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Molecular and Cellular Biology, October 2000, p. 7602-7612, Vol. 20, No. 20
0270-7306/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
Inhibition of Daxx-Mediated Apoptosis by Heat Shock
Protein 27
Steve J.
Charette,
Josée N.
Lavoie,
Herman
Lambert, and
Jacques
Landry*
Centre de Recherche en Cancérologie de
l'Université Laval, L'Hôtel-Dieu de Québec,
Québec, Canada G1R 2J6
Received 18 February 2000/Returned for modification 13 April
2000/Accepted 25 July 2000
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ABSTRACT |
Heat shock protein 27 (HSP27) confers cellular protection against a
variety of cytotoxic stresses and also against physiological stresses
associated with growth arrest or receptor-mediated apoptosis. Phosphorylation modulates the activity of HSP27 by causing a major change in the supramolecular organization of the protein, which shifts
from oligomers to dimers. Here we show that phosphorylated dimers of
HSP27 interact with Daxx, a mediator of Fas-induced apoptosis,
preventing the interaction of Daxx with both Ask1 and Fas and blocking
Daxx-mediated apoptosis. No such inhibition was observed with an HSP27
phosphorylation mutant that is only expressed as oligomers or when
apoptosis was induced by transfection of a Daxx mutant lacking its
HSP27 binding domain. HSP27 expression had no effect on Fas-induced
FADD- and caspase-dependent apoptosis. However, HSP27 blocked
Fas-induced translocation of Daxx from the nucleus to the cytoplasm and
Fas-induced Daxx- and Ask1-dependent apoptosis. The observations
revealed a new level of regulation of the Fas pathway and suggest a
mechanism for the phosphorylation-dependent protective function of
HSP27 during stress and differentiation.
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INTRODUCTION |
The small heat shock protein HSP27
is expressed at various levels in different cell types and tissues.
HSP27 is regulated at both the transcriptional and posttranslational
levels (2). Like those of other heat shock proteins, its
concentration increases severalfold over the basal level under specific
stressful environmental conditions that activate the heat shock
transcription factor. Such overexpression confers cellular resistance
to a variety of stimuli that induce cell death with either necrotic or
apoptotic features, including physical and chemical stress, growth
factor withdrawal, and activation of death receptors (14, 20, 22, 28, 32, 34, 39-41, 65). HSP27 is also regulated at the posttranslational level by stress and by cytokines and growth factors
that activate stress-activated protein kinase 2 (SAPK2) p38, the
upstream activator of the HSP27 kinase mitogen-activated protein
kinase-activated protein (MAPKAP) kinase 2 (12, 15, 18, 21, 29,
31, 37, 40, 50, 57). Phosphorylation causes a major change in the
quaternary structure of HSP27, which shifts from large 600- to 800-kDa
homotypic multimers down to dimers and monomers (27, 49). A
similar shift from high-molecular-weight to dimeric complexes also
occurs in the Saccharomyces cerevisiae homologue of HSP27,
HSP26, suggesting conservation of an important regulatory mechanism
(17).
Two biochemical activities of HSP27 have been well documented. HSP27
phosphorylation modulates actin dynamics. In vitro, unphosphorylated monomers but not phosphorylated monomers or large multimers have been
shown to block polymerization of actin (3, 42, 43). In vivo,
actin polymerization and reorganization are modulated by HSP27
concentration and phosphorylation in response to growth factors
(33, 51). During stress, HSP27 phosphorylation-mediated microfilament reorganization contributes to filament stabilization in
some conditions but mediates cell blebbing in others (15, 18, 19,
30, 33, 34). HSP27 also possesses chaperone activities. In vitro,
high-molecular-weight complexes of HSP27 bind denatured proteins and
prevent their aggregation by keeping them in a renaturation-competent
state (11, 24, 35). A recent study with an HSP27 relative
from yeast suggested that this function involves the initial binding of
the denatured peptides on HSP27 dimers, followed by the reassembly of
the HSP27-denatured peptide complexes into high-molecular-weight
structures. This suggested that the phosphorylation-induced
dissociation of the mammalian HSP27 multimers into dimers may similarly
promote the chaperone function (17). An in vivo chaperone
function of HSP27, however, remains to be demonstrated.
HSP27 has a strong protective activity against a number of cytotoxic
agents, including heat shock, oxidative stress, chemotherapeutic agents, and cytokines (14, 20, 22, 28, 32, 34). While some
of these agents may affect protein structure or microfilament integrity, it appears unlikely that the known biochemical activities of
HSP27 can explain so wide a spectrum of protective activities. A better
explanation could come from its capacity to block apoptotic processes.
In neuronal cells, for example, HSP27 overexpression protects against
both thermal and ischemic stress and against apoptosis induced by nerve
growth factor withdrawal or retinoic acid treatments (36,
65). HSP27 also blocks cytotoxic drug-induced apoptosis in tumor
cells (13, 14). The expression and phosphorylation status of
HSP27 are also modulated in several mammalian cells during
differentiation and entry in the G1 phase of the cell
cycle, and this may play an essential role in preventing apoptosis
induction linked to cessation of cell growth (4, 14, 37, 40,
54-56). For example, HSP27 was shown to accumulate and to be
essential for preventing apoptosis during leukemia-inhibitory factor
withdrawal-induced differentiation of embryonic stem cells and
dopamine-mediated differentiation of rat olfactory neurons
(37, 40). The possibility that HSP27 has a specific target
in a key apoptotic signaling or execution pathway is supported by the
report that HSP27 can prevent activation of pro-caspase 9 after
etoposide treatment and can inhibit apoptosis induced by activation of
the Fas receptor (13, 41).
Regulation of cell death through apoptosis is of major importance in
the embryonic development, as well as the functioning, of a
multicellular organism. A key regulator of apoptosis is Fas (also named
CD95 and APO-1), which belongs to the tumor necrosis factor death
receptor superfamily and which is expressed constitutively on the
surfaces of many cells from many tissues (45). Upon binding its ligand, Fas-L, Fas recruits the adapter Fas-associated death domain
(FADD; also called MORT1) through an intracellular 80-amino-acid motif
called the death domain. The interaction is mediated by a similar death
domain in the C-terminal end of FADD, while the N terminus of FADD
mediates interaction with caspase 8 (MACH [FLICE]), an
interleukin-1
-converting enzyme family cysteine protease (5, 6,
9, 44). Activated caspase 8 in turn activates downstream caspases, leading to cleavage of essential substrates and cell death.
An alternative and independent apoptotic pathway induced by Fas
involves Daxx, a protein normally associated with the nuclear substructures named ND-10 or PML oncogenic domain (POD) (7, 8, 61,
66). The mechanism by which Daxx conveys the Fas apoptotic signal
is not totally clear. Mouse Daxx has been described as an adapter of
Fas that can recruit and activate apoptosis signal-regulated kinase 1 (Ask1), a mitogen-activated protein kinase kinase kinase. Activation of
Ask1 can then lead to the activation of stress-activated protein kinase
1-Jun N-terminal kinase (SAPK1/JNK) (7, 8, 66). The role of
SAPK1/JNK activation in Daxx-mediated cell death is, however, unclear.
It was also proposed that Daxx enhancement of Fas-induced apoptosis
results from the PML-mediated association of Daxx with POD
(61). In either case, it was concluded that Daxx acts at a
proximal postreceptor step in Fas signaling.
In the present study, we found that HSP27 in its phosphorylated dimeric
form but not in its unphosphorylated multimeric form interacts both in
vitro and in vivo with Daxx, preventing association of Daxx with Fas
and Ask1 and induction of apoptosis by Daxx when coexpressed with Ask1.
The physiological relevance of this interaction was investigated in 293 cells. We showed that stimulation of Fas results in two temporally
distinguishable apoptotic processes: a fast process, which was
dependent on FADD and which was inhibited by a dominant-negative form
of FADD or the pancaspase inhibitor z-VAD-fmk, and a slow process,
which was independent of caspases, dependent on Daxx, and enhanced by
Ask1. The Daxx-dependent pathway was inhibited by expression of HSP27
but not by an HSP27 phosphorylation mutant which fails to form dimeric
complexes and to interact with Daxx. Taken together, the observations
suggest a new mechanism for regulating the Fas pathway and for the
phosphorylation-dependent protective function of HSP27 during stress
and differentiation. Inhibition of Daxx-dependent apoptosis may be a
major mechanism of HSP27-mediated protection, particularly in some
differentiated or tumor cells in which the FADD-dependent pathway of
Fas-induced apoptosis is blocked.
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MATERIALS AND METHODS |
Plasmids and reagents.
pSVHa27WT encodes the full-length
sequence of Chinese hamster HSP27 (HaHSP27) (27). pSVHa27AA
and pSVHa27EE are similar to pSVHa27WT but encode serine-to-alanine and
serine-to-glutamate substitutions at positions 15 and 90, respectively
(27). pCINHu27WT expresses full-length human HSP27
(HuHSP27). It was constructed by cloning the EcoRI insert of
pGAD10-HuHSP27 (27) in pCI-NEO (Promega). GST-Fas-DD, a
fusion protein comprising glutathione S-transferase (GST)
and the death domain of Fas (Fas-DD), was produced in bacteria from the
plasmid pGST-Fas-DD, made by inserting the
HincII-HindIII insert from the Fas-encoding
clone 927519 (American Type Culture Collection [ATCC]) into pGEX 4T-3
(Amersham Pharmacia Biotech). GST-HuHSP27 and GST-55.1 were produced
similarly from plasmids pGST-HuHSP27 and pGST-55.1, made from
pCINHu27WT and pGADGH-55.1, respectively. pGADGH-55.1 was obtained in a
two-hybrid screen in this study and is described later. It encodes the
carboxy-terminal end (residues 472 to 740) of human Daxx. pCINHuDaxx
expresses full-length human Daxx protein and was constructed with the
insert of a Daxx cDNA (26). pCIN-AAD and pCIN-DaxxC express
residues 497 to 625 (apoptosis activation domain [AAD]) and 497 to
740 (DaxxC) of Daxx, respectively. They were constructed from
pGADGH-55.1 and clone 184860 from ATCC. Briefly, pCIN55.1 was produced
with the EcoRI-XhoI insert of pGADGH-55.1 cloned
in pCI-NEO. The EcoRI-BglII insert of pCIN55.1
was replaced by the EcoRI-BglII insert of clone 184860 to produce pCIN-DaxxC. pCIN-AAD was produced by removing the
C-terminal part of pCIN-DaxxC by AvaII digestion.
pCINmyc-FBD was produced by inserting an
AvaII-XhoI fragment of pGADGH-55.1 into pCINmyc.
pCINmyc was produced by inserting a DNA cassette coding for an
initiating methionine and c-myc epitope (MEQKLISEEDL) into the
multicloning site of pCI-NEO. pcDNA3-HA-Ask1 expresses full-length
human Ask1 tagged with the influenza virus hemagglutinin (HA) epitope
(52). pCINMyc-FADD expresses a full-length FADD tagged in
its N terminus with the myc epitope. The FADD cDNA was produced by PCR
amplification of a human kidney library (Clontech) and inserted into
pCINmyc. pCINMyc-FADD was digested with AccI to produce
pCINMyc-FADD-DN, which lacks the first 79 amino acids of FADD. pCMV
,
which expresses
-galactosidase, was from Clontech. All constructs
newly developed in this study were confirmed by DNA sequencing.
SB203580 was from Calbiochem, human Fas-activating antibody (clone
CH11) was from Upstate Biotechnology, and z-VAD-fmk was from Enzyme
Systems Products. 4',6-Diamidino-2-phenylindole (DAPI) was from Sigma.
Antibodies L2R3 against HaHSP27 and anti-Hu against HuHSP27 have been
described before (28, 34). The anti-Daxx EL-68 antibody was
developed in rabbits after injection of bacterially produced GST-55.1.
Anti-HA (12CA5) is a mouse monoclonal antibody recognizing the
YPYDVPDYA peptide sequence from human influenza virus HA protein (Roche
Molecular Biochemicals Corporation). Antimyc (9E10) is a mouse
monoclonal antibody recognizing theEQKLISEEDL peptide sequence from the
human c-Myc protein (ATCC).
Two-hybrid screening and analyses.
The two-hybrid screening
procedures have been described in detail elsewhere (27).
Briefly, the full-length HaHSP27 cDNA contained in pSVHa27WT was cloned
in phase with LexA cDNA in the pBTM116 vector to produce the bait
fusion protein LexA-HaHSP27. The LexA-HaHSP27 construct was used to
screen a HeLa cell cDNA library cloned at the
EcoRI-XhoI site of the pGADGH vector (Clontech). Screening was done using Saccharomyces cerevisiae reporter
strain L40. Colonies that grew on triple-selective media (lacking
histidine, leucine, and tryptophan) were tested for
-galactosidase
activity using a colony lift filter assay. Colonies were replica
plated, and one set was transferred to a filter disk (Whatman Inc.,
Clifton, N.J.), lysed by freezing, and incubated at 30°C with Z
buffer (0.1 M NaPO4, 10 mM KCl, 1 mM MgSO4,
0.27%
-mercaptoethanol, 0.33 mg of
5-bromo-4-chloro-3-indolyl-
-D-galactopyranoside
[Boehringer Mannheim Biochemicals]/ml, pH 7.0) until the blue
coloration appeared (4 to 12 h). The plasmids from positive clones
were purified and cotransfected with LexA-ras (val 12) and LexA-lamin C
(64) to eliminate false-positive clones. Only clone 55.1, which coded for the carboxy-terminal end (residues 472 to 740) of Daxx,
was considered in this study (see Fig. 1A).
Further two-hybrid
-galactosidase assays with pairs of GAL4
activation domain and LexA binding domain plasmids were performed. LexA-HuHSP27 was produced by inserting into pBTM116 full-length HuHSP27
cDNA from a pGADGH-HuHSP27 plasmid obtained in the same two-hybrid
screening. GAL4-AAD and GAL4-FBD (see Fig. 1A) were produced by
inserting AvaII-digested clone 55.1 cDNA encoding the N- and
C-terminal parts, respectively, in phase with the coding sequence for
the GAL4 activation domain contained in the pGADGH plasmid. All
constructs were confirmed by DNA sequencing. Pairs of vectors were
cotransfected in yeast strain L40 and grown in selective media. Cells
were lysed by chloroform and processed to evaluate
-galactosidase
expression by
o-nitrophenyl-
-D-galactopyranoside (Sigma)
hydrolysis, which was measured at 420 nm.
Cell culture and transfection.
293 cells were maintained at
37°C in a 5% CO2 humidified atmosphere in Dulbecco's
modified Eagle medium containing 2.2 g of NaHCO3 and
4.5 g of glucose/liter and supplemented with 10% fetal calf
serum. Transfection was done by calcium phosphate precipitation as
described before (28) except that 50 µM chloroquine was
added for the first 5 h of transfection.
GST pull-down assay and coimmunoprecipitation.
Exponentially
growing 293 cells were plated onto 6-cm-diameter dishes at 0.75 × 106 to 1.0 × 106 cells per well and
transfected 24 h later with the appropriate plasmid (4 to 10 µg). The cells were lysed 24 to 48 h later in buffer EM2
containing 50 mM HEPES (pH 7.6), 50 mM NaCl, 1% NP-40, 5 mM EDTA, 10%
glycerol, and 1 mM 4-(2-aminoethyl)-benzenesulfonyl fluoride (Sigma)
and centrifuged at 17,000 × g for 10 min at 4°C. Supernatants were used either for GST pull-down assays or
immunoprecipitation. Cell extracts (150 to 300 µl) were incubated
with 1 to 10 µg of GST-fused proteins adsorbed on
glutathione-Sepharose (Amersham Pharmacia Biotech) or with 10 µl of
the L2R3 anti-HaHSP27 antibody (34) adsorbed on protein
A-Sepharose (50% [vol/vol]) (Amersham Pharmacia Biotech) at 4°C
for 60 to 90 min. After incubation, beads were washed two times in 300 µl of buffer EM2. Proteins retained on beads and total cell extracts
were subjected to electrophoresis on a sodium dodecyl
sulfate-polyacrylamide gel and then transferred to a nitrocellulose
membrane. HuHSP27, HaHSP27, and Daxx proteins were revealed by
immunoblotting using anti-Hu, L2R3, or EL-68 antibodies, respectively,
and diluted 1/2,500 in 10 mM Tris-HCl (pH 7.4)-150 mM NaCl-1%
(wt/vol) free fatty acid powder milk. Ask1-HA and Myc-FBD were revealed
using 1/5,000 dilutions of anti-HA and anti-Myc antibodies,
respectively. Primary antibodies were detected using anti-rabbit or
anti-mouse immunoglobulin G coupled to horseradish peroxidase (diluted
1/5,000) (Jackson Laboratory). GST-fused proteins were visualized by
Ponceau red staining on a nitrocellulose membrane before immunoblotting.
Cell death assay.
Exponentially growing 293 cells were
plated at a concentration of 0.5 × 105 to 1.0 × 105 cells per well onto six-well dishes coated with 0.1%
gelatin. The next day, the cells were transfected with pCMV
together
with the plasmids to be tested. Concentrations of plasmids between groups within an experiment were varied slightly (0.1 to 0.5 µg/well) to maintain equal expression of the tested proteins. Within all experiments, the level of protein expression was kept constant, as
verified by Western blot analysis of total cell lysates as described
above. Apoptosis induction was measured by counting under the
microscope the number of
-galactosidase-positive cells with
apoptotic morphology. pCMV
-transfected cells were fixed with 0.05%
glutaraldehyde in phosphate-buffered saline for 10 min and stained for
-galactosidase expression by
5-bromo-4-chloro-3-indolyl-
-D-galactopyranoside hydrolysis. Cells were considered apoptotic if they showed intense cell
blebbing or were round and condensed. More than 200 blue cells were
analyzed per well. The percentage of apoptotic cells was 100 times the
number of blue cells with apoptotic morphology divided by the total
number of blue cells in each condition. Specific apoptosis is the
difference between the percentage of blue cells with apoptotic
morphology in cultures transfected with the test plasmid and that in
cultures transfected with an empty vector. Basal apoptosis ranged from
3 to 7%. Values presented are averages plus standard deviations of
triplicate determinations.
Immunofluorescence microscopy.
Immunolabeling of endogenous
or transfected Daxx was performed on 293 cells growing on
gelatin-coated six-well dishes. Cells were fixed with 3.7%
formaldehyde in phosphate-buffered saline (137 mM NaCl, 5 mM KCl, 10 mM
Na2HPO4, 11 mM glucose, pH 7.2) for 20 min and
permeabilized with 0.1% saponin for 15 min. EL-68 antibody diluted
1/100 was used to detect Daxx. The Daxx-antigen-antibody complex was
revealed with fluorescein isothiocyanate (FITC)-labeled anti-rabbit
immunoglobulin G antibodies (Jackson Laboratory) diluted 1/50. Nuclei
were revealed by DAPI staining (10 µg/ml). Epifluorescence microscopy
was done on a Nikon Eclipse E600 microscope equipped with a B2-A filter
for FITC detection and a UV-1A filter for DAPI staining. Pictures were
obtained with a Micromax cooled digital camera system (Princeton Instruments).
 |
RESULTS |
HSP27 dimers interact with Daxx and block Daxx-Ask1 and Daxx-Fas
interaction.
To identify proteins which could mediate the
protective function of HSP27, a two-hybrid screening of a library of
HeLa cell cDNA fused to the activation domain of Gal4 was done using
HaHSP27 fused to the LexA DNA-binding domain as bait. Among the
positive clones obtained, four identical clones typified by clone 55.1 specifically interacted in a two-hybrid assay with HaHSP27 and HuHSP27,
but not with ras (val 12) and lamin C (data not shown). Sequence
analysis revealed that clone 55.1 corresponded to the carboxy terminus
of the human Daxx protein from amino acid 472 to 740 (Fig.
1A). Clone 55.1 contained the sequences
corresponding to two characterized domains of mouse Daxx: the AAD,
which is sufficient for the apoptosis activity of Daxx and which
corresponds to human amino acids 485 to 626, and the Fas binding domain
(FBD), which corresponds to amino acids 626 to 740 of human Daxx and which mediates interaction of mouse Daxx with the death domain of Fas
(Fas-DD) (66).

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FIG. 1.
HSP27 interacts with Daxx. A partial cDNA of Daxx (clone
55.1) was obtained in a two-hybrid screen of a HeLa cell cDNA library
using HaHSP27 as a bait. (A) Schematic representation of the Daxx
sequences contained in clone 55.1. Represented are the acidic domain
(acid.), the AAD, and the FBD of human Daxx. Residue numbers at domain
boundaries are indicated. (B and C) GST pull-down assays. (B) Daxx is
retained on immobilized HuHSP27. Extracts from pCINHuDaxx-transfected
293 cells were incubated with immobilized GST-Fas-DD, GST-HuHSP27, or
GST. Retained Daxx protein was detected by Western blotting using
antibody EL-68. Also shown are the GST fusion proteins in the same gel
stained with Ponceau red. For convenience, bands were aligned at the
same level. The input track represents 6.7% of the total extract. (C)
HuHSP27 is retained on immobilized Daxx sequences contained in clone
55.1. Extracts from pCINHu27WT-transfected 293 cells were incubated
with immobilized GST-HuHSP27, GST-55.1, or GST. Retained HuHSP27
protein was detected by Western blotting using an anti-HuHSP27
antibody. Also shown are the GST fusion proteins in the same gel
stained with Ponceau red. For convenience, bands were aligned at the
same level. The asterisk indicates a GST-HuHSP27 degradation product
recognized by anti-Hu. The input track represents 7.5% of the total
extract. (D and E) HSP27 interacts with the Fas binding domain of Daxx.
(D) Two-hybrid interaction assay was performed with yeast after
transfection of LexA-HuHSP27 or the negative controls LexA-lamin C and
LexA-ras (val 12) with pGADGH-55.1, GAL4-AAD, or GAL4-FBD. The
interaction was quantified by measuring -galactosidase activities,
which are shown in arbitrary units. (E) 293 cells were transfected with
pCINmyc-FBD or with pCINmyc-FBD and pSVHa27WT. Extracts (6.1% of the
total) were analyzed by Western blotting (WB) with anti-Myc antibody
9E10 to detect Myc-FBD protein or with anti-HaHSP27 antibody L2R3 to
detect HaHSP27 expression (input). The extracts were also
immunoprecipitated (IP) with L2R3 and then probed with 9E10 to detect
coimmunoprecipitated Myc-FBD.
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The interaction between Daxx and HSP27 was confirmed in a GST pull-down
assay. Some Daxx from extracts of Daxx-transfected 293 cells was
retained on immobilized GST- HuHSP27 but not on immobilized
GST. Conversely, some HuHSP27 expressed in 293 cells was retained on
immobilized GST-55.1 but not on GST alone. As expected for a
multimeric protein, HSP27 was retained on GST-HSP27, and, as previously
demonstrated, Daxx was retained on immobilized GST-Fas-DD (Fig. 1B and
C). Transient expression in yeast and immunoprecipitation indicated
that the FBD domain of Daxx was sufficient to mediate the interaction
of Daxx with HSP27. In yeast, AAD did not interact with HSP27 whereas
FBD alone produced a signal even stronger than that obtained with the
protein coded for by clone 55.1 (Fig. 1D). In extracts from mammalian
cells transfected with Myc-tagged FBD and HaHSP27, Myc-tagged FBD could
be coimmunoprecipitated by HSP27 antibody L2R3 (Fig. 1E). To determine
whether the interaction between Daxx and HSP27 could be modulated by
phosphorylation, we expressed in 293 cells two previously characterized
HSP27 phosphorylation mutants. In HaHSP27-AA and HaHSP27-EE, Ser15 and
Ser90 were replaced by nonphosphorylatable and pseudophosphorylated
residues, respectively. HaHSP27-AA is expressed in cells mainly as a
homotypic multimer, whereas HaHSP27-EE is expressed as a dimer
(27). In extracts from transfected 293 cells, HaHSP27-AA and
HaHSP27-EE interacted efficiently with immobilized GST- HuHSP27,
indicating that the proteins were functional; however, HaHSP27-EE
interacted with the Daxx protein encoded by clone 55.1 much more
efficiently than HaHSP27-AA (Fig. 2).

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FIG. 2.
HSP27 phosphorylation modulates the interaction with
Daxx. Extracts from 293 cells transfected with pSVHa27EE (A) or
pSVHa27AA (B) were incubated with immobilized GST, GST-55.1, or
GST-HuHSP27. Retained HSP27 proteins were detected by Western blotting
using antibody L2R3. Also shown are the GST fusion proteins in the same
gel stained with Ponceau red. For convenience, bands were aligned at
the same level. The input tracks represent 5% of the total extracts.
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Daxx has been proposed to mediate cell killing by interacting with both
the death domain of Fas, Fas-DD, and Ask1. The interaction between Daxx
and Ask1 was confirmed by showing that Ask1 from extracts of 293 cells
was retained on immobilized GST-55.1 (Fig. 3C, lane 2) or coimmunoprecipitated with
antibodies against Daxx (data not shown). Similarly, Daxx was retained
on immobilized GST-Fas-DD (Fig. 3A, lane 2). The 293 cells have little
constitutive expression of HSP27 (data not shown). We tested the effect
of overexpressing HSP27 on Daxx-Ask1 and Daxx-Fas interactions. When extracts from HuHSP27- or HaHSP27-expressing 293 cells were mixed with
extracts of cells expressing Daxx or Ask1, the binding of Ask1 to
GST-55.1 or of Daxx to Fas-DD was strongly inhibited (Fig. 3A to D,
lanes 3). Expression of HaHSP27-AA had, however, little effect on the
interaction between Daxx and Ask1 or Fas, while HaHSP27-EE was as
effective, if not more effective, in blocking the interaction than
wild-type HSP27 (Fig. 3B and D, lanes 4 and 5). The differential
effects of HaHSP27-AA and HaHSP27-EE on Daxx-Ask1 and Daxx-Fas
interactions were consistent with the failure of the multimeric
HaHSP27-AA to interact with Daxx. It was concluded that the binding of
HSP27 to Daxx prevents Daxx interaction with both Ask1 and Fas.

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FIG. 3.
HSP27 competes with Fas (A and B) and Ask1 (C and D) for
interacting with Daxx. 293 cells were transfected with either
pCIN-Daxx, pcDNA3-HA-Ask1, pCINHu27WT, pSVHa27WT, pSVHa27AA, or
pSVHa27EE. Extracts from Daxx- (A and B) or HA-Ask1 (C and
D)-expressing cells were incubated with immobilized GST-Fas-DD or
GST-55.1, respectively, either alone (lanes 2) or after being mixed
with extracts from cells expressing either species of HSP27 (lanes 3 to
5) as indicated in the input lanes (HuHSP27 or HaHSP27-WT, -AA, or
-EE). Retained Daxx and Ask1 were detected by Western blotting using
anti-Daxx EL-68 and anti-HA 12CA5 antibodies, respectively. Ponceau
red-stained GST fusion proteins are shown on the bottom of each panel.
The input lanes in panels A to D represent 0.6, 0.3, 7.5, and 7.5% of
the total extracts, respectively.
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Daxx-induced apoptosis is inhibited by interaction of
phosphorylated HSP27 with Daxx.
Cells were transfected with Daxx
and/or Ask1 together with
-galactosidase. Twenty-four hours later,
-galactosidase-positive cells were monitored for apoptotic
morphology. Overexpression of Daxx or Ask1 alone induced little
apoptosis. However, cotransfection of Daxx together with Ask1 led to
apoptosis in proportions similar to that observed when, as a control,
Fas was overexpressed in the cells (Fig.
4A). Daxx-Ask1-transfected cells showed
typical apoptosis features such as cytoplasmic shrinking and nuclear
condensation at 24 h and nuclear fragmentation at 48 h (DAPI
staining [data not shown]). In comparison, apoptosis induced by
expression of Fas or FADD appeared faster, with most apoptotic cells
showing fragmented nuclei already at 24 h (data not shown).
Expression of DaxxC or Daxx-AAD with Ask1 also strongly induced
apoptosis, confirming that the AAD domain is sufficient to induce
apoptosis (Fig. 4B).

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FIG. 4.
Coexpression of Daxx and Ask1 induces apoptosis in 293 cells. 293 cells were cotransfected with various combinations of
pCIN-Daxx, pCIN-DaxxC, pCIN-AAD, pcDNA3-HA-Ask1, and pCIN-Fas, as
indicated. pCMV was also cotransfected as a marker to identify
transfected cells. Twenty-four hours later, the percentages of
-galactosidase-positive cells with apoptotic morphology were
calculated after correcting for apoptosis in cells transfected with the
marker gene only.
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We next determined whether HSP27 could block Daxx-induced apoptosis in
vivo. Expression of HuHSP27 or HaHSP27 blocked the apoptosis induced by
expression of Ask1 with either Daxx or DaxxC by up to 70% (Fig.
5A and B). Because in preliminary
experiments we observed that cotransfection of multiple plasmids often
influenced the expression of individual proteins, the expression of the
proapoptotic proteins was carefully monitored in the various
experimental groups. As shown in the insets of Fig. 5A and B, the
inhibitory activity of HSP27 was observed for equal quantities of
expressed Ask1 and Daxx or DaxxC. As observed before for the
interaction between Daxx and HSP27, the protection was also dependent
on the phosphorylation status of HSP27. At equal levels of expression,
HaHSP27-EE blocked cell death as efficiently as wild-type HaHSP27,
whereas HaHSP27-AA provided very little protection. To confirm that
phosphorylation was regulating the protective function of HSP27, we
tested the effect of expressing HSP27 in the presence of SB203580.
SB203580 is a specific inhibitor of p38 (10). By
inhibiting basal p38 activity and thereby lowering MAPKAP kinase 2 activity and HSP27 phosphorylation level, SB203580 lowers the
concentration of the active HSP27 dimers (data not shown), forcing
wild-type HSP27 into the inactive high-molecular-weight oligomeric
state. As expected, SB203580 abrogated the protective effect of
HuHSP27 on Daxx-Ask1- or DaxxC-Ask1-induced apoptosis. To rule out the
possibility that the observed effects of SB203580 could be the result
of blocking other functions of p38, SB203580 was also used in
combination with HaHSP27-EE and HaHSP27-AA. SB203580 had no
effect on the activity of the phosphorylation mutants, indicating that
HSP27 phosphorylation really modulated the protective activity of HSP27 (Fig. 5D). To confirm that HSP27 protection was the result of its
interaction with Daxx, we looked at the effect of HSP27 on cell death
induced by AAD. As expected, HSP27 could not block AAD-induced
apoptosis, which was consistent with the finding that HSP27 does not
interact with AAD (Fig. 5C).

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FIG. 5.
HSP27 blocks apoptosis induced by coexpression of Daxx
and Ask1. Apoptosis was induced by the cotransfection of the
appropriate plasmids to yield the coexpression of Ask1 with either Daxx
(A), DaxxC (B and D), or AAD (C), with or without HuHSP27 (Hu), HaHSP27
(Ha WT), or the phosphorylation mutants HaHSP27-AA (Ha AA) and
HaHSP27-EE (Ha EE). pCMV was also transfected in all cases to
identify transfected cells. Twenty-four hours after transfection, the
cells were processed to determine the number of
-galactosidase-positive cells with apoptotic morphology. When
indicated (Hu SB), the cells were incubated for the last 16 h in
the presence of SB203580 (5 µM). (A and B insets) Western blots
showing the concentrations of Ask1, Daxx or DaxxC, and HSP27 in an
aliquot of the cell lysates for each condition corresponding to the
histograms. Gel tracks in the insets are in the same order as in the
histograms.
|
|
Role of HSP27 in Fas-induced apoptosis.
The finding that HSP27
could block the apoptotic activity of Daxx suggested that it could
modulate Fas-induced apoptosis. Activation of Fas by incubation of
cells with a Fas-activating antibody or by overexpression of Fas
induces two independent pathways of cell death, one Daxx dependent and
presumably sensitive to HSP27 and the other FADD dependent and leading
to the activation of caspase 8. Consistent with the existence of these
two distinct pathways, we found that apoptosis induced by
overexpression of FADD was insensitive to coexpression of HaHSP27-EE,
which in the same experiment blocked Daxx-Ask1-induced cell death (Fig.
6B). Conversely, Daxx-induced cell death
was not influenced by coexpression of a dominant-negative form of FADD
(FADD-DN) which blocked apoptosis induced by the expression of Fas.
Treatments with the pancaspase inhibitor z-VAD-fmk, like treatments
with FADD-DN, blocked Fas-induced cell killing but had no effect on
Daxx-induced cell death (Fig. 6A). The latter result was highly
reproducible (see Fig. 7 and 8) and suggested, contrary to previous
findings (66), that Daxx-induced cell killing was caspase
independent.

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FIG. 6.
Specificity of the Daxx and FADD arms of the Fas
pathway. (A) Effect of expressing FADD-DN or inhibiting the caspases
with z-VAD-fmk on apoptosis induced by overexpression of Daxx and Ask1
or Fas. (B) Effect of expression of pseudophosphorylated HSP27
(HaHSP27-EE) on apoptosis induced by overexpression of Daxx and Ask1 or
FADD. 293 cells were transfected with the appropriate plasmids together
with pCMV , and apoptosis was measured 24 h later in
-galactosidase-positive cells. When indicated, z-VAD-fmk (50 µM)
was added 12 h before staining.
|
|
Since HSP27 can block only one arm of the Fas pathway, its effects on
Fas-induced apoptosis necessarily depend on the relative contributions
of the FADD and Daxx pathways. We found a strong time dependency for
the relative contributions of FADD and Daxx to apoptosis induced by
either overexpressing Fas (Fig. 7A and B)
or activating endogenous Fas (Fig. 7C to F). Expression of FADD-DN, a
dominant-negative form of FADD which can bind Fas but which lacks the
caspase-8 binding domain, or the presence of z-VAD-fmk had a major
inhibitory effect on Fas-induced apoptosis measured at 24 h,
suggesting that the FADD pathway played a major role at early times
(Fig. 7A, C, and E). Accordingly, inhibiting the Daxx pathway by
expressing FBD in cells in which the FADD pathway was also blocked by
the presence of FADD-DN had little additional protective effect (Fig.
7A and C). Under these conditions, HSP27 also had no effect. At 48 h poststimulation, however, the contribution of the FADD pathway became
less important. Cell death could not be prevented efficiently for such
a long period of time with FADD-DN alone and required that Daxx also be
inhibited. Under these conditions, HSP27-EE, but not HSP27-AA, was as
efficient as FBD in blocking Fas-induced apoptosis (Fig. 7B and D). The
contribution of the Daxx pathway could, however, be detected also at
24 h when the Daxx pathway was enhanced by expressing Ask1. In the
presence of a higher concentration of Ask1, Fas-induced apoptosis
measured at 24 h was only partially blocked by z-VAD-fmk and
z-VAD-fmk-resistant apoptosis was efficiently blocked by FBD or
HSP27-EE but not by HSP27-AA (Fig. 7C and D). The results indicated
that Fas induced a rapid apoptotic process which is mainly dependent on
the FADD pathway and the activation of caspases. Blocking the FADD
pathway reveals the existence of a longer-term apoptotic process,
dependent on the Daxx-Ask1 module and inhibitable by FBD and
phosphorylated HSP27. The result that Ask1 expression has no effect on
the total amount of cell death when the FADD pathway is functional
(Fig. 7E) suggests that the same individual cells are killed by the two
pathways; i.e., when both processes are operational, they are
overlapping rather than complementary.

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FIG. 7.
HSP27 inhibits the Daxx-sensitive arm of Fas-induced
apoptosis. (A to D) Effect of expression of Daxx-FBD, HaHSP27-AA, or
HaHSP27-EE, together with FADD-DN, on apoptosis induced 24 h (A and C)
or 48 h (B and D) after either overexpressing Fas by transfection
(A and B) or stimulating Fas with anti-Fas (C and D). Anti-Fas (100 ng/ml) was added 24 h after transfection of other plasmids. (E and
F) Overexpressing Ask1 amplifies the relative importance of the Daxx
pathway and of HSP27 inhibition of apoptosis induced 24 h after
Fas activation. The cells were transfected with the appropriate
plasmids in various combinations as indicated. Anti-Fas (100 ng/ml) was
added 12 h after transfection. z-VAD-fmk (50 µM) was added
1 h before Fas activation. pCMV was also transfected in all
cases, and apoptosis in the -galactosidase-positive cells was
measured.
|
|
HSP27 prevents Fas-induced relocalization of Daxx.
Daxx is a
nuclear protein, and therefore the mechanism by which it mediates
Fas-induced apoptosis is unclear. It has been demonstrated that Fas,
Ask1, and Daxx form a multiprotein complex after stimulation of Fas,
implying a change in the intracellular localization of Daxx
(7). By immunofluorescence using antibody EL-68, both
endogenous Daxx and Daxx expressed at a high concentration after
transfection were found localized in the nucleus, in many cases in
speckles (Fig. 8A and D) identified
previously as the POD (67). In unstimulated cells, only 1 to
2% of the cells show cytoplasmic Daxx. Twelve hours after stimulation
of Fas, this proportion typically increased to some 10% and Daxx was
often localized in the blebs of cells starting apoptosis. The exclusion of Daxx from the nucleus was not a consequence of apoptosis. Blocking the early phase of apoptosis with z-VAD-fmk either had no effect or
caused an even higher proportion of the cells to accumulate Daxx in the
cytoplasm, likely due to the accumulation of the preapoptotic cells by
z-VAD-fmk (Fig. 8B). Similar results were obtained with the endogenous
Daxx in untransfected cells (Fig. 8D and data not shown). To determine
the effect of HSP27 on Fas-induced translocation of Daxx, cells were
cotransfected with Daxx and either HSP27-AA or HSP27-EE and then
exposed to the activating antibody of Fas. Expression of HSP27
efficiently blocked Fas-induced Daxx translocation. As found for the
activity of HSP27 on Daxx-mediated apoptosis, HSP27-EE but not HSP27-AA
was active in blocking the translocation of Daxx (Fig. 8C).

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FIG. 8.
Fas-induced translocation of Daxx from the nucleus to
the cytoplasm is inhibited by HSP27. (A to C) 293 cells were
transfected with plasmid pCINHuDaxx, alone or together with plasmid
pSVHa27AA (AA) or pSVHa27EE (EE). Twelve hours after transfection the
cells were left untreated (control or con) or treated with 100 ng of
anti-Fas activating antibody/ml for 12 h before fixation. Where
indicated, z-VAD-fmk (50 µM) was added to the cells 30 min before Fas
stimulation. Daxx was localized by immunofluorescence using anti-Daxx
EL-68 (A). Nuclei were revealed by DAPI staining. Arrowheads indicate
nuclei of transfected cells. The percentages of cells in which Daxx was
localized in the cytoplasm (as illustrated in panel A) were determined
by direct counting under the microscope. (D) Immunolocalization of
endogenous Daxx. The procedure was the same as for panel A except that
the cells were treated directly without transfection. Endogenous Daxx
was not seen in panel A because of a much shorter exposure time
(15-fold) than that used for panel D.
|
|
 |
DISCUSSION |
HSP27 was initially characterized as a protein whose
phosphorylation and concentration were modulated by heat shock and
which had a potent ability to provide thermoresistance (28).
Subsequent studies showed that its spectrum of protection extends well
beyond elevated temperatures, providing increased survival to cells
exposed to a large variety of stimuli, including oxidative stress,
tumor necrosis factor and Fas death receptor activation, and several commonly used anticancer drugs (14, 20, 22, 28, 32, 34, 39-41,
65). HSP27 concentration and phosphorylation status were also
found to vary among different tissues and after treatments that induce
growth or differentiation, and it was shown that the increased HSP27
concentration that accompanies differentiation was essential to prevent
cell death associated with growth arrest (4, 14, 37, 40,
54-56). Various mechanisms have been proposed for its protective
activities. HSP27 modulates actin polymerization in vitro, and
expression of HSP27 stabilizes actin stress fibers in vivo during
oxidative stress (3, 15, 18, 19, 30, 33, 34). HSP27
possesses a chaperone activity in vitro. It binds denatured proteins
and prevents their aggregation (11, 24). HSP27 also has been
proposed to decrease intracellular reactive oxygen species
(38). However, conclusive evidence for a role of any of
these mechanisms in cell protection is lacking. Because apoptosis
represents a common mechanism of cell death in both physiological and
toxic conditions, the recent discovery that HSP27 could block apoptosis
induced by cytotoxic drugs and by activation of the death receptor Fas
(13, 41) provided a putative explanation for the general
protective function of HSP27. In the present study, we report for the
first time the functional association of HSP27 with a protein known as
a mediator of apoptosis. We showed that HSP27 associates both in vitro
and in vivo with Daxx, preventing its interaction with Fas and Ask1 and
inhibiting its ability to induce apoptosis.
Daxx was first described as an adapter of the Fas receptor, capable of
mediating Fas-induced apoptosis along a pathway distinct from that
mediated by the other Fas adapter, FADD. It was shown that Daxx binds
through its C-terminal domain FBD, an intracellular domain of Fas, in a
manner that did not compete with the binding of FADD (7, 8,
66). A Fas mutant impaired in its capacity to bind FADD but still
capable of binding Daxx mediated apoptosis, which developed slower than
FADD-mediated apoptosis and which was enhanced by the expression of
Ask1. Our results are also consistent with the existence of two
parallel pathways downstream of Fas. We found that cell death generated
by coexpressing Daxx with Ask1, in contrast to that generated by
expressing FADD, was not inhibited by z-VAD-fmk but could be totally
blocked by HSP27. In 293 cells, which were used as a cell model to
study the in vivo significance of Daxx-HSP27 interactions, we found
that in the presence of a dominant-negative form of FADD, which can
bind Fas but which cannot recruit caspases, activation of Fas triggered
a Daxx-dependent death pathway that became evident at 48 h and
that could then be totally inhibited by the Fas-binding domain of Daxx
or by HSP27. When Ask1 was overexpressed, a FADD-independent,
Daxx-dependent, HSP27-sensitive pathway of apoptosis could also be
evidenced at 24 h. Thus our results are consistent with the idea
that Daxx can mediate cell death downstream of Fas. Whether this
pathway plays a major role in a given situation will depend on the
concentration of a number of key molecules influencing the relative
strengths of the FADD (e.g., FLIP; see below) and Daxx (e.g., Ask1,
Daxx, and HSP27) pathways. In particular, the results predict that cell types that express HSP27 constitutively would not possess a very active
Daxx pathway and hence that FADD might appear in these cells as the
only pathway leading to apoptosis downstream of Fas. Studies with
FAD
/
and caspase 8
/
mice suggested that
thymocytes and embryonic fibroblasts have a very weak if not totally
inefficient Daxx pathway downstream of Fas (63, 67).
Although the notion that Daxx plays a role in apoptosis is well
accepted, the exact mechanism by which it can mediate the action of Fas
is controversial (7, 8, 61, 66). In particular, a major
problem has been the finding that Daxx is a nuclear protein, a result
which appeared inconsistent with the demonstration that upon Fas
stimulation Daxx mediates the formation of a multiprotein complex made
of Fas, Ask1, and Daxx (7, 8, 66). We confirmed that Daxx is
mostly nuclear under control conditions but found that upon activation
of Fas, endogenous or overexpressed Daxx becomes cytoplasmic in a large
percentage of the cells, thus explaining its interaction with Ask1 and
Fas. It is unclear why a previous study failed to detect such a
translocation of Daxx (61). One difficulty is that
activation of Fas is very toxic, and under some conditions the cells
may be killed before any cytoplasmic Daxx is detected or Daxx may be
observed only in dying cells (Fig. 8A), thereby producing data which
are difficult to interpret. Here we found that cytoplasmic Daxx was
highly reproducibly detected when Fas was stimulated in the presence of
z-VAD-fmk to block FADD-dependent apoptosis. A second possible cause
for the variable results obtained with the localization of Daxx may be
the variable level of expression of HSP27 found in different cell
lines. Daxx translocation did not occur in cells that expressed HSP27.
Intriguingly, our finding that a high concentration of HSP27 in a cell
extract can block the interaction of Fas or Ask1 with Daxx may also
explain some of the controversial results on the capacity of Daxx to
interact with these proteins (61).
HSP27 exists in cells as large homotypic multimers in dynamic
equilibrium with a smaller proportion of dimers. Dimers are formed
through stable intermolecular interactions of the carboxy-terminal
-crystallin-like domain. The dimers further multimerize in some 24-mers through additional intermolecular interactions mediated by the
amino-terminal domain. During stress, phosphorylation of HSP27
destabilizes the amino-terminal interactions, resulting in a shift in
the equilibrium between dimers and multimers and in a rapid
accumulation of dimers as the major species (27). The
protective activity of HSP27 against Daxx-mediated apoptosis was
totally dependent on the oligomerization and phosphorylation status of
HSP27. Wild-type HSP27, which is distributed in dimers and multimers
that totally dissociate into dimeric molecules upon phosphorylation,
and the pseudophosphorylated HSP27-EE mutant, which forms exclusively
dimeric molecules irrespective of phosphorylation (27),
could interact with Daxx, block its interaction with Fas and Ask1, and
protect from apoptosis. In contrast, the nonphosphorylatable HSP27-AA
mutant, which forms stable oligomeric molecules that do not dissociate
upon phosphorylation (27), did not interact with Daxx and
did not block its interaction with the other proteins or apoptosis.
This observation is consistent with several reports showing the
phosphorylation-dependent functions of HSP27. A nonphosphorylatable human or Chinese hamster HSP27 mutant could not protect cells against
heat shock or actin filaments from the disruptive effect of oxidative
stress or activation of the cholecystokinin A receptor (20, 34,
53). Pseudophosphorylated HSP27 was, in contrast, as effective as
wild-type HSP27 in protecting against heat shock or
cholecystokinin-induced actin filament disruption (unpublished results;
53). Furthermore, dissociation into dimers, which
for the yeast homologue HSP26 occurs spontaneously upon raising the temperature in vitro, has also been shown to enhance HSP26 chaperone activity (17). A previous correlation between the
phosphorylation state of HSP27 and its capacity to protect cells
against stress, together with the present results, suggests the
hypothesis that phosphorylation-induced changes in the supramolecular
organization of HSP27 expose a protective domain in the N-terminal
region of the protein (27).
HSP27 is phosphorylated upon cell stimulation by a number of growth
factor agonists, such as epidermal growth factor, vascular endothelial
growth factor, and thrombin; cytokines such as lipopolysaccharide, tumor necrosis factor alpha, and interleukin-1
; and stress such as
that due to heat shock and oxidants. It is phosphorylated by MAPKAP
kinase 2, a serine kinase activated through direct phosphorylation by
the MAP kinase p38 (12, 15, 18, 21, 29, 31, 37, 40, 50, 57).
In some cell lines, activation of Fas also results in the activation of
p38, which can be either FADD and caspase dependent or dependent on the
interaction between Daxx and Ask1 (8, 25, 62). This
mechanism is, however, not well understood and clearly not universal.
In the 293 cell lines used here, neither activation of Fas by
overexpression of Fas or exposure to a Fas-activating antibody nor
coexpression of Daxx and Ask1 led to a significant activation of JNK or
p38 (data not shown). A similar lack of activation of JNK by the
Daxx-Ask1 axis in HT1080 cells was previously reported (61).
At any rate, it is interesting that, at least in some specific cellular
contexts, the interaction between Daxx and HSP27 may define a new
mechanism for cross talk between different signaling pathways that
activate HSP27 phosphorylation and Fas, and even in some cases an
autoregulatory loop within the Fas pathway.
The contribution of the HSP27-Daxx interaction in the several
protective activities of HSP27 remains to be determined. Although there
is at least one experimental condition in which HSP27 overexpression has been shown to confer significant protection against Fas-induced apoptosis (41), HSP27 is not expected to contribute in a
major manner to Fas-induced cell death in most cases. Since HSP27 only blocks the Daxx-dependent arm of the Fas pathway, protection of Fas-induced cell death by HSP27 is expected to be significant only in
cellular contexts where FADD-dependent apoptosis is blocked. Intriguingly, there are a number of physiological and pathological situations where this may occur. Upon viral infection, for example, two
potent inhibitors of the FADD pathway are produced: CrmA, which
inhibits caspase 8, and v-FLIP, which prevents recruitment and
activation of caspase 8 (48, 59). In monocytes undergoing differentiation into macrophages, in lymphocytes upon activation, in
some tumor cells, and in motoneurons, upregulation of a cellular homologue of v-FLIP, c-FLIP, provides resistance to FAS-mediated apoptosis (1, 16, 23, 46, 47). The phosphorylation and
expression levels of HSP27 are also modulated during differentiation of
macrophages in different populations of lymphocytes as a function of
the cell cycle and are highly variable in different tumors (4, 14,
37, 40, 54-56, 58, 60). There is thus a possibility that in
those cases, expression and phosphorylation of HSP27 contribute to the
regulation of the Fas pathway. More studies will be required, however,
to determine the exact role of Daxx in Fas-mediated apoptosis and
possibly other mechanisms of toxic cell death and the contribution of
the HSP27-Daxx interaction to the general mechanism of protection of
this heat shock protein.
 |
ACKNOWLEDGMENTS |
We thank M. Kiriakidou and H. Ichijo for providing us with the
Daxx cDNA-containing plasmid and pcDNA3-HA-ASK1, respectively. We also
acknowledge the technical assistance of C. Champagne and E. Pellerin.
This work was supported by Medical Research Council of Canada grant
MT-7088. S.J.C. received a studentship from the Medical Research
Council of Canada.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Centre de
recherche en cancérologie de l'Université Laval,
L'Hôtel-Dieu de Québec, Centre hospitalier universitaire
de Québec, 9, rue McMahon, Quebec, Canada G1R 2J6. Phone: (418)
525-4444, ext. 5555. Fax: (418) 691-5439. E-mail:
jacques.landry{at}med.ulaval.ca.
 |
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