(American Journal of Pathology. 1998;153:39-45.)
© 1998 American Society for Investigative Pathology
Up-Regulation of p21WAF1 by Phorbol Ester and Calcium in Human Keratinocytes through a Protein Kinase C-Dependent Pathway
Carole Todd and
Nicholas J. Reynolds
From the Department of Dermatology, Medical School, University of
Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
 |
Abstract
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Terminal differentiation in a variety of cell types has been
associated with p53-independent up-regulation of p21WAF1.
p21WAF1 mRNA and protein are expressed at low levels in
normal human skin, but overexpression of p21WAF1
has been observed in differentiating keratinocytes in involved
psoriatic epidermis and in human squamous cell carcinoma. In this study
we investigated by immunohistochemistry and Western blotting whether
calcium and the phorbol ester
12-O-tetradecanoylphorbol-13-acetate, well
characterized differentiation signals, induce
p21WAF1 in cultured normal human keratinocytes and whether
induction of p21WAF1 in this system depends on protein
kinase C activation or functional p53. Phorbol ester induced
p21WAF1 expression, which was maximal at 4 to
8 h with reduction back to baseline by 24 to 48 h. In
contrast, increasing the extracellular Ca2+
concentration from 70 µmol/L to 1.5 mmol/L resulted in up-regulation
of p21WAF1 expression with a slower time course,
with peak induction at 18 to 24 h. No parallel increase in p53
expression was observed in normal human keratinocytes. Up-regulation of
p21WAF1 was also observed in response to phorbol ester in
HaCaT cells, which carry homozygous and inactivating mutations
for p53. Induction of p21WAF1 by phorbol ester and
Ca2+ was inhibited by the specific protein kinase C
inhibitor Ro 31-8220. The results demonstrate a differential time
course of p21WAF1 protein up-regulation in response to
phorbol ester and Ca2+, signals that result in
keratinocyte differentiation, and suggest that induction of
p21WAF1 in differentiating human keratinocytes occurs
through protein kinase C-dependent and p53-independent
mechanisms.
 |
Introduction
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Epidermis is a stratified squamous epithelium composed
predominantly of keratinocytes. These cells divide in the lower basal
layers and subsequently move upward through the epidermis and undergo a
complex program of morphological and biochemical changes, including the
sequential expression of differentiation-associated
proteins.1
These changes lead to the formation of
terminally differentiated cornified cells within the stratum corneum
that form the primary barrier of skin. Abnormalities in keratinocyte
differentiation are observed in a number of skin diseases, including
psoriasis2
and nonmelanoma skin cancer.3,4
Furthermore, it has been hypothesized that resistance of initiated
cells to differentiation signals promotes a growth advantage during
epidermal carcinogenesis.5,6
Although there are some important
differences between cell culture and human skin in vivo,
cultures of keratinocytes have proved useful in investigating cell
differentiation and identifying regulatory mechanisms involved in this
process. Studies on cultured keratinocytes and in vivo have
shown that the concentration of extracellular calcium
([Ca2+]o) and activation of the protein
kinase C (PKC) signal transduction pathway are important regulators of
keratinocyte differentiation.7-13
Increased
[Ca2+]o stimulates formation of inositol
1,4,5-trisphosphate and 1,2-diacylglycerol and activates PKC in mouse
keratinocytes,14,15
although whether activation of PKC is
required for [Ca2+]o-induced human
keratinocyte differentiation remains to be established. Indeed, mouse
skin differs from human skin in several respects, including epidermal
thickness, number of epidermal cell layers, and density of hair
follicles, and murine and human keratinocytes show different responses
to 12-O-tetradecanoylphorbol-13-acetate (TPA), a potent PKC
agonist and calcium.1
For example, induction of ornithine
decarboxylase is observed in mouse skin in vivo and cultured
mouse keratinocytes in response to TPA, whereas TPA suppresses
ornithine decarboxylase expression and enzyme activity in cultured
human keratinocytes.16,17
Terminal differentiation is coupled to withdrawal from the cell cycle,
and this process has been associated with increased expression of
p21WAF1 in a variety of tissues in vivo,
including muscle and gastrointestinal epithelia,18-21
and
in several well defined differentiating systems in vitro,
including HL-60 cells.22,23
p21WAF1 (also known
as CIPI, SDII, MDA6, or CAP20) is transcriptionally regulated by
p5324
and is a downstream mediator of p53-induced growth
arrest after DNA damage24
through its interaction with
proliferating cell nuclear antigen, cyclins, and cyclin-dependent
kinases.21,25-27
p21WAF1 may also be regulated
through p53-independent pathways in response to diverse stimuli
including growth factors,28
and experiments in p53-null
cells indicate that increased expression of p21WAF1 during
terminal differentiation occurs through p53-independent
pathways.23
Although some agents such as TPA induce
p21WAF1 and act as differentiation signals in several cell
systems, including HL-60 cells22,23
and
keratinocytes,29,30
cell type-specific mechanisms also
appear to be operating. In myoblasts, for example, the myoD family of
transcription factors regulates p21WAF1 promoter activity,
whereas in mouse keratinocytes another protein, p300, is
required.29
We have previously reported on increased p21WAF1 mRNA and
protein expression in suprabasal psoriatic epidermis,31
with virtually absent expression in the basal layer. In the same study,
we also observed up-regulation of p21WAF1 mRNA and protein
expression in skin in vivo in response to agents that induce
hyperproliferation,31
although whether p21 is involved in
regulating this hyperproliferative response is not clear.
Overexpression of p21WAF1 has also been reported in the
differentiating cells of human cutaneous squamous cell
carcinomas.32
In the present study we have investigated whether increased
[Ca2+]o and TPA, two well characterized
differentiation signals for human keratinocytes, induce
p21WAF1 in cultured normal human keratinocytes and whether
alteration in p21WAF1 expression is dependent on PKC
activation and/or functional p53.
 |
Materials and Methods
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Cell Culture
Cultures of human keratinocytes were established from normal skin
obtained from plastic and pediatric surgical procedures, essentially as
described.33
Epidermis was separated from dermis after
overnight incubation at 4°C in Dispase II (neutral protease)
(Boehringer Mannheim) and an epidermal cell suspension prepared after
incubation with 0.05% trypsin and 0.02% ethylenediaminetetraacetic
acid at 37°C. Keratinocytes were cultured in T75 flasks in MCDB-153
serum-free medium (Sigma-Aldrich) with a calcium concentration of 70
µmol/L, supplemented with ethanolamine (6.1 µl/L),
phosphoethanolamine (14 µg/ml), hydrocortisone (0.18 µg/ml),
insulin (5 µg/ml), transferrin (5 µg/ml), epidermal growth factor
(10 ng/ml), penicillin G (5 IU/ml), streptomycin (5 µg/ml), and amino
acids.34
Keratinocytes were expanded by serial passage and
used for experiments between passages 2 and 3. Spontaneously
immortalized HaCaT cells, a kind gift from Dr. NE Fusenig (German
Cancer Research Center, Heidelberg, Germany), were cultured in
Dulbecco's modified Eagle's medium (Sigma Laboratories, Poole, UK)
with 10% fetal calf serum.
Immunohistochemistry
Primary cultures of keratinocytes and HaCaT cells were passaged by
trypsinization and were subsequently seeded into 12-well plates
containing one round 16 mm-diameter coverslip/well at a density of
1 x 105
cells/well. After timed incubation with
specified agents or with medium containing 1.5 mmol/L Ca2+,
cells were fixed in 4% paraformaldehyde and immunostained with
anti-p21WAF1 monoclonal antibody, diluted 1:70 (Oncogene
Research Products, Cambridge, MA), using an avidin-biotin
immunoperoxidase kit (Vector Laboratories, Burlingame, CA), with
Ni2+ plus 3,3'-diaminobenzidine as the chromagen and
counterstained with methyl green.
Western Analysis
Cells were treated with the specified agents and scraped into 2x
sodium dodecyl sulfate lysis buffer (125 mmol/L Tris-HCl, pH 6.8,
0.05% bromphenol blue, 4% sodium dodecyl sulfate, 20% glycerol, and
10% ß-mercaptoethanol). Protein concentrations were determined on
samples, before addition of ß-mercaptoethanol, using the
bicinchoninic acid protein assay kit (Pierce Chemical Co., Rockford,
IL), according to the manufacturer's instructions. Equal protein
quantities of samples were electrophoresed through 12.5%
polyacrylamide gels, transferred onto nitrocellulose, blocked in
blocking buffer (5% nonfat milk in Ca2+ and
Mg2+-free PBS) for 1 hour at room temperature, and
subsequently incubated overnight at 4°C in the appropriate dilution
of primary mouse monoclonal antibody (anti-p21WAF1, 1:250;
DO7, anti-p53; 1:1000; Novocastra Laboratories, Newcastle, UK) in
blocking buffer. After incubation with rabbit anti-mouse
peroxidase-conjugated secondary antibody and avidin-biotin complex,
membranes were washed and protein bands were visualized using an
enhanced chemiluminescent Western blotting detection system (Pierce).
Band intensities were quantified by laser densitometry (LKB model
2222-020, LKB Prodakter, Bromma, Sweden) according to the
manufacturer's instructions.
 |
Results
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Human keratinocytes cultured as monolayers in low-calcium (70
µmol/L), serum-free MCDB-153 medium differentiate in response to TPA
and increased extracellular calcium [Ca2+]o
(1.5 mmol/L).8,10,12,13
We initially investigated changes
in p21WAF1 protein expression by immunohistochemistry in
human keratinocytes after exposure to TPA and increased
[Ca2+]o. Figure 1A
shows that compared to control, TPA
(50 nmol/L) induced p21WAF1 expression in cultured human
keratinocytes with maximal induction at 4 to 8 h and reduction
back toward baseline at 24 to 48 h. As expected,
p21WAF1 expression was predominantly nuclear. In parallel
experiments on keratinocytes derived from the same donor, increased
p21WAF1 expression was also observed in response to
increased [Ca2+]o but with a slower time
course compared to TPA (Figure 1B)
, and substantial expression
persisted at 24 and 48 h. Induction of p21WAF1
expression after treatment of paired human keratinocyte cultures with
TPA and increased [Ca2+]o was confirmed by
Western analysis (Figure 2, A and B)
.
Western blotting experiments also confirmed a differential time course
of p21WAF1 induction in response to TPA and increased
[Ca2+]o (Figure 1, C and D)
, with maximal
induction at 4 to 8 h and 18 h for TPA and increased
[Ca2+]o, respectively.

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Figure 1. Kinetics of increased p21WAF1 expression in human
keratinocytes in response to TPA and increased extracellular calcium.
A and B: Cultured human keratinocytes derived from the
same donor were treated with TPA (50
nmol/L) (A) or switched to medium
containing 1.5 mmol/L [Ca2+]o (B) for
various times (in hours)
and immunostained with anti-p21WAF1 monoclonal antibody.
Essentially identical results were obtained in at least three
independent experiments from three different donors. C and
D: Cultured human keratinocytes derived from the same donor
were treated for the specified times with TPA
(50 nmol/L) (C) or
switched to medium containing 1.5 mmol/L
[Ca2+]o (D), and cell lysates were
prepared, fractionated in sodium dodecyl sulfate/12.5% polyacrylamide
gels, transferred to nitrocellulose membrane, and immunoblotted with
anti-p21WAF1 monoclonal antibody, as described in Materials
and Methods. Lane 1, vehicle; lane 2, 2 h;
lane 3, 4 h; lane 4, 8 h; lane 5,
18 h; lane 6, 24 h; lane 7, 48 h.
Relative densitometric values (arbitrary
units) are indicated below the lanes.
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Figure 2. Ro 31-8220 partially inhibits up-regulation of p21WAF1 by
TPA and increased [Ca2+]o. Cell lysates were
prepared from cultured human keratinocytes treated with the specified
agents, separated by sodium dodecyl sulfate-polyacrylamide gel
electrophoresis, and immunoblotted with anti-p21WAF1
monoclonal antibody, as described in Materials and Methods.
A: Lane 1, vehicle; lane 2, TPA
(50 nmol/L) for 4 h;
lane 3, TPA (50
nmol/L) plus Ro 31-8220
(100 nmol/L) for 4
h; lane 4, Ro 31-8220 (100
nmol/L). B: Lane 1, vehicle;
lane 2, 1.5 mmol/L [Ca2+] for 8 h;
lane 3, 1.5 mmol/L [Ca2+] plus Ro 31-8220
(100 nmol/L) for 8
h. Relative densitometric values (arbitrary
units) are indicated below the lanes. Results
are representative of at least three independent experiments that
yielded similar results.
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Because PKC agonists induce keratinocyte differentiation and because
PKC-mediated cell cycle arrest involves induction of
p21WAF1 in a number of cell types, including HL-60 cells
and intestinal epithelial cells,23,35
we investigated the
effect of the relatively specific PKC inhibitor Ro
31-822036
on p21WAF1 expression in
differentiating human keratinocytes. Western analysis showed that Ro
31-8220 (100 nmol/L) substantially abrogated TPA-induced up-regulation
of p21WAF1 at 4 h and 1.5 mmol/L
[Ca2+]o-induced up-regulation of
p21WAF1 at 8 h (Figure 1, C and D)
. Similar results
were obtained using immunohistochemical analysis (data not shown). No
significant induction of p21WAF1 was observed after
exposure of keratinocytes to Ro 31-8220 alone (Figure 2A)
. These
results provide evidence that early up-regulation of
p21WAF1 in human keratinocytes in response to both TPA and
increased [Ca2+]o occurs through a
PKC-dependent pathway.
p53-null mouse keratinocytes retain their ability to respond to
differentiation signals and to up-regulate p21WAF1 in
response to increased
[Ca2+]o.29,30,37
In our
experiments in which TPA and increased
[Ca2+]o resulted in up-regulation of p21 in
normal human keratinocytes, we observed a progressive reduction in p53
expression after treatment with TPA (Figure 3A)
but no significant change in p53
expression in response to increased [Ca2+]o
(Figure 3B)
. Interestingly, TPA-induced down-regulation of p53 was
substantially reduced by Ro 31-8220 (Figure 3A)
. As p53-null human
keratinocytes are not currently available for study, we used HaCaT
cells (a spontaneously immortalized human keratinocyte cell line)
containing two mutant alleles of p53,38
which are unable to
transactivate p21,39
to examine whether p53 is required for
p21WAF1 induction in human keratinocytes. Induction of
p21WAF1 in HaCaT cells was observed by Western analysis
(Figure 3C)
and immunohistochemistry (data not shown), indicating that
p53 is not required for this response. No reduction in basal p53
protein expression was observed in HaCaT cells in response to TPA
(Figure 3D)
.

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Figure 3. Induction of p21WAF1 in human keratinocytes is independent
of p53. A and B: Cultured human keratinocytes derived
from the same donor were treated with the specified agents, and Western
analysis of cell lysates was performed using an anti-p53 monoclonal
antibody. A: Lane 1, vehicle; lane 2, TPA
(50 nmol/L) for 2 h;
lane 3, TPA (50
nmol/L) for 4 h; lane 4, TPA
(50 nmol/L) for 8 h;
lane 5, TPA (50
nmol/L) plus Ro 31-8220
(100 nmol/L) for 8
h; lane 6, TPA (50
nmol/L) for 18 h; lane 7, TPA
(50 nmol/L) for 24
h; lane 8, TPA (50
nmol/L) for 48 h. B: Lane 1, 70
µmol/L [Ca2+]o; lane 2, 1.5 mmol/L
[Ca2+]o for 2 h; lane 3, 1.5
mmol/L [Ca2+]o for 4 h; lane 4,
1.5 mmol/L [Ca2+]o for 8 h;
lane 5, 1.5 mmol/L [Ca2+]o plus Ro
31-8220 (100 nmol/L) for
8 h; lane 6, 1.5 mmol/L [Ca2+]o
for 18 h; lane 7, 1.5 mmol/L
[Ca2+]o for 24 h; lane 8, 1.5
mmol/L [Ca2+]o for 48 h. C and
D: Cultured HaCaT cells containing functionally inactive
homozygous mutations of p53 were treated with TPA
(50 nmol/L) for 4 h
(lane 2) or 24 h (lane 3) or treated with vehicle
(lane 1), and Western analysis of cell lysates was carried out
using anti-p21WAF1 (C) and anti-p53 monoclonal
antibodies (D). Relative densitometric values
(arbitrary units) are
indicated below the lanes.
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Discussion
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In this study we have examined the relationship between two well
characterized keratinocyte differentiation signals, increased
[Ca2+]o and TPA, and p21WAF1
expression in cultured normal human keratinocytes. We have used a
specific PKC inhibitor and HaCaT cells to determine whether induction
of p21WAF1 by increased [Ca2+]o
and TPA requires PKC activation or functional p53. Our results
demonstrate a low level of p21WAF1 protein expression in
proliferating cultured human keratinocytes consistent with virtually
absent p21WAF1 mRNA and protein expression in normal human
skin.31
Calcium-induced differentiation in mouse
keratinocytes has previously been associated with up-regulation of
p21WAF1.29,30
We observed up-regulation of
p21WAF1 in human keratinocytes in response to TPA and
increased [Ca2+]o. Both TPA and increased
[Ca2+]o induce growth arrest and terminal
differentiation in human keratinocytes.7,8,10,12
However,
TPA induces more rapid and profound differentiation than calcium in
these cells.40
Our experiments show a differential time
course of p21WAF1 up-regulation, with TPA inducing
p21WAF1 protein more swiftly than increased
[Ca2+]o. These results further support an
association between induction of p21WAF1 and terminal
differentiation in human keratinocytes. p21WAF1 expression
appears low in normal skin as detected by immunohistochemistry and
in situ hybridization, and it is therefore difficult to
comment about the relative expression of p21WAF1 in basal
and suprabasal differentiating keratinocytes.31
However,
increased p21WAF1 mRNA and protein was observed in
suprabasal differentiating keratinocytes in involved psoriatic
epidermis,31
which displays abnormal keratinocyte
differentiation.2
Similarly, in cutaneous human squamous
cell carcinomas, which show alterations in keratin expression compared
to normal epidermis,3,4
p21WAF1 is
overexpressed in superficial differentiating
keratinocytes.32
Further studies are required to determine
whether these observations reflect a role for p21WAF1 in
induction and maintenance of normal keratinocyte differentiation
in vivo or whether p21WAF1 accumulates because
of an abnormal differentiation program.
The bisindoylmaleimide Ro 31-8220 is a relatively specific PKC
inhibitor36
that inhibits TPA-induced growth arrest and
differentiation in human keratinocytes.41
Our studies with
Ro 31-8220 provide important evidence that induction of
p21WAF1 protein by both TPA and increased
[Ca2+]o in human keratinocytes is dependent
in part on PKC activation. In human keratinocytes, increased
[Ca2+]o results in inositol
1,4,5-trisphosphate formation42
and increased intracellular
Ca2+ ([Ca2+]i),43
but
whether increased [Ca2+]o activates PKC in
human keratinocytes remains to be formally established. We are
currently performing experiments to address this issue. Up-regulation
of p21WAF1 by PKC activation in human keratinocytes may
involve the Sp family of transcription factors, as TPA significantly
increased Sp1 protein levels and Sp1 binding in K562
cells,44
and Sp1 and Sp3 both activate the
p21WAF1 promoter, although overexpression studies suggest
that only Sp3 is directly involved in promoter induction during mouse
keratinocyte differentiation.45
Although up-regulation of p21WAF1 is associated with
cellular differentiation, p21WAF1-null mice showed normal
organ and skin development with no morphological defects in cell
differentiation, indicating that p21WAF1 is not
essential.46,47
However, primary keratinocytes derived from
p21WAF1-null mice showed a significantly increased
proliferative potential and an alteration of the keratinocyte
differentiation program with a reduction of late differentiation
markers.47
In addition, the absence of p21WAF1
resulted in aggressive keratinocyte-derived tumors after transformation
by ras.47
These results and our previous
work31
suggest that p21WAF1 may be involved in
the regulation of keratinocyte differentiation and that dysregulation
of p21WAF1 expression in human skin may contribute to
abnormal keratinocyte differentiation observed in psoriasis and
cutaneous squamous cell carcinoma.
Up-regulation of p21WAF1 in HaCaT cells by transforming
growth factor ß, which induces cell cycle arrest but not cell
differentiation, indicates that induction of p21WAF1 is not
sufficient for keratinocyte differentiation.39
Datto et al.
also showed that HaCaT cells contain two mutant p53 alleles that are
unable to transactivate the p21WAF1 promoter when
overexpressed, indicating that induction of p21WAF1 by
transforming growth factor ß occurs through a p53-independent
mechanism.39
Within lesional psoriatic epidermis in which
p21WAF1 was overexpressed in suprabasal layers, p53 protein
expression was only marginally elevated within the low epidermal
layers, suggesting that induction of p21WAF1 in psoriatic
epidermis may be independent of p53.31
Our observations in
human keratinocytes and HaCaT cells support this hypothesis. A decrease
in p53 protein expression was observed in response to TPA (Figure 3A)
consistent with experiments in mouse keratinocytes.30
Interestingly, this response was almost completely blocked by Ro
31-8220 (Figure 3A)
. However, our findings of stable p53 protein
expression in human keratinocytes after treatment with increased
[Ca2+]o (Figure 3B)
contrasts with reduced
p53 synthesis in mouse keratinocytes.30
Although the
absence of increased p53 protein expression in response to TPA and
increased extracellular Ca2+ (Figure 3, A and B)
does not
exclude a p53-mediated response,30
induction of
p21WAF1 by TPA in HaCaT cells provides evidence for a
p53-independent mechanism of action in human keratinocytes, consistent
with observations in p53-null mouse keratinocytes.29
Three main conclusions can be drawn from the results presented. TPA and
increased [Ca2+]o induced up-regulation of
p21WAF1 in human keratinocytes with different time courses.
Up-regulation of p21WAF1 by both TPA and increased
[Ca2+]o in human keratinocytes is dependent
in part on PKC activation. Finally, up-regulation of
p21WAF1 by TPA occurs through a p53-independent mechanism.
 |
Acknowledgements
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We thank Dr Eugene Healy and Professor Jonathan Rees for critical
review of the manuscript and helpful suggestions.
 |
Footnotes
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Address reprint requests to Dr. Nicholas J. Reynolds, Department of Dermatology, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK. E-mail: n.j.reynolds{at}ncl.ac.uk
Supported in part by British Skin Foundation Grant 148/97 (to NJR).
Accepted for publication April 14, 1998.
 |
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