Elizabeth Yang

Bcl-xL/Bcl-2 coordinately regulates apoptosis, cell cycle arrest and cell cycle entry.

Bcl‐xL and Bcl‐2 inhibit both apoptosis and proliferation. In investigating the relationship between these two functions of Bcl‐xL and Bcl‐2, an analysis of 24 Bcl‐xL and Bcl‐2 mutant alleles, including substitutions at residue Y28 previously reported to selectively abolish the cell cycle activity, showed that cell cycle delay and anti‐apoptosis co‐segregated in all cases. In determining whether Bcl‐2 and Bcl‐xL act in G0 or G1, forward scatter and pyronin Y fluorescence measurements indicated that Bcl‐2 and Bcl‐xL cells arrested more effectively in G0 than controls, and were delayed in G0–G1 transition. The cell cycle effects of Bcl‐2 and Bcl‐xL were reversed by Bad, a molecule that counters the survival function of Bcl‐2 and Bcl‐xL. When control and Bcl‐xL cells of equivalent size and pyronin Y fluorescence were compared, the kinetics of cell cycle entry were similar, demonstrating that the ability of Bcl‐xL and Bcl‐2 cells to enhance G0 arrest contributes significantly to cell cycle delay. Our data suggest that cell cycle effects and increased survival both result from intrinsic functions of Bcl‐2 and Bcl‐xL.

Protein Phosphatase 2A Dephosphorylation of Phosphoserine 112 Plays the Gatekeeper Role for BAD-Mediated Apoptosis

ABSTRACT BAD, a proapoptotic molecule of the BCL2 family, is regulated by reversible phosphorylation. During survival, BAD is sequestered by 14-3-3 through serine 136 phosphorylation and is dissociated from BCL-XL through serine 155 phosphorylation. We report that phosphoserine 112 (pSer112) dephosphorylation functions as a gatekeeper for BAD-mediated apoptosis. During apoptosis, dephosphorylation of pSer112 preceded pSer136 dephosphorylation. Dephosphorylation of pSer112 accelerated dephosphorylation of pSer136, and inhibition of pSer112 dephosphorylation prevented pSer136 dephosphorylation, indicating that dephosphorylation of pSer112 is required for dephosphorylation of pSer136. Protein phosphatase 2A (PP2A) is the major pSer112 phosphatase. PP2A competed with 14-3-3 for BAD binding, and survival factor withdrawal enhanced PP2A association with BAD. Dephosphorylation of the critical residue, pSer136, could only be blocked by inhibition of all known subfamilies of serine/threonine phosphatases, suggesting that multiple phosphatases are involved in pSer136 dephosphorylation. Inhibition of PP2A rescued FL5.12 cells from apoptosis, demonstrating a physiologic role for PP2A-mediated pSer112 dephosphorylation. Thus, PP2A dephosphorylation of pSer112 is the key initiating event regulating the activation of BAD during interleukin-3 withdrawal-induced apoptosis.

BCL-x(L) and BCL2 delay Myc-induced cell cycle entry through elevation of p27 and inhibition of G1 cyclin-dependent kinases.

The anti-apoptotic molecules BCL-xL and BCL2 delay cell cycle entry from quiescence. We used serum induction and induction of a Myc-estrogen receptor fusion protein (MycER) in quiescent fibroblasts to investigate the mechanisms underlying the cell cycle activity of BCL-xL and BCL2. We demonstrate for the first time that BCL-xL and BCL2 delayed serum-induced and Myc-induced, but not E2F-induced, cell cycle entry. The cyclin-dependent kinase inhibitor p27 was elevated during serum deprivation and cell cycle entry in BCL-xL or BCL2-expressing NIH3T3 cells and a Rat1MycER cell line. Activation of cyclin-dependent kinase 2 (cdk2) and cyclin-dependent kinase 4 (cdk4) were delayed during progression to S phase, while the induction of cyclin D1 protein, as well as the levels of cyclin E, cdk2, and cdk4 were unaltered by BCL-xL or BCL2. Inhibition of cyclin/cdk activities in BCL-xL or BCL2 expressing cells was associated with excess p27 in the cyclin/cdk complexes. Neither BCL-xL nor BCL2 delayed S phase entry in cells deficient in p27, thus p27 is required for the cell cycle function of BCL-xL and BCL2. The cell cycle effects of BCL-xL and BCL2 were more profound in Myc-induced than in serum-induced cell cycle entry. Our results suggest that one possible mechanism by which BCL-xL and BCL2 delay cell cycle entry may be the inhibition of Myc activity through the elevation of p27.

PP2A regulates the pro-apoptotic activity of FOXO1.

FOXO1, a member of the evolutionarily conserved forkhead family of transcription factors, regulates expression of a number of genes that play critical roles in cell cycle and apoptosis. A pivotal regulatory mechanism of FOXO is reversible phosphorylation, catalyzed by kinases and phosphatases. Phosphorylation of FOXO1 is associated with 14-3-3 binding and cytosolic localization, whereas dephosphorylated FOXO1 translocates to the nucleus and is transcriptionally active. Experiments were performed to identify the serine/threonine phosphatase that dephosphorylates FOXO1. PP2A inhibitors, okadaic acid and fostriecin, increased FOXO1 phosphorylation in vitro and in cells. Microcystin-agarose pull-downs suggested that a phosphatase binds to FOXO1, and PP2A catalytic subunit was identified in endogenous FOXO1 immunocomplexes, indicating that PP2A is a FOXO1 phosphatase. Purified PP2A interacted directly with FOXO1 and dephosphorylated FOXO1 in vitro. Silencing of PP2A protected FOXO1 from dephosphorylation and delayed FOXO1 nuclear translocation, confirming the physiologic role of PP2A in the regulation of FOXO1 function. Furthermore, inhibition of PP2A phosphatases rescued FOXO1-mediated cell death by regulating the level of the pro-apoptotic protein BIM. We conclude that PP2A is a physiologic phosphatase of FOXO1.

BAD/BCL-XL heterodimerization leads to bypass of G0/G1 arrest

The pro-apoptotic molecule BAD binds BCL-xL or BCL2 and inactivates their survival function. In addition to their anti-apoptotic function, BCL2 and BCL-xL also delay cell cycle entry from quiescence. We found that the BH3-only molecule BAD also exerted a cell cycle effect. BAD expression resulted in failure to cell cycle block in growth arrest conditions. In low serum and in confluence, fibroblasts constitutively or inducibly expressing BAD persisted in S phase, continued to incorporate BrdU, and exhibited sustained cyclin E/cdk2 activity. Mutation analysis indicated that the cell cycle effect of BAD was not dependent on its phosphorylation status or subcellular localization, but strictly co-segregated with BCL-xL binding. bclx−/− MEFs expressing BAD and bad−/− MEFs both arrested in G0/G1 in low serum similar to wild-type controls, suggesting that the ability to overcome the G0/G1 checkpoint resulted from the presence of BAD/BCL-xL heterodimers, rather than the absence of BCL-xL or BAD. These data provide evidence that in addition to regulating apoptosis, the BAD/BCL-xL heterodimer has a novel cell cycle function.

G0 function of BCL2 and BCL-xL requires BAX, BAK, and p27 phosphorylation by Mirk, revealing a novel role of BAX and BAK in quiescence regulation.

BCL2 and BCL-xL facilitate G0 quiescence by decreasing RNA content and cell size and up-regulating p27 protein, but the precise mechanism is not understood. We investigated the relationship between cell cycle regulation and the anti-apoptosis function of BCL2 and BCL-xL. Neither caspase inhibition nor abrogation of mitochondria-dependent apoptosis by BAX and BAK deletion fully recapitulated the G0 effects of BCL2 or BCL-xL, suggesting that mechanisms in addition to anti-apoptosis are involved in the cell cycle arrest function of BCL2 or BCL-xL. We found that BCL2 and BCL-xL expression in bax-/- bak-/- cells did not confer cell cycle effects, consistent with the G0 function of BCL2 and BCL-xL being mediated through BAX or BAK. Stabilization of p27 in G0 in BCL2 or BCL-xL cells was due to phosphorylation of p27 at Ser10 by the kinase Mirk. In bax-/- bak-/- cells, total p27 and p27 phosphorylated at Ser10 were elevated. Re-expression of BAX in bax-/- bak-/- cells and silencing of BAX and BAK in wild type cells confirmed that endogenous BAX and BAK modulated p27. These data revealed a novel role for BAX and BAK in the regulation of G0 quiescence.

Cystatin B inhibition of TRAIL-induced apoptosis is associated with the protection of FLIPL from degradation by the E3 ligase itch in human melanoma cells

Past studies have identified a number of distinct mechanisms that contribute to the resistance of melanoma cells against apoptosis induced by TNF-related apoptosis-inducing ligand (TRAIL). In this report we show that cystatin B is another endogenous inhibitor of TRAIL-induced apoptosis. Cystatin B-deficient melanoma cell lines established by shRNA knockdown displayed increased apoptosis that was associated with enhanced activation of caspase-8 induced by TRAIL. This was not related to the inhibitory effect of cystatin B on the lysosomal cysteine proteases, cathepsin B and L, as they did not have a role in TRAIL-induced apoptosis in most melanoma cell lines even when cystatin B was inhibited. Instead, sensitization of melanoma cells to TRAIL-induced apoptosis by inhibition of cystatin B appeared associated with decreased stability of FLIPL as the levels of FLIPL were reduced because of shortened half-life time in melanoma cells deficient in cystatin B. In contrast, over-expression of cystatin B increased the levels of FLIPL, decreased the amount of the E3 ligase Itch associated with FLIPL, and reduced FLIPL ubiquitination. Inhibition of Itch by siRNA restored the levels of FLIPL and blocked sensitization to TRAIL-induced apoptosis associated with deficiency in cystatin B. Taken together, these results indicate that cystatin B regulates Itch-mediated degradation of FLIPL and thereby TRAIL-induced apoptosis in melanoma cells.

Bcl-2 inhibition of T-cell proliferation is related to prolonged T-cell survival

Bcl-2 promotes oncogenesis by inhibiting cell death. Bcl-2 also inhibits proliferation and suppresses tumorigenesis in some settings. To clarify the role of the antiproliferative function of Bcl-2, mice expressing a mutant form of Bcl-2 reported to lack antiproliferative activity were generated (tyrosine 28 to alanine, Bcl-2-Y28A). As expected, both wild type (WT) and Bcl-2-Y28A inhibited apoptosis similarly. In contrast to previous results in cell lines, Bcl-2-Y28A inhibited T-cell proliferation identical to WT-Bcl-2. Significantly, both Bcl-2-Y28A and WT-Bcl-2 inhibited proliferation of T cells isolated from older animals, but not proliferation of T cells from immature mice. Instead, inhibition of cell activation correlated with T-cell size, p27 levels, and RNA content, all indicators of quiescent G0 arrest. Consistent with this model, Bcl-2 inhibition of T-cell proliferation was reversed by expression of Bax, again correlating cell proliferation with cell size. These experiments do not support genetically separate effects of Bcl-2 on apoptosis and proliferation. Instead, the data support a model in which Bcl-2 and Bax regulate T-cell proliferation by changes in T-cell size and by increasing the markers of quiescent G0 arrest. These changes likely result from prolonged T-cell survival.

Chronic transfusion practices for prevention of primary stroke in children with sickle cell anemia and abnormal TCD velocities

Chronic transfusions are recommended for children with sickle cell anemia (SCA) and abnormal transcranial Doppler (TCD) velocities ( 200 cm/sec) to help prevent the occurrence of a primary stroke [1]. The goal is usually to maintain the sickle hemoglobin concentration (HbS) <30%; however, this goal is often difficult to achieve in clinical practice. The NHLBI-sponsored trial ‘‘TCD With Transfusions Changing to Hydroxyurea (TWiTCH)’’ will compare standard therapy (transfusions) to alternative therapy (hydroxyurea) for the reduction of primary stroke risk in this patient population. Transfusions will be given according to current transfusion practices at participating sites. To determine current academic community standards for primary stroke prophylaxis in children with SCA, 32 clinical sites collected data on 340 children with abnormal TCD velocities receiving chronic transfusions to help prevent primary stroke. The average (mean ± 1 SD) pretransfusion HbS was 34 ± 11% (institutional average 23–48%); the 75th and 90th percentiles were 41 and 50%, respectively. Lower %HbS was associated with higher pretransfusion Hb values and receiving transfusions on time. These data indicate variable current transfusion practices among academic pediatric institutions and in practice, 30% HbS may not be an easily attainable goal in this cohort of children with SCA and abnormal TCD. Children with sickle cell anemia (SCA) compose a high risk group for the development of stroke. If untreated, 11% will experience a clinical stroke by 20 years of age [2]. Adams et al. have shown that children with SCA who are at risk for primary stroke can be identified by measuring time-averaged mean blood flow velocities in the internal carotid or middle cerebral arteries by TCD [3]. Abnormal TCD velocities ( 200 cm/sec) are associated with high risk for stroke and warrant transfusion therapy to reduce the risk of primary stroke. First stroke can be successfully prevented in 90% of children with SCA and abnormal TCD velocities by the use of chronic transfusion therapy, with a goal of keeping HbS concentrations less than 30% [1]. TCD with Transfusions Changing to Hydroxyurea (TWiTCH) is an NHLBIsponsored, Phase III, multicenter trial comparing standard therapy (monthly transfusions) to alternative therapy (daily hydroxyurea) to reduce the risk of primary stroke in children with SCA and documented abnormal TCD velocities. Since transfusions compose the standard treatment arm, accurate %HbS values achieved in actual clinical practice were needed for protocol development. The majority of our information about transfusing patients with SCA to prevent stroke comes from secondary stroke prevention, i.e., the use of chronic red blood cell transfusions to prevent a second stroke after a first clinical stroke has occurred. Classically, transfusions are administered at 4-week intervals to maintain HbS at less than 30%. After several years of transfusion therapy, a few centers increase transfusion interval to 5–6 weeks and allow HbS to increase toward 50% in selected patients [4,5]. Our previous study in 295 children with SCA who received transfusions for secondary stroke prevention revealed an average pretransfusion HbS of 35 ± 11% with highly variable institutional %HbS levels ranging from 22 to 51% [6] In order to determine the current clinical standard of transfusion therapy for primary stroke prevention for elevated TCD velocities, we performed a larger survey of potential TWiTCH sites. We hypothesized that average pretransfusion HbS values achieved at pediatric academic centers would be higher than 30%. This study defines the current practice at academic medical centers in provision of chronic transfusion therapy to help reduce the risk of primary stroke in children with SCA. A total of 340 children with SCA and history of abnormal TCD velocities receiving chronic PRBC transfusions for primary stroke prophylaxis were identified at 32 institutions (Table I). The number of patients per site ranged from 3 to 33 (median 9 per site). A total of 3,970 transfusions were administered over the 12-month period, with a mean of 11.7 ± 2.8 transfusions per patient. Results were similar when analyzed by each patient contributing equally or each transfusion contributing equally (Table II). The predominant transfusion type by patient was defined as the technique used 6 times over the 12-month period. Most children (79%) received primarily simple transfusions, while 19% had primarily exchange transfusions (11% partial / manual exchange, 8% erythrocytapheresis), and 2% multiple transfusion types. The transfusion goal was <30% at almost all sites (84%), while at five sites, the %HbS was allowed in selected patients to increase to 50% after a period of clinical stability. The majority (95%) of the transfusions were administered within the defined 7-day window. On average, late transfusions were given 1.3 ± 5.5 days after the defined 7-day window. Thirty percent of the patients had at least one late transfusion and 14% had 2 or more late transfusions in the 1-year period. For the 3,653 transfusions with reported %HbS values (representing 92% of the 3,970 transfusions), the mean pretransfusion HbS percentage was 33.2 ± 14.0% (median 32%). The 75th percentile for HbS values was 41%, while the 90th percentile was 51%. There were substantial differences among institutional pretransfusion %HbS values, ranging from 23 ± 14% HbS at one institution where HbS was reported for 103 transfusions given to nine patients during the 12-month period, to 48 ± 15% at another institution where HbS was reported for 95 transfusions administered to nine patients during the same time frame (Table III). The five sites with increased HbS goals to 50% in selected patients did not have higher values than others. For each transfusion, subjects were less likely to have pretransfusion HbS <30% if they were older [OR 0.92 for each year increase in age, 95% CI (0.89, 0.96)] and on transfusions for a longer period of time [OR 0.90 for each year increase in duration, 95% CI (0.86, 0.94)]. Patients with higher pretransfusion Hb levels were more likely to have pretransfusion HbS <30% [OR 1.63 for each g/dL increase in Hb, 95% CI (1.46, 1.83)] and late transfusions were less likely to be associated with a pretransfusion HbS <30% [OR 0.27, 95% CI (0.18, 0.41)]. The Hb result does not appear to be a function of late transfusions since both covariates remained significant when modeled jointly. History of alloor autoantibodies, TCD velocity, and erythrocytapheresis use were not significant predictors of a pretransfusion HbS <30%. During the initial STOP study, transfusions were given to maintain pretransfusion HbS values at less than 30% [3]. However, there were frequent transient rises of HbS above this level [7]. Furthermore, extended follow-up results from the STOP study showed that pretransfusion %HbS values during the post-trial follow-up were higher than those during the STOP study [8]. The average %HbS per patient was 27.5 ± 12.4, still within the desired goal of 30%. However, pretransfusion HbS levels were 30–34.9% in 12%, 35–39.9% in 7%, and greater than 40% in 12% of the transfusions. In the STOP2 study, where children with abnormal TCD velocities whose Doppler readings became normal were randomly assigned to continue or stop transfusions, 24% of the patients had pretransfusion HbS levels greater than 30% [9]. These findings indicate that even in the context of a prospective clinical trial, maintaining HbS <30% was difficult to achieve. With the subsequent recommendation to treat all children with SCA who are at risk for primary stroke with transfusions to maintain HbS <30%, the feasibility of this approach in actual clinical practice is not known. Possible Letters

Adherence to transcranial Doppler screening guidelines among children with sickle cell disease.

Little is known about adherence to guidelines recommending yearly screening with transcranial Doppler (TCD) ultrasonography to detect stroke risk for children with severe sickle cell disease. The objective was to determine the proportion of children with hemoglobin SS (HbSS) or sickle‐β0‐thalassemia (HbSβ0) aged 2–16 years who received recommended TCD screening from 1997 to 2008, and to identify factors associated with adherence.