Till minne av min älskade morfar
Till minne av min älskade morfar All our dreams can come true, if we have the courage to pursue them Walt Disney (1901-1966) POPULÄRVETENSKAPLIG SAMMANFATTNING Av en människas totala vikt utgör skelettmuskulaturen ca 40 %. Skelettmusklerna är viljestyrda och behövs för att vi skall kunna hålla oss upprätta och röra oss som vi vill. Muskler är uppbyggda av muskelfibrer och är den största proteinreservoaren i kroppen. Proteiner är uppbyggda av aminosyror, vissa av dessa aminosyror är essentiella och kan inte syntetiseras i kroppen utan dessa kan kroppen endast få via födan. Vid t.ex. svält, cancer, sepsis etc. bryts proteinerna ner till aminosyror som sedan omvandlas i levern till glukos för att ge kroppen ny energi. Ett organ i kroppen som är speciellt beroende av glukos är hjärnan. Förlust av muskelmassa som följd av proteinnedbrytning kan leda till försvagning av kroppen och orsaka följdsjukdomar. Därför är det viktigt att hålla musklerna friska. Forskningen i denna avhandling är grundforskning och i avhandlingen har olika proteiner involverade i muskelförtvining, atrofi, och uppbyggnad, hypertrofi, studerats ingående. Atrofi och hypertrofi regleras med hjälp av proteinnedbrytning samt proteinsyntes. Normalt balanserar dessa varandra men om den ena alternativt den andra överväger kan atrofi alternativt hypertrofi förekomma. Vid atrofi minskar muskelmassan, detta beror på att cellerna förlorar organeller, proteiner och cytoplasma. För att muskler skall kunna byggas upp alternativt brytas ned krävs att det skickas signaler via olika signaleringsvägar. En signaleringsväg är som en lång väg med påfarter, avfarter samt trafikljus och beroende på vilken riktning signalen går får man olika resultat. För att kunna studera atrofi/hypertrofi i muskler används olika djurmodeller, oftast mus och råtta men även djur som går in i dvala, så som björn och ekorre, studeras flitigt eftersom det har visat sig att de inte förlorar så mycket muskelmassa trots deras inaktivitet i flera månader. Detta är något som man skulle vilja kunna överföra på människan och i vården då människor ligger till sängs länge vid sjukdom vilket ger en försvagning och minskning i muskelmassa. Djurmodellen som har använts i de olika studierna till denna avhandling är en 6 dagars denerverad musmodell. Där man antingen har denerverat musens ben alternativt musens diafragma genom att klippa bort en bit av den nerv som styr den specifika muskelgruppen. Arbetena i denna avhandling har utgått från proteinet Akt och studerat olika faktorer som påverkas av Akt direkt, genom fosforylering och inhibering, och indirekt men även proteiner och faktorer som finns runt omkring och påverkar proteinsyntes och proteinnedbrytning. I paper I studerade vi Akt ingående och dess nedströmsfaktorer som indikerade en ökad proteinsyntes vilket fortsatte i paper IV där vi tittade på eIF4G som också påverkar proteinsyntesen. Paper II handlade om FoxO vars aktivitet kan regleras via fosforylering och acetylering och hur det påverkar faktorer av betydelse för proteinnedbrytningen. I paper III studerades hypotesen att skillnaden mellan denerverad atrofisk och hypertrofisk muskel beror på var p38 och MK2 är lokaliserade, om det är i cellens kärna eller i cellens cytoplasma. Slutsatsen som kan dras från dessa fyra arbeten är att det är inte bara en faktor som påverkar proteinnedbrytning och proteinsyntes utan flera och de verkar tillsammans i ett komplicerat system där man ännu inte är riktigt säker på vad alla faktorer gör och hur de påverkar varandra. LIST OF PUBLICATIONS This thesis is based on the following publications, referred to in the text by their roman numerals. Paper I: Akt (protein kinase B) isoform phosphorylation and signaling downstream of mTOR (mammalian target of rapamycin) in denervated atrophic and hypertrophic mouse skeletal muscle. Marlene Norrby, Kim Evertsson*, Ann-Kristin Fjällström*, Anna Svensson and Sven Tågerud Journal of Molecular Signaling 2012, 7:7. *equal contributors Paper II: Forkhead box O1 and Muscle RING Finger 1 protein expression in atrophic and hypertrophic denervated mouse skeletal muscle Ann-Kristin Fjällström, Kim Evertsson, Marlene Norrby and Sven Tågerud Journal of Molecular Signaling 2014, 9:9. Paper III: p38 mitogen-activated protein kinase and mitogen-activated protein kinase-activated protein kinase 2 (MK2) signaling in atrophic and hypertrophic denervated mouse skeletal muscle Kim Evertsson, Ann-Kristin Fjällström, Marlene Norrby and Sven Tågerud Journal of Molecular Signaling 2014, 7:7. Paper IV: Expression and phosphorylation of eukaryotic translation initiation factor 4-gamma (eIF4G) in denervated atrophic and hypertrophic mouse skeletal muscle Ann-Kristin Fjällström, Marlene Norrby and Sven Tågerud Submitted All published papers are reproduced with permission from the respective publisher. Additional work outside the scope of this thesis Effects of adjunct galantamine to risperidone, or haloperidol, in animal models of antipsychotic activity and extrapyramidal side-effect liability: involvement of the cholinergic muscarinic receptor. Marie-Louise G Wadenberg, Ann-Kristin Fjällström, Malin Federley, Pernilla Persson and Pia Stenqvist. Int J Neuropsychopharmacol. 2011, Jun;14(5):644-54. ABBREVIATIONS 4EBP1 Eukaryotic initiation factor 4E binding protein 1 AKT Protein kinase B CBP CREB-binding protein eIF Eukaryotic Initiation Factor Fn14 Factor-inducible 14 FoxO Forkhead Box O GR Glucocorticoid receptors GSK Glycogen synthase kinase HAT Histone acetyltransferase Hsp Heat shock protein IGF Insulin-like growth factor MAFbx/Atrogin-1 F-box protein atrogin 1/MAFbx/FBXO32 MK2 Mitogen-activated protein kinase-activated protein kinase 2 (MAPKAPK-2) Mnks Mitogen activated protein kinaseinteracting kinases mTOR Mammalian Target Of Rapamycin MuRF1 Muscle specific ring finger protein 1/ TRIM63 MyHC Myosin Heavy Chain NFκB Nuclear factor kappa B p38 MAPK p38 Mitogen Activated Protein Kinase p70S6K1 70 ribosomal protein S6 kinase PDK1 3’-phosphoinositide-dependent kinase 1 PIKK Phosphatidylinositol kinase related protein kinase PI3K Phosphatidylinositol 3-kinase rpS6 Ribosomal protein S6 S Serine T Threonine TNFα Tumor necrosis factor α TWEAK TNF-like weak inducer of apoptosis Y Tyrosine TABLE OF CONTENTS 1. INTRODUCTION ................................................................................ 13 2. SKELETAL MUSCLE .......................................................................... 15 Skeletal muscle anatomy ..................................................................... 15 Fiber types .......................................................................................... 16 Models for studying atrophy and hypertrophy ................................... 17 Atrophy models .................................................................................. 17 Disease models ................................................................................... 17 Disuse models ..................................................................................... 18 Hibernation ........................................................................................ 20 Hypertrophy models ........................................................................... 21 Denervation ........................................................................................ 21 3. ATROPHY and HYPERTROPHY SIGNALING PATHWAYS ..... 22 Protein degradation ............................................................................ 25 MuRF1 and MAFbx/atrogin-1.......................................................... 25 FoxO................................................................................................... 27 NFκB and TNFα ............................................................................... 31 p38, MK2 and heat shock proteins .................................................... 32 Glucocorticoids................................................................................... 36 Akt-Protein kinase B.......................................................................... 37 Protein synthesis ................................................................................. 37 p70S6K1 and rpS6 ............................................................................. 37 The eIF4 family .................................................................................. 37 eIF4G ................................................................................................. 39 4EBP1 and eIF4E .............................................................................. 40 eIF4F, sepsis and leucine .................................................................... 41 Mammalian Target of Rapamycin ..................................................... 42 GSK3β and eIF2B.............................................................................. 44 Akt-Protein kinase B.......................................................................... 44 4. AIM and OBJECTIVES ........................................................................ 47 Paper I ................................................................................................ 47 Paper II ............................................................................................... 47 Paper III ............................................................................................. 48 Paper IV ............................................................................................. 48 5. METHODOLOGICAL CONSIDERATIONS ................................. 49 Animals .............................................................................................. 49 Surgery and muscles ........................................................................... 49 Standard protein extraction Papers I-IV ............................................ 51 Nuclear and cytosolic fractions Papers II and III ............................... 51 Western blotting................................................................................. 52 Data analysis and statistics....................................................................... 54 6. RESULTS and DISCUSSION.................................................................... 56 Paper I ..................................................................................................... 57 Paper II .................................................................................................... 59 Paper III .................................................................................................. 62 Paper IV................................................................................................... 63 7. CONCLUSIONS......................................................................................... 66 8. ACKNOWLEDGEMENTS ...................................................................... 68 9. REFERENCES............................................................................................ 73 1. INTRODUCTION The human body is built up of cells, each cell has a purpose for example skeletal muscle cells build up muscle fibers to big muscles which control our movements and the ability to stand. Approximately 40 % of the human body weight consists of skeletal muscles. This muscle type is involved in many functions that are vital for maintaining a healthy life such as force generation and locomotion, heat production and glucose homeostasis. Muscles are also the body’s protein reservoir and regulating protein synthesis is important for cell metabolism and growth. Skeletal muscle mass and growth is controlled by protein synthesis and protein degradation which function together to maintain a balance [1] between increased or decreased muscle mass [2]. This balance is changed when atrophy occurs, a decrease in muscle mass that can be triggered by disuse, chronic diseases, immobilization, cancer [3] elevated glucocorticoids, inflammation or nutritional deprivation [4], or when hypertrophy occurs, a state of increased muscle mass due to increased mechanical load, high usage and/or anabolic stimulation [2, 5]. Plasticity in muscle mass and muscle function results from a number of changes in intracellular activities and signal pathways in response to various signals. These signals and responses occur both in the nucleus and the cytoplasm [1]. The main cellular degradation pathways include the ubiquitinproteasome system and the autophagy-lysosome pathway [6]. 13 Atrophy and hypertrophy can be studied using different animal models. In this thesis a denervation model has been used. Other models include e.g. sepsis/starvation as atrophy models and models based on alterations in muscle use such as hind limb suspension or mechanical overload resulting in atrophy and hypertrophy respectively. 14 2. SKELETAL MUSCLE Skeletal muscles consist of a large number of muscle fibers that are very large and multinucleated cells in contrast to most other cells that have only one nucleus. Each muscle fiber is surrounded by a basal membrane, a tube-like structure consisting of glycoproteins. Inside the basal membrane there are mononucleated satellite cells that can divide to form a new muscle fiber within the tube of basal membrane following damage to the original muscle fiber [7]. Skeletal muscle anatomy Skeletal muscles can be described at different levels e.g. whole muscles, motor units and muscle fiber types. A motor unit consists of a motor neuron and all the muscle fibers innervated by this motor neuron. The size of the motor unit i.e. the number of muscle fibers that a motor neuron controls varies between different muscles. Muscles requiring a high degree of fine motor control only have a few muscle fibers innervated by each motor neuron whereas e.g. postural muscles have larger numbers of muscle fibers in each motor unit. All muscle fibers in a given motor unit are of the same fiber type. The activity pattern in the motor neuron determines the fiber type of the innervated muscle fibers. There are four different skeletal muscle fiber types, type 1, 2A, 2X and 2B. For type 1 fibers the motor neurons show the highest degree of activity [8]. Most muscles consist of a mixture of fiber types. 15 Fiber types The four different fiber types in skeletal muscles express different specific myosin heavy chain (MyHC) isoforms [9]. Type 1 – MyHC-1/slow, coded by the MYH7 gene Type 2A – MyHC-2A, coded by the MYH2 gene Type 2X – MyHC-2X, coded by the MYH1 gene Type 2B – MyHC-2B, coded by the MYH4 gene [9] Type 1 and type 2A fibers use oxidative metabolism and are fibers that can endure a lot, while type 2B fibers use glycolytic metabolism and are fibers that do not endure for long and produce lactic acid. Type 2X fibers are intermediate and have properties intermediate between 2A and 2B fibers. All four fiber types can be found in most mammals but type 1, 2A and 2X are the fiber types that are present in most human muscles [9, 10]. When a muscle fiber only expresses a single MyHC it is a pure fiber type and when expressing two or more MyHCs it is called a hybrid fiber type [11]. The number of hybrid fibers (1 and 2A, 2A and 2X, or 2X and 2B) increases when fiber type shifts take place in response to muscle atrophy, induced by denervation or other causes, but also in response to exercise and electrical stimulation [12]. 16 Models for studying atrophy and hypertrophy Skeletal muscle is a very plastic tissue and a number of different conditions can cause alterations in muscle mass. Such changes in muscle mass likely occur as a result of changes in the rates of muscle protein synthesis and protein degradation. Atrophy models Disease models Sepsis, a systemic inflammatory response, may be caused by microbial infection or by administration of endotoxin, lipopolysaccharide (LPS), found in the cell wall of Gramnegative bacteria [13]. LPS administration inhibits protein synthesis and activates proteolysis in muscles through the ubiquitinproteasome pathway [13]. In rats made septic by injection of E. coli an acute septic phase (2 days post injection) was associated with increased protein degradation and a later, chronic septic phase (6 days post injection), was associated with both increased protein synthesis and increased proteolysis in epitrochlearis muscle incubated in vitro [14]. Caecal ligation and puncture (CLP) is another model of sepsis that has been associated with decreased protein synthesis and increased protein degradation in skeletal muscle [13]. Half of all patients with cancer experience cachexia and muscle wasting and approximately one fifth of these patients will die as a direct consequence of cachexia. A decrease in protein synthesis and an increase in protein degradation through activation of the ubiquitin-proteasome system results in loss of skeletal muscle mass. Studies of cachexia and cancer in animal models are done by transplanting tumour cells to the animal or by administering large amounts of potent carcinogens [13]. Increased protein degradation and 17 decreased protein synthesis appears to be common factors in many disease models of skeletal muscle atrophy. When muscles become atrophic in pathological states such as sepsis, starvation, cachexia etc. an increase in circulating glucocorticoid levels can be detected which indicates that glucocorticoids could trigger atrophy in these conditions [15]. Glucocorticoids increases the rate of protein degradation and decreases the rate of protein synthesis in skeletal muscle [15]. Disuse models Disuse muscle atrophy occurs as a consequence of bed rest, spinal cord injury, joint immobilization and neurodegeneration. During disuse, loss of muscle mass and cross-sectional area occurs in the muscles that are used in normal standing and locomotion such as the lower limb extensors and flexors [4]. The muscle loss is rapid during the first 14-30 days of unloading but a nadir is eventually reached after which no more muscle loss occurs despite the fact that the muscles remain in a state of unloading and inactivity [4]. In unloading conditions there is an immediate suppression of basal protein synthesis which remains suppressed for the whole unloading period. Animal and human studies appear to have a discrepancy regarding the rate of muscle loss in response to disuse where animals show a larger muscle loss than humans [4]. The degree of unloading and inactivity and the muscle type are factors that influence the rate and amount of muscle mass loss [16]. A number of different models of hind-limb immobilization have been used for studies of muscle atrophy. A significant atrophy and loss of muscle strength in hind-limb muscles was observed after two weeks of cast immobilization. There were no significant differences between atrophy in slow-twitch soleus following immobilization with plantarflexion and fast-twitch EDL muscles following immobilization with dorsiflexion [17]. The medial gastrocnemius 18 muscle in immobilization and hind-limb unloading disuse models has a muscle mass loss of 20-40% after 7-14 days depending on both a decrease in protein synthesis but also an increase in protein degradation [16]. Hind-limb suspension is a tail suspension model based on the absence of weight bearing, which is necessary for maintaining skeletal muscle mass and is used to study microgravity-induced atrophy. Rodents are elevated by their tail with an angle of 30° head-down tilt which avoids weight bearing by the hindquarters but provides normal weight bearing on the forelimbs [18]. Muscle mass reduction was maximal after 14 days of hind-limb suspension (quadriceps, anterior tibial, extensor digitorum longus, soleus, plantaris, left calf complex and gastrocnemius muscle). Both the functional strength and the isolated muscle strength were reduced [19]. Up to 30% of intensive care unit (ICU) patients experience muscle wasting. This is added to the primary disease of the patient and has negative effects both on the recovery time and increases the mortality [13]. This condition is called acute quadriplegic myopathy, AQM, and occurs in patients as a consequence of anesthesiology and intensive care. It causes severe muscle weakness and atrophy. The condition is studied in rodents in a model of corticosteroids combined with peripheral denervation of distal hind-limb muscles or in pharmacologically paralyzed and mechanically ventilated animals [20]. Protein synthesis is decreased in this disuse model and protein degradation is increased [13]. Spinal cord isolation is another disuse model in which a portion of the spinal cord is isolated via complete spinal cord transections. The muscles associated with the affected motor neurons become inactivated [21]. 19 Hibernation Hibernation is a physiological state that many animals go through during the winter as a period of inactivity with unloading and starvation and with lower core body temperature and suppressed metabolic rate [22]. Hibernation is unique in the sense that the skeletal muscles are largely protected from loss of muscle mass despite unloading, inactivity and nutritional deprivation during this period [4]. A frequently studied mammalian hibernator is the thirteen-lined ground squirrel which has a hibernation period of 6-7 months. During this period the squirrel has deep torpor but also short periods of arousal that last less than 24 hours. A reason for these arousal periods could be to decrease the disuseinduced muscle atrophy by having regular neural activation [4]. When present, skeletal muscle atrophy largely occurs in the first few months and does not progress in the final 3 months of hibernation [23]. The brown bear hibernates 5-6 months each year and skeletal muscle atrophy is minimal during this time period. Unilateral transection of the common peroneal nerve in summer active and winter hibernating bears showed that after 11 weeks of denervation the loss of muscle mass and fiber cross-sectional area in cranial tibial muscle (equivalent to anterior tibial in human) and the long digital extensor (EDL) were significantly less in hibernating animals compared to active animals [24]. 20 Hypertrophy models Functional overload (compensatory overload) [25] by synergist ablation or hind-limb reloading following hind-limb suspension are two models of mechanical loading of muscles [26]. A chronic increase in loading and activation and subsequent increase in muscle mass and strength in rodents occurs after functional overload (FO) [27, 28] caused by removal of the major synergistic muscle to the investigated muscle [29]. Chronic stretch is a nonsurgical hypertrophy model that gives a very fast and large hypertrophic response. The advantage of this model is that it can be executed in a similar way in both animals and humans. The animal has a cast that forces the muscle in question to be in a lengthened position [25]. Denervation Denervation is a model that leads to inactivity in muscles after a complete breakoff in the communication between muscle and nerve. This breakoff results in many changes in the properties of muscles, such as increased expression of acetylcholine receptors and expression of the embryonic acetylcholine receptor gamma-subunit [30]. Other changes include an increase in the expression of tetrodotoxin-resistant sodium channels [31, 32]. Hindlimb muscles such as the anterior tibial, gastrocnemius and soleus muscles undergo a continuous atrophy after denervation, like most skeletal muscles [33]. The hemidiaphragm muscle, on the other hand, goes through a transient hypertrophic state after denervation which may be as a result of passive stretching. This passive stretch is the result of the continued contractions in the contralateral innervated hemidiaphragm [34-36]. The transient hypertrophic state in the hemidiaphragm lasts somewhere between 6-10 days, after this time period the muscle loses muscle mass and becomes atrophic instead [34, 36]. 21 3. ATROPHY AND HYPERTROPHY SIGNALING PATHWAYS Skeletal muscle mass and fiber size changes depend on the balance between protein degradation and protein synthesis. Physical activity, metabolism and hormones are factors that induce adaptive changes in skeletal muscle mass. When the rate of protein degradation exceeds that of protein synthesis a state of muscle wasting (atrophy) occurs. Loss of muscle mass is a process that is regulated by catabolic conditions or inactivity induced signaling pathways. The ubiquitin-proteasome and the autophagy-lysosome system are major protein degradation pathways that are activated during muscle atrophy. A transcription dependent program that modulates the expression of ratelimiting factors in these proteolytic systems controls this response [6]. Atrophy is to some extent controlled by atrogenes which are controlled by transcription factors, and these transcription factors are controlled by signaling factors such as insulin-like growth factor 1 (IGF-1), amino acids, the protein kinase B (Akt) etc. Atrogenes include Muscle RING finger 1 (MuRF1/TRIM63) and muscle atrophy F-box protein (MAFbx/atrogin-1) which are atrophy-related E3 ubiquitin ligases. Forkhead box O (“others”) 22 (FoxO) transcription factors activate gene transcription of the atrogenes (Figure 1) [6, 37-41]. When phosphorylated by e.g. Akt, FoxO is transported out of the nucleus to the cytoplasm and will become transcriptionally inactive. This leads to less transcription of factors such as MuRF1 and MAFbx/atrogin-1, and decreased protein degradation. When dephosphorylated in the cytoplasm FoxO will be transported back into the nucleus. This increases the transcription of target genes and leads to increased muscle protein degradation [42]. Activation of Akt, thus, reduces protein degradation but also increases protein synthesis largely through activation of mammalian target of rapamycin (mTOR) and downstream factors [43] although Akt also influences protein synthesis through inhibition of glycogen synthase kinase 3-β (GSK-3β) [44]. mTOR is also regulated by factors other than Akt and will in the presence of glucose and nutrients increase protein synthesis through a rapamycin sensitive signaling pathway [45] and promote phosphorylation of eukaryotic translation initiation factor 4E-binding protein 1 (4EBP1) and 70 kDa ribosomal protein S6 kinase 1 (p70S6K1) [46] both of which are important for the regulation of protein synthesis. 23 Figure 1. Simplified schematic image over signaling factors that affect protein synthesis and protein degradation. Eukaryotic translation factors are required for protein synthesis and include eukaryotic initiation-, elongation- and termination factors [5]. p38 Mitogen Activated Protein Kinase, p38 MAPK has also been suggested to play a role in the balance between protein synthesis and protein degradation [47, 48]. p38 phosphorylates serine/threonine residues in substrates [49] such as mitogenactivated protein kinase-activated protein kinase 2 (MAPKAPK-2/MK2) [50]. MK2 may regulate nuclear export of p38 [51] and also phosphorylates the heat shock protein (Hsp) 25/27 in the cytoplasm. Heat shock proteins are a group of proteins believed to have a major role in the maintenance of muscle homeostasis, especially during adaptation to various stressors [52-54]. 24 Protein degradation MuRF1 and MAFbx/atrogin-1 MuRF1 and MAFbx/atrogin-1 are atrophy-related E3 ubiquitin ligases [6, 38-40, 55]. Proteins that are degraded by the 26S proteasome are targeted by ubiquitin (Figure 2) [55]. E1 is an ubiquitin activating enzyme, E2 is an ubiquitin conjugating enzyme and E3 is an ubiquitin-ligase that moves ubiquitin from E2 to the protein substrate [47, 55]. The ubiquitinated protein becomes docked at the proteasome and degraded. Only a few E3s are known to be involved in the regulation of atrophy and are transcriptionally induced in atrophying muscle [6]. Figure 2. Proteins that are to be degraded by the 26S proteasome will be targeted by ubiquitin. The enzymes E1 (ubiquitin activating enzyme), E2 (ubiquitin conjugating enzyme) and E3 (ubiquitin-ligase) move ubiquitin residues between each other until the substrate has several ubiquitin residues attached and is ready to enter the proteasome where the protein is degraded to peptides. 25 MuRF1 and MAFbx/atrogin-1 expression in resting muscles are low but as a response to e.g. unloading, inactivity, denervation, nutritional deprivation, elevated glucocorticoids, inflammation and oxidative stress they become transcriptionally up-regulated [4, 56]. MuRF1 and MAFbx/atrogin-1 have been used as markers of muscle atrophy and null deletions of each gene in mice result in attenuation of muscle mass loss following disuse, including denervation [57-59]. After denervation gastrocnemius muscles of MuRF1-/mice had less muscle mass loss compared to wildtype mice. A significant difference was observed at day 14 but not at day 7 after denervation. MAFbx/atrogin-1–/– mice had significant muscle sparing at both 7 and 14 days after denervation [59]. Immobilization of anterior tibial muscle induced muscle atrophy with a 36 % reduction in myofiber size compared with the untreated contralateral muscle within a few days after immobilization. MuRF1 and MAFbx/atrogin-1 were used as molecular markers and mRNA expressions were significantly upregulated by 5.9 and 1.9 fold respectively in mice [60]. MuRF1 inactivation (MuRF1-/- mice) prevented atrophy of the soleus muscle after 10 days of hindlimb suspension [58]. A significant decrease in muscle mass and fiber crosssectional area with age occurs in wildtype but not in MuRF1-/- mice studied up to the age of 24 months. The plantaris muscles of old wildtype mice (18 months) had significantly less growth relative to young mice (6 months) after functional overload whereas old MuRF1-/- mice had a normal growth response [61]. After 14 days of dexamethasone treatment MuRF1-/- mice had a major sparing of fibre cross-sectional area in gastrocnemius muscles and had attenuated muscle weight loss in anterior tibial and triceps surae muscles. 26 MAFbx/atrogin-1–/– and wildtype mice, however, showed similar extents of muscle weight loss after dexamethasone treatment [57]. FoxO FoxO is a superfamily of proteins involved in for example stress resistance and metabolism by regulating the expression of target genes. There are four different types of FoxO in the FoxO family in mammalians, FoxO1 (FKHL), FoxO3 (FKHRL1), FoxO4 (AFX) and FoxO6 [62-64]. FoxO1 and FoxO3 are thought to be involved in the regulation of muscle mass since overexpression of these transcription factors has been shown to lead to reduced skeletal muscle mass [40, 65]. There is only one FoxO gene in invertebrates compared to the mammalian four and it seems that this transcription factor in invertebrates extends longevity [42]. FoxO proteins bind to the conserved consensus core recognition motif TTGTTTAC and act as transcriptional activators [66]. A wide range of external stimuli e.g. insulin, IGF-1, other growth factors, neurotrophins, nutrients, cytokines and oxidative stress regulate the FoxO transcription factors by influencing FoxO protein levels, subcellular localization, DNA-binding and transcriptional activity [42]. Phosphorylation, acetylation, ubiquitination (mono and poly) and possibly other modifications regulate FoxO functions (Figure 3) [42]. FoxO proteins are to a high extent located in the cytoplasm in growing cells [67] since nuclear export is a response to growth signals and nuclear import is a response to stress signals such as oxidative stress [67, 68]. Phosphorylations of FoxO occur at serine and threonine sites [69], and are sequential [67]. There are three phosphorylation sites for Akt that are essential for the translocation 27 Figure 3. Phosphorylation of FoxO by Akt and acetylation forces FoxO out of the nucleus and into the cytoplasm where it becomes inactivated. Dephosphorylation and deacetylation in the cytoplasm makes it possible for FoxO to be transported back to the nucleus and become active again to stimulate gene expression. of FoxO into the cytoplasm (cytoplasmic translocation), the location of these three sites are: one in the forkhead domain, one at the N-terminal and the last one at the C-terminal [67]. In contrast to FoxO1, 3 and 4, FoxO6 is not regulated by nucleo-cytoplasmic shuttling. A reason for this could be that FoxO6 becomes phosphorylated at only two of three sites [70] compared to FoxO1, FoxO3 and FoxO4 [42]. Akt, serum- and glucocorticoid-inducible kinases (SGKs) phosphorylate FoxO1 at the first (T24) and second (S256 in human FoxO1, S253 in mouse FoxO1) phosphorylation sites which leads to creation of a binding site for chaperone protein 14-3-3 [71-73]. 14-3-3 proteins belong to a family of regulatory proteins that are involved in e.g. cell cycle control, apoptosis etc. [74, 75]. They bind to other proteins in a phosphorylation-dependent way and function as molecular scaffolds controlling the conformation of their binding 28 partners [76, 77]. This chaperone protein modifies the DNA binding domain of FoxO and reduces the DNA-binding activity [78]. 14-3-3 binds to the FoxO factors inside the nucleus and induces an active export of FoxO out to the cytosol. This probably occurs by exposing FoxOs nuclear export sequence [79]. The nuclear localization signal of FoxO is also affected by the binding of 14-3-3 [71] leading to reduced re-entry into the nucleus. A negative charge in the basic stretch of residues that forms the nuclear localization signal is introduced when the second site (S256 in FoxO1) is phosphorylated which prevents FoxO from returning to the nucleus [80]. This leads to increased FoxO levels in the cytoplasm due to nuclear export and a decrease in the amount of FoxO returning to the nucleus. Mutations of T32 and S253 in FoxO3 (correspond to T24 and S256 in FoxO1 human sequences), the two sites that 14-3-3 proteins bind to, promote nuclear localization of FoxO3 and an increase in transcriptional activity [73]. In a FoxO1 mutant where the nuclear export sequence had been disrupted FoxO1 was still inhibited by the PI3K-AKT/SGK/ pathway but resided inside the nucleus instead of in the cytoplasm [81]. When Akt phosphorylates FoxO1 at S256 a binding site for S-phase kinaseassociated protein 2 (Skp2) [67], an oncogenic subunit of the Skp1/Cul1/Fbox protein ubiquitin complex [82], is also created [67]. Skp2 decreases the level of FoxO1 through degradation [82]. FoxO1 can also be phosphorylated by SGKs at S319, SGK becomes activated by the PI3K pathway the same as for Akt [68]. The response to acetylation of transcription factors depends on which functional domain gets acetylated. FoxO1 has three different acetylation sites which are positioned within the wing 2 region on the C terminus of the forkhead domain. This region partakes in DNA recognition and stabilization 29 of the FoxO DNA complex and acetylation of positively charged lysine residues in wing 2 could inhibit FoxO binding to DNA [64]. Acetylation of FoxO1 appears to decrease the DNA binding capability but also seems to induce increased phosphorylation on S253. It appears that acetylation and phosphorylation influence each other to control FoxO1s function [64, 83]. p300 and CREB-binding protein (CBP) are histone acetyltransferase (HAT) proteins which have an intrinsic acetyltransferase activity that transfers an acetyl group to specific lysine residues on target proteins such as FoxO [8385]. Transfection of rat soleus muscle with a dominant-negative p300 (lacks HAT activity and inhibits endogenous p300 HAT activity) leads to an increase in FoxO activity and increased transcription of MAFbx/atrogin-1. HAT activity increased after transfection of wild-type p300 or wild-type CBP which leads to a decrease in FoxO activation in vivo as a response to muscle disuse [86]. An increase in HAT results in a decrease in FoxO3 nuclear localization whereas p300 appears to give an increase in FoxO1 nuclear localization. Evidence for FoxOs being involved in the regulation of muscle mass include an observed decrease in the nuclear content of FoxO1 in human quadriceps muscle after resistance training associated with muscle growth and then during a de-training period the amount of FoxO1 increases in the nucleus [87]. After unilateral denervation of rat diaphragm, the amount of nuclear FoxO1 was significantly increased after 1 day but decreased with time [88]. Removal of growth factors and starvation of C2C12 myotubes for 6h led to myotube atrophy, reduced phosphorylation of FoxO1 and FoxO3, an increase in FoxO binding to DNA and increased expression of MAFbx/atrogin-1 [40]. Constitutively active FoxO1 did not, however, increase the expression of MAFbx/atrogin-1 or MuRF1 in myotubes [39]. A decrease in muscle mass occurs when human FoxO1 is overexpressed in mouse skeletal muscle [65] but 30 transgenic mice overexpressing FoxO1 do not have consistent alterations in MAFbx/atrogin-1 or MuRF1 levels [65]. In the presence of FoxO1 the glucocorticoid concentration needed for activation of MuRF1 transcription was, however, strongly reduced [37]. Transfection of constitutively active FoxO3 increases MAFbx transcription in C2C12 myotubes and induces muscle fiber atrophy in mouse anterior tibial muscle [40]. A dominant negative FoxO3 prevents immobilization induced increases in MAFbx/atrogin-1 and MuRF1 promoter activities in rat soleus muscle as well as muscle fiber atrophy [89, 90]. Hibernating mammals suppress protein synthesis for energy conservation. Skeletal muscles require activation of the mTORC1 complex for growth [4] and during torpor, Akt phosphorylation is suppressed relative to summer active animals [91]. No evidence suggest an increase in transcription or a decrease in phosphorylation of FoxO1 or FoxO3 [91] whereas in mice and rats with disuse-induced atrophy the FoxO transcription factors are activated and seem to be important mediators of the atrophy response [40, 89]. The expression levels of MuRF1 and MAFbx/atrogin-1 in quadriceps muscles were decreased in hibernating compared to summer active thirteen-lined squirrels [91]. NFκB and TNFα Nuclear factor kappa B, NFκB, is a transcription factor and is suggested to mediate muscle wasting and cachexia caused by tumor necrosis factor α, TNFα, and other inflammatory cytokines [92]. NFκB exists in an active and an inactive state. In the inactive state NFκB is located in the cytoplasm bound to inhibitory proteins IκB. IκB will in response to TNFα become phosphorylated which results in ubiquitination and proteasomal degradation 31 which frees NFκB for nuclear translocation and activation of gene transcription. Treatment with TNFα causes up-regulation of MuRF1 and MAFbx/atrogin-1 [92]. A member of the TNF superfamily is also TNF-like weak inducer of apoptosis, TWEAK that has also been found to induce muscle atrophy. TWEAK binds to fibroblast growth factor-inducible 14, Fn14, which is a cell-surface receptor that is up-regulated in denervated muscle which leads to NFκB activation and MuRF1 expression. The level of Fn14 does not increase in all types of muscle atrophy such as dexamethasone treatment [92]. p38, MK2 and heat shock proteins p38 is a mitogen-activated protein kinase (MAPK) and has four different isoforms p38α,β,γ and δ [93]. p38α (MAPK14 also called CSAIDs binding protein (CSBP) and SAPK2a) has an essential role in myogenesis [94]. p38β (MAPK11 also called SAPK2b and p38-2) overexpression up-regulates the E3 ubiquitin ligase MAFbx/atrogin-1 to cause loss of muscle mass [95]. p38γ (MAPK12 also called SAPK3 and ERK6) is involved in mitochondrial biogenesis and angiogenesis in response to endurance exercise [96]. p38δ, (MAPK13 also called SAPK4) and p38γ have low kinase activity towards the substrate MK2 [97-100]. The p38 α and β isoforms are also involved in muscle differentiation [49]. After activation by phosphorylation the p38 isoforms phosphorylate serine/threonine residues in their substrates [49]. MK2 is a target of activated p38 (mainly α and possibly β) and has been suggested to be involved in regulating mRNA stability, chromatin remodeling, cell cycle regulation, cell migration etc. [50]. MK2 may also be the main protein mediating nuclear export of p38 [51]. MK2 is phosphorylated by p38 at two sites, T205 and T317 in mouse (T222 and T334 in human) [101, 102]. Both phosphorylation sites are believed to be important for activation of 32 MK2, it is believed that phosphorylation on T317 might serve as a switch for MK2s nuclear import and export [103]. An auto-inhibitory helix is released from the core of the kinase domain on MK2 when it becomes phosphorylated at T317 thereby exposing the nuclear export signal which allows MK2 to leave the nucleus in a complex with p38 [104, 105]. However, it has also been proposed that MK2 can leave the nucleus without p38 but still reliant on its phosphorylation [106]. p38 phosphorylation (activation) is associated with muscle growth as a response to functional overload and mechanical stimuli such as stretch and exercise [107-112]. In fast twitch muscles of rats (epitrochlearis and extensor digitotium longus) an increase in phosphorylation of p38 MAPK has also been shown to occur after intermittent tetanic stimulation [113]. p38 activation (phosphorylation) has, however, also been found in different atrophy models such as cast immobilization [114], denervation [115] and hind-limb unloading [116]. Gastrocnemius muscle displays increased MuRF1 expression and elevated phosphorylation of p38 after cast immobilization in rats. L6 rat skeletal myoblasts had an increase in MuRF1 expression after serum starvation and this response decreased after inhibition of p38. Serum starvation also induced size changes of L6 myoblasts and this was reversed after transfection of MuRF1 siRNA or treatment with a p38 inhibitor [114]. TNF-α has also been suggested to increase MAFbx/atrogin-1 gene expression in skeletal muscle by acting via p38 [117]. MK2 might have a role in the regulation of muscle mass together with its upstream activator p38 [48]. Hsp25/27 is an established substrate of MK2 in the cytoplasm [118]. Murine Hsp25 is the homolog to Hsp27 in human, both are functionally similar and share >80% homology at the amino acid level [119]. 33 Heat shock proteins are a group of proteins believed to have a major role in the maintenance of muscle homeostasis, especially during adaptation to various stressors They help cells to survive stressful situations such as oxidative stress, inflammation and muscle damage [52-54]. This group of proteins includes both large, e.g. Hsp70, and small, e.g. Hsp25/27 proteins. In skeletal muscle Hsp25/27 and Hsp70 are heavily expressed [52, 120]. Increased Hsp25/27 phosphorylation is associated with skeletal muscle hypertrophy whereas decreased phosphorylation occurs in atrophy [111, 121, 122]. Spinal cord isolation, an inactivity model, was used in rats to study Hsp25 total protein levels in soleus, plantaris, adductor longus and anterior tibial muscles. After 7 days the level of Hsp25 was unchanged in anterior tibial muscle. In soleus, plantaris and adductor muscles the levels of Hsp25 were lower compared to control animals [120]. Skeletal muscle disuse atrophy in rats has been shown to decrease after overexpression of Hsp27 [119]. Functional overload of soleus and plantaris muscles in rats is associated with an increase in Hsp 25 expression and phosphorylation [111, 122]. After functional overload in rats Hsp25 mRNA showed a time dependent increase in both soleus and plantaris muscles. At three and seven days of functional overload the expression of Hsp25 protein and phosphorylated Hsp25 in the soluble fraction was increased in both muscle types but higher in plantaris. Hsp25 was increased after three and seven days in the insoluble fraction in both muscles but phosphorylated Hsp25 increased in the plantaris muscle at day seven. The plantaris muscle had an increase in both p38 and phosphorylated p38 at both time points whereas in the soleus muscle only phosphorylated p38 increased at day seven [111]. Expression level and phosphorylation of Hsp25 increased in mouse plantaris muscle 3 and 7 days 34 after functional overload and in soleus muscle 7 days after functional overload compared to controls. [123]. Hsp70 is one of the proteins that has been studied the most in skeletal muscle, both in human and animal models, it responds to acute and chronic changes in muscle activity and loading [124, 125]. Mice and rats with functional overload of plantaris and soleus muscles showed high levels of Hsp70 after 3 and 7 days compared to control animals [123]. The soleus muscle and the plantaris muscle in the rat consist of predominantly slow fibers respectively fast fibers and the soleus muscle has higher levels of Hsp70 compared to plantaris [126]. Hsp25 also seem to be highly expressed in rat skeletal muscles containing mainly slow type 1 muscle fibers [120]. This difference was not observed in mice [123]. Hsp70 is expressed in rat soleus and plantaris muscles at embryonic day 22 in slow type I fibers. The level of Hsp70 in soleus muscles increased from embryonic day 22 to postnatal day 56 in parallel with the increase in the type I MyHC isoform. In the plantaris muscle, only a small increase could be detected [52]. In plantaris muscles of rats exposed to functional overload the size of all fiber types increase, the levels of Hsp70 increase, and, the relative percentage of slower fiber types and MyHC isoforms also increase [127]. Several models of muscle atrophy such as hind-limb unloading and tail suspension show a significant down regulation of Hsp70 [128-131] and this down regulations seems to last for up to nine weeks in a disuse model in rats [131]. Hsp70 seems to be able to inhibit FoxO3 and NFκB signaling which can help to prevent atrophy. This inhibition of FoxO3 resulted in a decrease in the promotor activity for MAFbx/atrogin-1 and MuRF1 in rats in an immobilization model [90]. 35 Glucocorticoids Glucocorticoids are steroid hormones and include cortisol, corticosterone and cortisone which are secreted from the adrenal cortex. Glucocorticoids influence metabolism in different tissues and skeletal muscle is a major target tissue where glucocorticoids mainly regulate protein and glucose metabolism. Glucocorticoids cause increased protein degradation and decreased protein synthesis mainly by acting on the intracellular glucocorticoid receptors, GR [56]. Amino acid transport into the muscle is inhibited by glucocorticoids, which decreases protein synthesis. Glucocorticoids can also inhibit the stimulatory effect of insulin, IGF-1 and amino acids on the phosphorylation of 4EBP1 and p70S6K1, two factors involved in the control of protein synthesis [15]. An increased muscle proteolysis through the activation of the ubiquitin proteasome and lysosomal systems is thought to play a major part in the catabolic action of glucocorticoids. The expression levels of atrogenes such as MuRF1 and MAFbx/atrogin1 are increased following glucocorticoid stimulation [15]. The expression of FoxO1 and FoxO3 in skeletal muscle is also increased by glucocorticoids [37, 132]. Several GR binding regions are present in or near the FoxO3 genomic region indicating that FoxO3 is a primary glucocorticoid target [133, 134]. Younger adult rats have a faster recovery time than older after glucocorticoid induced atrophy, a reason behind this could be that glucocorticoids cause mainly an increase in protein breakdown in younger adult animals but also a depressed protein synthesis in aged animals [135]. Fast-twitch, glycolytic muscle fiber atrophy, demonstrated by decreased fiber cross-sectional area and reduced myofibrillar protein content is characteristic for glucocorticoidinduced muscle atrophy [15]. 36 Akt-Protein kinase B Akt is suggested to block the up-regulation of MAFbx/atrogin-1 and MuRF1 through negative regulation of FoxO transcription factors [39, 40]. FoxO proteins are phosphorylated by Akt which leads to FoxO being exported out of the nucleus to the cytoplasm. Akt is also involved in protein synthesis (see below). Protein synthesis p70S6K1 and rpS6 p70S6K1 is primarily located in the cytoplasm [136] and has three rapamycin sensitive phosphorylation sites T220, T389 and S404 where T389 seems to be critical for kinase activity [137-139]. rpS6 is a substrate of p70S6K1 and is phosphorylated in the specific order of S236, S235, S240, S244 and S247 [140]. Hind-limb unloading in rats causes atrophy and a decrease in phosphorylation of rpS6 [121] while synergist ablation, which causes hypertrophy, increases phosphorylation of rpS6 in rats [121, 141, 142]. Mice deficient in rpS6 phosphorylation have decreased muscle mass and decreased abundance of contractile proteins [143]. Skeletal muscle atrophy occurs in mice that lack the gene for p70S6K1 [144]. Interestingly, the life span of female mice was increased with 19 % in p70S6K1 -/- mice but for male mice there was no significant difference in life span [143]. The eIF4 family Eukaryotic initiation factor 4, eIF4, consists of several subunits; eIF4A, eIF4E and eIF4G which together make up the eIF4F translation initiation complex with the task to catalyze recognition, unwinding and binding of mRNA to the 43S preinitiation complex (Figure 4) [145]. The number of eIF4F complexes formed depends on the availability of free eIF4E and on phosphorylated 37 eIF4G. In nutrient-poor conditions 4EBP1 is unphosphorylated and binds to eIF4E thereby decreasing the amount of eIF4F complexes formed. In growth promoting conditions 4EBP1 becomes phosphorylated by mTOR which releases eIF4E to participate in the formation of eIF4F complexes [5] leading to increased protein synthesis [146, 147]. eIF4B helps in the binding of the ribosome to the mRNA. Without eIF4B being present, the 48S initiation complex can still be formed which suggests that eIF4B only has an assisting role [148]. Formation of the 43S preinitiation complex seems not to increase at feeding [145] but assembly of active eIF4F increases with acute provision of nutrients [145, 149]. eIF4F is necessary for cap dependent translation [150, 151]. The control of mRNA translation plays a critical role in cell growth, proliferation and differentiation. mRNA is translated in a cap-dependent manner in most eukaryotes. The cap structure consists of m7GpppN, where N can be any nucleotide, and is located at the 5’ terminus [46]. In addition to being a rate-limiting factor for the formation of the eIF4F complex eIF4E is a mRNA 5’ cap-binding protein [46]. eIF4A, an ATP-dependent helicase, and eIF4G, a large scaffolding protein, are also part of the eIF4F complex. eIF4G is the docking site for other proteins [46]. 38 Figure 4. The 43S preinitiation complex is formed by the 40S ribosomal subunit and Met-tRNA. Formation of the 48S initiation complex occurs with the help of eIF4 factors. The 60S ribosomal subunit is then attached to form the 80S complex for protein synthesis. eIF4G eIF4G is important for translation initiation where it functions as a scaffold protein [152] for eIF4E, eIF4A and the mRNA. Binding of eIF4G to eIF4E appears to accelerate the mRNA translation initiation [153]. eIF4G has binding sites for eIF4E, eIF4A and eIF3 making eIF4G appear as a nucleus, around which the initiation complex will form which is vital for promoting ribosome recruitment to the mRNA [153]. eIF4G is a phosphoprotein and delivers the 43S preinitiation complex to the 5’ cap of RNA molecules by interacting with eIF4E, eIF4A, poly(A)-binding protein (PABP), mitogen activated protein kinase-interacting kinases (Mnks) and eIF3 [145, 154, 155]. eIF4G has 30 identified serine or threonine phosphorylation sites. Phosphorylation of eIF4G at S1108 is associated with increased protein translation and the phosphorylation is promoted by IGF-1, insulin and serum. mTOR is suggested to control the phosphorylation of eIF4G at S1108 since 39 rapamycin and starvation decrease the phosphorylation [5]. Sepsis also affects protein synthesis in a negative way and reduces the phosphorylation of S1108. S1108 is located in the C-terminal of eIF4G and Mnks bind near S1108 [5]. Mnk2 has recently been shown to inhibit eIF4G [5]. Knockdown of Mnk2 in cultured myotubes increases the phosphorylation of eIF4G and overrules the inhibitory effect of rapamycin on eIF4G. Mice lacking Mnk2 had an increase in phosphorylation of eIF4G at S1108 in gastrocnemius muscle, the increase was stable during atrophy conditions and upon starvation in the null-Mnk2 mice. Increased Mnk2 mRNA expression was also reported in gastrocnemius muscle 4 days following denervation and this was associated with a decrease in S1108 phosphorylation of eIF4G. The effect of Mnk2 on eIF4G was suggested to be indirect and mediated through a pathway involving serinearginine-rich protein kinase (SRPK) [5]. 4EBP1 and eIF4E 4EBPs are small heat-stable proteins which inhibit cap-dependent translation. There are three 4EBPs; 4EBP1, 4EBP2 and 4EBP3 [46]. 4EBP1, has several phosphorylation sites but only four (T37, T46, S65 and T70) are considered to be important for release of eIF4E from the complex it forms with 4EBP1 [156]. 4EBP1 reduces translation initiation by binding to eIF4E and this is a rate limiting step for translation [146, 148]. In the hypophosphorylated state 4EBP1 binds strongly to eIF4E but the binding is weakened when 4EBP1 is hyperphosphorylated (Figure 5). Free eIF4E, that binds to eIF4G, increases by extracellular stimuli such as amino acids, hormones, growth factors etc. which increase phosphorylation of 4EBP1 [148]. C2C12 myotubes that are nutrient-deprived and are given insulin or IGF-1 will have an increase in protein synthesis and a dose-dependent phosphorylation of 4EBP1 [157]. 40 Figure 5. 4EBP1 forms a complex with eIF4E, the complex dissociates after 4EBP1 gets phosphorylated at several sites which makes it possible for eIF4G to bind to and form a complex with eIF4E which will lead to increased protein synthesis. The interaction between 4EBP1 and eIF4E has been studied in hibernating Golden-mantled ground squirrels using Western blot. The regulation of eIF4E by 4EBP1 differed with the different seasons. 4EPB1 was hyperphosphorylated during the summer, which promotes initiation and the activity of eIF4E was controlled through direct phosphorylation. In the winter, when the squirrel was in torpor, 4EBP1 was hypophosphorylated which lead to restricted translation through regulation of the availability of eIF4E [158]. eIF4F, sepsis and leucine Leucine is a branched-chain amino acid that can by itself account for most of the stimulation of protein synthesis caused by a mixture of amino acids. Leucine is involved in postprandial stimulation of muscle protein synthesis and functions as an important nutritional signal. After short term starvation followed by amino acid refeeding an increase in muscle protein syntheses will 41 occur [150]. Leucine-induced phosphorylation of 4EBP1 and p70S6K1 gives an increase in eIF4F-complexes [150] but also an increase in rpS6 phosphorylation which leads to an increase in protein synthesis [159]. A diet of high leucine and protein concentration was introduced to rats and accessible for 3 hours. After 0.5, 1, 3, 6 and 9 hours post meal introduction the gastrocnemius muscle was investigated and an increase in eIF4G-eIF4E complex was found which returned to normal 3 hours post meal introduction [145]. The normal protein synthesis response to leucine is impaired by sepsis and endotoxins. Sepsis results in increased secretion of TNFα and glucocorticoids, these will also impair protein synthesis. Sepsis gives an increase in muscle protein degradation and a decrease in muscle protein synthesis which leads to muscle catabolism [150, 159]. Mammalian Target of Rapamycin mTOR is a member of the family phosphatidylinositol kinase-related protein kinases (PIKK) with a carboxy-terminal region that has a sequence similar to the catalytic domains of PI3-kinases. Despite this homology to lipid kinases it acts as a serine/threonine protein kinase [45, 46]. Rapamycin inhibits mTOR signaling and reduces muscle hypertrophy [160]. Rapamycin, also known as Sirolimus, is used clinically as an immunosuppressive drug and is an inhibitor of the mTORC1 complex [161, 162]. Rapamycin causes G1-phase arrest in yeast cells and in mammalian lymphocytes but in other cell types rapamycin rather decreases cell cycle progression instead of blocking it [162]. There are two TOR proteins, TOR1 and TOR2, which form complexes TORC1 (associated with raptor) and TORC2 (associated with rictor). These two proteins were first discovered in yeast but later one was cloned in mammals 42 and is known as mTOR or FKBP12-rapamycin-associated protein (FRAP, RAFT or RAPT) [46, 162]. Nutrient availability controls the activity of TOR in yeast; in mammals both growth factors and nutrients control TOR [45, 151]. mTOR becomes active in nutrient-rich conditions and inactive in nutrient poor conditions [163]. A stress response program is triggered in yeast by TOR gene depletion or rapamycin exposure, this response is similar to the nutrient starvation phenotype in yeast [45, 151]. Growth factors, nutrients and certain hormones induce anabolic cellular processes, such as ribosomal gene transcription, protein synthesis, cell growth and cell proliferation, when they signal through mTORC1 [161]. mTORC1 and mTORC2 share some proteins but also contain unique ones, that results in unique cellular functions but also different sensitivity to rapamycin where mTORC1 is the more sensitive complex compared to mTORC2 [151]. Raptor, regulatory associated protein of mTOR, functions as a scaffolding protein between mTOR kinase and mTORC1 substrates to promote mTORC1 signaling. The binding of raptor and mTOR is weakened by rapamycin [151, 161]. Akt activates mTOR indirectly by phosphorylation of TSC2 in the TSC1/TSC2 heterodimer, which otherwise inhibits mTOR [164]. This starts a chain reaction where downstream factors of mTOR become phosphorylated [156, 165]. The phosphorylation of 4EBP1 and p70S6K1 leads to release of eIF4E and phosphorylation of rpS6 which correlates with an increase in translation of 5’ terminal oligopyrimidine tract, 5’TOP, containing mRNAs that encode poly (A) binding proteins, ribosomal proteins and elongation factors [46]. 4EBP1 and p70S6K1 contain TOR signaling (TOS) motifs, mammalian cell size is controlled through these two substrates and downstream pathways [45, 162, 166]. These two substrates are bound directly 43 to raptor which links them with mTOR kinase [151]. 4EBP1 and p70S6K1 become rapidly dephosphorylated when cultured mammalian cells are transferred to a medium without amino acids and glucose. By nutrient restoration mTOR multiphosphorylates 4EBP1 resulting in release of eIF4E and increased protein synthesis. Nutrients will also rephosphorylate p70S6K1 by mTOR and increase translational capacity by stimulating ribosome biogenesis [167]. Rapamycin inhibits overall protein synthesis, translation of mRNA and 4EBP1 phosphorylation independent of p70S6K1 activity [168]. The rapamycin-sensitive and mTOR-regulated pathway has been studied with regard to p70S6K1 and 4EBP1, it was found that ribosomal biogenesis was regulated through p70S6K1 and the overall translation initiation rate through 4EBP1 [168]. GSK3β and eIF2B GSK-3β is a downstream target of Akt [169] and inactivates eukaryotic initiation factor 2B, elF2B, by phosphorylation. eIF2B is both important for increased protein synthesis and ribosome recycling. Akt phosphorylates S9 on GSK-3β and thereby inhibits its functions, eIF2B becomes activated when GSK-3β is phosphorylated and an increase in protein synthesis occurs [44, 47]. Response from growth factors and insulin will inhibit GSK-3β through serine phosphorylation [169]. Y216 is a tyrosine site where GSK-3β can also be phosphorylated by an unidentified tyrosine kinase in mammals; it has been identified in slime molds as Zak1 [2, 44, 47, 170]. Akt-Protein kinase B Akt has three isoforms; Akt1, Akt2 and Akt3 which are encoded by the three genes PKBα, PKBβ and PKBγ [171]. The three genes have a homology of more than 85% sequence identity, and share the same structural organization 44 [172]. Akt2 and Akt3 have 40 respectively 25 amino acids more than Akt1 in the C-terminal domain [172, 173]. To a certain extent each Akt isoform has distinctive functions which have been evaluated with the help of murine gene disruption [171]. Akt1 seems to be involved in growth compared to Akt2 which has been suggested to have a major role in glucose metabolism. Evidence to support this has been shown in studies on mice lacking Akt1 or Akt2 [174, 175]. Akt1 and Akt2 are both involved in skeletal muscle protein synthesis and degradation. Skeletal muscles become hypertrophic when Akt1 is overexpressed [176] but both Akt1 and Akt2 are suggested to be involved in muscle growth and size [177] and are expressed in most tissues [178]. Akt3 is primarily found in the brain and testes but can also be found to a lesser extent in mammary gland, lung and fat [178]. IGF-1 and insulin trigger the activation of the Akt pathway by activating phosphatidylinositol 3-kinase, PI(3)K. PI(3)K generates phosphatidylinositol triphosphate, PIP3, in the cell membrane which binds to Akt and translocate Akt to the plasma membrane where Akt needs to be phosphorylated at both S473 and T308 for full activation [179, 180]. Akt is a serine/threonine kinase and is thought to play an important role in controlling apoptosis and cell survival through phosphorylation and inhibition of factors such as FoxO [171]. Akt phosphorylates FoxO1, FoxO3 and FoxO4 which results in nuclear export and transcriptional inactivity of FoxO [39]. In resistance exercise and weight-bearing locomotion following a period of disuse an increase in mechanical loading occurs. This leads to increased mTORC1 complex formation and activation with an increase in protein translation and ribosome biogenesis that result in adaptive muscle hypertrophy [181]. A decrease in activation of Akt and mTORC1 occurs as a result of 45 disuse induced by immobilization or hind-limb unloading in young adult rodents [160, 182]. In models of skeletal muscle hypertrophy, such as functional overload of the rat or mouse plantaris muscle, the levels of S473 phosphorylated Akt is increased [160]. In atrophy models based on skeletal muscle inactivity, such as 10 days of hind-limb immobilization or 10–14 days of hind-limb suspension, Akt S473 phosphorylation has been reported to be decreased in rat medial gastrocnemius muscle [160] and soleus muscle [183-186] but not in rat extensor digitorum longus muscle [184]. Constitutively active Akt has been shown to inhibit atrophy of denervated anterior tibial muscle in mice and denervated soleus muscle in rats [160, 187]. 46 4. AIM AND OBJECTIVES The overall aim of this thesis was to investigate changes in expression and post translation modifications of some factors involved in the regulation of protein synthesis and protein degradation in 6-days denervated atrophic and hypertrophic mouse skeletal muscle. Paper I Paper I examines the hypothesis that Akt/mTOR signaling is increased in hypertrophic and decreased in atrophic denervated muscle. Protein expression and phosphorylation of Akt1, Akt2, GSK-3β, 4EBP1, p70S6K1 and rpS6 were examined in six-days denervated mouse anterior tibial (atrophic) and hemidiaphragm (hypertrophic) muscles. Paper II The purpose of paper II was to investigate FoxO1 protein expression, phosphorylation and acetylation as well as MuRF1 protein expression in atrophic (anterior tibial and pooled gastrocnemius and soleus) and hypertrophic (hemidiaphragm) 6-days denervated mouse skeletal muscle. 47 Paper III Paper III examines the hypothesis that the differential response of hemidiaphragm (hypertrophy) and hind-limb muscles (atrophy) to denervation is related to a differential nuclear/cytosolic localization of p38 and/or MK2. The expression and phosphorylation of p38, MK2 and related proteins were studied in cytosolic and nuclear fractions from 6-days denervated atrophic anterior tibial muscle and hypertrophic hemidiaphragm muscle. Similar studies were also performed on unfractionated homogenates of pooled gastrocnemius and soleus muscles. Paper IV The aim of paper IV was to test the hypothesis that S1108 phosphorylation of eIF4G is differentially affected in 6-days denervated atrophic hind-limb muscles (pooled gastrocnemius and soleus muscles) and 6-days denervated hypertrophic (hemidiaphragm) muscle. 48 5. METHODOLOGICAL CONSIDERATIONS Animals The animals used in this thesis were adult male NMRI mice with an approximate weight of 30g. The reason for using males rather than females is that females have a hormonal cycle that may affect the results. Animals were housed with environment enrichment and with free access to a standard laboratory diet and tap water for a week before experiments so they became familiar with the surrounding. The studies on protein expression were performed 6-days after denervation. The reason for choosing this time point is because of the hypertrophic peak in denervated hemidiaphragm before the hemidiaphragm becomes atrophic [34-36]. All the experiments have been approved by the Ethical Committee for Animal Experiments, Linköping, Sweden. Surgery and muscles The animals were anaesthetized by inhalation of isoflurane and received a subcutaneous injection of buprenorphine (50 μg/kg) for post-operative analgesia. The atrophic muscles studied in this thesis were anterior tibial and pooled gastrocnemius and soleus muscles. These muscles were denervated by 49 sectioning and removing a few mm of the sciatic nerve and the wound was closed with a metallic clip [188]. Lidocain was applied onto the sciatic nerve before removing a part of it to prevent neural activity and autotomy [189]. To obtain a hypertrophic muscle the hemidiaphragm was denervated by a unilateral thoracotomy and then a few mm of the left phrenic nerve was removed and the wound was closed with metallic clips (see Table I). Eight randomly selected animals were used in each group (denervated hemidiaphragm muscle, denervated anterior tibial muscle, denervated pooled gastrocnemius and soleus muscles). For hemidiaphragm studies eight animals went through sham surgery. These animals were anaesthetized by inhalation of isoflurane, had a subcutaneous injection of buprenorphine and a unilateral thoracotomy without touching the phrenic nerve. The mice were killed six days after denervation or sham surgery by cervical dislocation, muscles were dissected (hemidiaphragm, anterior tibial and gastrocnemius together with soleus), weighed, frozen on dry ice and stored at -80o C. Innervated left control hemidiaphragms were collected from eight separate animals that had received no surgery. Innervated control hind-limb muscles (anterior tibial and pooled gastrocnemius and soleus muscles) were collected from the contralateral (right) leg of animals that were denervated by sectioning the left sciatic nerve. An additional eight animals for each of denervated and innervated hemidiaphragm muscles and innervated/denervated anterior tibial muscles were used for studies on separated nuclear and cytosolic fractions. 50 Table I. Different muscle types that were investigated in this thesis with the corresponding nerve that has been sectioned and which type of response that occurs in the different muscles. Muscle Nerve Left/right Fiber side of types Atrophy/hypertrophy animal Anterior tibial Sciatic Left II Atrophy Gastrocnemius and Sciatic Left I,II Atrophy Phrenic Left I,II Hypertrophy soleus (pooled) Hemidiaphragm Standard protein extraction Papers I-IV Muscles were homogenized using an Ultra-Turrax homogenizer (Janke and Kunkel, Staufen, Germany) in 1 ml (hemidiaphragm and anterior tibial muscles) or 2 ml (pooled gastrocnemius and soleus muscles) buffer containing 100 mM Tris-HCl, pH 7.6, 150 mM NaCl, 1 mM EDTA, 1% NP-40, 0.1% sodium deoxycholate and 1% HaltTM Protease and Phosphatase Inhibitor Cocktail (Thermo Scientific, Rockford, IL). The supernatant was recovered and the pellet was resuspended in 0.5 ml (anterior tibial and hemidiaphragm muscles) or 1.0 ml (pooled gastrocnemius and soleus muscles) of homogenization buffer and recentrifuged. The supernatants were combined and the protein concentration was determined using the Bradford assay [190]. Nuclear and cytosolic fractions Papers II and III Hemidiaphragm and anterior tibial muscles were used for cytosolic and nuclear protein extraction. The method used was slightly modified from [191]. The muscles were homogenized using an Ultra-Turrax homogenizer (Janke and Kunkel, Staufen, Germany) in 1 ml low salt lysis buffer (10 mM HEPES, 10 mM KCl, 1.5 mM MgCl2, 0.1 mM EDTA, 0.1 mM EGTA, 1 mM 51 dithiothreitol (DTT); pH 7.9 with 1% HaltTM Protease and Phosphatase Inhibitor Cocktail from Thermo Scientific, Rockford, IL). The homogenized tissue was vortexed for 15 s, put on ice for 10 min, vortexed again for 15 s and centrifuged at 16.000 g for 15 s. The supernatant cytosolic extract was immediately frozen (-80o C) for subsequent analyses. The nuclear pellet was resuspended on ice in a high salt nuclear extraction buffer (20 mM HEPES, 420 mM NaCl, 1 mM EDTA, 1 mM EGTA, 1 mM DTT, 25% glycerol; pH 7.9 with 1% HaltTM Protease and Phosphatase Inhibitor Cocktail from Thermo Scientific, Rockford, IL) at a ratio of 4 μl of nuclear extraction buffer per mg muscle wet weight. Preparations were incubated on ice for 30 min and vortexed for 10 s every 5 min before being centrifuged at 16.000 g for 6 min. The supernatant nuclear extract was then removed and frozen (-80o C) for subsequent analyses. Protein concentrations for each fraction were obtained using the Bradford assay [190]. The author of the present thesis did not actively participate in this part of papers II and III. Western blotting Western blot is a widely used method in research which makes it possible to fractionate proteins by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), transfer onto a polyvinylidene difluoride (PVDF) membrane, detect with antibodies and semi-quantify the amount of protein in a sample with chemiluminescence. Even proteins in low abundance can be detected with this method. The different antibodies used in the present thesis are shown in Table II. 52 Table II. Antibodies used in the present thesis. Antibody Site Dilution Paper Ab Supplier Akt1 - 1:2000 I 2967+ pAkt1 S473 1:2000 I 07-310** Akt2 - 1:2000 I 2962+ pAkt2 S474 1:2000 I 38513++ GSK-3β - 1:2000 I 610202*** pGSK-3β S9 1:2000 I 9336+ 4EBP1 - 1:1000 I 9452+ p4EBP1 S65 1:1000 I 9451+ p70S6K1 - 1:500 I 9202+ pp70S6K1 T389 1:500 I 9205+ rpS6 - 1:2000 I 2317+ prpS6 S235/236 1:2000 I 2211+ FoxO1 - 1:800 II 2880+ pFoxO1 S256 1:800 II 9461+ Ac-FoxO1 - 1:2000 II sc-49437* FoxO3 - 1:800 unpublished 2497+ pFoxO3 S253 1:800 unpublished 9466+ MuRF1 - 1:1000 II AF5366+++ Lamin A/C - 1:1000 III 2032+ p38 MAPK - 1:1000 III 9212+ pp38 MAPK T180/Y182 1:1000 III 4511+ MK2 - 1:2000 III 3042+ pMK2 T317 1:1000 III 3041+ pMK2 T205 1:1000 III 3316+ Hsp27 - 1:1000 III 2442+ pHsp27 S82 1:1000 III 2401+ Hsp70 - 1:1000 III 4876+ SOD-1 - 1:10000 III Sc-8637* 53 eIF4G - 1:800 IV 2858+ peIF4G S1108 1:800 IV 2441+ β-actin - 1:10 000 unpublished 8227++ + Cell signaling Technology, *Santa Cruz Biotechnology, Solutions, *** ++ Abcam, **Upstate Cell Signaling BD Transduction Laboratories, +++R&D Systems Data analysis and statistics The expression levels of total, phosphorylated and acetylated proteins were studied semi-quantitatively using data from Western blots. Equal amounts of total, cytosolic or nuclear proteins from innervated, sham operated or denervated muscles were loaded on the gels. Measured levels of total, phosphorylated or acetylated proteins are expressed without normalization to any specific protein (loading control). Any differences in protein quantifications, pipetting steps, protein transfers etc. are, thus, included in the variations of the data sets. Image analysis was performed using the gel plotting macro of the program ImageJ (Rasband, W.S., ImageJ, US National Institutes of Health, Bethesda, MD, http://rsb.info.nih.gov/ij/, 1997–2007). Results were obtained in uncalibrated optical density units. For quantification of protein expression in the different whole muscle homogenates studied one of the innervated muscle samples was used as a reference sample and was included in all gels. All other samples were measured relative to this reference, the signal of which was set to 100.0. In the final analysis all signals were again normalized in such a way that the average signal from innervated muscles became 100.0. 54 For quantification of protein expression in separated cytosolic and nuclear fractions one of the cytosolic fractions from an innervated muscle was used as a reference sample and was included in all gels. All other samples were measured relative to this reference, the signal of which was set to 100.0. From the amount of protein loaded on gels in relation to the total amount of protein extracted in the nuclear and cytosolic fractions a total cytosolic and a total nuclear signal was calculated for whole muscles. In the final analysis total cytosolic and total nuclear signals were again normalized in such a way that the sum of the average nuclear and cytosolic signals became 100.0 in innervated muscle. Data are presented as mean values ± standard error of the mean (SEM). For statistical comparisons of unfractionated hemidiaphragm muscles (innervated, sham operated and denervated) one-way ANOVA was used followed by the Tukey’s multiple comparisons test, for normally distributed data (according to D’Agostino-Pearson omnibus K2 normality test). Statistical significance for data not being normally distributed was determined using the Kruskal-Wallis test with Dunn’s multiple comparisons test. For other comparisons Student’s t-test (paired observations for hind-limb muscles, unpaired observations for hemidiaphragm muscles) was used for normally distributed data (according to D’Agostino-Pearson omnibus K2 normality test). Statistical significance for data not being normally distributed was determined using the Mann-Whitney test (hemidiaphragm muscles) and Wilcoxon matched-pairs signed rank test (anterior tibial and pooled gastrocnemius and soleus muscles). 55 6. RESULTS AND DISCUSSION Most skeletal muscles become atrophic after denervation but the hemidiaphragm is unique since it undergoes a transient hypertrophic state after denervation which might be a as a result of passive stretch because of the continued contractions in the contralateral innervated hemidiaphragm [3436]. All the muscles used in papers I-IV were weighed before freezing and the results are compiled in Table III. Table III. Muscle wet weights for muscles used in papers I-IV. n=8 except in *n=9 Muscle Anterior Tibial Hemidiaphragm Gastrocnemius and soleus 56 Innervated Sham Denervated Paper 55.1+1.7 mg - 44.1+1.8 mg I 65.9+1.8 mg 60.8+1.9mg 28.8+1.4 mg 28.2+0.8 mg 29.6+0.6 mg 198.3+5.7 mg 29.7+0.9 mg - 51.6+1.8 mg 44.7+1.8mg 44.4+0.7 mg* 43.3+0.7 mg 40.3+1.5 mg 149.1+4.4 mg II,III,IV II,III I II,III,IV II,III II,III,IV Paper I It has been proposed that the Akt/mTOR signaling pathway plays a major role in the regulation of skeletal muscle mass. Total protein expression and phosphorylation levels of Akt1 and Akt2 as well as the Akt substrate GSK-3β and the downstream factors of mTOR, 4EBP1, p70S6K1 and rpS6 were studied in 6-days denervated atrophic and hypertrophic muscles. The results obtained in paper I are summarized in Table IV. In hypertrophic hemidiaphragm expression of all proteins and phosphorylations were increased except 4EBP1 total protein. No decreases in total protein expressions or phosphorylation levels were observed in denervated atrophic anterior tibial muscle. On the contrary total Akt1, total Akt2 and total rpS6 as well as phosphorylated levels of Akt2, 4EBP1, p70S6K1 and rpS6 were increased in denervated atrophic muscle. The results obtained agree with several other studies of hypertrophic skeletal muscle which indicate increased signaling through the Akt/mTOR pathway [87, 108, 160]. p70S6K1 and 4EBP1 with increased phosphorylation levels have been reported previously [88] in denervated rat hemidiaphragm muscles, increased rpS6 [192] and GSK-3β [193] phosphorylations have also been reported previously. In the present study no decrease was observed in signaling through the Akt/mTOR pathway in atrophic denervated anterior tibial muscle. GSK-3β (S9) showed no decrease in phosphorylation in atrophic muscle which has also been reported previously [193]. Another study has also reported increased Akt protein expression and phosphorylation levels in atrophic mouse muscle two weeks after denervation [194]. 57 The results from this paper suggest increased rather than decreased signaling through mTOR, which indicates increased protein synthesis, in denervated atrophic muscles as well as in denervated hypertrophic muscles. It is therefore likely that increased protein degradation is responsible for the loss of muscle mass in denervated atrophic muscles rather than decreased protein synthesis. Previous studies and the present results are in line with each other indicating increased protein synthesis in hypertrophic hemidiaphragm muscle [195] as well as in atrophic hind-limb muscles of adult mice [33] denervated for similar time periods as in the present study. Akt S473 phosphorylation has been reported to be decreased in medial gastrocnemius muscle [160] and soleus muscle [183-186] from rat but not in extensor digitorum longus muscle [184] in atrophy models based on skeletal muscle inactivity such as 10 days of hind-limb immobilization or 10– 14 days of hind-limb suspension. Increased protein degradation may be more important after denervation compared to hind-limb suspension where a suppression of protein synthesis has been suggested to be more important for muscle atrophy [196]. The difference in the response of GSK-3β to denervation in atrophic anterior tibial and hypertrophic hemidiaphragm muscles could be further studied in denervated pooled gastrocnemius and soleus muscles to investigate whether or not the response depends on differences in muscle fiber type composition. 58 Table IV. Changes in total protein expression and phosphorylations in 6-days denervated atrophic anterior tibial muscle and in 6-days denervated hypertrophic hemidiaphragm. ~ No change. Anterior tibial (atrophic) Hemidiaphragm (hypertrophic) Akt1 ↑ ↑ pAkt1 (S473) ~ ↑ Akt2 ↑ ↑ pAkt2 (S474) ↑ ↑ GSK-3β ~ ↑ pGSK-3β (S9) ~ ↑ 4EBP1 ~ ~ p4EBP1 (S65) ↑ ↑ p70S6K1 ~ ↑ pp70S6K1 (T389) ↑ ↑ rpS6 ↑ ↑ prpS6 (S235/236) ↑ ↑ Paper II FoxO1 total expression, phosphorylation level and acetylation as well as MuRF1 protein expression were examined in this paper in both atrophic and hypertrophic denervated muscle. Since anterior tibial and hemidiaphragm muscles differ in fiber type compositions pooled gastrocnemius and soleus muscles were also included in paper II. In mouse the hemidiaphragm muscle consists primarily of type II fibers but also has around 12% of type I fibers [197] whereas the anterior tibial muscle contains no type I fibers [198]. Pooled gastrocnemius and soleus muscles contain both type I and type II 59 fibers [198, 199]. Separated nuclear and cytosolic fractions of innervated and denervated anterior tibial and hemidiaphragm muscles were also included in paper II. The results obtained in paper II are summarized in Table V. FoxO1 total protein expression was increased in both atrophic and hypertrophic muscles after 6 days of denervation. The level of phosphorylated FoxO1 was upregulated both in denervated hemidiaphragm (hypertrophic) and pooled denervated gastrocnemius and soleus muscles (atrophic) but not in denervated anterior tibial muscle. Acetylated FoxO1 was up-regulated in denervated atrophic anterior tibial muscles but not in denervated hemidiaphragm muscles (hypertrophic) nor in atrophic denervated pooled gastrocnemius and soleus muscles. Total MuRF1 protein expression was increased in all denervated muscles studied both in atrophic anterior tibial and pooled gastrocnemius and soleus muscles and in hypertrophic hemidiaphragm muscle. In denervated atrophic anterior tibial muscle total FoxO1 increased only in the cytoplasmic fraction. A small but statistically significant increase in phosphorylated FoxO1 was also observed in cytosolic fractions of denervated anterior tibial muscle. In denervated hypertrophic hemidiaphragm total FoxO1 as well as phosphorylated FoxO1 increased in both cytosolic and nuclear fractions. This study confirms an increased MuRF1 protein expression in denervated atrophic hind-limb muscle and also shows that MuRF1 protein expression is increased in denervated hemidiaphragm muscle at a time point when the muscle is in a hypertrophic state relative to innervated control muscles. Despite the hypertrophic state previous studies on denervated rat hemidiaphragm indicate that from 5 days following denervation protein 60 degradation, as well as protein synthesis, is increased in this muscle [200]. The present study shows that the expression of FoxO1 protein is increased in all 6days denervated skeletal muscles studied, atrophic as well as hypertrophic. This may suggest that FoxO1 plays a role in denervation changes other than those leading to alterations in muscle mass. Increased FoxO1 expression in denervated atrophic hind-limb muscle was recently also published by others [201]. Differences in fiber type composition of the muscles studied may be related to the different effects of denervation on the level of phosphorylated and acetylated FoxO1 in the different muscles studied. FoxO3 expression has previously been reported to increase in denervated atrophic skeletal muscle [202-204]. In the present study the ambition was to also compare FoxO3 total protein expression and phosphorylation (at S253) in denervated atrophic and hypertrophic muscles. Despite several attempts with different antibodies, different dilutions of antibodies and different concentrations of milk and bovine serum albumin in the blocking buffer no detectable bands of correct size that could be analyzed were obtained. Table V. Changes in total protein expression, phosphorylation and acetylation in 6-days denervated atrophic and hypertrophic muscle. Whole muscle homogenates. ~ No change. Muscles Fiber FoxO1 types Anterior tibial Gastrocnemius and pFoxO1 Ac- (S256) FoxO1 MuRF1 I and II ↑ ↑ ~ ↑ ↑ ~ ↑ ↑ I and II ↑ ↑ ~ ↑ II soleus (pooled) Hemidiaphragm 61 Paper III A previous study has shown that MK2 phosphorylation on T317 correlates with muscle weight in denervated atrophic anterior tibial muscle, denervated hypertrophic hemidiaphragm muscle and innervated control muscles [48]. Paper III examines the hypothesis that the differential response of hemidiaphragm and hind-limb muscles to denervation is related to a differential nuclear/cytosolic localization of p38 and/or MK2. The protein expression and phosphorylation status of p38, MK2 and the MK2 substrate Hsp25 as well as Hsp70 protein expression were examined in separated cytosolic and nuclear fractions. The proteins and phosphorylations were also examined in unfractionated homogenates of pooled gastrocnemius and soleus muscles in order to examine hind-limb muscles that, like the hemidiaphragm, contain type I muscle fibers in addition to type II fibers [197, 199] but like the anterior tibial muscle become atrophic following denervation. The results obtained in paper III are summarized in Table VI. No support was obtained for a differential nuclear/cytosolic localization of p38 or MK2 in denervated atrophic and hypertrophic muscle. A differential response of MK2 T317 phosphorylation was confirmed in denervated atrophic and hypertrophic muscle and decreased T317 phosphorylation was also observed in denervated atrophic pooled gastrocnemius and soleus muscles. Hsp70 increased substantially only in denervated hypertrophic muscle which might suggest that Hsp70 could be important for the differential effect of denervation on T317 phosphorylation of MK2 in denervated hypertrophic and atrophic muscle. Hsp70 has been reported to play a role in the phosphorylation of MK2 by p38 [205]. A significant increase of Hsp25 phosphorylation in all denervated 62 muscles was observed suggesting that other factors in addition to MK2 are important for the regulation of this phosphorylation. Table VI. Changes in total protein expression and phosphorylations in 6-days denervated atrophic and hypertrophic muscle. Whole muscle homogenates or separated nuclear and cytosolic fractions + ( ).~ No change. Anterior tibial (atrophic) ↓+ ↑cytosol+ p38 pp38 (T180/Y182) MK2 pMK2 (T205) pMK2 (T317) Hsp25 pHsp25 (S82) Hsp70 Gastrocnemius and soleus (atrophic) ↓+ ↑cytosol+ ↓+ ↑+ ↑cytosol+ ↑nuclear+ Hemidiaphragm (hypertrophic) ~ ↑ ~+ ↓nuclear+ ↓ ↑ ↓ ↑ ↑ ~ ↑+ ↑cytosol+ ↑+ ↑+ ↑+ ↑+ Paper IV The eukaryotic translation initiation factor 4-gamma (eIF4G) is important for initiation of protein synthesis and phosphorylation on S1108 correlates with increased protein synthesis [206]. A decrease in S1108 phosphorylation of eIF4G has been reported by Hu et al. 2012 [5] in denervated gastrocnemius muscle. The decrease in S1108 phosphorylation was associated with an increase in Mnk2 mRNA expression. A previous study from our lab has also found increased Mnk2 mRNA expression in denervated hind-limb muscle but this was not observed in denervated hemidiaphragm (unpublished results). The present study tests the hypothesis that S1108 phosphorylation of eIF4G is differentially affected in 6-days denervated atrophic hind-limb muscles (pooled gastrocnemius and soleus muscles) and 6-days denervated hypertrophic (hemidiaphragm) muscle. 63 The results obtained are shown in Table VII. The results from denervated atrophic pooled gastrocnemius and soleus muscle show a decrease in the phosphorylation but no change in total eIF4G expression, as also reported by Hu et al. 2012. In denervated hypertrophic hemidiaphragm a significant increase was found in both total eIF4G expression and S1108 phosphorylated eIF4G, with no significant change in the ratio of phosphorylated/total eIF4G. Table VII. Changes in eIF4G total protein expression and S1108 phosphorylation in 6-days denervated atrophic and hypertrophic muscle. Whole muscle homogenates. ~ No change. Gastrocnemius and soleus (atrophic) eIF4G peIF4G (S1108) peIF4G (S1108) / eIF4G ~ ↓ ↓ Hemidiaphragm (hypertrophic) ↑ ↑ ~ The different alterations in muscle mass of hind-limb and hemidiaphragm muscles following denervation should be possible to relate to alterations in the regulation of muscle protein synthesis and/or degradation. The assembly of the eIF4F-complex is an important step for the control of the initiation of protein synthesis. This complex contains eIF4A, an RNA helicase, eIF4E and eIF4G. eIF4G acts as a scaffold for the other components in this complex. Phosphorylation of eIF4G S1108 is associated with increased formation of eIF4G-eIF4E complex which correlates with increased protein synthesis [206]. The amount of free eIF4E that can bind to eIF4G is regulated by 4EBP1 which competes with eIF4G to bind to eIF4E [207, 208]. The results reported in paper I indicate that phosphorylation of 4EBP1 increases in denervated hypertrophic hemidiaphragm and denervated atrophic hind-limb muscle which suggests increased availability of eIF4E in both cases therefore allowing increased formation of eIF4F-complexes and protein synthesis. The increased or maintained phosphorylation of eIF4G S1108 in hypertrophic hemidiaphragm versus decreased phosphorylation in atrophic 64 hind-limb muscle may represent one regulatory mechanism that helps explain the different responses of the hemidiaphragm muscle compared to hind-limb muscles following denervation. 65 7. CONCLUSIONS In this thesis different cell signaling pathways and factors involved in atrophy and hypertrophy have been investigated in denervated skeletal muscle. In paper I Akt and downstream factors of mTOR were investigated and the results suggest an increase in protein synthesis in both denervated atrophic anterior tibial muscle and hypertrophic hemidiaphragm muscle. This implies that increased protein degradation is more likely to be responsible for the loss of muscle mass in denervated atrophic muscle than a decrease in protein synthesis. In paper II FoxO1 and MuRF1 expression were shown to increase in both denervated atrophic and hypertrophic muscles which suggest that these two proteins participate in the tissue remodeling that occurs after denervation. Acetylation and phosphorylation of FoxO1 after denervation differed in the different muscles studied which could be related to differences in fiber type compositions of the muscles. In paper III p38 and related factors were investigated. A differential response of MK2 T317 phosphorylation in denervated hypertrophic and atrophic muscles was confirmed and Hsp70 was suggested to possibly be important for 66 this differential response. In all denervated muscles studied an increased phosphorylation of Hsp25 was observed which suggests that other factors than MK2 are important for regulating this phosphorylation. In paper IV the S1108 phosphorylation of eIF4G was investigated in atrophic pooled gastrocnemius and soleus muscles and hypertrophic hemidiaphragm muscle. A decrease in S1108 phosphorylation of eIF4G was confirmed in denervated atrophic muscles, but was not observed in denervated hypertrophic muscle. In denervated hypertrophic hemidiaphragm muscle there was an increase in expression of both total and S1108 phosphorylated eIF4G. The differential effect of denervation on S1108 phosphorylation of eIF4G in hemidiaphragm and hind-limb muscles may represent a mechanism that could clarify the differential responses of these muscles following denervation. All the research reported in this thesis is basic research which is an important first step in science, but it then needs to be taken a step further so it can help people that suffer from different conditions in which loss of muscle mass can be devastating. 67 8. ACKNOWLEDGEMENTS The writing of this thesis has taken more time then I could ever have imagined. Despite the frustrations and the feeling I would never get here, I finally made the finish line and it feels so good. There are so many people that have made such a difference for me during this journey and I hope I haven’t forgotten to mention anyone. This thesis could not have been completed without the help of my Supervisor Sven Tågerud. Sven taught me that science is at least 2 steps forward and 1.5 step backwards and that we learn more from our mistakes then our successes. And you are right; discoveries can’t be made without mistakes. Thank you for giving me the opportunity to research and the willingness to teach me all about atrophy and hypertrophy; and for wanting your PhD students to be as prepared as possible for when we stand on our own two feet. I also would like to thank Marlene Norrby, who was a part of this research group as a senior PhD student when I joined the group, and who today are my co-supervisor. All the help you have given me over these years and the proof reading has been wonderful. You are the best at “fulfixa” thank you . A huge thanks to Marie-Louise Wadenberg, I am forever grateful to you for the inspiration to move to Kalmar. Your knowledge, your enthusiasm for 68 research and your willingness to teach has been crucial for my journey forwards this goal. I am so grateful to Jonas Burén for opening my eyes to research all those years ago in Umeå. Thank you for showing me how much fun research is, and giving me a special opportunity and an internship in a lab. I am forever grateful too you! I want to especially thank Kim, present member of the research group. Thank you for all the fun on the conferences and helping out whenever needed, but I know you shake your head at me in the lab some days . Anna, my dear colleague and friend you always listen and have the best advice. You have a magical gift in getting me to say what I really think about things. THANK YOU! Norrgård is filled with wonderful people but there are some that needs an extra mentioning such as Johanna, who is the best optician I know and always helpful with my eye sight. Thanks to Camilla for being a wonderful travel companion on your conferences, it has been great. A special thanks to Anneli for being such a wonderful lunch companion, I am so glad that it is not just me that is hungry before 11 am . How Norrgård would survive without Stefan, Bosse and Mattias is for me a mystery, you always help out when we have problems and for that I am very grateful. I also would like to thank the Ann, Biggan and Ing-marie for making my mornings feel less lonely; it is always fun talking with you. Nina and Annette for helping and making sure that we have the material we need to make everything in the student lab run smoothly. Lena, Berit, Lilita, Ymke, Per and Anna-Lena, what would I have done without the great and prompt service you have provided that have made my life so much easier as a PhD student. 69 A big thanks to a little boy named Max for being so nice and lending me his mummy when I need someone to talk to. There is no one like you Solveig, and you make my problems disappear with your solutions. And thank you Scott for not stopping to try to teach me how electronic devices such as computers and phones work . Kalle and Karin, my wonderful friends, we have so much fun, great dinners, evenings with wine, long talks and board games. Twiggy has a very special place in this family and we are all so happy when she comes and visit and thank you for taking so good care of Malou, she loves it. To Susanne my wonderful “sister”, your love and enthusiasm for bearded collies is what made us friends but today that friendship is so much more. To have you, your husband, Torbjörn, and your three bearded collies in our life, fills it with more love and laughs and the children love spending time with their godparents. Thank you both for being there for us. When I was at a crossroad and did not know which way to go, Gun and Plurre talked some sense into me and I am very grateful for that today. I followed your advice and it turned out great, thank you for letting me stay with you whenever I am in Stockholm. Britt and Rickard, you are the best godparents anyone could ever wish for and I am so happy that you are still part of my life. 70 Till min älskade farmor, en krutgumma på 95 år. Jag är väldigt övertygad om varifrån jag har fått min envishet och egensinnighet. Jag hoppas att jag är lika pigg som du när jag blir gammal, du är min idol. Kära mormor, tack för allt stöd och underbara minnen som du och morfar har givit mig, jag önskar att morfar hade fått se mig idag, men jag är övertygad om att han tittar ner och är stolt. Jag hoppas att jag i framtiden kan bli en lika bra mormor som du är till mig. Stora Gun, min extra mormor, du har alltid funnits där och det har varit så roligt att få hälsa på dig på loven. Vi har varit på många äventyr och haft massor av skoj och har många minnen. Jag älskar er alla tre så oerhört mycket, tack för att ni finns i mitt liv. Not everyone can say that they have an extra set of parents but I can. Hans and Monica, life is more interesting with you two in my life. I know that you can’t choose your in-laws but I have the best ones there is. Thank you both for always being there when I need you and for all the help and love you give. Thanks to Camilla and Kristoffer for your support. Camilla you are always kind and listen to me and give me good advice. Kristoffer, you are always fun to be around and you “get me”. I love you all. I have two loving parents, mum and dad, that read my articles and try to understand what I am working on, I know it is not easy but I love that you keep trying . You both have always supported me in everything I do. All that support and love goes a long way and look at me now, I made it! Thank you both from the bottom of my heart, and I love you both so very much! 71 Björn, thank you for all the help you have given us with the children, dogs and the fun movie nights. You are a big part of our family. Me, Joakim and the children, we all love “björnen”. You are the best little (big) brother there is, I love you! I don’t know what my life would be without my two wonderful children, Anton and Isabelle. Your smiles and laughs make the sun come out even on the darkest and rainiest day. One kiss or hug melts me to a big puddle of love. I love you both so very much. To my husband Joakim, the love of my life. You are always there for me, even when the world around me seems to be crumbling down. Your unconditional love and support means the world to me. I love you all the way to eternity and back, and some more… 72 9. REFERENCES 1. Sandri M: Signaling in muscle atrophy and hypertrophy. Physiology 2008, 23:160-170. 2. Nader GA: Molecular determinants of skeletal muscle mass: getting the "AKT" together. International Journal of Biochemistry & Cell Biology 2005, 37:1985-1996. 3. 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