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From the Tumour Microcirculation Group,* Gray Cancer Institute, Mount Vernon Hospital, Northood, Middlesex, United Kingdom; the Department of Cystic Fibrosis,
National Heart and Lung Institute, Imperial College, London, United Kingdom; and the Institut de Physiologie et Biologie Cellulaire,
UMR CNRS 6187, Université de Poitiers, France
| Abstract |
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7.5 nmol/L, CA-4-P damages mitotic spindles, arrests cells at metaphase, and leads to the death of mitotic cells with characteristic G2/M DNA content. Mitotic arrest was associated with elevated levels of cyclin B1 protein and p34cdc2 activity. Inhibition of p34cdc2 activity by purvalanol A caused mitotic-arrested cells to rapidly exit mitosis, suggesting that sustained p34cdc2 activity was responsible for metaphase arrest. Pharmacological prevention of entry into mitosis protected cells from undergoing cell death, further establishing the link between mitosis and cell death induction by CA-4-P. CA-4-P-mediated cell death shared characteristics of apoptosis but was independent of caspase activation suggesting the involvement of a non-caspase pathway(s). These data suggest that induction of apoptosis in endothelial cells by CA-4-P is associated with prolonged mitotic arrest. Therefore, by activating cell death pathways, CA-4-P, in addition to being an effective anti-vascular agent, may also interfere with regrowth of blood vessels in the tumor.
Disruption of interphase microtubules can account for the rapid anti-vascular effects of CA-4-P described above. However, microtubule-binding agents also disrupt mitotic spindles and are classically known for their anti-mitotic properties. For instance, the taxols and the vinca alkaloids are potent anti-mitotic drugs clinically used for the treatment of cancer.10 Although these agents do have rapid anti-vascular effects, they are only observed at close to their maximum tolerated doses.11-13 Several lines of evidence suggest that these anti-mitotics also act by inhibiting angiogenesis, possibly because of inhibitory effects on endothelial cell proliferation and induction of apoptosis.14-16 CA-4-P itself, inhibits endothelial cell proliferation and induces apoptosis in proliferating endothelial cells in vitro.17,18 In vivo it is active against angiogenesis associated with proliferative retinopathy19 but there is only limited data regarding possible anti-angiogenic activity in tumors.20
Disruption of the mitotic spindle activates the spindle assembly checkpoint and as a result arrests cells in mitosis.21 Mitotic arrest caused by various microtubule-interacting drugs was found to precede tumor cell apoptosis and the hypothesis that mitotic arrest was the cause of apoptosis has gained widespread support.22-24 Eukaryotic cell entry into mitosis and subsequent exit into G1 requires the sequential entry of cyclin B1 into the nucleus during prophase where it activates p34cdc2 kinase, followed by subsequent degradation of cyclin B1 and thus down-regulation of p34cdc2 activity during anaphase that allows the cell to exit from mitosis.25,26 A sustained activation of p34cdc2 is associated with mitotic arrest in response to various microtubule-targeting agents and is thought to be a trigger for apoptotic cell death induction in some cell systems.24,27,28 Other investigators, however, are more in support of the idea that anti-microtubule agents induce apoptosis via mechanisms that are independent of their capacity to arrest cells in mitosis.29,30
We have previously demonstrated that CA-4-P induces a rapid form of primarily necrotic cell death in post-confluent non-proliferating endothelial cells that could contribute to the disruption of the tumor vascular function observed in vivo.8 In the present report we analyze the mechanisms involved in the induction of cell death by CA-4-P in proliferating human endothelial cells, which has significance for potential downstream anti-angiogenic effects of the drug. Here we investigate the involvement of the cell cycle in the mechanism by which endothelial cells die after CA-4-P treatment and the potential link between entry into mitosis and induction of cell death by apoptosis. Understanding these mechanisms is important for exploiting the potential of this drug for the treatment of angioproliferative diseases including cancer.
| Materials and Methods |
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CA-4-P was obtained from OXiGENE, Inc. (Watertown, MA). Anti-ß-tubulin monoclonal antibody (clone TUB.2.1), fibronectin, heparin, mammalian protease inhibitor cocktail, and cell culture media were from Sigma (Poole, UK). Fetal calf serum was from Helena Biosciences (Tyne and Wear, UK). Mouse anti-cyclin B1 antibody was purchased from BD Biosciences Pharmigen (Oxford, UK). Mouse anti-poly-(ADP)-ribose polymerase (PARP) and anti-phopsho-histone H1 antibodies were obtained from Upstate (Botolph Claydon, UK). Purvalanol A and Z-VAD-FMK were from Calbiochem (Beeston, UK).
Cell Culture
Human umbilical vein endothelial cells from pooled donors (TCS CellWorks, Botolph Clayton, UK) were grown on gelatin-coated culture dishes in M199 supplemented with 20% fetal calf serum, 4 mmol/L L-glutamine, 20 µg/ml endothelial cell growth supplement (First Link, Birmingham, UK), and 80 µg/ml heparin. Cells were plated at 104 cells/cm2 and were used 24 to 48 hours after plating. Only cells between the first and fourth passages were used for experiments.
Determination of Proliferation/Cell Viability
Cells were plated onto gelatin-coated dishes at a density of 2 x 104 cells/cm2 and allowed to adhere for 24 hours after which they were treated with CA-4-P in fresh medium. At the end of the incubation period (24 to 48 hours), both adherent and non-adherent cells were harvested, pooled, and counted in a hemocytometer. Cell viability was evaluated by the trypan blue exclusion assay.
Analysis of DNA by Flow Cytometry
Cells were plated and treated with CA-4-P as described for the proliferation assay above. Adherent cells collected by trypsinization were pooled with floating cells, washed in phosphate-buffered saline (PBS), and fixed with ice-cold 70% ethanol. Fixed samples were extensively washed in PBS, treated with RNase A (20 µg/ml, 30 minutes, 37°C), and resuspended in propidium iodide (PI) (20 µg/ml). Stained cells were analyzed on a FACS flow cytometer (Becton Dickinson). The low-level gate was set at 10% of the value of the G1 peak and the percentages of cells within the G1 and G2/M phases of the cell cycle were determined by analysis with CellQuest software (Becton Dickinson).
Immunofluorescence Microscopy
Cells were cultured on Permanox Lab-Tek chamber slides coated with 10 µg/ml human fibronectin (Invitrogen, Paisley, UK). For immunofluorescence visualization of microtubules and localization of cyclin B and phosphorylated histone H1, cells were fixed in 3.7% formaldehyde in PBS, permeabilized with 0.1% Triton X-100, and incubated with primary antibodies followed by sequential incubations with biotin-labeled anti-mouse/anti-rabbit IgG and fluorescein isothiocyanate-labeled avidin D (Vector Laboratories, Peterborough, UK). For simultaneous visualization of actin, 5 U/ml Texas Red-conjugated phalloidin (Molecular Probes, Leiden, The Netherlands) was added together with the avidin. Slides were mounted in Vectashield with 4,6-diamidino-2-phenylindole (DAPI) (Vector Laboratories) to visualize nuclei. Fluorescence or phase contrast images were acquired with a Nikon Eclipse TE200 inverted microscope and a cooled charge-couple device camera (Cohu, San Diego, CA) and processed using Adobe Photoshop software.
Cell Death Enzyme-Linked Immunosorbent Assay (ELISA)
To assay apoptotic cell death, an ELISA-based photometric assay kit was used (Cell Death Detection ELISAPLUS;Roche Diagnositics, Lews, UK) that measures cytoplasmic DNA-histone nucleosome complexes generated during apoptotic DNA fragmentation. Briefly cells were plated in 24-well cluster plates at a density of 104 cells/cm2 and allowed to adhere overnight before exposure to drug in fresh medium. At specified times, cluster plates were centrifuged for 10 minutes at 200 x g and after removal of supernatants cells were lysed directly in the wells in 200 µl of lysis buffer supplied in the kit. Cytoplasmic fractions were analyzed for presence of nucleosomes according to the manufacturers instructions. The increase in optical density over that obtained by control untreated cells is represented as fold increase in released nucleosomes.
Annexin V Staining of Apoptotic Cells
To determine whether exposure of phosphatidylserine occurred to the outer leaf membrane of cells, an indication of apoptosis, unfixed cells were analyzed using the Annexin-V-FLUOS staining kit (Roche Diagnostics). Briefly, cells in chamber slides were exposed to CA-4-P for specified time periods. The culture medium was then removed and any nonadherent cells were collected by centrifugation and replaced into their corresponding slide wells. Cells were covered with a solution containing annexin V and PI as recommended by the manufacturer and analyzed under an inverted fluorescence microscope.
Western Blotting Analysis
Cell lysates were prepared as described before.31 Equal amounts of protein (Pierce BCA microassay) were separated on Novex Tris-glycine gels (Invitrogen), transferred to nitrocellulose membranes, and immunoreactive bands were visualized by enhanced chemiluminescence (Amersham-Pharmacia Biotech, Chalfont St. Giles, UK).
Statistical Analysis
Quantitative experimental data were analyzed by using a standard analysis of variance followed by the Tukey-Kramer honest significance difference test for multiple comparisons (JMP Statistics for the Apple Macintosh). A value of P < 0.05 was considered significant.
| Results |
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The capacity of CA-4-P to modulate endothelial cell cycle progression was evaluated using asynchronous proliferating endothelial cultures, continuously exposed to the drug which were then stained with PI and analyzed by flow cytometry. Treatment with 100 nmol/L CA-4-P for 24 hours led to an accumulation of cells in G2/M (65%) (Figure 1B)
compared to control cells (20%) (Figure 1A)
. Under these conditions, numerous rounded loosely adherent, mitotic in appearance, cells accumulated in the cultures (Figure 1
, compare F with E) and these cells had a characteristic G2/M DNA content (Figure 1D)
in contrast to the remaining strongly adherent cells that were distributed throughout the cell cycle (Figure 1C)
. Staining of cell nuclei of CA-4-P-treated cultures with DAPI revealed characteristically condensed mitotic metaphase chromosomes that often appeared damaged and fragmented and unevenly displayed in a significant proportion of the cells (Figure 1
, compare H with G).
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8 hours of continuous CA-4-P exposure, with 32% of the cells in G2/M compared to 23% in parallel untreated cultures (data not shown) and was maximal at 24 hours (Figure 2)
7.5 nmol/L CA-4-P, interphase microtubules were still evident although severely damaged (Figure 3
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7.5 nmol/L CA-4-P, sustained increased levels of cyclin B1 were detected, specifically localized to mitotic-arrested cells (Figure 5, C and D)
7.5 nmol/L) a significant proportion of cells become specifically arrested in mitosis and fail to progress through the cell cycle.
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CA-4-P Induces Cell Death in Mitotic-Arrested Endothelial Cells
Apoptosis can occur at any stage in the cell cycle via activation of complex signal transduction pathways.34
For microtubule-interacting agents, apoptosis is often but not inevitably associated with mitotic block.22,23,29
An ELISA-based cell death assay that detects cytoplasmic DNA-histone complexes generated during apoptotic DNA fragmentation into nucleosomes revealed that CA-4-P induced apoptosis that was detectable after 8 hours of continuous exposure of the cells to the drug (Figure 7A)
, a time that correlated with accumulation of mitotic-arrested cells (see previous Results section).
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Dose analysis revealed that a wide range of concentrations of CA-4-P (7.5 to 104
nmol/L) led to significant nucleosome generation (Figure 7C)
, consistent with the mitotic arrest data (Figure 2)
. Nucleosome generation was also evident, but to a lesser extent, when lower concentrations of CA-4-P (2.5 or 5 nmol/L) were used that did not induce mitotic arrest. It should be noted that at these lower concentrations, CA-4-P did cause spindle malformation (Figure 3)
and nuclear DNA damage (Figure 4)
that could account for apoptotic degradation in the absence of mitotic arrest.
To investigate further the involvement of mitotic-arrested cells in the initiation of apoptotic cell death, parallel experiments were performed in which live cells were stained in situ with fluorescein isothiocyanate-annexin V to determine exposure of phosphatidylserine to the outer cell membrane. No annexin V-positive staining was evident in cultures exposed to CA-4-P for
6 hours (data not shown). However, annexin V staining was evident starting at 8 hours of exposure to CA-4-P, which led to the accumulation of mitotic cells in the culture. In these cells, annexin V fluorescence co-localized with the mitotic cells and was absent from all adherent spread-out cells (Figure 8A)
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Block of Entry into Mitosis Attenuates CA-4-P-Induced Cell Death
The link between mitotic arrest and induction of endothelial cell death by CA-4-P was established by preventing cell entry into mitosis using the pharmacological inhibitor, purvalanol A. This inhibitor of p34cdc2 kinase was previously shown to exhibit anti-mitotic properties by inducing a G2/M block in exponentially growing fibroblasts and various tumor cell lines.33,36
In agreement with such reports, proliferating endothelial cells treated with 10 µmol/L purvalanol A for 24 hours accumulated in G2/M (compare Figure 9A
with Figure 1A
) with no detectable reduction in cell viability (data not shown). In a recent report, we demonstrated that concentrations of
100 nmol/L CA-4-P induced rapid membrane blebbing and necrosis in proliferating endothelial cells if p42/p44 MAPK were inhibited.8
Purvalanol A is also a potent inhibitor of p42/p44 MAPK36
and in combination with
100 nmol/L CA-4-P was indeed found to induce rapid membrane blebbing and necrosis (data not shown). Therefore, in the next experiments 10 nmol/L CA-4-P was specifically chosen for its efficacy at mediating mitotic arrest and apoptosis without inducing membrane blebbing and necrosis in the presence of inhibitors of p42/p44 MAPK such as PD98059 and purvalanol A (data not shown). Purvalanol A prevented a further progression of cells through the cell cycle in response to simultaneous treatment with CA-4-P (Figure 9
, compare B with A) and inhibited any significant accumulation of mitotic cells (Figure 9B
, inset). This decrease in frequency of mitotic cells correlated with reduction in the levels of expression of cyclin B1, which rose in cells arrested by CA-4-P (Figure 9C)
. Cyclin B1, although expressed in both G2 and M, is generally higher in M-phase cells. Furthermore, phosphorylated histone H1, which is a characteristic of mitotic cells, was also absent in cells treated with purvalanol A. Taken together, these data strongly suggest that purvalanol A prevents endothelial cells from entering mitosis by mediating their arrest in the G2 phase of the cell cycle.
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| Discussion |
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There is compelling evidence that tubulin-binding agents such as paclitaxel and the vinca alkaloids kill cancer cells primarily by apoptosis.10,37 Because mitotic arrest caused by such agents was frequently found to precede apoptosis, a hypothesis that arrest of the cell cycle at mitosis is the primary stimulus for apoptosis has been widely accepted. For example, apoptosis induced by paclitaxel was found to either occur directly after a mitotic arrest or after an aberrant mitotic exit into a G1-like multinucleate state.22,23,38 Nevertheless, some investigators have provided evidence against the involvement of mitotic arrest in apoptosis induction by microtubule-binding agents by demonstrating apoptotic events in other phases of the cell cycle.29,30 The link between mitotic arrest or damage of the mitotic machinery and CA-4-P-mediated endothelial cell death is clear from the results of the current study. However, what is not clear is whether arrest in mitosis is the actual trigger for cell death. Purvalanol A, used here to block entry into mitosis, could also be inhibiting other signal kinases that are upstream of pro-apoptotic pathways.39 Endothelial mitotic cell death could therefore result from the culmination of upstream events that may involve activation or expression of proapoptotic genes by the action of CA-4-P on pre-mitotic cells. It would be of particular interest to investigate further the mechanisms involved in the apoptotic actions of CA-4-P by studying gene expression using apoptotic gene arrays. Identification of apoptosis-related genes that are positively or negatively regulated by CA-4-P would provide further insight into the mechanisms by which this compound kills proliferating endothelial cells.
Several signaling pathways are activated by CA-4-P in endothelial cells4
and these could contribute toward cell death. For instance, we have recently demonstrated that CA-4-P activates the GTPase Rho8
that is implicated in proapoptotic pathways40
and could therefore signal to apoptosis in this system. However, the fact that a wide range of CA-4-P concentrations (7.5 nmol/L to 10 µmol/L) arrested cells in mitosis and induced endothelial cell death to a similar extent (Figure 7)
suggests that the death-inducing stimulus is associated primarily with mitotic arrest and not some other signal generated by interaction with interphase microtubules.
Microtubule targeting compounds activate the mitotic spindle checkpoint that monitors chromosome attachment to the mitotic spindle and delays chromosome segregation during anaphase until defects in the mitotic spindle apparatus are corrected.21 In parallel, degradation of cyclin B1 is inhibited leading to a prolonged activation of cyclin B/p34cdc2 activity. A sustained p34cdc2 activity is a consequence of mitotic arrest of various tumor cell lines by drugs such as taxol28,41 and also in normal endothelial cells in response to CA-4-P, as we demonstrate here. p34cdc2 activity is thought to act as a pro-apoptotic mediator in some systems. For example taxol-mediated death of breast cancer cells was shown to be inhibited by inhibitors of p34cdc2 activity or cyclin B anti-sense oligonucleotides.41 Furthermore, a sustained p34cdc2 activity was found to be required for apoptosis induction by noscapine, an anti-microtubule drug, in mitotic-arrested murine mammary carcinoma cells.24 Whether sustained p34cdc2 activity is the actual trigger for cell death induction by microtubule-targeting agents is not currently known. Certainly, sustained p34cdc2 activity is required for the continuous arrest of endothelial cells in metaphase, because treatment of such CA-4-P metaphase-arrested cells with p34cdc2 activity inhibitor purvalanol A, caused the majority of mitotic-arrested cells to exit mitosis. This indicates that a sustained p34cdc2 activity is a key component of the mitotic block and cells can proceed to exit mitosis even in the absence of spindle assembly, provided p34cdc2 activity is efficiently down-regulated.
The cellular context is likely to be important in determining the mechanisms by which cell death is induced by agents such as CA-4-P. Whereas studies on the apoptotic effects of microtubule targeting agents have been conducted primarily on tumor cell lines, very little is known about the way these compounds affect normal cells and endothelial cells in particular. Endothelial cells appear to have a functional spindle assembly checkpoint and CA-4-P was found to arrest these cells in metaphase. A recent study has demonstrated that a functional spindle assembly checkpoint is associated with susceptibility to induction of apoptosis by anti-microtubule agents in some human lung cancer lines as opposed to lung cancer cell lines with defective spindle assembly checkpoints that were resistant to induction of apoptosis.42 Defects in spindle assembly checkpoint have been linked to the pathogenesis of several human tumors and can result in the aberrant exit of cells from mitosis and subsequent generation of aneuploid cells.43 A defective spindle assembly is likely to be the cause of frequently observed aberrant mitoses in response to microtubule-targeting agents.10 Nevertheless such aberrant mitotic exit resulting in G1-multinucleate cells can also be the trigger for apoptosis as described for paclitaxel and some tumor cell types.23,38 Indeed, CA-4-P leads to the formation of multinucleate cells in several human and murine tumor cell lines (our unpublished observations) which suggests that differences in spindle assembly checkpoints operate in different cell types and may affect the subsequent fate of the cells in response to this compound.
Mitotic catastrophe has been described as the predominant form of cell death mediated by CA-4-P in human B-lymphoid tumors and some leukemia cell lines.44
Mitotic catastrophe results from aberrant mitosis leading to the formation of giant non-viable multinucleated cells and is a form of cell death thought to share some common pathways with apoptosis.45
CA-4-P-arrested mitotic endothelial cells appeared to remain arrested in metaphase from which they subsequently entered a cell death pathway without exiting mitosis. Cells treated with low concentrations of CA-4-P (2.5 to 5 nmol/L), appeared to exit mitosis but nuclei were characteristically deformed (Figure 4)
. Based on these morphological observations it is likely that endothelial cells treated with CA-4-P share at least some characteristics with cells undergoing mitotic catastrophe. Nucleosome generation, a characteristic of apoptotic cell death, was detected in these cells, which suggests that apoptotic mechanisms play an important role. Caspases however, do not appear to be necessary for CA-4-P-mediated mitotic endothelial cell death because the general caspase inhibitor of Z-VAD-fms failed to prevent either the entry of cells into mitosis or the subsequent generation of nucleosomes and cell death. Therefore, cell death induction by CA-4-P is caspase-independent, even though caspases appear to be co-activated in the process. This is in agreement with findings by Nabha and colleagues44
who showed that inhibition of caspases, that were activated by CA-4-P treatment in leukemia cell lines, did not prevent the observed mitotic catastrophe and cell death. Caspase-independent cell death, while caspases were co-activated, has also been reported for other microtubule-binding agents such as paclitaxel and nocodazole which suggests that caspase activation may be a mere bystander effect of such agents.42,46
We have previously demonstrated that CA-4-P induces a rapid form of primarily necrotic type of cell death in predominantly postconfluent endothelial cells.8
This form of cell death was observed at high doses of CA-4-P (
100 nmol/L) and was associated with the capacity of the drug to activate Rho kinase and induce a blebbing morphology, which was characterized by altered actin reorganization and reduced adhesion. The postconfluent nature of the cell cultures used in those experiments, which were characterized by a very low mitotic index, and the fact that high concentrations of the drug were required to induce necrotic cell death precluded that mitotic cells were specifically targeted.
The specific targeting of proliferating endothelial cells cannot explain the rapid tumor blood flow reduction seen as a result of drug administration in vivo. However specific targeting of proliferating endothelial cells is important for the efficacy of anti-angiogenic cancer therapies. Indeed, using several models of angiogenesis in vitro and in vivo, Ahmed and colleagues20
recently demonstrated an anti-angiogenic component in the mechanism of action of CA-4-P. Here we demonstrate that spindle microtubules are very sensitive to treatment with CA-4-P. This appears to be the case for other microtubule-binding agents such as colchicine, vinblastine, and taxol that also cause mitotic arrest at concentrations below those required to depolymerize certain populations of cytoskeletal microtubules.37,47
Nanomolar concentrations of CA-4-P were found to be effective at inhibiting endothelial spindle assembly in vitro which could imply that low doses could confer potent anti-proliferative and anti-angiogenic effects. Whether low-dose regiments of CA-4-P can inhibit tumor angiogenesis in vivo remains to be determined. An important limitation would be the relative short half life of the drug in vivo.48
However, exposure to drug is undoubtedly higher in tumors than in normal tissues because of self-trapping as blood flow decreases. Cells in mitosis or about to enter mitosis at the time of CA-4-P administration would be most susceptible to these effects described here. Cells in asynchronous cell cultures began to accumulate in mitosis and showed signs of apoptosis at
8 hours after CA-4-P treatment. This correlation between time of detectable arrest in mitosis and detectable apoptosis may suggest that apoptosis follows after a relatively short period of mitotic arrest. Efficient targeting of the mitotic endothelial cell fraction would, in principle, benefit from repeated dosing of the drug in vivo. Interestingly, CA-4-P was recently shown to inhibit angiogenesis in a mouse model of proliferative retinopathy after a schedule of daily dosing of the drug.19
Further studies are necessary to establish whether repeated dose regimens of CA-4-P could be effective at inhibiting tumor blood vessel growth.
In conclusion the results of the current study identify a definitive link between mitotic arrest caused by the microtubule-targeting agent CA-4-P and cell death of endothelial cells. Further studies are warranted to better understand the underlying molecular mechanisms of mitotic arrest and the influence of the tumor microenvironment, to improve the susceptibility of the tumor microvasculature to microtubule-targeting agents such as CA-4-P.
| Footnotes |
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Supported by Cancer Research UK (grant no C1276/A3307).
Accepted for publication June 10, 2004.
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