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Circulation Research. 2005;97:655-662
Published online before print August 25, 2005, doi: 10.1161/01.RES.0000183880.49270.f9
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(Circulation Research. 2005;97:655.)
© 2005 American Heart Association, Inc.


Cellular Biology

Enhanced Functional Gap Junction Neoformation by Protein Kinase A–Dependent and Epac-Dependent Signals Downstream of cAMP in Cardiac Myocytes

Satoshi Somekawa, Shigetomo Fukuhara, Yoshikazu Nakaoka, Hisakazu Fujita, Yoshihiko Saito, Naoki Mochizuki

From the Department of Structural Analysis (S.F., Y.N., H.F., N.M.), National Cardiovascular Center Research Institute, Suita, Osaka; the First Department of Internal Medicine (S.S., Y.S.), Nara Medical University, Kashihara, Nara, Japan.

Correspondence to Naoki Mochizuki, Department of Structural Analysis, National Cardiovascular Center Research Institute, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan. E-mail nmochizu{at}ri.ncvc.go.jp


*    Abstract
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*Abstract
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Gap junctions (GJs) constituted by neighboring cardiac myocytes are essential for gating ions and small molecules to coordinate cardiac contractions. cAMP is suggested to be a potent stimulus for enhancement of GJ function. However, it remains elusive how cAMP potentiates the GJ of cardiomyocytes. Here we demonstrated that the gating function of GJ is enhanced by the protein kinase A (PKA)–dependent signal, and that the accumulation of connexin43 (Cx43), the most abundant Cx in myocytes, is enhanced by an exchange protein directly activated by cAMP (Epac) (Rap1 activator)–dependent signal. The gating function of GJs was analyzed by microinjected dye transfer method. The accumulation of Cx43 was analyzed by quantitative immunostaining. Using the PKA-specific activator N6-benzoyladenosine-3',5'-cyclic monophosphate (6Bnz) and Epac-specific activator 8-(4-chlorophenylthio)-2'-O-methyladenosine-3',5'-cyclic monophosphate (8CPT), we could delineate the two important downstream signals of cAMP for enhanced GJ neoformation. Whereas 6Bnz potentiated gating function of GJs with slight accumulation of Cx43 at cell–cell contacts, 8CPT remarkably enhanced the accumulation of Cx43 with a slight effect on gating. We further noticed that adherens junctions (AJs) were maturated by 8CPT, as marked by increased neural-cadherin immunostaining. Because AJ formation precedes the GJ formation, AJ formation accelerated by Epac-Rap1 signal may result in enhanced GJ formation. The involvement of Epac-Rap1 signal in GJ neoformation was further confirmed by evidence that inactivation of Rap1 by overexpression of Rap1GAP1b perturbed the accumulation of Cx43 at cell–cell contacts. Collectively, PKA and Epac cooperatively enhance functional GJ neoformation in cardiomyocytes.


Key Words: gap junction • connexin43 • myocardial structure • cardiac gap junction connexins


*    Introduction
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up arrowAbstract
*Introduction
down arrowMaterials and Methods
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down arrowDiscussion
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Gap junctions (GJs) are channels formed by two docking connexons; one connexon is provided by each of the two contiguous cells and is constituted of six connexin (Cx) molecules.1 Among the 20 Cx members, Cx40, Cx43, and Cx45 are expressed in the heart.2 Of the three, Cx43 is predominantly expressed in working heart muscle cells.3,4 GJs in the heart are characterized by their localization at the intercalated disk between each myocyte and also by their role in electrical conductance required for coordinated electrical excitation.5 Myocytes electrically coupled by GJs show synchronized contraction. The importance of Cx43 in electrical excitation in vivo is evident by cardiac-specific depletion of Cx43 leading to cardiac arrhythmia.6

The overall function of GJs depends on the number of GJs and the gating function of assembled GJs. GJs are upregulated by increased transcription of Cx, increased distribution of Cx at cell–cell contacts, and decreased degradation of Cx from the cell membrane. cAMP increases Cx43 mRNA.7 cAMP also enhances the trafficking of Cx43 from the endoplasmic reticulum/Golgi apparatus to the plasma membrane.8 Cx43 turnover is regulated by proteosomal and lysosomal degradation, and the half-life of Cx43 is less than two hours, suggesting that a rapid synthesis and trafficking system operates in cardiac myocytes.9

GJ is modulated by the phosphorylation of Cx43 on Ser and Tyr residues. The intercellular communication through Cx43 is decelerated and accelerated by its phosphorylation on Ser368 by protein kinase C and on Ser364 by protein kinase A (PKA), respectively.10,11 In addition to Ser phosphorylation, phosphorylated Cx43 on Tyr247 and Tyr265 is repressed from junctional communication.12 In addition to phosphorylation, GJ formation is regulated by Cx43-binding molecules. Cx43 binds to the junctional adhesion molecule-associating proteins zonula occludens-1 (ZO-1) and ß-catenin.13,14 Dominant-negative ZO-1, which dissociates the endogenous ZO-1 from Cx43, disturbs the localization of Cx43 at the cell–cell contacts, resulting in the reduced conductance of GJs.13 Wnt-1 signal prevents ß-catenin degradation, thereby increasing ß-catenin, which not only drives Cx43 expression but also associates with the Cx43 at the cell–cell contacts, where ß-catenin localizes with cadherin.14

cAMP-induced Cx43 assembly has been extensively characterized in terms of Cx43 synthesis, delivery to the plasma membrane, and phosphorylation, which is believed to depend exclusively on PKA.15 However, other downstream molecules of cAMP have not been elucidated in the neoformation of GJs. We and others have demonstrated that exchange protein directly activated by cAMP (Epac)/cAMP-GEF, a guanine nucleotide exchange factor (GEF) for Rap1, is activated by cAMP,16,17 and that cAMP–Epac-Rap1 signal enhances the barrier function of vascular endothelial cells by stabilizing cadherin-mediated cell adhesion.18,19 Analogous to this Epac-induced cadherin-based cell adhesion, we hypothesized that Epac may be involved in GJ neoformation as a cAMP-triggered signaling molecule in cardiac myocytes.

In this study, we investigated the molecular mechanism by which GJ neoformation is regulated by cAMP using a PKA-specific activator and an Epac-specific activator. We analyzed the GJ accumulation at cell–cell contacts by immunostaining of Cx43 and the gating function of GJs by dye spreading in neonatal rat cardiomyocytes (NRCMs) stimulated with these activators. We demonstrate that the Cx43 accumulation at cell–cell contacts depends on Epac and that dye spreading depends on PKA. Therefore, PKA and Epac downstream of cAMP cooperatively enhance functional GJ neoformation in cardiac myocytes.


*    Materials and Methods
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*Materials and Methods
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Reagents and cAMP Analogs
Dibutyryl-cAMP (dbcAMP) was purchased from Sigma-Aldrich, Epac-specific activator 8-(4-chlorophenylthio)-2'-O-methyladenosine-3',5'-cyclic monophosphate (8CPT) from Calbiochem; and PKA-specific activator N6-benzoyladenosine-3',5'-cyclic monophosphate (6Bnz) was from BIOLOG Life Science Institute. Other chemical compounds, antibodies, and adenoviruses are listed in the supplemental information (available online at http://circres.ahajournals.org).

Cell Culture
NRCMs were isolated from Wistar rats (1 to 2 days old; Kiwa Jikken Dobutsu, Japan) on a Percoll gradient as described previously.20 The details of cardiac myocyte preparation are described in the supplemental information. The NRCMs spread onto the glass-base dishes for 24 hours after isolation were subjected to immunostaining or dye transfer assay after drug treatment for another 12 hours. We observed that the adherens junctions (AJs) were not maturated, although NRCMs contacted each other before the drug treatment, indicating that we used the reassembling NRCMs for the experiments. Experiments using animals were approved by our institutional animal use and care committee. All animal procedures were performed according to the Guide for the Care and Use of Laboratory Animals (NIH, revision 1996).

Immunocytochemistry
NRCMs stimulated with cAMP analogs were immunostained as described previously.21 Briefly, cells cultured on glass-base dish were blocked with PBS containing 4% BSA for 1 hour at room temperature (RT), then stained with anti-Cx43, anti–sarcomeric {alpha}-actinin (S-{alpha}A), and anti–neural (N)-cadherin at RT. Protein reacting with primary antibodies was visualized with Alexa 488–labeled goat anti-rabbit IgG and Alexa 546–labeled goat anti-mouse IgG. Images were recorded with a confocal microscope (BX50WI; Olympus). For quantitative immunofluorescence analysis, images were also recorded using an epifluorescence microscope (IX-71; Olympus) controlled by MetaMorph version 6.2 software (Molecular Devices). The number of Cx43-positive dots at the cell–cell contacts on the fluorescence images were counted as Cx43 puncta.

Gating Function of GJs Analyzed by Microinjected Dye Transfer
Microinjected dye transfer was performed as described by Doble et al, with minor modifications.22 The details of dye transfer method are described in the supplemental information.

RT-PCR Analysis
Total RNAs extracted from NRCMs and human cervical carcinoma cell line (HeLa) cells using Trizol (Invitrogen) were reverse-transcribed using SuperScript II and random primers (Invitrogen). The resultant DNAs were PCR-amplified using Epac-specific primers described in the supplemental information.

Western Blot Analysis and N-Cadherin Translocation Assay
NRCMs were lysed in buffer described in the supplemental information. Lysates precleared by centrifugation at 15 000g for 10 minutes were subjected to SDS-PAGE and immunoblotting with antibodies as indicated in Figures 3, 4, 5, and 6DownDownDown. Proteins reacting with primary antibodies were visualized by an enhanced chemiluminescence system (Amersham Biosciences) with peroxidase-conjugated and species-matched secondary antibodies and analyzed with an LAS-1000 system (Fuji Film). N-cadherin translocation assay was performed as described previously.18

Detection of GTP-Bound Form of Rap1
Rap1 activity was assessed by a modified Bos method as described previously.23 Briefly, NRCMs starved in DMEM for 3 hours were treated with the stimulants as indicated in Figures 3 and 6Down and lysed at 4°C in a pull-down lysis buffer described in the supplemental information. GTP-bound Rap1 was collected on glutathione S-transferase fused with Rap1 binding domain of Ral guanine nucleotide dissociation stimulator precoupled to glutathione-Sepharose beads and subjected to SDS-PAGE followed by immunoblotting using anti-Rap1.

Statistical Analysis
The results were expressed as the mean±SD. Student t test was used to analyze differences between two groups. Group differences were assessed with one-way ANOVA or two-way ANOVA, followed by post hoc comparisons tested with Scheffe’s method. At least 3 fields randomly selected from each culture for analysis of Cx43 staining or at least 4 cells for dye transfer assay from each culture were used to yield a single value for each culture. The number of the cultures for analysis was indicated in the figure legends as n. Significant differences were indicated as P value <0.05 (*).


*    Results
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up arrowAbstract
up arrowIntroduction
up arrowMaterials and Methods
*Results
down arrowDiscussion
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cAMP Enhances Functional GJ Neoformation in Cultured NRCMs
Because cAMP has been reported previously to enhance GJ formation,7 we confirmed the dbcAMP–regulated functional GJ neoformation by quantitatively analyzing Cx43 accumulation at the cell–cell contacts by immunostaining and gating function of GJs by microinjected dye transfer assay. dbcAMP enhanced the Cx43 accumulation at the cell–cell contacts (Figure 1A and 1B). To neglect the possibility of cardiac fibroblast contamination in the NRCMs in the following experiments, and to show the confluence of the NRCMs, cells were immunostained for sarcomeric {alpha}-actinin (Figure 1A, bottom). The Cx43 puncta in the cells treated with dbcAMP for 12 hours were clearly observed at the cell–cell contacts, where N-cadherin localized (Figure 1C), indicating that dbcAMP induces the accumulation of Cx43 at the cell–cell contacts. We investigated the effect of dbcAMP on gating function of GJs by microinjected dye transfer assays (Figure 1D and 1E). Microinjected dye was more widely transferred to the neighboring cells in dbcAMP-treated NRCMs than vehicle-treated cells (Figure 1D). The quantitative data are shown in Figure 1E. These results are in agreement with previous reports7,8 and validated the assays we used in this study.



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Figure 1. cAMP induces Cx43 accumulation at cell–cell contacts and enhances gap junctional intercellular communication. A, NRCMs cultured 24 hours after cell preparation were stimulated with vehicle or 1 mmol/L dbcAMP for 12 hours. Cells were stained with anti-Cx43 (green) and anti–S-{alpha}A (red). Images were obtained through a confocal microscope (BX50WI). Bar=20 µm. B, NRCMs stimulated by dbcAMP were analyzed for Cx43 accumulation by counting the number of puncta at cell–cell contacts. Mean number±SD is expressed as fold increase relative to that observed in the cell treated with vehicle. *P<0.05 vs vehicle as analyzed by Student’s t test (n=4). Three fields randomly selected from each culture were used for measuring the fold activation between vehicle- and dbcAMP-treated culture by counting Cx43-positive puncta. C, Cells treated with dbcAMP were immunostained with anti-Cx43 (green) and anti–N-cadherin (red). A merged image is shown on the right. Note that puncta for Cx43 are localized to cell–cell contacts as indicated by the N-cadherin immunostaining. Bar=5 µm. D, Microinjected dye transfer assay shows the extent of dye transferring between neighboring cells through GJs. NRCMs stimulated with 1 mmol/L dbcAMP for 12 hours were microinjected with 10% Lucifer yellow. Cells 3 minutes after dye injection were phase contrast imaged (top panels) and fluorescence imaged (bottom panels). Asterisks indicate dye-injected cells. Arrows and arrowheads denote typical dye-transferred cell and cell debris emitting nonspecific fluorescence, respectively. Bar=50 µm. E, Quantitative analysis of D is shown as mean number of dye-positive cells in either vehicle or dbcAMP-treated NRCMs. *P<0.05 as analyzed by Student’s t test (n=6).

PKA Is Required But Not Sufficient Alone for cAMP-Enhanced GJ Neoformation
Because PKA is involved in the enhancement of GJ formation,15 we first tested the effect of H89, a specific PKA inhibitor, on cAMP-enhanced accumulation of Cx43. Unexpectedly, H89 did not block the dbcAMP-induced accumulation of Cx43 (Figure 2A and 2B), although H89 did block cAMP-enhanced intercellular communication assessed by microinjected dye transfer assays (Figure 2C).



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Figure 2. PKA signaling mainly contributes to gating function of GJs. A, NRCMs pretreated with or without 5 µmol/L H89 for 30 minutes were stimulated with or without 1 mmol/L dbcAMP in the presence or absence of 5 µmol/L H89 for 12 hours. After the stimulation, cells were immunostained with anti-Cx43 and anti–S-{alpha}A as described in Figure 1A legend. Bar=20 µm. B, Cx43 accumulation in cells treated as in A was quantitatively analyzed. Statistical significance between groups was analyzed by two-way ANOVA with Scheffe’s method, indicating that the factor of with/without dbcAMP is significant but not that of vehicle/H89 (*P<0.05; n=6) C, Effect of H89 on dbcAMP-enhanced gap junctional intercellular communication was evaluated by microinjected dye transfer assay as described in Figure 1E legend. Statistical significance between groups was analyzed by two-way ANOVA with Scheffe’s method, indicating that both factors, with/without dbcAMP and vehicle/H89, are significant (*P<0.05; n=6). D, NRCMs were stimulated with either vehicle or 1 mmol/L 6Bnz for 12 hours and immunostained with anti-Cx43 and anti–S-{alpha}A. Bar=20 µm. E, The effect of 1 mmol/L 6Bnz on Cx43 accumulation at the cell–cell contacts was evaluated similarly to Figure 1B. Statistical significance between groups was analyzed by one-way ANOVA with Scheffe’s method (*P<0.05; n=4). F, The effect of 6Bnz on junctional intercellular communication between NRCMs was similarly evaluated by microinjected dye transfer assay to the Figure 1D. Statistical significance was evaluated by one-way ANOVA with Scheffe’s method (*P<0.05; n=4).

We next examined the effect of 6Bnz, a specific activator for PKA,24 on intercellular communication and Cx43 accumulation at cell–cell contacts to directly assess the involvement of PKA in cAMP-enhanced GJ formation. 6Bnz induced Cx43 accumulation slightly but to a much lesser extent than dbcAMP (Figure 2D and 2E). Notably, 6Bnz enhanced dye transfer to a greater extent than vehicle but to a lesser extent than dbcAMP (Figure 2F). These results indicate that PKA signaling is required but not sufficient alone for cAMP-enhanced GJ neoformation and suggest that there is a novel signaling downstream of cAMP in addition to PKA involved in Cx43 accumulation at cell–cell contacts for functional GJ neoformation.

cAMP Activates PKA and Epac-Rap1 Signaling in NRCMs
Epac has been identified as a novel cAMP target and a Rap1-specific GEF. We therefore hypothesized that Epac-Rap1 signaling may be involved in cAMP-enhanced GJ neoformation. RT-PCR analysis revealed the expression of Epac in NRCM but not in HeLa cells used as a negative control (Figure 3A). To test the hypothesis, we first examined whether dbcAMP induces the activation of Rap1 and the phosphorylation of cAMP response element binding protein (CREB) in NRCMs. As shown in Figure 3B, dbcAMP induced Rap1 and CREB activation in NRCMs. Rap1 activation by dbcAMP is dependent on time and concentration (supplemental Figure IA and IB, available online at http://circres.ahajournals.org). H89 inhibited dbcAMP-induced CREB phosphorylation but not dbcAMP-induced Rap1 activation (Figure 3B and 3C), indicating that Rap1 activation does not depend on PKA, whereas CREB phosphorylation depends exclusively on PKA. We next tested whether Rap1 activation and CREB phosphorylation are induced by 8CPT, which has been developed recently as a specific activator for Epac.25 8CPT only activated Rap1, not CREB. In striking contrast, 6Bnz induced CREB activation but did not affect Rap1 activity (Figure 3D and 3E). Together, these findings demonstrate that cAMP activates Epac-Rap1 and PKA signaling pathways in NRCMs.



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Figure 3. cAMP induces Epac-Rap1 signal as well as PKA signal in NRCMs. A, RT-PCR analysis shows the expression of Epac in NRCMs but not in HeLa cells (used as a negative control). GAPDH was shown as a positive control for RT-PCR. B, Serum-starved NRCMs were stimulated with 1 mmol/L dbcAMP in the absence or presence of H89 for 15 minutes. GTP-bound Rap1 were assessed by pull-down assay. Phosphorylation of CREB was analyzed by Western blot analysis using anti-CREB and anti–phospho-CREB (pCREB). A representative result of 3 independent experiments is shown. C, Data obtained from 4 independent experiments were analyzed quantitatively. Fold activation indicates the ratio of the poststimulation GTP-Rap1 and pCREB intensity of total Rap1 and CREB intensity to the prestimulation GTP-Rap1 and pCREB intensity of total Rap1 and CREB intensity. D, Serum-starved NRCMs were stimulated with either vehicle, 1 mmol/L dbcAMP, 1 mmol/L 8CPT, 1 mmol/L 6Bnz, or 1 mmol/L 8CPT and 1 mmol/L 6Bnz for 15 minutes. GTP-bound Rap1 and phosphorylation of CREB were assessed as described in B. E, Data obtained from 4 independent experiments were analyzed similarly to C.

Activation of Epac Signaling Leads to Cx43 Accumulation at Cell–Cell Contacts
Because we observed Rap1 activation in response to dbcAMP, we proceeded to investigate the involvement of Epac-Rap1 signaling in cAMP-induced Cx43 accumulation at cell–cell contacts. Like dbcAMP, 8CPT significantly enhanced the accumulation of Cx43 at the cell–cell contacts (Figure 4A and 4B). 8CPT induced Cx43 accumulation at the cell–cell contacts to a similar extent to dbcAMP and to a greater extent than 6Bnz. 6Bnz only slightly increased the number of Cx43 puncta (Figure 4B) compared with vehicle and did not further increase the accumulation of Cx43 at cell–cell contacts caused by 8CPT alone. These results indicate that Epac-mediated signaling is mainly responsible for cAMP-induced Cx43 accumulation at the cell–cell contacts.



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Figure 4. Activation of Epac signaling induces Cx43 accumulation at cell–cell contacts. A, NRCMs stimulated for 12 hours with drugs as indicated at the top were stained with anti-Cx43 and anti–S-{alpha}A as described in Figure 1A legend. Bar=20 µm. B, Cx43 accumulation was quantitatively analyzed in Figure 1B. Significant differences between vehicle-treated cells and all drug-treated cells was analyzed by one-way ANOVA with Scheffe’s method (*P<0.05; n=6). C, NRCMs stimulated as indicated at the top were examined for Cx43 by Western blot analysis. Upper and lower bands correspond to phosphorylated (PO) and nonphosphorylated (NP) Cx43, respectively. D, Total Cx43 (phosphorylated and nonphosphorylated) expression of NRCMs treated for 12 hours with drugs as indicated at the bottom was quantitatively analyzed by three independent Western blot analyses for Cx43. The intensity of the drug-stimulated Cx43 normalized by ß-catenin divided by that of vehicle-stimulated Cx43 was expressed as fold activation. E, The ratio is expressed by the intensity of phosphorylated Cx43 (PO) divided by that of nonphosphorylated Cx43 (NP).

We excluded the possibility that increased synthesis of Cx43 on cAMP stimulation resulted in the accumulation of Cx43 at the cell–cell contacts. No discernible increase was observed in the cells stimulated with vehicle, dbcAMP, 8CPT, 6Bnz, and a combination of 8CPT and 6Bnz for 12 hours (Figure 4C and 4D), suggesting that distribution or functional augmentation of GJs is essential for cAMP-induced functional GJ neoformation. In addition, phosphorylation of Cx43 was not affected by dbcAMP, 8CPT, or 6Bnz, nor a combination of 8CPT and 6Bnz (Figure 4C and 4E).

Epac Enhances AJ Formation
Several lines of evidence suggest that AJ formation organized by N-cadherin is a prerequisite for GJ assembly in cardiomyocytes when reassembling and recoupling.26–28 We used reassembling NRCMs before drug treatment. Recently, we and others revealed that Rap1 is involved in the cell–cell contacts mediated by epithelial (E)-cadherins and vascular endothelial–cadherins (VE-cadherins).18,29 Thus, it is possible that cAMP enhances GJ neoformation by enhancing N-cadherin–mediated AJ formation preceding the GJ formation in NRCMs. To address this possibility, we investigated whether cAMP induces N-cadherin–mediated AJ formation in NRCMs. N-cadherin distribution at cell–cell contacts was enhanced by dbcAMP and 8CPT, whereas 6Bnz neither affected the distribution of N-cadherin nor enhanced the effect of 8CPT (Figure 5A).



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Figure 5. Activation of Epac induces AJ formation. A, NRCMs stimulated for 12 hours with drugs as indicated at the top were immunostained with anti-Cx43 (green) and anti–N-cadherin (red). Bar=20 µm. B, NRCMs stimulated as in A were fractionated with cytoskeleton stabilizing buffer. Triton X-100–insoluble fraction was subjected to SDS-PAGE followed by Western blot analysis (WB) with anti–N-cadherin. A representative result of three independent experiments is shown. C, The data obtained from three independent experiments of B was quantitatively analyzed. The result is indicated as fold increase calculated by dividing the amount of insoluble N-cadherin from the cells treated with the drug by that from the cells treated with vehicle.

To quantitatively analyze the localization of N-cadherin after drug treatment, we performed a biochemical N-cadherin translocation assay. Because N-cadherin is connected to actin cytoskeleton in maturated AJs, cadherin anchored to actin cytoskeleton can be detected in detergent-insoluble fractions of cell lysates. We found an increase in N-cadherin in Triton X-100–insoluble fraction when stimulated by dbcAMP and 8CPT (Figure 5B). However, 6Bnz did not change either basal- or 8CPT-increased levels of N-cadherin in the Triton X-100–insoluble fraction (Figure 5B and 5C). Collectively, these findings indicate that cAMP enhances AJ formation through Epac in NRCMs. We found no difference in N-cadherin expression in NRCMs stimulated with dbcAMP, 8CPT, or 6Bnz, or a combination of 8CPT and 6Bnz by immunoblotting (data not shown).

Rap1 Activation Is Essential for cAMP-Mediated Cx43 Redistribution and AJ Formation
We investigated the role of Rap1 in cAMP-induced Cx43 accumulation and AJ formation in NRCMs. To examine the effect of Rap1 on AJ and GJ formation, we inactivated Rap1 by adenovirus-expressing Rap1GAP1b, which specifically catalyzes the hydrolysis of GTP to GDP on Rap1.30 Endogenous Rap1 activity was almost completely suppressed by the expression of increasing amount of Rap1GAP1b in NRCMs (Figure 6A). Moreover, overexpression of Rap1GAP1b inhibited cAMP-induced Rap1 activity without affecting cAMP-stimulated CREB phosphorylation (Figure 6B), confirming that Rap1GAP1b specifically blocks Epac-Rap1 pathway but not PKA-mediated signaling.



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Figure 6. Rap1 activation is required for cAMP-induced Cx43 accumulation at the cell–cell contacts and AJ formation. A, Rap1 inactivation by Rap1GAP1b was verified by detecting GTP-Rap1 in NRCMs infected with different multiplicity of infection (MOI) of adenovirus-expressing Rap1GAP1b (Ad-RapGAP). An adenovirus-expressing LacZ (Ad-LacZ) at 50 MOI was used as a control. GTP-Rap1 was detected by pull-down assay. Rap1 and Rap1GAP1b (RapGAP) expression was examined by Western blot analysis using antibodies as indicated at the left. B, NRCMs infected with either Ad-LacZ or Ad-RapGAP at an MOI of 50 for 24 hours were stimulated with vehicle (–) or 1 mmol/L dbcAMP (+) for 15 minutes and analyzed for Rap1 and CREB activation. C, Localization of N-cadherin and Cx43 was examined similarly to Figure 5A in NRCMs infected with Ad-LacZ or Ad-RapGAP after stimulated with vehicle or 1 mmol/L dbcAMP for 12 hours. Bar=20 µm. D, The effect of inactivation of Rap1 on dbcAMP-induced accumulation of Cx43 was analyzed by two-way ANOVA with Scheffe’s method, indicating that both factors, with/without dbcAMP and LacZ/RapGAP, are significant (*P<0.05; n=6). E, Translocation of N-cadherin was examined in NRCMs infected with Ad-LacZ or Ad-RapGAP after stimulation of dbcAMP. A representative of three independent results is shown. F, The three independent results from D were analyzed similarly to Figure 5C.

Inactivation of Rap1 blocked the cAMP-induced accumulation of Cx43 and N-cadherin at the cell–cell contacts (Figure 6C and 6D). dbcAMP-induced translocation of N-cadherin to cytoskeleton-anchored fraction was inhibited by inactivation of Rap1 but not by LacZ overexpression (Figure 6E and 6F). These results suggest that cAMP induces N-cadherin–based AJ assembly through an Epac-Rap1 signaling pathway, which may precede the accumulation of Cx43-based GJs.

PKA and Epac-Rap1 Signaling Cooperatively Enhances GJ Neoformation in NRCMs
Because we found that PKA alone is not sufficient for cAMP-enhanced GJ neoformation and that Epac-Rap1 signaling is involved in cAMP-induced accumulation of Cx43, we assessed the effect of PKA activation and Epac-Rap1 activation on gating function of GJs. 8CPT merely showed the weak enhancement of the intercellular connection, as revealed by microinjected dye transfer assay (Figure 7A). However, 8CPT significantly enhanced 6Bnz-mediated intercellular communication (Figure 7B). The effect of the combination of 8CPT and 6Bnz was comparable to that of dbcAMP. Given that 8CPT induces the Cx43 accumulation at the cell–cell contacts, cAMP potentiates functional GJ neoformation via a PKA-mediated enhanced gating function and Epac-Rap1 signal-mediated accumulation of Cx43 to cell–cell contacts.



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Figure 7. PKA signal and Epac-Rap1 signal cooperatively enhance intercellular communication through GJs. A, Intercellular communication was assessed by microinjected dye transfer assay using NRCMs stimulated with drugs as indicated at the top. B, Dye spread was quantitatively analyzed similarly to Figure 2F. Statistical significance between groups was evaluated by one-way ANOVA with Scheffe’s method (*P<0.05; n=6).


*    Discussion
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up arrowAbstract
up arrowIntroduction
up arrowMaterials and Methods
up arrowResults
*Discussion
down arrowReferences
 
The function of GJs in the heart depends on the number of GJs between neighboring cells and the gating function of individual GJ at the cell–cell contacts. We investigated how cAMP induces Cx43 accumulation at cell–cell contacts and enhances gating function in NRCMs that were about to develop the mature cell–cell contacts. For the first time, we demonstrated the involvement of Epac-Rap1 signaling downstream of cAMP in GJ neoformation of cardiomyocytes. Although Cx43 accumulated at the cell–cell contacts on cAMP stimulation has been ascribed to PKA,7 this study demonstrated that Epac-Rap1 signaling activated by cAMP is mainly responsible for the redistribution of Cx43 to cell–cell contacts.

The number of GJs was increased by Epac-Rap1 downstream of cAMP as indicated by the increase in Cx43-positive puncta at cell–cell contacts. However, there was no increase in the amount of Cx43 after cAMP treatment, indicating the importance of the redistribution of Cx43 rather than increase of Cx43 transcription on cAMP. How does Epac signaling induce the accumulation of Cx43 at cell–cell contacts? Epac-Rap1 activation resulted in enhancement of AJ formation accompanied by GJ formation, as evidenced by increases in N-cadherin and Cx43 at the cell–cell contacts after dbcAMP stimulation (Figure 5). AJ formation constituted by N-cadherin is a prerequisite for GJ neoformation.28,31 When adult myocytes are cultured, Cx43 is transported and accumulated at the plasma membrane, where N-cadherin accumulates on cell–cell contact.26 Therefore, GJ formation depends on N-cadherin–based AJ maturation. We have shown previously that the Epac-Rap1 signal enhances the VE-cadherin–based cell–cell contacts in vascular endothelial cells.18 In this study, we found that Epac activation resulted in the increased accumulation of N-cadherin at the intercellular junction of NRCMs. Thus, N-cadherin accumulation at the cell–cell contacts induced by the Epac-Rap1 signal may account for Cx43 accumulation in NRCMs by analogy to Epac-Rap1–triggered VE-cadherin accumulation in vascular endothelial cells.

The target of activated Rap1 for enhancement of cadherin-based AJ is still unclear. Rac belonging to Rho family GTPase and regulating actin cytoskeleton is suggested to function downstream of Rap1.32 Therefore, Rac may increase the chances of cell contacts and induce cadherin engagement by extending membrane downstream of Rap1. Maturated N-cadherin on Epac activation, which is detected in the cytoskeleton-anchored fraction, may be accompanied by translocation of Cx43 through cadherin-associating ß-catenin because Cx43 is capable of binding to ß-catenin.14 Because ZO-1 is recruited to AJs by binding to {alpha}-catenin and is also capable of binding to Cx43,33 ZO-1 may participate in the accumulation of Cx43 during maturation of AJs.

Another factor affecting functional GJ neoformation in addition to the number of GJs is the gating function of individual GJs. PKA activation facilitates intercellular communication without accumulation of Cx43 at cell–cell contacts, concurring with previous reports underpinning that PKA and cAMP increases single channel conductance of the GJ,34 although the characteristics of single GJ channel conductance evoked by PKA activation still remains elusive.15 We found a marked increase in dye transfer on PKA activation with a slightly increased accumulation of Cx43 at the cell–cell contacts (Figures 4 and 7Up). These results indicate that PKA mainly contributes to the functional neoformation of GJs by enhancing gating function of GJs. Phosphorylation of Cx43 on Ser residues is required for intercellular communication of GJs.35 Because we found no significant increase in either total Cx43 or phosphorylated Cx43, PKA may indirectly modulate GJ conductance in addition to direct phosphorylation of Cx43 or may phosphorylate a critical Ser/Thr that was indistinguishable in the phosphorylated Cx43 band in our immunoblot for Cx43 (Figure 4C).

The enhanced gating function of GJs is mainly ascribed to PKA, whereas the accumulation of Cx43 to cell–cell contacts is mainly attributable to Epac-Rap1 signal. Hence, Epac-Rap1 signal may accelerate the trafficking of Cx43 to the plasma membrane or inhibit the endocytosis of Cx43 from the plasma membrane. We did not quantify the translocation of Golgi fraction to cell–cell contacts on cAMP stimulation. Previously, GJ trafficking was dynamically monitored by green fluorescence protein–tagged Cx43.36 Therefore, it will be of great interest to observe the Cx43 dynamics on 8CPT stimulation to directly elucidate Epac-Rap1 signaling.

In conclusion, we demonstrated that cAMP potentiates functional GJ neoformation by a PKA-dependent increase in intercellular communication and by an Epac-Rap1–dependent accumulation of Cx43 in NRCMs.


*    Acknowledgments
 
This work was supported in part by grants from the Ministry of Health, Labor, and Welfare Foundation of Japan; the Ministry of Education, Science, Sports, and Culture of Japan; the Promotion of Fundamental Studies in Health Science of the Organization for Pharmaceutical Safety and Research of Japan; the Japan Health Science Foundation; and Astellas Foundation for Research on Metabolic Disorders. We thank Michiyuki Matsuda and Akihiro Umezawa for their helpful input; Nobuo Shirahashi for statistical analysis; James T. Pearson and Michael E. Mendelsohn for critical reading; and Yuko Matsuura and Manami Sone for their technical assistance.


*    Footnotes
 
Original received May 10, 2005; resubmission received July 12, 2005; revised resubmission received August 11, 2005; accepted August 16, 2005.


*    References
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up arrowMaterials and Methods
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*References
 

  1. Yeager M. Structure of cardiac gap junction intercellular channels. J Struct Biol. 1998; 121: 231–245.[CrossRef][Medline] [Order article via Infotrieve]
  2. Sohl G, Willecke K. Gap junctions and the connexin protein family. Cardiovasc Res. 2004; 62: 228–232.[CrossRef][Medline] [Order article via Infotrieve]
  3. Vozzi C, Dupont E, Coppen SR, Yeh HI, Severs NJ. Chamber-related differences in connexin expression in the human heart. J Mol Cell Cardiol. 1999; 31: 991–1003.[CrossRef][Medline] [Order article via Infotrieve]
  4. Davis LM, Rodefeld ME, Green K, Beyer EC, Saffitz JE. Gap junction protein phenotypes of the human heart and conduction system. J Cardiovasc Electrophysiol. 1995; 6: 813–822.[Medline] [Order article via Infotrieve]
  5. Saffitz JE, Kleber AG. Effects of mechanical forces and mediators of hypertrophy on remodeling of gap junctions in the heart. Circ Res. 2004; 94: 585–591.[Abstract/Free Full Text]
  6. Gutstein DE, Morley GE, Fishman GI. Conditional gene targeting of connexin43: exploring the consequences of gap junction remodeling in the heart. Cell Commun Adhes. 2001; 8: 345–348.[Medline] [Order article via Infotrieve]
  7. Darrow BJ, Fast VG, Kleber AG, Beyer EC, Saffitz JE. Functional and structural assessment of intercellular communication. Increased conduction velocity and enhanced connexin expression in dibutyryl cAMP-treated cultured cardiac myocytes. Circ Res. 1996; 79: 174–183.[Abstract/Free Full Text]
  8. Paulson AF, Lampe PD, Meyer RA, TenBroek E, Atkinson MM, Walseth TF, Johnson RG. Cyclic AMP and LDL trigger a rapid enhancement in gap junction assembly through a stimulation of connexin trafficking. J Cell Sci. 2000; 113: 3037–3049.[Abstract]
  9. Saffitz JE, Laing JG, Yamada KA. Connexin expression and turnover: implications for cardiac excitability. Circ Res. 2000; 86: 723–728.[Abstract/Free Full Text]
  10. Lampe PD, TenBroek EM, Burt JM, Kurata WE, Johnson RG, Lau AF. Phosphorylation of connexin43 on serine368 by protein kinase C regulates gap junctional communication. J Cell Biol. 2000; 149: 1503–1512.[Abstract/Free Full Text]
  11. TenBroek EM, Lampe PD, Solan JL, Reynhout JK, Johnson RG. Ser364 of connexin43 and the upregulation of gap junction assembly by cAMP. J Cell Biol. 2001; 155: 1307–1318.[Abstract/Free Full Text]
  12. Lin R, Warn-Cramer BJ, Kurata WE, Lau AF. v-Src phosphorylation of connexin 43 on Tyr247 and Tyr265 disrupts gap junctional communication. J Cell Biol. 2001; 154: 815–827.[Abstract/Free Full Text]
  13. Toyofuku T, Yabuki M, Otsu K, Kuzuya T, Hori M, Tada M. Direct association of the gap junction protein connexin-43 with ZO-1 in cardiac myocytes. J Biol Chem. 1998; 273: 12725–12731.[Abstract/Free Full Text]
  14. Ai Z, Fischer A, Spray DC, Brown AM, Fishman GI. Wnt-1 regulation of connexin43 in cardiac myocytes. J Clin Invest. 2000; 105: 161–171.[Medline] [Order article via Infotrieve]
  15. Schulz R, Heusch G. Connexin 43 and ischemic preconditioning. Cardiovasc Res. 2004; 62: 335–344.[Abstract/Free Full Text]
  16. Kawasaki H, Springett GM, Mochizuki N, Toki S, Nakaya M, Matsuda M, Housman DE, Graybiel AM. A family of cAMP-binding proteins that directly activate Rap1. Science. 1998; 282: 2275–2279.[Abstract/Free Full Text]
  17. de Rooij J, Zwartkruis FJ, Verheijen MH, Cool RH, Nijman SM, Wittinghofer A, Bos JL. Epac is a Rap1 guanine-nucleotide-exchange factor directly activated by cyclic AMP. Nature. 1998; 396: 474–477.[CrossRef][Medline] [Order article via Infotrieve]
  18. Fukuhara S, Sakurai A, Sano H, Yamagishi A, Somekawa S, Takakura N, Saito Y, Kangawa K, Mochizuki N. Cyclic AMP potentiates vascular endothelial cadherin-mediated cell-cell contact to enhance endothelial barrier function through an Epac-Rap1 signaling pathway. Mol Cell Biol. 2005; 25: 136–146.[Abstract/Free Full Text]
  19. Cullere X, Shaw SK, Andersson L, Hirahashi J, Luscinskas FW, Mayadas TN. Regulation of vascular endothelial barrier function by Epac, a cAMP-activated exchange factor for Rap GTPase. Blood. 2005; 105: 1950–1955.[Abstract/Free Full Text]
  20. Oyamada Y, Zhou W, Oyamada H, Takamatsu T, Oyamada M. Dominant-negative connexin43-EGFP inhibits calcium-transient synchronization of primary neonatal rat cardiomyocytes. Exp Cell Res. 2002; 273: 85–94.[CrossRef][Medline] [Order article via Infotrieve]
  21. Ogita H, Kunimoto S, Kamioka Y, Sawa H, Masuda M, Mochizuki N. EphA4-mediated Rho activation via Vsm-RhoGEF expressed specifically in vascular smooth muscle cells. Circ Res. 2003; 93: 23–31.[Abstract/Free Full Text]
  22. Doble BW, Chen Y, Bosc DG, Litchfield DW, Kardami E. Fibroblast growth factor-2 decreases metabolic coupling and stimulates phosphorylation as well as masking of connexin43 epitopes in cardiac myocytes. Circ Res. 1996; 79: 647–658.[Abstract/Free Full Text]
  23. Ohba Y, Ikuta K, Ogura A, Matsuda J, Mochizuki N, Nagashima K, Kurokawa K, Mayer BJ, Maki K, Miyazaki J, Matsuda M. Requirement for C3G-dependent Rap1 activation for cell adhesion and embryogenesis. EMBO J. 2001; 20: 3333–3341.[CrossRef][Medline] [Order article via Infotrieve]
  24. Christensen AE, Selheim F, de Rooij J, Dremier S, Schwede F, Dao KK, Martinez A, Maenhaut C, Bos JL, Genieser HG, Doskeland SO. cAMP analog mapping of Epac1 and cAMP kinase. Discriminating analogs demonstrate that Epac and cAMP kinase act synergistically to promote PC-12 cell neurite extension. J Biol Chem. 2003; 278: 35394–35402.[Abstract/Free Full Text]
  25. Enserink JM, Christensen AE, de Rooij J, van Triest M, Schwede F, Genieser HG, Doskeland SO, Blank JL, Bos JL. A novel Epac-specific cAMP analogue demonstrates independent regulation of Rap1 and ERK. Nat Cell Biol. 2002; 4: 901–906.[CrossRef][Medline] [Order article via Infotrieve]
  26. Hertig CM, Butz S, Koch S, Eppenberger-Eberhardt M, Kemler R, Eppenberger HM. N-cadherin in adult rat cardiomyocytes in culture. II. Spatio-temporal appearance of proteins involved in cell-cell contact and communication. Formation of two distinct N-cadherin/catenin complexes. J Cell Sci. 1996; 109: 11–20.[Abstract]
  27. Kostetskii I, Li J, Xiong Y, Zhou R, Ferrari VA, Patel VV, Molkentin JD, Radice GL. Induced deletion of the N-cadherin gene in the heart leads to dissolution of the intercalated disc structure. Circ Res. 2005; 96: 346–354.[Abstract/Free Full Text]
  28. Kostin S, Hein S, Bauer EP, Schaper J. Spatiotemporal development and distribution of intercellular junctions in adult rat cardiomyocytes in culture. Circ Res. 1999; 85: 154–167.[Abstract/Free Full Text]
  29. Hogan C, Serpente N, Cogram P, Hosking CR, Bialucha CU, Feller SM, Braga VM, Birchmeier W, Fujita Y. Rap1 regulates the formation of E-cadherin-based cell-cell contacts. Mol Cell Biol. 2004; 24: 6690–6700.[Abstract/Free Full Text]
  30. Mochizuki N, Ohba Y, Kiyokawa E, Kurata T, Murakami T, Ozaki T, Kitabatake A, Nagashima K, Matsuda M. Activation of the ERK/MAPK pathway by an isoform of rap1GAP associated with G alpha(i). Nature. 1999; 400: 891–894.[CrossRef][Medline] [Order article via Infotrieve]
  31. Volk T, Geiger B. A 135-kDa membrane protein of intercellular adherens junctions. EMBO J. 1984; 3: 2249–2260.[Medline] [Order article via Infotrieve]
  32. Maillet M, Robert SJ, Cacquevel M, Gastineau M, Vivien D, Bertoglio J, Zugaza JL, Fischmeister R, Lezoualc’h F. Crosstalk between Rap1 and Rac regulates secretion of sAPPalpha. Nat Cell Biol. 2003; 5: 633–639.[CrossRef][Medline] [Order article via Infotrieve]
  33. Itoh M, Nagafuchi A, Moroi S, Tsukita S. Involvement of ZO-1 in cadherin-based cell adhesion through its direct binding to alpha catenin and actin filaments. J Cell Biol. 1997; 138: 181–192.[Abstract/Free Full Text]
  34. De Mello WC. Impaired regulation of cell communication by beta-adrenergic receptor activation in the failing heart. Hypertension. 1996; 27: 265–268.[Abstract/Free Full Text]
  35. Duncan JC, Fletcher WH. Alpha-1 connexin (connexin43) gap junctions and activities of cAMP-dependent protein kinase and protein kinase C in developing mouse heart. Dev Dyn. 2002; 223: 96–107.[CrossRef][Medline] [Order article via Infotrieve]
  36. Lauf U, Giepmans BN, Lopez P, Braconnot S, Chen SC, Falk MM. Dynamic trafficking and delivery of connexons to the plasma membrane and accretion to gap junctions in living cells. Proc Natl Acad Sci U S A. 2002; 99: 10446–10451.[Abstract/Free Full Text]



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