .
Summerton et al., “Morpholino Antisense Oligomers: Design, Preparation, and Properties,” Antisense & Nucleic Acid Drug Development 7: 187-195, 1997. cited by applicant .
Wright et al., “The Human IL-17F/IL-17A Heterodimeric Cytokine Signals through the IL-17RA/IL-17RC Receptor Complex,” The Journal of Immunology 181: 2799-2805, 2008. cited by applicant .

 

Immunity. 2015 Oct 20;43(4):739-50. doi: 10.1016/j.immuni.2015.08.019. Epub 2015 Sep 29.

Differential Roles for Interleukin-23 and Interleukin-17 in Intestinal Immunoregulation.

Maxwell JR1Zhang Y1Brown WA1Smith CL1Byrne FR2Fiorino M2Stevens E3Bigler J4Davis JA5Rottman JB6Budelsky AL1Symons A1Towne JE7.

 

Interleukin-23 (IL-23) and IL-17 are cytokines currently being targeted in clinical trials. Although inhibition of both of these cytokines is effective for treating psoriasis, IL-12 and IL-23 p40 inhibition attenuates Crohn’s disease, whereas IL-17A or IL-17 receptor A (IL-17RA) inhibition exacerbates Crohn’s disease. This dichotomy between IL-23 and IL-17 was effectively modeled in the multidrug resistance-1a-ablated (Abcb1a(-/-)) mouse model of colitis. IL-23 inhibition attenuated disease by decreasing colonic inflammation while enhancing regulatory T (Treg) cell accumulation. Exacerbation of colitis by IL-17A or IL-17RA inhibition was associated with severe weakening of the intestinal epithelial barrier, culminating in increased colonic inflammation and accelerated mortality. These data show that IL-17A acts on intestinal epithelium to promote barrier function and provide insight into mechanisms underlying exacerbation of Crohn’s disease when IL-17A or IL-17RA is inhibited.

 

Immunity. 2015 Oct 20;43(4):727-38. doi: 10.1016/j.immuni.2015.09.003. Epub 2015 Sep 29.

Interleukin-23-Independent IL-17 Production Regulates Intestinal Epithelial Permeability.

Lee JS1Tato CM1Joyce-Shaikh B1Gulan F2Cayatte C1Chen Y1Blumenschein WM1Judo M1Ayanoglu G1McClanahan TK1Li X2Cua DJ3.

Whether interleukin-17A (IL-17A) has pathogenic and/or protective roles in the gut mucosa is controversial and few studies have analyzed specific cell populations for protective functions within the inflamed colonic tissue. Here we have provided evidence for IL-17A-dependent regulation of the tight junction protein occludin during epithelial injury that limits excessive permeability and maintains barrier integrity. Analysis of epithelial cells showed that in the absence of signaling via the IL-17 receptor adaptor protein Act-1, the protective effect of IL-17A was abrogated and inflammation was enhanced. We have demonstrated that after acute intestinal injury, IL-23R(+) γδ T cells in the colonic lamina propria were the primary producers of early, gut-protective IL-17A, and this production of IL-17A was IL-23 independent, leaving protective IL-17 intact in the absence of IL-23. These results suggest that IL-17-producing γδ T cells are important for the maintenance and protection of epithelial barriers in the intestinal mucosa.

 

Gastroenterology. 2008 Apr;134(4):1038-48. doi: 10.1053/j.gastro.2008.01.041. Epub 2008 Jan 17.

Regulation of gut inflammation and th17 cell response by interleukin-21.

Fina D1Sarra MFantini MCRizzo ACaruso RCaprioli FStolfi CCardolini IDottori MBoirivant MPallone FMacdonald TT,Monteleone G.

Interleukin (IL)-21, a T-cell-derived cytokine, is overproduced in inflammatory bowel diseases (IBD), but its role in the pathogenesis of gut inflammation remains unknown. We here examined whether IL-21 is necessary for the initiation and progress of experimental colitis and whether it regulates specific pathways of inflammation.

Both dextran sulfate sodium colitis and trinitrobenzene sulfonic acid-relapsing colitis were induced in wild-type and IL-21-deficient mice. CD4(+)CD25(-) T cells from wild-type and IL-21-deficient mice were differentiated in T helper cell (Th)17-polarizing conditions, with or without IL-21 or an antagonistic IL-21R/Fc. We also examined whether blockade of IL-21 by anti-IL-21 antibody reduced IL-17 in cultures of IBD lamina propria CD3(+) T lymphocytes. Cytokines were evaluated by real-time polymerase chain reaction and/or enzyme-linked immunosorbent assay.

High IL-21 was seen in wild-type mice with dextran sulfate sodium- and trinitrobenzene sulfonic acid-relapsing colitis. IL-21-deficient mice were largely protected against both colitides and were unable to up-regulate Th17-associated molecules during gut inflammation, thus suggesting a role for IL-21 in controlling Th17 cell responses. Indeed, naïve T cells from IL-21-deficient mice failed to differentiate into Th17 cells. Treatment of developing Th17 cells from wild-type mice with IL-21R/Fc reduced IL-17 production. Moreover, in the presence of transforming growth factor-beta1, exogenous IL-21 substituted for IL-6 in driving IL-17 induction. Neutralization of IL-21 reduced IL-17 secretion by IBD lamina propria lymphocytes.

These results indicate that IL-21 is a critical regulator of inflammation and Th17 cell responses in the gut.

 

Neurochem Res. 2010 Jun;35(6):940-6. doi: 10.1007/s11064-009-0091-9. Epub 2009 Nov 14.

Synergy of IL-23 and Th17 cytokines: new light on inflammatory bowel disease.

Shen W1Durum SK.

Inflammatory bowel diseases (IBDs), including Crohn’s disease and ulcerative colitis, involve an interplay between host genetics and environmental factors including intestinal microbiota. Animal models of IBD have indicated that chronic inflammation can result from over-production of inflammatory responses or deficiencies in key negative regulatory pathways. Recent research advances in both T-helper 1 (Th1) and T-helper 17 (Th17) effect responses have offered new insights on the induction and regulation of mucosal immunity which is linked to the development of IBD. Th17 cytokines, such as IL-17 and IL-22, in combination with IL-23, play crucial roles in intestinal protection and homeostasis. IL-23 is expressed in gut mucosa and tends to orchestrate T-cell-independent pathways of intestinal inflammation as well as T cell dependent pathways mediated by cytokines produced by Th1 and Th17 cells. Th17 cells, generally found to be proinflammatory, have specific functions in host defense against infection by recruiting neutrophils and macrophages to infected tissues. Here we will review emerging data on those cytokines and their related regulatory networks that appear to govern the complex development of chronic intestinal inflammation; we will focus on how IL-23 and Th17 cytokines act coordinately to influence the balance between tolerance and immunity in the intestine.

 

Eur J Immunol. 2007 Oct;37(10):2680-2.

IL-23 and IL-17 have a multi-faceted largely negative role in fungal infection.

Cooper AM1.

The role of IL-23 and IL-17 in the response to fungal infection has been the focus of recent reports. In this issue of the European Journal of Immunology there is an article that reports an important role for IL-23 and IL-17 in limiting fungal control, promoting neutrophillic inflammation and regulating the killing activity of neutrophils. In the fungal model it appears that IL-23 and IL-17 are counter-productive for protection.

 

IL-12 and IL-23 cytokines: from discovery to targeted therapies for immune-mediated inflammatory diseases

MWL TengEP BowmanJJ McElwee,…, AM Cooper & DJ Cua
Nature Med July 2016; 21(7):719–729
http://www.nature.com/nm/journal/v21/n7/full/nm.3895.html

The cytokine interleukin-12 (IL-12) was thought to have a central role in T cell–mediated responses in inflammation for more than a decade after it was first identified. Discovery of the cytokine IL-23, which shares a common p40 subunit with IL-12, prompted efforts to clarify the relative contribution of these two cytokines in immune regulation. Ustekinumab, a therapeutic agent targeting both cytokines, was recently approved to treat psoriasis and psoriatic arthritis, and related agents are in clinical testing for a variety of inflammatory disorders. Here we discuss the therapeutic rationale for targeting these cytokines, the unintended consequences for host defense and tumor surveillance and potential ways in which these therapies can be applied to treat additional immune disorders.

IL-12 and IL-23 are produced by inflammatory myeloid cells and influence the development of TH1 cell and IL-17–producing T helper (TH17) cell responses, respectively. The rationale for developing IL-12 antagonists was prompted by observations that mice deficient in IL-12p40 are resistant to experimentally induced autoimmune conditions, including paralysis induction after immunization with brain-derived antigens, arthritis inflammation after immunization with a joint antigen, ocular disease after immunization with a retinal antigen and multiple gut disease models. This suggested that IL-12 could be an effective therapeutic target1, 2, 3, 4, 5. Studies of neutralizing antibodies to IL-12p40 in multiple mouse strains seemed to confirm the importance of therapeutically targeting IL-12 to decrease immune pathology6, 7. However, mice deficient in the other IL-12 subunit, IL-12p35, showed no protection or showed exacerbated disease in some models1, 2. Following the recognition, in 2000, that IL-12 and IL-23 share the IL-12p40 subunit but only IL-23 uses the p19 subunit8, it was determined that mice deficient in IL-23 but not IL-12 are resistant to experimental immune-mediated disease1, 2, 3, 4, 5. By 2000, the first anti–IL-12p40 therapy targeting IL-12—subsequently recognized to target IL-23 as well—was under evaluation in patients with Crohn’s disease9. Currently, at least 10 therapeutic agents targeting IL-12, IL-23 or IL-17A are being tested in the clinic for more than 17 immune-mediated diseases (Table 1). Here we discuss the preclinical and clinical data validating these therapeutic strategies and the potential consequences of targeting these immune pathways.

Figure 1: Schematic representation of IL-12 and IL-23, and their receptors and downstream signaling pathways

Schematic representation of IL-12 and IL-23, and their receptors and downstream signaling pathways.

IL-12 is made up of the IL-12/23p40 and IL-12p35 subunits, and IL-23 comprises IL-23p19 and IL-12/23p40. IL-12 signals through the IL-12Rβ1 and IL-12Rβ2 subunits, and IL-23 signals through IL-12Rβ1 and IL-23R. IL-12 stimulation of JAK2…

Figure 4: Schematic representation of the mechanisms by which IL-23 indirectly or directly promotes tumorigenesis, growth and metastasis.

 

Schematic representation of the mechanisms by which IL-23 indirectly or directly promotes tumorigenesis, growth and metastasis.

IL-23 is produced by myeloid cells in response to exogenous or endogenous signals such as damage-associated molecular patterns (DAMPs), pathogen-associated molecular patterns (PAMPs) or tumor-secreted factors such as prostaglandin E2 (PGE2). IL-23 can act directly on tumor cells to promote their transformation, proliferation and/or metastasis. In mice, IL-23R is expressed on several innate and adaptive immune cell types, which are found in various proportions in tumors. Stimulation of IL-23R on these immune cells leads to production of cytokines such as IL-17 and/or IL-22, which can have direct proliferative effects on stromal or tumor cells. IL-17 and/or IL-22 also elicit a range of factors from various hematopoietic and nonhematopoietic cells, which can have direct effects on tumor proliferation and metastasis or induce the production of additional inflammatory cytokines, chemokines and mediators such as IL-6, IL-8, matrix metallopeptidases (MMPs) and vascular endothelial growth factor (VEGF), all of which can contribute to the generation of a tumor microenvironment in which CD8 and NK cell effector functions are suppressed. DC, dendritic cell; Mφ, macrophage.

IL-12 and IL-23 cytokines: from discovery to targeted therapies for immune-mediated inflammatory diseases

Michele W L TengEdward P Bowman,…., & Daniel J Cua

Nature Medicine 21, 719–729 (2015) doi:10.1038/nm.3895

Familial genetic studies, large-scale genome-wide association studies (GWAS) and next-generation sequencing approaches have highlighted therapeutic indications where IL-23 may contribute to inflammatory disease risk. For example, a psoriasis GWAS reported a protective association for the single-nucleotide polymorphism (SNP) rs11209026 (c.1142G>A; p.Arg381Gln) residing in the IL-23R protein-coding sequence with a modest odds ratio (OR) of 0.67 (P = 7 × 10−7)25. A GWAS in ileal Crohn’s disease also showed an association with rs11209026 (ref. 26), with the minor glutamine variant protective for Crohn’s disease risk with an OR of 0.26–0.45. The protective association of this variant (and other SNPs in linkage disequilibrium with it) in Crohn’s disease was also shown in ulcerative colitis27, 28, 29, 30, 31,32, 33, 34, 35, 36, 37, 38, 39, 40, 41. The largest meta-analysis of all inflammatory bowel disease GWAS to date (~40,000 cases and ~40,000 controls) indicates that carriage of the glutamine variant gives a modest reduction for disease risk (OR = 0.43, P = 8 × 10−161) (ref. 36). The rs11209026 allele is also associated with protection from ankylosing spondylitis42, 43, psoriatic arthritis44, 45, 46, 47 and graft-versus-host disease48, 49, 50, 51. Notably, this IL-23R variant has not been reliably associated with other common inflammatory diseases such as rheumatoid arthritis, type 1 diabetes or multiple sclerosis in GWAS powered to detect protective effects similar to those seen in Crohn’s disease and psoriasis52, 53, 54. Although these GWAS findings are compelling, it is important to keep in mind the limitations of such studies; these common loci tend to additively explain only a small proportion of the narrow-sense heritability of disease risk55.

Treatment of inflammatory disease with any immunosuppressive agent carries the theoretical risk of impaired host defense responses to pathogens and/or decreased tumor surveillance. Emerging data from human loss-of-function variants and mouse preclinical studies have informed the relative risks of targeting IL-12 and/or IL-23.

The theoretical risk of compromised immunity are of particular concern owing to immune defects discovered in patients with autosomal recessive deficiencies in IL-12/23p40 and IL-12Rβ1 (refs.105,106,107) (Fig. 3). Both deficiencies are genetic etiologies of Mendelian susceptibility to mycobacterial disease (MSMD) (genes involved in MSMD are listed at http://www.biobase-international.com), a rare condition in otherwise healthy patients who have a selective infection predisposition to weakly virulent mycobacteria such as Bacillus Calmette-Guerin (BCG) vaccines, nontuberculous environmental mycobacteria and virulent Mycobacterium tuberculosis (OMIM209950)108, 109, 110, 111, 112, 113. Half of patients with MSMD also have nontyphoidal and, to a lesser extent, typhoidal Salmonella infection.

Owing to the roles of IL-12 and/or IL-23 in host defense and tumor surveillance, particular attention has been focused on infectious disease–related adverse events after anti–IL-12/23p40 treatment in humans. Meta-analysis of briakinumab’s phase 2, phase 3 and open-label extension (OLE) psoriasis databases in 2010 identified 14 cases of candidiasis (including mucocutaneous esophageal and oral candidiasis); no reports of mycobacteria or Salmonella were noted. With regard to the roles of IL-12 and/or IL-23 in tumorigenesis, malignancies were observed at a rate of 1.7 events per 100 patient years (PY), and were cancers commonly seen in the general population.

Concluding remarks

Clinical testing of IL-23 and IL-17A inhibitors have confirmed the initial hypotheses that IL-23–TH17 pathways are indispensable in promoting immune-mediated diseases, and agents targeting these pathways work particularly well in specific disease settings. However, it is not clear why IL-17A and IL-17RA antagonists work well for psoriasis but exacerbate Crohn’s disease95, 96. It appears that different classes of inhibitor targeting IL-23 and IL-17 pathways may have unique nonoverlapping attributes in different clinical settings. Investigators are still learning where the overlap occurs and what the differences are between targeting IL-23 and targeting other related pathway cytokines. For example, mouse innate lymphoid cells constitutively produce gut protective IL-17A and IL-22 in an IL-23–independent manner. The constitutive IL-17A and IL-22 expression levels generated in response to commensal gut organisms seem to be crucial for maintenance of epithelial barrier function185 and tight junction formation (D.J.C., unpublished observation). However, high levels of IL-17A and IL-22 induced by IL-23 can be pathogenic during tissue injury responses in the presence of additional inflammatory cytokines such as IL-1, IL-6, GM-CSF and TNF. Therefore, targeting IL-23 via anti–IL-23p19 will partially suppress IL-17A and reduce inflammation, whereas anti–IL-17A therapy will neutralize all protective IL-17A.

The immune system’s function is to maintain balance in the face of insult from external pathogens and accumulation of genetic errors leading to cancer. Disruption of this balance toward immune-exuberance can lead to autoimmunity and immunopathology after infection, whereas inadequate immunity can allow pathogen evasion and breakdown in tumor surveillance. The common thread that connects autoimmunity, infection and cancer is inflammation, and the drivers of inflammation are intercellular messengers that enable cross-talk between immune cells and surrounding stromal tissues. We have underscored the importance of innate cell-produced IL-12 and IL-23 as intermediaries that act on T cells and NK cells to promote inflammation and highlighted that IL-12 and IL-23 have overlapping cellular immune functions. Whereas IL-12 is important in driving STAT1- and STAT4-mediated immune surveillance against specific intracellular pathogens and immunity against neoplasm, IL-23 promotes STAT3-dependent antifungal immunity and drives ‘sterile’ wound-healing responses in psoriatic lesions, which have a gene signature similar to that of many autoinflammatory conditions186, 187. Strikingly, this signature of uncontrolled wound-healing response is also observed in many cancers188. Although there is insufficient clinical data to determine the long-term safety of IL-23 inhibitors, preclinical models suggest that IL-23 paradoxically promotes tumorigenesis by enhancing skin and mucosal tissue inflammation associated with immune evasion mechanisms.

As the roles of IL-12 and IL-23 were elucidated in preclinical models, there was concern that inhibiting these factors could lead to profound immune suppression. Is it better to target factors capable of regulating a broad range of immune function and may leave patients unprotected against pathogens and cancers or to aim for a restricted pathway that may have limited efficacy for treatment of immune disorders? Although the efficacy and safety profiles of IL-12/23p40, IL-23p19 and IL-17A and IL-17RA therapies become clearer with each clinical trial, the decisions to progress these targets were made many years in advance, on the basis of limited data. Animal studies are important for elucidating the cellular and molecular mechanisms, but clinical testing is required to determine whether a specific disease mechanism also operates in humans. Immunological research is at an inflection point, where the basic concepts of molecular and cellular immunology are being translated into effective therapies for diseases that were considered intractable only a few years ago. Despite the challenges, efforts to translate basic disease mechanisms to the clinic are finally paying off. Although much work remains to be done, the fundamental question of which immune target will benefit which patient population is now being clarified. We optimistically await the answers that will change the lives of patients with serious immune-mediate conditions.

 

Cytokines in Crohn’s colitis.

Sher ME1D’Angelo AJStein TABailey BBurns GWise L.
Am J Surg. 1995 Jan; 169(1):133-6.

Increasing evidence points to a pathologic role for cytokines in Crohn’s colitis. Levels of cytokines are increased in diseased segments of colon in Crohn’s colitis, but no one has studied the concentration of cytokines in clinically and histologically nondiseased segments.

Mucosal biopsies were obtained from 7 patients with active segmental Crohn’s colitis and from 7 controls without inflammatory bowel disease. The concentration of Interleukin (IL)-1 beta, IL-2, IL-6, and IL-8 in patients and controls were determined using enzyme linked immunosorbent assay and compared. Histologic sections were also performed to confirm diseased and nondiseased segments of colon.

The concentrations of IL-1 beta, IL-6, and IL-8 were significantly higher in the involved segments of colon (10.3 +/- 4.1, 3.7 +/- 1.0, 34.4 +/- 6.9 picograms [pg] per mg) when compared to controls (1.8 +/- 0.5, 1.1 +/- 0.5, 5.3 +/- 1.0 pg/mg). The concentrations of IL-1 beta, IL-2, and IL-8 (8.5 +/- 2.9, 5.3 +/- 1.2, 26.3 +/- 8.8 pg/mg) in normal appearing segments of colon of patients with Crohn’s colitis were also significantly higher than in controls, whose IL-2 level was 2.0 +/- 0.5 pg/mg. IL-1 beta and IL-8 were significantly more concentrated in both the involved and uninvolved colonic segments of patients with Crohn’s colitis compared to controls. IL-2 and IL-6 were also more concentrated in Crohn’s patients than in controls, but not significantly. The differences in interleukin concentrations between involved and uninvolved segments of colon in patients with segmental Crohn’s colitis were not significant.

Although Crohn’s colitis is often a segmental disease, concentrations of IL-1 beta and IL-8 are increased throughout the entire colon. These observations reinforce the hypothesis that Crohn’s colitis involves the whole colon even when this is not apparent clinically or histologically.

 

Clin Exp Immunol. 2000 May;120(2):241-6.

Increased production of matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 by inflamed mucosa in inflammatory bowel disease.

Louis E1Ribbens CGodon AFranchimont DDe Groote DHardy NBoniver JBelaiche JMalaise M.

Inflammatory bowel diseases (IBD) are characterized by a sustained inflammatory cascade that gives rise to the release of mediators capable of degrading and modifying bowel wall structure. Our aims were (i) to measure the production of matrix metalloproteinase-3 (MMP-3), and its tissue inhibitor, tissue inhibitor of metalloproteinase-1 (TIMP-1), by inflamed and uninflamed colonic mucosa in IBD, and (ii) to correlate their production with that of proinflammatory cytokines and the anti-inflammatory cytokine, IL-10. Thirty-eight patients with IBD, including 25 with Crohn’s disease and 13 with ulcerative colitis, were included. Ten controls were also studied. Biopsies were taken from inflamed and uninflamed regions and inflammation was graded both macroscopically and histologically. Organ cultures were performed for 18 h. Tumour necrosis factor-alpha (TNF-alpha), IL-6, IL-1beta, IL-10, MMP-3 and TIMP-1 concentrations were measured using specific immunoassays. The production of both MMP-3 and the TIMP-1 were either undetectable or below the sensitivity of our immunoassay in the vast majority of uninflamed samples either from controls or from those with Crohn’s disease or ulcerative colitis. In inflamed mucosa, the production of these mediators increased significantly both in Crohn’s disease (P < 0.01 and 0.001, respectively) and ulcerative colitis (P < 0.001 and 0.001, respectively). Mediator production in both cases was significantly correlated with the production of proinflammatory cytokines and IL-10, as well as with the degree of macroscopic and microscopic inflammation. Inflamed mucosa of both Crohn’s disease and ulcerative colitis show increased production of both MMP-3 and its tissue inhibitor, which correlates very well with production of IL-1beta, IL-6, TNF-alpha and IL-10.

 

Gut. 1997 Apr;40(4):475-80.

In vitro effects of oxpentifylline on inflammatory cytokine release in patients with inflammatory bowel disease.

Reimund JM1Dumont SMuller CDKenney JSKedinger MBaumann RPoindron PDuclos B.

Inflammatory cytokines, including tumour necrosis factor-alpha (TNF-alpha) and interleukin (IL)-1 beta, have been implicated as primary mediators of intestinal inflammation in inflammatory bowel disease.

To investigate the in vitro effects of oxpentifylline (pentoxifylline; PTX; a phosphodiesterase inhibitor) on inflammatory cytokine production (1) by peripheral mononuclear cells (PBMCs) and (2) by inflamed intestinal mucosa cultures from patients with Crohn’s disease and patients with ulcerative colitis.

PBMCs and mucosal biopsy specimens were cultured for 24 hours in the absence or presence of PTX (up to 100 micrograms/ml), and the secretion of TNF-alpha, IL-1 beta, IL-6, and IL-8 determined by enzyme linked immunosorbent assays (ELISAs).

PTX inhibited the release of TNF-alpha by PBMCs from patients with inflammatory bowel disease and the secretion of TNF-alpha and IL-1 beta by organ cultures of inflamed mucosa from the same patients. Secretion of TNF-alpha by PBMCs was inhibited by about 50% at a PTX concentration of 25 micrograms/ml (IC50). PTX was equally potent in cultures from controls, patients with Crohn’s disease, and those with ulcerative colitis. The concentrations of IL-6 and IL-8 were not significantly modified in PBMCs, but IL-6 increased slightly in organ culture supernatants.

PTX or more potent related compounds may represent a new family of cytokine inhibitors, potentially interesting for treatment of inflammatory bowel disease.

 

Inflamm Bowel Dis. 2015 May;21(5):973-84. doi: 10.1097/MIB.0000000000000353.

Neutralizing IL-23 is superior to blocking IL-17 in suppressing intestinal inflammation in a spontaneous murine colitis model.

Wang R1Hasnain SZTong HDas IChe-Hao Chen AOancea IProctor MFlorin THEri RDMcGuckin MA.

IL-23/T(H)17 inflammatory responses are regarded as central to the pathogenesis of inflammatory bowel disease, but clinically IL-17A antibodies have shown low efficacy and increased infections in Crohn’s disease. Hence, we decided to closely examine the role of the IL-23/T(H)17 axis in 3 models of colitis.

IL-17A(-/-) and IL-17Ra(-/-) T cells were transferred into Rag1 and RaW mice to assess the role of IL-17A-IL-17Ra signaling in T cells during colitis. In Winnie mice with spontaneous colitis due to an epithelial defect, we studied the progression of colitis in the absence of IL-17A and the efficacy of neutralizing antibodies against the IL-17A or IL-23p19 cytokines.

In transfer colitis models, IL-17A-deficient T cells failed to ameliorate disease, and IL-17Ra-deficient T cells were more colitogenic than wild-type T cells. In Winnie mice with an epithelial defect and spontaneous T(H)17-dominated inflammation, genetic deficiency of IL-17A did not suppress initiation of colitis but limited colitis progression. Furthermore, inhibition of IL-17A by monoclonal antibodies did not reduce colitis severity. In contrast, neutralizing IL-23 using an anti-p19 antibody significantly alleviated both emerging and established colitis, downregulating T(H)17 proinflammatory cytokine expression and diminishing neutrophil infiltration.

Our results support clinical studies showing that IL-17 neutralization is not therapeutic but that targeting IL-23 suppresses intestinal inflammation. Effects of IL-23 distinct from its effects on maturation of IL-17A-producing lymphocytes may underlie the protection from inflammatory bowel disease conveyed by hypomorphic IL-23 receptor polymorphisms and contribute to the efficacy of IL-23 neutralizing antibodies in inflammatory bowel disease.

  1. Luger, D. et al. Either a Th17 or a Th1 effector response can drive autoimmunity: conditions of disease induction affect dominant effector category. J. Exp. Med. 205, 799810 (2008).
  2. Yen, D. et al. IL-23 is essential for T cell-mediated colitis and promotes inflammation via IL-17 and IL-6. J. Clin. Invest. 116, 13101316 (2006).
  3. Uhlig, H.H. et al. Differential activity of IL-12 and IL-23 in mucosal and systemic innate immune pathology. Immunity 25, 309318 (2006).

 

IL-17A signaling in colonic epithelial cells inhibits pro-inflammatory cytokine production by enhancing the activity of ERK and PI3K.

Guo X1Jiang X2Xiao Y3Zhou T2Guo Y4Wang R2Zhao Z2Xiao H2Hou C2Ma L3Lin Y2Lang X2Feng J2Chen G2Shen B2Han G2Li Y2.
PLoS One. 2014 Feb 25;9(2):e89714. doi: 10.1371/journal.pone.0089714. eCollection 2014.

Our previous data suggested that IL-17A contributes to the inhibition of Th1 cell function in the gut. However, the underlying mechanisms remain unclear. Here we demonstrate that IL-17A signaling in colonic epithelial cells (CECs) increases TNF-α-induced PI3K-AKT and ERK phosphorylation and inhibits TNF-α induced expression of IL-12P35 and of a Th1 cell chemokine, CXCL11 at mRNA level. In a co-culture system using HT-29 cells and PBMCs, IL-17A inhibited TNF-α-induced IL-12P35 expression by HT-29 cells and led to decreased expression of IFN-γ and T-bet by PBMCs. Finally, adoptive transfer of CECs from mice with Crohn’s Disease (CD) led to an enhanced Th1 cell response and exacerbated colitis in CD mouse recipients. The pathogenic effect of CECs derived from CD mice was reversed by co-administration of recombinant IL-17A. Our data demonstrate a new IL-17A-mediated regulatory mechanism in CD. A better understanding of this pathway might shed new light on the pathogenesis of CD.

 

J Immunol. 2008 Aug 15;181(4):2799-805.

The human IL-17F/IL-17A heterodimeric cytokine signals through the IL-17RA/IL-17RC receptor complex.

Wright JF1Bennett FLi BBrooks JLuxenberg DPWhitters MJTomkinson KNFitz LJWolfman NMCollins MDunussi-Joannopoulos KChatterjee-Kishore MCarreno BM.

IL-17A and IL-17F, produced by the Th17 CD4(+) T cell lineage, have been linked to a variety of inflammatory and autoimmune conditions. We recently reported that activated human CD4(+) T cells produce not only IL-17A and IL-17F homodimers but also an IL-17F/IL-17A heterodimeric cytokine. All three cytokines can induce chemokine secretion from bronchial epithelial cells, albeit with different potencies. In this study, we used small interfering RNA and Abs to IL-17RA and IL-17RC to demonstrate that heterodimeric IL-17F/IL-17A cytokine activity is dependent on the IL-17RA/IL-17RC receptor complex. Interestingly, surface plasmon resonance studies indicate that the three cytokines bind to IL-17RC with comparable affinities, whereas they bind to IL-17RA with different affinities. Thus, we evaluated the effect of the soluble receptors on cytokine activity and we find that soluble receptors exhibit preferential cytokine blockade. IL-17A activity is inhibited by IL-17RA, IL-17F is inhibited by IL-17RC, and a combination of soluble IL-17RA/IL-17RC receptors is required for inhibition of the IL-17F/IL-17A activity. Altogether, these results indicate that human IL-17F/IL-17A cytokine can bind and signal through the same receptor complex as human IL-17F and IL-17A. However, the distinct affinities of the receptor components for IL-17A, IL-17F, and IL-17F/IL-17A heterodimer can be exploited to differentially affect the activity of these cytokines.

 

Am J Surg. 1995 Jan;169(1):133-6.

Cytokines in Crohn’s colitis.

Sher ME1D’Angelo AJStein TABailey BBurns GWise L.

Increasing evidence points to a pathologic role for cytokines in Crohn’s colitis. Levels of cytokines are increased in diseased segments of colon in Crohn’s colitis, but no one has studied the concentration of cytokines in clinically and histologically nondiseased segments.

Mucosal biopsies were obtained from 7 patients with active segmental Crohn’s colitis and from 7 controls without inflammatory bowel disease. The concentration of Interleukin (IL)-1 beta, IL-2, IL-6, and IL-8 in patients and controls were determined using enzyme linked immunosorbent assay and compared. Histologic sections were also performed to confirm diseased and nondiseased segments of colon.

The concentrations of IL-1 beta, IL-6, and IL-8 were significantly higher in the involved segments of colon (10.3 +/- 4.1, 3.7 +/- 1.0, 34.4 +/- 6.9 picograms [pg] per mg) when compared to controls (1.8 +/- 0.5, 1.1 +/- 0.5, 5.3 +/- 1.0 pg/mg). The concentrations of IL-1 beta, IL-2, and IL-8 (8.5 +/- 2.9, 5.3 +/- 1.2, 26.3 +/- 8.8 pg/mg) in normal appearing segments of colon of patients with Crohn’s colitis were also significantly higher than in controls, whose IL-2 level was 2.0 +/- 0.5 pg/mg. IL-1 beta and IL-8 were significantly more concentrated in both the involved and uninvolved colonic segments of patients with Crohn’s colitis compared to controls. IL-2 and IL-6 were also more concentrated in Crohn’s patients than in controls, but not significantly. The differences in interleukin concentrations between involved and uninvolved segments of colon in patients with segmental Crohn’s colitis were not significant.

Although Crohn’s colitis is often a segmental disease, concentrations of IL-1 beta and IL-8 are increased throughout the entire colon. These observations reinforce the hypothesis that Crohn’s colitis involves the whole colon even when this is not apparent clinically or histologically.

 

Protein Pept Lett. 2015;22(7):570-8.

An Overview of Interleukin-17A and Interleukin-17 Receptor A Structure, Interaction and Signaling.

Krstic JObradovic HKukolj TMojsilovic SOkic-Dordevic IBugarski DSantibanez JF1.

Interleukin-17A (IL-17A) and its receptor (IL-17RA) are prototype members of IL-17 ligand/receptor family firstly identified in CD4+ T cells, which comprises six ligands (IL-17A to IL- 17F) and five receptors (IL-17RA to IL-17RE). IL-17A is predominantly secreted by T helper 17 (Th17) cells, and plays important roles in the development of autoimmune and inflammatory diseases. IL-17RA is widely expressed, and forms a complex with IL-17RC. Binding of IL-17A to this receptor complex triggers the activation of several intracellular signaling pathways. In this review, we aimed to summarize literature data about molecular features of IL-17A and IL-17RA from gene to mature protein. We are also providing insight into regulatory mechanisms, protein structural conformation, including ligand-receptor interaction, and an overview of signaling pathways. Our aim was to compile the data on molecular characteristics of IL-17A and IL-17RA which may help in the understanding of their functions in health and disease.

 

Gut. 2014 Dec;63(12):1902-12. doi: 10.1136/gutjnl-2013-305632. Epub 2014 Feb 17.

Involvement of interleukin-17A-induced expression of heat shock protein 47 in intestinal fibrosis in Crohn’s disease.

Honzawa Y1Nakase H1Shiokawa M1Yoshino T1Imaeda H2Matsuura M1Kodama Y1Ikeuchi H3Andoh A2Sakai Y4Nagata K5Chiba T1.

Intestinal fibrosis is a clinically important issue in Crohn’s disease (CD). Heat shock protein (HSP) 47 is a collagen-specific molecular chaperone involved in fibrotic diseases. The molecular mechanisms of HSP47 induction in intestinal fibrosis related to CD, however, remain unclear. Here we investigated the role of interleukin (IL)-17A-induced HSP47 expression in intestinal fibrosis in CD.

Expressions of HSP47 and IL-17A in the intestinal tissues of patients with IBD were determined. HSP47 and collagen I expressions were assessed in intestinal subepithelial myofibroblasts (ISEMFs) isolated from patients with IBD and CCD-18Co cells treated with IL-17A. We examined the role of HSP47 in IL-17A-induced collagen I expression by administration of short hairpin RNA (shRNA) to HSP47 and investigated signalling pathways of IL-17A-induced HSP47 expression using specific inhibitors in CCD-18Co cells.

Gene expressions of HSP47 and IL-17A were significantly elevated in the intestinal tissues of patients with active CD. Immunohistochemistry revealed HSP47 was expressed in α-smooth muscle actin (α-SMA)-positive cells and the number of HSP47-positive cells was significantly increased in the intestinal tissues of patients with active CD. IL-17A enhanced HSP47 and collagen I expressions in ISEMFs and CCD-18Co cells. Knockdown of HSP47 in these cells resulted in the inhibition of IL-17A-induced collagen I expression, and analysis of IL-17A signalling pathways revealed the involvement of c-Jun N-terminal kinase in IL-17A-induced HSP47 expression.

IL-17A-induced HSP47 expression is involved in collagen I expression in ISEMFs, which might contribute to intestinal fibrosis in CD.

 

 

Biochem Biophys Res Commun. 2011 Jan 14;404(2):599-604. doi: 10.1016/j.bbrc.2010.12.006. Epub 2010 Dec 6.

Role of heat shock protein 47 in intestinal fibrosis of experimental colitis.

Kitamura H1Yamamoto SNakase HMatsuura MHonzawa YMatsumura KTakeda YUza NNagata KChiba T.

Intestinal fibrosis is a clinically important issue of inflammatory bowel disease (IBD). It is unclear whether or not heat shock protein 47 (HSP47), a collagen-specific molecular chaperone, plays a critical role in intestinal fibrosis. The aim of this study is to investigate the role of HSP47 in intestinal fibrosis of murine colitis.

HSP47 expression and localization were evaluated in interleukin-10 knockout (IL-10KO) and wild-type (WT, C57BL/6) mice by immunohistochemistry. Expression of HSP47 and transforming growth factor-β1 (TGF-β1) in colonic tissue was measured. In vitro studies were conducted in NIH/3T3 cells and primary culture of myofibroblasts separated from colonic tissue of IL-10KO (PMF KO) and WT mice (PMF WT) with stimulation of several cytokines. We evaluated the inhibitory effect of administration of small interfering RNA (siRNA) targeting HSP47 on intestinal fibrosis in IL-10KO mice in vivo.

Immunohistochemistry revealed HSP47 positive cells were observed in the mesenchymal and submucosal area of both WT and IL-10 KO mice. Gene expressions of HSP47 and TGF-β1 were significantly higher in IL-10KO mice than in WT mice and correlated with the severity of inflammation. In vitro experiments with NIH3T3 cells, TGF-β1 only induced HSP47 gene expression. There was a significant difference of HSP47 gene expression between PMF KO and PMF WT. Administration of siRNA targeting HSP47 remarkably reduced collagen deposition in colonic tissue of IL-10KO mice.

Our results indicate that HSP47 plays an essential role in intestinal fibrosis of IL-10KO mice, and may be a potential target for intestinal fibrosis associated with IBD.

 

Kidney Int. 2003 Sep;64(3):887-96.

Antisense oligonucleotides against collagen-binding stress protein HSP47 suppress peritoneal fibrosis in rats.

Nishino T1Miyazaki MAbe KFurusu AMishima YHarada TOzono YKoji TKohno S.

Peritoneal fibrosis is a serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD), but the molecular mechanism of this process remains unclear. Heat shock protein 47 (HSP47), a collagen-specific molecular chaperone, is essential for biosynthesis and secretion of collagen molecules, and is expressed in the tissue of human peritoneal fibrosis. In the present study, we examined the effect of HSP47 antisense oligonucleotides (ODNs) on the development of experimental peritoneal fibrosis induced by daily intraperitoneal injections of chlorhexidine gluconate (CG).

HSP47 antisense or sense ODNs were injected simultaneously with CG from day 14, after injections of CG alone. Peritoneal tissue was dissected out 28 days after CG injection. The expression patterns of HSP47, type I and type III collagen, alpha-smooth muscle actin (alpha-SMA), as a marker of myofibroblasts, ED-1 (as a marker of macrophages), and factor VIII were examined by immunohistochemistry.

In rats treated with CG alone, the submesothelial collagenous compact zone was thickened, where the expression levels of HSP47, type I and type III collagen and alpha-SMA were increased. Marked macrophage infiltration was also noted and the number of vessels positively stained for factor VIII increased in the CG-treated group. Treatment with antisense ODNs, but not sense ODNs, abrogated CG-induced changes in the expression of HSP47, type I and III collagen, alpha-SMA, and the number of infiltrating macrophages and vessels.

Our results indicate the involvement of HSP47 in the progression of peritoneal fibrosis and that inhibition of HSP47 expression might merit further clinical investigation for the treatment of peritoneal fibrosis in CAPD patients.

 

Trends Mol Med. 2007 Feb;13(2):45-53. Epub 2006 Dec 13.

The collagen-specific molecular chaperone HSP47: is there a role in fibrosis?

Taguchi T1Razzaque MS.

Heat shock protein 47 (HSP47) is a collagen-specific molecular chaperone that is required for molecular maturation of various types of collagens. Recent studies have shown a close association between increased expression of HSP47 and excessive accumulation of collagens in scar tissues of various human and experimental fibrotic diseases. It is presumed that the increased levels of HSP47 in fibrotic diseases assist in excessive assembly and intracellular processing of procollagen molecules and, thereby, contribute to the formation of fibrotic lesions. Studies have also shown that suppression of HSP47 expression can reduce accumulation of collagens to delay the progression of fibrotic diseases in experimental animal models. Because HSP47 is a specific chaperone for collagen synthesis, it provides a selective target to manipulate collagen production, a phenomenon that might have enormous clinical impact in controlling a wide range of fibrotic diseases. Here, we outline the fibrogenic role of HSP47 and discuss the potential usefulness of HSP47 as an anti-fibrotic therapeutic target.

 

Arthritis Rheum. 2013 May;65(5):1347-56. doi: 10.1002/art.37860.

Interleukin-17A+ cell counts are increased in systemic sclerosis skin and their number is inversely correlated with the extent of skin involvement.

Truchetet ME1Brembilla NCMontanari ELonati PRaschi EZeni SFontao LMeroni PLChizzolini C.

Levels of interleukin-17A (IL-17A) have been found to be increased in synovial fluid from individuals with systemic sclerosis (SSc). This study was undertaken to investigate whether IL-17A-producing cells are present in affected SSc skin, and whether IL-17A exerts a role in the transdifferentiation of myofibroblasts.

Skin biopsy samples were obtained from the involved skin of 8 SSc patients and from 8 healthy control donors undergoing plastic surgery. Immunohistochemistry and multicolor immunofluorescence techniques were used to identify and quantify the cell subsets in vivo, including IL-17A+, IL-4+, CD3+, tryptase-positive, α-smooth muscle actin (α-SMA)-positive, myeloperoxidase-positive, and CD1a+ cells. Dermal fibroblast cell lines were generated from all skin biopsy samples, and quantitative polymerase chain reaction, Western blotting, and solid-phase assays were used to quantify α-SMA, type I collagen, and matrix metalloproteinase 1 (MMP-1) production by the cultured fibroblasts.

IL-17A+ cells were significantly more numerous in SSc skin than in healthy control skin (P = 0.0019) and were observed to be present in both the superficial and deep dermis. Involvement of both T cells and tryptase-positive mast cells in the production of IL-17A was observed. Fibroblasts positive for α-SMA were found adjacent to IL-17A+ cells, but not IL-4+ cells. However, IL-17A did not induce α-SMA expression in cultured fibroblasts. In the presence of IL-17A, the α-SMA expression induced in response to transforming growth factor β was decreased, while MMP-1 production was directly enhanced. Furthermore, the frequency of IL-17A+ cells was higher in the skin of SSc patients with greater severity of skin fibrosis (lower global skin thickness score).

IL-17A+ cells belonging to the innate and adaptive immune system are numerous in SSc skin. IL-17A participates in inflammation while exerting an inhibitory activity on myofibroblast transdifferentiation. These findings are consistent with the notion that IL-17A has a direct negative-regulatory role in the development of dermal fibrosis in humans.

 

Gut. 2014 Dec;63(12):1902-12. doi: 10.1136/gutjnl-2013-305632. Epub 2014 Feb 17.

Involvement of interleukin-17A-induced expression of heat shock protein 47 in intestinal fibrosis in Crohn’s disease.

Honzawa Y1Nakase H1Shiokawa M1Yoshino T1Imaeda H2Matsuura M1Kodama Y1Ikeuchi H3Andoh A2Sakai Y4Nagata K5Chiba T1.

Intestinal fibrosis is a clinically important issue in Crohn’s disease (CD). Heat shock protein (HSP) 47 is a collagen-specific molecular chaperone involved in fibrotic diseases. The molecular mechanisms of HSP47 induction in intestinal fibrosis related to CD, however, remain unclear. Here we investigated the role of interleukin (IL)-17A-induced HSP47 expression in intestinal fibrosis in CD.

Expressions of HSP47 and IL-17A in the intestinal tissues of patients with IBD were determined. HSP47 and collagen I expressions were assessed in intestinal subepithelial myofibroblasts (ISEMFs) isolated from patients with IBD and CCD-18Co cells treated with IL-17A. We examined the role of HSP47 in IL-17A-induced collagen I expression by administration of short hairpin RNA (shRNA) to HSP47 and investigated signalling pathways of IL-17A-induced HSP47 expression using specific inhibitors in CCD-18Co cells.

Gene expressions of HSP47 and IL-17A were significantly elevated in the intestinal tissues of patients with active CD. Immunohistochemistry revealed HSP47 was expressed in α-smooth muscle actin (α-SMA)-positive cells and the number of HSP47-positive cells was significantly increased in the intestinal tissues of patients with active CD. IL-17A enhanced HSP47 and collagen I expressions in ISEMFs and CCD-18Co cells. Knockdown of HSP47 in these cells resulted in the inhibition of IL-17A-induced collagen I expression, and analysis of IL-17A signalling pathways revealed the involvement of c-Jun N-terminal kinase in IL-17A-induced HSP47 expression.

IL-17A-induced HSP47 expression is involved in collagen I expression in ISEMFs, which might contribute to intestinal fibrosis in CD.

 

Kidney Int. 2003 Sep;64(3):887-96.

Antisense oligonucleotides against collagen-binding stress protein HSP47 suppress peritoneal fibrosis in rats.

Nishino T1Miyazaki MAbe KFurusu AMishima YHarada TOzono YKoji TKohno S.

Peritoneal fibrosis is a serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD), but the molecular mechanism of this process remains unclear. Heat shock protein 47 (HSP47), a collagen-specific molecular chaperone, is essential for biosynthesis and secretion of collagen molecules, and is expressed in the tissue of human peritoneal fibrosis. In the present study, we examined the effect of HSP47 antisense oligonucleotides (ODNs) on the development of experimental peritoneal fibrosis induced by daily intraperitoneal injections of chlorhexidine gluconate (CG).

HSP47 antisense or sense ODNs were injected simultaneously with CG from day 14, after injections of CG alone. Peritoneal tissue was dissected out 28 days after CG injection. The expression patterns of HSP47, type I and type III collagen, alpha-smooth muscle actin (alpha-SMA), as a marker of myofibroblasts, ED-1 (as a marker of macrophages), and factor VIII were examined by immunohistochemistry.

In rats treated with CG alone, the submesothelial collagenous compact zone was thickened, where the expression levels of HSP47, type I and type III collagen and alpha-SMA were increased. Marked macrophage infiltration was also noted and the number of vessels positively stained for factor VIII increased in the CG-treated group. Treatment with antisense ODNs, but not sense ODNs, abrogated CG-induced changes in the expression of HSP47, type I and III collagen, alpha-SMA, and the number of infiltrating macrophages and vessels.

Our results indicate the involvement of HSP47 in the progression of peritoneal fibrosis and that inhibition of HSP47 expression might merit further clinical investigation for the treatment of peritoneal fibrosis in CAPD patients.

 

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2007 Aug;32(4):650-5.

[Effect of heat shock protein 47 on the expression of collagen I induced by TGF-beta(1) in hepatic stellate cell-T6 cells].

[Article in Chinese]

Li Y1Wu WJiang YFWang KK.

To determine the effect of heat shock protein 47 (HSP47) on the expression of collagen I induced by transforming growth factor beta(1) (TGF-beta(1)) in hepatic stellate cell-T6 (HSC-T6) cells.

We used 1 ng/mL and 10 ng/mL recombinant human TGF-beta(1) to stimulate the cultured HSC-T6 cells. Heat shock response (HSR) and antisense oligonucleotides of HSP47 were used to induce and block the expression of HSP47, respectively. The expressions of HSP47 and collagen I were detected by Western blot and the cell viability was observed by MTT assay.

Both HSP47 and collagen I were expressed in normal HSC-T6 cells. Collagen I and HSP47 expression could be induced by both 1 ng/mL and 10 ng/mL TGF-beta(1) and collagen I was expressed the most after the treatment with 10 ng/mL TGF-beta(1). Although HSR could not affect the synthesis of collagen I as it induced the HSP47 expression, HSR could promote the expression of collagen I induced by TGF-beta(1). With no effect on the cell viability, antisense oligonucleotides could significantly inhibit HSR-mediated HSP47 expression and TGF-beta(1)-induced collagen I synthesis.

Over-expression of HSP47 enhances TGF-beta(1)-induced expression of collagen I in HSC-T6 cells, and HSP47 may play important roles in the process of hepatic fibrosis

 

Fibrogenesis Tissue Repair. 2013 Jul 8;6(1):13. doi: 10.1186/1755-1536-6-13.

The role of interleukin 17 in Crohn’s disease-associated intestinal fibrosis.

Biancheri P1Pender SLAmmoscato FGiuffrida PSampietro GArdizzone SGhanbari ACurciarello RPasini AMonteleone G,Corazza GRMacdonald TTDi Sabatino A.

Interleukin (IL)-17A and IL-17E (also known as IL-25) have been implicated in fibrosis in various tissues. However, the role of these cytokines in the development of intestinal strictures in Crohn’s disease (CD) has not been explored. We investigated the levels of IL-17A and IL-17E and their receptors in CD strictured and non-strictured gut, and the effects of IL-17A and IL-17E on CD myofibroblasts.

IL-17A was significantly overexpressed in strictured compared with non-strictured CD tissues, whereas no significant difference was found in the expression of IL-17E or IL-17A and IL-17E receptors (IL-17RC and IL-17RB, respectively) in strictured and non-strictured CD areas. Strictured CD explants released significantly higher amounts of IL-17A than non-strictured explants, whereas no difference was found as for IL-17E, IL-6, or tumor necrosis factor-α production. IL-17A, but not IL-17E, significantly inhibited myofibroblast migration, and also significantly upregulated matrix metalloproteinase (MMP)-3, MMP-12, tissue inhibitor of metalloproteinase-1 and collagen production by myofibroblasts from strictured CD tissues.

Our results suggest that IL-17A, but not IL-17E, is pro-fibrotic in CD. Further studies are needed to clarify whether the therapeutic blockade of IL-17A through the anti-IL-17A monoclonal antibody secukinumab is able to counteract the fibrogenic process in CD.

 

Int J Colorectal Dis. 2013 Jul;28(7):915-24. doi: 10.1007/s00384-012-1632-2. Epub 2012 Dec 28.

Role of N-acetylcysteine and GSH redox system on total and active MMP-2 in intestinal myofibroblasts of Crohn’s disease patients.

Romagnoli C1Marcucci TPicariello LTonelli FVincenzini MTIantomasi T.

Intestinal subepithelial myofibroblasts (ISEMFs)(1) are the predominant source of matrix metalloproteinase-2 (MMP-2) in gut, and a decrease in glutathione/oxidized glutathione (GSH/GSSG) ratio, intracellular redox state index, occurs in the ISEMFs of patients with Crohn’s disease (CD). The aim of this study is to demonstrate a relationship between MMP-2 secretion and activation and changes of GSH/GSSG ratio in ISEMFs stimulated or not with tumor necrosis factor alpha (TNFα).

ISEMFs were isolated from ill and healthy colon mucosa of patients with active CD. Buthionine sulfoximine, GSH synthesis inhibitor, and N-acetylcysteine (NAC), precursor of GSH synthesis, were used to modulate GSH/GSSG ratio. GSH and GSSG were measured by HPLC and MMP-2 by ELISA Kit.

In cells, stimulated or not with TNFα, a significant increase in MMP-2 secretion and activation, related to increased oxidative stress, due to low GSH/GSSG ratio, was detected. NAC treatment, increasing this ratio, reduced MMP-2 secretion and exhibited a direct effect on the secreted MMP-2 activity. In NAC-treated and TNFα-stimulated ISEMFs of CD patients’ MMP-2 activity were restored to physiological value. The involvement of c-Jun N-terminal kinase pathway on redox regulation of MMP-2 secretion has been demonstrated.

For the first time, in CD patient ISEMFs, a redox regulation of MMP-2 secretion and activation related to GSH/GSSG ratio and inflammatory state have been demonstrated. This study suggests that compounds able to maintain GSH/GSSG ratio to physiological values can be useful to restore normal MMP-2 levels reducing in CD patient intestine the dysfunction of epithelial barrier.

 

BMC Pulm Med. 2012 Jun 13;12:24. doi: 10.1186/1471-2466-12-24.

Pirfenidone inhibits TGF-β1-induced over-expression of collagen type I and heat shock protein 47 in A549 cells.

Hisatomi K1Mukae HSakamoto NIshimatsu YKakugawa THara SFujita HNakamichi SOku HUrata YKubota HNagata K,Kohno S.

Pirfenidone is a novel anti-fibrotic and anti-inflammatory agent that inhibits the progression of fibrosis in animal models and in patients with idiopathic pulmonary fibrosis (IPF). We previously showed that pirfenidone inhibits the over-expression of collagen type I and of heat shock protein (HSP) 47, a collagen-specific molecular chaperone, in human lung fibroblasts stimulated with transforming growth factor (TGF)-β1 in vitro. The increased numbers of HSP47-positive type II pneumocytes as well as fibroblasts were also diminished by pirfenidone in an animal model of pulmonary fibrosis induced by bleomycin. The present study evaluates the effects of pirfenidone on collagen type I and HSP47 expression in the human alveolar epithelial cell line, A549 cells in vitro.

The expression of collagen type I, HSP47 and E-cadherin mRNAs in A549 cells stimulated with TGF-β1 was evaluated by Northern blotting or real-time PCR. The expression of collagen type I, HSP47 and fibronectin proteins was assessed by immunocytochemical staining.

TGF-β1 stimulated collagen type I and HSP47 mRNA and protein expression in A549 cells, and pirfenidone significantly inhibited this process. Pirfenidone also inhibited over-expression of the fibroblast phenotypic marker fibronectin in A549 cells induced by TGF-β1.

We concluded that the anti-fibrotic effects of pirfenidone might be mediated not only through the direct inhibition of collagen type I expression but also through the inhibition of HSP47 expression in alveolar epithelial cells, which results in reduced collagen synthesis in lung fibrosis. Furthermore, pirfenidone might partially inhibit the epithelial-mesenchymal transition.

 

 

 

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Promoting the Expression of endomucin may prevent the collection of White Blood Cells that causes Tissues to become Inflamed

Reporter: Aviva Lev-Ari, PhD, RN

 

 

Endomucin prevents leukocyte–endothelial cell adhesion and has a critical role under resting and inflammatory conditions

Abstract

Endomucin is a membrane-bound glycoprotein expressed luminally by endothelial cells that line postcapillary venules, a primary site of leukocyte recruitment during inflammation. Here we show that endomucin abrogation on quiescent endothelial cells enables neutrophils to adhere firmly, via LFA-1-mediated binding to ICAM-1 constitutively expressed by endothelial cells. Moreover, TNF-αstimulation downregulates cell surface expression of endomucin concurrent with increased expression of adhesion molecules. Adenovirus-mediated expression of endomucin under inflammatory conditions prevents neutrophil adhesion in vitro and reduces the infiltration of CD45+ and NIMP-R14+ cells in vivo. These results indicate that endomucin prevents leukocyte contact with adhesion molecules in non-inflamed tissues and that downregulation of endomucin is critical to facilitate adhesion of leukocytes into inflamed tissues.

Researchers Shed Light on Anti-Adhesive Molecule in Vascular Endothelium, Suggest New Direction for Anti-Inflammatory Therapy

FEBRUARY 02, 2016
Contact: Suzanne Day, Office of Communications
617-573-3897
Suzanne_Day@meei.harvard.edu

Mass. Eye and Ear researchers describe the role of endomucin, a molecule that – under healthy circumstances – resists the adhesion of white blood cells as they move through the circulatory system. These findings suggest that promoting the expression of endomucin (displayed in red in image) may prevent the collection of white blood cells that causes tissues to become inflamed.

BOSTON — Researchers from the Harvard Medical School (HMS) Department of Ophthalmology and the Schepens Eye Research Institute of Massachusetts Eye and Ear have gained new insight into how a non-inflammatory state is maintained in the body. Their work focuses on the role of endomucin, a key molecule with anti-adhesive properties that encourages neutrophils  – prevalent white blood cells that sense signals of injury — to travel past the vascular endothelium.  Their findings, published in the current issue of Nature Communications, represent a paradigm shift in our understanding of inflammation.

Blood cells move through the circulatory system from the heart through the arteries to the smallest capillaries, and then to the veins and back to the heart. The vascular system is lined with the endothelium, a thin layer of cells that serve as an interface between the blood and the tissues. When there is an injury or disease process, the body sends out signals that recruit circulating neutrophils to stick to the endothelium; the neutrophils then migrate between the endothelial cells to and pass into tissue. The accumulation of neutrophils and other white blood cells in the injured tissues is facilitated an increase in adhesive molecules on the surface of the small vessels in injured tissue.

The research, led by Drs. Patricia D’Amore, Charles L. Schepens Professor of Ophthalmology and Pablo Argüeso, Associate Professor of Ophthalmology, both at Harvard Medical School, shows that in healthy, non-inflamed tissue, endomucin plays a critical role in preventing the neutrophils from sticking to the endothelium. During inflammatory conditions, however, the endomucin on the endothelial cell surface is dramatically reduced and the levels of pro-adhesives molecules (such as ICAM) on the endothelium increase, resulting in neutrophil accumulation. The researchers showed both in tissue culture and animal models that the adherence and infiltration of inflammatory cells could be blocked by experimentally expressing excess endomucin in the vascular endothelium.

“Until now researchers studying the role of the endothelium in inflammation have primarily focused on pro-adhesive molecules that trap the white blood cells at the site of injury,” said Pablo Argüeso, Ph.D. “We have now shown that there is also a mechanism to maintain an anti-adhesive surface on the vascular endothelium. Endomucin acts to prevent the inflammatory cells from adhering to blood vessels. The fact that endomucin decreases during inflammation suggests that this molecule may be as important in transforming the endothelial cell surface to a proinflammatory state as the elevation in adhesive molecules.”

Most current treatments for inflammation involve targeting the activities of cytokines and inflammatory mediators, which have risks and limitations. This new knowledge may be used to develop treatments for inflammation by promoting the expression of endomucin to prevent the movement of inflammatory cells from the capillaries into inflamed tissues.

“In our experiments, we have shown that there is potential to interfere with inflammation by promoting the expression of endomucin,” said Dr. Argüeso. “Many diseases have an inflammatory component, and by targeting this molecule, we believe we can reduce unnecessary inflammation.”

Additional co-authors of the Nature Communications paper include Alisar Zahr, Pilar Alcaide, Jinling Yang, Alexander Jones, Meredith Gregory, Nathanial G. dela Paz, Sunita Patel-Hett, Tania nevers, Francis W. Luscinskas, Magali Saint-Geniez and Bruce Ksander of Massachusetts Eye and Ear/ Schepens Eye Research Institute and the Department of Ophthalmology at Harvard Medical School.

This study was supported by the Schepens Eye Research Institute Co-Investigative Pilot Project Initiative (P.A.D. and P.Ar.), National Eye Institute Grants EY014847 (P.Ar.) and
EY05318 (P.A.D.), and National Heart, Lung and Blood Institute Grants HL036028 (F.W.L.), HL094706 (P.Al.) and HL123658 (P.Al.).

About Massachusetts Eye and Ear
Mass. Eye and Ear clinicians and scientists are driven by a mission to find cures for blindness, deafness and diseases of the head and neck.  Now united with Schepens Eye Research Institute, Mass. Eye and Ear is the world’s largest vision and hearing research center, developing new treatments and cures through discovery and innovation. Mass. Eye and Ear is a Harvard Medical School teaching hospital and trains future medical leaders in ophthalmology and otolaryngology, through residency as well as clinical and research fellowships.  Internationally acclaimed since its founding in 1824, Mass. Eye and Ear employs full-time, board-certified physicians who offer high-quality and affordable specialty care that ranges from the routine to the very complex.  U.S. News & World Report’s “Best Hospitals Survey” has consistently ranked the Mass. Eye and Ear Departments of Otolaryngology and Ophthalmology as top in the nation.  For more information about life-changing care and research, or to learn how you can help, please visit MassEyeAndEar.org.

SOURCE

http://www.masseyeandear.org/news/press-releases/2016/01/researchers-shed-light-on-anti-adhesive-molecule-in-vascular-endothelium

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Two New Drugs for Inflammatory Bowel Syndrome Are Giving Patients Hope

Reporter: Stephen J. Williams, Ph.D.

Actavis Receives FDA Approval for VIBERZI (eluxadoline) for the Treatment of Irritable Bowel Syndrome with Diarrhea (IBS-D) in Adults -First in class treatment for IBS-D treats hallmark symptoms of IBS-D; abdominal pain and diarrhea

DUBLIN, May 27, 2015 /PRNewswire/ — Actavis plc (NYSE: ACT) announced today that VIBERZI™ (eluxadoline) was approved by the Food and Drug Administration (FDA) as a twice-daily, oral treatment for adults suffering from irritable bowel syndrome with diarrhea (IBS-D). VIBERZI (eluxadoline) has mixed opioid receptor activity, it is a mu receptor agonist, a delta receptor antagonist, and a kappa receptor agonist.

Logo – http://photos.prnewswire.com/prnh/20130124/NY47381LOGO

“The FDA’s approval of VIBERZI is the first step to providing physicians with a new, evidence-based, treatment option for their adult patients with IBS-D,” said David Nicholson, Executive Vice President, Actavis Global Brands R&D. “At Actavis, we are dedicated to providing new treatment options, and the development of new agents that help address the most bothersome symptoms of IBS-D. We are very pleased to be working with the FDA to advance this IBS-D treatment and we eagerly await DEA scheduling determination later this year.”

IBS-D is a multifactorial disorder marked by recurrent abdominal pain or discomfort and altered bowel function that affects as many as 15 million adult Americans, impacting about twice as many women as men.i,ii,iii There are few treatment options available for IBS-D, particularly options that relieve both the diarrhea and abdominal pain associated with IBS-D.

“The unpredictable symptoms experienced by patients with IBS-D can have a significant impact on everyday life,” said William D. Chey, MD, Nostrant Professor of Gastroenterology at the University of Michigan Health System. “It’s exciting when physicians are able to add an additional treatment option like VIBERZI to their toolbox for patients with IBS-D.”

The FDA has recommended that VIBERZI be classified as a controlled substance. This recommendation has been submitted to the U.S. Drug Enforcement Administration (DEA).  Once VIBERZI receives final scheduling designation, the updated label will be available. Pending final scheduling designation, product launch is anticipated in Q1 2016.

About VIBERZI

VIBERZI is an orally active compound indicated for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in men and women. VIBERZI (eluxadoline) has mixed opioid receptor activity, it is a mu receptor agonist, a delta receptor antagonist, and a kappa receptor agonist.

Efficacy was established in two Phase III clinical studies, demonstrating significant superiority over placebo on the composite endpoint of simultaneous improvement in both abdominal pain and diarrhea at both 75 mg and 100 mg twice daily doses. The primary efficacy responder endpoint was evaluated over the duration of double-blind, placebo-controlled treatment. Response rates were compared based on patients who met the daily composite response criteria (improvement in both abdominal pain and stool consistency on the same day) for at least 50% of the days from weeks 1 to 12 (FDA endpoint) and weeks 1 to 26 (European Medicines Agency endpoint).

The most common adverse events in the two Phase III clinical trials were constipation (7% and 8% for eluxadoline 75 mg and 100 mg; 2% for placebo) and nausea (8% and 7% for eluxadoline 75 mg and 100 mg; 5% for placebo). Rates of severe constipation were less than 1% in patients receiving 75 mg and 100 mg eluxadoline. Rates of discontinuation due to constipation were low for both eluxadoline and placebo (≤2%) and similar rates of constipation occurred between the active and placebo arms beyond 3 months of treatment. A total of 2,426 subjects were enrolled across the two studies.

For more information including full prescribing information about VIBERZI at http://www.actavis.com/Actavis/media/PDFDocuments/VIBERZI_PI.pdf

About IBS-D

Irritable bowel syndrome with diarrhea (IBS-D) is a functional bowel disorder characterized by chronic abdominal pain and frequent diarrhea, which affects approximately 15 million patients in the U.S.  Although the exact cause of IBS-D is not known, symptoms are thought to result from a disturbance in the way the gastrointestinal tract and nervous system interact.

IBS-D can be debilitating and there are limited therapeutic options for managing the chronic symptoms. IBS-D is associated with economic burden in direct medical costs and indirect social costs such as absenteeism and lost productivity, along with decreased quality of life.

About Actavis
Actavis plc (NYSE: ACT), headquartered in Dublin, Ireland, is a unique, global pharmaceutical company and a leader in a new industry model—Growth Pharma. Actavis is focused on developing, manufacturing and commercializing innovative branded pharmaceuticals, high-quality generic and over-the-counter medicines and biologic products for patients around the world.

Actavis markets a portfolio of best-in-class products that provide valuable treatments for the central nervous system, eye care, medical aesthetics, gastroenterology, women’s health, urology, cardiovascular and anti-infective therapeutic categories, and operates the world’s third-largest global generics business, providing patients around the globe with increased access to affordable, high-quality medicines. Actavis is an industry leader in research and development, with one of the broadest development pipelines in the pharmaceutical industry and a leading position in the submission of generic product applications globally.

With commercial operations in approximately 100 countries, Actavis is committed to working with physicians, healthcare providers and patients to deliver innovative and meaningful treatments that help people around the world live longer, healthier lives.

Actavis intends to adopt a new global name – Allergan – pending shareholder approval in 2015.

For more information, visit Actavis’ website at www.actavis.com.

Actavis Cautionary Statement Regarding Forward-Looking Statements

Statements contained in this communication that refer to Actavis’ estimated or anticipated future results, including estimated synergies, or other non-historical facts are forward-looking statements that reflect Actavis’ current perspective of existing trends and information as of the date of this communication. Actual results may differ materially from Actavis’ current expectations depending upon a number of factors affecting Actavis’ business. These factors include, among others, the timing and success of product launches; the difficulty of predicting the timing or outcome of product development efforts and regulatory agency approvals or actions, if any; market acceptance of and continued demand for Actavis’ products; difficulties or delays in manufacturing; and such other risks and uncertainties detailed in Actavis’ periodic public filings with the Securities and Exchange Commission, including but not limited to Actavis plc’s Quarterly Report on Form 10-Q for the quarter ended March 31, 2015 and from time to time in Actavis’ other investor communications. Except as expressly required by law, Actavis disclaims any intent or obligation to update or revise these forward-looking statements.

i Camilleri M. Current and future pharmacological treatments for diarrhea-predominant irritable bowel syndrome. Expert Opinion on Pharmacotherapy. 2013;14:1151.

ii Grundmann O, Yoon SL. Irritable bowel syndrome: epidemiology, diagnosis, and treatment: an update for health-care practitioners. Journal of Gastroenterology and Hepatology. 2010;25:691–699.

iii Eluxadoline Xifaxin Summary Final. November 2014.

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Synergy’s Looming FDA Filing Makes It Pharma of the Month

By James Passeri Follow

| Jan 05, 2016 | 8:39 AM EST  | 0

Keep an eye on Synergy Pharmaceuticals (SGYP) this month: Analysts like it, its shares have waned since a big spike this summer, and the official filing of its star product is expected any day.

When the New York-based pharmaceutical company, which specializes in gastrointestinal therapy, announced that it passed clinical trials on its flagship drug plecanatide this summer, shares rocketed 95%.

But today analysts appear mystified at why the stock has receded 45% from its July high, especially with plecanatide’s new drug application with the Food and Drug Administration expected this month. (It’s currently trading below $6, and the consensus price target is over $13, according to data provided by Bloomberg.)

Synergy should be raking in $600 million from plecanatide, a daily tablet that treats patients with irritable bowel syndrome (IBS), within five years of obtaining FDA approval (expected in 2017, according to equity research firm BTIG. Synergy currently has a market capitalization of just $645 million.

BTIG’s $11 price target is also buoyed by roughly $142 million on the balance sheet, as well as newly appointed management including CFO Gary Sender and COO Troy Hamilton, both former executives at pharma success story Shire (SHPG). Though Shire shares are down just under 4% over the past 12 month, they have rocketed 112% over the past two years.

Synergy also stands to benefit from a growing demand for gastrointestinal treatments, feeding the appetite of Big Pharma for potential acquisitions, according to BTIG.

“With about 45 million Americans suffering from chronic constipation and IBS, and major companies like Allergan(AGN) and Valeant (VRX) focusing their marketing efforts on GI treatments, it seems logical to imagine SGYP as a takeover candidate,” BTIG analyst Timothy Chiang wrote in a November report.

Whether or not this leads to a buyout or another stock surge, Synergy certainly can be counted on for a healthy dose of small-cap volatility as its chief product takes the final steps toward reaching its customers.

 

 

Synergy Pharmaceuticals Announces Successful End-of-Phase 2 Meeting with FDA for Plecanatide in Irritable Bowel Syndrome with Constipation

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Pivotal Phase 3 IBS-C Program to be Initiated in the Fourth Quarter of 2014

NEW YORK– Synergy Pharmaceuticals Inc. (NASDAQ:SGYP) today announced that it has successfully completed an End-of-Phase 2 meeting with the U.S. Food and Drug Administration (FDA) on its lead drug plecanatide for the treatment of irritable bowel syndrome with constipation (IBS-C). Agreement was reached with the FDA for the plecanatide pivotal phase 3 IBS-C clinical development program that is scheduled to begin in the fourth quarter of this year.

“We are very pleased with the outcome of our meeting with the FDA and have a clear path forward to start the IBS-C registration program with plecanatide this year,” said Dr. Gary S. Jacob, Chairman and CEO of Synergy. “The pivotal phase 3 IBS-C trials will include both 3.0 mg and 6.0 mg plecanatide, which are consistent with the doses currently being evaluated in our phase 3 chronic idiopathic constipation (CIC) program. Plecanatide has demonstrated a clinical dose-response for efficacy with an excellent tolerability profile that is observed across trials. This is an important advantage as we look to bring two doses to market in both indications and provide physicians with options for addressing individual patient needs.”

Synergy’s pivotal phase 3 IBS-C clinical development program will consist of two registration trials, each including 1,050 patients who will receive either placebo, 3.0 mg or 6.0 mg plecanatide. IBS-C patients successfully completing either of the 12-week placebo-controlled registration trials will be offered enrollment into a long-term safety trial in order to complement and support the ongoing long-term safety database for the CIC indication.

About Plecanatide

Plecanatide is Synergy’s lead uroguanylin analog in late-stage clinical development to treat patients with CIC and IBS-C. Uroguanylin is a natural gastrointestinal (GI) hormone produced by humans in the small intestine and plays a key role in regulating the normal functioning of the digestive tract through its activity on the guanylate cyclase-C (GC-C) receptor. The GC-C receptor is known to be a primary source for stimulating a variety of beneficial physiological responses. Orally administered plecanatide mimics uroguanylin’s functions by binding to and activating the GC-C receptor to stimulate fluid and ion transit required for normal bowel function. Synergy has successfully completed a phase 2b trial of plecanatide in 951 patients with CIC and is currently enrolling patients in two pivotal phase 3 CIC trials. The company also recently announced positive top-line data results from a phase 2b dose-ranging study with plecanatide in patients with IBS-C.

About Synergy Pharmaceuticals

Synergy Pharmaceuticals (NASDAQ:SGYP) is a biopharmaceutical company focused on the development of novel therapies based on the natural human hormone, uroguanylin, to treat GI diseases and disorders. Synergy has created two unique analogs of uroguanylin – plecanatide and SP-333 – designed to mimic the natural hormone’s activity on the GC-C receptor and target a variety of GI conditions. SP-333 is currently in phase 2 development for opioid-induced constipation and is also being explored for ulcerative colitis. For more information, please visit www.synergypharma.com.

 

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Nuts and health in aging

Larry H. Bernstein, MD, FCAP, Curator

LPBI

 

 

Nut consumption and age-related disease

Giuseppe GrossoRamon Estruch

MATURITAS · OCT 2015     http://dx.doi.org/10.1016/j.maturitas.2015.10.014

Current knowledge on the effects of nut consumption on human health has rapidly increased in recent years and it now appears that nuts may play a role in the prevention of chronic age-related diseases. Frequent nut consumption has been associated with better metabolic status, decreased body weight as well as lower body weight gain over time and thus reduce the risk of obesity. The effect of nuts on glucose metabolism, blood lipids, and blood pressure are still controversial. However, significant decreased cardiovascular risk has been reported in a number of observational and clinical intervention studies. Thus, findings from cohort studies show that increased nut consumption is associated with a reduced risk of cardiovascular disease and mortality (especially that due to cardiovascular-related causes). Similarly, nut consumption has been also associated with reduced risk of certain cancers, such as colorectal, endometrial, and pancreatic neoplasms. Evidence regarding nut consumption and neurological or psychiatric disorders is scarce, but a number of studies suggest significant protective effects against depression, mild cognitive disorders and Alzheimer’s disease. The underlying mechanisms appear to include antioxidant and anti-inflammatory actions, particularly related to their mono- and polyunsaturated fatty acids (MUFA and PUFA, as well as vitamin and polyphenol content. MUFA have been demonstrated to improve pancreatic beta-cell function and regulation of postprandial glycemia and insulin sensitivity. PUFA may act on the central nervous system protecting neuronal and cell-signaling function and maintenance. The fiber and mineral content of nuts may also confer health benefits. Nuts therefore show promise as useful adjuvants to prevent, delay or ameliorate a number of chronic conditions in older people. Their association with decreased mortality suggests a potential in reducing disease burden, including cardiovascular disease, cancer, and cognitive impairments.

 

Global life expectancy has increased from 65 years in 1990 to about 71 years in 2013 [1]. As life expectancy has increased, the number of healthy years lost due to disability has also risen in most countries, consistent with greater morbidity [2]. Reduction of mortality rates in developed countries has been associated with a shift towards more chronic non-communicable diseases [1]. Cardiovascular diseases (CVDs) and related risk factors, such as hypertension, diabetes mellitus, hypercholesterolemia, and obesity are the top causes of death globally, accounting for nearly one-third of all deaths worldwide [3]. Equally, the estimated incidence, mortality, and disability- adjusted life-years (DALYs) for cancer rose to 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs, with the highest impact of prostate and breast cancer in men and women, respectively [4]. Depression is a leading cause of disability worldwide (in terms of total years lost due to disability), especially in high-income countries, increasing from 15th to 11th rank (37% increase) and accounting for 18% of total DALYs (almost 100 million DALYs) [5]. Overall, the global rise in chronic non-communicable diseases is congruent with a similar rise in the elderly population. The proportion of people over the age of 60 is growing faster than any other age group and is estimated to double from about 11% to 22% within the next 50 years [6]. Public health efforts are needed to face this epidemiological and demographic transition, both improving the healthcare systems, as well as assuring a better health in older people. Accordingly, a preventive approach is crucial to dealing with an ageing population to reduce the burden of chronic disease.

In this context, lifestyle behaviors have demonstrated the highest impact for older adults in preventing and controlling the morbidity and mortality due to non- communicable diseases [7]. Unhealthy behaviors, such as unbalanced dietary patterns, lack of physical activity and smoking, play a central role in increasing both cardiovascular and cancer risk [7]. Equally, social isolation and depression in later life may boost health decline and significantly contribute to mortality risk [8]. The role of diet in prevention of disability and death is a well-established factor, which has an even more important role in geriatric populations. Research has focused on the effect of both single foods and whole dietary patterns on a number of health outcomes, including mortality, cardiovascular disease (CVD), cancer and mental health disorders (such as cognitive decline and depression) [9-13]. Plantbased dietary patterns demonstrate the most convincing evidence in preventing chronic non-communicable diseases [14-17]. Among the main components (including fruit and vegetables, legumes and cereals), only lately has attention focused on foods such as nuts. Knowledge on the effect of nut consumption on human health has increased rapidly in recent years. The aim of this narrative review is to examine recent evidence regarding the role of nut consumption in preventing chronic disease in older people.

Tree nuts are dry fruits with an edible seed and a hard shell. The most popular tree nuts are almonds (Prunus amigdalis), hazelnuts (Corylus avellana), walnuts (Juglans regia), pistachios (Pistachia vera), cashews (Anacardium occidentale), pecans (Carya illinoiensis), pine nuts (Pinus pinea), macadamias (Macadamia integrifolia), Brazil nuts (Bertholletia excelsa), and chestnuts (Castanea sativa). When considering the “nut” group, researchers also include peanuts (Arachis hypogea), which technically are groundnuts. Nuts are nutrient dense foods, rich in proteins, fats (mainly unsaturated fatty acids), fiber, vitamins, minerals, as well as a number of phytochemicals, such as phytosterols and polyphenols [18]. Proteins account for about 10-25% of energy, including individual aminoacids, such as L-arginine, which is involved in the production of nitric oxide (NO), an endogenous vasodilatator [19].

The fatty acids composition of nuts involves saturated fats for 415% and unsaturated fatty acids for 30-60% of the content. Unsaturated fatty acids are different depending on the nut type, including monounsaturated fatty acids (MUFA, such as oleic acid in most of nuts, whereas polyunsaturated fatty acids (PUFA, such as alpha-linolenic acid) in pine nuts and walnuts [20]. Also fiber content is similar among most nut types (about 10%), although pine nuts and cashews hold the least content. Vitamins contained in nuts are group B vitamins, such as B6 (involved in many aspects of macronutrient metabolism) and folate (necessary for normal cellular function, DNA synthesis and metabolism, and homocysteine detoxification), as well as tocopherols, involved in anti-oxidant mechanisms [21]. Among minerals contained in vegetables, nuts have an optimal content in calcium, magnesium, and potassium, with an extremely low amount of sodium, which is implicated on a number of pathological conditions, such as bone demineralization, hypertension and insulin resistance[22]. Nuts are also rich in phytosterols, non-nutritive components of certain plant-foods that exert both structural (at cellular membrane phospholipids level) and hormonal (estrogen-like) activities [23]. Finally, nuts have been demonstrated to be a rich source of polyphenols, which account for a key role in their antioxidant and anti-inflammatory effects.

 

Metabolic disorders are mainly characterized by obesity, hypertension, dyslipidemia, and hyperglycemia/ hyperinsulinemia/type-2 diabetes, all of which act synergistically to increase morbidity and mortality of aging population.

Obesity Increasing high carbohydrate and fat food intake in the last decades has contributed significantly to the rise in metabolic disorders. Nuts are energy-dense foods that have been thought to be positively associated with increased body mass index (BMI). As calorie-dense foods, nuts may contain 160–200 calories per ounce. The recommendation from the American Heart  Association to consume 5 servings per week (with an average recommended serving size of 28 g) corresponds to a net increase of 800–1000 calories per week, which may cause weight gain. However, an inverse relation between the frequency of nut consumption and BMI has been observed in large cohort studies [24]. Pooling the baseline observations of BMI by category of nut consumption in 5 cohort studies found a significant decreasing trend in BMI values with increasing nut intake [24]. While the evidence regarding nut consumption and obesity is limited, findings so far are encouraging [25, 26]. When the association between nut consumption and body weight has been evaluated longitudinally over time, nut intake was associated with a slightly lower risk of weight gain and obesity [25]. In the Nurses’ Health Study II (NHS II), women who eat nuts ≥2 times per week had slightly less weight gain (5.04 kg) than did women who rarely ate nuts (5.55 kg) and marginally significant 23% lower risk of obesity after 9-year follow-up [25]. Further evaluation of the NHS II data and the Physicians’ Health Study (PHS) comprising a total of 120,877 US women and men and followed up to 20 years revealed that 4-y weight change was inversely associated with a 1-serving increment in the intake of nuts (20.26 kg) [27]. In the “Seguimiento Universidad de Navarra” (SUN) cohort study, a significant decreased weight change has been observed over a period of 6 years [26]. After adjustment for potential confounding factors the analysis was no longer significant, but overall no weight gain associated with >2 servings per week of nuts has been observed. Finally, when considering the role of the whole diet on body weight, a meta-analysis of 31 clinical trials led to the conclusion of a null effect of nut intake on body weight, BMI, and waist circumference [28].

Glucose metabolism and type-2 diabetes The association between nut consumption and risk of type-2 diabetes in prospective cohort studies is controversial [29-32]. A pooled analysis relied on the examination of five large cohorts, including the NHS, the Shanghai Women’s Health Study, the Iowa Women’s Health Study, and the PHS, and two European studies conducted in Spain (the PREDIMED trial) and Finland including a total of more than 230,000 participants and 13,000 cases, respectively. Consumption of 4 servings per week was associated with 13% reduced risk of type-2 diabetes without effect modification by age [29]. In contrast, other pooled analyses showed non-significant reduction of risk for increased intakes of nuts, underlying that the inverse association between the consumption of nuts and diabetes was attenuated after adjustment for confounding factors, including BMI [30]. However, results from experimental studies showed promising results. Thus, nut consumption has been demonstrated to exert beneficial metabolic effects due to their action on post-prandial glycemia an insulin sensitivity. A number of RCTs have demonstrated positive effects of nut consumption on post-prandial glycemia in healthy individuals [33-38]. Moreover, a meta-analysis of RCTs on the effects of nut intake on glycemic control in diabetic individuals including 12 trials and a total of 450 participants showed that diets with an emphasis on nuts (median dose = 56 g/d) significantly lowered HbA1c (Mean Difference [MD] : -0.07%; 95% confidence interval [CI]: -0.10, -0.03%; P = 0.0003) and fasting glucose (MD : -0.15 mmol/L; 95% CI: -0.27, -0.02 mmol/L; P = 0.03) compared with control diets [39]. No significant treatment effects were observed for fasting insulin and homeostatic model assessment (HOMA-IR), despite the direction of effect favoring diet regimens including nuts.

Blood lipids and hypertension Hypertension and dyslipidemia are major risk factors for CVD. Diet alone has a predominant role in blood pressure and plasma lipid homeostasis. One systematic review [40] and 3 pooled quantitative analyses of RCTs [41-43] evaluated the effects of nut consumption on lipid profiles. A general agreement was relevant on certain markers, as daily consumption of nuts (mean = 67 g/d) induced a pooled reduction of total cholesterol concentration (10.9 mg/dL [5.1% change]), low-density lipoprotein cholesterol concentration (LDL-C) (10.2 mg/dL [7.4% change]), ratio of LDL-C to high-density lipoprotein cholesterol concentration (HDL-C) (0.22 [8.3% change]), and ratio of total cholesterol concentration to HDL-C (0.24 [5.6% change]) (P <0.001 for all) [42]. All meta-analyses showed no significant effects of nut (including walnut) consumption on HDL cholesterol or triglyceride concentrations in healthy individuals [41], although reduced plasma triglyceride levels were found in individuals with hypertriglyceridemia [42]. Interestingly, the effects of nut consumption were dose related, and different types of nuts had similar effects on blood lipid concentrations.

There is only limited evidence from observational studies to suggest that nuts have a protective role on blood pressure. A pooled analysis of prospective cohort studies on nut consumption and hypertension reported a decreased risk associated with increased intake of nuts [32]. Specifically, only a limited number of cohort studies have been conducted exploring the association between nut consumption and hypertension (n = 3), but overall reporting an 8% reduced risk of hypertension for individuals consuming >2 servings per week (Risk Ratio [RR] = 0.92, 95% CI: 0.87-0.97) compared with never/rare consumers, whereas consumption of nuts at one serving per week had similar risk estimates (RR = 0.97, 95% CI: 0.83, 1.13) [32]. These findings are consistent with results obtained in a pooled analysis of 21 experimental studies reporting the effect of consuming single or mixed nuts (in doses ranging from 30 to 100 g/d) on systolic (SBP) and diastolic blood pressure (DBP) [44]. A pooled analysis found a significant reduction in SBP in participants without type2 diabetes [MD: -1.29 mmHg; 95% CI: -2.35, -0.22; P = 0.02] and DBP (MD: -1.19; 95% CI: -2.35, -0.03; P = 0.04), whereas subgroup analyses of different nut types showed that pistachios, but not other nuts, significantly reduced SBP (MD: -1.82; 95% CI: -2.97, -0.67; P = 0.002) and SBP (MD: -0.80; 95% CI: -1.43, -0.17; P = 0.01) [44].

Nut consumption and CVD risk Clustering of metabolic risk factors occurs in most obese individuals, greatly increasing risk of CVD. The association between nut consumption and CVD incidence [29-31] and mortality [24] has been explored in several pooled analyses of prospective studies. The overall risk calculated for CVD on a total of 8,862 cases was reduced by 29% for individuals consuming 7 servings per week (RR = 0.71, 95% CI: 0.59, 0.85) [30]. A meta-analysis including 9 studies on coronary artery disease (CAD) including 179,885 individuals and 7,236 cases, reporting that 1-serving/day increment would reduce risk of CAD of about 20% (RR = 0.81, 95% CI: 0.72, 0.91) [31]. Similar risk estimates were calculated for ischemic heart disease (IHD), with a comprehensive reduced risk of about 25-30% associated with a daily intake of nuts [29, 30]. Findings from 4 prospective studies have been pooled to estimate the association between nut consumption and risk of stroke, and a non-significant/borderline reduced risk was found [29-31, 45]. CVD mortality was explored in a recent meta-analysis including a total of 354,933 participants, 44,636 cumulative incident deaths, and 3,746,534 cumulative person-years [24]. One serving of nuts per week and per day resulted in decreased risk of CVD mortality (RR = 0.93, 95% CI: 0.88, 0.99 and RR =0.61, 95% CI: 0.42, 0.91, respectively], primarily driven by decreased coronary artery disease (CAD) deaths rather than stroke deaths [24]. Overall, all pooled analyses demonstrated a significant association between nut consumption and cardiovascular health. However, it has been argued that nut consumption was consistently associated with healthier background characteristics reflecting overall healthier lifestyle choices that eventually lead to decreased CVD mortality risk.

Nut consumption and cancer risk Cancer is one of the leading causes of death in the elderly population. After the evaluation of the impact on cancer burden of food and nutrients, it has been concluded that up to one third of malignancies may be prevented by healthy lifestyle choices. Fruit and vegetable intake has been the focus of major attention, but studies on nut consumption and cancer are scarce. A recent metaanalysis pooled together findings of observational studies on cancer incidence, including a total of 16 cohort and 20 casecontrol studies comprising 30,708 cases, compared the highest category of nut consumption with the lowest category and found a lower risk of any cancer of 25% (RR = 0.85, 95% CI: 0.86, 0.95) [46]. When the analysis was conducted by cancer site, highest consumption of nuts was associated with decreased risk of colorectal (RR = 0.76, 95% CI: 0.61, 0.96), endometrial (RR = 0.58, 95% CI: 0.43, 0.79), and pancreatic cancer (RR = 0.71, 95% CI: 0.51, 0.99), with only one cohort study was conducted on the last [46]. The potential protective effects of nut consumption on cancer outcomes was supported also by pooled analysis of 3 cohort studies [comprising the PREDIMED, the NHS, the HPS, and the Health Professionals Follow-Up Study (HPFS) cohorts] showing a decreased risk of cancer death for individuals consuming 3-5 servings of nuts per week compared with never eaters (RR = 0.86, 95% CI: 0.75, 0.98) [24]. The analysis was recently updated by including results from the Netherlands Cohort Study reaching a total of 14,340 deaths out of 247,030 men and women observed, confirming previous results with no evidence of between-study heterogeneity (RR = 0.85, 95% CI: 0.77, 0.93) [47]. However, a dose- response relation showed the non-linearity of the association, suggesting that only moderate daily consumption up to 5 g reduced risk of cancer mortality, and extra increased intakes were associated with no further decreased risk.

Nut consumption and affective/cognitive disorders Age-related cognitive decline is one of the most detrimental health problems in older people. Cognitive decline is a paraphysiological process of aging, but timing and severity of onset has been demonstrated to be affected by modifiable lifestyle factors, including diet. In fact, the nature of the age- related conditions leading to a mild cognitive impairment (MCI) differs by inflammation-related chronic neurodegenerative diseases, such as dementia, Alzheimer’s disease, Parkinson’s disease and depression. Evidence restricted to nut consumption alone is scarce, but a number of studies have been conducted on dietary patterns including nuts as a major component. A pooled analysis synthesizing findings of studies examining the association between adherence to a traditional Mediterranean diet and risk of depression (n = 9), cognitive decline (n = 8), and Parkinson’s disease (n = 1) showed a reduction of risk of depression (RR = 0.68, 95% CI: 0.54, 0.86) and cognitive impairment (RR = 0.60, 95% CI: 0.43, 0.83) in individuals with increased dietary adherence [10].

The study that first found a decreased risk of Alzheimer’s disease in individuals highly adherent to the Mediterranean diet was conducted in over 2,000 individuals in the Washington/Hamilton Heights-Inwood Columbia Aging Project (WHICAP), a cohort of non-demented elders aged 65 and older living in a multi-ethnic community of Northern Manhattan in the US (Hazard Ratio [HR] = 0.91, 95% CI: 0.83, 0.98) [48]. These results have been replicated in further studies on the Mediterranean diet, however nut consumption was not documented [49, 50]. A number of observational studies also demonstrated a significant association between this dietary pattern and a range of other cognitive outcomes, including slower global cognitive decline [51]. However, evidence from experimental studies is limited to the PREDIMED trial, providing interesting insights on the association between the Mediterranean diet supplemented with mixed nuts and both depression and cognitive outcomes. Regarding depression, the nutritional intervention with a Mediterranean diet supplemented with nuts showed a lower risk of about 40% in participants with type-2 diabetes (RR = 0.59, 95% CI: 0.36, 0.98) compared with the control diet [52]. However the effect was not significant in the whole cohort overall [52]. Regarding cognitive outcomes after a mean follow-up of 4.1 years, findings from the same trial showed significant improvements in memory and global cognition tests for individuals allocated to the Mediterranean diet supplemented with nuts [adjusted differences: -0.09 (95% CI: -0.05, 0.23), P = 0.04 and -0.05 (95% CI: -0.27, 0.18), P = 0.04, respectively], compared to control group, showing that Mediterranean diet plus mixed nuts is associated with improved cognitive function [53].

 

Potential mechanisms of protection of nut consumption Despite the exact mechanisms by which nuts may ameliorate human health being largely unknown, new evidence has allowed us to start to better understand the protection of some high-fat, vegetable, energy-dense foods such as nuts. Non- communicable disease burden related with nutritional habits is mainly secondary to exaggerated intakes of refined sugars and saturated fats, such as processed and fast- foods. Nuts provide a number of nutrient and non-nutrient compounds and it is only recently that scientists have tried to examine their effects on metabolic pathways.

Metabolic and cardiovascular protection With special regard to body weight and their potential effects in decreasing the risk of obesity (or weight gain, in general), nuts may induce satiation (reduction in the total amount of food eaten in a single meal) and satiety (reduction in the frequency of meals) due to their content in fibers and proteins, which are associated with increased release of glucagon-like protein 1 (GLP-1) and cholecystokinin (CCK), gastrointestinal hormones with satiety effects [54, 55]. The content in fiber of nuts may also increase thermogenesis and resting energy expenditure, and reduce post- prandial changes of glucose, thus ameliorating inflammation and insulin resistance. Moreover, the specific content profile of MUFA and PUFA provides readily oxidized fats than saturated or trans fatty acids, leading to reduced fat accumulation [56, 57]. The beneficial effects of nuts toward glucose metabolism may be provided by their MUFA content that improves the efficiency of pancreatic beta-cell function by enhancing the secretion of GLP1, which in turn helps the regulation of postprandial glycemia and insulin sensitivity [58]. MUFA and PUFA are also able to reduce serum concentrations of the vasoconstrictor thromboxane 2, which might influence blood pressure regulation. Together with polyphenols and anti-oxidant vitamins, nuts may also ameliorate inflammatory status at the vascular level, reducing circulating levels of soluble cellular adhesion molecules, such as intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin, which are released from the activated endothelium and circulating monocytes [59]. Moreover, nuts may improve vascular reactivity due to their content in L-arginine, which is a potent precursor of the endogenous vasodilator nitric oxide. Nuts content in microelements is characterized by a mixture that may exert a direct effect in modulating blood pressure, including low content of sodium and richness in magnesium, potassium and calcium, which may interact to beneficially influence blood pressure
Despite the exact mechanisms by which nuts may ameliorate human health being largely unknown, new evidence has allowed us to start to better understand the protection of some high-fat, vegetable, energy-dense foods such as nuts. Non- communicable disease burden related with nutritional habits is mainly secondary to exaggerated intakes of refined sugars and saturated fats, such as processed and fast- foods. Nuts provide a number of nutrient and non-nutrient compounds and it is only recently that scientists have tried to examine their effects on metabolic pathways.

Cancer protection The potential mechanisms of action of nuts that may intervene in the prevention of cancer have not been totally elucidated. Numerous hypotheses have been proposed on the basis of basic research exploring the antioxidant and anti-inflammatory compounds characterizing nuts [61]. Vitamin E can regulate cell differentiation and proliferation, whereas polyphenols (particularly flavonoids such as quercetin and stilbenes such as resveratrol) have been shown to inhibit chemically-induced carcinogenesis [62]. Polyphenols may regulate the inflammatory response and immunological activity by acting on the formation of the prostaglandins and pro-inflammatory cytokines, which may be an important mechanism involved in a number of cancers, including colorectal, gastric, cervical and pancreatic neoplasms [62]. Among other compounds contained in nuts, dietary fiber may exert protective effects toward certain cancers (including, but not limited to colorectal cancer) by the aforementioned metabolic effects as well as increasing the volume of feces and anaerobic fermentation, and reducing the length of intestinal transit. As a result, the intestinal mucosa is exposed to carcinogens for a reduced time and the carcinogens in the colon are diluted [62]. Finally, there is no specific pathway demonstrating the protective effect of PUFA intake against cancer, but their interference with cytokines and prostaglandin metabolism may inhibit a state of chronic inflammation that may increase cancer risk [63].

Cognitive aging and neuro-protection There is no universal mechanism of action for nuts with regard to age-related conditions. A number of systemic biological conditions, such as oxidative stress, inflammation, and reduced cerebral blood flow have been considered as key factors in the pathogenesis of both normal cognitive ageing and chronic neurodegenerative disease [64]. Nuts, alone or as part of healthy dietary patterns, may exert beneficial effects due to their richness in antioxidants, including vitamins, polyphenols and unsaturated fatty acids, that may be protective against the development of cognitive decline and depression [65, 66]. Both animal studies and experimental clinical trials demonstrated vascular benefits of nuts, including the aforementioned lowering of inflammatory markers and improved endothelial function, which all appear to contribute to improved cognitive function [67]. The antioxidant action may affect the physiology of the ageing brain directly, by protecting neuronal and cell-signaling function and maintenance. Moreover, certain compounds contained in nuts may directly interact with the physiology and functioning of the brain. For instance, walnuts are largely composed of PUFA, especially ALA, which have been suggested to induce structural change in brain areas associated with affective experience [66]. Moreover, PUFA have been associated with improved symptoms in depressed patients, suggesting an active role in the underlying pathophysiological mechanisms [68]. Thus, the mechanisms of action of nut consumption on age-related cognitive and depressive disorders are complex, involving direct effects on brain physiology at the neuronal and cellular level and indirect effects by influencing inflammation.

 

Summary From an epidemiological point of view, nut eaters have been associated with overall healthier lifestyle habits, such as increased physical activity, lower prevalence of smoking, and increased consumption of fruits and vegetables [24]. These variables represent strong confounding factors in determining the effects of nuts alone on human health and final conclusions cannot be drawn. Nevertheless, results from clinical trials are encouraging. Nuts show promise as useful adjuvants to prevent, delay or ameliorate a number of chronic conditions in older people.

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Muscular dystrophy has deficient stem cell dystrophin

Larry H. Bernstein, MD, FCAP, Curator

LPBI

Article ID #198: Muscular dystrophy has deficient stem cell dystrophin. Published on 11/21/2015

WordCloud Image Produced by Adam Tubman

Dystrophin Deficient Stem Cell Pathology

Muscular Dystrophy is a Stem Cell-Based Disease

Because DMD results from mutations in the dystrophin gene, the vast majority of muscular dystrophy research was based on a simple model in which the Dystrophin protein played a structural role in the structural integrity of muscle fibers. Abnormal versions of the Dystrophin protein caused the muscle fibers to become damaged and die as a result of contraction.  Dystrophin anchors the cytoskeleton of the muscle fibers, which are essential for muscle contraction, to the muscle cell membrane, and then to the extracellular matrix outside the cell that serves as a foundation upon which the muscle cells are built.

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However in this current study, Rudnicki and his team discovered that muscle stem cells also express the dystrophin protein. This is a revelation because Dystrophin was thought to be protein that ONLY appeared in mature muscle. However, in this study, it became exceedingly clear that in the absence of Dystrophin, muscle stem cells generated ten-fold fewer muscle precursor cells, and, consequently, far fewer functional muscle fibers. Dystrophin is also a component of a signal transduction pathway that allows muscle stem cells to properly ascertain if they need to replace dead or dying muscle.  Muscle stem cells repair the muscle in response to injury or exercise by dividing to generate precursor cells that differentiate into muscle fibers.

Even though Rudnicki used mice as a model system in these experiments, the Dystrophin protein is highly conserved in most vertebrate animals. Therefore, it is highly likely that these results will also apply to human muscle stem cells.

Gene therapy experiments and trials are in progress and even show some promise, but Rudnicki’s work tells us that gene therapy approaches must target muscle stem cells as well as muscle fibers if they are to work properly.

“We’re already looking at approaches to correct this problem in muscle stem cells,” said Dr. Rudnicki.

This paper has received high praise from the likes of Ronald Worton, who was one of the co-discovers of the dystrophin gene with Louis Kunkel in 1987.

Early pathogenesis of Duchenne muscular dystrophy modelled in patient-derived human induced pluripotent stem cells

Emi Shoji, Hidetoshi Sakurai, Tokiko Nishino, Tatsutoshi Nakahata, Toshio Heike, Tomonari Awaya, Nobuharu Fujii, Yasuko Manabe, Masafumi Matsuo & Atsuko Sehara-Fujisawa

Scientific Reports 5, Article number: 12831 (2015)   http://dx.doi.org:/10.1038/srep12831

Duchenne muscular dystrophy (DMD) is a progressive and fatal muscle degenerating disease caused by a dystrophin deficiency. Effective suppression of the primary pathology observed in DMD is critical for treatment. Patient-derived human induced pluripotent stem cells (hiPSCs) are a promising tool for drug discovery. Here, we report an in vitro evaluation system for a DMD therapy using hiPSCs that recapitulate the primary pathology and can be used for DMD drug screening. Skeletal myotubes generated from hiPSCs are intact, which allows them to be used to model the initial pathology of DMD in vitro. Induced control and DMD myotubes were morphologically and physiologically comparable. However, electric stimulation of these myotubes for in vitro contraction caused pronounced calcium ion (Ca2+) influx only in DMD myocytes. Restoration of dystrophin by the exon-skipping technique suppressed this Ca2+ overflow and reduced the secretion of creatine kinase (CK) in DMD myotubes. These results suggest that the early pathogenesis of DMD can be effectively modelled in skeletal myotubes induced from patient-derived iPSCs, thereby enabling the development and evaluation of novel drugs.

Duchenne muscular dystrophy (DMD) is characterised by progressive muscle atrophy and weakness that eventually leads to ambulatory and respiratory deficiency from early childhood1. It is an X-linked recessive inherited disease with a relatively high frequency of 1 in 3500 males1,2.DMD, which is responsible for DMD, encodes 79 exons and produces dystrophin, which is one of the largest known cytoskeletal structural proteins3. Most DMD patients have various types of deletions or mutations in DMD that create premature terminations, resulting in a loss of protein expression4. Several promising approaches could be used to treat this devastating disease, such as mutation-specific drug exon-skipping5,6, cell therapy7, and gene therapy1,2.

Myoblasts from patients are the most common cell sources for assessing the disease phenotypes of DMD11,12. …Previous reports have shown that muscle cell differentiation from DMD patient myoblasts is delayed and that these cells have poor proliferation capacity compared to those of healthy individuals11,12. Our study revealed that control and DMD myoblasts obtained by activating tetracycline-dependent MyoD transfected into iPS cells (iPStet-MyoD cells) have comparable growth and differentiation potential and can produce a large number of intact and homogeneous myotubes repeatedly.

The pathogenesis of DMD is initiated and progresses with muscle contraction. The degree of muscle cell damage at the early stage of DMD can be evaluated by measuring the leakage of creatine kinase (CK) into the extracellular space15. Excess calcium ion (Ca2+) influx into skeletal muscle cells, together with increased susceptibility to plasma membrane injury, is regarded as the initial trigger of muscle damage in DMD19,20,21,22,23,24. Targeting these early pathogenic events is considered essential for developing therapeutics for DMD.

In this study, we established a novel evaluation system to analyse the cellular basis of early DMD pathogenesis by comparing DMD myotubes with the same clone but with truncated dystrophin-expressing DMD myotubes, using the exon-skipping technique. We demonstrated through in vitro contraction that excessive Ca2+ influx is one of the earliest events to occur in intact dystrophin-deficient muscle leading to extracellular leakage of CK in DMD myotubes.

Generation of tetracycline-inducible MyoD-transfected DMD patient-derived iPSCs (iPStet-MyoD cells)

Figure 1: Generation and characterization of control and DMD patient-derived Tet-MyoD-transfected hiPS cells.   Full size image

Morphologically and physiologically comparable intact myotubes differentiated from control and DMD-derived hiPSCs

Figure 2: Morphologically and physiologically comparable skeletal muscle cells differentiated from Control-iPStet-MyoD and DMD-iPStet-MyoD.   Full size image

Exon-skipping with AO88 restored expression of Dystrophin in DMD myotubes differentiated from DMD-iPStet-MyoD cells

 

Figure 3: Restoration of dystrophin protein expression by AO88.   Full size image

 
Restored dystrophin expression attenuates Ca2+ overflow in DMD-Myocytes

 

Figure 4: Restored expression of dystrophin diminishes Ca2+ influx in DMD muscle in response to electric stimulation.   Full size image


Ca2+ influx provokes skeletal muscle cellular damage in DMD muscle

 

Figure 5: Ca2+ influx induces prominent skeletal muscle cellular damage in DMD-Myocytes.   Full size image

 

Skeletal muscle differentiation in myoblasts from DMD patients is generally delayed compared to that in healthy individuals11,36,37.  Our differentiation system successfully induced the formation of myotubes from DMD patients, and the myotubes displayed analogous morphology and maturity compared with control myotubes (Fig. 2a–c).  Comparing myotubes generated from patient-derived iPS cells with those derived from the same DMD clones but expressing dystrophin by application of the exon-skipping technique enabled us to demonstrate the primary cellular phenotypes in skeletal muscle solely resulting from the loss of the dystrophin protein (Fig. 4b).  Our results demonstrate that truncated but functional dystrophin protein expression improved the cellular phenotype of DMD myotubes.

In DMD, the lack of dystrophin induces an excess influx of Ca2+ , leading to pathological dystrophic changes22. We consistently observed excess Ca2+ influx in DMD-Myocytes compared to Control-Myocytes (Supplementary Figure S3a and S3b) in response to electric stimulation. TRP channels, which are mechanical stimuli-activated Ca2+ channels40that are expressed in skeletal muscle cells41, can account for this pathogenic Ca2+ influx…

In conclusion, our study revealed that the absence of dystrophin protein induces skeletal muscle damage by allowing excess Ca2+ influx in DMD myotubes. Our experimental system recapitulated the early phase of DMD pathology as demonstrated by visualisation and quantification of Ca2+ influx using intact myotubes differentiated from hiPS cells.  This evaluation system significantly expands prospective applications with regard to assessing the effectiveness of exon-skipping drugs and also enables the discovery of drugs that regulate the initial events in DMD.

Duchenne muscular dystrophy affects stem cells, University of Ottawa study finds  

New treatments could one day be available for the most common form of muscular dystrophy after a study suggests the debilitating genetic disease affects the stem cells that produce healthy muscle fibres.

The findings are based on research from the University of Ottawa and The Ottawa Hospital, published Monday in the journal Nature Medicine.

For nearly two decades, doctors had thought the muscular weakness that is the hallmark of the disease was due to problems with human muscle fibers, said Dr. Michael Rudnicki, the study’s senior author.

The new research shows the specific protein characterized by its absence in Duchenne muscular dystrophy normally exists in stem cells.

Dystrophin protein found in stem cells

“The prevailing notion was that the protein that’s missing in Duchenne muscular dystrophy — a protein called dystrophin — was not involved at all in the function of the stem cells.”

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When the genetic mutations caused by Duchenne muscular dystrophy inhibit the production of dystrophin in stem cells, those stem cells produce significantly fewer precursor cells — and thus fewer properly functioning muscle fibres.  Further, stem cells need dystrophin to sense their environment to figure out if they need to divide to produce more stem cells or perform muscle repair work.

Genetic repair might treat Duchenne muscular dystrophy

July 25, 2011|By Thomas H. Maugh II, Los Angeles Times
 

A genetic technique that allows the body to work around a crucial mutation that causes Duchenne muscular dystrophy increased the mass and function of muscles in a small group of patients with the devastating disease, paving the way for larger clinical trials of the drug. The study in a handful of boys age 5 to 15 showed that patients receiving the highest level of the drug, called AVI-4658 or eteplirsen, had a significant increase in production of a missing protein and increases in muscle fibers. The study demonstrated that the drug is safe in the short term. Results were reported Sunday in the journal Lancet.

Duchenne muscular dystrophy affects about one in every 3,500 males worldwide. It is caused by any one of several different mutations that affect production of a protein called dystrophin, which is important for the production and maintenance of muscle fibers. Affected patients become unable to walk and must use a wheelchair by age 8 to 12. Deterioration continues through their teens and 20s, and the condition typically proves fatal as muscle failure impairs their ability to breathe.

This study is designed to assess the efficacy, safety, tolerability, and pharmacokinetics (PK) of AVI-4658 (eteplirsen) in both 50.0 mg/kg and 30.0 mg/kg doses administered over 24 weeks in subjects diagnosed with Duchenne muscular dystrophy (DMD).

 

Condition Intervention Phase
Duchenne Muscular Dystrophy Drug: AVI-4658 (Eteplirsen)
Other: Placebo
Phase 2
Study Type:Interventional
Study Design:Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title:A Randomized, Double-Blind, Placebo-Controlled, Multiple Dose Efficacy, Safety, Tolerability and Pharmacokinetics Study of AVI-4658(Eteplirsen),in the Treatment of Ambulant Subjects With Duchenne Muscular Dystrophy
 
 
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Dystrophin expression in muscle stem cells regulates their polarity and asymmetric division

Nature Medicine(2015)   http://dx.doi.org:/10.1038/nm.3990

Dystrophin is expressed in differentiated myofibers, in which it is required for sarcolemmal integrity, and loss-of-function mutations in the gene that encodes it result in Duchenne muscular dystrophy (DMD), a disease characterized by progressive and severe skeletal muscle degeneration. Here we found that dystrophin is also highly expressed in activated muscle stem cells (also known as satellite cells), in which it associates with the serine-threonine kinase Mark2 (also known as Par1b), an important regulator of cell polarity. In the absence of dystrophin, expression of Mark2 protein is downregulated, resulting in the inability to localize the cell polarity regulator Pard3 to the opposite side of the cell. Consequently, the number of asymmetric divisions is strikingly reduced in dystrophin-deficient satellite cells, which also display a loss of polarity, abnormal division patterns (including centrosome amplification), impaired mitotic spindle orientation and prolonged cell divisions. Altogether, these intrinsic defects strongly reduce the generation of myogenic progenitors that are needed for proper muscle regeneration. Therefore, we conclude that dystrophin has an essential role in the regulation of satellite cell polarity and asymmetric division. Our findings indicate that muscle wasting in DMD not only is caused by myofiber fragility, but also is exacerbated by impaired regeneration owing to intrinsic satellite cell dysfunction.

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Irreconciliable Dissonance in Physical Space and Cellular Metabolic Conception

Irreconciliable Dissonance in Physical Space and Cellular Metabolic Conception

Curator: Larry H. Bernstein, MD, FCAP

Pasteur Effect – Warburg Effect – What its history can teach us today. 

José Eduardo de Salles Roselino

The Warburg effect, in reality the “Pasteur-effect” was the first example of metabolic regulation described. A decrease in the carbon flux originated at the sugar molecule towards the end of the catabolic pathway, with ethanol and carbon dioxide observed when yeast cells were transferred from an anaerobic environmental condition to an aerobic one. In Pasteur´s studies, sugar metabolism was measured mainly by the decrease of sugar concentration in the yeast growth media observed after a measured period of time. The decrease of the sugar concentration in the media occurs at great speed in yeast grown in anaerobiosis (oxygen deficient) and its speed was greatly reduced by the transfer of the yeast culture to an aerobic condition. This finding was very important for the wine industry of France in Pasteur’s time, since most of the undesirable outcomes in the industrial use of yeast were perceived when yeasts cells took a very long time to create, a rather selective anaerobic condition. This selective culture media was characterized by the higher carbon dioxide levels produced by fast growing yeast cells and by a higher alcohol content in the yeast culture media.

However, in biochemical terms, this finding was required to understand Lavoisier’s results indicating that chemical and biological oxidation of sugars produced the same calorimetric (heat generation) results. This observation requires a control mechanism (metabolic regulation) to avoid burning living cells by fast heat released by the sugar biological oxidative processes (metabolism). In addition, Lavoisier´s results were the first indications that both processes happened inside similar thermodynamics limits. In much resumed form, these observations indicate the major reasons that led Warburg to test failure in control mechanisms in cancer cells in comparison with the ones observed in normal cells.

[It might be added that the availability of O2 and CO2 and climatic conditions over 750 million years that included volcanic activity, tectonic movements of the earth crust, and glaciation, and more recently the use of carbon fuels and the extensive deforestation of our land masses have had a large role in determining the biological speciation over time, in sea and on land. O2 is generated by plants utilizing energy from the sun and conversion of CO2. Remove the plants and we tip the balance. A large source of CO2 is from beneath the earth’s surface.]

Biology inside classical thermodynamics places some challenges to scientists. For instance, all classical thermodynamics must be measured in reversible thermodynamic conditions. In an isolated system, increase in P (pressure) leads to increase in V (volume), all this occurring in a condition in which infinitesimal changes in one affects in the same way the other, a continuum response. Not even a quantic amount of energy will stand beyond those parameters.

In a reversible system, a decrease in V, under same condition, will led to an increase in P. In biochemistry, reversible usually indicates a reaction that easily goes either from A to B or B to A. For instance, when it was required to search for an anti-ischemic effect of Chlorpromazine in an extra hepatic obstructed liver, it was necessary to use an adequate system of increased biliary system pressure in a reversible manner to exclude a direct effect of this drug over the biological system pressure inducer (bile secretion) in Braz. J. Med. Biol. Res 1989; 22: 889-893. Frequently, these details are jumped over by those who read biology in ATGC letters.

Very important observations can be made in this regard, when neutral mutations are taken into consideration since, after several mutations (not affecting previous activity and function), a last mutant may provide a new transcript RNA for a protein and elicit a new function. For an example, consider a Prion C from lamb getting similar to bovine Prion C while preserving  its normal role in the lamb when its ability to change Human Prion C is considered (Stanley Prusiner).

This observation is good enough, to confirm one of the most important contributions of Erwin Schrodinger in his What is Life:

“This little book arose from a course of public lectures, delivered by a theoretical physicist to an audience of about four hundred which did not substantially dwindle, though warned at the outset that the subject matter was a difficult one and that the lectures could not be termed popular, even though the physicist’s most dreaded weapon, mathematical deduction, would hardly be utilized. The reason for this was not that the subject was simple enough to be explained without mathematics, but rather that it was much too involved to be fully accessible to mathematics.”

After Hans Krebs, description of the cyclic nature of the citrate metabolism and after its followers described its requirement for aerobic catabolism two major lines of research started the search for the understanding of the mechanism of energy transfer that explains how ADP is converted into ATP. One followed the organic chemistry line of reasoning and therefore, searched for a mechanism that could explain how the breakdown of carbon-carbon link could have its energy transferred to ATP synthesis. One of the major leaders of this research line was Britton Chance. He took into account that relatively earlier in the series of Krebs cycle reactions, two carbon atoms of acetyl were released as carbon dioxide ( In fact, not the real acetyl carbons but those on the opposite side of citrate molecule). In stoichiometric terms, it was not important whether the released carbons were or were not exactly those originated from glucose carbons. His research aimed at to find out an intermediate proteinaceous intermediary that could act as an energy reservoir. The intermediary could store in a phosphorylated amino acid the energy of carbon-carbon bond breakdown. This activated amino acid could transfer its phosphate group to ADP producing ATP. A key intermediate involved in the transfer was identified by Kaplan and Lipmann at John Hopkins as acetyl coenzyme A, for which Fritz Lipmann received a Nobel Prize.

Alternatively, under possible influence of the excellent results of Hodgkin and Huxley a second line of research appears. The work of Hodgkin & Huxley indicated that the storage of electrical potential energy in transmembrane ionic asymmetries and presented the explanation for the change from resting to action potential in excitable cells. This second line of research, under the leadership of Peter Mitchell postulated a mechanism for the transfer of oxide/reductive power of organic molecules oxidation through electron transfer as the key for the energetic transfer mechanism required for ATP synthesis.
This diverted the attention from high energy (~P) phosphate bond to the transfer of electrons. During most of the time the harsh period of the two confronting points of view, Paul Boyer and followers attempted to act as a conciliatory third party, without getting good results, according to personal accounts (in L. A. or Latin America) heard from those few of our scientists who were able to follow the major scientific events held in USA, and who could present to us later. Paul  Boyer could present how the energy was transduced by a molecular machine that changes in conformation in a series of 3 steps while rotating in one direction in order to produce ATP and in opposite direction in order to produce ADP plus Pi from ATP (reversibility).

However, earlier, a victorious Peter Mitchell obtained the result in the conceptual dispute, over the Britton Chance point of view, after he used E. Coli mutants to show H+ gradients in the cell membrane and its use as energy source, for which he received a Nobel Prize. Somehow, this outcome represents such a blow to Chance’s previous work that somehow it seems to have cast a shadow over very important findings obtained during his earlier career that should not be affected by one or another form of energy transfer mechanism.  For instance, Britton Chance got the simple and rapid polarographic assay method of oxidative phosphorylation and the idea of control of energy metabolism that brings us back to Pasteur.

This metabolic alternative result seems to have been neglected in the recent years of obesity epidemics, which led to a search for a single molecular mechanism required for the understanding of the accumulation of chemical (adipose tissue) reserve in our body. It does not mean that here the role of central nervous system is neglected. In short, in respiring mitochondria the rate of electron transport linked to the rate of ATP production is determined primarily by the relative concentrations of ADP, ATP and phosphate in the external media (cytosol) and not by the concentration of respiratory substrate as pyruvate. Therefore, when the yield of ATP is high as it is in aerobiosis and the cellular use of ATP is not changed, the oxidation of pyruvate and therefore of glycolysis is quickly (without change in gene expression), throttled down to the resting state. The dependence of respiratory rate on ADP concentration is also seen in intact cells. A muscle at rest and using no ATP has a very low respiratory rate.   [When skeletal muscle is stressed by high exertion, lactic acid produced is released into the circulation and is metabolized aerobically by the heart at the end of the activity].

This respiratory control of metabolism will lead to preservation of body carbon reserves and in case of high caloric intake in a diet, also shows increase in fat reserves essential for our biological ancestors survival (Today for our obesity epidemics). No matter how important this observation is, it is only one focal point of metabolic control. We cannot reduce the problem of obesity to the existence of metabolic control. There are numerous other factors but on the other hand, we cannot neglect or remove this vital process in order to correct obesity. However, we cannot explain obesity ignoring this metabolic control. This topic is so neglected in modern times that we cannot follow major research lines of the past that were interrupted by the emerging molecular biology techniques and the vain belief that a dogmatic vision of biology could replace all previous knowledge by a new one based upon ATGC readings. For instance, in order to display bad consequences derived from the ignorance of these old scientific facts, we can take into account, for instance, how ion movements across membranes affects membrane protein conformation and therefore contradicts the wrong central dogma of molecular biology. This change in protein conformation (with unchanged amino acid sequence) and/or the lack of change in protein conformation is linked to the factors that affect vital processes as the heart beats. This modern ignorance could also explain some major pitfalls seen in new drugs clinical trials and in a small scale on bad medical practices.

The work of Britton Chance and of Peter Mitchell have deep and sound scientific roots that were made with excellent scientific techniques, supported by excellent scientific reasoning and that were produced in a large series of very important intermediary scientific results. Their sole difference was to aim at very different scientific explanations as their goals (They have different Teleology in their minds made by their previous experiences). When, with the use of mutants obtained in microorganisms P Mitchell´s goal was found to survive and B Chance to succumb to the experimental evidence, all those excellent findings of B Chance and followers were directed to the dustbin of scientific history as an example of lack of scientific consideration.  [On the one hand, the Mitchell model used a unicellular organism; on the other, Chance’s work was with eukaryotic cells, quite relevant to the discussion.]

We can resume the challenge faced by these two great scientists in the following form: The first conceptual unification in bioenergetics, achieved in the 1940s, is inextricably bound up with the name of Fritz Lipmann. Its central feature was the recognition that adenosine triphosphate, ATP, serves as a universal energy  “currency” much as money serves as economic currency. In a nutshell, the purpose of metabolism is to support the synthesis of ATP. In microorganisms, this is perfect! In humans or mammals, or vertebrates, by the same reason that we cannot consider that gene expression is equivalent to protein function (an acceptable error in the case of microorganisms) this oversimplifies the metabolic requirement with a huge error. However, in case our concern is ATP chemistry only, the metabolism produces ATP and the hydrolysis of ATP pays for the performance of almost, all kinds of works. It is possible to presume that to find out how the flow of metabolism (carbon flow) led to ATP production must be considered a major focal point of research of the two contenders. Consequently, what could be a minor fall of one of the contenders, in case we take into account all that was found during their entire life of research, the real failure in B Chance’s final goal was amplified far beyond what may be considered by reason!

Another aspect that must be taken into account: Both contenders have in the scientific past a very sound root. Metabolism may produce two forms of energy currency (I personally don´t like this expression*) and I use it here because it was used by both groups in order to express their findings. Together with simplistic thermodynamics, this expression conveys wrong ideas): The second kind of energy currency is the current of ions passing from one side of a membrane to the other. The P. Mitchell scientific root undoubtedly have the work of Hodgkin & Huxley, Huxley &  Huxley, Huxley & Simmons

*ATP is produced under the guidance of cell needs and not by its yield. When glucose yields only 2 ATPs per molecule it is oxidized at very high speed (anaerobiosis) as is required to match cellular needs. On the other hand, when it may yield (thermodynamic terms) 38 ATP the same molecule is oxidized at low speed. It would be similar to an investor choice its least money yield form for its investment (1940s to 1972) as a solid support. B. Chance had the enzymologists involved in clarifying how ATP could be produced directly from NADH + H+ oxidative reductive metabolic reactions or from the hydrolysis of an enolpyruvate intermediary. Both competitors had their work supported by different but, sound scientific roots and have produced very important scientific results while trying to present their hypothetical point of view.

Before the winning results of P. Mitchell were displayed, one line of defense used by B. Chance followers was to create a conflict between what would be expected by a restrictive role of proteins through its specificity ionic interactions and the general ability of ionic asymmetries that could be associated with mitochondrial ATP production. Chemical catalyzed protein activities do not have perfect specificity but an outstanding degree of selective interaction was presented by the lock and key model of enzyme interaction. A large group of outstanding “mitochondriologists” were able to show ATP synthesis associated with Na+, K+, Ca2+… asymmetries on mitochondrial membranes and any time they did this, P. Mitchell have to display the existence of antiporters that exchange X for hydrogen as the final common source of chemiosmotic energy used by mitochondria for ATP synthesis.

This conceptual battle has generated an enormous knowledge that was laid to rest, somehow discontinued in the form of scientific research, when the final E. Coli mutant studies presented the convincing final evidence in favor of P. Mitchell point of view.

Not surprisingly, a “wise anonymous” later, pointed out: “No matter what you are doing, you will always be better off in case you have a mutant”

(Principles of Medical Genetics T D Gelehrter & F.S. Collins chapter 7, 1990).

However, let’s take the example of a mechanical wristwatch. It clearly indicates when the watch is working in an acceptable way, that its normal functioning condition is not the result of one of its isolated components – or something that can be shown by a reductionist molecular view.  Usually it will be considered that it is working in an acceptable way, in case it is found that its accuracy falls inside a normal functional range, for instance, one or two standard deviations bellow or above the mean value for normal function, what depends upon the rigor wisely adopted. While, only when it has a faulty component (a genetic inborn error) we can indicate a single isolated piece as the cause of its failure (a reductionist molecular view).

We need to teach in medicine, first the major reasons why the watch works fine (not saying it is “automatic”). The functions may cross the reversible to irreversible regulatory limit change, faster than what we can imagine. Latter, when these ideas about normal are held very clear in the mind set of medical doctors (not medical technicians) we may address the inborn errors and what we may have learn from it. A modern medical technician may cause admiration when he uses an “innocent” virus to correct for a faulty gene (a rather impressive technological advance). However, in case the virus, later shows signals that indicate that it was not so innocent, a real medical doctor will be called upon to put things in correct place again.

Among the missing parts of normal evolution in biochemistry a lot about ion fluxes can be found. Even those oscillatory changes in Ca2+ that were shown to affect gene expression (C. De Duve) were laid to rest since, they clearly indicate a source of biological information that despite the fact that it does not change nucleotides order in the DNA, it shows an opposing flux of biological information against the dogma (DNA to RNA to proteins). Another, line has shown a hierarchy, on the use of mitochondrial membrane potential: First the potential is used for Ca2+ uptake and only afterwards, the potential is used for ADP conversion into ATP (A. L. Lehninger). In fact, the real idea of A. L. Lehninger was by far, more complex since according to him, mitochondria works like a buffer for intracellular calcium releasing it to outside in case of a deep decrease in cytosol levels or capturing it from cytosol when facing transient increase in Ca2+ load. As some of Krebs cycle dehydrogenases were activated by Ca2+, this finding was used to propose a new control factor in addition to the one of ADP (B. Chance). All this was discontinued with the wrong use of calculus (today we could indicate bioinformatics in a similar role) in biochemistry that has established less importance to a mitochondrial role after comparative kinetics that today are seen as faulty.

It is important to combat dogmatic reasoning and restore sound scientific foundations in basic medical courses that must urgently reverse the faulty trend that tries to impose a view that goes from the detail towards generalization instead of the correct form that goes from the general finding well understood towards its molecular details. The view that led to curious subjects as bioinformatics in medical courses as training in sequence finding activities can only be explained by its commercial value. The usual form of scientific thinking respects the limits of our ability to grasp new knowledge and relies on reproducibility of scientific results as a form to surpass lack of mathematical equation that defines relationship of variables and the determination of its functional domains. It also uses old scientific roots, as its sound support never replaces existing knowledge by dogmatic and/or wishful thinking. When the sequence of DNA was found as a technical advance to find amino acid sequence in proteins it was just a technical advance. This technical advance by no means could be considered a scientific result presented as an indication that DNA sequences alone have replaced the need to study protein chemistry, its responses to microenvironmental changes in order to understand its multiple conformations, changes in activities and function. As E. Schrodinger correctly describes the chemical structure responsible for the coded form stored of genetic information must have minimal interaction with its microenvironment in order to endure hundreds and hundreds years as seen in Hapsburg’s lips. Only magical reasoning assumes that it is possible to find out in non-reactive chemical structures the properties of the reactive ones.

For instance, knowledge of the reactions of the Krebs cycle clearly indicate a role for solvent that no longer could be considered to be an inert bath for catalytic activity of the enzymes when the transfer of energy include a role for hydrogen transport. The great increase in understanding this change on chemical reaction arrived from conformational energy.

Again, even a rather simplistic view of this atomic property (Conformational energy) is enough to confirm once more, one of the most important contribution of E. Schrodinger in his What is Life:

“This little book arose from a course of public lectures, delivered by a theoretical physicist to an audience of about four hundred which did not substantially dwindle, though warned at the outset that the subject matter was a difficult one and that the lectures could not be termed popular, even though the physicist’s most dreaded weapon, mathematical deduction, would hardly be utilized. The reason for this was not that the subject was simple enough to be explained without mathematics, but rather that it was much too involved to be fully accessible to mathematics.”

In a very simplistic view, while energy manifests itself by the ability to perform work conformational energy as a property derived from our atomic structure can be neutral, positive or negative (no effect, increased or decreased reactivity upon any chemistry reactivity measured as work)

Also:

“I mean the fact that we, whose total being is entirely based on a marvelous interplay of this very kind, yet if all possess the power of acquiring considerable knowledge about it. I think it possible that this knowledge may advance to little just a short of a complete understanding -of the first marvel. The second may well be beyond human understanding.”

In fact, scientific knowledge allows us to understand how biological evolution may have occurred or have not occurred and yet does not present a proof about how it would have being occurred. It will be always be an indication of possible against highly unlike and never a scientific proven fact about the real form of its occurrence.

As was the case of B. Chance in its bioenergetics findings, we may get very important findings that indicates wrong directions in the future as was his case, or directed toward our past.

The Skeleton of Physical Time – Quantum Energies in Relative Space of S-labs

By Radoslav S. Bozov  Independent Researcher

WSEAS, Biology and BioSystems of Biomedicine

Space does not equate to distance, displacement of an object by classically defined forces – electromagnetic, gravity or inertia. In perceiving quantum open systems, a quanta, a package of energy, displaces properties of wave interference and statistical outcomes of sums of paths of particles detected by a design of S-labs.

The notion of S-labs, space labs, deals with inherent problems of operational module, R(i+1), where an imagination number ‘struggles’ to work under roots of a negative sign, a reflection of an observable set of sums reaching out of the limits of the human being organ, an eye or other foundational signal processing system.

While heavenly bodies, planets, star systems, and other exotic forms of light reflecting and/or emitting objects, observable via naked eye have been deduced to operate under numerical systems that calculate a periodic displacement of one relative to another, atomic clocks of nanospace open our eyes to ever expanding energy spaces, where matrices of interactive variables point to the problem of infinity of variations in scalar spaces, however, defining properties of minute universes as a mirror image of an astronomical system. The first and furthermost problem is essentially the same as those mathematical methodologies deduced by Isaac Newton and Albert Einstein for processing a surface. I will introduce you to a surface interference method by describing undetermined objective space in terms of determined subjective time.

Therefore, the moment will be an outcome of statistical sums of a numerical system extending from near zero to near one. Three strings hold down a dual system entangled via interference of two waves, where a single wave is a product of three particles (today named accordingly to either weak or strong interactions) momentum.

The above described system emerges from duality into trinity the objective space value of physical realities. The triangle of physical observables – charge, gravity and electromagnetism, is an outcome of interference of particles, strings and waves, where particles are not particles, or are strings strings, or  are waves waves of an infinite character in an open system which we attempt to define to predict outcomes of tomorrow’s parameters, either dependent or independent as well as both subjective to time simulations.

We now know that aging of a biological organism cannot be defined within singularity. Thereafter, clocks are subjective to apparatuses measuring oscillation of defined parameters which enable us to calculate both amplitude and a period, which we know to be dependent on phase transitions.

The problem of phase was solved by the applicability of carbon relative systems. A piece of diamond does not get wet, yet it holds water’s light entangled property. Water is the dark force of light. To formulate such statement, we have been searching truth by examining cooling objects where the Maxwell demon is translated into information, a data complex system.

Modern perspectives in computing quantum based matrices, 0+1 =1 and/or 0+0=1, and/or 1+1 =0, will be reduced by applying a conceptual frame of Aladdin’s flying anti-gravity carpet, unwrapping both past and future by sending a photon to both, placing present always near zero. Thus, each parallel quantum computation of a natural system approaching the limit of a vibration of a string defining 0 does not equal 0, and 1 does not equal 1. In any case, if our method 1+1 = 1, yet, 1 is not 1 at time i+1. This will set the fundamentals of an operational module, called labris operator or in simplicity S-labs. Note, that 1 as a result is an event predictable to future, while interacting parameters of addition 1+1 may be both, 1 as an observable past, and 1 as an imaginary system, or 1+1 displaced interactive parameters of past observable events. This is the foundation of Future Quantum Relative Systems Interference (QRSI), taking analytical technologies of future as a result of data matrices compressing principle relative to carbon as a reference matter rational to water based properties.

Goedel’s concept of loops exist therefore only upon discrete relative space uniting to parallel absolute continuity of time ‘lags’. ( Goedel, Escher and Bach: An Eternal Golden Braid. A Metaphorical Fugue on Minds and Machines in the Spirit of Lewis Carroll. D Hofstadter.  Chapter XX: Strange Loops, Or Tangled Hierarchies. A grand windup of many of the ideas about hierarchical systems and self-reference. It is concerned with the snarls which arise when systems turn back on themselves-for example, science probing science, government investigating governmental wrongdoing, art violating the rules of art, and finally, humans thinking about their own brains and minds. Does Gödel’s Theorem have anything to say about this last “snarl”? Are free will and the sensation of consciousness connected to Gödel’s Theorem? The Chapter ends by tying Gödel, Escher, and Bach together once again.)  The fight struggle in-between time creates dark spaces within which strings manage to obey light properties – entangled bozons of information carrying future outcomes of a systems processing consciousness. Therefore, Albert Einstein was correct in his quantum time realities by rejecting a resolving cube of sugar within a cup of tea (Henri Bergson 19th century philosopher. Bergson’s concept of multiplicity attempts to unify in a consistent way two contradictory features: heterogeneity and continuity. Many philosophers today think that this concept of multiplicity, despite its difficulty, is revolutionary.) However, the unity of time and space could not be achieved by deducing time to charge, gravity and electromagnetic properties of energy and mass.

Charge is further deduced to interference of particles/strings/waves, contrary to the Hawking idea of irreducibility of chemical energy carrying ‘units’, and gravity is accounted for by intrinsic properties of   anti-gravity carbon systems processing light, an electromagnetic force, that I have deduced towards ever expanding discrete energy space-energies rational to compressing mass/time. The role of loops seems to operate to control formalities where boundaries of space fluctuate as a result of what we called above – dark time-spaces.

Indeed, the concept of horizon is a constant due to ever expanding observables. Thus, it fails to acquire a rational approach towards space-time issues.

Richard Feynman has touched on issues of touching of space, sums of paths of particle traveling through time. In a way he has resolved an important paradigm, storing information and possibly studying it by opening a black box. Schroedinger’s cat is alive again, but incapable of climbing a tree when chased by a dog. Every time a cat climbs a garden tree, a fruit falls on hedgehogs carried away parallel to living wormholes whose purpose of generating information lies upon carbon units resolving light.

In order to deal with such a paradigm, we will introduce i+1 under square root in relativity, therefore taking negative one ( -1 = sqrt (i+1), an operational module R dealing with Wheelers foam squeezed by light, releasing water – dark spaces. Thousand words down!

What is a number? Is that a name or some kind of language or both? Is the issue of number theory possibly accountable to the value of the concept of entropic timing? Light penetrating a pyramid holding bean seeds on a piece of paper and a piece of slice of bread, a triple set, where a church mouse has taken a drop of tear, but a blood drop. What an amazing physics! The magic of biology lies above egoism, above pride, and below Saints.

We will set up the twelve parameters seen through 3+1 in classic realities:

–              discrete absolute energies/forces – no contradiction for now between Newtonian and Albert Einstein mechanics

–              mass absolute continuity – conservational law of physics in accordance to weak and strong forces

–              quantum relative spaces – issuing a paradox of Albert Einstein’s space-time resolved by the uncertainty principle

–              parallel continuity of multiple time/universes – resolving uncertainty of united space and energy through evolving statistical concepts of scalar relative space expansion and vector quantum energies by compressing relative continuity of matter in it, ever compressing flat surfaces – finding the inverse link between deterministic mechanics of displacement and imaginary space, where spheres fit within surface of triangles as time unwraps past by pulling strings from future.

To us, common human beings, with an extra curiosity overloaded by real dreams, value happens to play in the intricate foundation of life – the garden of love, its carbon management in mind, collecting pieces of squeezed cooling time.

The infinite interference of each operational module to another composing ever emerging time constrains unified by the Solar system, objective to humanity, perhaps answers that a drop of blood and a drop of tear is united by a droplet of a substance separating negative entropy to time courses of a physical realities as defined by an open algorithm where chasing power subdue to space becomes an issue of time.

Jose Eduardo de Salles Roselino

Some small errors: For intance an increase i P leads to a decrease in V ( not an increase in V)..

 

Radoslav S. Bozov  Independent Researcher

If we were to use a preventative measures of medical science, instruments of medical science must predict future outcomes based on observable parameters of history….. There are several key issues arising: 1. Despite pinning a difference on genomic scale , say pieces of information, we do not know how to have changed that – that is shift methylome occupying genome surfaces , in a precise manner.. 2. Living systems operational quo DO NOT work as by vector gravity physics of ‘building blocks. That is projecting a delusional concept of a masonry trick, who has not worked by corner stones and ever shifting momenta … Assuming genomic assembling worked, that is dealing with inferences through data mining and annotation, we are not in a position to read future in real time, and we will never be, because of the rtPCR technology self restriction into data -time processing .. We know of existing post translational modalities… 3. We don’t know what we don’t know, and that foundational to future medicine – that is dealing with biological clocks, behavior, and various daily life inputs ranging from radiation to water systems, food quality, drugs…

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Cell Death Pathway Insights, Volume 2 (Volume Two: Latest in Genomics Methodologies for Therapeutics: Gene Editing, NGS and BioInformatics, Simulations and the Genome Ontology), Part 2: CRISPR for Gene Editing and DNA Repair

Cell Death Pathway Insights

Larry H. Bernstein, MD, FCAP, Curator

LPBI

Phosphorylation and activation of ubiquitin-specific protease-14 by Akt regulates the 1 ubiquitin-proteasome system

Daichao Xu1,2, Bing Shan1,4, Byung-Hoon Lee3,4, Kezhou Zhu1,4, Tao Zhang1,4, Huawang Sun1, 4 Min Liu1, Linyu Shi1, Wei Liang1, et al.
eLife 2015;10.7554/eLife.10510    DOI: http://dx.doi.org/10.7554/eLife.10510

In this study, we report that USP14 is an Akt substrate and that this phosphorylation activates the DUB activity of USP14 both in vitro and in cells. We also demonstrate that phosphorylation of USP14 is critical for Akt to control UPS and consequentially global protein degradation via the UPS.

Regulation of ubiquitin-proteasome system (UPS), which controls the turnover of short-lived proteins in eukaryotic cells, is critical in maintaining cellular proteostasis. Here we show that 40 USP14, a major deubiquitinating enzyme that regulates the UPS, is a substrate of Akt, a serine/threonine-specific protein kinase critical in mediating intracellular signaling transducer for growth factors. We report that Akt-mediated phosphorylation of USP14 at Ser432, which normally blocks its catalytic site in the inactive conformation, activates its deubiquitinating activity in vitro and in cells. We also demonstrate that phosphorylation of USP14 is critical for Akt to regulate proteasome activity and consequently global protein degradation. Since Akt can be activated by a wide range of growth factors and is under negative control by phosphoinosotide phosphatase PTEN, we suggest that regulation of UPS by Akt-mediated phosphorylation of USP14 may provide a common mechanism for growth factors to control global proteostasis and for promoting tumorigenesis in PTEN-negative cancer cells.

The ubiquitin-proteasome system (UPS), a major degradative mechanism in eukaryotic cells, is involved in the degradation of short-lived proteins as well as misfolded and damaged proteins 69 (Komander and Rape, 2012). The 26S proteasome specifically targets and degrades proteins conjugated to ubiquitin. Regulation of protein deubiquitination by deubiquitinating enzymes (DUBs) is recognized as an important regulatory step in the ubiquitin-proteasome system. USP14, a deubiquitinating enzyme reversibly associated with the proteasome, negatively regulates the activity of proteasomes by trimming ubiquitin chains on proteasome-bound substrates (Borodovsky et al., 2001; Koulich et al., 2008; Lee et al., 2010). Purified recombinant USP14 is largely inactive and can be highly activated when in association with proteasome (Hu 76 et al., 2005; Koulich et al., 2008; Lee et al., 2010). However, a significant fraction of USP14 is present intracellularly in a proteasome-free state (Koulich et al., 2008) and it is not clear if and how proteasome-free USP14 might serve a significant physiological function. Akt, a serine/threonine-specific protein kinase and an important intracellular signaling transducer for growth factors such as insulin, is involved in regulating cell proliferation, metabolism, transcription, migration and apoptosis (Manning and Cantley, 2007). The activity of Akt is regulated by PI(3,4,5)P3, a lipid product of the phosphoinositide 3-kinases (PI3Ks). The intracellular levels of PI(3,4,5)P3 are negatively regulated by phosphatases such as SHIP1/2 and PTEN. The latter, a phosphoinoside phosphatase, is encoded by a tumor suppressor gene that is mutated in human cancers at high frequency (Cantley and Neel, 1999). Akt has been reported to mediate the phosphorylation of many substrates that in turn regulate cell proliferation, metabolism, transcription, migration and apoptosis. However, very little is known about its role in the UPS, and furthermore no mechanistic link between Akt and UPS has been elucidated.

Two forms of USP14 have been determined crystallographically: the inactive free form and an adduct between Ub-aldehyde (Ubal) and USP14, which provides insight into the catalytically active state (Hu et al., 2005). The key difference between these two structures is in the position of the blocking loops, BL1 and BL2, which project over the catalytic cleft of USP14 and block the access of the C-terminal residues of ubiquitin in the inactive form (Figure 1A). In  Ubal-modified USP14, BL1 and BL2 are rearranged, thus exposing the cleft. In particular, Ser432, located within BL2, shifts its position over a distance of 3-5Å between the two states (Hu et al., 2005) (Figure 1B). Since Ser432 residue is located very close to a highly negatively charged patch (Figure 107 1C), we reasoned that when Ser432 residue was phosphorylated, the negatively charged phosphate group might induce a repulsive force, thereby inducing rearrangement of the BL2 loop and removing the inhibitory effect of this loop on the activity of USP14. The amino acid 110 sequences around Ser432 are highly evolutionarily conserved among USP14 orthologues 111 (Figure 1D) and Ser432 is predicted to be an Akt substrate by Scansite (http://scansite3.mit.edu/#home). We therefore tested the possibility that USP14 might be a substrate of activated Akt. We first examined the interaction between USP14 and Akt using a co-immunoprecipitation assay. As shown in Figure1-figure supplement 1A, when USP14 and Akt were overexpressed in HEK293T cells, their interaction was readily detectable. To test whether Akt could phosphorylate USP14, we overexpressed USP14 and an activated Akt (Myr-Akt) in HEK293T cells, and performed a quantitative phosphoproteomic analysis (Figure 118 1-figure supplement 1B). We identified four phosphorylation sites on USP14 when it was 119 expressed alone: Ser143, Ser230, Thr235, and Ser432 (Figure 1-figure supplement 1C-D). Notably, the phosphorylation levels of two of the four sites, Ser143 and Ser432, were increased considerably in cells expressing activated Akt (Figure 1E).

Figure 1. Structural basis of USP14 activation by phosphorylation of Ser432. (A) Detailed view of blocking loop 2 (BL2), which occludes the active site of USP14 (PDB access code 2AYN). The BL2 loop, which contains Ser432, is shown in stick model, in the apo form. (B) Combined ribbon representation and stick model showing a comparison of the conformations of the BL2 loop containing in the apo form (blue, PDB access code 2AYN) and in the USP14-Ubal adduct (orange, PDB access code 2AYO). In this drawing, the Ser432 and Cys114 residues are 504 shown in stick model, and the bound Ubal (a ubiquitin derivative in which the C-terminal 505 carboxylate is replaced by an aldehyde) in the complex is drawn in green. (C) A surface charge potential representation (contoured at ±7 kT/eV; blue/red) of USP14 (PDB accession 2AYN) showing that the S432 residue is very close to a highly negatively charged patch mainly formed by the acidic E188, D199 and E202 residues. When S432 is phosphorylated, the negatively charged phosphate group may induce a repulsive force, thereby relieving inhibition of the catalytic activity of USP14. (D) USP14 domain organization and sequence alignment of the Akt 511 phosphorylation site within USP14 orthologues from different species. Two blocking loops (BL1 512 and BL2) covering the USP14 active site are shown. The Akt phosphorylation site in USP14 from different species as predicted by Scansite. (E) S432 is the major phosphorylation site in USP14. HEK293T cells were treated as in Figure 1-figure supplement 1B, followed by ESI-MS analysis. Spectral counts were determined by ESI-MS. (F) Akt phosphorylates USP14 in vitro. Bacterially expressed and purified USP14 was incubated with active Akt in the presence of ATP. Reaction products were resolved by SDS-PAGE, and phosphorylated species were detected by a phospho-Ser antibody.

Since Ser432 residue is located very close to a highly negatively charged patch (Figure 107 1C), we reasoned that when Ser432 residue was phosphorylated, the negatively charged phosphate group might induce a repulsive force, thereby inducing rearrangement of the BL2 loop and removing the inhibitory effect of this loop on the activity of USP14. The amino acid sequences around Ser432 are highly evolutionarily conserved among USP14 orthologues (Figure 1D) and Ser432 is predicted to be an Akt substrate by Scansite (http://scansite3.mit.edu/#home). We therefore tested the possibility that USP14 might be a substrate of activated Akt. We first examined the interaction between USP14 and Akt using a co-immunoprecipitation assay. As shown in Figure1-figure supplement 1A, when USP14 and Akt were overexpressed in HEK293T cells, their interaction was readily detectable. To test whether Akt could phosphorylate USP14, we overexpressed USP14 and an activated Akt  (Myr-Akt) in HEK293T cells, and performed a quantitative phosphoproteomic analysis (Figure 1-figure supplement 1B). We identified four phosphorylation sites on USP14 when it was expressed alone: Ser143, Ser230, Thr235, and Ser432 (Figure 1-figure supplement 1C-D). Notably, the phosphorylation levels of two of the four sites, Ser143 and Ser432, were increased considerably in cells expressing activated Akt (Figure 1E).

To examine whether USP14 is a direct substrate for Akt, we conducted an in vitro kinase 123 assay using activated recombinant Akt and purified recombinant USP14 expressed in E. coli. We 124 found that co-incubation of USP14 and Akt led to modification of USP14 as detected by a pan phospho-Ser antibody (Figure 1F), suggesting that USP14 is a substrate for Akt.

Figure 1-figure supplement 1. Akt phosphorylates USP14. (A) Akt interacts with USP14. HEK293T cells were transfected with indicated plasmids for 24 h. The cell lysates were collected for co-immunoprecipitation and western blotting analysis. (B) Schematic representation of mass spectrometry assay to determine USP14 phosphorylation sites by Akt. (C) Four phosphorylation sites of USP14 were determined by mass spectrometry. (D) The representative MS/MS spectrum of phosphorylated tryptic peptide ‘SSSphosSGHYVSWVK’ of human USP14 protein. The peptide sequence ‘SSSphosSGHYVSWVK’ containing phosphorylated S432 was identified by shotgun analysis using mass spectrometry when USP14 was co-expressed with Myr-Akt in HEK293T cells. Fragmentation ion of the amide bond of the peptide result in formation of ‘b’ ion and ‘y’ ion series corresponding to the N-terminal and C-terminal fragments respectively. Representative ions with phosphorylation and H2O loss were manually labeled in red on the spectrum.

To determine if Ser143 and Ser432 were indeed phosphorylated by Akt, we used this pan phospho-Ser antibody as above and found phosphorylation of WT USP14, but not of S143A/S432A mutant USP14, after incubating with activated Akt in a kinase assay (Figure 2A). To differentiate the relative importance of Ser143 and Ser432 as phosphorylation sites by Akt, we overexpressed activated Akt (Myr-Akt) in HEK293T cells with WT, S143A, S432A or double S143A/S432A (AA) mutants. We found that S143A mutant showed partially reduced phosphorylation as compared to that of WT, whereas phosphorylation of the USP14 S432A mutant was significantly decreased and that of AA double mutant was completely eliminated (Figure 2B). These results suggested S432 as a major and S143 as a minor phosphorylation site of Akt.

The phosphorylation of USP14 by Akt was further confirmed using an Akt phosphorylation-consensus motif (R××S/T) antibody (Figure 2-figure supplement 1A). The reactivity of USP14 with pan phospho-Ser antibody was eliminated after incubation with lambda phosphatase (Figure 2C). Notably, the phosphorylation levels of USP14 were decreased in cells when treated with MK2206, an inhibitor of Akt (Figure 2D), or when serum deprived, a condition known to inactivate endogenous Akt (Zhang et al., 2015) (Figure 2D).

To further verify the phosphorylation of USP14 S432 by Akt, we developed a phospho-Ser432 specific antibody. Phosphorylation of S432 can be detected after incubation of WT, but not S432A mutant USP14, with recombinant activated Akt in a kinase reaction (Figure 145 2E). This was further confirmed by using phos-tag electrophoresis which can specifically retard the migration of phosphorylated protein species (Kinoshita et al., 2009) (Figure 2E). Expression of Myr-Akt also led to S342 phosphorylation of endogenous USP14 (Figure 2F). Treatment with  either MK2206 or AZD5363, two structurally unrelated Akt inhibitors, led to decrease of USP14 S432 phosphorylation levels (Figure 2-figure supplement 1B-C). Moreover, treatment with PI3K inhibitors, either Wortmannin or GDC0941, but not ERK1/2 inhibitor U0126, also significantly decreased the phosphorylation levels of USP14 S432 (Figure 2-figure supplement 152 1D-E). In addition, we tested growth factors such as IGF-1 or EGF, both of which are known to promote activation of Akt. We found that the treatment of IGF-1 or EGF resulted in phosphorylation of USP14 S432, which was blocked in cells pre-treated with MK2206 (Figure 155 2G-H). Finally, USP14 S432 is dramatically more phosphorylated in PTEN knockout mouse embryonic fibroblasts (MEFs), which carry high levels of Akt activity, than that of WT MEFs as determined by western blotting using the phospho-USP14(S432) antibody and phos-tag electrophoresis (Figure 2I), and the phosphorylation of USP14 S432 was blocked by Akt inhibitors (Figure 2-figure supplement 1F). From these results, we conclude that Ser432 of USP14 is a major phosphorylation site by Akt.

Figure 2. USP14 is phosphorylated at Ser432 by activated Akt. (A) In vitro phosphorylation 521 of USP14 at S432 by Akt. Bacterially expressed and purified wide type USP14 or AA mutant incubated with active Akt in the presence of ATP. Reaction products were resolved by SDS-PAGE, and phosphorylation was detected by the phospho-Ser antibody. (B) Akt phosphorylates USP14 at S432 in vivo. Western blot analysis of whole cell lysate and immunoprecipitates derived from HEK293T cells transfected with wild type USP14, USP14 S143A, USP14 S432A and USP14 S143A/S432A (AA) constructs using the phospho-Ser antibody. L.E., long exposure. (C) Immunoprecipitation (IP) and IB analysis of HEK293T cells transfected with HA-USP14 and Myr-Akt and preincubated with or without λ-phosphatase as indicated. (D) Inhibition of Akt decreased exogenous USP14 phosphorylation. HEK293T cells were transfected with Myc-USP14 for 20 h then treated with 1 μM MK2206 or deprived of serum for another 4 h before harvest. (E) In vitro kinase assay to detect Akt phosphorylation of USP14 by phospho-Ser432 specific antibody and phos-tag-containing gels. Bacterially expressed and purified wide type USP14 or S432A mutant was incubated with active Akt in the presence of ATP. The reaction products were resolved by SDS-PAGE, and USP14 phosphorylation was detected using an antibody that specifically recognizes Ser432 phosphorylation of USP14 or determined by differential migration on phos-tag gels. (F) In vivo detection of endogenous USP14 Ser432 phosphorylation by anti-p-Ser432 specific antibody. Western blot analysis of immunoprecipitates derived from H4 cells transfected with or without Myr-Akt plasmids using the anti-p-Ser432 specific antibody. (G, H) Phosphorylation of endogenous USP14 S432 upon 540 stimulation with IGF-1 or EGF. HEK293T cells were serum-starved and pre-treated with Akt inhibitor MK2206 (1 μM) for 30 min before stimulation with IGF-1 (100 ng/mL) for 30 min (G) or EGF (100 ng/mL) for 1 h (H). The cell lysates were immunoprecipitated with USP14 antibody and western-blotted with anti-p-S432 antibody. (I) Phosphorylation of endogenous USP14 S432 in Pten knockout cells with high activity of Akt. Lysates from MEFs with indicated genotypes 545 were immunoprecipitated with USP14 antibody and then western-blotted with p-S432 antibody. The differential migration of phospho-USP14 on phos-tag-containing gels was determined as shown in the bottom panel.

Activation of USP14 by Akt mediated phosphorylation Because bacterially expressed and purified USP14 protein exhibits very low catalytic activity (Lee et al., 2010), we tested whether Akt-mediated phosphorylation might activate the DUB activity of USP14. We compared the activity of recombinant USP14 in a Ub-AMC (ubiquitin-7-amido-4-methylcoumarin, a fluorogenic substrate) hydrolysis assay in the presence or absence of Akt. Bacterially expressed and purified USP14 (Figure 3-figure supplement 1) showed trace hydrolyzing activity towards Ub-AMC as reported (Lee et al., 2010), while USP14 incubated with Akt showed high activity (Figure 3A). To validate Akt-mediated activation of USP14 in cells, we co-expressed USP14 and Myr-Akt in HEK293T cells. USP14 immunoprecipitated from cells co-expressing activated Akt showed higher activity in Ub-AMC assay than that expressed alone (Figure 3B). On the other hand, USP14 isolated from HEK293T cells incubated with Akt inhibitor MK2206 showed reduced activity in Ub-AMC assay (Figure 3C). Moreover, USP14 isolated from HEK293T cells stimulated with IGF-1 showed higher
activity, which was suppressed when cells were pre-treated with MK2206 (Figure 3D). To determine the specific contribution of Ser432, we compared the activity of USP14 S432A mutant protein in Ub-AMC assay with that of WT in the presence of Akt, and found that the stimulating effect of Akt on the hydrolyzing activity of USP14 was largely blocked by S432A mutation (Figure 3E), but not by S143A mutation (Figure 3-figure supplement 2B).

To further characterize the effect of Ser432 phosphorylation, we expressed and purified recombinant S432E USP14 protein, which mimics the phosphorylation state of USP14, from E. coli (Figure 3-figure supplement 1) and analyzed its activity by Ub-AMC assay. Interestingly, we found that USP14 S432E mutant protein alone showed high levels of Ub-AMC hydrolyzing activity (Figure 3F). Consistent with S432 as the major phosphorylation site by Akt, double E mutant (S143E/S432E) showed almost the same levels of hydrolyzing activity as that of S432E single mutant and S143E mutation had no significant impact on the activity of USP14 (Figure 3-figure supplement 2C-D). To determine its enzyme kinetics, we incubated USP14 S432E mutant protein with increasing amounts of Ub-AMC (Figure 3-figure supplement 2E) and determined the Km value (Km = 26 μM) from the slope of a Lineweaver-Burk plot (Figure 3G).

We characterized the distributions of p-S432 USP14 and total USP14 with that of proteasome in Pten-/- MEFs using glycerol gradient centrifugation (Koulich et al., 2008). We found that majority of p-S432 USP14 was distributed in the fractions with lower molecular weight proteins and distinguishable from the fractions where larger protein complexes, such as proteasomes, were localized. On the other hand, unphosphorylated USP14 was found in the fractions where larger molecular weight complexes, such as proteasome, are known to be localized (Figure 3-figure supplement 2F). Thus, S432 phosphorylated and unphosphorylated USP14 might be distributed differently in the cells. We next determined whether phospho-mimetic mutant of USP14 could be further activated by interacting with proteasome. Interestingly, we found that the Ub-AMC hydrolytic activity of S432E mutant could be further 200 activated when incubated with proteasome in vitro (Figure 3H). Taken together, these results suggest that S432 phosphorylation and intraction with proteasome may be two different
regulatory mechanisms for USP14.

Figure 3. Phosphorylation of USP14 by Akt activates USP14 DUB activity. (A) Akt activates USP14 DUB activity in vitro. USP14 protein (1μg) was incubated with or without active Akt (1 μg) in kinase assay buffer in a total volume of 50 μL for 1 h at 30oC, then the reaction mixtures were subjected to Ub-AMC assay. RFU, relative fluorescence units. (B, C) Akt activates USP14 in cells. USP14 was immunoprecipitated from HEK293T cells co-expressed with activated Akt  (B) or treated with 10 μM MK2206 for 4h (C) and then eluted with HA-peptide following Ub-AMC hydrolysis assay. (D) Activation of USP14 by stimulating cells with IGF-1. HEK293T cells were serum-starved and pre-treated with or without Akt inhibitor MK2206 (1 μM) for 30 min before stimulation with IGF-1 (100ng/mL) for 30 min. USP14 was then immunoprecipitated and eluted with HA-peptide. The activity of USP14 was determined using Ub-AMC hydrolysis assay. (E) USP14 activation by Akt is blocked by S432A mutation. Ub-AMC hydrolysis assay of wide type USP14 or S432A mutant in the presence or absence of active Akt. (F) Ub-AMC hydrolysis assay of bacterially expressed and purified wide type USP14 or S432E mutant. (G) Lineweaver-Burk analysis of USP14 S432E, obtained by measuring the initial rates at varying Ub-AMC concentrations (see Figure 3-figure supplement 2E for reference). (H) The activity of phospho-mimetic USP14 mutant can be further stimulated by the presence of proteasome. Ub-AMC hydrolysis assay of wild type USP14 or S432E mutant in the presence or absence of Ub-VS-treated human proteasome [VS-proteasome (see Lee et al., 2010); 1 nM]. Ptsm, 26S proteasome.

Phosphorylation of USP14 promotes both K48 and K63 deubiquitination activity  To assess the impact of USP14 phosphorylation on its selectivity towards different types of 206 ubiquitin linkages, we incubated USP14 WT and S432E mutant protein with diubiquitin species of K48, K63 and linear linkages. Conversion to monomeric Ub was monitored via SDS-PAGE followed by western blotting. We observed significantly increased hydrolytic activity of S432E mutant, as compared to that of WT, towards both Lys48 and Lys63 diubiquitin, while linear diubiquitin was not readily cleaved by WT or mutant USP14 (Figure 4A-B and Figure 4-figure supplement 1A). Similarly, immunoprecipitated USP14 from cells showed significant activity toward both Lys48 and Lys63 diubiquitin, but not linear diubiquitin (Figure 4-figure supplement 1B-C). In contrast, S432A mutant immunoprecipitated from cells showed lower activity towards both Lys48 and Lys63 diubiquitin than that of WT (Figure 4C). Regulation of ubiquitin-proteasome system by Akt depends on phosphorylation of USP14. Since USP14 is a negative regulator of the UPS (Koulich et al., 2008; Lee et al., 2010; Lee et al., 2011) and we found USP14 can be phosphorylated and activated by Akt, we reasoned that 219 Akt-mediated activation of USP14 might lead to inhibition of the ubiquitin-proteasome system (UPS) and generally enhance the stability of many proteins. To this end, we generated a stable 221 cell line expressing GFP-CL1 (also known as GFPu), an engineered ubiquitin-dependent proteasome substrate widely used as a reporter for UPS activity (Bence et al., 2001; Kelly et al., 2007; Li et al., 2013; Liu et al., 2014) (Figure 5-figure supplement 1A-C). Treatment of cells with Akt inhibitors or serum deprivation or PI3K inhibitor, all of which can block Akt activity (Zhang et al., 2015), led to reduced level of GFP-CL1 as detected by both western blotting and fluorescence microscopy (Figure 5A-C and Figure 5-figure supplement 1D). Conversely, the expression of activated Akt (Myr-Akt) led to increased levels of GFP-CL1 protein. Treatment of WT H4 cells with IGF-1 or EGF also led to increased levels of GFP-CL1 protein (Figure 5D-G and Figure 5-figure supplement 1E). In contrast, in USP14 knockout H4 cells (generated using CRISPR/Cas9 technology, Figure 5-figure supplement 2A-D), the expression of Myr-Akt did not affect the levels of GFP-CL1 (Figure 5H). From these results, we conclude that Akt 232 negatively regulates the UPS in an USP14-dependent manner.

We next tested the importance of USP14 phosphorylation for Akt to regulate UPS. We found that in contrast to USP14 WT reconstituted H4 cells, USP14 AA mutant reconstituted H4 cells showed no increase in the accumulation of GFP-CL1 in response to the expression of activated Akt (Figure 5-figure supplement 2E and Figure 5I). As a control, we found that the expression of Akt had no effect on a ubiquitin-independent substrate of the proteasome, C-terminal ornithine decarboxylase-GFP (GFP-cODC) (Hoyt et al., 2005; Kelly et al., 2007; Lee et al., 2010) (Figure 5-figure supplement 2F-G), suggesting that Akt does not inhibit the UPS through a general inhibition of the proteasome itself. Taken together, these data show that 241 phosphorylation of USP14 by Akt is important for this kinase to negatively regulate the UPS in a ubiquitin-dependent manner.

Phosphorylation of USP14 regulates global protein degradation To further understand the physiological roles of Akt-mediated USP14 phosphorylation and subsequently activation, we sought to study the impact of USP14 phosphorylation on global protein degradation. Since the loss of USP14 accelerates cellular proteolysis (Koulich et al., 2008; Lee et al., 2010), we performed a quantitative proteomic analysis to determine the levels of proteins in WT H4 cells, H4 USP14-KO cells, and H4 USP14-KO cells complemented with WT USP14, S143A/S432A (AA) or S143D/S432D (DD) mutants. Using an isobaric TMT labeling approach, our mass spectrometry analysis identified 18,400 peptides with high confidence (q<0.01), corresponding to 3,648 proteins with a minimum of two peptides from each protein. 2,763 proteins, which were quantified in at least 2 replicates, were subjected to further analysis. We found the global protein patterns of H4 USP14-KO cells were similar to those of H4 USP14 KO-AA cells, but distinct from those of WT H4 cells. We identified a common set of 87 proteins that were reduced in H4 KO cells as compared to H4 WT cells or to H4 KO cells complemented with WT USP14 (KO-WT) (Figure 6, Lane1-2). The levels of these proteins were also significantly reduced in H4 KO-AA cells (Figure 6, Lane 3). Importantly, the levels of this set of 87 proteins in H4 KO-DD cells were significantly higher than that of H4 KO-AA cells (Figure 6, Lane 4).

Figure 6. Phosphorylation of USP14 regulates global protein degradation. The quantitative 605 analysis of proteome change in USP14 knockout or USP14 mutant cells were performed by 606 TMT-isobaric labeling followed by shotgun analysis. The heat map was plotted based on the set of 87 proteins that are down-regulated greater than or equal to 1.2 fold in H4 KO cells compared to H4 WT cells or to H4 KO cells complemented with WT USP14 (KO-WT). The log base 2 of average ratios was plotted as indicated.

To verify that the identified changes in protein abundance were due to proteasomal degradation, we treated H4 KO-AA cells with proteasome inhibitor MG132 and analyzed the protein level change of these 87 proteins. We found that the levels of these proteins increased significantly in MG132-treated KO-AA cells compared to that of control KO-AA cells (Figure 6, Lane 5), suggesting that these proteins were indeed subject to an increased rate of proteasome degradation with expression of non-phosphorylatable USP14. Interestingly, the top hit on this list of 87 proteins that were differentially regulated upon the loss of USP14 is mTOR, a central established regulator of cellular metabolism and tumorigenesis. We confirmed the role of USP14 on the levels of mTOR by western blotting. We found that the levels of mTOR were reduced inH4 KO and H4 KO cells complemented with USP14 AA mutant, but restored upon the expression of USP14 DD mutant (Figure 6-figure supplement 1). Taken together, our results suggest that phosphorylation of USP14 may provide a mechanism for Akt to regulate global protein degradation through the proteasome, which in turn may control key cellular pathways involved in regulating metabolism and tumorigenesis.

NF-kB-Independent Role of IKKa/IKKb in Preventing RIPK1 Kinase-Dependent Apoptotic and Necroptotic Cell Death during TNF Signaling

Yves Dondelinger, Sandrine Jouan-Lanhouet, Tatyana Divert, …, Emmanuel Dejardin, Peter Vandenabeele, Mathieu J.M. Bertrand
Molecular Cell 2015; 60, 1–14    http://dx.doi.org/10.1016/j.molcel.2015.07.032

Highlights

  1.  IKKa/IKKb prevent RIPK1 kinase-dependent death independently of NF-kB activation
  2.  IKKa/IKKb directly phosphorylate RIPK1 in TNFR1 complex I
  3.  Impaired phosphorylation of RIPK1 correlates with enhanced binding to FADD/caspase-8
  4.  IKK kinase inhibition induces TNF-mediated RIPK1 kinasedependent cell death in vivo

In Brief Dondelinger et al. describe an unexpected NF-kB-independent function of the IKK complex in protecting against TNF-induced RIPK1 kinase-dependent cell death. In TNFR1 complex I, IKKa/ IKKb directly phosphorylates RIPK1, leading to a reduction in RIPK1’s ability to bind FADD/caspase-8 and to induce apoptosis.

TNF is a master pro-inflammatory cytokine. Activation of TNFR1 by TNF can result in both RIPK1-independent apoptosis and RIPK1 kinase-dependent apoptosisornecroptosis.Thesecelldeathoutcomes are regulated by two distinct checkpoints during TNFR1 signaling. TNF-mediated NF-kB-dependent induction of pro-survival or anti-apoptotic molecules is a well-known late checkpoint in the pathway, protecting cells from RIPK1-independent death. On the other hand, the molecular mechanism regulating the contribution of RIPK1 to cell death is far less understood. We demonstrate here that the IKK complex phosphorylates RIPK1 at TNFR1 complex I and protects cells from RIPK1 kinase-dependent death, independent of its function in NF-kB activation. We provide in vitro and in vivo evidence that inhibition of IKKa/IKKb or its upstream activators sensitizes cells to death by inducing RIPK1 kinase-dependent apoptosis or necroptosis. We therefore report on an unexpected, NF-kB-independent role for the IKK complex in protecting cells from RIPK1-dependent death downstream of TNFR1.

The IkB kinase (IKK) complex, composed of the regulatory subunit NEMO (also known as IKKg) and the two catalytic subunits IKKa and IKKb, plays a central role in the induction of immune and inflammatory responses as well as in promoting cell survival and tumorigenesis (Baldwin, 2012; Baud and Karin, 2009; Hayden and Ghosh, 2012; Liu et al., 2012). Its activation constitutes the ignition phase of the canonical NF-kB pathway, which
ultimately results in the translocation of NF-kB dimers to the nucleus, where they promote transcription of a myriad of genes involved in inflammation, survival, and tumorigenesis.

TNF is a master pro-inflammatory cytokine, and inappropriate TNF signaling has been demonstrated to drive many inflammatory diseases. Activation of TNFR1 by TNF promotes inflammation either directly by activating the canonical NF-kB pathway or indirectly by promoting cell death, which exacerbates inflammation by releasing damage-associated molecular patterns (DAMPs) as well as by affecting the permeability of the bodily barriers to microbes (Pasparakis and Vandenabeele, 2015). In most cell types, activation of TNFR1 does not induce death but triggers canonical NF-kB-dependent transcriptional upregulation of genes encoding pro-survival and pro-inflammatory molecules. Ligation of TNF to trimeric TNFR1 induces the rapid assembly of a plasma membrane-bound signaling complex, known as complex I, that contains TRADD, RIPK1, and the E3 ubiquitin ligases TRAF2, cIAP1, cIAP2, and LUBAC (Walczak, 2011). The conjugation of ubiquitin chains to RIPK1 by cIAP1/ cIAP2 generates binding sites for TAB2/TAB3 and NEMO and allows further recruitment and activation of TAK1 and IKKa/ IKKb (Bertrand et al., 2008; Ea et al., 2006; Gerlach et al., 2011; Kanayama et al., 2004; Mahoney et al., 2008; Wu et al., 2006). TAK1 activates the IKK complex by phosphorylation, resulting in the rapid and selective IKK-mediated phosphorylation of IkBa and in its subsequent ubiquitylation-dependent proteasomal degradation. IkBa degradation then permits translocation of the NF-kB heterodimer p50/p65 to the nucleus, where it induces transcription of multiple responsive genes, including pro-survival genes such as cFLIP (Hayden and Ghosh, 2014). The anti-apoptotic potential of cFLIP resides in its ability to counteract activation of caspase-8 from a cytosolic TRADD-FADD-caspase-8 cytosolic complex, named complex IIa, which is believed to originate from complex I internalization (Irmler et al., 1997; Micheau and Tschopp, 2003; Wang et al., 2008; Wilson et al., 2009). Accordingly, TNFR1-mediated RIPK1-independent apoptosis requires inhibition of the NF-kB response (Van Antwerp et al., 1996), commonly obtained in vitro by the use of pharmacological inhibitors of transcription or translation, respectively, Actinomycin D (ActD) and cycloheximide (CHX).

The NF-kB-mediated induction of pro-survival/anti-apoptotic molecules is, however, not the only cell death checkpoint in the TNFR1 pathway (O’Donnell and Ting, 2011). Indeed, altering activation of the canonical NF-kB pathway by inhibiting components located upstream of IkBa, namely, cIAP1/cIAP2, TAK1, and NEMO, was reported to further sensitize cells to death by additionally inducing RIPK1-dependent death (Dondelinger et al., 2013; Legarda-Addison et al., 2009; O’Donnell et al., 2012). Depending on the cellular context, activated RIPK1 accelerates cell death either by promoting assembly of a RIPK1FADD-caspase-8 cytosolic apoptotic complex, referred to as complex IIb (Wilson et al., 2009), or by promoting necroptosis via activation of the RIPK3-MLKL pathway (Pasparakis and Vandenabeele, 2015). Although initiated by cIAP1/cIAP2-mediated ubiquitylation of RIPK1 in complex I, the last molecular step in the regulation of this early RIPK1 kinase-dependent cell death checkpoint is currently unknown. In this study, we demonstrate that RIPK1 is a bona fide substrate of IKKa and IKKb and that IKKa/IKKb-mediated phosphorylation of RIPK1 in complex I protects cells from RIPK1 kinase-dependent death.

NEMO Deficiency and IKKa/IKKb Double Deficiencies Induce TNFR1-Mediated RIPK1 Kinase-Dependent Apoptosis We previously reported that the ubiquitin chains conjugated to RIPK1 by cIAP1/cIAP2 do not constitute the ultimate step regulating the contribution of RIPK1 to TNF-induced cell death. Indeed, genetic or pharmacological inhibition of TAK1 also drivesRIPK1-dependentdeathwithoutaffectingRIPK1ubiquitylation in complex I (Dondelinger et al., 2013). In this study, we investigated the role of the IKK complex in the regulation of this cell death checkpoint. Indeed, the IKK complex lies between TAK1andIkBainthepathway,andalthoughexpressionofaproteasome-resistant form of IkBa (IkBaSR) induces RIPK1-independent apoptosis (Dondelinger et al., 2013), NEMO deficiency was reported to sensitize cells to TNF-induced death by additionally promoting RIPK1-dependent apoptosis (Legarda-Addison et al., 2009). In absence of cIAP1/cIAP2 or TAK1, TNF-mediated RIPK1-dependent apoptosis was shown to rely on RIPK1 kinase activity (Dondelinger et al., 2013; Wang et al., 2008). To test whether this is also true in absence of NEMO, we first stimulated NEMO-deficient mouse embryonic fibroblasts (MEFs) with TNF in the absence or presence of Nec-1, a RIPK1 kinase inhibitor. Interestingly, we found that Nec-1 greatly, but not entirely,protectedNemo/MEFsfromTNF-induced apoptosis, as monitored by cell permeability, caspase-3 activity, and caspase-3 and caspase-8 processing (Figures 1A–1D, 1K, and 1L). These results indicated that, similarly as cIAP1/cIAP2 and TAK1, NEMO also regulates both RIPK1 kinase-dependent and RIPK1-independent cell death checkpoints downstream of TNFR1. To test whether this protective function of NEMO
reflects its role as adaptor protein recruiting IKKa and IKKb to TNFR1 complex I, we next stimulated Ikka/, Ikkb/, and Ikka//Ikkb/ MEFs with TNF. Interestingly, while IKKa or IKKb single deficiency had little effect on apoptosis induction (Figures 1E–1H), their combined depletion mimicked the phenotype observed in the Nemo/ MEFs (Figures 1I–1L), suggesting redundant roles of IKKa and IKKb downstream of NEMO in preventing RIPK1-dependent apoptosis. To exclude the possibility that the phenotypes observed in the various MEF genotypes were originating from intrinsic defects due to clonal expansion, we confirmed our findings in Ripk1+/+ and Ripk1/ MEFs depleted of IKK proteins by siRNA (Figure S1). Of note, NEMO siRNA had little effect on cell death induction in these experiments, probably due to the poor efficiency in repressing NEMO.

Figure 1. NEMO Deficiency and IKKa/IKKb Double Deficiencies Induce TNFR1-Mediated RIPK1 Kinase-Dependent Apoptosis (A–L)MEFsoftheindicatedgenotypesweretreatedwith20ng/mlhTNFinthepresenceorabsenceofNec-1,andcelldeath(A,C,E,G,andI)andcaspaseactivity (B, D, F, H, and J) were measured in function of time, respectively, by SytoxGreen positivity and DEVD-AMC fluorescence. Protein levels were determined by immunoblotting in unstimulated cells (K) or 15 hr poststimulation with the indicated compounds (L). Forthe celldeath results, error bars represent theSEM ofthreeindependent experiments. Forthe caspase-3activity results, error bars represent SDof triplicates of one representative experiment. See also Figure S1.

IKKa and IKKb Mediate Their Protective Effect on RIPK1 via Their Enzymatic Activities Because IKKa and IKKb are serine/threonine kinases, we next evaluated the requirement of their enzymatic activities for their ability to repress RIPK1-dependent apoptosis. To do so, we tested the effect of five different IKK inhibitors on TNF-induced death and found that all of them led to a combination of RIPK1 kinase-dependent and RIPK1-independent death, as observed in the Ikka//Ikkb/ MEFs (Figures S2A and S2B). We further confirmed RIPK1 kinase-dependent apoptosis induction using TPCA-1 (Figures 2A–2C), as this inhibitor had no effect on TNF-induced death in Ikka//Ikkb/ MEFs (Figure S2B). TPCA-1 was used at 5 mM, a concentration reported to inhibit both IKKa and IKKb kinase activities (IC50 = 400 nM and 17.9 nM for IKKa and IKKb, respectively) (Podolin et al., 2005). We demonstrated that the apoptotic cell death was mostly depending on RIPK1 kinase activity by either co-incubating cells with Nec-1 (Figures 2A–2C) or by stimulating RIPK1 kinase-dead-expressing MEFs (Ripk1 K45A)(Figures 2D and 2E) (Berger et al., 2014). Importantly, Nec-1 had no effect in Ripk1 K45A MEFs, excluding any off-target effect (Figures S2E andS2F). Of note, similar results were obtained upon pharmacological inhibition of cIAP1/cIAP2 or TAK1 (Figures 2F, 2G, S2C, and S2D). In line with a role of IKKa and IKKb downstream of cIAP1/cIAP2, TAK1, and NEMO in the pathway, we tested the effect of TPCA-1 on TNF-induced death in ciap1/2/, Tak1/, and Nemo/ MEFs and found no additional effect (Figures 2H–2K). Together, these results indicate that the kinase activities of IKKa/IKKb regulate, downstream of cIAP1/cIAP2, TAK1, and NEMO, both RIPK1 kinasedependent and RIPK1-independent cell death checkpoints.

Figure 2. IKKa and IKKb Mediate Their Protective Effect on RIPK1 via Their Enzymatic Activities (A, B,and D–K)Ripk1+/+ or MEFsof theindicated genotypes weretreated with20ng/ml hTNF inthepresenceof theindicated compounds, and celldeath (A,D,F, H, I, J, K) and caspase-3 activity (B, E, G) were measured in function of time, respectively, by SytoxGreen positivity and DEVD-AMC fluorescence. (C) Protein levels in wild-type MEFs determined by immunoblotting 4 hr poststimulation. Forthecell death results,error bars represent the SEMof three independent experiments. Forthe caspase-3 activity results, error bars represent SDoftriplicates of one representative experiment. See also Figure S2.

IKKa/IKKb Protect Cells from RIPK1-Dependent Apoptosis Independently of NF-kB We previously demonstrated that, in absence of cIAP1/cIAP2 or TAK1, RIPK1 contribution to TNF-induced death is regulated independently of a defect in the canonical NF-kB-dependent upregulation of pro-survival genes (Dondelinger et al., 2013). Moreover, NEMO was also reported to inhibit RIPK1 activation in an NF-kB-independent manner (Legarda-Addison et al., 2009; O’Donnell et al., 2012). IKKa and IKKb are best known for their roles in NF-kB activation, but NF-kB-independent functions have also been reported (Hinz and Scheidereit, 2014). To confirm that IKKa and IKKb regulate RIPK1 activation independently of the canonical NF-kB response, we took two different approaches. In the first one, we tested the effect of inhibiting IKKa/IKKb in conditions where the NF-kB response is prevented by incubating the cells with the translational inhibitor CHX. In the second, we used p65/ MEFs, which are defective for canonical NF-kB activation (Beg et al., 1995). As previously reported (Wang et al., 2008), apoptosis induced by TNF+CHX occurred with a slow kinetic and independently of RIPK1 kinase activity (Figures 3A–3C). Remarkably, a pretreatment with TPCA-1 greatly sensitized cells to apoptosis, and this sensitization was prevented by Nec-1 (Figures 3A– 3C, S3A, and S3B). Similar results were obtained when stimu
lating NF-kB-deficient p65/ MEFs with TNF and TPCA-1 (Figures 3D–3F) or in combination with TAK1 and cIAP1/ cIAP2 inhibitors (Figures S3C and S3D). Together, these results demonstrate that RIPK1-independent and -dependent apoptotic pathways are regulated by two different cell death checkpoints downstream of TNFR1 and that IKKa/IKKb regulate both of them in NF-kB-dependent and -independent manners, respectively.

Figure 3. IKKa/IKKb Protect Cells from RIPK1-Dependent Apoptosis Independently of NF-kB (A,B,D,andE)Ripk1+/+ (AandB)orp65/(DandE)MEFswerestimulatedwith20ng/mlhTNFinthepresenceoftheindicatedcompounds,andcelldeath(Aand D) and caspase activity (B and E) were measured in function of time, respectively, by SytoxGreen positivity and DEVD-AMC fluorescence. (C and F) Ripk1+/+ (C) or p65/ (F) MEFs were stimulated for, respectively, 15 hr and 8 hr with the indicated compounds, and protein levels were determined by immunoblotting. Forthe celldeath results, error bars represent theSEM ofthreeindependent experiments. Forthe caspase-3activity results, error bars represent SDof triplicates of one representative experiment. See also Figure S3.

Defective RIPK1 Phosphorylation in Complex I Correlates with RIPK1 Kinase-Dependent Contribution to TNF-Induced Apoptosis Knowing that the IKK complex physically interacts with RIPK1 in complex I, we hypothesized that the kinase-dependent role of IKKa/IKKb in preventing RIPK1 kinase-dependent apoptosis results from its ability to phosphorylate RIPK1. To test this hypothesis, we analyzed whether RIPK1 is phosphorylated in complex I and whether its phosphorylation state is altered in conditions affecting activation of IKKa/IKKb, but not when the pathway is inhibited downstream of IKKa/IKKb. Because RIPK1 is highly ubiquitylated in complex I (which prevents the detection by immunoblot of potential mobility shifts resulting from its phosphorylation), we removed the ubiquitin chains conjugated to RIPK1 by incubating complex I, pulled-down using FLAG-TNF, with the deubiquitylase USP2 (Figure 4A). By doing so, we observed that the pool of deubiquitylated RIPK1 was running at a higher molecular weight than normal and confirmed, by l-phosphatase treatment, that this mobility shift was resulting from phosphorylation, but not auto-phosphorylation since it was not inhibited by Nec-1 or in Ripk1 K45A MEFs (Figures 4A–4C). Remarkably, and in line with the model of cIAP1/ cIAP2-mediated ubiquitylation-dependent recruitment of TAK1 and NEMO/IKKa/IKKb to complex I and with our cell death results, we found that RIPK1 phosphorylation in complex I is affected in ciap1/2/, Tak1/, Nemo/, and Ikka//Ikkb/, but not in Ikka/, Ikkb/, and p65/ MEFs or in MEFs preincubated with CHX (Figures 4D, 4E, 4G, and 4H). Importantly, IKK activity is greatly affected (as observed by IkBa phosphorylation) in all conditions in which we observed impaired RIPK1 phosphorylation, thereby further demonstrating the link between RIPK1 phosphorylation and IKK enzymatic activities (Figure 4E). Defective RIPK1 phosphorylation in complex I was also observed following pharmacological inhibition of cIAP1/ cIAP2, TAK1, or IKKa/IKKb (Figure 4F).

Figure 4. Defective RIPK1 Phosphorylation in Complex I Correlates with RIPK1 Kinase-Dependent Contribution to TNF-Induced Apoptosis (A–H) Ripk1+/+ MEFs (A, B, F, and H) or MEFs with the indicated genotype (C, D, E, and G) were stimulated for 5 min with 2 mg/ml FLAG-hTNF in the presence or absence of the indicated compounds. TNFR1 complex I was then FLAG immunoprecipitated, incubated with the deubiquitylating enzyme USP2 or lambda phosphatase (l PPase) when indicated, and RIPK1 ubiquitylation and phosphorylation finally analyzed by immunoblotting. * indicates an aspecific band. See also Figure S7

Direct Phosphorylation of RIPK1 by IKKa/IKKb Prevents RIPK1 from Integrating Complex IIb To test the direct contribution of IKKa/IKKb to RIPK1 phosphorylation, we next performed in vitro kinase assays using recombinant proteins and included Nec-1 in the reactions to prevent RIPK1 autophosphorylation. We found that both IKKa and IKKb directly phosphorylated full-length RIPK1 or a mutated version lacking the death and RHIM domain (RIPK11–479)(Figures 5A, 5B, and S4A). Of note, RIPK1 phosphorylation by IKKb induced a mobility shift of RIPK1 not detected when using IKKa (Figures 5A and 5B), suggesting some specificity in the residues phosphorylated by both kinases. In line with our cellular data, TPCA-1 repressed, although with different efficiencies, the direct phosphorylation of RIPK1 by IKKa and IKKb. In contrast, recombinant TAB1/TAK1 did notlead to detectable RIPK1 phosphorylation by autoradiography (Figure 5C).

We next tested the consequence of genetic or pharmacological inhibition of IKKa/IKKb, and of the resulting defective phosphorylation of RIPK1 in complex I, on the ability of RIPK1 to integrate the cytosolic caspase-8-activating complex IIb. We found, by performing FADD and caspase-8 immunoprecipitations, that inhibition of IKKa/IKKb enzymatic activities resulted in the binding of RIPK1 to FADD and caspase-8, a process relying on RIPK1 kinase activity (Figures 5D–5G). In contrast, CHX pre-treatment, which does not affect phosphorylation of RIPK1 in complex I (Figure 4H), led to much less recruitment of RIPK1 to FADD/caspase-8, and this recruitment was not inhibited by Nec-1 (Figures 5F, 5G, and S4B). Of note, association of TRADD with FADD/caspase-8 was not observed under these conditions. Together, these results suggest that IKKa/IKKb-mediated phosphorylation of RIPK1 either represses RIPK1 kinase activity or interferes with RIPK1’s ability to bind complex IIb components.

Figure 5. Direct Phosphorylation of RIPK1 by IKKa/IKKb Prevents RIPK1 from Integrating Complex IIb (A–C) Recombinant GST-IKKa, GST-IKKb, or GST-TAB1-TAK1 fusion protein was incubated with a recombinant truncated (GST-RIPK11–479) or full-length (GST-RIPK1FL) form of RIPK1 in a radioactive in vitro kinase assay in the presence of the indicated inhibitors. Phosphorylation was revealed by SDS-PAGE followed by autoradiography. (D–G) MEFs with the indicated genotype (D and E) or Ripk1+/+ MEFs (F and G) were pre-incubated with zVAD-fmk and with the indicated compounds for 30 min and then stimulated with 20 ng/ml hTNF. After 4 hr, complex II was isolated by FADD or caspase-8 immunoprecipitation and RIPK1 binding revealed by immunoblotting. See also Figure S4.

IKKa/IKKb Mediate In Vivo Protection to RIPK1 KinaseDependent Death To test the in vivo relevance of our in vitro findings, we evaluated the contribution of RIPK1 kinase activity to two different mouse models of TNF-induced death. In the first one, we injected Ripk1K45A/K45A and Ripk1+/+ littermates with TNF in association with D-galactosamine. In this well-known model of acute hepatitis, TNF-mediated hepatocyte apoptosis is reported to result from transcriptional inhibition (Decker and Keppler, 1974), thereby affecting the NF-kB pathway downstream of IKKa/ IKKb. In accordance with our in vitro results, we found that Ripk1K45A/K45A mice were not protected from TNF-induced lethality and apoptotic liver damage, as monitored by survival curves, blood levels of aspartate transaminase/alanine transaminase (AST/ALT), caspase-3 activation in the liver by DEVDase assays, and active caspase-3 staining (Figures 6A–6E). Blood levels of lactate dehydrogenase (LDH), a marker of necrosis, were not upregulated by TNF+GalN injection (Figure 6F).

In the next model, we injected Ripk1K45A/K45A and Ripk1+/+ littermates with a sub-lethal dose of TNF (5 mg) in presence or absence of TPCA-1 (10 mg/kg) to inhibit the canonical NF-kB pathway at the level of IKKa/IKKb. Remarkably, while TPCA-1 hadnotoxicity onitsown(FiguresS5AandS5B),itscombination with TNF resulted in the rapid death of all Ripk1+/+, but no Ripk1K45A/K45A, mice (Figure 6G). Accordingly, Ripk1K45A/K45A mice were protected from TNF-induced hypothermia and had no increase in serum levels of ASL/ALT or caspase-3 activation in the liver (Figures 6H–6L). In contrast to TNF+GalN injection, TNF+TPCA-1 led to a substantial increase of LDH levels in the serum that was also absent in Ripk1K45A/K45A mice, suggesting additional necroptosis induction (Figure 6M). Importantly, RIPK1 kinase inhibition by co-administration of Nec-1s (Degterev et al., 2013), a modified and more stable version of Nec-1, in C57BL/6J mice also significantly delayed the death and injury induced by TNF+TPCA-1 injection (Figures S5C–S5I).

Together, these in vivo results demonstrate TNF-mediated RIPK1-independent and RIPK1 kinase-dependent hepatocyte apoptosis in condition of NF-kB inhibition downstream or at the level of IKKa/IKKb, respectively.

Figure 6. IKKa/IKKb Mediate In Vivo Protection to RIPK1 Kinase-Dependent Death (A) Cumulative survival rates of littermate Ripk1+/+ and Ripk1K45A/K45A C57BL/6J females injected with GalN 15 min prior to injection with mTNF (n = 5). (B, C, and F) Blood AST (B), ALT (C), and LDH (F) levels determined 3 hr post-TNF injection (Ripk1+/+ n = 3, and Ripk1K45A/K45A n = 4). (D and E) Caspase-3 activity in liver samples (Ripk1+/+ n = 3, and Ripk1K45A/K45A n = 4) isolated 3 hr post-TNF injection and determined by Ac-DEVD-AMC fluorescence assay (D) or anti-cleaved caspase-3 staining (E). (G) Cumulative survival rates of littermate Ripk1+/+ and Ripk1K45A/K45A C57BL/6J females injected with TPCA-1 20 min prior to injection with mTNF (n = 5). (H) Body temperature as a function of time. (I, J, and M) Blood AST (I), ALT (J), and LDH (M) levels determined 3 hr post-TNF injection (n = 4). (K and L) Caspase-3 activity in liver samples (n = 4) isolated 3 hr post-TNF injection and determined by Ac-DEVD-AMC fluorescence assay (K) or anti-cleaved caspase-3 staining (L). Scale bar, 25 mm. Error bars represent the SEM of the indicated n values. See also Figure S5.

IKKa/IKKb Protect Cells from RIPK1 Kinase-Dependent Necroptosis Independently of NF-kB Our in vivo results suggested that TNF+TPCA-1 additionally induced necroptosis in the injected mice. To test the possibility that IKKa/IKKb also regulates RIPK1 kinase-dependent necroptosis independently of NF-kB, we in vitro stimulated MEFs with TNF+CHX in the presence of the pan caspase inhibitor zVAD-fmk and of TPCA-1. As shown in Figure 7A,TNF-mediated
necroptosis induced by TNF+CHX+zVAD is fully repressed by Nec-1 but still greatly enhanced by additionally inhibiting IKKa/ IKKb with TPCA-1 (Figures 7A and S6A). The mouse fibrosarcoma cell line L929sAhFAS is a prototypic model for necroptosis since these cells succumb by necroptosis upon single TNF stimulation. While inhibiting NF-kB by CHX sensitized these cells to necroptosis, the sensitization was again enhanced when IKKa/ IKKb was additionally inhibited by TPCA-1 (Figures 7B and S6B). Our results therefore demonstrate that IKKa/IKKb prevent RIPK1 kinase-dependent apoptosis and necroptosis downstream of TNFR1 independently of their known function in protecting the cells from death by mediating NF-kB-dependent upregulation of pro-survival/anti-death genes.

RIPK1 kinase-dependent necroptosis relies on the downstream activation of the RIPK3-MLKL pathway (Cho et al., 2009; He et al., 2009; Pasparakis and Vandenabeele, 2015;Sun et al., 2012; Zhang et al., 2009; Zhao et al., 2012). To further characterize the contribution of RIPK3 to the lethality resulting from the in vivo injection of TNF+TPCA-1, we challenged Ripk3+/+ and Ripk3/ littermates with this trigger. Contrary to Ripk1K45A/K45A mice, Ripk3/ mice were greatly, but not entirely, protected from death and hypothermia induced by TNF+TPCA-1 (Figures 7C and 7D). Interestingly, the protection was not originating from the liver, as RIPK3 deficiency did not prevent liver damage (Figures 7E–7H). Instead, RIPK3 deficiency prevented the increased of LDH levels in the blood, resulting from necrosis of undefined organ(s) (Figure 7I). These in vivo results therefore suggest that the lethality induced by TNF+TPCA-1 results from both RIPK1 kinase-dependent apoptosis and necroptosis.

Figure 7. IKKa/IKKb Protect Cells from RIPK1 Kinase-Dependent Necroptosis Independently of NF-kB (A and B) Ripk1+/+ MEFs (A) and L929sAhFas cells (B) were stimulated with hTNF (20 ng/ml in A and 33 pg/ml in B) in the presence of the indicated compounds, and cell death was measured as a function of time by SytoxGreen positivity. (C) Cumulative survival rates of littermate Ripk3+/+ and Ripk3/ C57BL/6J females injected with TPCA-1 20 min prior to injection with mTNF (Ripk3+/+ n = 4, and Ripk3/ n = 7). (D) Body temperature as a function of time. (E, F, and I) Blood AST (E), ALT (F), and LDH (I) levels determined 3 hr post-TNF injection (Ripk3+/+ n = 4, and Ripk3/ n = 3). (G and H) Caspase-3 activity in liver samples (Ripk3+/+ n = 4, and Ripk3/n = 3) isolated 3 hr post-TNF injection and determined by Ac-DEVD-AMC fluorescence assay (G) or anti-cleaved caspase-3 staining (H). Scale bar,25mm.Fortheinvitrocell death results,error bars represent the SEM of three independent experiments. For the in vivo results,error bars represent the SEM of the indicated n values

Sensing of TNF by TNFR1 at the cell surface can paradoxically result in the activation of signaling pathways with opposite consequences: cell survival or cell death. The fact that survival is the dominant outcome in most cell types indicates the existence of molecular mechanisms actively repressing TNFR1-mediated cell death.Two major mechanisms have been reported to control cell death downstream of TNFR1 (O’Donnell and Ting, 2011).The first identified one is well characterized and consists in a relatively slow process involving the NF-kB-dependent induction of pro-survival/anti-death molecules, such as cFLIP (Karin and Lin, 2002; Kreuz et al., 2001; Liu et al., 1996; Micheau et al., 2001; Panayotova-Dimitrova et al., 2013; Van Antwerp et al., 1996; Wang et al., 1998). The second one, which is less understood and more recently reported, is believed to take place at an earlier stage following TNFR1 activation and is shown to be independent of the NF-kB response (Dondelinger et al., 2013; Legarda-Addison et al., 2009; O’Donnell et al., 2007, 2012; Wang et al., 2008). Interestingly, while the first checkpoint regulates slow apoptosis by inhibiting activation of complex IIa (TRADD-FADD-caspase-8), the second one regulates the contribution of RIPK1 to cell death by either preventing RIPK1 from integrating the apoptotic complex IIb (RIPK1-FADD-casapase-8) or by limiting its contribution to the necrosome (RIPK1RIPK3-MLKL) (Cho et al., 2009; He et al., 2009; Sun et al., 2012; Vanlangenakker et al., 2011; Wang et al., 2008; Wilson et al., 2009; Zhang et al., 2009; Zhao et al., 2012). It has long been thought that IKKa/IKKb inhibits TNF-induced cell death through activation of the NF-kB pathway. In this study, we provide evidences that IKKa and IKKb also regulate cell death by direct phosphorylation of RIPK1 at the level of TNFR1 complex I.

TNF-induced RIPK1-dependent apoptosis was first described in conditions affecting cIAP1/cIAP2-mediated RIPK1 ubiquitylation (Bertrand et al., 2008; O’Donnell et al., 2007; Petersen et al., 2007; Wang et al., 2008), which led to the hypothesis that the ubiquitin chains on RIPK1 were directly preventing its binding to FADD, keeping RIPK1 in a survival modus. This‘‘direct’’effect, however, has later been challenged. Binding of the adaptor proteins TABs and NEMO to RIPK1 ubiquitin chains allows recruitment of TAK1 and of IKKa/IKKb to TNFR1 complex I (Ea et al., 2006; Li et al., 2006; Wu et al., 2006), and TAK1 inhibition was shown to result in TNF-mediated RIPK1-dependent apoptosis without affecting RIPK1 ubiquitylation status (Dondelinger et al., 2013). We show here that RIPK1 is phosphorylated in complex I and that affecting RIPK1 ubiquitylation by cIAP1/ cIAP2depletion directlyimpactsitsphosphorylation.Incontrast, TAK1, NEMO, or IKKa/IKKb depletion affects RIPK1 phosphorylation and induces RIPK1-dependent cell death but does not alter its ubiquitylation state in complex I. Together, these results indicate that ubiquitylation and phosphorylation of RIPK1 occur sequentially and that RIPK1 phosphorylation regulates its killing potential. Because activation of the IKK complex lies downstream of TAK1 but upstream of IkBa and p65, our results suggest a model in which IKKa/IKKb constitute the last step in the regulation of the RIPK1 cell death checkpoint (graphical abstract). Indeed, p65 deletion, expression of IkBaSR, or CHX pre-treatment induces TNF-mediated RIPK1-independent apoptosis and does not alter RIPK1 ubiquitylation or phosphorylation in complex I.

RIPK1 enzymatic activity is needed for the integration of RIPK1 to complex IIb and to the necrosome, which respectively drives apoptosis or necroptosis under TNF-stimulated conditions (Cho et al., 2009; Dondelinger et al., 2013; He et al., 2009; Wang et al., 2008). The precise role of RIPK1 kinase activity in these processes remains unclear but may involve autophosphorylation-driven conformational changes allowing increased binding of RIPK1 to the death complex components. The kinase activity of RIPK1 therefore requires active repression to avoid unnecessary cell death. A recent report suggests that RIPK1 phosphorylation on Ser89 suppresses its kinase activity (McQuade et al., 2013). It is therefore tempting to speculate that IKK-mediated phosphorylation of RIPK1 in complex I affects RIPK1 kinase activity. Alternatively, the phosphorylation of RIPK1 by IKKs may directly affect binding of RIPK1 to the death complex components or facilitate its dissociation from complex I. We performed mass spectrometry analysis to identify the residues of RIPK1 phosphorylated by IKKa and IKKb and found several sites, but not Ser89 (Figures S4C and S4D). Unfortunately, we were unable to demonstrate the direct physiological relevance of the identified phosphorylation sites due to the fact that all Ripk1/ reconstituted MEFs, even those with WT RIPK1 (irrespective of RIPK1 expression levels), started to succumb upon single TNF stimulation (data not shown), a problem previously reported (Gentleetal., 2011). The fact that the combined repression of IKKa and IKKb is needed to induce RIPK1 kinase-dependent death, and that the phosphorylation by each kinase results in different RIPK1 mobility shifts when run on gels, may indicate that phosphorylation on several residues is required to negatively regulate RIPK1.

IKKa and IKKb are best known for their roles in NF-kB activation, but NF-kB-independent functions have also been reported, some of which are even implicated in cell fate decisions (Hinz and Scheidereit, 2014). Using pharmacological inhibition of IKKa/IKKb in a p65-deficient background, or together with CHX, we demonstrated an NF-kB-independent function of IKKa/IKKb in protecting cells from TNF-induced RIPK1 kinasedependent apoptosis and necroptosis. In vivo, we demonstrate that TNF induces apoptosis of hepatocytes independently of RIPK1 when the NF-kB pathway is affected downstream of IKKa/IKKb (TNF+GalN). In contrast, pharmacological inhibition of the NF-kB pathway at the level of IKKa/IKKb (TNF+TPCA-1) sensitizesmicetoTNF-inducedshock,whichisaccompaniedby RIPK1 kinase-dependent, but RIPK3-independent, apoptosis of hepatocytes and RIPK1/RIPK3-dependent cellular death, presumably necroptosis, in undefined organs. We can indeed not formally rule out the possibility that the increase in serum LDH levels originates from secondary necrosis of apoptotic cells. Importantly, genetic and chemical inhibition of RIPK1 enzymatic activity protected the mice from TNF-induced cellular damage and death. These results therefore demonstrate the in vivo roles of IKKa/IKKb in protecting cells from RIPK1 kinase-dependent death.

The LUBAC complex, which includes its component Sharpin, is recruited to complex I during TNF signaling, and the inactivating mouse Sharpin cpdm mutation was reported to cause multi-organinflammationresultingfromTNF-mediated RIPK1kinase-dependent death (Berger et al., 2014; Kumari et al., 2014; Rickard et al., 2014). In line with our results, we found that TNF-mediated RIPK1 kinase-dependent death of mouse dermal fibroblasts (MDFs) isolated from Sharpincpdm mice is associated with defective RIPK1 phosphorylation in complex I (Figures S7A and S7B), probably resulting from the altered recruitment of IKK proteins to complex I, as previously reported for other LUBAC components (Haas et al., 2009). The genetic disruption of Nemo, Ikka, Ikkb, orIkka/Ikkb in mice results in early lethality with massive cellular death in several organs, such as the liver, the skin, and, in the case of Ikka//b/ mice, the nervous system (Hu et al., 1999; Li et al., 1999, 2000; Rudolph et al., 2000; Takeda et al., 1999). So far, these phenotypes have exclusively been explained by defects in NF-kB activation, but our study indicates that RIPK1 activation probably contributes to these pathological conditions. In the same line, RIPK1 kinase-dependent apoptosis may drive the spontaneous development of hepatocellular carcinoma observed in mice ablated of Nemo in the liver parenchymal cells (Luedde et al., 2007). Testing the contribution of RIPK1 to those phenotypes is an exciting future challenge, which may open doors for the use of chemical inhibitors of RIPK1 in the treatment of human diseases associated with IKK malfunctions, such as incontinentia pigmenti (Conte et al., 2014).

Translocation of interleukin-1β into a vesicle intermediate in autophagy-mediated secretion
Min Zhang1, Sam Kenny2, Liang Ge1, Ke Xu2 and Randy Schekman1*
eLife 2015;10.7554/eLife.11205    http://dx.doi.org/10.7554/eLife.11205

In this study, we probed the organelle association and molecular requirements for the secretion of one such unconventional cargo protein, IL-1β. Using surrogate cell lines rather than macrophages to reconstitute autophagy-mediated secretion of IL-1β (Figure 1), we find mature IL-1β localized to the lumen of the membrane in early intermediates and mature autophagosomes (Figures 2-4, 6). This surprising location may help to explain how mature IL-1β is secreted in a soluble form to the cell surface (Figure 9C). However, localization to the lumen between the two membranes of the autophagosome would require that IL-1β is translocated from the cytoplasm across the membrane precursor of a phagophore, rather than being engulfed as the phagophore membrane matures by closure into an autophagosome.

The exact route by which the autophagosome delivers mature IL-1β to the cell surface as well as how it avoids fusion with degradative lysosome remains obscure, possibly involving interaction with the multi-vesicular body or some form of lysosome as a prelude to fusion at the cell surface (Figure 9C), and this process may require selective recruitment of membrane sorting and targeting factors such as Rabs and SNAREs.

Recent evidence suggests that autophagy facilitates the unconventional secretion of the pro-inflammatory cytokine interleukin 1β (IL-1β). Here, we reconstituted an autophagy-regulated secretion of mature IL-1β (m-IL-1β) in non-macrophage cells. We found that cytoplasmic IL-1β associates with the autophagosome and m-IL-1β enters into the lumen of a vesicle intermediate but not into the cytoplasmic interior formed by engulfment of the autophagic membrane. In advance of secretion, m-IL-1β appears to be translocated across a membrane in an event that may require m-IL-1β to be unfolded or remain conformationally flexible and is dependent on two KFERQ-like motifs essential for the association of IL-1β with HSP90. A vesicle, possibly a precursor of the phagophore, contains translocated m-IL-1β and later turns into an autophagosome in which m-IL-1β resides within the intermembrane space of the double-membrane structure. Completion of IL-1β secretion requires Golgi reassembly and stacking proteins (GRASPs) and multi-vesicular body (MVB) formation.

Most eukaryotic secretory proteins with an N-terminal signal peptide are delivered through the classical secretion pathway involving an endoplasmic reticulum (ER)-to-Golgi apparatus itinerary (Lee et al., 2004; Schatz and Dobberstein, 1996). However, a substantial number of secretory proteins lack a classical signal peptide, called leaderless cargoes, and are released by unconventional means of secretion (Nickel and Rabouille, 2009; Nickel and Seedorf, 2008). The range of unconventional secretory cargoes encompasses angiogenic growth factors, inflammatory cytokines and extracellular matrix components etc. most of which play essential roles for development, immune surveillance and tissue organization (Nickel, 2003; Rabouille et al., 2012). Unlike a unified route for classical protein secretion, leaderless cargoes undergoing unconventional secretion employ multiple means of protein delivery, the details of which are largely unknown (Ding et al., 2012; Nickel, 2010; Rabouille et al., 2012; Zhang and Schekman, 2013).

IL-1β is one of the most intensely investigated cargoes of unconventional secretion. A biologically inactive 31 kDa precursor, pro-IL-1β, is made following initiation of the NF-κB signaling cascade. Pro-IL-1β is subsequently converted into the active form, the 17 kDa mature IL-1β, by the pro-inflammatory protease caspase-1 which is activated, in response to extracellular stimuli, after its recruitment to a multi-protein complex called the inflammasome (Burns et al., 2003; Cerretti et al., 1992; Rathinam et al., 2012; Thornberry et al., 1992). Interpretation of the mechanism of unconventional secretion of IL-1β is complicated by the fact that one of the physiologic reservoirs of this cytokine, macrophages, undergoes pyroptotic death and cell lysis under conditions of inflammasome activation of caspase-1. Indeed, many reports including two recent publications make the case for cell lysis as a means of release of mature IL-1β (Liu et al., 2014; Shirasaki et al., 2014). In contrast, other reports demonstrate proper secretion of mature IL-1β without cell lysis in, for example, neutrophils, which are nonetheless dependent on the inflammasome response to activate caspase-1 and secrete mature IL-1β (Chen et al., 2014).

Macroautophagy (hereafter autophagy) is a fundamental mechanism for bulk turnover of intracellular components in response to stresses such as starvation, oxidative stress and pathogen invasion (Mizushima and Levine, 2010; Yang and Klionsky, 2010). The process is characterized by the formation of a double-membrane vesicle, called the autophagosome, through the elongation and closure of a cup-shaped membrane precursor, termed the phagophore, to engulf cytoplasmic cargoes (Hamasaki et al., 2013; Lamb et al., 2013). Completion of autophagosome formation requires a sophisticated protein-vesicle network organized by autophagic factors, such as autophagy-related (ATG) proteins, and target membranes (Feng et al., 2014; Mizushima et al., 2011). Besides the degradative function, autophagy or ATG proteins have recently been implicated in multiple secretory pathways including the delivery of leaderless cargoes undergoing unconventional secretion, such as the mammalian pro-inflammatory cytokines IL-1β and IL-18, the nuclear factor HMGB1, and the yeast acyl coenzyme A-binding protein Acb1, to the extracellular space (Bruns et al., 2011; Dupont et al., 2011; Duran et al., 2010; Manjithaya and Subramani, 2011; Pfeffer, 2010; Subramani and Malhotra, 2013). The Golgi reassembly and stacking protein(s) GRASP(s) (GRASP55 and GRASP65 in mammals, dGRASP in Drosophila, GrpA in Dictyostelium and Grh1 in yeast) are required for autophagy-regulated unconventional secretion (Giuliani et al., 2011; Kinseth et al., 2007; Levi and Glick, 2007; Manjithaya et al., 2010).

Dupont et al. (2011) documented a role for autophagy in the secretion of mature IL-1β (Dupont et al., 2011), but how a protein sequestered within an autophagosome could be exported as a soluble protein was unexplained. Here, we sought to understand how conditions of starvation-induced autophagy could localize IL-1β into an autophagosomal membrane. We reconstituted the autophagy-regulated secretion of IL-1β in cultured cell lines and detected a vesicle intermediate, possibly an autophagosome precursor, containing mature IL-1β. Three-dimensional (3D) Stochastic Optical Reconstruction Microscopy (STORM) demonstrated that, after entering into the autophagosome, IL-1β colocalizes with LC3 on the autophagosomal membrane, which, together with an antibody accessibility assay and observations from biochemical assays, implies a topological distribution in the intermembrane space of the autophagosome. This distribution of IL-1β explains the mechanism accounting for its secretion as a soluble protein through either a direct fusion of autophagosome with the plasma membrane or via the MVB pathway. Quite aside from the possible complication of cell lysis, another body of work has suggested an unconventional pathway for the proper secretion of IL-1β. Pro-IL-1β lacks a typical signal peptide and the propeptide is processed in the cytosol rather than the ER (Rubartelli et al., 1990; Singer et al., 1988). Although mature IL-1β appears to be incorporated into a vesicular transport system, secretion is not blocked by Brefeldin A, a drug that blocks the traffic of standard secretory proteins form the Golgi apparatus (Rubartelli et al., 1990). Multiple mechanisms have been implicated in the unconventional secretion of IL-1β, including autophagy, secretory lysosomes, multi-vesicular body (MVB) formation and micro-vesicle shedding (Andrei et al., 1999; Andrei et al., 2004; Brough et al., 2003; Lopez-Castejon and Brough, 2011; MacKenzie et al., 2001; Qu et al., 2007; Verhoef et al., 2003). However, a clear demonstration of the mechanism for the entry of IL-1β into a vesicular carrier, e.g. the autophagosome, is lacking.

Reconstitution of autophagy-regulated IL-1β secretion

A dual effect of autophagy has been proposed on the secretion of IL-1β in macrophages (Deretic et al., 2012; Jiang et al., 2013). On one hand, induction of autophagy directly promotes IL-1β secretion after inflammasome activation by incorporating it into the autophagosomal carrier (Dupont et al., 2011). On the other hand, autophagy indirectly dampens IL-1β secretion by degrading components of the inflammasome as well as reducing endogenous triggers for inflammasome assembly, including reactive oxygen species (ROS) and damaged components, which are required for the activation of caspase-1 and the production of active IL-1β (Harris et al., 2011; Nakahira et al., 2011; Shi et al., 2012; Zhou et al., 2011).

To focus our study specifically on the role of autophagy in IL-1β secretion, we reconstituted a stage of IL-1β secretion downstream of inflammasome activation by co-expressing pro-IL-1β (p-IL-1β) and pro-caspase-1 (p-caspase-1) in non-macrophage cells. As shown in Figure 1A, the generation and secretion (~5%) of mature IL-1β (m-IL-1β) was achieved by co-expression of p-IL-1β and p-caspase-1 in HEK293T cells. Mature IL-1β was not produced or secreted without p-caspase-1, whereas a low level of secreted p-IL-1β (~0.2%) was detected with or without the expression of p-caspase-1. Furthermore, little cell lysis occurred during the treatment we used to induce IL-1β secretion: Much less precursor than mature IL-1β and little cytoplasmic tubulin was detected released into the cell supernatant during the 2 h incubation in starvation medium (Figure 1A). Starvation, a condition that stimulates autophagy, enhanced IL-1β secretion (~3 fold) and reduced the level of IL-1β in the cell lysates (Figure 1A, B). Inhibition of autophagy by the phosphatidylinositol 3-kinase (PI3K) inhibitors 3-methyladenine (3-MA) or wortmannin (Wtm) blocked IL-1β secretion activated by starvation and caused the accumulation of mature IL-1β in the cell (Figure 1B). Likewise, in an autophagy-deficient cell line, Atg5 knockout (KO) mouse embryo fibroblasts (MEFs) (Mizushima et al., 2001), IL-1β secretion was reduced and failed to respond to starvation (Figure 1C). Moreover, IL-1β secretion was also inhibited in a dose-dependent manner in the presence of an ATG4B mutant (C74A) (Fujita et al., 2008), or after the depletion of ATG2A and B (Velikkakath et al., 2012), or FIP200 (Hara et al., 2008), which block autophagosome biogenesis at different stages (Figure 1D-F). Therefore, the reconstituted system recapitulates the autophagy-regulated secretion of IL-1β.

In macrophages, MVB formation and GRASP proteins are required for IL-1β secretion (Dupont et al., 2011; Qu et al., 2007). Inhibiting MVB formation by depletion of the ESCRT components, hepatocyte growth factor receptor substrate (Hrs) or TSG101, compromised secretion of IL-1β and CD63, an exosome marker (Figure 1-figure supplement 1A). Knockdown of the GRASP55 or GRASP65 also led to the reduction of IL-1β secretion (Figure 1- figure supplement 1B). Therefore, in addition to functions required for autophagy, the secretion of IL-1β in HEK293T cells depends on GRASP proteins and at least two proteins implicated in MVB formation, as reported previously (Dupont et al., 2011; Qu et al., 2007).

Figure 1 Reconstitution of autophagy-regulated IL-1β secretion in cultured cells (A) Reconstitution of starvation-induced IL-1β secretion in HEK293T cells. HEK293T cells were transfected with a single plasmid encoding p-IL-1β or together with the p-caspase-1 plasmid. After transfection (24 h), the cells were either treated in regular (DMEM) or starvation (EBSS) medium for 2 h. The medium and cells were collected separately and immunoblot was performed to determine the level of indicated proteins. (B) PI3K inhibitors 3-methyladenine (3-MA) or wortmannin (Wtm) inhibit IL-1β secretion. HEK293T cells transfected with p-IL-1β and p-caspase-1 plasmids were cultured in DMEM, EBSS, or EBSS containing 10 mM 3-MA or 20 nM wortmannin for 2 h. The medium and cells were collected separately and immunoblot was performed as shown in (A). (C) IL-1β secretion is blocked in Atg5 KO MEFs. Control WT or Atg5 KO MEFs were transfected with p-IL-1β and p-caspase-1 plasmids. After transfection (24 h), the cells were either cultured in DMEM or EBSS for 2 h followed by immunoblot as shown in (A). (D) IL-1β secretion is inhibited by the ATG4B mutant (C74A). HEK293T cells were transfected with plasmids encoding p-IL-1β, p-caspase-1 and different amounts of ATG4B (C74A) plasmid DNA as indicated. After transfection (24 h), cells were starved in EBSS for 2 h followed by immunoblot as shown in (A). (E) Knockdown of Atg2 reduces IL-1β secretion. HEK293T cells were transfected with control siRNA or siRNAs against Atg2A, Atg2B alone or both. After transfection (48 h), the cells were transfected with p-IL-1β and p-caspase-1 plasmids. After another 24 h, the cells were starved in EBSS for 2 h followed by immunoblot as shown in (A). (F) Knockdown of FIP200 reduces IL-1β secretion. HEK293T cells were transfected with control siRNA or FIP200 siRNA. IL-1β secretion under starvation conditions was determined as shown in (E). Quantification of IL-1β secretion was calculated as the ratio between the amount of IL-1β in the medium and the total amount (the sum of IL-1β in both medium and lysate).

Figure 1- figure supplement 1  Depletion of ESCRT or GRASPs affects IL-1β secretion HEK293T cells were transfected with indicated siRNAs (Hrs (ESCRT-0) (A), Tsg101 (ESCRT-I) (A), GRASP55 (B) or GRASP65 (B)). After transfection (48 h), the cells were transfected with p-IL-1β and p-caspase-1 plasmids. After another 24 h, the cells were starved in EBSS for 2 h followed by immunoblot as shown in Figure 1A. Quantification of IL-1β secretion was calculated as the ratio between the amount of IL-1β in the medium and the total amount (the sum of IL-1β in both medium and lysate).

IL-1β transits through an autophagosomal carrier during secretion.

To study if autophagy directly regulates IL-1β secretion, we employed a three-step membrane fractionation procedure as described previously (Figure 2A)(Ge et al., 2013). We first performed a differential centrifugation to obtain 3k, 25k and 100k membrane pellet fractions. Both IL-1β and the lipidated form of LC3 (LC3-II), a protein marker of autophagosome, were mainly enriched in the 25k membrane fraction (Figure 2B). We then separated the 25k membrane through a sucrose step gradient ultracentrifugation where both IL-1β and LC3-II co-distributed in the L fraction at the boundary between 0.25 M and 1.1 M layer of sucrose (Figure 2B). Further fractionation of the L fraction using an OptiPrep gradient showed co-fractionation of IL-1β with LC3-II (Figure 2C). To confirm the presence of IL-1β in the autophagosome, we performed immunoisolation of LC3-positive autophagosomes from the 25k fraction and found that IL-1β, especially the mature form, co-sedimented with autophagosomes (Figure 2D). Consistent with our observations, a recent study also showed a colocalization of IL-1β and LC3 in the form of puncta in macrophages (Dupont et al., 2011). These data demonstrate that at least a fraction of intracellular mature IL-1β associates with the autophagosome, possibly related to its role in IL-1β secretion.

Figure 2 IL-1β vesicles co-fractionate with LC3 vesicles (A) Membrane fractionation scheme. Briefly, HEK293T cells transfected with p-IL-1β and p-caspase-1 plasmids were starved in EBSS for 2 h, collected and homogenized. Cell lysates were subjected to differential centrifugations at 3,000×g (3k), 25,000×g (25k) and 100,000×g (100k). The level of IL-1β in each membrane fraction was determined by immunoblot. The 25k pellet, in which IL-1β was mainly enriched, was selected and a sucrose gradient ultracentrifugation was performed to separate membranes in the 25k pellet to the L (light) and P (pellet) fractions. The L fraction, which contained the majority of IL-1β, was further resolved on an OptiPrep gradient after which ten fractions from the top were collected. (B, C) Immunoblot was performed to examine the distribution of IL-1β, LC3 as well as the indicated membrane markers in the indicated membrane fractions. T, top; B, bottom (D) HEK293T cells transfected with p-IL-1β, p-caspase-1 and FLAG-tagged LC3-I plasmids were starved in EBSS for 2 h. LC3 positive membranes were immunoisolated with anti-FLAG agarose from the 25k pellet and the presence of IL-1β was determined by immunoblot analysis. FT, flowthrough.

To determine if IL-1β is localized to the phagophore in the absence of autophagosome completion, we fractionated membranes from ATG2-depleted cells, which are deficient in phagophore elongation and therefore fail to form mature autophagosomes (Velikkakath et al., 2012), and examined the distribution of LC3-II, which remains attached to immature phagophore membranes, and mature and precursor IL-1β. We performed the three-step fractionation described above. In control cells, IL-1β co-distributed with LC3-II in all three steps (Figure 3). Depletion of ATG2 did not affect the co-fractionation of IL-1β and LC3-II (Figure 3), indicating that IL-1β enters into the phagophore membrane before the completion of the autophagosome.

Figure 3 IL-1β co-distributes with LC3 in Atg2-depleted cells (A) HEK293T cells were transfected with siRNAs against Atg2A and Atg2B followed with p-IL-1β and 739 p-caspase-1 plasmids as shown in Figure 1E. The cells were starved in EBSS for 2 h. Membrane fractions (3k, 25k, 100k (×g), L and P) were separated from the post-nuclear supernatant as depicted in Figure 2B. (B) Ten membrane fractions were collected from the OptiPrep gradient ultracentrifugation as depicted in Figure 2C. Immunoblot was performed to examine the distribution of IL-1β, LC3 as well as the indicated membrane markers. T, top; B, bottom.

Autophagosome formation is not required for entry of IL-1β into vesicles

We asked how IL-1β enters into the autophagosome. One possibility is engulfment through the closure of the phagophore membrane during autophagosome maturation as in the capture of autophagic cargo. In this scenario, closure of the phagophore to complete autophagosome formation would be required to sequester IL-1β away from the cytoplasm. Alternatively, we considered the possibility that IL-1β may be translocated through a membrane into the lumen of the phagophore envelope and be sequestered from the cytoplasm even before the mature autophagosome is sealed. To test this possibility, we performed proteinase K protection experiments with the membranes from ATG2-depleted cells (Figure 4A). In control cells, p62 (an autophagic cargo) and a fraction of LC3-II (which was encapsulated after autophagosome completion), as well as mature IL-1β, were largely resistant to proteinase K digestion similar to the ER luminal protein, protein disulfide isomerase (PDI). In contrast, SEC22B, a membrane anchored SNARE protein exposed to the cytoplasm, was sensitive to proteinase K digestion (Figure 4A). Triton X-100 treatment permeabilized the membrane and rendered all proteins tested sensitive to proteinase K digestion (Figure 4A). This demonstrated that the majority of membrane localized IL-1β was sequestered within an organelle, likely the autophagosome, as demonstrated by the fractionation results of Figures 2 and 3. However, the result did not pinpoint where within the autophagosome IL-1β was housed. In ATG2-depleted cells, p62 and LC3-II remained sensitive to proteinase K digestion, consistent with the hypothesis that ATG2 is essential for maturation and closure of the autophagosome (Figure 4A). However, in the same samples the majority of IL-1β resisted degradation by proteinase K treatment (Figure 4A), except on addition of Triton X-100 to permeabilize membranes. Although the precursor form of IL-1β remained associated with isolated autophagosome and phagophore membranes (Figure 3), the protein was degraded when membranes from normal and ATG2-depleted cells were treated with protease in the presence or absence of Triton X-100 (data not shown). Thus, the mature but not the precursor IL-1β appears to be transported into the phagophore.

A most recent study showed that small, closed double-membrane structures could be observed in ATG2-depleted cells (Kishi-Itakura et al., 2014). To rule out the possibility that IL-1β was engulfed by the small closed autophagosomes, we employed Atg5 KO MEFs in which the phagophore could not be closed (Kishi-Itakura et al., 2014; Mizushima et al., 2001). Similar to what we observed in ATG2-depleted cells, IL-1β was protected from proteinase K digestion in membranes from Atg5 KO MEFs (Figure 4B). In addition, IL-1β was sequestered within vesicles in FIP200 (another early factor in phagophore development (Hara et al., 2008)) knockdown cells (Figure 4C). These data indicate that the entry of IL-1β into the vesicle carrier is not dependent on the formation of the autophagosome. These results are inconsistent with a role for engulfment of IL-1β by the maturing phagophore and suggest instead that IL-1β may be translocated across a membrane into a vesicle precursor of the phagophore, possibly at a very early stage in the development of the organelle.

Figure 4 Closure of the autophagosome is not required for the entry of IL-1β into vesicles (A) HEK293T cells were transfected with siRNAs against Atg2A and Atg2B followed by transfection with p-IL-1β and p-caspase-1 plasmids as shown in Figure 1E. The cells were starved in EBSS for 2 h and proteinase K digestion was performed with the 25k membrane fractions. (B) Atg5 WT, KO MEFs were transfected with p-IL-1β and p-caspase-1 plasmids as shown in Figure 1B. The cells were starved in EBSS for 2 h followed by proteinase K digestion as shown in (A). 752 (C) HEK293T cells were transfected with siRNA against FIP200 followed by analysis of membrane entry of 753 IL-1β as shown in (A). The level of proteinase K protection was calculated as the percentage of the total protein. Error bars represent standard deviations of at least three experiments.

Entry of IL-1β into the vesicle carrier requires protein conformational flexibility

We then sought to test if IL-1β could directly translocate across the membrane of a vesicle carrier. As protein unfolding is usually required for protein translocation, we adopted an approach used in many other circumstances wherein a targeted protein is fused to dihydrofolate reductase (DHFR), an enzyme whose three-dimensional structure is stabilized by the folate derivative aminopterin, hence providing a chemical ligand to impede the unfolding process (Backhaus et al., 2004; Eilers and Schatz, 1986; Wienhues et al., 1991). We first determined the secretion of the DHFR-fused IL-1β. As shown in Figure 5A, secretion of a mature IL-1β-DHFR fusion protein was enhanced by starvation similar to the untagged counterpart. Importantly, IL-1β-DHFR secretion was reduced in a dose-dependent manner in the presence of aminopterin (Figure 5B). Of notice, treatment of aminopterin did not completely abolish IL-1β secretion perhaps due to a cell death-induced release of IL-1β at high concentrations of aminopterin, as indicated by the release of a low level of tubulin into the medium fraction (Figure 5B). As a control, aminopterin did not reduce the secretion of untagged IL-1β, confirming its specific effect on DHFR (Figure 5- figure supplement 1). Fractionation of cells 185 incubated with aminopterin showed a reduced level of IL-1β in the membrane fraction with a corresponding 186 increase in the cytosol fraction (Figure 5C). The residual DHFR-tagged IL-1β associated with membranes from aminopterin-treated cells was sensitive to proteinase K digestion (Figure 5D), indicating that this pool of membrane-associated IL-1β did not translocate into the lumen of the vesicle. The data suggest that entry of IL-1β into a vesicle carrier involves a process of protein unfolding and translocation.

Figure 5  Protein unfolding is required for the entry of IL-1β into vesicles (A) Secretion of DHFR-tagged IL-1β. HEK293T cells were transfected with p-IL-1β-DHFR and p-caspase-1 plasmids. After transfection (24 h), the cells were treated with DMEM or EBSS for 2 h. Release of IL-1β was determined as shown in Figure 1. (B) Secretion of IL-1β-DHFR was inhibited by aminopterin. HEK293T cells were transfected with p-IL-1β-DHFR and p-caspase-1 plasmids. After transfection (24 h), the cells were treated with EBSS, or EBSS containing different concentrations of aminopterin as indicated for 15 min followed by determination of IL-1β secretion as shown in (A). Quantification of IL-1β secretion was calculated as the ratio between the amount of IL-1β in the medium and the total amount (the sum of IL-1β in both medium and lysate). (C) Less IL-1β enters into membrane in the presence of aminopterin. HEK293T cells were transfected with p-IL-1β-DHFR and p-caspase-1 plasmids. After transfection (24 h), the cells were either untreated or treated with 5 μM aminopterin in EBSS for 2 h. The membrane fraction was collected from the top fractions of a Nycodenz density gradient resolved from membranes in a 25k pellet as described in Material and Methods. The cytosolic fraction was collected as the supernatant after 100k×g centrifugation. All fractions were analyzed by immunoblotting using indicated antibodies. (D) IL-1β-DHFR is not protected from proteinase K in the presence of aminopterin. Nycodenz -floated membrane fraction collected as shown in (C) was subjected to proteinase K digestion and then analyzed by immunoblotting using indicated antibodies.

Figure 5- figure supplement 1 Secretion of IL-1β is not affected by aminopterin HEK293T cells were transfected with p-IL-1β and p-caspase-1 plasmids. After transfection (24 h), the cells were treated with EBSS, or EBSS containing different concentrations of aminopterin as indicated for 15 min followed by determination of IL-1β secretion as shown in Figure 1 (A).

IL-1β colocalizes with LC3 on the autophagosome envelope

If IL-1β is directly translocated across the membrane of a vesicle intermediate, fusion of these vesicles to form a double-membrane autophagosome would deposit IL-1β in the lumen between the two membranes of the autophagosome. To visualize the subcellular localization of IL-1β, we employed U2OS cells, which formed 194 large and distinct autophagosomes after starvation. U2OS cells co-expressing p-IL-1β and p-caspase-1 secreted IL-1β in a starvation-enhanced and PI3K-dependent manner similar to HEK293T cells (Figure 6- figure supplement 1). To prepare for the subsequent fluorescence imaging, we also employed a FLAG-tagged m-IL-1β, which allowed us to directly determine the topological localization of the m-IL-1β. Secretion of m-IL-1β-FLAG from U2OS cells was stimulated by starvation and dependent on PI3K (Figure 6- figure supplement 1).

To determine the topological distribution of IL-1β, we first performed confocal immunofluorescence labeling experiments. After starvation, cells were exposed to 40 μg/ml of digitonin to permeabilize the plasma membrane, harvested and washed with cold PBS to remove the excess cytosolic m-IL-1β-FLAG. In cells expressing either p-IL-1β and p-caspase-1, or m-IL-1β alone, LC3 and IL-1β were observed by confocal microscopy to localize together or adjacent to one another on the edge of ring-shaped autophagosomes (Figure 6- figure supplement 2). To further resolve these ring structures, we employed 3D STORM (Huang et al., 2008; Rust et al., 2006) super-resolution microscopy (Hell, 2007; Huang et al., 2010) (Figure 6 and Figure 6- figure supplements 3, 4 and Videos 1 and 2). Ring-shaped autophagosomes positive for LC3 (cyan) formed after starvation. Some IL-1β (magenta) also organized in ring-shaped structures that co-localized with LC3 (Figure 6 and Figure 6- figure supplement 3). Around 18 ring structures of IL-1β accounting for ~5% of the total IL-1β signal were observed in each cell. A 3D virtual Z-stack analysis confirmed the spatial co-distribution of LC3 and IL-1β on a ball-shaped vesicle (Video 1 and 2). The diameter of the structures double-labeled with LC3 and IL-1β are ~700 nm (larger structures up to 2 μm in diameter were also found) which is comparable to the size of the autophagosome. Occasionally, we also found IL-1β localized in the center of the ring structure, where cytoplasmic autophagic cargoes fill, surrounded by LC3 (Figure 6-figure supplement 4). This portion of IL-1β was possibly being engulfed by the autophagosome.

The visual detection of IL-1β localized to ring-shaped autophagosomes is consistent with our biochemical assays that place IL-1β in the intermembrane space between the outer and inner membrane of the autophagosome. We devised a further visual test of this conclusion using selective permeabilization of cell surface and intracellular membranes with digitonin and saponin, respectively (Figure 6-figure supplement 5). We compared antibody accessibility to IL-1β and DFCP1, a marker located on the cytosolic surface of the omegasome (a harbor for the phagophore) in both WT and Atg5 KO cells. Consistent with a cytosolic surface localization, DFCP1 was readily labeled in cells treated with digitonin alone (selectively permeabilizes the plasma membrane) in both WT and Atg5 KO cells (Figure 6-figure supplement 5A-E). In contrast, IL-1β was accessible to the antibody only after treatment with digitonin and saponin (gently permeabilizes the endomembrane) (Figure 6-figure supplement 5A, B and F) in WT cells. This by itself would not distinguish localization of IL-1β to the intermembrane space vs the cytoplasmic enclosed space of a mature autophagosome. However, in Atg5 KO cells where the phagophore precursor envelope remains open and exposed to the cytosol, saponin treatment was necessary to expose IL-1β to antibody and roughly half of the labeled structures coincided with the phagophore marker DFCP1 (Figure 6-figure supplement 5C, D and F). This visual assay further confirms the intermembrane localization of IL-1β in the phagophore and 231 autophagosome.

Figure 6 Topological localization of IL-1β in the autophagosomal carrier determined by STORM U2OS cells were transfected with a plasmid containing the expression cassette of FLAG-tagged mature IL-1β (m-IL-1β-FLAG). After transfection (24 h), the cells were starved in EBSS for 1 h followed by immunofluorescence labeling with mouse monoclonal anti-LC3 and rabbit polyclonal anti-FLAG antibodies. STORM analysis imaging and data analysis were performed as described in Materials and Methods. Cyan, LC3; Magenta, IL-1β; Bars: 2 μm (original image) and 500 nm (magnified inset)

Figure 6- figure supplement 1  Secretion of IL-1β in U2OS cells 795 U2OS cells were transfected with plasmids encoding the p-IL-1β and p-caspase-1 (first 4 lanes) or m-IL-1β-FLAG (last 4 lanes). After transfection (24 h), the cells were untreated or starved in the absence or presence of indicated PI3K inhibitors (3-MA or wortmannin (Wtm)) followed by measurement of secretion as indicated in Figure 1 (A) and (B). α-m-IL-1β, IL-1b antibody; α-FLAG, FLAG antibody

Figure 6- figure supplement 2 Localization of IL-1β determined by confocal microscopy U2OS cells were transfected with plasmids encoding the p-IL-1β and p-caspase-1 (A) or m-IL-1β-FLAG (B). After transfection (24 h), the cells were starved for 1 h followed by immunofluorescence labeling and confocal 804 microscopy analysis. Bar: 10 μm

Figure 6- figure supplement 3  Extra images for Figure 6  Bars: 2 μm (original image) and 500 nm (magnified inset)

Figure 6- figure supplement 4  A minority of IL-1β engulfed by autophagosome  U2OS cells were transfected and treated followed by STORM analysis as shown in Figure 6. Arrow head points to the autophagosome with engulfed IL-1β. Bar: 2 μm

Figure 6- figure supplement 5  Determination of the topological localization of IL-1β in the autophagosome and phagophore  (A, C) Diagrams of autophagosome (A)/phagophore (B) and omegasome, antibody accessibility for each possible situation of IL-1β localization, and summaries of the antibody accessibility of m-IL-1β-FLAG (red) and EGFP-DFCP1 (green) are illustrated. (B, D) U2OS cells (B) and Atg5 KO MEFs (D) were transfected with plasmids encoding the m-IL-1β-FLAG and EGFP-DFCP1. After transfection (24 h), the cells were starved in EBSS for 1 h followed by digitonin treatment and fixation (see Materials and Methods). The cells were either labeled with anti-FLAG (to label IL-1β) and anti-EGFP (to label EGFP-DFCP1) antibodies (Digitonin) or further treated with Saponin followed by antibody labeling (Digitonin+Saponin). Images were acquired by confocal microscopy. Bar: 10 μm 825 (E) Quantification of the percentage of EGFP-DFCP1 labeled by EGFP antibody. Percentage was counted by 826 the ratio of puncta numbers of antibody labeled EGFP-DFCP1 and EGFP-DFCP1 according to the EGFP signal. Error bars are standard deviations of more than 50 cells in two independent experiments. (F) Quantification of the puncta number for m-IL-1β-FLAG puncta (red) and those colocalized with DFCP1 (yellow). Error bars are standard deviations of more than 50 cells in two independent experiments.

Video 1 832 3D section of the magnified structure in Figure 6 (upper one) 833 The virtual Z-section thickness is 150 nm, and the step size is 50 nm. Cyan, LC3; Magenta, IL-1β; Bar 500 nm 834 835 Video 2 836 3D section of the magnified structure in Figure 6 (lower one) 837 The virtual Z-section thickness is 150 nm, and the step size is 50 nm. Cyan, LC3; Magenta, IL-1β; Bar 500 nm

Two KFERQ-like motifs are required for the entry of IL-1β into the vesicle carrier

In chaperone-mediated autophagy (CMA), cargoes are recognized by a KFERQ sequence motif for transport into the lysosome (Dice et al., 1986; Kaushik and Cuervo, 2012). We analyzed the primary sequence of IL-1β and found three KFERQ-like motifs on IL-1β including 127LRDEQ131, 132QKSLV136 and 198QLESV202 (Figure 7A). We mutated the glutamine, which has been shown to be essential for the function of the motif, as well as an adjacent amino acid in each motif (E130Q131, Q132K133 and Q198L199) to alanines and examined the secretion efficiency of these mutants. The 130-131AA mutant did not affect secretion of IL-1β (Figure 7B). However, the Q132K133 and Q198L199 mutations were both defective in secretion of mature IL-1β which instead accumulated in the cytoplasmic fraction (Figure 7B). A low level of release of the pro-forms persisted as seen with WT and mutant protein (Figure 7B). The cytoplasmic mature forms of the mutant proteins were less abundant in the membrane fraction compared with the WT mature IL-1β (Figure 7C, compare the lanes without proteinase K treatment). In addition, the membrane associated mutant IL-1β remained proteinase K accessible (less than 10% of protection compared with ~45% of WT IL-1β), demonstrating that these two KFERQ-like motifs are required for the membrane translocation of IL-1β (Figure 7C). Equal amounts of WT and mutant p-IL-1β associated with the membrane but both remained largely proteinase K accessible (Figure 7C).

Figure 7 Mutation of the KFERQ-like motif affects IL-1β secretion and entry into vesicles (A) Protein sequence of IL-1β. The yellow region indicates mature IL-1β. Three KFERQ-like motifs (aa127-131, aa132-136 and aa198-202) are highlighted in red underlined bold. (B) Secretion of IL-1β mutants. HEK293T cells were transfected with p-IL-1β-DHFR and p-caspase-1 plasmids. After transfection (24 h), the cells were either treated with DMEM or EBSS for 2 h. Secretion of 845 IL-1β mutant proteins was detected by immunoblot. (C) IL-1β mutant 132-133AA or 198-199AA is accessible to proteinase K digestion. HEK293T cells were transfected with plasmids encoding p-caspase-1 and IL-1β mutant 132-133AA or 198-199AA. After transfection (24 h), the cells were treated with EBSS for 2 h. The 25k membrane fraction was collected and subjected to proteinase K digestion assay and then analyzed by immunoblot using indicated antibodies. The level of proteinase K protection was calculated as the percentage of the total protein. Error bars represent standard deviations of at least three experiments.

HSP90 is required for the entry of IL-1β into the vesicle intermediate 

The chaperone protein HSC70 and HSP90 have been reported to function in chaperone-mediated autophagy (CMA) (Kaushik and Cuervo, 2012; Majeski and Dice, 2004). HSP70 has also been implicated in autophagy and stress responses (Murphy, 2013). We performed shRNA-mediated knockdown of the three chaperone proteins to assess their potential role in the membrane translocation of IL-1β. Knockdown of Hsp90, but not of Hsp70 or Hsc70 substantially reduced IL-1β secretion (Figure 8A). As a control, knockdown of Hsc70 compromised CMA as indicated by the stabilization of a CMA cargo, GAPDH (Figure 8-figure supplement 1A). Moreover, secretion of mature IL-1β was inhibited in a dose-dependent manner by an HSP90 inhibitor geldanamycin (Figure 8B). In both experiments, mature IL-1β accumulated in the cytosol fraction at the expense of secretion. Knockdown of Hsp90 also rendered IL-1β accessible to proteinase K digestion (Figure 8C), consistent with a role for HSP90 in the translocation of IL-1β as opposed to some later secretion event. Furthermore, in a co-immunoprecipitation assay, HSP90 associated with m-IL-1β but not the translocation-deficient mutants Q132K133 and Q198L199 (Figure 8D). Although p-IL-1β also formed a complex with HSP90, the efficiency appeared lower than for m-IL-1β. These results suggest that HSP90 binds to a region of the mature IL-1β, including the essential residues Q132K133 and Q198L199, to promote the translocation event. Cleavage of p-IL-1β by caspase-1 may potentiate the recruitment of HSP90 to the mature form of IL-1β however chaperone binding is not required for this proteolytic event (Figures 8D and 7B).

In the CMA pathway, HSC70 and HSP90 play different roles. HSC70 binds to cargoes and delivers them into 266 the lysosome as well as disassembling LAMP2A oligomers, whereas HSP90 is required for the oligomerization and stability of LAMP2A (Bandyopadhyay et al., 2008; Chiang et al., 1989). Co-immunoprecipitation indicated that IL-1β associates with HSP90 but not HSC70 (Figure 8-figure supplement 1B). In addition, knockdown of Lamp2A compromised CMA but did not affect the secretion of IL-1β, and disruption of the lysosome did not result in the release of IL-1β from the membrane carrier (Figure 8-figure supplement 1C-E). These data suggest that the translocation of IL-1β into the vesicle carrier is mechanistically distinct from CMA.

Figure 8 HSP90 is involved in the entry of IL-1β into vesicles (A) Knockdown of Hsp90 inhibits IL-1β secretion. HEK293T cells were transduced with lentivirus carrying control (Ctrl) shRNA or shRNA against Hsc70, Hsp90 or Hsp70. Then the cells were transfected with p-IL-1β and p-caspase-1 plasmids. After transfection (24 h), the cells were cultured in EBSS for 2 h followed by determination of IL-1β secretion by immunoblot. (B) IL-1β secretion is reduced in the presence of HSP90 inhibitor geldanamycin. HEK293T cells were transfected with p-IL-1β and p-caspase-1 plasmids. After transfection (24 h), the cells were treated with EBSS containing different concentrations of geldanamycin as indicated. Immunoblot was performed as shown in Figure 1. Quantification of IL-1β secretion was calculated as the ratio between the amount of IL-1β in the medium and the total amount (the sum of IL-1β in both medium and lysate). (C) IL-1β remains accessible to proteinase K in Hsp90 knockdown cells. HEK293T cells were transduced with lentivirus carrying control (Ctrl) shRNA or shRNA against Hsp90. Then the cells were transfected with p-IL-1β and p-caspase-1 plasmids. After transfection (24 h), the cells were cultured in EBSS for 2 h. The 25k membrane fraction was collected and digested with proteinase K and then analyzed by immunoblotting using indicated antibodies. (D) Association of HSP90 with IL-1β WT and mutants. HEK293T cells transfected with p-caspase-1 and IL-1β mutant 132-133AA or 198-199AA were starved in EBSS for 2 h. Immunoprecipitation (IP) with anti-HSP90 antibody coupled to protein G-agarose was performed, followed by an immunoblot with anti-IL-1β and anti-HSP90 antibodies.

Figure 8- figure supplement 1 Translocation of IL-1β is mechanistically different from CMA (A) Knockdown of Hsc70 reduces CMA. HEK293T cells transduced with lentivirus carrying control (Ctrl) shRNA or shRNA against Hsc70 were incubated with regular medium (-CMA) or DMEM (+CMA) in the presence of 20 μg/ml cycloheximide for 24 h. The cells were lysed and analyzed by immunoblotting using indicated antibodies. For quantification, the ratio of GAPDH and tubulin was calculated and normalized by that in control (-CMA) treatment which was set as one. (B) Co-immunoprecipitation of HSC70 or HSP90 with IL-1β. HEK293T cells transfected with m-IL-1β-FLAG were starved in EBSS for 2 h. Immunoprecipitation (IP) with anti-HSC70 or anti-HSP90 antibody coupled to protein A/G-agarose was performed, followed by an immunoblot with indicated antibodies. (C) Knockdown of Lamp2 blocks CMA. HEK293T cells were transfected with control or LAMP2 siRNA. After transfection (48 h), the cells were trypsinized and plated. After 24 h, siRNA transfection was repeated. After another 48 h, the cells were trypsinized and plated. After 24 h, the cells were incubated with regular medium (-CMA) or DMEM (+CMA) in the presence of 20 μg/ml cycloheximide for 24 h. The cells were lysed and analyzed by immunoblotting using indicated antibodies. For quantification, the ratio of GAPDH and Tubulin was calculated and normalized by that in control (-CMA) treatment which was set as one. (D) Knockdown of LAMP2 does not affect IL-1β secretion. HEK293T cells were transfected with control or LAMP2 siRNA as show in (C). After the second siRNA transfection (24h), the cells were transfected with m-IL-1β-FLAG plasmid. After transfection (24 h), the cells were either cultured in DMEM or EBSS for 2 h followed by determination of IL-1β secretion by immunoblot as shown in Figure 1A. Quantification of IL-1β secretion was calculated as the ratio between the amount of IL-1β in the medium and the total amount (the sum of IL-1β in both medium and lysate). (E) Level of IL-1β in the membrane fraction was not affected by lysosome disruption. HEK293T cells 897 transfected with m-IL-1β were cultured in EBSS for 2 h and then treated with DMSO or 0.5 mM glycyl-L-phenylalanine-2-naphthylamide (GPN) for 10 min. The membrane fraction was collected from the top fractions of a Nycodenz density gradient resolved from membranes in a 25k pellet as described in Material and Methods. Both membrane fraction and cell lysis were analyzed by immunoblotting using indicated antibodies.

We next asked if starvation regulated the association between HSP90 and IL-1β. We performed an HSP90 co-immunoprecipitation experiment with cytosol prepared from cells grown in nutrient-rich or starvation conditions (Figure 9A). Starvation led to a ~2.5 fold increase of the association of HSP90 and IL-1β (Figure 9A). This increase was likely not due to starvation-stimulated processing of p-IL-1β because starvation had no effect on the cleavage of mutant forms of IL-1β unable to bind HSP90 (Figure 7B). Starvation led to a ~ 2 fold increase in the membrane localization and cytosolic depletion of mature IL-1β (Figure 9B). Starvation may stimulate the recruitment of a complex of m-IL-1β/HSP90 to the membrane responsible for IL-1β translocation (Figure 9B).

Figure 9 Induction of autophagy enhances the membrane incorporation of IL-1β (A) Starvation enhances the association of IL-1β with HSP90. HEK293T cells transfected with p-IL-1β and p-caspase-1 were cultured in DMEM or EBSS for 2 h. Immunoprecipitation with anti-HSP90 antibody was performed followed by an immunoblot with anti-IL-1β and anti-HSP90 antibodies. (B) Starvation promotes the entry of IL-1β into the membrane fraction. HEK293T cells transfected with p-IL-1β and p-caspase-1 were cultured in DMEM or EBSS for 2 h. The membrane fraction was collected from the top fractions of a Nycodenz density gradient resolved from membranes in a 25k pellet as described in Material and Methods. The cytosolic fraction was collected as the supernatant after 100k×g centrifugation. Immunoblot was performed to determine the levels of IL-1β in both fractions. (C) A proposed model for autophagy-mediated IL-1β secretion. Cytosolic IL-1β associates with HSP90 which facilitates the translocation of IL-1β into the lumen of a vesicle carrier which later either turns into a  phagophore and an autophagosome or fuses with them. IL-1β localizes between the outer and inner membrane after the double membrane autophagosome forms. The topological distribution ensures the secretion of IL-1β in a soluble form. The IL-1β-containing autophagosome may directly fuse with the plasma membrane or further fuse with a MVB followed by fusion with the plasma membrane.

Genetic and cell biological studies have implicated autophagy in the transport of several leaderless cargoes to the extracellular space (Bruns et al., 2011; Dupont et al., 2011; Duran et al., 2010; Manjithaya et al., 2010). Unconventional secretory cargoes, such as IL-1β and Acb1, have been shown to have overlapping requirements with formation of the autophagosome or its precursor suggesting that the autophagosome may physically convey these cargo proteins to the cell surface. A key question is if and how these cargoes engage the autophagosome and how this structure exports soluble cargo molecules. In this study, we probed the organelle association and molecular requirements for the secretion of one such unconventional cargo protein, IL-1β. Using surrogate cell lines rather than macrophages to reconstitute autophagy-mediated secretion of IL-1β (Figure 1), we find mature IL-1β localized to the lumen of the membrane in early intermediates and mature autophagosomes (Figures 2-4, 6). This surprising location may help to explain how mature IL-1β is secreted in a soluble form to the cell surface (Figure 9C). However, localization to the lumen between the two membranes of the autophagosome would require that IL-1β is translocated from the cytoplasm across the membrane precursor of a phagophore, rather than being engulfed as the phagophore membrane matures by closure into an autophagosome. Our evidence suggests that IL-1β must unfold or be held in an unfolded state to promote membrane translocation (Figure 5) and that a complex sorting signal in the mature portion of IL-1β interacts with HSP90 to deliver the chaperone and its cargo to a site on a phagophore precursor membrane where the mature species is translocated (Figures 7-9).

The unconventional secretory cargo fibroblast growth factor 2 (FGF2) has been shown to directly translocate across the plasma membrane as a folded protein without the apparent aid of chaperones (Backhaus et al., 2004; Steringer et al., 2015). Unlike FGF2, the entry of IL-1β into the autophagosomal carrier appears to be dependent on protein unfolding in a conformational state that may be fostered by the association of HSP90 with two KFERQ-like sequences within the mature portion of IL-1β (Figure 5 and 8). This translocation mechanism appears superficially similar to another delivery process termed HSC70-dependent CMA in which autophagic cargoes bearing KFERQ targeting motifs are directed into the lysosome for degradation. Indeed, using a cell-free approach to study the import of CMA cargo into isolated lysosomes, Salvador et al. (2000) reported that DHFR fused to a CMA cargo is blocked in translocation by addition of methotrexate, a drug that stabilizes DHFR to unfolding, just as we have shown that IL-1β fused to DHFR is blocked in cells treated with a cell permeable folate analog, aminopterin (Wei et al., 2013). In our fractionation study, IL-1β distributed in LC3-positive autophagosomal carriers that were separated from the lysosome marker LAMP2, the proposed receptor or channel for uptake of CMA cargo (Kaushik and Cuervo, 2012)(Figure 2B). This observation, together with the involvement of a different chaperone i.e. HSP90, suggests distinct routes for IL-1β and cargoes of the CMA pathway.

The target membrane for IL-1β translocation may be a vesicle that could fuse with or form the autophagosome. We find that mature IL-1β can be detected within protease inaccessible membranes in cells blocked early in the autophagic pathway (e.g. ATG5 null cells and cells depleted of FIP200, both of which block at a stage prior to the lipidation of LC3). The identity of the vesicle carrier is unknown and could be any one of those reported to supply membrane to the formation of the autophagosome (Ge et al., 2014a; Lamb et al., 2013). Although we have ruled out the involvement of LAMP2A IL-1β translocation, it is likely that a membrane receptor locating on the membrane of the vesicle carrier, perhaps a functional equivalent of LAMP2A, recruits the protein complex of HSP90 and IL-1β, therefore designating the correct membrane targeting of IL-1β. In addition, a protein conducting channel may be involved in the translocation of IL-1β into the membrane. It seems unlikely that a standard translocation channel, such as SEC61, is involved in this import process, but no current evidence bears on this point.

The exact route by which the autophagosome delivers mature IL-1β to the cell surface as well as how it avoids fusion with degradative lysosome remains obscure, possibly involving interaction with the multi-vesicular body or some form of lysosome as a prelude to fusion at the cell surface (Figure 9C), and this process may require selective recruitment of membrane sorting and targeting factors such as Rabs and SNAREs. Fusion of the autophagosome directly with the plasma membrane would lead to the release of soluble IL-1β available to trigger an inflammatory response in the surrounding tissue. If mature IL-1β were engulfed within the cytoplasmic interior of the autophagosome, fusion of this organelle at the cell surface might release an intact vesicle corresponding to the inner membrane-enclosed cytoplasmic compartment of the autophagosome. We found mature IL-1β secreted by macrophages or in our surrogate cell system to be completely soluble, thus inconsistent with the engulfment model (data not shown). An alternative possibility may be that the autophagosome fuses with another intracellular organelle such as the MVB or the lysosome under conditions where the inner membrane of the autophagosome is degraded. If so, mature IL-1β would be available for secretion if the combined organelle (amphisome, Figure 9C) fused with the plasma membrane. However, for this model to be viable, the mature IL-1β released on dissolution of the autophagosome inner membrane would have to withstand proteolytic attack such as may be encountered in an amphisome or lysosome. Because mature IL-1β is clearly sensitive to proteolysis (Figure 4), thus any compartment engaged in presenting autophagosomal content to the cell surface must be depleted of proteases. The nature of the organelle that delivers autophagosome content to the plasma membrane may be probed by selective ablation of different Rab proteins, e.g. Rab11, Rab27 and Rab35, which appear to be required for fusion of the MVB with the cell surface (Hsu et al., 2010; Ostrowski et al., 2010; Savina et al., 2002), or Rab27a and Rab38, implicated in the fusion of lysosomes at the cell surface (Blott and Griffiths, 2002; Hume et al., 2001; Jager et al., 2000.

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The Human Proteome Map Completed

Reporter and Curator: Larry H. Bernstein, MD, FCAP

UPDATED 6/02/2024

The genetic, pharmacogenomic, and immune landscapes associated with protein expression across human cancers.

Source: Chen C, Liu Y, Li Q, Zhang Z, Luo M, Liu Y, Han L. The Genetic, Pharmacogenomic, and Immune Landscapes Associated with Protein Expression across Human Cancers. Cancer Res. 2023 Nov 15;83(22):3673-3680. doi: 10.1158/0008-5472.CAN-23-0758. PMID: 37548539; PMCID: PMC10843800.

Abstract

Proteomics is a powerful approach that can rapidly enhance our understanding of cancer development. Detailed characterization of the genetic, pharmacogenomic, and immune landscape in relation to protein expression in cancer patients could provide new insights into the functional roles of proteins in cancer. By taking advantage of the genotype data from The Cancer Genome Atlas (TCGA) and protein expression data from The Cancer Proteome Atlas (TCPA), we characterized the effects of genetic variants on protein expression across 31 cancer types and identified approximately 100,000 protein quantitative trait loci (pQTL). Among these, over 8000 pQTL were associated with patient overall survival. Furthermore, characterization of the impact of protein expression on more than 350 imputed anticancer drug responses in patients revealed nearly 230,000 significant associations. In addition, approximately 21,000 significant associations were identified between protein expression and immune cell abundance. Finally, a user-friendly data portal, GPIP (https://hanlaboratory.com/GPIP), was developed featuring multiple modules that enable researchers to explore, visualize, and browse multidimensional data. This detailed analysis reveals the associations between the proteomic landscape and genetic variation, patient outcome, the immune microenvironment, and drug response across cancer types, providing a resource that may offer valuable clinical insights and encourage further functional investigations of proteins in cancer.

Introduction

Functional proteomics is a powerful approach that helps us understand cancer pathophysiology and identify potential therapeutic strategies (). Functional protein analysis using reverse-phase protein arrays (RPPA) has already proven highly effective in studying large numbers of TCGA samples, especially when integrated with genomic, transcriptomic, and clinical information (). Previous works demonstrated that a QTL mapping approach is effective to understand the genetic basis of multiple molecular features in human diseases (). Identifying the sequence determinants of protein levels (pQTLs) may guide the search for causal genes and facilitate understanding the underlying mechanisms of human diseases. However, it remains challenging to further understand the functional roles of protein expression in cancers. For example, it is unclear whether proteins are associated with drug response and/or immune features in patients. In this study, we systematically investigated the effects of genetic variants on protein expression and characterized the impact of protein expression on imputed drug responses and immune cell abundances from different sources (Fig. 1). To facilitate broad access of these data for the biomedical research community, we developed a user-friendly database, GPIP (https://hanlaboratory.com/GPIP). We expect this study to have a significant clinical impact on the future development of protein-based targeted therapies.

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Impact of genetic variants on protein expression.

A Workflow of GPIP to identify pQTLs and survival-associated pQTLs. B The number of pQTLs identified for each cancer type. C Association between CYCLINB1 protein expression level and rs12576855 in LUAD patients. D Association between CYCLINB1 protein expression level and rs2722796 in LGG patients. E The number of survival-associated pQTLs identified for each cancer type. F Kaplan–Meier plot showing the association between rs10918659 (pQTL of HER2_pY1248) genotypes and overall survival times of STAD patients. G Kaplan–Meier plot showing the association between rs13158796 (pQTL of HER2_pY1248) genotypes and overall survival times of STAD patients.

Identification of protein–drug associations

To investigate potential associations between protein expression and drug response, we calculated the Spearman rank correlation between protein expression data and drug response from DrVAEN and cancerRxTissue. These two datasets employed distinct predictive models that integrated omics data from CCLE and drug response data from GDSC to predict drug response in TCGA samples (Fig. 2A) (,). Association with |Rs| > 0.3 and FDR < 0.05 were considered as significant associations in each cancer type.

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Exploring the pharmacogenomics of protein in human cancer.

A Workflow of GPIP to identify Drug-associated proteins. B The number of protein-drug response pairs identified from DrVAEN (left) and cancerRxTissue (right) for each cancer type. C Visualization of the associations between proteins and drugs (DrVAEN) within and across different cancer signaling pathways. Blue links represent associations within a single pathway, while orange links represent associations cross pathways. D Enrichment analysis of drug target pathways among significant protein-drug response pairs. The color represents the log2 (odds ratio) of Fisher’s exact test. The size represents the FDR value.

Identification of protein–immune cell associations

To examine the relationship between protein expression and immune cell abundance, we utilized Spearman rank correlation coefficient to calculate the associations between protein expression data and immune cell abundance data from TIMER, CIBERSORT, ImmuneCellAI, and ImmuneCellGSVA (Fig. 3). These datasets utilized different methods to evaluate immune cell abundance by leveraging immune gene signatures as a proxy (). We considered correlations with |Rs| > 0.3 and FDR < 0.05 as significant associations.

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Exploring the immune landscapes of protein in human cancer.

A Workflow of GPIP to identify Immune cell-associated proteins. B The number of protein-drug response pairs identified from ImmuneCellsGSVA (purple), ImmuCellAI (yellow), TIMER (red) and CIBERSORT (green) for each cancer type. C The top 10 proteins with the highest number of significantly associated immune cell types in HNSC. The color represents the Rs between protein expression and immune cell abundance (ImmuneCellGSVA). The size represents the FDR value. D Association between PREX1expression and impute MDSC abundance in HNSC patients.

Database construction

GPIP was developed using Python Flask-RESTful API frameworks (https://flask-restful.readthedocs.io/), AngularJS (https://angularjs.org), and Bootstrap (https://getbootstrap.com/). The database for GPIP was implemented using the NoSQL database program MongoDB (https://www.mongodb.com/). The user-friendly interface of the GPIP web application was served through the Apache HTTP Server, allowing users to access the database and perform queries and analysis through a web browser.

Data availability

All results generated in this study can be found in GPIP database, (https://hanlaboratory.com/GPIP). Publicly available data generated by others were used by the authors in this study: The genotype data and clinical data were obtained from The Cancer Genome Atlas (TCGA) data portal at https://tcga-data.nci.nih.gov/tcga/. The reverse-phase protein array (RPPA) protein expression data was obtained from The Cancer Proteome Atlas (TCPA) data portal at https://www.tcpaportal.org/. The imputed pharmacogenomic data were obtained from DrVAEN at https://bioinfo.uth.edu/drvaen/ and cancerRxTissue at https://manticore.niehs.nih.gov/cancerRxTissue/. The immune-cell infiltration data were obtained from Tumor Immune Estimation Resource (TIMER) at http://timer.cistrome.org/, Immune Cell Abundance Identifier (ImmuCellAI) at http://bioinfo.life.hust.edu.cn/ImmuCellAI/, and CIBERSORT at https://cibersort.stanford.edu/.

A comprehensive data portal

We developed a user-friendly data portal, GPIP (https://hanlaboratory.com/GPIP), to facilitate visualizing, searching, and browsing of our results by the biomedical research community (Fig. 4A). GPIP contains four main modules: Protein-QTLs, Surivial-QTLs, Drug Response, and Immune Infiltration (Fig. 4B). Querying can be easily performed by selecting cancer type, protein, drug, immune cell abundance, or entering the SNP ID of interest (Fig. 4C). For example, in the Protein-QTLs and Survival-QTLs modules, users can search for pQTLs by selecting a cancer type (e.g., LUAD) and entering a protein name (e.g., CYCLINB1) or an SNP ID (e.g., rs12576855). In the Drug Response module, users can search for protein-drug response associations by selecting a data source for imputed drug response (e.g., DrVAEN) and selecting an anticancer drug (e.g., Talazoparib) or a protein (e.g., PARP1). In the Immune Infiltration module, users can search for protein-immune infiltration pairs by selecting a data source for imputed immune cell abundance (e.g., ImmuneCellsGSVA), and selecting an immune cell type (e.g., Activated B cell) or a protein (e.g., PDL1). In addition, on the bottom of the main page, we developed a cancer type module where users can click on a specific cancer type (e.g., BLCA) to search for related information across all 4 modules (Fig. 4D). The search results for each module included a table to list related information accordingly (Fig. 4E). A “Details” button for each result item was clicked for generating a box plot in protein-QTLs module (Fig. 4F), a Kaplan–Meier plot in Survival-QTLs module (Fig. 4G) and a scatter plot in Drug Response and Immune Infiltration modules, respectively (Fig. 4H,I).I). Our database provides a valuable resource for cancer research and will be of great interest to the research community.

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Content and interface of GPIP.

A GPIP homepage and browser bar. B The four main modules of GPIP. C Search boxes in the pQTLs module. D Search boxes in the cancer type-specific search module. E An example of resulting list in the pQTL module. F An example of boxplot for the pQTLs module result. G An example of Kaplan–Meier plot for the Survival protein-QTLs module result. H An example of scatter plot for the Drug Response module result. I An example of scatter plot for the Immune Infiltration module result.

Discussion

Proteomics plays a crucial role in identifying potential therapeutic strategies and understanding cancer pathophysiology (). In this study, we investigated the effects of genetic variants on protein expression and characterized the impact of protein expression on imputed drug responses and immune cell abundances across human cancers. We also developed the user-friendly data portal, GPIP, to provide access to these results. Our study provides a comprehensive analysis of protein expression in different cancer types and their association with drug response and immune cell abundance.

Identifying genetic variants associated with cancer has revolutionized our understanding of the disease and holds promise for improved diagnosis and treatment. In GPIP, we identified ~100,000 pQTLs across 31 cancer types and 8.8% of them were found to be associated with patient survival (Fig. 1). These genetic variants hold significant promise for unraveling the underlying biological mechanisms of disease progression and response to treatments. For example, a survival-associated pQTL may help to identify a genetic variant that controls the expression of a protein crucial for tumor growth or immune response, thus impacting patient survival. Our results suggest that pQTLs have the potential to serve as prognostic biomarkers and aid in the development of precision medicine.

Despite the promising implications, it is crucial to consider potential limitations of pQTL identification. One limitation is the small number of tumor samples in rare cancers, which limits statistical power and the detection of significant pQTLs. For example, only 8 proteins with pQTLs were found in CHOL, likely due to the small sample size (Table S1). Additionally, we observed that some cancer types with large sample sizes identified only a small number of pQTLs (e.g., BRAC), possibly due to the data quality of protein abundance. Tumors originating from different tissues may have variations in protein extraction quality or protein measurement accuracy (). Furthermore, cancer type heterogeneity can impact pQTL identification, as tumors from different tissues exhibit distinct protein expression profiles and genetic landscapes. Addressing these limitations is necessary to ensure valid and reliable results.

Protein expression levels in tumors can impact response of cancer cells to therapeutic drugs due to their role as targets of drug action, with alterations in expression potentially modifying drug sensitivity or resistance. In GPIP, we utilized the imputed drug response and protein expression data in TCGA patients to identify the potential associations between protein expression and drug response (Fig. 2). Our results revealed that certain proteins were significantly associated with drug sensitivity or resistance, suggesting that protein expression levels could potentially be used as biomarkers to predict drug response in cancer patients. Recent studies have shown that the impact of genetic variants on drug response can be mediated through protein-protein interaction (PPI) networks (,). Integrating genetic variants and PPI to further understand the associations between protein expression and drug response may provide further insights.

The protein expression level in tumors is crucial in the context of tumor immune microenvironment and immunotherapy, as it might impact immune cell abundance and response, and potentially improve the efficacy of immunotherapy. In GPIP, we examined the association between protein expression levels and imputed immune cell abundance across multiple cancer types. Our study identified ~21,000 significant correlations between proteins and immune cell types, highlighting the potential role of protein expression levels in shaping the tumor immune microenvironment (Fig. 3). Our results offer a promising avenue for future research to understand the interplay between protein expression and the tumor immune microenvironment, leading to personalized immunotherapy strategies and better treatment outcomes for cancer patients.

In summary, GPIP is a comprehensive and multifaceted data platform designed to aid functional and clinical research on protein in cancer patients. As more relevant datasets become available, we will continually update GPIP to ensure its relevance and usefulness to the research community.

Significance:

Comprehensive characterization of the relationship between protein expression and the genetic, pharmacogenomic, and immune landscape of tumors across cancer types provides a foundation for investigating the role of protein expression in cancer development and treatment.

Researchers Produce First Map of Human Proteome, and Reveal New
Significance in The Human Proteome

HAHNE, TECHNISCHE UNIVERSITÄT MÜNCHENTwo international teams have
independently produced the first drafts of the human proteome. These curated
catalogs of the proteins expressed in most non-diseased human tissues and
organs can be used as a baseline to better understand changes that occur in
disease states. Their findings were published today (May 29) in Nature.

Both teams uncovered new complexities of the human genome, identifying novel
proteins from regions of the genome previously thought to be non-coding.

“the real breakthrough with these two projects is the comprehensive coverage of
more than 80 percent of the expected human proteome” said Hanno Steen, director
of proteomics at Boston Children’s Hospital, who was not involved in the work.

The human proteome map provides a catalog of proteins expressed in nondiseased tissues and organs to use as baseline in understanding changes that occur in disease

Given the growing importance of proteins in medical laboratory testing,

Experts are comparing this to the first complete map of the human genome

  • and this information provides for rapid advances
  • in understanding transcriptomics and metabolomics

Map of Human Proteome Expected to Advance Medical Science

“Housekeeping genes” that are expressed in all tissues and cell types

  • have been thought to be involved in basic cellular functions.

Two teams developing a Human Proteome Map

  • detected proteins encoded by 2,350 genes
  • across all human cells and tissues.

The corresponding housekeeping proteins comprised
about 75% of total protein mass.

  •  histones,
  • ribosomal proteins,
  • metabolic enzymes, and
  • cytoskeletal proteins

The two international teams produced

  • the first drafts of the human protoeome,
  • a catalog of proteins expressed in most
  • nondiseased human issues and organs.

The evidence suggests there is translation from DNA regions

  • that were not thought to be translated—including
  • more than 400 translated long, intergenic non-coding RNAs (lincRNAs)—
    found by the Küster team—and
  • 193 new proteins—uncovered by the Pandey team.

This proteome map can be used as a baseline to understand

  • changes that occur in the disease state

These studies are part of the Human Proteome Project,

  1. an international effort by the Human Proteome Organization
  2. to revolutionize our understanding of the human proteome
  3. by coordinating research at laboratories around the world directed
  4. at mapping the entire human proteome.

This new information about the human proteome

  • is expected to trigger rapid advances in medical science
  • and a better understanding of the underlying causes of human diseases.

One Study Team Was at Johns Hopkins University

  • In one study, which was headed by Ahilesh Pandey, M.D.,
    at Johns Hopkins University in Baltimore,
  • and colleague Harsha Gowda, Ph.D.,
    of the Institute of Bioinformatics in Bangalore, India,
  • the research team used an advanced form of mass spectrometry to analyze proteins
  • to create the human proteome map,

according to a report published in NIH Research Matters.

The research team examined

  1. 30 normal human tissue and cell types:
  2. 17 adult tissues,
  3. 7 fetal tissue and
  4. 6 blood cell types.

Samples from three people per tissue type

  • were processed through several steps.

The protein fragments, or peptides, were analyzed on

The amino acid sequences were

  • then compared to known sequences.

Their results were published in the May 28, 2014, issue of Nature.

The resulting draft map of the human proteome map includes

  • proteins encoded by more than 17,000 genes,
  • noted the Research Matters article.

Among these are hundreds of proteins from regions

  • previously thought to be non-coding.

This study also provided a new understanding of

  • how genes are expressed.

For example, almost 200 genes begin in locations

  • other than those predicted based on genetic sequence.

“The fact that 193 of the proteins came from DNA sequences

  • predicted to be non-coding means that
  • we don’t fully understand how cells read DNA,
  • since the sequences code for proteins

This study also produced the Human Proteome Map,

  • an interactive online portal.

This can be accessed at this link.

The study data will soon be accessible through

German’s ProteomicsDB Analyzed a Mix of Available and New Tissue Data

The other study was conducted by a team lead by  Bernhard Küster
of the Technische Universität München in Germany.

Küster and his colleagues created a

This database contains 92% of the

  • estimated 19,629 human proteins,

noted The Scientist article.

Küster’s team also used mass spectrometry

  • to analyze human tissue samples.

This team’s approach differed from Johns Hopkins’ in that

  • it compiled about 60% of the information
  • in the ProteomicsDB database
  1. by using existing raw mass spec (MS) data
  2. from databases and colleagues’ contributions.

To fill data gaps, the Küster lab generated its own
MS data after analyzing

  1. 60 human tissues,
  2. 13 body fluids, and
  3. 147 cancer cell lines.

High-resolution public data

  • was selected and computationally processed
  • for strict quality

The database for ProteomicsDB is

  • public and searchable.

It can be accessed at this link.

German Study Added New Insights to Transcription Process

Comparing the ratio of protein to mRNA levels for every protein globally,

  • the Küster lab found that the translation rate
  • is a constant feature of each mRNA transcript. 

The proteomics community has viewed

  • transcriptome and proteome data as two sides of a coin.

But this analysis shows that at least, at steady state,

  • once the ratio for an mRNA/protein pair has been calculated,
  1. protein levels can be determined
  2. just from specific mRNA levels.

Proteomics researchers in Toronto maintaining ionic balance and in Boston commented on the
importance of the findings, even a “new paradigm” because of

  • the fixed ratio of protein to mRNA

This is quite in keeping with what we have been learning

  • with respect to homeostasis.

In 2003, the Human Genome Project created a

  • draft map of the human genome—
  • all the genes in the human body.

Genomics has since driven many advances in medical science.

This was a progress from the classic discovery of Watson and Crick –

  • the classical dogma holds that
  • DNA makes RNA makes protein.
  • no constraints are place on this

But the cell is functioning in contact with other cells,

  • immersed in interstitial fluid
  • maintaining cationic and anionic balance
  • and mitochondrial energy balance and ubiquitin systems interact
  • and protein interacts with the chromatin and transcriptional RNA

So the restriction that has been discovered has credence,

  • the classical diagram has to be redrawn

Deeper Knowledge of Proteome to Improve Diagnostics and Therapeutics

In the two projects is:

  • the comprehensive coverage of more than 80% of
  • the expected human proteome,

These studies indicate that to get to

  • a deep level of proteome coverage,
  • many different tissue types must be probed.

the  studies are  complimentary.

  1. The Hopkins group provided a survey of human proteins from a single source, which allows for easy comparisons within their data.
  2. The ProteomeDB effort connected new information with existing data

A deeper knowledge of the human proteome could help

  • fill the gap between genomes and phenotypes.

As this occurs, it has the potential to transform

  • the way diagnostics and therapeutics are developed,
  •  enhancing overall biomedical research and healthcare,

it was noted in a report presented to scientific leaders at a NIH workshop

  • on advances in proteomics and its applications.

Having completed a draft map of the human proteome—
the set of all proteins in the human body

  • It opens another window to cell function.

It has been ASSUMED –

  • genes control the most basic functions of the cell,
  • including what proteins to make and when.
  • but we have assumed for too much in assigning
    full control to the genome

Researchers have identified more than 20,000 protein- coding genes.

However, scientific understanding of the proteome has

  • lagged behind that of the genome,
  • partly because of the proteome’s complexities.

The relationship between genes and proteins isn’t a simple matter of

  • one gene coding for one protein.

Stretches of DNA can be read and translated

  • into proteins in different ways.

Proteins are also more difficult to sequence than genes.

The importance of these latest studies to pathologists and Ph.D.s working

  • in molecular diagnostics laboratories is that
  • this information will expedite further research into the human proteome.

Such research is expected to lead to

  • novel methods of diagnosis and complex
  • “multi-analyte” clinical laboratory tests that
  • look for multiple proteins in a single assay.

“The prevalent view was that information transfer was from genome to transcriptome to proteome.
What these efforts show is that it’s a two-way road— proteomics can be used to annotate the genome.
The importance is that, using these datasets, we can improve the annotation of the genome and the
algorithms that predict transcription and translation,” said Steen. “The genomics field can now hugely
benefit from proteomics data.”

Wilhelm et al., “Mass-spectrometry- based draft of the human proteome,”
Nature,  http://dx.doi.doi:/10.1038/nature13319, 2014

M.S. Kim et al. “A draft map of the human proteome,”
Nature,  http://dx.doi.org:/10.1038/nature13302, 2014.

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proteomicsnoncoding RNAhuman researchhuman proteome projecthuman genetics and genomics

http://www.the-scientist.com/?articles.view/articleNo/40083/title/Human-Proteome-Mapped/

 

__Patricia Kirk

__by Harrison Wein, Ph.D.

__by Anna Azvolinsky

Related Information:

Revealing The Human Proteome

Human Proteome Mapped

The human proteome – a scientific opportunity for transforming diagnostics, therapeutics, and healthcare

Reference: A draft map of the human proteome.
Kim MS, Pinto SM, Getnet D, Nirujogi RS, Manda SS, Donahue CA, Gowda H, Pandey A.
Nature. 2014 May 29;509(7502):575-81. http://dx.doi.org:/10.1038/nature13302. PMID: 24870542

Funding: NIH’s National Institute of General Medical Sciences (NIGMS), National Cancer Institute (NCI),
and National Heart, Lung, and Blood Institute (NHLBI); the Sol Goldman Pancreatic Cancer Research Center;
India’s Council of Scientific and Industrial Research; and Wellcome Trust/DBT India Alliance.

http://nihprod.cit.nih.gov/researchmatters/june2014/06092014proteome.htm

 

 

 

 

 

 

 

 

 

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