Circulation Research. 2006;98:1240-1243
doi: 10.1161/01.RES.0000225860.41648.63
(Circulation Research. 2006;98:1240.)
© 2006 American Heart Association, Inc.
Ca2+, Calmodulin, and Cyclins in Vascular Smooth Muscle Cell Cycle
Vera V. Koledova,
Raouf A. Khalil
From the Division of Vascular Surgery, Brigham and Womens Hospital and Harvard Medical School, Boston, Mass.
Correspondence to Raouf A Khalil, MD, PhD, Harvard Medical School, Brigham and Womens Hospital, Division of Vascular Surgery, NRB 435, 77 Ave Louis Pasteur, Boston, MA 02115. E-mail raouf_khalil{at}hms.harvard.edu
See related article, pages 12731281
Key Words: calcium calmodulin cell cycle cyclins vascular smooth muscle
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Introduction
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Ca
2+ is a major determinant of many biochemical processes in
various cell types, from the beginning of new life and egg fertilization
to the end of life and cell death.
1 In vascular smooth muscle
(VSM), physiological resting levels of intracellular free Ca
2+ concentration ([Ca
2+]
i) in the nanomolar range are necessary
to maintain basal vascular tone.
24 VSM activation is
associated with an increase in [Ca
2+]
i in the micromolar range,
24 and large increases in VSM [Ca
2+]
i have been identified in excessive
vasoconstriction disorders such as hypertension and coronary
vasospasm.
2,5 Activation of surface membrane receptors in VSM
triggers increases in [Ca
2+]
i attributable to Ca
2+ release from
the intracellular stores in the sarcoplasmic reticulum and Ca
2+ entry from the extracellular space through Ca
2+ channels (see
Figure). Ca
2+ then activates specific protein kinases and phosphatases
that are involved in VSM contraction and relaxation.
2,3,6 Ca
2+ may also function as a second messenger to activate other signaling
pathways such as cytosolic phospholipase A2

, phospholipase C,
protein kinase C and phosphodiesterase.
68 An increase
in [Ca
2+]
i could also modulate plasma membrane channels and
pumps such as Ca
2+-activated K
+ channels and the plasma membrane
CaATPase (PMCA).
9,10 Additionally, Ca
2+ may affect sarcoplasmic
reticulum channels and pumps such as the inositol 1,4,5-trisphosphate
(IP
3) receptor, the ryanodine-sensitive receptor and intracellular
Ca
2+ release channels, and the Ca
2+ uptake pump (SERCA).
11,12

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Agonist (A)-receptor (R) interaction increases the hydrolysis of phosphatidylinositol 4,5-bisphosphate (PIP2) and IP3 production in VSM. IP3 stimulates Ca2+ release from the sarcoplasmic reticulum (SR). Also, extracellular Ca2+ enters VSMC through Ca2+ channels. Ca2+ binds calmodulin (CaM), which could activate myosin light chain (MLC) kinase and initiate contraction, or regulate the activity of K+ channels, Ca2+ release channels, Ca2+ pumps, and CaM kinase II. During vascular injury, VSMC transforms into undifferentiated phenotype and enters a cell cycle which consists of G1, growth, and preparation of the chromosomes for replication; S, synthesis of DNA; G2, preparation for mitosis; and M, mitosis. Ca2+/CaM increases the activity of cyclin E/CDK2 and stimulates G1/S transition, and thereby promotes VSM growth and proliferation.
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Calmodulin, a Ca2+ Sensor and Regulatory Protein
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Ca
2+ performs most of its functions by interacting with specific
Ca
2+ binding proteins, which serve as Ca
2+ sensors and regulatory
proteins. Calmodulin (CaM) is a critical Ca
2+ sensor and regulatory
protein in VSM. CaM is a ubiquitous small acidic protein of
16.7 kDa that is involved in virtually all Ca
2+-dependent intracellular
events.
2,3 The total intracellular concentration of CaM in the
cell is significantly lower than the total concentration of
its intracellular targets, making it a limiting factor in their
regulation. CaM contains 4 EF-hand Ca
2+ binding sites. The formation
of Ca
2+/CaM complex is necessary to activate myosin light chain
(MLC) kinase, leading to MLC phosphorylation, actin-myosin interaction,
and VSM contraction. On the other hand, Ca
2+/CaM-dependent protein
phosphatase initiates MLC dephosphorylation and VSM relaxation.
Also, Ca
2+/CaM-dependent protein kinase II (CaMKII) is a ubiquitous
mediator of Ca
2+-linked signaling pathways that phosphorylates
a wide range of substrates to coordinate and regulate Ca
2+-mediated
cellular functions.
1315 For example, CaMKII phosphorylates
and inactivates MLC kinase, a process that may be essential
in the regulation of VSM contraction.
16
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Ca2+/CaM in VSM Cell Cycle and Growth
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Vascular tissue injury in response to hypoxia, hyperlipidemia,
oxidative stress, and nicotine smoking is associated with increased
production of growth factors/promoters such as hypoxia-inducible
factor, epidermal growth factor, fibroblast growth factor, platelet
derived growth factor, angiotensin II, and endothelin-1.
1722 The growth factors stimulate the expression and phosphorylation
of ERK1/2 and JNK, and increase the DNA binding activity of
activator protein-1 (AP-1) and nuclear factor-

B (NF-

B).
17,23 These nuclear events induce the phenotypic transformation of
VSM into undifferentiated rapidly growing cells. VSM cell (VSMC)
growth contributes to the pathogenesis of vascular hypertrophic
disorders such as hypertension, atherosclerosis, and vascular
restenosis after angioplasty.
2426
Studies have implicated Ca2+ as a regulator of mammalian cell cycle during early G1 phase and near the G1 to S phase transition.27 However, the molecular mechanisms underlying the Ca2+ sensitivity of the G1/S phase transition in VSM cell cycle have not been clearly elucidated. Also, while some studies have suggested a role for CaM in cell cycle and have shown that Ca2+/CaM is required for cell proliferation in both unicellular and multicellular eukaryotes,27,28 the specific molecular targets of the Ca2+/CaM-dependent pathways are unclear.
Potential Ca2+/CaM-dependent targets include the serine/threonine phosphatase calcineurin and the family of multifunctional Ca2+/CaM-dependent protein kinases (CaMKs). In mammalian cells, both types of enzymes contribute to the regulation of cell cycle progression. However, the mechanism by which Ca2+/CaM and its downstream targets, particularly calcineurin and CaMKs, regulate key cell cycleregulatory proteins, remains enigmatic. By understanding how Ca2+/CaM regulates cell cycle progression in normal mammalian cells, we would gain insight into how hormones control cell division, and how VSMCs coordinate Ca2+ and its downstream targets during the cell transformation into the rapidly growing proliferative phenotype.28
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Ca2+/CaMCyclin Interaction During VSM Cell Cycle
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The passage of a cell through the cell cycle is controlled by
proteins in the cytoplasm called cyclins. Recent studies have
revealed the important role of cyclins in vascular and cardiac
tissue injury, inflammation, and wound repair.
29 Cyclins bind
to and activate specific cyclin-dependent kinases (CDKs), which
in turn phosphorylate a variety of protein substrates that control
the cell cycle. Although the levels of CDKs in the cell remain
fairly stable, the levels of certain cyclins rise and fall with
the specific stages of the cell cycle. Cyclin D and CDK4 mainly
control the G
1 phase, cyclins A and E, and CDK2 control the
S-phase, while cyclins A and B and CDK1 control the mitotic
phase. Growth factors stimulate the expression and tyrosine
phosphorylation of ERK-1, which in turn promote the expression
of cyclins and induce VSMC growth.
21 On the other hand, a decrease
in tyrosine phosphorylation of ERK1/2 reduces the expression
of cyclins D1 and E, resulting in G
1 phase cell cycle arrest
and inhibition of VSMC proliferation.
30
Studies have shown that depletion of Ca2+ pools in VSMC using the SERCA inhibitor thapsigargin causes inhibition of translocation of activated ERK1/2 to the nucleus and prevents cyclin D1 expression, thus delaying the progression into the S-phase and the cell cycle.31 Also, forced gene expression of SERCA2a in a model of balloon injury of the rat carotid artery is associated with decreased cyclin D1 in VSMCs, cell cycle arrest at the G1 phase, and reduced VSMC proliferation and neointima formation.32 Although these studies suggest possible effects of intracellular Ca2+ on cyclin expression and the CDK activity, the specific molecular interactions and targets involved have not been clarified.
In this issue of Circulation Research, Choi and colleagues describe a possible CaM binding site on cyclin E which could be involved in Ca2+-sensitive G1/S transition in VSMCs.33 They report that the kinase activity of cyclin E/CDK2 was responsive to physiological changes in Ca2+ concentration. Pharmacological inhibition of CaM using calmidazolium abrogated the Ca2+-sensitivity of cyclin E/CDK2, retarded VSMC proliferation, and caused cell cycle arrest at G1 phase. A highly conserved 22-aa N-terminal CaM-binding motif in cyclin E genes was essential in mediating the Ca2+-sensitive kinase activity of cyclin E/CDK2. Mutant cyclin E protein, lacking this CaM-binding motif, did not respond to alterations in Ca2+ concentration. These data clearly suggest that CaM-dependent cyclin E/CDK2 activity could mediate the Ca2+-sensitivity of the G1/S transition in VSM cell cycle. These novel findings not only further elucidate the molecular mechanisms underlying VSMC growth, but may also help in the design of therapies that specifically aim at Ca2+/CaM-dependent cyclin E/CDK2 activity and can be used in the prevention/treatment of hypertrophic VSMC disorders. The study also raises interest in further understanding the role of Ca2+, CaM, and cyclins in VSMC proliferation and the factors that regulate the levels of the Ca2+/CaM complex and the cyclin/CDK activity.
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Regulation of Ca2+/CaM in Quiescent and Growing VSMC
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An important point relates to the level of Ca
2+ that triggers
the G
1/S transition. Because of its small molecular size, Ca
2+ is expected to rapidly and homogeneously distribute inside the
cell. However, some studies suggest localized Ca
2+ gradients
and sparks in the subplasmalemmal region and perinuclear sites.
4,34 Also, the regulation of Ca
2+ in the nucleus, where important
Ca
2+-sensitive transcriptional processes reside, is a debated
issue.
35 Cells may also show oscillations in [Ca
2+]
i,
4 and it
is possible that the levels of the Ca
2+/CaM complex may mirror
those of the Ca
2+ oscillations. In effect, the levels of Ca
2+/CaM
may play a role in the intracellular Ca
2+ oscillatory behavior
and in the regulation of the Ca
2+ mobilization mechanisms. IP
3 receptors in the sarcoplasmic reticulum are tetrameric intracellular
Ca
2+ channels, the opening of which is regulated by both IP
3 and Ca
2+. IP
3 receptors are biphasically regulated by cytosolic
Ca
2+, which binds to two distinct sites. IP
3 promotes channel
opening by controlling whether Ca
2+ binds to the stimulatory
or inhibitory sites. Inhibition of IP
3 receptors by Ca
2+ may
require CaM. It is likely that one lobe of CaM tethers it to
the IP
3 receptor, while the other lobe binds Ca
2+ and then interact
with a second site on the receptor to cause its inhibition.
11
Also, the CaATPase (commonly called the Ca2+ pump) is a fine-tuner of intracellular Ca2+. The plasma membrane CaATPase (PMCA) plays a role in Ca2+ extrusion. PMCA is a large enzyme, with 10 transmembrane domains and a C-terminal cytosolic tail that contains regulatory sites, including a CaM-binding domain.10 The sarcoplasmic reticulum CaATPase (SERCA) plays a role in Ca2+ reuptake. Reported posttranslational modifications affecting SERCA pump activity involve N-glycosylation, glutathionylation, and CaMKII-dependent phosphorylation.12
CaM may also be regulated by phosphorylation. CaM is phosphorylated both in vitro and in vivo by multiple serine/threonine and tyrosine protein kinases. Casein kinase II and MLC kinase are two serine/threonine kinases that have been implicated in this process. Also, within the tyrosine kinases involved in CaM phosphorylation are receptors with tyrosine kinase activity, such as the insulin receptor and the epidermal growth factor receptor, and nonreceptor tyrosine kinases, such as the Src family kinases, Janus kinase 2, and p38Syk. CaM phosphorylation brings important consequences for the physiological cell function and the cell growth as the phosphoCaM species have differential actions as compared with nonphosphorylated CaM when acting on different CaM-dependent systems.36
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Regulation of Cyclin/CDK Activity
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The activity of CDKs is controlled not only by Ca
2+/CaM and
cyclins, but also by CDK inhibitors (CKIs). Growth promotion
is associated with upregulation of cyclins and CDKs and downregulation
of CKIs, and the reverse occurs during growth arrest. The p16(INK4a),
p21(Cip1/Waf1), p27(Kip1), and p57(Kip2) are known inhibitors
of CDK.
23,37,38 Studies have shown that PPAR-

, a nuclear receptor
that regulates lipid metabolism and inflammation, controls VSM
cell cycle progression at the G
1/S transition by targeting the
CKI p16(INK4a).
39 Also, downregulation of p27(kip1) and p57(kip2)
in response to mitogenic stimulation plays a key role in the
VSM cell cycle progression.
38 Additionally, the mitogenic effect
of hyperlipemic sera and oxLDL in VSMC may occur via inhibition
of p21(Cip1) expression and subsequent increase in DNA synthesis
and cell proliferation.
22 Furthermore, antioxidants not only
downregulate cyclins D and E and CDKs 2 and 4, but also upregulate
p21(Cip 1) and p27(Kip 1), leading to inhibition of CDK and
arrest of cell cycle progression.
23 Nevertheless, it is not
clear whether reduction in [Ca
2+]
i and Ca
2+/CaM would stimulate
the CKIs.
Also, the potential role of newly discovered Ca2+ sensors and binding proteins in the regulation of cyclin/CDK activity and VSM cell cycle should be investigated. A novel Ca2+-binding protein called DREAM has been shown to interact with regulatory sequences of DNA, thereby acting as a Ca2+-dependent transcriptional regulator.40 Expression of the human prodynorphin gene, which is involved in memory acquisition and pain, is regulated through its downstream regulatory element (DRE) sequence. The transcriptional repressor DRE-antagonist modulator (DREAM) specifically binds to the DRE. DREAM contains 4 Ca2+-binding domains of the EF-hand type. On stimulation by Ca2+, the ability of DREAM to bind to the DRE and its repressor function are prevented. Mutation of the EF-hands abolishes the response of DREAM to Ca2+. Also, S100B, a dimeric EF-hand Ca2+-binding protein, interacts with the cell growth suppressor p53 and controls its transcriptional activity.41
Finally, the effect of other cations on the VSM cell cycle remains to be clarified. For instance, Mg2+ is known to affect Ca2+ entry into VSM and to counteract the effects of Ca2+ on VSM contraction. However, studies have shown VSM cell cycle activation and growth regulation by Mg2+ via ERK1/2-dependent, p38 MAP kinase-independent pathways.42
Thus Ca2+ remains to be a master regulator of VSM contraction and growth. Several studies have clarified the role of CaM as a major Ca2+ sensor that regulates the activity of VSM channels, pumps, and contractile proteins. New careful studies are now beginning to shed light on the intricate interaction between Ca2+, CaM, and cyclins in the regulation of VSM growth and proliferation.
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Acknowledgments
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The authors acknowledge the support of grants from the National
Heart, Lung, & Blood Institute (HL65998, HL70659).
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Footnotes
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The opinions expressed in this editorial are not necessarily
those of the editors or of the American Heart Association.
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