Review |
From Molecular Cardiology, Whitaker Cardiovascular Institute, Boston University School of Medicine, Mass.
Correspondence to Kenneth Walsh, PhD, Molecular Cardiology/Whitaker Cardiovascular Institute, Boston University School of Medicine, 715 Albany Street, W611, Boston, MA 02118. E-mail kxwalsh{at}bu.edu
This Review is part of a thematic series on Transcription Factors, which includes the following articles:
Regulation of Vascular Inflammation and Remodeling by ETS Factors
Myocardin-Related Transcription Factors: Critical Coactivators Regulating
Cardiovascular Development and Adaptation
Notch Signaling in Blood Vessels: Who is Talking to Whom About What?
Role of Krüppel-like transcription factors in Endothelial Biology
Forkhead Transcription Factors and Cardiovascular Biology
Epigenetic regulation of Vascular Endothelial Gene Expression
Mukesh Jain Guest Editor
| Abstract |
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Key Words: angiogenesis endothelial cells forkhead transcription factors vascular biology
| Introduction |
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| FoxO Overview |
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| Regulation of FoxO Proteins |
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After their phosphorylation by kinases such as Akt and SGK, nuclear FoxO factors are tagged for export to the cytoplasm. Several mechanisms have been proposed to mediate this regulatory step.41 Phosphorylation on a serine residue (ie, S256 in FoxO1) situated at the C-terminal boundary of the forkhead domain (Figure 1) occurs within the nuclear localization signal (NLS) which spans that area.42,43 It is possible that such a phosphorylation event could interfere with the ability of NLS to interact with an importin family member and thereby reduce the tendency of FoxO to re-enter the nucleus. Furthermore, members of the protein family 14-3-3 that bind to phospho-serine and phospho-threonine motifs have been also implicated in the nucleocytoplasmic shuttling of FoxO. After phosphorylation at a conserved motif at the N terminus of the forkhead domain (ie, T24 in FoxO1), 14-3-3 proteins present in the nucleus are recruited to bind the FoxO protein. The phosphorylated motif at the NLS is also targeted for 14-3-3 binding.42–45 It is suggested that the conformational changes induced by 14-3-3 binding exposes nuclear export signals (NES) present in the FoxO protein.44 Generally, NES can be recognized for binding by the chromosomal region maintenance protein 1 (Crm1/exportin). This protein in turn can interact with nuclear Ran-GTP which mediates active translocation of Crm1/FoxO complexes to the cytoplasm. Additionally, 14-3-3 proteins could also mediate FoxO nuclear exclusion via NLS masking and there is also evidence that 14-3-3 interferes with the DNA-binding activity of FoxO.46–48 Collectively, the complexity of the mechanisms described above highlights the significance of this posttranslational modification in the overall regulation of FoxO proteins in the cell.
Another important question in FoxO regulation is how these factors control the transcription of target genes. Early studies using comparative and PCR-assisted binding selection approaches identified the core consensus sequence TTGTTTAC as a binding site for FoxO.18,19 This sequence termed the Daf-16 family protein-binding element (DBE) is likely the optimal sequence that affords the strongest binding for all FoxO isoforms (FoxO1, FoxO3, FoxO4) and their C. elegans homolog Daf-16. This sequence occurs in the promoter regions of the human and worm genes encoding manganese superoxide dismutase (MnSOD),49 which has been identified as a downstream target of FoxO3.5 Recently, the crystal structure of the FoxO3 forkhead domain/DBE complex has been elucidated.50 Using a bioinformatics approach to search for genes containing DBE-like sequences, a number of genes from different species were identified as candidate FoxO targets.49 Moreover, sequences with similarity to the DBE are commonly found within insulin responsive elements.51 For example, the core insulin response sequence (IRS) is found in the promoters of glucose-6 phosphatase (G6Pase), phosphoenol- pyruvate carboxykinase (PEPCK) and the insulin-like growth factor binding protein-1.52,53 This IRS sequence [T(G/A)TTTTG] differs from the DBE in the last 2 bases and displays a weaker affinity for FoxO in in vitro DNA binding assays.19 This variability between optimal and suboptimal FoxO binding elements together with the tissue-specific expression pattern of the FoxO isoforms may contribute to a tightly controlled program of gene expression regulation. The list of candidate FoxO targets in the cardiovascular system is continuously expanding. A summary of confirmed FoxO target genes in vascular and cardiac cells can be found in the supplemental Table (available online at http://circres.ahajournals.org). Some of these genes are also discussed in other sections of the review.
On binding to target DNA sequences, FoxO factors can interact with other DNA/chromatin-associated proteins. The interaction between FoxO and the various cofactors is likely mediated by the transactivation domain (Figure 1). The LxxLL motif, found near the C-terminus of the transactivation domain, has been proposed to mediate the binding of FoxO with proteins from the family of nuclear receptors (NR).54 This is in agreement with studies demonstrating the functional interaction of FoxO with the estrogen receptor (ER), androgen receptor (AR), and retinoic acid receptor (RAR).54–56 Members from the NR family can bind directly to DNA and mediate either transcriptional activation or repression of their target genes, through modulating the chromatin structure around the promoter. Therefore, by facilitating the recruitment of NR family members to the promoters of target genes, FoxO can promote transcriptional activation or repression.
FoxO may also interact with other nuclear proteins to regulate transcription. For example, FoxO1 interacts with Smad transcriptional regulators to activate the transcription of p21cip.57 An interaction has been identified between FoxO and the transcriptional coactivator β-catenin in the context of oxidative stress in mammalian cells.58 FoxO1 has been shown to interact with the peroxisome proliferative activated receptor-
coactivator 1 (PGC-1) to activate the expression of G6Pase and PEPCK in hepatocytes.10 Interestingly, FoxO1 has been also shown to functionally interact with the transcription factor CCAAT/enhancer binding protein β (C/EBPβ),59 a protein that can also be expressed in liver and is implicated in the transcriptional activation of PEPCK.60 Taken together, these findings document the complex interaction between FoxO and a variety of transcriptional regulators that allow the cell to control the expression of related sets of target genes in a coordinated manner.
FoxO transcriptional activity is also regulated by acetylation/deacetylation. Silent information regulator (Sir) 2 is a class III histone deacetylase (HDAC) that regulates longevity in lower organisms.61–63 Sirt1, a mammalian homolog of Sir2, has been shown to promote resistance to environmental stress and suppress apoptosis through a FoxO-dependent mechanism in mammalian cells.64,65 FoxO3 is acetylated on at least 5 lysine residues. Generally, Sirt1 deacetylase action promotes stress adaptation and cell cycle arrest (and longevity in lower organisms), whereas the acetylation of FoxO promotes its apoptotic action. Therefore, it appears that phosphorylation controls the nuclear translocation of FoxO, but whether FoxO functions to promote survival or apoptosis in the nucleus may depend on an interaction with Sirt1 and its status of lysine acetylation. Recently, it has been demonstrated that FoxO represent molecular targets of Sirt1 in endothelial cells (ECs).66 In this cellular context it was found that Sirt1 activity is associated with negative regulation of FoxO1, which is in contrast with other reports suggesting a positive effect of Sirt1-mediated deacetylation on FoxO transcriptional activity.65,67,68 In this study it is also proposed that HDAC, likely from group I/II, can be also involved in the deacetylation of FoxO to mediate transcriptional inactivation in ECs.66
| FoxO in Cellular Life and Death Decisions |
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In contrast, the Daf-16/Sir2 signaling axis in C. elegans has been shown to be important for cellular viability, adaptation to oxidative stress, and longevity.63,71 Similarly, studies in mammalian cells have shown that an important function of FoxO is the detoxification of ROS,5,6 a feature that is likely to contribute to its prosurvival and longevity-promoting actions. For example, a number of FoxO consensus binding sites occur in the catalase and MnSOD promoters, and both promoters are activated by FoxO in transient transfection assays in PC12 and 3T3-L6 cells, respectively.5,6 Brunet et al65 have reported that H2O2, but not UV irradiation or growth factor stimulation, promotes the deacetylation of FoxO, and this posttranslational modification promotes stress adaptation and cell cycle arrest versus apoptosis in mammalian cells. These data indicate that Sirt1 action changes FoxO-dependent responses from apoptosis-promoting to stress-resistance, thereby decreasing the stress-induced apoptosis that is associated with aging. Thus it appears that the ability of the FoxO factors to promote or inhibit apoptosis is highly dependent on the cellular environment. Under conditions of stimulation by mitogens, Akt signaling predominates and cells initiate a growth program. Under these conditions, the FoxO factors are inactivated and cellular survival is dependent on the PI3K/Akt signaling. On the other hand, FoxO signaling will predominate under conditions of quiescence, and the FoxO factors will activate pathways that ensure cell cycle arrest and long-term survival that is mediated by the ability of these transcription factors to activate ROS detoxification genes. Thus the opposing actions of Akt and the FoxO factors represent a checks and balances system that provides different mechanisms to ensure cell survival depending on whether the cell is actively growing in a nutrient rich environment (high levels of Akt signaling) or in a quiescent state where the ability to cope with oxidant stress over long periods is desirable (high levels of FoxO transcription).5 Given these considerations, it is reasonable to speculate that the apoptosis resulting from forced FoxO expression in many cellular contexts may be attributable to the generation of conflicting signals between Akt and FoxO regulatory programs.
| FoxO Forkhead Factors in the Regulation of Endothelial Cell Biology |
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The significance of FoxO factors in the postnatal vasculature has been further highlighted by the use of genetically engineered mice that allow the inducible ablation of FoxO genes.74 This system not only permits the study of homozygous null-FoxO1 mice that would otherwise die during embryogenesis, but also allows for different combinations of FoxO null alleles to be generated thereby revealing potential hierarchies and overlapping patterns of activity among these factors. Accordingly, generalized deletion of all 3 FoxO genes (FoxO1, FoxO3, and FoxO4) by the transient activation of Cre recombinase through the Mx1 promoter in 4- to 5-week-old mice results in the appearance of benign endothelial cell tumors termed hemangiomas. A less penetrant tumorigenic potential was also evident in mice rendered deficient in FoxO1, after Cre induction, with female mice developing uterine hemangiomas by the age of 60 weeks. Importantly, deficiency in either FoxO3 or FoxO4, or a compound FoxO3/FoxO4 gene deletion did not recapitulate the tumor prone phenotype observed in FoxO1-deficient mice, suggesting that in ECs, FoxO1 is the dominant factor required for the suppression of tumor formation. Downstream targets of FoxO in ECs identified in this study include the FGF-signaling antagonist Sprouty2, which is positively regulated by FoxO, and the homeobox-like transcription factor Pbx1, which is downregulated by the activity of FoxO.74 Collectively, these findings are consistent with the long purported role of FoxO factors in tumor suppression and they further illustrate the extensive functional redundancy of these factors. Moreover, they document the physiological significance of these factors in the maintenance of postnatal vasculature.
A number of studies have focused on FoxO factors in ECs as downstream targets of PI3K/Akt signaling (Figure 2). Several approaches have been used to activate Akt and modulate FoxO phosphorylation. In one study, vascular endothelial growth factor (VEGF) signaling was implicated in the regulation of FoxO transcriptional activity.75 Akt phosphorylation and activation was induced in cultured ECs treated with VEGF and this resulted in the phosphorylation, cytoplasmic sequestration, and transcriptional inactivation of FoxO factors. Moreover, VEGF stimulation induced the survival and proliferation of ECs whereas the adenoviral delivery of a FoxO3 isoform which is triply mutated at the conserved Akt phosphorylation sites (TM-FoxO3) abolished these effects. Concomitant treatment of cells with VEGF and transfection with TM-FoxO3 led to the identification of a number of VEGF-responsive genes in ECs that appear to be upregulated by the synergistic actions of both VEGF and FoxO activities.76 Examples of these genes include matrix metalloproteinase-10 (MMP-10), vascular endothelial cell adhesion molecule-1 (VCAM-1), endothelial specific molecule-1 (ESM-1), bone morphogenetic protein 2 (BMP-2), and CBP-interacting transactivator-2 (CITED-2). Additionally, the identification of putative FoxO responsive elements in the promoters of these genes suggests direct transcriptional regulation, although this merits further investigation. Another gene upregulated by VEGF and FoxO is MnSOD,75 a gene frequently shown to be upregulated by FoxO activity in many different cellular contexts and required for scavenging ROS. The fact that FoxO act in concert with VEGF to positively regulate the expression of target genes is paradoxical because of the documented ability of VEGF to induce the phosphorylation and nuclear exclusion of FoxO through activation of Akt signaling. Thus the regulation of genes by VEGF and FoxO is complex, and different degrees of phosphorylation or other posttranslational modifications may confer distinct effects. Furthermore, the interaction of FoxO with other transcription factors such as nuclear factor-
B (NF-
B) would likely contribute to this complexity.76
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In addition to VEGF, angiopoietin-1 (Ang-1) has also been reported to mediate inhibitory actions on FoxO in ECs.77 Ang-1 was shown to induce endothelial cell survival through the PI3K/Akt pathway,78 and unlike VEGF it does not induce vessel sprouting after EC proliferation but instead regulates vessel diameter.79 Ang-1 stimulation results in FoxO1 phosphorylation and inactivation, whereas transfection of primary ECs with constitutively-active FoxO1 (TM-FoxO1) promotes apoptosis.77 Microarray analysis of TM-FoxO1 transfected cells revealed regulation of several genes associated with either extracellular matrix remodeling (decorin, matrix metalloproteinase), angiogenesis (Flt-1, angiopoietin-2 [Ang-2]), apoptosis (TNF
-related apoptosis-inducing ligand [TRAIL], survivin) or cell cycle (cyclin D1).77 In this regard, it has been shown that Ang-2 secretion in ECs expressing TM-FoxO1 can activate the receptor Tie2.80 This, in turn, can stimulate PI3K/Akt signaling leading to phosphorylation and inhibition of FoxO. Accordingly, it is conceivable that under conditions of EC stress, excessive apoptosis conferred by the activation of FoxO1 can be bypassed by the initiation of a negative feedback loop involving autocrine stimulation of PI3K/Akt signaling by Ang-2.80
An important regulator of EC biology is fluid shear stress generated by blood flow, which leads to activation of Akt, eNOS, and AMP activated protein kinase (AMPK).81–83 Consistent with the regulation of FoxO factors by at least some of the above molecules, there is emerging evidence to suggest that FoxO factors may have functional implications in the response of ECs to shear forces.81,84 Under conditions of sustained fluid shear stress it has been shown that FoxO1 becomes rapidly phosphorylated and inactivated, likely involving an AMPK-dependent mechanism rather than Akt.81 Moreover, FoxO1 activity in this system has been associated with the expression of 3-hydroxyl 3-methylglutaryl-coenzyme A reductase (HMG-CoA-R), which catalyzes the rate limiting step in the de novo biosynthesis of cholesterol. Indeed, knockdown of FoxO1 in endothelial cells results in reduced amounts of mRNA encoding HMG-CoA-R.81 The biological significance of HMG-CoA-R downregulation in the context of fluid shear stress remains elusive, although a proposed mechanism suggests that reduced enzymatic activity can result in attenuated isoprenylation of small guanosine triphosphatases (GTPase) such as Ras, which activate the MEK/ERK pathway. Nevertheless, inhibition of FoxO activity, mediated by AMPK can promote survival of ECs, based on the general proapoptotic potential of FoxO factors. FoxO1 downregulation in response to shear stress has been also documented independently, although in this case Akt is shown to mediate the phosphorylation/inactivation step.84 Here, FoxO1 inhibition was accompanied by a downregulation of p27kip, as well as Ang-2, which is consistent with previous studies demonstrating a dependence of Ang-2 expression on FoxO1 activity.77,80
In another study, 11, 12-epoxyeicosatrienoic acid (11, 12-EET), which has mitogenic effects on ECs,85 attenuated the expression of the cyclin dependent kinase (CDK) inhibitor p27kip.86 Further investigation revealed that PI3K/Akt signaling was activated in ECs on 11, 12-EET treatment, and this promoted the phosphorylation and transcriptional inactivation of FoxO1 and FoxO3.
Further analysis of the role of FoxO factors has revealed that different members of the subgroup have overlapping but not identical regulatory functions in ECs. For example, it has been reported that constitutively-active FoxO1 and FoxO3 but not FoxO4 reduce sprout formation and migration in vitro.87 Conversely, knockdown of endogenous FoxO1 and FoxO3 enhances the angiogenic activity of cultured ECs. Consistent with these observations, FoxO3-null mice exhibited enhanced neovascularization in ischemic hind limbs and matrigel implants.87 Analysis of downstream targets likely to be regulated by FoxO1 or FoxO3 demonstrated that these transcription factors were functionally redundant in ECs, although there are some gene-specific effects as well. For example, endothelial nitric oxide synthase (eNOS) expression was found to be negatively regulated by both FoxO1 and FoxO3, whereas Ang-2 was positively regulated by FoxO1 but not FoxO3. The negative effects of FoxO on eNOS are of particular interest with regard to the well documented significance of eNOS in vascular remodeling, vasodilation, and postnatal neovascularization. This study also demonstrated that both FoxO1 and FoxO3, but not FoxO4, can physically interact with a conserved forkhead responsive element in the promoter of the eNOS gene and inhibit the transcription of this gene.87
Additional studies in ECs demonstrated that FoxO factors regulate the extrinsic apoptotic pathway, mediated by the death-inducing signaling complex (DISC), or the intrinsic apoptotic pathway, mediated by the apoptosome.70,88 Caspase-8 (FLICE) performs the initiating phase of the extrinsic apoptotic cascade and its activity can be inhibited by FLICE inhibitory protein (FLIP), which in ECs has been demonstrated to be under the positive regulation of PI3K/Akt signaling.89 Conversely, transduction of ECs with adenovirus expressing TM-FoxO3 results in a reduction of FLIP mRNA and protein levels, and this is associated with increased caspase-8 activity and reduced EC viability.70 Furthermore, in a screen for downstream targets of PI3K/Akt signaling in ECs, heat shock protein (Hsp)-70 was found to be potently upregulated, an effect largely reversed by the ectopic expression of TM-FoxO3.88 Hsp70 downregulation as a result of TM-FoxO3 activity resulted in reduced EC viability. Hsp70 has been shown to inhibit Apaf-1 oligomerization and interfere with the recruitment of pro–caspase-9 to the apoptosome thereby blocking the intrinsic apoptotic pathway.90 Collectively, these studies indicate that FoxO3 can play a role in coordinating the processes that regulate EC apoptosis.
There is also evidence implicating FoxO factors in the inhibition of EC senescence mediated by the accumulation of ROS. In cultured primary ECs, it was shown that constitutively-active Akt signaling reduces cellular lifespan and is associated with premature growth arrest.91 Inhibition of FoxO3 by Akt was essential for growth arrest to occur. The growth arrest effect likely stems from the hyperactivation of the transcription factor p53 and subsequent accumulation of the cyclin-dependent kinase inhibitor p21cip. Although the connection between p53 and FoxO is not fully understood, this study suggests that activation of Akt results in the inhibition of FoxO3 and accumulation of ROS that eventually activate p53 and its downstream target p21cip.91
| FoxO Forkhead Factors and Endothelial Progenitor Cells |
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Pertinent to the findings suggesting that EPCs isolated from diabetic patients are largely dysfunctional,95,100 a recent study has established a link between glucotoxicity and FoxO activity in EPCs.96 In this study, it was shown that increased levels of glucose induce a distinct pattern of posttranslational modifications on FoxO1, characterized by reduced phosphorylation on Akt consensus sites, and enhanced acetylation on lysine residues. Under these conditions FoxO1 nuclear localization is accompanied by upregulation of the proapoptotic factors Bim and FasL. Furthermore, catalase expression is downregulated suggesting a switch in gene expression patterns from stress resistance to cell death. Indeed, EPCs treated with high levels of glucose show increased rates of apoptosis, and this effect was reversed by benfotiamine,96 a thiamine derivative shown to inhibit vascular damage under conditions of hyperglycemia.101 Therefore, it is suggested that aberrant activation of FoxO factors under conditions of glucose toxicity may be associated with the impaired ability of EPCs to differentiate and promote de novo tube formation.96 Taken together, studies where EPCs are challenged with high doses of H2O2 or glucose suggest that FoxO factors are intimately associated with induction of apoptosis, which can be at least in part inhibited by active PI3K/Akt signaling.
| FoxO Forkhead Factors in Vascular Smooth Muscle Cells |
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The involvement of FoxO factors in regulating VSMC proliferation through modulation of cell cycle has also been documented. For example, cyclic strain has been shown to induce an integrin-dependent downregulation of p27kip, and this is associated with increased cell cycle entry.103 Under these conditions, p27kip downregulation requires the phosphorylation and activation of Akt, and this effect is reversed by transduction with TM-FoxO3 or TM-FoxO4. FoxO-mediated p27kip regulation in VSMCs has been also documented in other experimental models. Stimulation of coronary artery VSMCs with platelet-derived growth factor (PDGF), tumor necrosis factor-
(TNF-
), or insulin-like growth factor-1 results in the phosphorylation and nuclear exclusion of FoxO factors in VSMCs.104 Moreover, this study shows that transduction with TM-FoxO3 increases p27kip mRNA levels, suppresses proliferation induced by mitogens, and increases the number of apoptotic cells. Some of these effects appeared to be mediated by the upregulation of p27kip, as siRNA knockdown of the gene partly abrogated the anti-proliferative effects of active FoxO3.
Carotid artery balloon injury has been used to test the significance of FoxO on VSMC proliferation in vivo. Consistent with its antiproliferative effect in cultured cells, adenoviral delivery of TM-FoxO3 in arteries decreases the proliferation of VSMCs and reduces the intima/media ratio and these effects are accompanied by an increase in p27kip levels.104,105 Moreover, it was also shown that TM-FoxO3 delivered to the site of injury will increase the frequency of VSMC apoptosis,105 an effect that is consistent with earlier observations documenting the proapoptotic effects of active FoxO in cultured VSMCs.69 Collectively, findings from these studies point to FoxO factors in VSMCs as important regulators of neointimal hyperplasia after angioplasty.
Recent evidence also suggests that the upregulation of p27kip may not be the only mechanism by which FoxO factors inhibit the proliferation of VSMCs. Indeed, the cysteine-rich protein 61 (CYR61), a potent angiogenic factor rapidly secreted after angioplasty or angiotensin II stimulation, has been shown to be negatively regulated by FoxO in VSMCs.106 CYR61 is an extracellular matrix–associated protein that can interact with integrins to promote VSMC migration and adhesion, and it has been implicated in processes such as vascular development, postnatal neovascularization, atherosclerosis, and vascular restenosis.107–111 A functional association between FoxO and CYR61 was first noted after identification of a forkhead binding element in the promoter of CYR61 gene. Adenoviral delivery of constitutively-active FoxO3 was shown to suppress CYR61 expression, inhibit proliferation, and reduce cell viability.106 Overexpression of CYR61 partially reverses the antiproliferative but not the proapoptotic effect conferred by activated FoxO3. Furthermore, transduction with TM-FoxO3 interferes with the pathway that mediates activation of CYR61 by angiotensin II and suppresses the migration-stimulating effect of CYR61 in VSMCs in vitro. This study also showed that adenoviral delivery of constitutively-active FoxO3 in rat carotid arteries after balloon injury results in reduced neointimal hyperplasia, an effect that was paralleled by a reduction of endogenous CYR61 expression. Conversely, concomitant delivery of adenovirus expressing CYR61 reversed the intima-sparing effect of TM-FoxO3.106 Thus, this study illustrates another pathway through which FoxO factors can minimize the increase in cellularity in the vessel wall after acute injury.
Cyclins D1 and D2 are key regulators of cell proliferation that promote the transition from the G1 to the S phase of the cell cycle. Previous studies performed in primary embryonic fibroblasts and cancer cell lines showed that enforced FoxO4 expression resulted in the suppression of D-type cyclins, and this effect was associated with reduced CDK activity and subsequent cell cycle arrest independent of p27kip regulation.112 More recently, a correlation between FoxO activity and cyclin D expression was also reported in the regulation of VSMC proliferation.113 In this study, betacellulin (BTC), which acts as a ligand for the epidermal growth factor receptor, was shown to activate the PI3K/Akt signaling pathway leading to the phosphorylation of FoxO. BTC-stimulation also induced glycogen synthase kinase-3
/β (GSK-3
/β) phosphorylation and increased nuclear localization of β-catenin, which associates with T-cell factor (TCF) to upregulate downstream target genes such as Cyclin D. BTC-stimulated Akt signaling also promoted the phosphorylation of FoxO, and it was suggested that β-catenin nuclear localization in conjunction with FoxO phosphorylation is required for the upregulation of cyclin D1.113 Along these lines, there is emerging evidence from C. elegans to suggest that in conditions of oxidative stress β-catenin may interact directly with FoxO to activate its transcriptional activity.58 These findings support a model in which β-catenin can switch partners between FoxO and TCF to mediate cell cycle arrest or progression, respectively, depending on environmental conditions.
The well-documented association between FoxO and MnSOD expression has also been described in VSMCs.114 MnSOD protein levels and activity were shown to be reduced in VSMC upon aging. Further investigation demonstrated that FoxO activity is required for optimal MnSOD transcription and that reduced nuclear localization of FoxO occurs in VSMC derived from old animals. Moreover, the attenuated nuclear localization of FoxO factors could be ascribed to hyperactivation of the PI3K/Akt signaling. These data suggest that aged VSMCs may be in higher risk for oxidative damage because the pathway maintaining MnSOD expression has been impaired as a result of aberrant activation of Akt.
The transition of VSMCs from a contractile to a more proliferative phenotype has been recently shown to be modulated by FoxO4.115 FoxO4 localization in the nuclei of cultured aortic smooth muscle cells was associated with reduced expression of myogenic markers. Myogenic differentiation-specific genes likely to be repressed by nuclear FoxO4 include SM
-actin, SM-calponin, and SM-22
. These genes are under the positive regulation of myocardin,116 a transcription coactivator which is essential for the induction of differentiation in VSMCs.117,118 The physical interaction of FoxO4 with myocardin in cultured aortic smooth muscle cells was shown to repress the ability of myocardin to initiate the smooth muscle cell differentiation program.115 These findings suggest a model whereby the stimulation of VSMCs with growth factors, such as insulin-like growth factor-1, activates the PI3K/Akt pathway, which in turn inactivates FoxO4 and derepresses a myogenic program which is under the positive regulation of myocardin and its transcriptional partner serum response factor (SRF). Conversely, nuclear prevalence of FoxO4 is expected to suppress the differentiation program and promote a dedifferentiated and more proliferative phenotype. In agreement with this model, the nuclear translocation of FoxO4 was found to occur in proliferating VSMCs after in vivo vascular injury.115 These findings appear to be somewhat contradictory to the evidence described earlier, where constitutive nuclear localization of FoxO3 was shown to inhibit neointimal hyperplasia104,105 and that nuclear exclusion of FoxO3 is rapidly induced after carotid balloon injury.105 Nevertheless, it is possible that different FoxO factors may function in a distinct or even opposite manner in response to vascular injury, although no mechanistic evidence is currently available to support this notion. In this regard, it should be noted that FoxO4 was found to mediate its inhibitory effects on VSMC differentiation in a DNA-binding independent manner,115 suggesting that FoxO domains other than the forkhead domain may be responsible for this functional diversification.
In atherosclerotic lesions, TNF-
is released by macrophages and VSMCs and it enhances VSMC migration and promotes the expression of cell adhesion molecules and matrix metalloproteinases (MMP).119 Although the effects of TNF-
on vascular pathophysiology are likely to be pleiotropic, recent data suggest that these effects in VSMCs can be partially mediated by FoxO4 in a PI3K/Akt-independent manner.120 It has been demonstrated that FoxO4 genetic insufficiency (knockout or knockdown) in cultured aortic smooth muscle cells impairs their ability to migrate in response to TNF-
and this effect is partially reversed by the addition of MMP9 in the cultures. Consistent with a model whereby TNF-
activates MMP9 expression through FoxO4, depletion of FoxO4 in VSMCs blocks the induction of MMP9 after TNF-
stimulation. Moreover, FoxO4 ectopic expression in VSMCs was shown to activate MMP9 reporter constructs, and the DNA-binding activity of FoxO4 was dispensable for this effect.120 Further investigation demonstrated a specific interaction between FoxO4 and the transcription factor Sp1, suggesting that the formation of a ternary complex relying on the DNA-binding activity of Sp1 is necessary for the activation of MMP9 transcription. Finally, FoxO4-null mice subjected to carotid artery ligation exhibited reduced intimal formation compared with wild-type mice, and this effect was paralleled by a reduced expression of MMP9 in the knockout mice.120 This study implicates FoxO4 in the regulation of genes which are required for VSMC migration after inflammatory stimulation through its ability to supply transactivating domains, rather than directly engaging target DNA sites. This study also supports the notion that FoxO4 may have unique functions that are distinct from FoxO1 or FoxO3. Indeed, FoxO1 was not able to upregulate MMP9 in response to TNF-
, although it was shown to interact with Sp1. However, when the C-terminal region of FoxO4 was used to replace that of FoxO1, the resulting protein achieved comparable transactivation of MMP9. Thus, distinct functional domains between different FoxO factors may explain why in some studies FoxO3 activity is found to inhibit VSMC proliferation and neointimal hyperplasia, whereas in others FoxO4 activity promotes VSMC dedifferentiation and enhanced migration.
| Non-FoxO Forkheads Implicated in Vascular Development and Homeostasis |
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The role of FoxF1 in the lung vasculature has been highlighted by gene-targeting studies in mice. FoxF1 deficiency results in premature death before embryonic day 10 because of defects in extra-embryonic mesoderm (Table).127 In contrast, FoxF1 haploinsufficiency results in perinatal lethality attributable to lung malformations128 and hemorrhage,129 indicating that FoxF1 is essential for lung morphogenesis. Immunohistochemical studies showed that FoxF1 is expressed in alveolar endothelial cells positive for the platelet endothelial cell adhesion molecule-1 (PECAM-1/CD31), and this expression was shown to be partly dependent on the activity of the sonic hedgehog (Shh) signaling pathway.128 Further histological examination showed that the tight junctions formed between endothelial and epithelial cells were defective in FoxF1-deficient lungs, resulting in disruption of the alveolar capillaries.129 Additionally, lung microvasculature abnormalities associated to FoxF1 haploinsufficiency were paralleled by reduced levels of Notch-2 receptor, and it was shown that the FoxF1 can directly interact with putative binding sites situated in the promoter of the Notch-2 receptor gene.130 Collectively, these data suggest that FoxF1 expressed in lung endothelial cells can integrate multiple inputs from morphogens, such as Shh, BMP, and FGF, and mediate normal development of peripheral lung microvasculature through activation of Notch-2 receptor pathway. Of note, FoxF1 binding sites have been identified in the regulatory elements of genes that are critical for EC viability and maintenance of vascular homeostasis, such as the receptor tyrosine kinase Flk1, vascular endothelial cadherin, and PECAM-1.131
There is also evidence implicating FoxM1 transcription factor in lung vasculogenesis. Targeted deletion of FoxM1 gene in mice results in embryonic lethality attributable to multiple defects, including malformation of peripheral pulmonary capillaries and excessive hypertrophy of arteriolar smooth muscle cells.132 These defects were attributed to reduced proliferation rates of the lung mesenchyme and lower than normal expression levels of different endothelial specific molecules including Flt-1, PECAM-1, and FoxF1. Transgene-mediated overexpression of FoxM1 was associated with increased proliferation levels of pulmonary endothelial and smooth muscle cells and an improved response to lung repair after experimental injury.133 It is proposed that FoxM1 functions during lung development to enhance lung mesenchyme proliferation, including the vascular compartment, and its upregulation during adult life can be beneficial in injured lung, through enhanced proliferation of vasculature and other lung cells. These findings were further corroborated by studies using endothelial-restricted ablation of FoxM1.134 After LPS-induced microvascular injury in the lung, severe edema and increased mortality was observed in these mice, attributed to an inability to reestablish the endothelial barrier. Mechanistically, it is proposed that FoxM1 increases proliferative rates in endothelial cells by upregulating cyclin B1 and Cdc25C and by repressing p27Kip1 activities.134 Thus, in endothelial and vascular smooth muscle cells, FoxM1 may operate in an opposite manner from that of the FoxO proteins which must be inactivated to allow cell cycle progression.86,113 FoxM1 is also regulated at the level of cytoplasmic retention,135 a feature reminiscent to the regulation of FoxO proteins by Akt phosphorylation and their nuclear exclusion.9,34
| Forkhead Factors and Lymphangiogenesis |
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| FoxO Factors in Cardiac Hypertrophy |
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Target genes thought to mediate the antihypertrophic actions of FoxO factors include atrogin-1/MAFbx and MuRF1 E3 ubiquitin ligases, which promote proteasome-mediated protein degradation.16 In the heart, atrogin-1/MAFbx mRNA is downregulated by activation of an Akt1 transgene in myocytes and upregulated after Akt1 transgene repression.17a,144 These data suggest that Akt signaling simultaneously activates protein synthesis and inhibits protein degradation in the heart. This notion is consistent with the observation that termination of Akt transgene expression after 2 weeks of induction results in an extremely rapid decrease in heart size in an inducible Akt1 transgenic mouse model.145 This rapid decrease in heart size is presumably attributable to combinatorial effects of decreased protein synthesis and increased protein degradation.
In the heart, atrogin-1 is reported to interact with and repress calcineurin by targeting calcineurin for ubiquitin-mediated proteolysis, leading to inhibition of cardiac hypertrophy in response to pathologic stimuli.146 Ni et al reported that overexpression of either wild-type and constitutively-active forms of FoxO1 or FoxO3 reduces calcineurin phosphatase activity and suppresses the expression of the modulatory calcineurin interacting protein exon 4 isoform MCIP1.4, a direct target of the calcineurin/NFAT cascade.147 They also documented that FoxO3-deficient mice showed
10% increase in heart weight compared with wild-type mice at baseline, but both strains displayed similar degrees of cardiac hypertrophy when subjected to pressure overload. Interestingly, it was recently reported that FoxO1 and FoxO3 can be direct targets of atrogin-1 ubiquitination in the heart.148 The ubiquitination does not target FoxO factors for proteasomal degradation but enhances their transcriptional activity. These findings suggest a feed-forward mechanism involving FoxO and atrogin-1 and provide additional insights about the complex regulation of FoxO factors during postnatal heart growth.
Alcendor et al have shown that moderate levels of Sirt1 overexpression protect the heart from oxidative stress and apoptosis through a FoxO1-dependent mechanism.149 They also showed that overexpression of either Sirt1 or constitutively-active FoxO1 stimulated expression of catalase, whereas transduction of dominant negative FoxO1 in cultured cardiac myocytes resulted in reduced catalase expression. On the other hand, it was also reported that overexpression of FoxO1 activated transcription of TRAIL in cultured cardiac myocytes, and this response was enhanced by phenylephrine and inhibited by epidermal growth factor.150
| Non-FoxO Forkheads Involved in Cardiac Development |
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| Summary and Future Directions |
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Gene targeting in mice has greatly contributed to our understanding of the function of FoxO in the vasculature. Mice simultaneously deficient for FoxO1, FoxO3, and FoxO4 display a hyperproliferative phenotype in ECs that ultimately leads to formation of hemangiomas. In addition, gene targeting has shown that members of forkhead subgroups other than FoxO participate in the regulation of the developing heart and vasculature. Factors from the subgroup FoxC are involved in arterial specification during development, lymphatic vessel morphogenesis, and in the patterning of the outflow tract and right ventricle in the developing heart. Moreover, factors from the subgroup FoxM are involved in the regulation of cell proliferation of lung peripheral microvasculature while they also participate in the coordinated proliferation and growth of cardiac and vascular myocytes.
Although great progress has been made in our understanding of forkhead factors, many questions remain to be answered. The study of forkheads in vivo has been greatly hampered by the fact that some homozygous knockout mice display embryonic lethality attributable to severe developmental defects in the heart and vasculature. Thus, greater use of both spatial and temporal conditional knockouts will permit a better dissection of the in vivo functions of these factors which so heavily impact the cardiovascular system.
With regard to the established roles of FoxO, it is apparent that the regulation conferred by these factors is very complex, and they can activate opposing cell fates (eg, apoptosis and stress-resistance) depending on their degree of posttranslational modification and cellular context. The regulation by Akt or Sirt1 may be the most pronounced examples of a complex network of FoxO protein modifications that regulate their function. Additional complexity may derive from the ability of these factors to either cooperate or antagonize the activity of other transcription factors or DNA-associated proteins. Additionally, complexity exists within the FoxO group itself. In vivo and in vitro studies have shown that despite a general functional redundancy, FoxO isoforms may also exhibit individual functions that are conferred by protein regions outside of the forkhead domain.
With regard to EPCs, future studies should test the hypothesis that FoxO transcription factors control the function of these cells by regulating their resistance to oxidative stress. Presumably, FoxO transcription factors activate a genetic program that confers quiescence and resistance to stress when EPCs are present in their bone marrow niche. However, under conditions of EPC mobilization a new program that confers proliferation and differentiation is activated through an increase in Akt signaling and an inhibition of the FoxO transcriptional program.
With regard to the heart, it will be interesting to test whether FoxO factors regulate autophagy, an intracellular degradation process for protein and organelles. Importantly, autophagy is increased by stresses in the heart, and this process appears to be dysregulated in various cardiac pathologies. Finally, myocardial substrate metabolism plays a key role in the maintenance of contractile function particularly under ischemic conditions. Because FoxO factors regulate metabolism in various tissues, the analysis of FoxO in acute or chronic myocardial ischemia could provide interesting insights.
| Acknowledgments |
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This work was supported by NIH grants HL86785, HL77774, and HL81587.
Disclosures
None.
| Footnotes |
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| References |
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