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Autophagy, meaning “self-eating”, is an important cellular waste disposal mechanism. Thereby, damaged proteins, lipids and organelles are enclosed by autophagosomes and subsequently transported to the lysosomes for degradation into basic, cellular building blocks. Under basal conditions autophagy prevents the accumulation of defective and harmful material and generally promotes cell survival. However, several studies reported that hyperactivated autophagy, e.g. during developmental processes in lower eukaryotes, or during chemotherapeutic treatment of cancer cells, can also trigger cell death.
In recent years, autophagic cell death (ACD) has been considered as an alternative cell death pathway for tumor therapy, especially for solid tumors with high apoptosis resistance such as glioblastoma. Glioblastoma (GBM) is a very aggressive, malignant primary brain tumor with a median survival of ~ 15 months despite surgery and chemoradiotherapy. Accordingly, there is a great interest in improving GBM therapy through alternative cell death mechanisms. Interestingly, it has been shown that various substances, e.g. AT 101, cannabinoids and the combination of imipramine and ticlopidine (IM+TIC), induce ACD in GBM cells.
The aim of this project was to identify the underlying mechanisms of stress- and drug-induced ACD and its therapeutic potential for glioblastoma treatment. For detailed investigation of ACD, a CRISPR/Cas9-based approach was used to generate ATG5 and ATG7 knockouts as genetic models of autophagy deficiency. In a previous study of our lab it was demonstrated that administration of AT 101 triggers ACD in glioblastoma cells, which was associated with early mitochondrial fragmentation but no signs of apoptosis. Since mitochondrial fragmentation often precedes mitophagy, the first part of this thesis explored the potential role of mitophagy in AT 101-induced cell death.
ATG5-depleted cells confirmed that AT 101 induces ACD. In addition, treatment with AT 101 resulted in a pronounced mitochondrial depolarization, which was at least partly caused by the opening of the mitochondrial permeability pore. Global proteome analysis of AT 101-treated GBM cells revealed a robust decrease in mitochondrial protein clusters as well as a strong increase in the enzyme heme oxygenase-1 (HMOX1). Subsequent experiments for detailed investigation of mitophagy following AT 101 treatment (western blot, flow cytometric MTG and mt-mKeima, qRT-PCR of mitochondrial vs nuclear DNA) consistently indicated strong mitophagy induction by AT 101, which could be reduced by genetic or pharmacological inhibition of autophagy. Furthermore, siRNA-mediated knockdown experiments revealed that the selective mitophagy receptors BNIP3 and BNIP3L and the HMOX1 enzyme play an essential role in AT 101-induced mitophagy and subsequent cell death. Taken together, these data demonstrate that AT 101-induced mitochondrial dysfunction and HMOX1 induction synergize to promote excessive mitophagy with a lethal outcome in glioma cells.
The second part of this thesis focused on the identification of new substances that cause ACD and the investigation of the underlying cell death pathways. Using a cell death screen of the ENZO Screen-Well™ autophagy library in MZ-54 wild-type vs ATG5 and ATG7-depleted cells, loperamide, pimozide, and STF-62247 were identified as ACD-inducing agents. The increase of the autophagic flux and the induction of ACD by these substances was confirmed by using different ATG5 and ATG7 knockout cell lines and the already established positive control IM+TIC.
In contrast to AT 101, IM+TIC, STF-62247, loperamide and pimozide produced neither mitochondrial dysfunction nor mitophagy. Interestingly, it has been described that imipramine, loperamide and pimozide inhibit the lysosomal enzyme acid sphingomyelinase, which is associated with impaired lipid transport. Global proteome analysis and cholesterol staining confirmed that all four substances, but especially loperamide and pimozide, inhibit cellular lipid transport, leading to massive lipid accumulation in the lysosomes. In the further course of the experiments, the connection between defective lipid transport and autophagy was investigated in more detail. On the one hand, the defective lipid transport contributed to the induction of autophagy, on the other hand the massive accumulation of lipids led to lysosomal membrane damage, inhibition of lysosomal degradation at later time points and finally to a lysosomal cell death. Remarkably, it has been shown that hyperactivated autophagy by IM+TIC, loperamide and pimozide massively promotes lysosomal membrane damage. This result highlights the difficulties of a clear distinction between autophagic and lysosomal cell death.
In summary, two new signaling pathways that induce autophagic cell death in GBM cells and may be relevant for glioblastoma therapy were investigated in this study.
Alzheimer’s disease is a chronic neurodegenerative disease that causes problems with memory, thinking and behavior. The pathophysiological hallmarks of AD are extracellular senile plaques and intracellular neurofibrillary tangles. Amyloid plaques mainly contain the amyloid-β (Aβ) peptide, which appears as a cleavage product of the APP. APP is a type I transmembrane protein with a large extracellular domain and a short cytoplasmic tail. It is expressed in variety of tissues e.g. in neuronal tissue (brain, spinal cord, retina), and non-neuronal tissues (kidney, lung, pancreas, prostate gland, and thyroid gland) (Dawkins and Small, 2014). APP has been studied because of its link to AD, however, its role in normal brain function is poorly understood. APP is processed by two different pathways, amyloidogenic pathway and non-amyloidogenic pathway. In physiological condition, the majority of APP is processed via the non-amyloidogenic, thus leading to the generation of the secreted N-terminal APP processing product sAPPα. sAPPα is formed due to the cleavage of APP by α-secretase. In previous studies, our group has shown that sAPPα produce potent neuroprotective effect by altering gene expression, as well as by antagonizing several different types of neurotoxic stress stimuli (Copanaki et al., 2010; Kögel et al., 2003, 2005; Milosch et al., 2014). Several studies have shown that protein degradation is reduced in AD (Hong et al., 2014; Lipinski et al., 2010) but the role of APP and its cleavage products in protein degradation is still unknown. This thesis discusses about the physiological functions of APP in neuroprotection and protein homeostasis.
In the first part of the thesis (Section 4.1 - 4.4), the neuroprotective properties of yeast derived sAPPα and E1 (N-terminal domain of sAPPα) were investigated under serum and glucose deprivation conditions. In previous work, it was shown that recombinant sAPPα evoked a significant decrease in serum deprivation triggered cell death in human SH-SY5Y neuroblastoma cells and mouse embryonic fibroblast MEF cells. It was also observed that sAPPα induces the phosphorylation of Akt which leads to neuroprotection (Milosch et al., 2014). This study investigated whether this neuroprotection is associated with altered expression of downstream intracellular Akt targets such as FoxO, Bim, Bcl-xL and Mcl-1 under stress conditions. Here it was shown that sAPPα prevents activation and nuclear translocation of FoxO. FoxO act as a transcription factor for different proapoptotic genes such as Bim. It was also observed that Bim protein and mRNA expression was significantly reduced with sAPPα and E1 treatment. The expression of antiapoptotic protiens such as Bcl-xL and Mcl-1 were also examined and it was observed that sAPPα and E1 increases expression of both these proteins. Furthermore, it was previously demonstrated that uncleaved holo-APP functionally cooperates with sAPPα to activate Akt and provide neuroprotection (Milosch et al., 2014). Therefore, to investigate the function of the APP in sAPPα regulated Akt downstream proteins expressions, MEF APP KO cells were used. E1 and sAPPα only showed neuroprotective modulatory effect on these Akt downstream targets in MEF wt cells, but not in APP KO cells. In addition, sAPPα also showed neuroprotection in primary wt hippocampal neurons under trophic factor deprivation. Cellular fractionation experiments were also done to determine the role of sAPPα in cytochrome c release from mitochondria. It was observed that sAPPα treatment can inhibit mitochondrial cytochrome c release in wt MEF cells.
The second part of the thesis (Section 4.5 - 4.9) discusses about the role of sAPPα in protein homeostasis. It was observed that sAPPα prevents proteotoxic stress induced BAG3 protein expression in SH-SY5Y and MEF cells. This was also observed in mRNA levels which indicate a transcriptional regulation. Furthermore, treatment with sAPPα was also shown to decrease aggresomes formation. Aggresomes are perinuclear aggregates which are formed due to accumulation of damaged and misfolded proteins and BAG3 plays important role in their formation and the transport of degradation prone proteins into these structures. The analysis of proteasomal activity showed a reduced accumulation of proteasomal substrate d2 by sAPPα under proteasomal stress. In proteasomal activity assay, sAPPα was shown to increase the degradation of proteasomal substrate SUC-LLVY-AMC and the fluorigenic signal was measured spectrophotometrically. The sAPPβ fragment which is generated via the amyloidogenic pathway was also examined for its role in BAG3 expression and proteasomal degradation. sAPPβ, which has almost similar structure as sAPPα, only 17 amino acids at the C-terminus is missing, was failed to modulate BAG3 expression and proteostasis. This indicates that these biological effects are highly specific for sAPPα.
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Der Hirntumor Glioblastom (GBM) ist aufgrund seines infiltrativen Wachstums, der hohen intra- und intertumoralen Heterogenität, der hohen Therapieresistenz als auch aufgrund der sogenannten gliomartigen Stammzellen sehr schwer zu behandeln und führt fast immer zu Rezidiven. Da es in den letzten Jahrzehnten kaum Fortschritte in der Behandlung des GBMs gab, bis auf die Therapie mit Tumortherapiefeldern, wird weiterhin nach alternativen Zelltodtherapien geforscht, wie zum Beispiel dem Autophagie-abhängigen Zelltod. Der Autophagie-abhängige Zelltod ist durch einen erhöhten autophagischen Flux gekennzeichnet und obwohl die Autophagie, als auch selektive Formen wie die Lysophagie und Mitophagie, normalerweise als überlebensfördernde Mechanismen gelten, konnten viele Studien eine duale Rolle in der Tumorentstehung, -progression und -behandlung aufzeigen, die vor allem vom Tumortyp und stadium abhängt. Um die zugrunde liegenden Mechanismen des durch Medikamente induzierten Autophagie-abhängigen Zelltods im GBM weiter zu entschlüsseln, habe ich in meiner Dissertation verschiedene Substanzen untersucht, die einen Autophagie-abhängigen Zelltod induzieren.
In einer zuvor in unserem Labor durchgeführten Studie konnte gezeigt werden, dass das Antipsychotikum Pimozid (PIMO) und der Opioidrezeptor-Antagonist Loperamid (LOP) einen Autophagie-abhängigen Zelltod in GBM Zellen induzieren können. Darauf aufbauend habe ich die Fähigkeit zur Induktion des Autophagie-abhängigen Zelltods in weiteren Zellmodellen validiert. Dies bestätigte einen erhöhten autophagischen Flux nach PIMO und LOP Behandlung, während der Zelltod als auch der autophagische Flux in Autophagie-defizienten Zellen reduziert war. In weiteren Versuchen konnte ich die Involvierung der LC3-assoziierten Phagozytose (LAP), ein Signalweg der auf die Funktion einiger autophagischer Proteine angewiesen ist, ausschließen. Weiterhin konnte ich eine massive Störung des Cholesterin- und Lipidstoffwechsels beobachten. Unter anderem akkumulierte Cholesterin in den Lysosomen gefolgt von massiven Schäden des lysosomalen Kompartiments und der Permeabiliserung der lysosomalen Membran. Dies trug einerseits zur Aktivierung überlebensfördernder Lysophagie als auch der Zell-schädigenden „Bulk“-Autophagie bei. Letztendlich konnte aber die erhöhte Lysophagie die Zellen nicht vor dem Zelltod retten und die Zellen starben einen Autophagie-abhängigen lysosomalen Zelltod. Da die Eignung von LOP als Therapie für das GBM aufgrund der fehlenden Blut-Hirn-Schranken Permeabilität und von dem Antipsychotikum PIMO aufgrund teils schwerer Nebenwirkungen eingeschränkt ist, habe ich mich im weiteren Verlauf meiner Dissertation mit einer Substanz mit einem anderen Wirkmechanismus beschäftigt.
Der Eisenchelator und oxidative Phosphorylierungs (OXPHOS) Inhibitor VLX600 wurde zuvor berichtet mitochondriale Dysfunktion und Zelltod in Kolonkarzinomzellen zu induzieren. Allerdings hat meines Wissens nach bisher noch keine Studie die therapeutische Eignung von VLX600 für das GBM untersucht. Hier zeige ich eine neuartige Autophagie-abhängige Zelltod-induzierende Fähigkeit von VLX600 für GBM Zellen, da der Zelltod signifikant in Autophagie-defizienten Zellen aber nicht durch Caspase-Inhibitoren gehemmt wurde und der autophagische Flux erhöht war. Darüber hinaus konnte ich die Hemmung der OXPHOS und die Induktion von mitochondrialem Stress in GBM Zellen bestätigen und weiterhin aufzeigen, dass VLX600 nicht nur die mitochondriale Homöostase stört, sondern auch zu einer BNIP3-BNIP3L-abhängigen Mitophagie führt, die wahrscheinlich durch HIF1A reguliert wird aber keinen erkennbaren Nettoeffekt auf den von VLX600 induzierten Zelltod hat. Demnach induziert VLX600 letale „Bulk“-Autophagie in den hier verwendeten Zellmodellen. Darüber hinaus konnte ich zeigen, dass die Eisenchelatierung durch VLX600 eine große Rolle für den von VLX600-induzierten Zelltod spielt aber auch für die Mitophagie Induktion, Histon Lysin Methylierung und den ribosomalen Stress. Letztendlich ist es wahrscheinlich ein Zusammenspiel all dieser Faktoren, die zur Zelltodinduktion durch VLX600 führen und interessanterweise werden Eisenchelatoren bereits in präklinischen und klinischen Studien für Krebstherapien untersucht. Dabei könnten gewisse metabolische Eigenschaften verschiedener Tumorzellen die Sensitivität von Wirkstoffen, die auf den Metabolismus wirken wie VLX600, beeinflussen was in zukünftigen Studien beachtet werden sollte um den bestmöglichsten Therapieerfolg zu erzielen. Zusammenfassend unterstützt meine Dissertation die duale Rolle der Autophagie, die stark vom jeweiligen Kontext abhängt und befürwortet die weitere Forschung von Substanzen, die einen Autophagie-abhängigen Zelltod induzieren, für das GBM.