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Circulation Research. 2001;88:1004-1011
Published online before print May 10, 2001, doi: 10.1161/hh1001.090878
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(Circulation Research. 2001;88:1004.)
© 2001 American Heart Association, Inc.


Molecular Medicine

Coexpression of Mutant p53 and p193 Renders Embryonic Stem Cell–Derived Cardiomyocytes Responsive to the Growth-Promoting Activities of Adenoviral E1A

Kishore B. S. Pasumarthi, Shih-Chong Tsai, Loren J. Field

From the Wells Center for Pediatric Research and Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Ind. Present address of S.-C.T. is Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, Republic of China.

Correspondence to Dr Loren J. Field, Herman B Wells Center for Pediatric Research, James Whitcomb Riley Hospital for Children, 702 Barnhill Dr, Room 2600, Indianapolis, IN 46202-5225. E-mail ljfield{at}iupui.edu


*    Abstract
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*Abstract
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Abstract—Expression of adenoviral E1A in cardiomyocytes results in the activation of DNA synthesis followed by apoptosis. In contrast, expression of simian virus 40 large T antigen induces sustained cardiomyocyte proliferation. Previous studies have shown that T antigen binds to 2 proapoptotic proteins in cardiomyocytes, namely the p53 tumor suppressor and p193 (a new member of the BH3-only proapoptosis subfamily). Structure-function analyses identified a p193 C-terminal truncation mutant that encodes prosurvival activity. This mutant was used to test the role of p193 in E1A-induced cardiomyocyte apoptosis. E1A induced apoptosis in cardiomyocytes derived from differentiating embryonic stem cells. Expression of the prosurvival p193 mutant alone or a mutant p53 alone did not block E1A-induced apoptosis. In contrast, combinatorial expression of mutant p193 and mutant p53 blocked E1A-induced apoptosis, resulting in a proliferative response indistinguishable from that seen with T antigen. These results confirm the hypothesis that there are 2 proapoptotic pathways, encoded by p53 and p193, respectively, which restrict cardiomyocyte cell cycle activity in differentiating embryonic stem cell cultures. Furthermore, these results explain in molecular terms the phenotypic differences of E1A versus T-antigen gene transfer in cardiomyocytes.


Key Words: cardiomyocyte proliferation • cardiac myocyte apoptosis • heart regeneration


*    Introduction
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*Introduction
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The capacity of adult mammalian cardiomyocytes to initiate DNA synthesis and to subsequently divide appears to be quite limited.1 2 Consequently, the ability of the heart to undergo regenerative growth in disease states is also limited, a fact underscored by the high morbidity and mortality rates for individuals with severe cardiovascular disease. It is generally believed that increasing the number of functional cardiomyocytes in a diseased heart would have a positive impact on contractile activity provided that the new cells participate in a functional syncytium. This belief has fostered the development of a number of novel approaches to increase cardiomyocyte number.3 4 One approach has focused on the identification of key cardiomyocyte cell cycle–regulatory proteins, with the hope that exploitation of these proteins (or their respective regulatory pathways) could promote regenerative myocardial growth.3 Toward that end, a number of gene transfer approaches have been used to target expression of the simian virus 40 (SV40) large T antigen (T-Ag) or the adenoviral E1A oncoproteins to cardiomyocytes in an effort to induce proliferation. Targeted expression of T-Ag to atrial or ventricular myocardium in transgenic mice can induce a proliferative response,5 6 7 which in most instances results in the formation of tumors comprising differentiated, proliferating cardiomyocytes. In contrast, the ability of E1A to induce cardiomyocyte proliferation appears to be more restricted. Although E1A expression in cultured fetal or neonatal cardiomyocytes can reactivate DNA synthesis, this is followed rapidly by apoptosis.8 9 10 11 12

It is well established that DNA tumor virus oncoproteins subjugate cell cycle activity by binding to and altering the activity of endogenous cell cycle regulators.13 In light of this paradigm, identification of the cardiomyocyte T-Ag and E1A binding partners could provide insight into cell cycle regulation in the myocardium. In the case of T-Ag, 3 prominent cardiomyocyte binding proteins have been identified. They are the p53 tumor suppressor,14 15 p107 (a member of the retinoblastoma protein gene family),14 16 and p193 (a novel member of the BH3-only family of proapoptosis proteins).14 17 The same set of T-Ag binding proteins was detected in multiple independently derived tumor cell lines, as well as in primary cardiomyocyte cultures from the transgenic tumors. In the case of E1A, retinoblastoma protein family members (pRB, p107, and p130) and p300 (a transcriptional coactivator with intrinsic histone acetylase activity) were identified as cardiomyocyte binding proteins.10 Thus, T-Ag possesses several antiapoptotic activities that are lacking in E1A (namely the ability to bind to 2 proapoptotic proteins, p53 and p193). Given the cell death observed in response to E1A expression, we would anticipate that expression of E1A in conjunction with blockade of both the p53 and the p193 pathways would induce cardiomyocyte proliferation, rather than apoptosis, as was reported previously where one or both of these proapoptotic pathways were intact.8 9 10

In this report, a preliminary structure-function study was initiated to further characterize the proapoptotic activity encoded by p193. Surprisingly, a mutant molecule encoding p193 amino acid residues 1 to 1152 possessed growth-promoting activity in an NIH-3T3 assay similar to that observed with a p193 antisense expression construct. Additional analyses revealed that expression of this mutant rendered NIH-3T3 cells resistant to methyl methanesulfonate (MMS)–induced apoptosis. The availability of a prosurvival p193 variant and a mutant p53 (which is able to block p53-induced apoptosis) enabled us to directly test the hypothesis that DNA tumor viral oncoprotein activation of the cardiomyocyte cell cycle requires blockade of both the p193 and the p53 pathways. Expression of E1A in embryonic stem (ES) cell–derived cardiomyocytes led to widespread apoptosis. E1A induced similar levels of apoptosis in cardiomyocytes expressing mutant p53 or mutant p193. In contrast, coexpression of mutant p53 and mutant p193 blocked E1A-induced apoptosis, resulting in a proliferative response indistinguishable from that seen with SV40 T-Ag gene transfer. These results provide an explanation in molecular terms for the different phenotypes observed in cardiomyocytes expressing T-Ag versus E1A.


*    Materials and Methods
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*Materials and Methods
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Recombinant Clones
cDNAs encoding full-length17 and C-terminal–deleted p193 were subcloned into the pRC/cytomegalovirus (CMV) expression vector (Invitrogen). The mouse {alpha}-cardiac myosin heavy chain (MHC) promoter18 was used to generate expression constructs for the ES cell–derived cardiomyocyte colony growth assay. For generation of a mutant p53 expression cassette, a p53 genomic clone from CB7 cells was used.19 20 For generation of an E1A expression cassette, a wild-type E1A genomic clone was used.

NIH-3T3 Colony Growth Assay
NIH-3T3 cells (American Type Culture Collection) were transfected using a calcium phosphate approach,21 selected in G418 (300 µg/mL) for 15 days, and stained with gentian violet. Stable cell lines were obtained by prolonged G418 selection. Transfection efficiencies were calculated by monitoring expression of a cotransfected CMV-ßGAL reporter gene at 48 hours after transfection.

Assessment of Apoptosis
NIH-3T3 cells were grown at a concentration of 3x106 cells per dish and treated with MMS. In other experiments, cells from microdissected beating clusters from the ES cell–derived cardiomyocyte colony growth assay were analyzed. Cells were processed using a DNA ladder kit (Roche). For terminal deoxynucleotidyltransferase–mediated dUTP nick-end labeling (TUNEL), dispersed cell preparations were plated onto fibronectin-coated chamber slides and processed using an in situ cell death detection kit (Roche).

ES Cell Culture Conditions and Cardiomyocyte Colony Growth Assay
Undifferentiated R1 ES cells were transfected via electroporation with a construct carrying both an {alpha}-MHC–aminoglycoside phosphotransferase (MHC-neor) and a phosphoglycerate kinase (pGK)-hygromycin–resistant transgene in a common pBM20 vector backbone (Boehringer-Mannheim).22 In some studies, the cells were cotransfected with multiple expression vectors. Transfected cells were selected by incubation in growth medium containing hygromycin B (200 µg/mL) for 7 days and dissociated, and 4x106 cells were plated per 100-mm bacterial dish and cultured in growth medium lacking leukemia inhibitory factor (LIF). After 4 days of culture, the resulting embryoid bodies were plated onto cell culture dishes. When spontaneous contractile activity was noticed, growth medium supplemented with G418 (200 µg/mL) was added to eliminate the noncardiomyocytes. Transfection efficiencies were calculated by monitoring expression of a cotransfected CMV-ßGAL reporter gene at 48 hours after transfection. To visualize cardiomyogenic induction, the plates were stained with periodic acid–Schiff (PAS) reagent.

Assessment of Gene Expression
For Western blots, protein samples were displayed on polyacrylamide gels; transferred to nitrocellulose; and reacted with anti-p53 PC35 (Oncogene), anti-E1A M73 (Santa Cruz Biotechnology), anti–T-Ag PAB-416 (Oncogene), or anti–sarcomeric myosin MF20 (Developmental Studies Hybridoma Bank, University of Iowa, Iowa City, Iowa) as described.17 23 24 For Northern blots, total RNA was purified and processed as described.17 21 25

An expanded Materials and Methods section can be found in the online data supplement available at http://www.circresaha.org.


*    Results
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*Results
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Identification of a p193 Mutant Encoding Prosurvival Activity
In a preliminary effort to establish structure-function relationships, a series of expression vectors encoding p193 molecules with nested C-terminal truncations was generated and tested in an NIH colony growth assay. Transfection with a control expression vector lacking a cDNA insert indicates the cumulative sum of cell growth and death under the conditions used. In agreement with previous results,17 transfection with an expression vector encoding full-length p193 failed to give rise to colonies because of its proapoptotic activity, and transfection with an expression vector encoding a full-length p193 in the antisense orientation resulted in enhanced growth (as evidenced by a marked increase in both colony size and number) compared with the control construct (Figure 1ADown). Surprisingly, transfection with an expression vector encoding p193 amino acid residues 1 through 1343 (1343stp) resulted in slightly enhanced growth in a subset of the resultant colonies. This effect was even more pronounced with an expression vector encoding p193 amino acid residues 1 through 1152 (1152stp); transfection with this construct resulted in the formation of a large number of colonies with, on average, markedly increased size as compared with the other constructs tested. Progressively greater C-terminal truncations (912stp, 309stp, and 243stp) resulted in a loss of the growth-promoting phenotype seen with 1152stp. The level of growth enhancement obtained with 1152stp was similar to that obtained with the p193 antisense construct (Figure 1Down).17 Importantly, similar transfection efficiencies were obtained with all of the p193 constructs tested, as determined by cotransfection with a reporter gene encoding ß-galactosidase activity (Figure 1Down legend).



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Figure 1. p193-1152stp promotes growth in an NIH-3T3 colony growth assay. A, Colony growth assay of cells transfected with control (CMV expression vector lacking insert), p193 (CMV expression vector expressing a full-length p193 cDNA), or p193as (CMV expression vector expressing a full-length p193 cDNA in the antisense orientation). B, Colony growth assay of NIH-3T3 cells transfected with transgenes expressing the various C-terminal mutants. Transfected cells were selected in G418, and dishes were fixed and stained with gentian violet. Transfection efficiencies in parallel cultures were calculated by monitoring expression of a cotransfected CMV-ßGAL reporter gene at 48 hours after transfection. ßGAL activities (relative light units/mg protein, x103) were as follows: control, 3.7±0.64; 193, 3.6±0.54; 1342stp, 4.7±0.29; 1152stp, 4.9±0.17; 912stp, 3.7±0.26; 309stp, 4.3±0.21; and 243stp, 3.4±0.88. There was no significant difference between groups by Kruskal-Wallis nonparametric ANOVA test. Transfections were preformed in duplicate, and similar results were obtained with a minimum of 3 independent transfection studies per DNA construct, with a minimum of 2 independent DNA preparations.

Because p193 encodes a BH3-only proapoptosis activity, the marked growth enhancement observed with the 1152stp construct was rather surprising. Stable cell lines carrying either the control or the 1152stp expression vectors were generated to determine whether 1152stp encoded prosurvival activity. The cells were incubated with increasing concentrations of MMS, an agent that promotes DNA damage and that has previously been shown to induce apoptosis via both p53-dependent and p53-independent pathways.26 27 28 29 30 31 DNA prepared from the control cells incubated in MMS at high concentration exhibited pronounced internucleosomal cleavage (Figure 2Down), indicative of a strong apoptotic response. In contrast, DNA prepared from the 1152stp cells incubated with MMS showed no evidence of internucleosomal cleavage (Figure 2Down), suggesting that apoptosis was either delayed or blocked in cells expressing 1152stp. These data indicate that C-terminal truncation of p193 at amino acid residue 1152 bestows a prosurvival activity on the molecule.



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Figure 2. Expression of p193-1152stp inhibits MMS-induced apoptosis in NIH-3T3 cells. NIH-3T3 cells stably transfected with the CMV-null or CMV-1152stp transgenes were exposed to increasing concentrations of MMS. DNA prepared from cells was analyzed by agarose gel electrophoresis. DNA fragmentation was evident in CMV-null cells cultured at the highest MMS concentration, but not in CMV-1152stp cells.

Coexpression of Mutant p53, p193, and E1A Markedly Increases the Yield of ES Cell–Derived Cardiomyocytes
To directly determine the importance of the p53 and p193 proapoptotic pathways in cardiomyocyte cell cycle regulation, expression constructs encoding a mutant p53 (designated CB7; see Reference 1919 ), the prosurvival p193 mutant (1152stp), and E1A under the regulation of the mouse {alpha}-cardiac MHC promoter were generated and used in an ES cell–derived cardiomyocyte colony growth assay. The cardiomyocyte colony growth assay was based on the previous observation that essentially pure cardiomyocyte cultures suitable for long-term studies can easily be generated from differentiating ES cells that carry an MHC-neor/pGK-hygror transgene.22 Undifferentiated ES cells were transfected with an MHC-neor/pGK-hygror transgene alone or in combination with the MHC-CB7, MHC-1152stp, and/or MHC-E1A transgenes. The presence of pGK-hygror sequences allowed for the selection of colonies of transfected, undifferentiated ES cells. The resulting colonies were pooled and used to generate embryoid bodies for in vitro differentiation. The presence of MHC-neor sequences allowed for enrichment of cardiomyocytes after in vitro differentiation; once cardiomyogenic induction was observed (as evidenced by the presence of spontaneous contractile activity), G418 was added to the cultures to eliminate nonmyocytes. After 60 days of culture, the dishes were stained with PAS reagent to visualize the cardiomyocytes (PAS stains glycogen-containing cells intense violet).

The results are shown in Figure 3Down. The control dish depicts cardiomyocytes obtained by transfection with the MHC-neor/pGK-hygror transgene alone and is indicative of the baseline rate of ES cell–derived cardiomyocyte growth under the conditions used. Expression of CB7 or 1152stp did not have a marked impact on the yield of cardiomyocytes. In contrast, expression of E1A dramatically decreased cardiomyocyte yield, consistent with the proapoptotic activity of this molecule in cardiomyocytes as described by others. Coexpression of E1A and CB7 or E1A and 1152stp did not result in enhanced cardiomyocyte yield as compared with expression of CB7 or 1152stp alone, although the yield was increased as compared with cultures transfected with E1A only. In contrast, coexpression of E1A, CB7, and 1152stp markedly increased the yield of cardiomyocytes, with levels similar to those obtained from transfection with T-Ag.



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Figure 3. Coexpression of mutant p53 (CB7) and the prosurvival p193 mutant (1152stp) renders ES cell–derived cardiomyocytes responsive to E1A. An ES cell–derived cardiomyocyte colony growth assay was used to monitor the effects of transgene expression on cardiomyocyte growth. All cultures were transfected with an MHC-neor/pGK-hygror transgene, as well as with MHC-promoted expression cassettes encoding the proteins indicated. After transfection and subsequent hygromycin selection, the ES cells were pooled and allowed to differentiate. Noncardiomyocytes were removed by the addition of G418, and the yield of cardiomyocytes was directly visualized via PAS staining. The cultures were processed after 60 days of differentiation. Transfection efficiencies in parallel cultures were calculated by monitoring expression of a cotransfected CMV-ßGAL reporter gene at 48 hours after transfection. ßGAL activities (relative light units/mg protein, x103) were as follows: control, 1.2±0.07; CB7, 1.0±0.04; 1152stp, 1.1±0.06; E1A, 1.2±0.01; E1A+CB7, 1.3±0.05; E1A+1152stp, 1.2±0.05; CB7+1152stp, 1.0±0.04; E1A+CB7+1152stp, 1.2±0.06; and T-Ag 1.2±0.02. There was no significant difference between groups by Kruskal-Wallis nonparametric ANOVA test.

Coexpression of CB7 and 1152stp Inhibits E1A-Induced Apoptosis in ES Cell–Derived Cardiomyocytes
The results presented above are consistent with the hypothesis that coexpression of CB7 and 1152stp blocks cardiomyocyte apoptosis in response to E1A expression. Several analyses were performed to further test this hypothesis. DNA was prepared from parallel cultures of ES cell–derived cardiomyocytes after 15 days of differentiation. Gel electrophoresis revealed the presence of marked internucleosomal DNA fragmentation from cultures expressing E1A alone, E1A and CB7, or E1A and 1152stp (Figure 4Down). In contrast, no evidence for internucleosomal DNA fragmentation was observed in cultures coexpressing E1A, CB7, and 1152stp, consistent with the absence of apoptosis in these cells. DNAs prepared from the other cultures in this series were included as additional controls (Figure 4Down).



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Figure 4. Inhibition of DNA fragmentation in ES cell–derived cardiomyocyte cultures coexpressing E1A+CB7+1152stp. ES cell–derived cardiomyocyte cultures transfected with various MHC-promoted expression cassettes were harvested after 15 days of differentiation. DNA prepared from various cultures was analyzed by agarose gel electrophoresis. Marked internucleosomal DNA fragmentation was evident in ES cell–derived cardiomyocyte cultures expressing E1A, E1A+CB7, and E1A+1152stp, but not in cultures expressing E1A+CB7+1152stp. DNA fragmentation was not detected in any other cultures analyzed.

TUNEL analysis was also used to monitor apoptosis. Dispersed cell preparations were generated after 15 days of differentiation, and the cardiomyocytes were replated at low density on chamber slides. After an additional 24 hours of culture, the samples were processed for TUNEL analysis. TUNEL-positive cardiomyocytes were readily detected in cultures expressing E1A alone, but not in cultures coexpressing E1A, CB7, and 1152stp (Figure 5ADown). The frequency of TUNEL positivity was scored in all of the cultures (Figure 5BDown). Frequencies of TUNEL positivity ranging from 40% to 50% were observed in cultures expressing E1A alone, E1A and CB7, or E1A and 1152stp, whereas the frequency observed in cultures cotransfected with E1A, CB7, and 1152stp was comparable with the control cultures. These data collectively indicate that coexpression of CB7 and 1152stp blocks E1A-induced apoptosis in ES cell–derived cardiomyocytes.



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Figure 5. Decreased TUNEL positivity in ES cell–derived cardiomyocytes coexpressing E1A+CB7+1152stp. Dispersed cell preparations were generated from ES cell–derived cardiomyocyte cultures transfected with the various MHC-promoted expression cassettes after 15 days of differentiation. Dispersed cells were replated on chamber slides and assessed for TUNEL positivity after an additional 24 hours of culture. A, Representative images of TUNEL reactivity (green signal) for ES cell–derived cardiomyocytes expressing E1A alone or expressing E1A+CB7+1152stp are shown. Samples were counterstained with Hoechst 33342 to permit visualization of nuclei. B, Percentage of TUNEL-positive cells in all cultures of ES cell–derived cardiomyocytes. High rates of TUNEL positivity were evident in cultures expressing E1A, E1A+CB7, and E1A+1152stp, but not in cultures expressing E1A+CB7+1152stp. For each sample, a total of 300 cells were counted from 12 independent microscopic fields.

ES Cell–Derived Cardiomyocytes Expressing E1A and CB7 or E1A and 1152stp Are Not Viable
Transgene expression was monitored using protein and RNA prepared from cultures after 60 days of differentiation (Figure 6Down). Seventy-five micrograms of protein or 10 µg of RNA from each sample was analyzed. High levels of CB7 protein and 1152stp mRNA were observed in all cultures transfected with the MHC-CB7 and MHC-1152stp constructs, respectively. In contrast, E1A protein was detected only in the cultures cotransfected with MHC-E1A, MHC-CB7, and MHC-1152stp. As expected, T-Ag protein was only detected in cultures transfected with the MHC–T-Ag construct. The absence of E1A protein in colonies arising from ES cells transfected with the MHC-E1A alone, or from ES cells cotransfected with MHC-E1A and MHC-CB7 or MHC-E1A and MHC-1152stp, is consistent with the high levels of DNA degradation and cardiomyocyte TUNEL positivity observed in these cultures. Importantly, these expression analyses confirm that cardiomyocytes expressing E1A are only viable if both CB7 and 1152stp are expressed.



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Figure 6. Confirmation of transgene expression in the ES cell–derived cardiomyocyte cultures. Protein and RNA were prepared from ES cell–derived cardiomyocyte cultures transfected with various MHC-promoted expression cassettes after 60 days of differentiation. Total protein (75 µg) was subjected to Western blot analysis to monitor CB7, E1A, and T-Ag expression, and 10 µg of total RNA was subjected to Northern blot analysis to monitor 1152stp expression. For MHC expression, 1% of the total protein present in culture dishes was analyzed. Note that T-Ag expression stabilizes endogenous p53, which is also detected by the antibody used.

To quantify the differential effect of transgene expression on cardiomyocyte yield, MHC expression was monitored. One percent of the total protein from each culture dish was subjected to Western blot analysis using an anti-MHC antibody (MF20; see Figure 6Up). Consistent with the qualitative observations from PAS-stained cultures, the cardiomyocyte yield was markedly enhanced in cultures coexpressing E1A, CB7, and 1152stp, with total yields similar to that seen with cultures expressing T-Ag. Importantly, all of the ES cell–derived cultures contained differentiated, spontaneously contracting cardiomyocytes. The relatively low MHC signal in the control and singly transfected cultures is due to the low protein input on the Western blot; because of the marked enhancement of cardiomyocyte yield in the cotransfected and T-Ag cultures, low protein input was necessary to capture signals in the linear range of the film. Finally, the ES cell–derived cardiomyocyte colony growth assay was highly reproducible, and a similar effect of transgene expression on cardiomyocyte growth has been obtained in 5 independent experiments.


*    Discussion
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*Discussion
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The results presented here indicate that E1A-induced cell cycle activation in ES cell–derived cardiomyocytes provokes an apoptotic response similar to that observed after adenovirus-mediated E1A gene transfer in fetal or neonatal cardiomyocyte cultures. Furthermore, coexpression of mutant p53 and mutant p193 blocked E1A-induced apoptosis in an ES cell–derived cardiomyocyte colony growth assay, resulting in a proliferative response indistinguishable from that seen with SV40 T-Ag gene transfer. These results provide an explanation in molecular terms for some of the phenotypic differences observed in response to T-Ag versus E1A expression in cardiomyocytes. Studies with transgenic mice have indicated that targeted expression of T-Ag promotes sustained proliferation of differentiated cardiomyocytes.5 6 7 Biochemical analyses of cardiomyocytes derived from the transgenic animals identified 2 proapoptotic T-Ag binding proteins, p53 and p193,14 17 leading to the hypothesis that there are 2 prominent proapoptotic activities, encoded by p53 and p193, respectively, that function to block cardiomyocyte proliferation induced by targeted expression of DNA tumor virus oncoproteins.17

In contrast, targeted expression of E1A using either the atrial natriuretic factor (ANF) or {alpha}-cardiac actin promoters failed to produce viable transgenic mice (K.B.S.P. and L.J.F., unpublished results, 1991). This observation is consistent with the profound cardiomyocyte apoptosis observed in response to adenoviral delivery of E1A to fetal cardiomyocytes8 9 10 11 12 or in response to E1A expression in ES cell–derived cardiomyocytes as described in this report. The observation that the combinatorial activities encoded by mutant p53 and mutant p193 block E1A-induced apoptosis in ES cell–derived cardiomyocytes and thereby renders the cells proliferative supports the hypothesis that these 2 proapoptotic pathways must be compromised for successful cell cycle progression to occur in response to DNA tumor virus oncoprotein expression. This scenario is further supported by the previous observations that E1A expression induced apoptosis in fetal or neonatal cardiomyocytes in which one or both of these proapoptotic pathways were intact.8 9 10 However, because the molecular activities of 1152stp are not fully characterized, we cannot at present rule out the possibility that expression of mutant p193 has a direct cell cycle effect in ES cell–derived cardiomyocytes, in addition to the clearly documented antiapoptotic effects. Indeed, although an overt cell cycle effect was not evident in the singly transfected ES cell–derived cardiomyocyte cultures (see Figure 3Up), expression of 1152stp appeared to have a cell cycle effect in NIH-3T3 cells (see the colony growth assay in Figure 1Up). It is also noteworthy that our studies used a genomic E1A clone, which can encode the 9S, 12S, and 13S splice variants. Most early cardiomyocyte E1A studies used cDNAs encoding the 12S splice variant only. Western analyses clearly indicate that the products of both the 12S and 13S transcripts are expressed in our study (Figure 6Up). Finally, preliminary studies revealed that expression of Bcl-2 and E2F-1 are not markedly increased in response to coexpression of E1A, CB7, and/or 1152stp in the ES cell–derived cardiomyocytes (see the online data supplement available at http://www.circresaha.org), which suggests that the altered survival and proliferation observed in this model do not simply result from altered expression of these molecules.

Members of the Bcl family of apoptosis regulators share homology to Bcl-2, the prototypical family member, at one or more motifs known as Bcl-2 Homology domains (BH1, BH2, BH3, and/or BH4). Family members with the greatest homology to Bcl-2 tend to promote cell survival, whereas those more distantly related tend to promote apoptosis.32 The proapoptosis activity of the BH3-only proteins resides largely in their ability to heterodimerize with, and thereby alter the activity of, prosurvival Bcl-2 family members. Deletion of the BH3 domain blocks the ability of BH-3–only proteins to form heterodimers and in most instances concomitantly abolishes their apoptotic activity.33 34 It was therefore not surprising that deletion of the C-terminal BH3 domain abolished the proapoptotic activity of p193.17 In contrast, the observation that 1152stp encodes prosurvival activity was quite surprising.

There are several instances wherein modification of a prosurvival Bcl family member produced a proapoptotic variant. For example, alternative splicing of Bcl-XL produces a proapoptotic variant, Bcl-xS, containing BH3 and BH4 domains.35 Similarly, alternative splicing of Mcl-1 and Bok-L (prosurvival proteins that contain BH1, BH2, and BH3 domains) disrupts the BH1 and BH2 domains in these molecules, resulting in the formation of proapoptotic BH3-only splice variants.36 37 38 In contrast, we are unaware of previous examples in which modification of a proapoptotic BH3-only protein resulted in a prosurvival phenotype. At present the molecular basis for the prosurvival and growth-enhancing phenotypes encoded by 1152stp is not clear. It is unlikely that these activities result from simple titration of the normal p193 binding partners, as marked and consistent growth enhancement was only observed with the 1152stp construct. Rather, disequilibrium resulting from the titration of only a subset of the proteins that bind to full-length p193 might underlie the activities encoded by 1152stp. Unfortunately, the primary amino acid sequence and subcellular localization of p193 do not suggest an obvious mechanistic explanation for the activity encoded by 1152stp.

Expression of p193-antisense constructs in an NIH-3T3 colony growth assay resulted in decreased levels of the endogenous p193 transcript with a concomitant increase in cell growth17 (see also Figure 1Up). The phenotype of cells expressing 1152stp closely mimicked that of cells with antisense-mediated p193 loss of function, raising the possibility that 1152stp may directly antagonize the proapoptotic activity of endogenous p193. This view is supported by the observation that 1152stp expression bestows a potent prosurvival phenotype in 2 independent model systems (resistance to MMS-induced apoptosis in NIH-3T3 cells and, in combination with coexpression of mutant p53, resistance to E1A-induced apoptosis in ES cell–derived cardiomyocytes). The enhanced proliferation and prosurvival phenotypes resulting from 1152stp expression are both consistent with the notion that this molecule encodes dominant negative p193 activity. Despite these circumstantial arguments, additional experimentation is required before 1153stp can be designated as a dominant negative p193.

The ES cell–derived cardiomyocyte colony growth assay relied on cotransfection of an MHC-neor/pGK-hygror transgene in combination with the genes of interest. On differentiation, imposition of G418 selection resulted in cultures that were markedly enriched for cardiomyocytes. This approach is quite analogous to and enjoys the benefits of standard fibroblast colony growth assays and also provides a relatively rapid system with which to examine the effects of a given gene on cardiomyocyte proliferation and/or survival. Moreover, the cultures are not subject to temporal limitations resulting from proliferation of noncardiomyocytes. However, because multiple genes were introduced via cotransfection, the approach as described does suffer from the possibility of partial gene transfer. For example, it is likely that the presence of CB7-positive/E1A-negative and 1152stp-positive/E1A-negative cardiomyocytes (Figures 3Up and 6Up) is attributable to the differentiation of progenitor cells that were not transfected with the E1A expression construct. In support of this, polymerase chain reaction analysis of DNA prepared from these cultures indicated that the E1A transgene was absent (see the online data supplement). Similarly, the slight increase in TUNEL positivity in cultures cotransfected with E1A, CB7, and 1152stp as compared with control cultures is also likely attributable to partial gene transfer (Figure 5Up). Importantly, coexpression of E1A, CB7, and 1152stp had a similar effect on cardiomyocyte proliferation when using either ANF-promoted transgenes or a combination of ANF- and MHC-promoted transgenes (data not shown), indicating that promoter squelching is not a problem with this assay.

The observation that E1A induces proliferation only in ES cell–derived cardiomyocytes that also express mutant p53 and mutant p193 supports the notion that there are 2 proapoptotic pathways that can negatively regulate cell cycle activity in ES cell–derived cardiomyocytes. This finding may have important implications for therapeutic myocardial regeneration. For example, if no additional cell cycle checkpoints are activated on terminal differentiation, the results presented here would predict that abrogation of p53 and p193 activity should render adult cardiomyocytes responsive to cell cycle activation. In light of this, it is of interest to note that several groups have shown that E1A and E2F-1 have very similar activities when expressed in fetal cardiomyocytes in vitro.8 9 10 11 12 39 Furthermore, E2F-1 expression in adult cardiomyocytes results in initiation of DNA synthesis followed by apoptosis.40 It will thus be of great interest to determine whether coexpression of E2F-1 (or E1A), CB7, and 1152stp is sufficient to promote proliferation in adult cardiomyocytes. The p53 and p193 may also impact on pathophysiologic apoptosis in the heart. Forced expression of p53 is sufficient to induce cardiomyocyte apoptosis, and although p53 has been implicated in some forms of myocardial apoptosis, its role as a causative agent in this process remains controversial. Combinatorial blockade of p53 and p193 may have a greater protective effect during pathophysiologic apoptosis, similar to that seen after E1A gene transfer.


*    Acknowledgments
 
This work was supported by grants from the National Heart, Lung, and Blood Institute. We thank Dr Betty Moran (Fels Institute for Cancer Research and Molecular Biology, Philadelphia, Pa) for sequences encoding E1A, Alan Bernstein (Canadian Institutes of Health Research, Ottawa, Ontario, Canada) for the CB7 genomic clone, and Andres Nagy (Samuel Luenfeld Research Institute, Toronto, Ontario, Canada) for R1 ES cells.


*    Footnotes
 
Original received February 2, 2001; revision received April 2, 2001; accepted April 2, 2001.


*    References
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up arrowAbstract
up arrowIntroduction
up arrowMaterials and Methods
up arrowResults
up arrowDiscussion
*References
 

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