Literature DB >> 33178023

Cell Death Triggered by the Autophagy Inhibitory Drug 3-Methyladenine in Growing Conditions Proceeds With DNA Damage.

Javier Chicote1,2, Víctor J Yuste3,4, Jacint Boix5, Judit Ribas1,2.   

Abstract

Macroautophagy (hereafter autophagy) is a multistep intracellular catabolic process with pleiotropic implications in cell fate. Attending to its activation, autophagy can be classified into inducible or constitutive. Constitutive, or basal autophagy, unfolds under nutrient-replete conditions to maintain the cellular homeostasis. Autophagy inhibitory drugs are powerful tools to interrogate the role of autophagy and its consequences on cell fate. However, 3-methyladenine and various of these compounds present an intrinsic capacity to trigger cell death, for instance the broadly-employed 3-methyladenine. To elucidate whether the inhibition of basal autophagy is causative of cell demise, we have employed several representative compounds acting at different phases of the autophagic process: initiation (SBI0206965 and MHY1485), nucleation (3-methyladenine, SAR405, Spautin-1 and Cpd18), and completion (Bafilomycin A1 and Chloroquine). These compounds inhibited the basal autophagy of MEF cultures in growing conditions. Among them, 3-methyladenine, SBI-0206965, Chloroquine, and Bafilomycin A1 triggered BAX- and/or BAK-dependent cytotoxicity and caspase activation. 3-methyladenine was the only compound to induce a consistent and abrupt decrease in cell viability across a series of ontologically unrelated human cell lines. 3-methyladenine-induced cytotoxicity was not driven by the inhibition of the AKT/mTOR axis. Autophagy-deficient Fip200-/- MEFs displayed an increased sensitivity to activate caspases and to undergo cell death in response to 3-methyladenine. The cytotoxicity induced by 3-methyladenine correlated with a massive DNA damage, as shown by γ-H2A.X. This genotoxicity was observed at 10 mM 3-methyladenine, the usual concentration to inhibit autophagy and was maximized in Fip200-/- MEFs. In sum, our results suggest that, in growing conditions, autophagy acts as a protective mechanism to diminish the intrinsic cytotoxicity of 3-methyladenine. However, when the cellular stress exerted by 3-methyladenine surpasses the protective effect of basal autophagy, caspase activation and DNA damage compromise the cell viability.
Copyright © 2020 Chicote, Yuste, Boix and Ribas.

Entities:  

Keywords:  3-methyladenine; apoptosis; autophagy inhibitor; basal autophagy; Ɣ-H2A.X

Year:  2020        PMID: 33178023      PMCID: PMC7593545          DOI: 10.3389/fphar.2020.580343

Source DB:  PubMed          Journal:  Front Pharmacol        ISSN: 1663-9812            Impact factor:   5.810


Introduction

Macroautophagy (herein, autophagy) is a highly regulated cellular process by which cellular constituents are engulfed into autophagosomes before being degraded and reused. Autophagy is a constitutive process observed in most tissues in non-stressed nutrient-replete conditions (basal autophagy). However, it also increases in response to environmental cues such as nutrient starvation or the exposure to a plethora of stressors (inducible autophagy) (Kuma et al., 2004; Degterev et al., 2005; Mizushima, 2007; Mattiolo et al., 2015). Basal autophagy participates in essential housekeeping functions like the elimination of damaged organelles, toxic aggregates of misfolded macromolecules and, probably, in other crucial aspects of the cell and organism homeostasis (Boya et al., 2013). Nonetheless, over-stimulated autophagy may also lead to cell death type II (Clarke, 1990) due to an excessive degradation of intracellular components (Bialik et al., 2018). Regardless of the final cellular outcome, inappropriate levels of autophagy are at the origin of many pathologies, and thus modulation of this process is believed to have great therapeutic avenues. In this sense, inhibition of autophagy could be beneficial in the treatment of some types of cancer, chronic obstructive pulmonary diseases, neonatal asphyxia, and specific inflammatory-based illnesses (Galluzzi et al., 2017). Chloroquine and its derivative, hydroxychloroquine, are the only FDA-licensed drugs approved in clinical trials that aim to block autophagy. This historical shortage has been compensated by the development of an expanding arsenal of new pharmacological inhibitors. The selection of those with a better inhibitory profile and with less unspecific cytotoxicity demands of an accurate characterization. Prior to the commitment into autophagy, cells must integrate information from hormonal, metabolic and stress stimuli to ensure that cell growth and proliferation are only engaged in favorable conditions. This coordination is achieved by cellular sensors like mTORC1 (mammalian target of rapamycin complex 1), which in its active form promotes cell growth and directs the metabolism into anabolic reactions. While the inhibition of mTORC1 triggers the activation of autophagy, maintaining a proper function stalls the process. Indeed, this strategy has been pharmacologically exploited by the autophagy inhibitory compound MHY1485, an activator of mTOR by a yet unknown mechanism (Choi et al., 2012). The autophagic process is orchestrated by the sequential activation of a series of protein complexes. Based on their order of participation, several autophagic phases are proposed. The “initiation phase” () involves the activation of the “ULK Initiation Complex”, which is under control of cellular sensors such as mTORC1 (D. Egan et al., 2011). This complex contains key serine/threonine kinases such as Unc-51-like kinase 1 (ULK1) or ULK2 and the scaffold protein FIP200, among other components. SBI-0206965 is an autophagy inhibitor that suppresses the kinase activity of ULK1/2 (D. F. Egan et al., 2015). The “initiation phase” gives way to the “Nucleation phase” of autophagy, which also comprises the elongation of the phagophore (). This phase begins with the activation of the “VPS34 Nucleation Complex” at the sites of autophagosome formation. VPS34 (vacuolar protein sorting 34) is a class 3 phosphatidylinositol 3-kinase (PI3KC3) that forms a multiprotein complex with BECLIN-1. The generation of PI3P (phosphatidyl inositol 3-phosphate) by VPS34 and the recruitment of PI3P-binding proteins is a crucial step for the nucleation and elongation of the growing autophagosomes, which eventually seal to originate a mature vesicle (Jaber et al., 2012). 3-methyladenine has become a standard tool to test the involvement of autophagy in numerous biological paradigms through its blockage of VPS34 (Seglen and Gordon, 1982). Nonetheless, the high concentrations of 3-methyladenine required to block autophagy are facilitating its off-target effects (Wu et al., 2013). In addition, 3-methyladenine is not specific for VPS34, being class I PI3K (PI3KC1) also inhibited (Wu et al., 2010). To overcome these limitations, Cpd18 and SAR405, two inhibitors of VPS34 kinase activity with improved potency and selectivity, have been developed (Wu et al., 2013; Ronan et al., 2014; Pasquier, 2015). On the other hand, Spautin-1 inactivates VPS34 complex through the inhibition of two ubiquitin-specific peptidases (USPs) and thus increasing BECLIN-1 ubiquitination and degradation (Liu et al., 2011).
Figure 1

Schematic illustration depicting the process of autophagy and the targets of the autophagy inhibitory drugs. mTOR is a serine/threonine protein kinase that regulates cell growth and anabolism. Associated to other proteins, mTOR forms a complex known as mTORC1, a sensor of the nutritional state of the cell. In growing conditions, mTORC1 constitutively blocks the “ULK initiation complex” and hence, autophagy. MHY1485 is an activator of mTOR that acts through a yet unknown mechanism. The “ULK initiation complex” contains ULK1 or its homolog ULK2, FIP200, and ATG13 and triggers the first step of autophagy known as Initiation. SBI-0206965 is an inhibitor of ULK1 and ULK2. The “ULK initiation complex” drives the formation of the precursors of the autophagosomes through the direct activation of the “VPS34 Nucleation Complex”, for instance by phosphorylating VPS34 (Vacuolar Protein Sorting 34) and BECLIN-1. Spautin-1 triggers the destruction of BECLIN-1 through the inhibition of two of its deubiquitinases. On the other hand, VPS34 is a class 3 phosphatidylinositol 3-phosphate-kinase (PI3KC3) accountable for the production of the phospholipid phosphatidylinositol 3-phosphate (PI3P) necessary for the recruitment of PI3P-binding proteins that lead the nucleation and elongation of the vesicles. 3-MA, its close analog Cpd18 and SAR405 are inhibitors of VPS34. In addition, a third complex consisting of ATG16L1–ATG5–ATG12 plays a key role in the “Nucleation and Elongation” phase. This complex orchestrates a conjugation similar to what E3-ubiquitin ligases do, but in this case, they catalyze the transfer of the “ubiquitin-like” LC3-I to the lipid phosphatidylethanolamine, giving rise to LC3-II. p62/SQSTM1 is an autophagy receptor that binds the ubiquitinylated cargo and directs it to the growing double-membrane autophagosome by interacting with LC3-II and other related proteins. Finally, the “Completion of the autophagic process” includes two phases: “Fusion” and “Degradation”. During “Fusion”, the mature autophagosome fuses with lysosomes, originating a new vesicle known as autolysosome. The activation of the H+ pumps triggers the activation of the lysosomal hydrolases, which are in charge of degrading the cargo. Bafilomycin A1 inhibits the acidification of the autolysosome by blocking the vacuolar-type H+-V-ATPase while Chloroquine impairs the fusion of lysosomes with autophagosomes. Finally, products from degradation reach the cytosol through permeases and enter into metabolic circuitries. All drugs are depicted within squares.

Figure 9

3-methyladenine triggers the phosphorylation of H2A.X at Ser139. Western blots probed with antibodies against phosphorylated Ser139-H2A.X (γ-H2A.X) and total H2A.X are shown. Quantifications are the ratios between the intensity of γ-H2A.X normalized to total H2A.X. Naphthol blue (NB) stained membrane served as a loading control. (A) Protein extracts of wt MEFs treated with 3-MA at 2.5, 5, and 10 mM for 24 h. Extracts of control cells are depicted as “0”. (B) Protein extracts of Fip200–/– and Fip200+/+ MEFs challenged during 24 h with 10 mM 3-MA or left untreated (C) Protein extracts of MEFs untreated (C) or treated for 24 h with 5 μM SAR, for 20 and 40 h with 20 μM SBI and for 12 and 24 h with 10 mM 3-MA, 100 nM BafA1 and 50 μM CQ. Images in (A–C) are a representative experiment out of, at least, three independent experiments.

Schematic illustration depicting the process of autophagy and the targets of the autophagy inhibitory drugs. mTOR is a serine/threonine protein kinase that regulates cell growth and anabolism. Associated to other proteins, mTOR forms a complex known as mTORC1, a sensor of the nutritional state of the cell. In growing conditions, mTORC1 constitutively blocks the “ULK initiation complex” and hence, autophagy. MHY1485 is an activator of mTOR that acts through a yet unknown mechanism. The “ULK initiation complex” contains ULK1 or its homolog ULK2, FIP200, and ATG13 and triggers the first step of autophagy known as Initiation. SBI-0206965 is an inhibitor of ULK1 and ULK2. The “ULK initiation complex” drives the formation of the precursors of the autophagosomes through the direct activation of the “VPS34 Nucleation Complex”, for instance by phosphorylating VPS34 (Vacuolar Protein Sorting 34) and BECLIN-1. Spautin-1 triggers the destruction of BECLIN-1 through the inhibition of two of its deubiquitinases. On the other hand, VPS34 is a class 3 phosphatidylinositol 3-phosphate-kinase (PI3KC3) accountable for the production of the phospholipid phosphatidylinositol 3-phosphate (PI3P) necessary for the recruitment of PI3P-binding proteins that lead the nucleation and elongation of the vesicles. 3-MA, its close analog Cpd18 and SAR405 are inhibitors of VPS34. In addition, a third complex consisting of ATG16L1ATG5ATG12 plays a key role in the “Nucleation and Elongation” phase. This complex orchestrates a conjugation similar to what E3-ubiquitin ligases do, but in this case, they catalyze the transfer of the “ubiquitin-like” LC3-I to the lipid phosphatidylethanolamine, giving rise to LC3-II. p62/SQSTM1 is an autophagy receptor that binds the ubiquitinylated cargo and directs it to the growing double-membrane autophagosome by interacting with LC3-II and other related proteins. Finally, the “Completion of the autophagic process” includes two phases: “Fusion” and “Degradation”. During “Fusion”, the mature autophagosome fuses with lysosomes, originating a new vesicle known as autolysosome. The activation of the H+ pumps triggers the activation of the lysosomal hydrolases, which are in charge of degrading the cargo. Bafilomycin A1 inhibits the acidification of the autolysosome by blocking the vacuolar-type H+-V-ATPase while Chloroquine impairs the fusion of lysosomes with autophagosomes. Finally, products from degradation reach the cytosol through permeases and enter into metabolic circuitries. All drugs are depicted within squares. The loading of the autophagic cargo occurs during nucleation and elongation phases. It requires the participation of specific ubiquitin-like conjugation enzymes such as the E3-like complex formed by ATG16L1-ATG5-ATG12, which catalyzes the conjugation of cleaved MAP1LC3/LC3 to the lipid phosphatidylethanolamine, originating the LC3-II. LC3-II and the cargo receptor p62/SQSTM1 play relevant roles in cargo recognition and loading (Schaaf et al., 2016). During the “Fusion phase”, the mature autophagosomes fuse to lysosomes originating the autolysosomes. These organelles contain the proteases in charge of the “Degradation” phase, whereby the cargo and structural molecules such as LC3-II and p62/SQSTM1 will be proteolyzed and recycled. For simplicity reasons, we clustered these final phases under the term “Completion phase of the autophagic process” (). Chloroquine is a classical anti-malarial drug that suppresses autophagy by inhibiting the fusion of autophagosomes and lysosomes (Mauthe et al., 2018). On the other hand, Bafilomycin A1 belongs to the macrolide-type of antibiotics and inhibits the vacuolar H+-V-ATPase (V-ATPase), which is in charge of the lysosomal acidification. The pharmacological inhibition of lysosomal function allows the determination of the autophagic flux by comparing the accumulation of LC3-II and p62 in inhibited and non-inhibited conditions (Mizushima et al., 2010; Klionsky et al., 2016). In this study, we set out to identify the autophagy inhibitory compounds that were cytotoxic in growing conditions, regardless of their autophagy inhibitory function. All the compounds tested were able to block basal autophagy but only SBI-0206965 (“Initiation phase”), 3-methyladenine (“Nucleation phase”), and Bafilomycin A1 and Chloroquine (“Completion phase”) triggered regulated cell death with the implication of caspases, and BAX and/or BAK. Among these drugs, 3-methyladenine showed the strongest activity at diminishing cell viability across four ontologically-unrelated human cell lines. The impairment of AKT/mTOR axis was not the leading mechanism of 3-methyladenine-driven cytotoxicity. 3-methyladenine-mediated cell death occurred independently of its basal autophagy blocking action, as demonstrated by using Fip200−/− MEFs. However, basal autophagy acted as a protective mechanism facing 3-methyladenine-induced caspase activation and cell death. Finally, cells cultured in the presence of cytotoxic concentrations of 3-methyladenine, displayed γ-H2A.X. Our study demonstrates that 3-methyladenine works as a genotoxic compound independently of its ability to block basal autophagy.

Materials and Methods

Cell Lines and Cell Culture Conditions

Immortalized Bax−/− Bak−/− (DKO) MEFs and their wild type (MEFs) counterparts were obtained from Dr. Korsmeyer’s laboratory. Fip200−/− MEFs and their counterparts (Fip200+/+ MEFs) were gently supplied by Dr. Molinari and originated at Dr. Guan’s laboratory. SH-SY5Y, HeLa, HEK 293 cell lines were obtained from the American Type Culture Collection (ATCC; Manassas, VA, USA). HCT116 human adenocarcinoma cell line was kindly provided by Dr Vogelstein (The Howard Hughes Medical Institute, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins School of Medicine, Baltimore, MD, USA). All cell lines were maintained in DMEM (Gibco, Paisley, Scotland, UK) supplemented with 10% FCS (Gibco, Paisley, Scotland, UK) with the exception of HCT116, which were maintained in McCoy’s 5A (Biowest, Riverside, MO, USA) supplemented with 10% FCS. 5 μg/ml Plasmocin™ (InvivoGen, San Diego, CA, USA) was used as the media antibiotic. General culturing conditions were 37°C and a water-saturated, 5% CO2 atmosphere. Culture dishes and other plastic disposable tools were supplied by VWR (Radnor, PA, USA) and Becton Dickinson (Franklin Lakes, NJ, USA).

Drug Treatment of Cells in Culture

As autophagy inhibitory drugs, we have used MHY1485 (Ref. 500554), Spautin-1 (Ref. 567569) and Cpd18 (Ref. 505980) from Calbiochem, part of Merck, Darmstadt, Germany. SBI-0206965 (Ref. S-7885) and SAR405 (Ref. S7682) were purchased from Selleck chemicals, Houston, TX, USA. MHY1485, SBI-0206965, SAR405 and Spautin-1 were dissolved in DMSO at a final concentration of 20 mM, 20 mM, 10 mM and 10 mM respectively. A 8 mM working solution of Cpd18 was prepared in HBSS without glucose. 3-methyladenine was obtained either from Acros Organics (Morris Planes, NJ, USA) or ApexBio (A8353, Huston, TX, USA) and dissolved in HBSS (Hank’s buffer salt solution) without glucose at a final concentration of 40 mM. Before treating the cells, 3-MA was sonicated during 20 min to prevent the formation of aggregates. Chloroquine (Sigma-Aldrich, C6628) was dissolved in PBS at a final concentration of 50 mM. Wortmannin (SC-3505) was purchased from Santa Cruz Biotechnology Inc., Dallas, Texas, USA and prepared in PBS at a final concentration of 100 mM. Bafilomycin A1 (Ref. 11038, Cayman chemical, Ann Arbor, MI, USA) was dissolved in DMSO at a final concentration of 1 mM. To treat cells, a 100 μM working solution was prepared in PBS. From these stock solutions, the drugs were delivered to the culture media and adjusted to the final concentrations reported in the text and figures. All the treatments were performed in the presence of ¼ HBSS + ¾ DMEM 10% FBS, the maximal concentrations of HBSS without glucose reached with the 10 mM 3-MA. Cells were also treated with this medium plus the highest concentration of DMSO resulting from the drug treatments, thus becoming the drug-untreated control of our experiments. DMSO concentrations never surpassed a 0.1% in the medium. At this concentration, we have observed no alteration in the cultured cells. To inhibit apoptotic caspases, cell cultures were treated with the pan-caspase inhibitor q-VD-OPh (Ref 551476, Calbiochem, part of Merck, Darmstadt, Germany) dissolved in DMSO and employed at the concentration indicated in the figure legend.

Cell Staining Procedures

In order to visualize acidic vesicular organelles (AVOs), cells were stained with the monodansylcadaverine reagent (sc-214851, Santa Cruz Biotechnology Inc., Dallas, Texas, USA). In brief, cell cultures were incubated for 15 min with 50 μM monodansylcadaverine in the treatment medium before replacing it with fresh medium. To evidence the autophagic flux, DalGreen (D675, Dojindo, Japan) staining was used according to the supplier’s instructions. Briefly, 2,500 MEF cells were plated in 96-well plates. After 24 h, DALGreen reagent diluted in fresh medium was added to the cultures to reach a final concentration of 1 µM. After an incubation of 30 min, loading medium was replaced with fresh cell culture medium. Next, cells were subjected to the treatment conditions indicated in the figure. In order to detect the apoptotic nuclear morphology, cultured cells were directly stained with bis-benzimide (Hoechst 33342) at a final concentration of 2 ug/ml. Following the aforementioned procedures, cells were observed with an inverted fluorescence microscope (Nikon Eclipse Ts2R) and images captured and processed through NIS-Elements Basic Research Software. To quantify the number of monodansylcadaverine positive vesicles or the DALGreen Fluorescent intensity per cell, images of at least 50 cells from three independent wells were analyzed using ImageJ software (National Institutes of Health, Bethesda, MD, USA).

Cell Viability Determinations

To determine cell survival, alamarBlue™ Cell Viability Assay Reagent (Pierce Biotechnology, Rockford, IL, USA) was used according to the manufacturer’s protocol. This assay couples a non-specific cellular reductase activity of viable cells to the reduction of alamarBlue (AB) into a fluorescent product. Briefly, cells plated in 96-well plates were subjected to drug treatments, then AB (1/10th of the final volume) was added to each well. After an incubation of 3 h, fluorescent signal was quantified by means of a fluorescence plate reader (Infinite M200, Tecan). Percentage of viability was obtained by referring these values to the ones obtained in untreated control. To determine cell death, cells were collected by trypsinization and stained with 5 μg/ml propidium iodide (PI) from Sigma-Aldrich (St. Louis, MO, USA) directly in the cell culture medium. Following 15 min incubation at room temperature, cells were subjected to flow cytometry analysis.

Measurement of Caspase Activation

The activity of effector caspases (DEVDase activity) was obtained by quantifying the fluorescence released from Ac-DEVD-afc substrate (Cayman chemical, Ann Arbor, MI, USA). Cells in culture were lysed and incubated in the presence of this substrate at 37°C. This procedure was initially validated by Ribas et al. (Ribas et al., 2005) and routinely used in our laboratory afterwards.

Western-Blot

To obtain cytosolic extracts, cells were harvested and lysed in a buffer containing 50 mM NaCl, 25 mM Tris pH 6.8, 1 mM EDTA, 0.1% Triton X-100 supplemented with the Protease Inhibitor Cocktail Set III, EDTA-free (Calbiochem, part of Merck, Darmstadt, Germany). If a protein phosphorylation was examined, the phosphatase Inhibitor Cocktail II (Alfa Aesar part of Thermo Fisher scientific Inc., Kandel, Germany) was added to the buffer. Cell lysates were centrifuged at 15,000 r.p.m. for 30 min at 4°C before the determination of the protein content. To study histone H2A.X, whole cell protein extracts were obtained by lysing cells in a buffer containing 100 mM Tris/ClH pH 6.8, 1% SDS, 1 mM EDTA plus the protease and phosphatase inhibitory cocktails afore mentioned. Cell lysates were sonicated on ice for two rounds of 10 s before being clarified by centrifugation at 15,000 r.p.m. for 30 min. The amount of protein in the supernatants was quantified by a modified Lowry assay (DC protein assay, Bio-Rad, Hercules, CA, USA). Equal amounts of protein were loaded in the wells of SDS-polyacrylamide gels and separated in an electric field. Next, gels were electrotransferred onto 0.45 μm PVDF membranes (EMD Millipore, part of Merck Darmstadt, Germany) and blocked with Tris-buffered saline with 0.1% Tween 20 and 5% non-fat dry milk. Blocked membranes were probed with the following specific primary antibodies: anti-LC3B (1:1,000; L7543) from Sigma-Aldrich (St. Louis, MO, USA), anti-p62 (1:2,000; PM045) from Medical and Biological laboratories Co. “MBL” (Nagoya, Japan), anti-caspase 3 (1:2,000; clone 8G10, #9665 or 1:1,000; #9662), anti-phospho Ser757-ULK1 (1:1,000; #6888), anti-ULK1 (1:1,000; clone D8H5, #8054), anti-phospho Thr37/46-4E-BP1(1:1,000; clone 136B4, #2855), anti-4E-BP1 (1:1,000; clone 53H11, #9644) from Cell Signaling Technology, anti-α-Fodrin (1:15,000; MAB1622) and anti- H2A.X (1:1,000; #07-627) anti-phospho Ser139H2A.X (1:1,000; clone JBW301, #05-636-I) from Millipore (part of Merck, Darmstadt, Germany). After incubation with the corresponding horseradish peroxidase-conjugated secondary antibody, the immunoblots were developed with the Immobilon™ reagent (Millipore, part of Merck, Darmstadt, Germany). Chemiluminescent images were recorded by means of a Chemidoc XRS apparatus and analyzed with the Image Lab version 4.0.1 software from Bio-Rad (Bio-Rad, Marnes-la-Coquette, France). Loading of each sample was assessed by staining the membranes during 5 min in a solution containing 10% methanol, 2% acetic acid, and 0.1% of Naphthol blue black Sigma-Aldrich (St. Louis, MO, USA). Then, membranes were de-stained in a 10% methanol and 2% acetic acid solution during 10 min. Membranes were allowed to dry before capturing images with the Chemidoc XRS apparatus. Otherwise stated, the westerns presented are a representative of at least three independent experiments. To calculate the percentage of Basal Autophagic Flux (LC3-II T+BafA1/LC3-II T), LC3-II bands were detected on Chemidoc XRS (Bio-Rad, Marnes-la-Coquette, France). LC3-II protein levels were determined by computer-assisted densitometric analysis (Image Lab version 4.0.1 software from Bio-Rad). The density of each band was normalized to its respective loading control (Naphtol blue stained lane). Data obtained were expressed as the intensity ratio of LC3-II in cells subjected to an experimental condition in the presence of Bafilomycin A1 (“T+ BafA1”) to that of the same protein in cells subjected to the same experimental condition in the absence of Bafilomycin A1 (“T”). These intensity ratios were referred to the ratios of the basal autophagic flux in untreated cultures and expressed as a percentage, being 100% value assigned to control untreated cultures. The intensity of the protein bands was quantified with the assistance of densitometric software (Image Lab version 4.0.1 software from Bio-Rad). After a step of normalization (see Figure legend), ratios were displayed in the figures.

Results

Cytotoxicity Induced by Autophagy Inhibitory Compounds Is Observed at Concentrations Inhibiting the Basal Autophagic Process

Pharmacological inhibitors of autophagy are a common tool to interrogate the role of autophagy in a specific setting. As detailed in , autophagy inhibitors acting at the initiation phase (MHY1485 -MHY- and SBI0206965 -SBI-), at the nucleation phase (3-methyladenine -3-MA-, Cpd18, Spautin-1 -SPT-1- and SAR405 -SAR-) or at the completion phase (Chloroquine -CQ- and BafilomycinA1 -BafA1-) were selected to be studied. To quickly screen the inhibitory effects of these chemicals on basal autophagy, first we employed a method to evidence the presence of acidic vesicular organelles (AVOs). MEFs subjected for 6 h to previously reported concentrations of the selected autophagy inhibitors (Choi et al., 2012; Zhao et al., 2016; Wu et al., 2010; Liu et al., 2011; Wu et al., 2013; Manic et al., 2014; Shao et al., 2014; Egan et al., 2015; Martin et al., 2018) were stained with the lysosomotropic fluorophore monodansylcadaverine (MDC). As observed in , a consistent reduction of AVOs was observed in response to the inhibitors. These results were corroborated through the quantification of MDC-positive vesicles per cell (). The accumulation of AVOs in response to CQ was a previously reported phenomenon and was employed as a positive control to evidence the maximal amount of MDC-stained vesicles (Mauthe et al., 2018). BafA1, which suppressed the acidic accumulation of MDC into AVOs, was employed as a negative control (Bowman et al., 1988). Next, we explored the time-dependent changes of LC3-II, a widely used read-out of the autophagic flux. Treatments consisted in incubations for 3 h or 12 h with the different inhibitors in the presence or absence of BafA1 for the last 3 h of treatment. Again, we confirmed that all the inhibitors blocked the basal autophagic flux to some extent (). Remarkably, at 3 h, MHY, SAR, and CQ reduced the autophagic flux percentage to less than 25% while Cpd18 reduced it to a 63% compared with the untreated control (). At 12 h, all the compounds diminished the percentage of autophagic flux to values less than 45%, with the exception of 3-MA and Cpd18, which displayed values of autophagic flux of 49 and 54%, respectively (12 h, ). Of note, CQ and BafA1, two common drugs used to assess the autophagic flux (Klionsky et al., 2016), triggered the greatest blockage of the autophagic flux at both 3 h and 12 h ().
Figure 2

Basal autophagy is blocked in response to autophagy inhibitory drugs. (A) MEFs treated for 6 h with the drugs at the concentrations stated in the panel were stained with monodansylcadaverine (MDC) and observed with a fluorescence microscope. Acidic vesicles are displayed as puncta. Bar = 20 μm. Representative images of at least two independent experiments are shown. (B) Protein extracts of MEFs treated for 3 and 12 h, as indicated in the panel, were analyzed by western blot. “12 h BafA1” is a control and refers to MEFs treated for 12 h with this drug. Intensity of the LC3-II band, normalized to the loading of each lane (naphtol blue staining) and referred to “C” (untreated control) without BafA1, was shown. Western blots are the result of a significant experiment out of three independent experiments. A histogram representing “% Basal Autophagic Flux (LC3-II T+BafA1/LC3-II T)” at 3 h (white bars) and 12 h (black bars) of treatment was calculated as reported in the “MATERIAL and METHODS” section. The percentages represent the quotient between LC3-II band intensities in “T” and “T+ BafA1”. “T” is treatment and “T+ BafA1” is treatment in the presence of BafA1. Naphthol blue (NB) stained membrane served as a loading control. The percentage of basal autophagic flux is expressed as mean ± SEM of at least three independent experiments (n = 3). Student’s t-test *P < 0.05 and **P < 0.01.

Basal autophagy is blocked in response to autophagy inhibitory drugs. (A) MEFs treated for 6 h with the drugs at the concentrations stated in the panel were stained with monodansylcadaverine (MDC) and observed with a fluorescence microscope. Acidic vesicles are displayed as puncta. Bar = 20 μm. Representative images of at least two independent experiments are shown. (B) Protein extracts of MEFs treated for 3 and 12 h, as indicated in the panel, were analyzed by western blot. “12 h BafA1” is a control and refers to MEFs treated for 12 h with this drug. Intensity of the LC3-II band, normalized to the loading of each lane (naphtol blue staining) and referred to “C” (untreated control) without BafA1, was shown. Western blots are the result of a significant experiment out of three independent experiments. A histogram representing “% Basal Autophagic Flux (LC3-II T+BafA1/LC3-II T)” at 3 h (white bars) and 12 h (black bars) of treatment was calculated as reported in the “MATERIAL and METHODS” section. The percentages represent the quotient between LC3-II band intensities in “T” and “T+ BafA1”. “T” is treatment and “T+ BafA1” is treatment in the presence of BafA1. Naphthol blue (NB) stained membrane served as a loading control. The percentage of basal autophagic flux is expressed as mean ± SEM of at least three independent experiments (n = 3). Student’s t-test *P < 0.05 and **P < 0.01. Cell viability, after 24 h of treatment, was explored through the quantification of alamarBlue (AB) reduction. As shown in , among the inhibitors used, 3-MA and CQ diminished cell viability to 50% or below. Permeabilization of the external membrane with propidium iodide (PI) was evaluated at 48 h of treatment. The results evidenced that SBI (40%), 3-MA (70%), BafA1 (96%), and CQ (80%) triggered the most significant levels of cell lethality in growing medium, while cells challenged with MHY, SAR, Cpd18, and SPT-1 preserved the integrity of their plasma membrane ().
Figure 3

Cells cultured in growing media undergo cell death in response to the autophagy inhibitory compounds, 3-methyladenine, SBI-0206965, Bafilomycin A1 or Chloroquine. MEFs were treated with the drugs at the concentrations stated in the panel. (A) After 24 h, cell viability was measured by the cellular ability to reduce AB reagent. Bar value is the mean ± SEM (n = 3). Student’s t-test *P < 0.01, **P < 0.005 and ***P < 0.001. (B) After 48 h, the percentage of propidium iodide (PI)-positive cells (dead cells) was determined by flow cytometry. Bar value is the mean ± SEM (n = 3). Student’s t-test **P < 0.005 and ***P < 0.001.

Cells cultured in growing media undergo cell death in response to the autophagy inhibitory compounds, 3-methyladenine, SBI-0206965, Bafilomycin A1 or Chloroquine. MEFs were treated with the drugs at the concentrations stated in the panel. (A) After 24 h, cell viability was measured by the cellular ability to reduce AB reagent. Bar value is the mean ± SEM (n = 3). Student’s t-test *P < 0.01, **P < 0.005 and ***P < 0.001. (B) After 48 h, the percentage of propidium iodide (PI)-positive cells (dead cells) was determined by flow cytometry. Bar value is the mean ± SEM (n = 3). Student’s t-test **P < 0.005 and ***P < 0.001. Altogether, despite some differences in their efficiency, MHY, SBI, 3-MA, Cpd18, SAR405, Spautin-1, CQ, and BafA1 are bona fide inhibitors of basal autophagy. Besides, our results prove that the inhibition of basal autophagy is not deleterious for MEF cultures in growing conditions.

Cytotoxic Autophagy Inhibitory Drugs Trigger BAX- and/or BAK-Dependent Cell Death and Caspase Activation

Apoptosis is the most frequent type of regulated cell death in response to chemotherapeutical drugs. Apoptotic cell death was reported in different cell models treated for more than 24 h with 3-MA (Boya et al., 2005; Hou et al., 2012), or with BafA1 or CQ, used as control compounds (Boya et al., 2003; Boya et al., 2005; Walls et al., 2010; Wang et al., 2018). DNA staining of the treated cell cultures with bis-benzimide was used to highlight the presence of pyknotic and/or karyorrhectic nuclei, two of the most characteristic morphological features of apoptosis. As shown in , MEFs cultured in the presence of SBI, 3-MA, CQ, or BafA1 displayed pyknotic/karyorrhectic nuclear morphologies, thus pointing to apoptosis as the leading subroutine of cell death. Apoptosis is characterized by the sequential activation of caspases, resulting in a well-organized disassembly of the cell. Caspase activity was addressed at 24 and 48 h through the internal cleavage of Ac-DEVD-afc, a widely-used fluorescent substrate of caspases. Only the cell cultures subjected to SBI, 3-MA, CQ, or BafA1 challenges displayed a significant increase of the caspase activity with respect to the other inhibitors (). At 24 h, 3-MA, CQ, and BafA1 were the top activators of caspases (), while SBI required 48 h of treatment to reach equivalent levels of caspase activation. In line with these results, SBI, 3-MA, CQ, or BafA1 or elicited the activation of the effector caspase-3 after 48 h of treatment (). Adding the pan-inhibitor of caspases q-VD-OPh to the culture media reverted the cleavage of caspase-3 in response to the compounds mentioned before. Caspase-3 was efficiently activated in response to these inhibitors, since we observed the presence of a specific 120 kDa-cleaved fragment of α-Fodrin, which was avoided with q-VD-OPh (). To assess the involvement of caspases in the observed cellular toxicity, we evaluated the cell death in the presence of q-VD-OPh (). To control these experiments, q-VD-OPh was used to block cell death of cultures treated with staurosporine (STS), a canonical trigger of apoptosis. In these conditions, we confirmed a decrease of cell death from 77% (STS) to 15% (STS+q-VD-OPh, results not shown). The addition of q-VD-OPh to the cultures attenuated the cell death in response to all the autophagy inhibitory drugs tested up to 48 h of treatment ( and ). Finally, we explored the involvement of the mitochondrial intrinsic pathway in the observed apoptotic cell death. As reported before (Boya et al., 2005), Bax−/− Bak−/− (DKO) MEFs were resistant against apoptotic cell death induced by CQ and BafA1. Cell death of DKO MEFs and wt MEFs challenged with SBI, 3-MA, CQ, or BafA1 was compared. As shown in , DKO MEFs were resistant against the cytotoxicity mediated by all the employed compounds, including SBI and 3-MA. Altogether, these results show that caspases and BAX and/or BAK orchestrate the cell death induced by the assayed cytotoxic autophagy inhibitory drugs. Therefore, cytotoxicity comes from a regulated intracellular signaling rather than an uncontrolled mechanism of cell death.
Figure 4

Cytotoxic inhibitors of autophagy engage the mitochondrial pathway of apoptotic cell death. MEFs were treated with the autophagy inhibitory drugs at the concentrations stated in the panel. (A) After 24 h of 3-MA and BafA1 treatment or after 48 h of SBI and CQ treatment, cells were stained with bisbenzimide 33342 and analyzed by fluorescence microscopy. Arrowheads point to the typical images of apoptotic nuclei. Bar = 40 μm. Images representative of several independent experiments are shown. (B) After 24 and 48 h of treatment, effector caspase activity (DEVDase activity) was quantified in arbitrary fluorescent units (a.f.u.). Bar value is the mean ± SEM (n = 3). Student’s t-test **P < 0.005 and ***P < 0.001. Protein extracts of MEFs treated with 3-MA, BafA1, SBI, and CQ for 48 h in the presence (+) or absence (−) of 40 μM of q-VD-OPh were analyzed by western blot. Intensity of the cleaved caspase-3 or 120 kDa α-Fodrin bands, normalized to the loading of each lane, was shown. Naphthol blue (NB) stained membrane served as a loading control. The images represent one representative western out of three independent experiments. The antibodies used were (C) anti-caspase-3 and (D) anti-α-Fodrin. (E) MEFs were challenged with the cytotoxic inhibitors of autophagy for the time indicated in the panel in the presence (+QVD) or absence (–QVD) of the caspase inhibitor q-VD-OPh at 40 μM. Bar value is the mean ± SEM (n = 3). Student’s t-test ***P < 0.001. (F) wt MEFs and Bax–/–Bak–/–MEFs (DKO MEFs) were challenged with the cytotoxic autophagy inhibitory drugs for 48 h. Drug concentrations are displayed in the panel. Cell death was quantified by means of PI incorporation and flow cytometry. Data are expressed as mean ± SEM (n = 3). Student’s t-test *P < 0.01, **P < 0.005 and ***P < 0.001.

Cytotoxic inhibitors of autophagy engage the mitochondrial pathway of apoptotic cell death. MEFs were treated with the autophagy inhibitory drugs at the concentrations stated in the panel. (A) After 24 h of 3-MA and BafA1 treatment or after 48 h of SBI and CQ treatment, cells were stained with bisbenzimide 33342 and analyzed by fluorescence microscopy. Arrowheads point to the typical images of apoptotic nuclei. Bar = 40 μm. Images representative of several independent experiments are shown. (B) After 24 and 48 h of treatment, effector caspase activity (DEVDase activity) was quantified in arbitrary fluorescent units (a.f.u.). Bar value is the mean ± SEM (n = 3). Student’s t-test **P < 0.005 and ***P < 0.001. Protein extracts of MEFs treated with 3-MA, BafA1, SBI, and CQ for 48 h in the presence (+) or absence (−) of 40 μM of q-VD-OPh were analyzed by western blot. Intensity of the cleaved caspase-3 or 120 kDa α-Fodrin bands, normalized to the loading of each lane, was shown. Naphthol blue (NB) stained membrane served as a loading control. The images represent one representative western out of three independent experiments. The antibodies used were (C) anti-caspase-3 and (D) anti-α-Fodrin. (E) MEFs were challenged with the cytotoxic inhibitors of autophagy for the time indicated in the panel in the presence (+QVD) or absence (–QVD) of the caspase inhibitor q-VD-OPh at 40 μM. Bar value is the mean ± SEM (n = 3). Student’s t-test ***P < 0.001. (F) wt MEFs and Bax–/–Bak–/–MEFs (DKO MEFs) were challenged with the cytotoxic autophagy inhibitory drugs for 48 h. Drug concentrations are displayed in the panel. Cell death was quantified by means of PI incorporation and flow cytometry. Data are expressed as mean ± SEM (n = 3). Student’s t-test *P < 0.01, **P < 0.005 and ***P < 0.001.

Among the Autophagy Inhibitors Employed, 3-MA Is the Most Effective Compound at Decreasing Cell Viability of Several Ontologically Unrelated Human Cell Lines

To confirm the cytotoxicity of the assayed autophagy inhibitory compounds, an ontologically different panel of human cell lines, such as HCT116 (colon adenocarcinoma), HEK293 (human embryonic kidney), HeLa (cervix adenocarcinoma), and SH-SY5Y (neuroblastoma), was challenged with the initiation, nucleation, and completion inhibitors. As shown in , 3-MA decreased the viability of all the assayed cell lines to less than 40% compared to control populations. In the same line, the 3-MA derivative Cpd18 also elicited a significant reduction in cell viability in three out of four cell lines (HEK293, HeLa and SH-SY5Y cells, ). On the other hand, the reduction of cell viability in response to SBI was similar to the one observed with Cpd18 (). Notably, at the assayed concentrations, CQ and BafA1 were innocuous in most of the cell lines. In sum, 3-MA emerges as the most effective autophagy inhibitor at decreasing cell viability across several unrelated cellular models.
Figure 5

Effects of autophagy inhibitory drugs on the cellular viability in different human cell lines. HCT116, HEK293, HeLa, and SH-SY5Y cells were treated with the “Initiation” and “Nucleation” autophagy inhibitory drugs from previous experiments. Drug concentrations are indicated in the panel. Cell viability was measured by the AB reducing procedure after 24 h of treatment. Bar value is the mean ± SEM (n = 3). Student’s t-test **P < 0.005 and ***P < 0.001.

Effects of autophagy inhibitory drugs on the cellular viability in different human cell lines. HCT116, HEK293, HeLa, and SH-SY5Y cells were treated with the “Initiation” and “Nucleation” autophagy inhibitory drugs from previous experiments. Drug concentrations are indicated in the panel. Cell viability was measured by the AB reducing procedure after 24 h of treatment. Bar value is the mean ± SEM (n = 3). Student’s t-test **P < 0.005 and ***P < 0.001.

Basal Autophagy-Deficient Cells Are More Sensitive to 3-MA and SBI-Driven Cytotoxicity

Deletion of the focal adhesion kinase family interacting protein of 200 kDa (FIP200) avoids the formation of LC3-II, ATG16L1, and PI3P-binding protein puncta (Itakura and Mizushima, 2010) and abrogates the emergence of the autophagy isolation membrane (Kishi-Itakura et al., 2014; Tsuboyama et al., 2016). Based on these characteristics and its apical position in the autophagy pathway (), it is considered as one of the best genetic approaches to suppress basal and induced autophagy. First, we assessed by western blot that Fip200−/− MEFs presented reduced levels of basal and inducible autophagy compared to their wild type genetic counterparts, Fip200+/+ MEFs. As shown in , the generation of LC3-II was markedly reduced in Fip200−/− MEFs maintained in full media (“basal autophagy”, ) or subjected to a complete deprivation of nutrients and trophic factors (“starvation” in ). Likewise, p62 pool remained elevated in both conditions (). These results support that FIP200 is a key protein for both basal and starvation-driven autophagy. To disprove that 3-MA- or SBI-driven cytotoxicity was a consequence of the inhibition of basal autophagy, we quantified the cell death induced by these inhibitors in Fip200+/+ and Fip200−/− MEFs. As negative controls, we included those non-cytotoxic compounds above-employed (MHY, Cpd18, SAR and SPT-1), which remained harmless after 48 h of incubation, regardless of the presence or the absence of FIP200 (). In contrast, cell cytotoxicity in response to 3-MA or SBI was enhanced in the autophagy-suppressed background, Fip200−/− MEFs (). In parallel, greater levels of caspase activity were observed in Fip200−/− MEFs treated with 3-MA, SBI () or with the classical inducer of apoptosis, staurosporine (STS, ). In sum, these results evidence that 3-MA- or SBI-mediated cytotoxicities are not due to the inhibition of basal autophagy. On the opposite, basal autophagy acts as a protective mechanism facing 3-MA or SBI-mediated cell death.
Figure 6

Fip200–/– MEFs display increased sensitivity to apoptosis triggered by 3-methyladenine or SBI-0206965, but not to MHY1485, Cpd18, SAR405 or Spautin-1. (A) Protein extracts from Fip200–/– and Fip200+/+ MEFs cultured in full media or Hank’s buffer without glucose (starvation) for 6h, either in the presence (+) or absence (–) of BafA1, were analyzed by western blot. Autophagy was evaluated by LC3-II and p62. Intensity of these bands, normalized to the loading of each lane and referred to the values of these proteins in Fip200+/+ maintained in growing medium, was shown. Naphthol blue (NB) stained membrane served as a loading control. The image belongs to a representative image out of three independent experiments. (B) Fip200–/– and Fip200+/+ MEFs were challenged with the drugs at the concentrations indicated in the panel. After staining with PI, the percentage of dead cells was determined by flow cytometry. Bar value is the mean ± SEM (n = 3). Student’s t-test *P < 0.01 (C, D) Effector caspase activity (DEVDase activity) was quantified in arbitrary fluorescent units (a.f.u.) after 24 h of treatment with the compounds indicated in the panel. Bar value is the mean ± SEM (n = 3). Student’s t-test *P < 0.01 and ***P < 0.001.

Fip200–/– MEFs display increased sensitivity to apoptosis triggered by 3-methyladenine or SBI-0206965, but not to MHY1485, Cpd18, SAR405 or Spautin-1. (A) Protein extracts from Fip200–/– and Fip200+/+ MEFs cultured in full media or Hank’s buffer without glucose (starvation) for 6h, either in the presence (+) or absence (–) of BafA1, were analyzed by western blot. Autophagy was evaluated by LC3-II and p62. Intensity of these bands, normalized to the loading of each lane and referred to the values of these proteins in Fip200+/+ maintained in growing medium, was shown. Naphthol blue (NB) stained membrane served as a loading control. The image belongs to a representative image out of three independent experiments. (B) Fip200–/– and Fip200+/+ MEFs were challenged with the drugs at the concentrations indicated in the panel. After staining with PI, the percentage of dead cells was determined by flow cytometry. Bar value is the mean ± SEM (n = 3). Student’s t-test *P < 0.01 (C, D) Effector caspase activity (DEVDase activity) was quantified in arbitrary fluorescent units (a.f.u.) after 24 h of treatment with the compounds indicated in the panel. Bar value is the mean ± SEM (n = 3). Student’s t-test *P < 0.01 and ***P < 0.001.

3-MA-Driven Cytotoxicity Is Shared by Its Structural Derivative Cpd18

We focused our interest on 3-MA-elicited cell death because of its extensive use and its greater cytotoxicity compared to SBI (see , ). 3-MA and Cpd18 are structurally related compounds that differ in a methylpiperidin group positioned at the C6 of the adenine (). We first confirmed the ability of 10 mM 3-MA and 0.5 mM Cpd18 to inhibit the autophagic flux. DALGreen is an innovative fluorescent molecule that stains the autophagosomes. Interestingly, the fluorescence of DALGreen is enhanced at acidic pH, which is suitable for monitoring the degradation phase of autophagy (Iwashita et al., 2018). After 8 h, cells treated with 3-MA (17.79 ± 0.96 a.u.f.) or Cpd18 (20.49 ± 0.94 a.u.f.) displayed a diminished DALGreen fluorescent signal compared to control populations (38.96 ± 1.08 a.u.f.), indicating that both compounds inhibit the autophagic flux (). 3-MA is a widely-used drug to inhibit autophagy at concentrations ranging from 2.5 to 10 mM, being 10 mM the most frequently used (Seglen and Gordon, 1982; Petiot et al., 2000; Boya et al., 2005; Devereaux et al., 2013). Nonetheless, the calculated IC80 of 3-MA and its close analog Cpd18 to suppress starvation-driven autophagy are 6 and 1 mM, respectively (Wu et al., 2013). We re-evaluated the autophagy inhibitory effects of 3-MA in a concentration-dependent manner. In parallel, we also tested Cpd18 at concentrations ranging from 0.25 to 2 mM. The results with LC3-II and p62 evidenced a dose-dependent reduction of the autophagic flux in response to 3-MA and Cpd18 ( and , respectively). Next, we evaluated the cell death using the afore-employed concentrations of 3-MA and Cpd18. Cell death by 3-MA remained lower than 25% at concentrations below 10 mM but experienced an abrupt increase up to 82% at 10 mM (). The same behavior was observed at 2 mM Cpd18, which triggered a similar intensification of the cell cytotoxicity when increased from 1 up to 2 mM (23 to 64%, respectively, ). Notably, the concentrations of 3-MA and Cpd18 that presented a greater attenuation of the autophagic flux were the ones associated with larger amounts of cell death. Altogether, these results stress the relevance of 3-MA and Cpd18 backbone structure to block autophagy as well as to engage cells into cell death.
Figure 7

Concentration-dependent cytotoxicity of 3-methyladenine and its structural derivative Cpd18. (A) Chemical structure of 3-MA and Cpd18 (images borrowed from Selleckchem and MerckMillipore webpages, respectively). (B) Western blot of MEFs protein extracts treated for 8 h with growing concentrations of 3-MA and Cpd18 in the presence (+) or absence (–) of 100 nM BafA1 for the whole treatment. Intensity of the LC3-II band, normalized to the loading of each lane (naphtol blue staining) and referred to “0” without BafA1, was shown. Western blots are a significant experiment out of three independent experiments. A histogram representing “% Basal Autophagic Flux (LC3-II T+BafA1/LC3-II T)” was calculated as reported in the “MATERIAL and METHODS” section. The percentages represent the quotient between LC3-II band intensities in “T” and “T+ BafA1”. “T” is treatment and “T+ BafA1”is treatment in the presence of BafA1. Naphthol blue (NB) stained membrane served as a loading control. The percentage of basal autophagic flux is expressed as mean ± SEM of at least three independent experiments (n = 3). (C) MEFs were treated with the concentrations of 3-MA and Cpd18 indicated in the panel. After 48 h, the percentage of propidium iodide (PI)-positive cells (dead cells) was determined by flow cytometry. Bar value is the mean ± SEM (n = 3).

Concentration-dependent cytotoxicity of 3-methyladenine and its structural derivative Cpd18. (A) Chemical structure of 3-MA and Cpd18 (images borrowed from Selleckchem and MerckMillipore webpages, respectively). (B) Western blot of MEFs protein extracts treated for 8 h with growing concentrations of 3-MA and Cpd18 in the presence (+) or absence (–) of 100 nM BafA1 for the whole treatment. Intensity of the LC3-II band, normalized to the loading of each lane (naphtol blue staining) and referred to “0” without BafA1, was shown. Western blots are a significant experiment out of three independent experiments. A histogram representing “% Basal Autophagic Flux (LC3-II T+BafA1/LC3-II T)” was calculated as reported in the “MATERIAL and METHODS” section. The percentages represent the quotient between LC3-II band intensities in “T” and “T+ BafA1”. “T” is treatment and “T+ BafA1”is treatment in the presence of BafA1. Naphthol blue (NB) stained membrane served as a loading control. The percentage of basal autophagic flux is expressed as mean ± SEM of at least three independent experiments (n = 3). (C) MEFs were treated with the concentrations of 3-MA and Cpd18 indicated in the panel. After 48 h, the percentage of propidium iodide (PI)-positive cells (dead cells) was determined by flow cytometry. Bar value is the mean ± SEM (n = 3).

Disruption of the AKT/mTOR Axis Is Not the Main Mechanism Driving 3-MA-Mediated Cell Death

In addition to its well-known inhibition of PI3K of class 3 (PI3KC3), 3-MA can also inhibit PI3K class 1 (PI3KC1) and mTOR (Ito et al., 2007; Wu et al., 2010). This lack of selectivity is also shared by wortmannin (Wn), an irreversible and potent pan-inhibitor of PI3Ks, including VPS34 (a PI3KC3) and mTOR (Arcaro and Wymann, 1993; Brunn et al., 1996). First, we assessed the blockage of the autophagic flux by wortmannin in a concentration-dependent manner. Among the concentrations employed, 100 μM wortmannin was the one exhibiting a most robust blockage of the autophagic flux () and, hence, this concentration was selected to perform the following experiments. The serine/threonine kinase AKT is a target of phosphoinositide-dependent protein kinase-1 (PDK1), which is in turn regulated by PI3KC1 and holds a pro-survival/anti-apoptotic role in response to growth or survival factors. The activation of AKT is directed by two phosphorylations: one in threonine 308 (Thr308) by PDK1 and the other on serine 473 (Ser473) by several kinases, among them, the complex 2 of mTOR (mTORC2). We confirmed by Western blot that 10 mM 3-MA and 100 μM wortmannin were reducing the phosphorylations of AKT at Thr308 and at Ser473 already at 6 h of treatment (). Wortmannin triggered a severe abrogation of Ser473 phosphorylation and a partial, but intense, suppression of Thr308. Meanwhile, 3-MA was diminishing the phosphorylation of both positions, with a more pronounced inhibitory effect on Ser473. These results indicate that wortmannin is more efficient than 3-MA in inhibiting the activity of AKT, at least at the employed concentrations. Our experiments included Cpd18 and SAR405, which were reported to inhibit VPS34/PI3KC3 without affecting PI3KC1 (Wu et al., 2013; Ronan et al., 2014; Pasquier, 2015). As shown in , we observed a reduction of both AKT phosphorylations in response to these inhibitors. Nonetheless, the effects of SAR405 and Cpd18 were less pronounced than the effects of 3-MA.
Figure 8

AKT/PKB and/or mTORC1 inhibition are not the leading mechanisms of 3-methyladenine-mediated cytotoxicity. (A) Protein extracts of MEFs subjected to growing concentrations of wortmannin either in the presence (+) or absence (–) of BafA1 for 8 h were analyzed by western blot. Autophagy was evaluated by LC3-II. Naphthol blue (NB) stained membrane served as a loading control. The image belongs to a representative image out of two experiments. (B) Protein extracts of control untreated MEFs (C) or MEFs treated with 10 mM 3-MA (3-MA), 100 μM Wortmannin (Wn), 5 μM SAR (SAR), 0.5 mM Cpd18 (Cpd18) at 6 and 12 h were analyzed by western blot with antibodies against phospho-AKT (p-AKT) (Ser473 and 308), AKT1, p-ULK (Ser757), ULK, p-4E-BP1(Thr37/46), and 4E-BP1. Quantifications are the ratios between the intensity of phosphorylated proteins normalized to unphosphorylated proteins. Naphthol blue (NB) stained membrane served as a loading control. The images belong to a representative experiment out of three independent repetitions. (C) MEFs were treated for 48 h with the drugs at concentrations stated in the panel. The percentage of propidium iodide (PI)-positive cells (dead cells) was determined by flow cytometry. Bar value is the mean ± SEM (n = 3).

AKT/PKB and/or mTORC1 inhibition are not the leading mechanisms of 3-methyladenine-mediated cytotoxicity. (A) Protein extracts of MEFs subjected to growing concentrations of wortmannin either in the presence (+) or absence (–) of BafA1 for 8 h were analyzed by western blot. Autophagy was evaluated by LC3-II. Naphthol blue (NB) stained membrane served as a loading control. The image belongs to a representative image out of two experiments. (B) Protein extracts of control untreated MEFs (C) or MEFs treated with 10 mM 3-MA (3-MA), 100 μM Wortmannin (Wn), 5 μM SAR (SAR), 0.5 mM Cpd18 (Cpd18) at 6 and 12 h were analyzed by western blot with antibodies against phospho-AKT (p-AKT) (Ser473 and 308), AKT1, p-ULK (Ser757), ULK, p-4E-BP1(Thr37/46), and 4E-BP1. Quantifications are the ratios between the intensity of phosphorylated proteins normalized to unphosphorylated proteins. Naphthol blue (NB) stained membrane served as a loading control. The images belong to a representative experiment out of three independent repetitions. (C) MEFs were treated for 48 h with the drugs at concentrations stated in the panel. The percentage of propidium iodide (PI)-positive cells (dead cells) was determined by flow cytometry. Bar value is the mean ± SEM (n = 3). The phosphorylations of ULK (Ser757) and 4E-BP1 (Thr37/46) are two surrogate markers of mTORC1 activity (Gingras et al., 1999; Kim et al., 2011). Wortmannin efficiently prevented the phosphorylation of ULK and 4E-BP1 at times as early as 6 h of treatment (). However, we were unable to observe a reduction of p-ULK in response to 3-MA. Likewise, 3-MA triggered only a mild reduction of p-4E-BP1. Overall, these results supported that differently from wortmannin, 3-MA was a weak inhibitor of AKT and mTORC1 activity. To further disprove the inhibition of PI3KC1 and/or mTOR as the main mechanisms of 3-MA-driven cytotoxicity, we compared cell death in response to wortmannin or 3-MA. Despite using high concentrations of wortmannin (100 μM), cell death induced by 10 mM 3-MA was greater than the one in response to wortmannin (15% cell death, ). Moreover, concentrations of wortmannin as high as 250 µM were still less toxic (40% cell death by PI, ) than 10 mM 3-MA (80% cell death by PI, ). In conclusion, while the inhibition of PI3KC1 and/or mTOR can partially contribute to 3-MA-mediated cell death, we rule out these phenomena as the main mechanisms guiding the 3-MA-elicited apoptotic cell death.

3-MA Induces γ-H2A.X in Cells at Cytotoxic Concentrations

Next, we interrogated whether apoptotic concentrations of 3-MA were also damaging the DNA. DNA damage was evaluated by the presence of the phosphorylated histone H2A.X at Ser139, also known as γ-H2A.X (Rogakou et al., 1998). First, we evaluated the levels of γ-H2A.X in response to growing concentrations of 3-MA. As shown in , 10 mM of 3-MA promoted a prominent increase of γ-H2A.X not paralleled by non-cytotoxic concentrations of 3-MA (2.5 and 5 mM). These results indicated a relationship between the degree of cytotoxicity and the amounts of γ-H2A.X. To further support this observation, we explored the induction of γ-H2A.X in Fip200−/− MEFs, which were more sensitive to cytotoxicity driven by 10 mM 3-MA (). As depicted in , 3-MA-treated Fip200−/− MEFs displayed greater amounts of γ-H2A.X as compared to Fip200+/+ MEFs. To test if the observed DNA damage is a response restricted to 3-MA, we employed the cytotoxic inhibitors studied before. As a control, we also included SAR, a non-cytotoxic inhibitor of autophagy. As shown in , increased levels of γ-H2A.X were evidenced in response to all of the cytotoxic inhibitors. Remarkably, 3-MA stood as the top inducer of γ-H2A.X among the rest of cytotoxic compounds. On the other hand, SAR was unable to promote γ-H2A.X. These results discard, first, the direct inhibition of VPS34 and second, the suppression of basal autophagy, as the mechanisms accountable for the 3-MA-mediated increase of H2A.X phosphorylation at Ser139. As far as we know, this is the first time that the cytotoxic inhibitors of autophagy, particularly 3-MA, emerge as inducers of DNA damage, as detected by γ-H2A.X. 3-methyladenine triggers the phosphorylation of H2A.X at Ser139. Western blots probed with antibodies against phosphorylated Ser139-H2A.X (γ-H2A.X) and total H2A.X are shown. Quantifications are the ratios between the intensity of γ-H2A.X normalized to total H2A.X. Naphthol blue (NB) stained membrane served as a loading control. (A) Protein extracts of wt MEFs treated with 3-MA at 2.5, 5, and 10 mM for 24 h. Extracts of control cells are depicted as “0”. (B) Protein extracts of Fip200–/– and Fip200+/+ MEFs challenged during 24 h with 10 mM 3-MA or left untreated (C) Protein extracts of MEFs untreated (C) or treated for 24 h with 5 μM SAR, for 20 and 40 h with 20 μM SBI and for 12 and 24 h with 10 mM 3-MA, 100 nM BafA1 and 50 μM CQ. Images in (A–C) are a representative experiment out of, at least, three independent experiments.

Discussion

The pharmacological inhibition of autophagy, either alone or in combination with other chemotherapeutical drugs, is under investigation to become a fully accepted antitumoral strategy. In this sense, the therapeutic benefit of inhibiting the different phases of the autophagic process remains a matter of debate (Mulcahy Levy and Thorburn, 2020). Here, we employed several classical or innovative pharmacological inhibitors of autophagy, acting at the initiation, nucleation, or completion phases of autophagy. We have interrogated the consequences for cell viability when these inhibitors are incubated under regular growing conditions. Despite some initial differences, at 12 h most of the assayed compounds inhibit the autophagic flux of MEF cells to a similar extent. Nonetheless, the evaluation of cell death evidences the cytotoxic effects of 3-methyladenine, SBI-0206965, Bafilomycin A1, and Chloroquine and the non-cytotoxic profile of MHY1485, Cpd18, SAR405, and Spautin-1. We examined the effects of these compounds on the cell viability of tumor-derived cell lines such as HCT116, HeLa, or SH-SY5Y and a non-tumoral embryonic cell line, HEK293. While most of the assayed inhibitors are non-cytotoxic, 3-methyladenine triggers a consistent and abrupt decrease of cell viability across all the cell lines. These results are in agreement with Eng and colleagues who have demonstrated that basal autophagy is dispensable for the survival of several cell lines in growing conditions. To impair autophagy, the authors employed genetic strategies targeting ATG7, ULK, or VPS34, or pharmacological approaches using the chloroquine analog, Lys01 (Eng et al., 2016). Collectively, these data support that the simple inhibition of basal autophagy is not cytotoxic for normal or tumor-derived cells in growing conditions. One possible explanation could be linked to the metabolic status of the cell. Notably, cells in growing conditions have access to a plethora of exogenous biomolecules necessary to fuel their metabolism, thus potentially compensating the impairment of the recycling pathways. In that sense, healthy metabolic cells with impaired basal autophagy would undergo cell demise if, a second, or even the same insult engages cytotoxic intracellular pathways. In agreement with this idea, our results show that some of the assayed autophagy inhibitors, for instance 3-methyladenine, SBI-0206965, Bafilomycin A1, and Chloroquine, while blocking basal autophagy, they also engage cell death. In this line, 3-methyladenine (Hou et al., 2012), SBI-0206965 (Tang et al., 2017), chloroquine (Eng et al., 2016), and Bafilomycin A1 (Yan et al., 2016) are reported inducers of deleterious cellular outcomes independently of their autophagy suppressive action. At the concentrations employed in this study, these compounds trigger cellular stresses that are able to initiate apoptotic intracellular pathways. Despite the cell protection conferred by q-VD-OPh, a subpopulation of cells still succumb to these inhibitors, pointing to the involvement of other subroutines of cell death. Notably, this situation is especially relevant in chloroquine-treated cultures since q-VD-OPh rescues less than 20% of the cells. These signaling pathways converge into the mitochondrion, as revealed by the resilience of Bax−/− Bak−/− double-knockout MEFs to undergo cell death. Our studies place the mitochondrion as the central target of the cytotoxic inhibitors of autophagy employed. According to this, those inhibitors of autophagy that are unable to stress the mitochondria would remain non-cytotoxic, regardless of their capacity to impair basal autophagy. This idea is also evidenced by employing Fip200−/− MEFs. Although these cells present a dramatic reduction of basal autophagy, the non-cytotoxic autophagy inhibitors remain non-cytotoxic, probably as a consequence of their inability to alter the mitochondrial homeostasis. On the opposite, autophagy deficient Fip200−/− MEFs are more vulnerable to cell death in response to compounds acting as disruptors of the mitochondrial viability, for instance 3-methyladenine and SBI-0206965. Basal or constitutive autophagy is active in healthy cells cultured in growing conditions and contributes to the preservation of cellular homeostasis. On the other hand, inducible autophagy is a cellular stress-responsive adaptation to unfavorable environmental conditions. In this sense, chemo- and radiotherapy are stressful stimuli that elicit inducible adaptative autophagy (Nagelkerke et al., 2015). Our results support that starvation-induced autophagy is not qualitatively superior than basal autophagy at protecting cells from staurosporine-elicited cell death (results not shown). In other words, inducible autophagy would be insufficient to counteract staurosporine-mediated mitochondrial damage of cells under adverse metabolic conditions (e.g., starved cells). The molecular clues that differentiate basal and inducible autophagy, if any, are not yet well characterized. Based on our own data and the more recent literature, we surmise both types of autophagy are part of the same continuum (“the basal-to-inducible autophagy continuum”), only differentiated by their intensity. 3-methyladenine, the main subject of this study, is a compound identical to the DNA adduct N3-methyl-adenine (3meA). The DNA content of 3meA adducts increases in response to metabolic intermediates (i.e., S-adenosyl-methionine) or alkylating poisons (Rydberg and Lindahl, 1982). 3meA adduct, which projects into the minor groove of the DNA, is a potent inhibitor of both RNA and most DNA polymerases and accounts for most of the cytotoxicity in response to alkylating drugs (Engelward et al., 1998; Johnson et al., 2007). The collapse of unstable blocked replication forks provokes double-stranded DNA breaks (DSBs) (Bobola et al., 2012) and replication stress (Burhans and Weinberger, 2007). The phosphorylation of histone H2A.X on Ser139 (γ-H2A.X) is a widely accepted marker of DSB (Rogakou et al., 1998). In our experiments, cytotoxic concentrations of 3-methyladenine trigger the most prominent induction of γ-H2A.X compared to the other cytotoxic inhibitors of autophagy. This genotoxicity is not a direct consequence of caspase activation since the addition of q-VD-OPh to the culture media is unable to reduce the burst of 3-methyladenine-elicited γ-H2A.X. These results raise interesting questions about the mechanism of 3-methyladenine-mediated genotoxicity. It is tempting to attribute this genotoxicity to the direct incorporation of 3-methyladenine into the replicating DNA. However, 3-methyladenine is an ambident nucleophile, and methylation of DNA requires electrophilic compounds (Wu et al., 2013). In this sense, in vitro experiments evidence the inefficiency of 3-methyladenine at directly generating DNA breaks into plasmid DNA (J. Ribas & V.J. Yuste, unshown data). One alternative explanation could be related to the metabolic reprogramming exerted by this drug. Strikingly, 3-methyladenine rewires the carbohydrate metabolism resulting in an accumulation of glucose-6-phosphate, fructose-6-phosphate and phosphoenol pyruvate. This phenomenon is caused by cAMP and is unrelated to its intrinsic autophagy inhibitory function (Caro et al., 1988). In this sense, it is known that reducing sugars (such as glucose-6-phosphate or fructose-6-phosphate) can modify nucleic acids in a non-enzymatic reaction. Indeed, glucose-6-phosphate and fructose-6-phosphate trigger DNA damage, mutagenesis, and cytotoxicity (Bucala et al., 1985; Levi and Werman, 2003). Based on our results and the broad usage of 3-methyladenine, it would be of outstanding interest to go deeply into the molecular mechanisms of 3-methyladenine generating DNA damage and its relationship with metabolic changes. With regard to the protective role of FIP200-mediated autophagy facing genotoxicity, we found that the upregulation of γ-H2A.X in response to 3-methyladenine is enhanced in the autophagy-deficient Fip200−/− MEFs. However, the simple inhibition of autophagy (either with SAR405 or in Fip200−/− MEFs) is unable to increase γ-H2A.X. These data indicate that increased γ-H2A.X is an autophagy-independent effect of 3-methyladenine and that autophagy is counteracting this genotoxic effects. This is in agreement with the role of autophagy in regulating DNA repair (Hewitt and Korolchuk, 2017). Notably, FIP200 deficiency diminishes DNA repair in response to irradiation, camptothecin or etoposide in a p62-dependent manner, thus increasing the cytotoxicity mediated by these stimuli (Bae and Guan, 2011). In support of these data, a direct link between p62 and the DNA damage machinery was established through the identification of its inhibitory role over RNF168, an H2A ubiquitinase that is essential for the recruitment of multiple DNA repair proteins (Wang et al., 2016). Moreover, autophagy is increased in cells subjected to an intense DNA damage in response to genotoxic stressors and is necessary for the recovery from replication stress (Vanzo et al., 2020). Autophagy is known to counteract oncogenic transformation of normal cells but, at the same time, it promotes tumor progression and resistance of tumor-derived cells (Galluzzi et al., 2017). For this reason, the inhibition of autophagy is under consideration as a sensitizing mechanism towards chemotherapeutic agents. Our results evidence that the cytotoxic inhibitors of autophagy promote cytotoxicity and increase DNA damage. The degree of genomic damage could derive into diverse consequences: first, the engagement of deleterious intracellular pathways if levels of DNA damage surpass the cellular DNA repair capacity; or, second, the survival of cells able to repair the inflicted DNA damage. In this last scenario, tumor cells could accumulate genomic mutations, thus potentially worsening their malignant behavior. Among the cytotoxic inhibitors of autophagy studied here, 3-methyladenine is the top inducer of DNA damage. This compound shows unfavorable features to be translated into the clinics since its poor hydrosolubility and effective concentrations in the millimolar range (Seglen and Gordon, 1982; Petiot et al., 2000; Boya et al., 2005; Wu et al., 2010; Devereaux et al., 2013; Wu et al., 2013). However, taking into consideration that autophagy also participates in the evasion of tumor cells from immune surveillance, the interest of targeting VPS34 in the field of cancer immunotherapy is reinforced (Mgrditchian et al., 2017; Noman et al., 2020). Indeed, the inhibition of VPS34 is under consideration as an adjuvant therapy for the inhibitors of the immune checkpoints (ICIs). SAR405, or the new inhibitor of VPS34 SB02024, trigger an inflammatory profile that allows the infiltration of antitumoral immune cells to the tumor bed (Noman et al., 2020). Besides SAR405, our research identifies MHY1485 and Spautin-1 as interesting pharmacological tools in terms of their efficacy in blocking autophagy and their lack of cytotoxicity. In this sense, our studies support the interest of these drugs as safe and efficient non-cytotoxic inhibitors of autophagy to potentially be applied in new therapeutic strategies. Overall, 3-methyladenine-driven DNA damage and cytotoxicity call for acautionary usage of this drug in those experimental paradigms where cell survival/death is interrogated. On the other hand, the lack of cytotoxicity of SAR405, MHY1485, and Spautin-1 portrays these compounds as great tools to address the role of autophagy in cell survival/death decisions, without the interference of distracting cytotoxic off-target effects.

Data Availability Statement

All datasets generated for this study are included in the article/.

Author Contributions

JC performed the experiments and participated in the elaboration of the graphs. VY contributed to the conceptualization of the research, provided some resources, and helped in writing the first draft as well as the final manuscript. JB contributed to the elaboration of the graphs, writing the first draft, and provided some equipment and resources. JR conceived and designed the research, performed the formal analysis, validated the results, supervised the research, contributed to writing the first draft, and the final draft. JR provided the main resources and funding for this research. All authors contributed to the article and approved the submitted version.

Funding

This work and its publication fee were supported by a “Retos” project (SAF2016-78657-R) from the “Ministerio de Economía, Industria y Competitividad”/Fondos FEDER (Spain), granted to JR. JR is a Serra Húnter Fellow. JC holds a Ph.D. student fellowship from University of Lleida.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Elaine Gutierrez; Maximiliano G Gutierrez; Ho-Shin Gwak; Albert Haas; James E Haber; Shinji Hadano; Monica Hagedorn; David R Hahn; Andrew J Halayko; Anne Hamacher-Brady; Kozo Hamada; Ahmed Hamai; Andrea Hamann; Maho Hamasaki; Isabelle Hamer; Qutayba Hamid; Ester M Hammond; Feng Han; Weidong Han; James T Handa; John A Hanover; Malene Hansen; Masaru Harada; Ljubica Harhaji-Trajkovic; J Wade Harper; Abdel Halim Harrath; Adrian L Harris; James Harris; Udo Hasler; Peter Hasselblatt; Kazuhisa Hasui; Robert G Hawley; Teresa S Hawley; Congcong He; Cynthia Y He; Fengtian He; Gu He; Rong-Rong He; Xian-Hui He; You-Wen He; Yu-Ying He; Joan K Heath; Marie-Josée Hébert; Robert A Heinzen; Gudmundur Vignir Helgason; Michael Hensel; Elizabeth P Henske; Chengtao Her; Paul K Herman; Agustín Hernández; Carlos Hernandez; Sonia Hernández-Tiedra; Claudio Hetz; P Robin Hiesinger; Katsumi Higaki; Sabine Hilfiker; Bradford G Hill; Joseph A Hill; William D Hill; Keisuke Hino; Daniel Hofius; Paul Hofman; Günter U Höglinger; Jörg Höhfeld; Marina K Holz; Yonggeun Hong; David A Hood; Jeroen Jm Hoozemans; Thorsten Hoppe; Chin Hsu; Chin-Yuan Hsu; Li-Chung Hsu; Dong Hu; Guochang Hu; Hong-Ming Hu; Hongbo Hu; Ming Chang Hu; Yu-Chen Hu; Zhuo-Wei Hu; Fang Hua; Ya Hua; Canhua Huang; Huey-Lan Huang; Kuo-How Huang; Kuo-Yang Huang; Shile Huang; Shiqian Huang; Wei-Pang Huang; Yi-Ran Huang; Yong Huang; Yunfei Huang; Tobias B Huber; Patricia Huebbe; Won-Ki Huh; Juha J Hulmi; Gang Min Hur; James H Hurley; Zvenyslava Husak; Sabah Na Hussain; Salik Hussain; Jung Jin Hwang; Seungmin Hwang; Thomas Is Hwang; Atsuhiro Ichihara; Yuzuru Imai; Carol Imbriano; Megumi Inomata; Takeshi Into; Valentina Iovane; Juan L Iovanna; Renato V Iozzo; Nancy Y Ip; Javier E Irazoqui; Pablo Iribarren; Yoshitaka Isaka; Aleksandra J Isakovic; Harry Ischiropoulos; Jeffrey S Isenberg; Mohammad Ishaq; Hiroyuki Ishida; Isao Ishii; Jane E Ishmael; Ciro Isidoro; Ken-Ichi Isobe; Erika Isono; Shohreh Issazadeh-Navikas; Koji Itahana; Eisuke Itakura; Andrei I Ivanov; Anand Krishnan V Iyer; José M Izquierdo; Yotaro Izumi; Valentina Izzo; Marja Jäättelä; Nadia Jaber; Daniel John Jackson; William T Jackson; Tony George Jacob; Thomas S Jacques; Chinnaswamy Jagannath; Ashish Jain; Nihar Ranjan Jana; Byoung Kuk Jang; Alkesh Jani; Bassam Janji; Paulo Roberto Jannig; Patric J Jansson; Steve Jean; Marina Jendrach; Ju-Hong Jeon; Niels Jessen; Eui-Bae Jeung; Kailiang Jia; Lijun Jia; Hong Jiang; Hongchi Jiang; Liwen Jiang; Teng Jiang; Xiaoyan Jiang; Xuejun Jiang; Xuejun Jiang; Ying Jiang; Yongjun Jiang; Alberto Jiménez; Cheng Jin; Hongchuan Jin; Lei Jin; Meiyan Jin; Shengkan Jin; Umesh Kumar Jinwal; Eun-Kyeong Jo; Terje Johansen; Daniel E Johnson; Gail Vw Johnson; James D Johnson; Eric Jonasch; Chris Jones; Leo Ab Joosten; Joaquin Jordan; Anna-Maria Joseph; Bertrand Joseph; Annie M Joubert; Dianwen Ju; Jingfang Ju; Hsueh-Fen Juan; Katrin Juenemann; Gábor Juhász; Hye Seung Jung; Jae U Jung; Yong-Keun Jung; Heinz Jungbluth; Matthew J Justice; Barry Jutten; Nadeem O Kaakoush; Kai Kaarniranta; Allen Kaasik; Tomohiro Kabuta; Bertrand Kaeffer; Katarina Kågedal; Alon Kahana; Shingo Kajimura; Or Kakhlon; Manjula Kalia; Dhan V Kalvakolanu; Yoshiaki Kamada; Konstantinos Kambas; Vitaliy O Kaminskyy; Harm H Kampinga; Mustapha Kandouz; Chanhee Kang; Rui Kang; Tae-Cheon Kang; Tomotake Kanki; Thirumala-Devi Kanneganti; Haruo Kanno; Anumantha G Kanthasamy; Marc Kantorow; Maria Kaparakis-Liaskos; Orsolya Kapuy; Vassiliki Karantza; Md Razaul Karim; Parimal Karmakar; Arthur Kaser; Susmita Kaushik; Thomas Kawula; A Murat Kaynar; Po-Yuan Ke; Zun-Ji Ke; John H Kehrl; Kate E Keller; Jongsook Kim Kemper; Anne K Kenworthy; Oliver Kepp; Andreas Kern; Santosh Kesari; David Kessel; Robin Ketteler; Isis do Carmo Kettelhut; Bilon Khambu; Muzamil Majid Khan; Vinoth Km Khandelwal; Sangeeta Khare; Juliann G Kiang; Amy A Kiger; Akio Kihara; Arianna L Kim; Cheol Hyeon Kim; Deok Ryong Kim; Do-Hyung Kim; Eung Kweon Kim; Hye Young Kim; Hyung-Ryong Kim; Jae-Sung Kim; Jeong Hun Kim; Jin Cheon Kim; Jin Hyoung Kim; Kwang Woon Kim; Michael D Kim; Moon-Moo Kim; Peter K Kim; Seong Who Kim; Soo-Youl Kim; Yong-Sun Kim; Yonghyun Kim; Adi Kimchi; Alec C Kimmelman; Tomonori Kimura; Jason S King; Karla Kirkegaard; Vladimir Kirkin; Lorrie A Kirshenbaum; Shuji Kishi; Yasuo Kitajima; Katsuhiko Kitamoto; Yasushi Kitaoka; Kaio Kitazato; Rudolf A Kley; Walter T Klimecki; Michael Klinkenberg; Jochen Klucken; Helene Knævelsrud; Erwin Knecht; Laura Knuppertz; Jiunn-Liang Ko; Satoru Kobayashi; Jan C Koch; Christelle Koechlin-Ramonatxo; Ulrich Koenig; Young Ho Koh; Katja Köhler; Sepp D Kohlwein; Masato Koike; Masaaki Komatsu; Eiki Kominami; Dexin Kong; Hee Jeong Kong; Eumorphia G Konstantakou; Benjamin T Kopp; Tamas Korcsmaros; Laura Korhonen; Viktor I Korolchuk; Nadya V Koshkina; Yanjun Kou; Michael I Koukourakis; Constantinos Koumenis; Attila L Kovács; Tibor Kovács; Werner J Kovacs; Daisuke Koya; Claudine Kraft; Dimitri Krainc; Helmut Kramer; Tamara Kravic-Stevovic; Wilhelm Krek; Carole Kretz-Remy; Roswitha Krick; Malathi Krishnamurthy; Janos Kriston-Vizi; Guido Kroemer; Michael C Kruer; Rejko Kruger; Nicholas T Ktistakis; Kazuyuki Kuchitsu; Christian Kuhn; Addanki Pratap Kumar; Anuj Kumar; Ashok Kumar; Deepak Kumar; Dhiraj Kumar; Rakesh Kumar; Sharad Kumar; Mondira Kundu; Hsing-Jien Kung; Atsushi Kuno; Sheng-Han Kuo; Jeff Kuret; Tino Kurz; Terry Kwok; Taeg Kyu Kwon; Yong Tae Kwon; Irene Kyrmizi; Albert R La Spada; Frank Lafont; Tim Lahm; Aparna Lakkaraju; Truong Lam; Trond Lamark; Steve Lancel; Terry H Landowski; Darius J R Lane; Jon D Lane; Cinzia Lanzi; Pierre Lapaquette; Louis R Lapierre; Jocelyn Laporte; Johanna Laukkarinen; Gordon W Laurie; Sergio Lavandero; Lena Lavie; Matthew J LaVoie; Betty Yuen Kwan Law; Helen Ka-Wai Law; Kelsey B Law; Robert Layfield; Pedro A Lazo; Laurent Le Cam; Karine G Le Roch; Hervé Le Stunff; Vijittra Leardkamolkarn; Marc Lecuit; Byung-Hoon Lee; Che-Hsin Lee; Erinna F Lee; Gyun Min Lee; He-Jin Lee; Hsinyu Lee; Jae Keun Lee; Jongdae Lee; Ju-Hyun Lee; Jun Hee Lee; Michael Lee; Myung-Shik Lee; Patty J Lee; Sam W Lee; Seung-Jae Lee; Shiow-Ju Lee; Stella Y Lee; Sug Hyung Lee; Sung Sik Lee; Sung-Joon Lee; Sunhee Lee; Ying-Ray Lee; Yong J Lee; Young H Lee; Christiaan Leeuwenburgh; Sylvain Lefort; Renaud Legouis; Jinzhi Lei; Qun-Ying Lei; David A Leib; Gil Leibowitz; Istvan Lekli; Stéphane D Lemaire; John J Lemasters; Marius K Lemberg; Antoinette Lemoine; Shuilong Leng; Guido Lenz; Paola Lenzi; Lilach O Lerman; Daniele Lettieri Barbato; Julia I-Ju Leu; Hing Y Leung; Beth Levine; Patrick A Lewis; Frank Lezoualc'h; Chi Li; Faqiang Li; Feng-Jun Li; Jun Li; Ke Li; Lian Li; Min Li; Min Li; Qiang Li; Rui Li; Sheng Li; Wei Li; Wei Li; Xiaotao Li; Yumin Li; Jiqin Lian; Chengyu Liang; Qiangrong Liang; Yulin Liao; Joana Liberal; Pawel P Liberski; Pearl Lie; Andrew P Lieberman; Hyunjung Jade Lim; Kah-Leong Lim; Kyu Lim; Raquel T Lima; Chang-Shen Lin; Chiou-Feng Lin; Fang Lin; Fangming Lin; Fu-Cheng Lin; Kui Lin; Kwang-Huei Lin; Pei-Hui Lin; Tianwei Lin; Wan-Wan Lin; Yee-Shin Lin; Yong Lin; Rafael Linden; Dan Lindholm; Lisa M Lindqvist; Paul Lingor; Andreas Linkermann; Lance A Liotta; Marta M Lipinski; Vitor A Lira; Michael P Lisanti; Paloma B Liton; Bo Liu; Chong Liu; Chun-Feng Liu; Fei Liu; Hung-Jen Liu; Jianxun Liu; Jing-Jing Liu; Jing-Lan Liu; Ke Liu; Leyuan Liu; Liang Liu; Quentin Liu; Rong-Yu Liu; Shiming Liu; Shuwen Liu; Wei Liu; Xian-De Liu; Xiangguo Liu; Xiao-Hong Liu; Xinfeng Liu; Xu Liu; Xueqin Liu; Yang Liu; Yule Liu; Zexian Liu; Zhe Liu; Juan P Liuzzi; Gérard Lizard; Mila Ljujic; Irfan J Lodhi; Susan E Logue; Bal L Lokeshwar; Yun Chau Long; Sagar Lonial; Benjamin Loos; Carlos López-Otín; Cristina López-Vicario; Mar Lorente; Philip L Lorenzi; Péter Lõrincz; Marek Los; Michael T Lotze; Penny E Lovat; Binfeng Lu; Bo Lu; Jiahong Lu; Qing Lu; She-Min Lu; Shuyan Lu; Yingying Lu; Frédéric Luciano; Shirley Luckhart; John Milton Lucocq; Paula Ludovico; Aurelia Lugea; Nicholas W Lukacs; Julian J Lum; Anders H Lund; Honglin Luo; Jia Luo; Shouqing Luo; Claudio Luparello; Timothy Lyons; Jianjie Ma; Yi Ma; Yong Ma; Zhenyi Ma; Juliano Machado; Glaucia M Machado-Santelli; Fernando Macian; Gustavo C MacIntosh; Jeffrey P MacKeigan; Kay F Macleod; John D MacMicking; Lee Ann MacMillan-Crow; Frank Madeo; Muniswamy Madesh; Julio Madrigal-Matute; Akiko Maeda; Tatsuya Maeda; Gustavo Maegawa; Emilia Maellaro; Hannelore Maes; Marta Magariños; Kenneth Maiese; Tapas K Maiti; Luigi Maiuri; Maria Chiara Maiuri; Carl G Maki; Roland Malli; Walter Malorni; Alina Maloyan; Fathia Mami-Chouaib; Na Man; Joseph D Mancias; Eva-Maria Mandelkow; Michael A Mandell; Angelo A Manfredi; Serge N Manié; Claudia Manzoni; Kai Mao; Zixu Mao; Zong-Wan Mao; Philippe Marambaud; Anna Maria Marconi; Zvonimir Marelja; Gabriella Marfe; Marta Margeta; Eva Margittai; Muriel Mari; Francesca V Mariani; Concepcio Marin; Sara Marinelli; Guillermo Mariño; Ivanka Markovic; Rebecca Marquez; Alberto M Martelli; Sascha Martens; Katie R Martin; Seamus J Martin; Shaun Martin; Miguel A Martin-Acebes; Paloma Martín-Sanz; Camille Martinand-Mari; Wim Martinet; Jennifer Martinez; Nuria Martinez-Lopez; Ubaldo Martinez-Outschoorn; Moisés Martínez-Velázquez; Marta Martinez-Vicente; Waleska Kerllen Martins; Hirosato Mashima; James A Mastrianni; Giuseppe Matarese; Paola Matarrese; Roberto Mateo; Satoaki Matoba; Naomichi Matsumoto; Takehiko Matsushita; Akira Matsuura; Takeshi Matsuzawa; Mark P Mattson; Soledad Matus; Norma Maugeri; Caroline Mauvezin; Andreas Mayer; Dusica Maysinger; Guillermo D Mazzolini; Mary Kate McBrayer; Kimberly McCall; Craig McCormick; Gerald M McInerney; Skye C McIver; Sharon McKenna; John J McMahon; Iain A McNeish; Fatima Mechta-Grigoriou; Jan Paul Medema; Diego L Medina; Klara Megyeri; Maryam Mehrpour; Jawahar L Mehta; Yide Mei; Ute-Christiane Meier; Alfred J Meijer; Alicia Meléndez; Gerry Melino; Sonia Melino; Edesio Jose Tenorio de Melo; Maria A Mena; Marc D Meneghini; Javier A Menendez; Regina Menezes; Liesu Meng; Ling-Hua Meng; Songshu Meng; Rossella Menghini; A Sue Menko; Rubem Fs Menna-Barreto; Manoj B Menon; Marco A Meraz-Ríos; Giuseppe Merla; Luciano Merlini; Angelica M Merlot; Andreas Meryk; Stefania Meschini; Joel N Meyer; Man-Tian Mi; Chao-Yu Miao; Lucia Micale; Simon Michaeli; Carine Michiels; Anna Rita Migliaccio; Anastasia Susie Mihailidou; Dalibor Mijaljica; Katsuhiko Mikoshiba; Enrico Milan; Leonor Miller-Fleming; Gordon B Mills; Ian G Mills; Georgia Minakaki; Berge A Minassian; Xiu-Fen Ming; Farida Minibayeva; Elena A Minina; Justine D Mintern; Saverio Minucci; Antonio Miranda-Vizuete; Claire H Mitchell; Shigeki Miyamoto; Keisuke Miyazawa; Noboru Mizushima; Katarzyna Mnich; Baharia Mograbi; Simin Mohseni; Luis Ferreira Moita; Marco Molinari; Maurizio Molinari; Andreas Buch Møller; Bertrand Mollereau; Faustino Mollinedo; Marco Mongillo; Martha M Monick; Serena Montagnaro; Craig Montell; Darren J Moore; Michael N Moore; Rodrigo Mora-Rodriguez; Paula I Moreira; Etienne Morel; Maria Beatrice Morelli; Sandra Moreno; Michael J Morgan; Arnaud Moris; Yuji Moriyasu; Janna L Morrison; Lynda A Morrison; Eugenia Morselli; Jorge Moscat; Pope L Moseley; Serge Mostowy; Elisa Motori; Denis Mottet; Jeremy C Mottram; Charbel E-H Moussa; Vassiliki E Mpakou; Hasan Mukhtar; Jean M Mulcahy Levy; Sylviane Muller; Raquel Muñoz-Moreno; Cristina Muñoz-Pinedo; Christian Münz; Maureen E Murphy; James T Murray; Aditya Murthy; Indira U Mysorekar; Ivan R Nabi; Massimo Nabissi; Gustavo A Nader; Yukitoshi Nagahara; Yoshitaka Nagai; Kazuhiro Nagata; Anika Nagelkerke; Péter Nagy; Samisubbu R Naidu; Sreejayan Nair; Hiroyasu Nakano; Hitoshi Nakatogawa; Meera Nanjundan; Gennaro Napolitano; Naweed I Naqvi; Roberta Nardacci; Derek P Narendra; Masashi Narita; Anna Chiara Nascimbeni; Ramesh Natarajan; Luiz C Navegantes; Steffan T Nawrocki; Taras Y Nazarko; Volodymyr Y Nazarko; Thomas Neill; Luca M Neri; Mihai G Netea; Romana T Netea-Maier; Bruno M Neves; Paul A Ney; Ioannis P Nezis; Hang Tt Nguyen; Huu Phuc Nguyen; Anne-Sophie Nicot; Hilde Nilsen; Per Nilsson; Mikio Nishimura; Ichizo Nishino; Mireia Niso-Santano; Hua Niu; Ralph A Nixon; Vincent Co Njar; Takeshi Noda; Angelika A Noegel; Elsie Magdalena Nolte; Erik Norberg; Koenraad K Norga; Sakineh Kazemi Noureini; Shoji Notomi; Lucia Notterpek; Karin Nowikovsky; Nobuyuki Nukina; Thorsten Nürnberger; Valerie B O'Donnell; Tracey O'Donovan; Peter J O'Dwyer; Ina Oehme; Clara L Oeste; Michinaga Ogawa; Besim Ogretmen; Yuji Ogura; Young J Oh; Masaki Ohmuraya; Takayuki Ohshima; Rani Ojha; Koji Okamoto; Toshiro Okazaki; F Javier Oliver; Karin Ollinger; Stefan Olsson; Daniel P Orban; Paulina Ordonez; Idil Orhon; Laszlo Orosz; Eyleen J O'Rourke; Helena Orozco; Angel L Ortega; Elena Ortona; Laura D Osellame; Junko Oshima; Shigeru Oshima; Heinz D Osiewacz; Takanobu Otomo; Kinya Otsu; Jing-Hsiung James Ou; Tiago F Outeiro; Dong-Yun Ouyang; Hongjiao Ouyang; Michael Overholtzer; Michelle A Ozbun; P Hande Ozdinler; Bulent Ozpolat; Consiglia Pacelli; Paolo Paganetti; Guylène Page; Gilles Pages; Ugo Pagnini; Beata Pajak; Stephen C Pak; Karolina Pakos-Zebrucka; Nazzy Pakpour; Zdena Palková; Francesca Palladino; Kathrin Pallauf; Nicolas Pallet; Marta Palmieri; Søren R Paludan; Camilla Palumbo; Silvia Palumbo; Olatz Pampliega; Hongming Pan; Wei Pan; Theocharis Panaretakis; Aseem Pandey; Areti Pantazopoulou; Zuzana Papackova; Daniela L Papademetrio; Issidora Papassideri; Alessio Papini; Nirmala Parajuli; Julian Pardo; Vrajesh V Parekh; Giancarlo Parenti; Jong-In Park; Junsoo Park; Ohkmae K Park; Roy Parker; Rosanna Parlato; Jan B Parys; Katherine R Parzych; Jean-Max Pasquet; Benoit Pasquier; Kishore Bs Pasumarthi; Daniel Patschan; Cam Patterson; Sophie Pattingre; Scott Pattison; Arnim Pause; Hermann Pavenstädt; Flaminia Pavone; Zully Pedrozo; Fernando J Peña; Miguel A Peñalva; Mario Pende; Jianxin Peng; Fabio Penna; Josef M Penninger; Anna Pensalfini; Salvatore Pepe; Gustavo Js Pereira; Paulo C Pereira; Verónica Pérez-de la Cruz; María Esther Pérez-Pérez; Diego Pérez-Rodríguez; Dolores Pérez-Sala; Celine Perier; Andras Perl; David H Perlmutter; Ida Perrotta; Shazib Pervaiz; Maija Pesonen; Jeffrey E Pessin; Godefridus J Peters; Morten Petersen; Irina Petrache; Basil J Petrof; Goran Petrovski; James M Phang; Mauro Piacentini; Marina Pierdominici; Philippe Pierre; Valérie Pierrefite-Carle; Federico Pietrocola; Felipe X Pimentel-Muiños; Mario Pinar; Benjamin Pineda; Ronit Pinkas-Kramarski; Marcello Pinti; Paolo Pinton; Bilal Piperdi; James M Piret; Leonidas C Platanias; Harald W Platta; Edward D Plowey; Stefanie Pöggeler; Marc Poirot; Peter Polčic; Angelo Poletti; Audrey H Poon; Hana Popelka; Blagovesta Popova; Izabela Poprawa; Shibu M Poulose; Joanna Poulton; Scott K Powers; Ted Powers; Mercedes Pozuelo-Rubio; Krisna Prak; Reinhild Prange; Mark Prescott; Muriel Priault; Sharon Prince; Richard L Proia; Tassula Proikas-Cezanne; Holger Prokisch; Vasilis J Promponas; Karin Przyklenk; Rosa Puertollano; Subbiah Pugazhenthi; Luigi Puglielli; Aurora Pujol; Julien Puyal; Dohun Pyeon; Xin Qi; Wen-Bin Qian; Zheng-Hong Qin; Yu Qiu; Ziwei Qu; Joe Quadrilatero; Frederick Quinn; Nina Raben; Hannah Rabinowich; Flavia Radogna; Michael J Ragusa; Mohamed Rahmani; Komal Raina; Sasanka Ramanadham; Rajagopal Ramesh; Abdelhaq Rami; Sarron Randall-Demllo; Felix Randow; Hai Rao; V Ashutosh Rao; Blake B Rasmussen; Tobias M Rasse; Edward A Ratovitski; Pierre-Emmanuel Rautou; Swapan K Ray; Babak Razani; Bruce H Reed; Fulvio Reggiori; Markus Rehm; Andreas S Reichert; Theo Rein; David J Reiner; Eric Reits; Jun Ren; Xingcong Ren; Maurizio Renna; Jane Eb Reusch; Jose L Revuelta; Leticia Reyes; Alireza R Rezaie; Robert I Richards; Des R Richardson; Clémence Richetta; Michael A Riehle; Bertrand H Rihn; Yasuko Rikihisa; Brigit E Riley; Gerald Rimbach; Maria Rita Rippo; Konstantinos Ritis; Federica Rizzi; Elizete Rizzo; Peter J Roach; Jeffrey Robbins; Michel Roberge; Gabriela Roca; Maria Carmela Roccheri; Sonia Rocha; Cecilia Mp Rodrigues; Clara I Rodríguez; Santiago Rodriguez de Cordoba; Natalia Rodriguez-Muela; Jeroen Roelofs; Vladimir V Rogov; Troy T Rohn; Bärbel Rohrer; Davide Romanelli; Luigina Romani; Patricia Silvia Romano; M Isabel G Roncero; Jose Luis Rosa; Alicia Rosello; Kirill V Rosen; Philip Rosenstiel; Magdalena Rost-Roszkowska; Kevin A Roth; Gael Roué; Mustapha Rouis; Kasper M Rouschop; Daniel T Ruan; Diego Ruano; David C Rubinsztein; Edmund B Rucker; Assaf Rudich; Emil Rudolf; Ruediger Rudolf; Markus A Ruegg; Carmen Ruiz-Roldan; Avnika Ashok Ruparelia; Paola Rusmini; David W Russ; Gian Luigi Russo; Giuseppe Russo; Rossella Russo; Tor Erik Rusten; Victoria Ryabovol; Kevin M Ryan; Stefan W Ryter; David M Sabatini; Michael Sacher; Carsten Sachse; Michael N Sack; Junichi Sadoshima; Paul Saftig; Ronit Sagi-Eisenberg; Sumit Sahni; Pothana Saikumar; Tsunenori Saito; Tatsuya Saitoh; Koichi Sakakura; Machiko Sakoh-Nakatogawa; Yasuhito Sakuraba; María Salazar-Roa; Paolo Salomoni; Ashok K Saluja; Paul M Salvaterra; Rosa Salvioli; Afshin Samali; Anthony Mj Sanchez; José A Sánchez-Alcázar; Ricardo Sanchez-Prieto; Marco Sandri; Miguel A Sanjuan; Stefano Santaguida; Laura Santambrogio; Giorgio Santoni; Claudia Nunes Dos Santos; Shweta Saran; Marco Sardiello; Graeme Sargent; Pallabi Sarkar; Sovan Sarkar; Maria Rosa Sarrias; Minnie M Sarwal; Chihiro Sasakawa; Motoko Sasaki; Miklos Sass; Ken Sato; Miyuki Sato; Joseph Satriano; Niramol Savaraj; Svetlana Saveljeva; Liliana Schaefer; Ulrich E Schaible; Michael Scharl; Hermann M Schatzl; Randy Schekman; Wiep Scheper; Alfonso Schiavi; Hyman M Schipper; Hana Schmeisser; Jens Schmidt; Ingo Schmitz; Bianca E Schneider; E Marion Schneider; Jaime L Schneider; Eric A Schon; Miriam J Schönenberger; Axel H Schönthal; Daniel F Schorderet; Bernd Schröder; Sebastian Schuck; Ryan J Schulze; Melanie Schwarten; Thomas L Schwarz; Sebastiano Sciarretta; Kathleen Scotto; A Ivana Scovassi; Robert A Screaton; Mark Screen; Hugo Seca; Simon Sedej; Laura Segatori; Nava Segev; Per O Seglen; Jose M Seguí-Simarro; Juan Segura-Aguilar; Ekihiro Seki; Christian Sell; Iban Seiliez; Clay F Semenkovich; Gregg L Semenza; Utpal Sen; Andreas L Serra; Ana Serrano-Puebla; Hiromi Sesaki; Takao Setoguchi; Carmine Settembre; John J Shacka; Ayesha N Shajahan-Haq; Irving M Shapiro; Shweta Sharma; Hua She; C-K James Shen; Chiung-Chyi Shen; Han-Ming Shen; Sanbing Shen; Weili Shen; Rui Sheng; Xianyong Sheng; Zu-Hang Sheng; Trevor G Shepherd; Junyan Shi; Qiang Shi; Qinghua Shi; Yuguang Shi; Shusaku Shibutani; Kenichi Shibuya; Yoshihiro Shidoji; Jeng-Jer Shieh; Chwen-Ming Shih; Yohta Shimada; Shigeomi Shimizu; Dong Wook Shin; Mari L Shinohara; Michiko Shintani; Takahiro Shintani; Tetsuo Shioi; Ken Shirabe; Ronit Shiri-Sverdlov; Orian Shirihai; Gordon C Shore; Chih-Wen Shu; Deepak Shukla; Andriy A Sibirny; Valentina Sica; Christina J Sigurdson; Einar M Sigurdsson; Puran Singh Sijwali; Beata Sikorska; Wilian A Silveira; Sandrine Silvente-Poirot; Gary A Silverman; Jan Simak; Thomas Simmet; Anna Katharina Simon; Hans-Uwe Simon; Cristiano Simone; Matias Simons; Anne Simonsen; Rajat Singh; Shivendra V Singh; Shrawan K Singh; Debasish Sinha; Sangita Sinha; Frank A Sinicrope; Agnieszka Sirko; Kapil Sirohi; Balindiwe Jn Sishi; Annie Sittler; Parco M Siu; Efthimios Sivridis; Anna Skwarska; Ruth Slack; Iva Slaninová; Nikolai Slavov; Soraya S Smaili; Keiran Sm Smalley; Duncan R Smith; Stefaan J Soenen; Scott A Soleimanpour; Anita Solhaug; Kumaravel Somasundaram; Jin H Son; Avinash Sonawane; Chunjuan Song; Fuyong Song; Hyun Kyu Song; Ju-Xian Song; Wei Song; Kai Y Soo; Anil K Sood; Tuck Wah Soong; Virawudh Soontornniyomkij; Maurizio Sorice; Federica Sotgia; David R Soto-Pantoja; Areechun Sotthibundhu; Maria João Sousa; Herman P Spaink; Paul N Span; Anne Spang; Janet D Sparks; Peter G Speck; Stephen A Spector; Claudia D Spies; Wolfdieter Springer; Daret St Clair; Alessandra Stacchiotti; Bart Staels; Michael T Stang; Daniel T Starczynowski; Petro Starokadomskyy; Clemens Steegborn; John W Steele; Leonidas Stefanis; Joan Steffan; Christine M Stellrecht; Harald Stenmark; Tomasz M Stepkowski; Stęphan T Stern; Craig Stevens; Brent R Stockwell; Veronika Stoka; Zuzana Storchova; Björn Stork; Vassilis Stratoulias; Dimitrios J Stravopodis; Pavel Strnad; Anne Marie Strohecker; Anna-Lena Ström; Per Stromhaug; Jiri Stulik; Yu-Xiong Su; Zhaoliang Su; Carlos S Subauste; Srinivasa Subramaniam; Carolyn M Sue; Sang Won Suh; Xinbing Sui; Supawadee Sukseree; David Sulzer; Fang-Lin Sun; Jiaren Sun; Jun Sun; Shi-Yong Sun; Yang Sun; Yi Sun; Yingjie Sun; Vinod Sundaramoorthy; Joseph Sung; Hidekazu Suzuki; Kuninori Suzuki; Naoki Suzuki; Tadashi Suzuki; Yuichiro J Suzuki; Michele S Swanson; Charles Swanton; Karl Swärd; Ghanshyam Swarup; Sean T Sweeney; Paul W Sylvester; Zsuzsanna Szatmari; Eva Szegezdi; Peter W Szlosarek; Heinrich Taegtmeyer; Marco Tafani; Emmanuel Taillebourg; Stephen Wg Tait; Krisztina Takacs-Vellai; Yoshinori Takahashi; Szabolcs Takáts; Genzou Takemura; Nagio Takigawa; Nicholas J Talbot; Elena Tamagno; Jerome Tamburini; Cai-Ping Tan; Lan Tan; Mei Lan Tan; Ming Tan; Yee-Joo Tan; Keiji Tanaka; Masaki Tanaka; Daolin Tang; Dingzhong Tang; Guomei Tang; Isei Tanida; Kunikazu Tanji; Bakhos A Tannous; Jose A Tapia; Inmaculada Tasset-Cuevas; Marc Tatar; Iman Tavassoly; Nektarios Tavernarakis; Allen Taylor; Graham S Taylor; Gregory A Taylor; J Paul Taylor; Mark J Taylor; Elena V Tchetina; Andrew R Tee; Fatima Teixeira-Clerc; Sucheta Telang; Tewin Tencomnao; Ba-Bie Teng; Ru-Jeng Teng; Faraj Terro; Gianluca Tettamanti; Arianne L Theiss; Anne E Theron; Kelly Jean Thomas; Marcos P Thomé; Paul G Thomes; Andrew Thorburn; Jeremy Thorner; Thomas Thum; Michael Thumm; Teresa Lm Thurston; Ling Tian; Andreas Till; Jenny Pan-Yun Ting; Vladimir I Titorenko; Lilach Toker; Stefano Toldo; Sharon A Tooze; Ivan Topisirovic; Maria Lyngaas Torgersen; Liliana Torosantucci; Alicia Torriglia; Maria Rosaria Torrisi; Cathy Tournier; Roberto Towns; Vladimir Trajkovic; Leonardo H Travassos; Gemma Triola; Durga Nand Tripathi; Daniela Trisciuoglio; Rodrigo Troncoso; Ioannis P Trougakos; Anita C Truttmann; Kuen-Jer Tsai; Mario P Tschan; Yi-Hsin Tseng; Takayuki Tsukuba; Allan Tsung; Andrey S Tsvetkov; Shuiping Tu; Hsing-Yu Tuan; Marco Tucci; David A Tumbarello; Boris Turk; Vito Turk; Robin Fb Turner; Anders A Tveita; Suresh C Tyagi; Makoto Ubukata; Yasuo Uchiyama; Andrej Udelnow; Takashi Ueno; Midori Umekawa; Rika Umemiya-Shirafuji; Benjamin R Underwood; Christian Ungermann; Rodrigo P Ureshino; Ryo Ushioda; Vladimir N Uversky; Néstor L Uzcátegui; Thomas Vaccari; Maria I Vaccaro; Libuše Váchová; Helin Vakifahmetoglu-Norberg; Rut Valdor; Enza Maria Valente; Francois Vallette; Angela M Valverde; Greet Van den Berghe; Ludo Van Den Bosch; Gijs R van den Brink; F Gisou van der Goot; Ida J van der Klei; Luc Jw van der Laan; Wouter G van Doorn; Marjolein van Egmond; Kenneth L van Golen; Luc Van Kaer; Menno van Lookeren Campagne; Peter Vandenabeele; Wim Vandenberghe; Ilse Vanhorebeek; Isabel Varela-Nieto; M Helena Vasconcelos; Radovan Vasko; Demetrios G Vavvas; Ignacio Vega-Naredo; Guillermo Velasco; Athanassios D Velentzas; Panagiotis D Velentzas; Tibor Vellai; Edo Vellenga; Mikkel Holm Vendelbo; Kartik Venkatachalam; Natascia Ventura; Salvador Ventura; Patrícia St Veras; Mireille Verdier; Beata G Vertessy; Andrea Viale; Michel Vidal; Helena L A Vieira; Richard D Vierstra; Nadarajah Vigneswaran; Neeraj Vij; Miquel Vila; Margarita Villar; Victor H Villar; Joan Villarroya; Cécile Vindis; Giampietro Viola; Maria Teresa Viscomi; Giovanni Vitale; Dan T Vogl; Olga V Voitsekhovskaja; Clarissa von Haefen; Karin von Schwarzenberg; Daniel E Voth; Valérie Vouret-Craviari; Kristina Vuori; Jatin M Vyas; Christian Waeber; Cheryl Lyn Walker; Mark J Walker; Jochen Walter; Lei Wan; Xiangbo Wan; Bo Wang; Caihong Wang; Chao-Yung Wang; Chengshu Wang; Chenran Wang; Chuangui Wang; Dong Wang; Fen Wang; Fuxin Wang; Guanghui Wang; Hai-Jie Wang; Haichao Wang; Hong-Gang Wang; Hongmin Wang; Horng-Dar Wang; Jing Wang; Junjun Wang; Mei Wang; Mei-Qing Wang; Pei-Yu Wang; Peng Wang; Richard C Wang; Shuo Wang; Ting-Fang Wang; Xian Wang; Xiao-Jia Wang; Xiao-Wei Wang; Xin Wang; Xuejun Wang; Yan Wang; Yanming Wang; Ying Wang; Ying-Jan Wang; Yipeng Wang; Yu Wang; Yu Tian Wang; Yuqing Wang; Zhi-Nong Wang; Pablo Wappner; Carl Ward; Diane McVey Ward; Gary Warnes; Hirotaka Watada; Yoshihisa Watanabe; Kei Watase; Timothy E Weaver; Colin D Weekes; Jiwu Wei; Thomas Weide; Conrad C Weihl; Günther Weindl; Simone Nardin Weis; Longping Wen; Xin Wen; Yunfei Wen; Benedikt Westermann; Cornelia M Weyand; Anthony R White; Eileen White; J Lindsay Whitton; Alexander J Whitworth; Joëlle Wiels; Franziska Wild; Manon E Wildenberg; Tom Wileman; Deepti Srinivas Wilkinson; Simon Wilkinson; Dieter Willbold; Chris Williams; Katherine Williams; Peter R Williamson; Konstanze F Winklhofer; Steven S Witkin; Stephanie E Wohlgemuth; Thomas Wollert; Ernst J Wolvetang; Esther Wong; G William Wong; Richard W Wong; Vincent Kam Wai Wong; Elizabeth A Woodcock; Karen L Wright; Chunlai Wu; Defeng Wu; Gen Sheng Wu; Jian Wu; Junfang Wu; Mian Wu; Min Wu; Shengzhou Wu; William Kk Wu; Yaohua Wu; Zhenlong Wu; Cristina Pr Xavier; Ramnik J Xavier; Gui-Xian Xia; Tian Xia; Weiliang Xia; Yong Xia; Hengyi Xiao; Jian Xiao; Shi Xiao; Wuhan Xiao; Chuan-Ming Xie; Zhiping Xie; Zhonglin Xie; Maria Xilouri; Yuyan Xiong; Chuanshan Xu; Congfeng Xu; Feng Xu; Haoxing Xu; Hongwei Xu; Jian Xu; Jianzhen Xu; Jinxian Xu; Liang Xu; Xiaolei Xu; Yangqing Xu; Ye Xu; Zhi-Xiang Xu; Ziheng Xu; Yu Xue; Takahiro Yamada; Ai Yamamoto; Koji Yamanaka; Shunhei Yamashina; Shigeko Yamashiro; Bing Yan; Bo Yan; Xianghua Yan; Zhen Yan; Yasuo Yanagi; Dun-Sheng Yang; Jin-Ming Yang; Liu Yang; Minghua Yang; Pei-Ming Yang; Peixin Yang; Qian Yang; Wannian Yang; Wei Yuan Yang; Xuesong Yang; Yi Yang; Ying Yang; Zhifen Yang; Zhihong Yang; Meng-Chao Yao; Pamela J Yao; Xiaofeng Yao; Zhenyu Yao; Zhiyuan Yao; Linda S Yasui; Mingxiang Ye; Barry Yedvobnick; Behzad Yeganeh; Elizabeth S Yeh; Patricia L Yeyati; Fan Yi; Long Yi; Xiao-Ming Yin; Calvin K Yip; Yeong-Min Yoo; Young Hyun Yoo; Seung-Yong Yoon; Ken-Ichi Yoshida; Tamotsu Yoshimori; Ken H Young; Huixin Yu; Jane J Yu; Jin-Tai Yu; Jun Yu; Li Yu; W Haung Yu; Xiao-Fang Yu; Zhengping Yu; Junying Yuan; Zhi-Min Yuan; Beatrice Yjt Yue; Jianbo Yue; Zhenyu Yue; David N Zacks; Eldad Zacksenhaus; Nadia Zaffaroni; Tania Zaglia; Zahra Zakeri; Vincent Zecchini; Jinsheng Zeng; Min Zeng; Qi Zeng; Antonis S Zervos; Donna D Zhang; Fan Zhang; Guo Zhang; Guo-Chang Zhang; Hao Zhang; Hong Zhang; Hong Zhang; Hongbing Zhang; Jian Zhang; Jian Zhang; Jiangwei Zhang; Jianhua Zhang; Jing-Pu Zhang; Li Zhang; Lin Zhang; Lin Zhang; Long Zhang; Ming-Yong Zhang; Xiangnan Zhang; Xu Dong Zhang; Yan Zhang; Yang Zhang; Yanjin Zhang; Yingmei Zhang; Yunjiao Zhang; Mei Zhao; Wei-Li Zhao; Xiaonan Zhao; Yan G Zhao; Ying Zhao; Yongchao Zhao; Yu-Xia Zhao; Zhendong Zhao; Zhizhuang J Zhao; Dexian Zheng; Xi-Long Zheng; Xiaoxiang Zheng; Boris Zhivotovsky; Qing Zhong; Guang-Zhou Zhou; Guofei Zhou; Huiping Zhou; Shu-Feng Zhou; Xu-Jie Zhou; Hongxin Zhu; Hua Zhu; Wei-Guo Zhu; Wenhua Zhu; Xiao-Feng Zhu; Yuhua Zhu; Shi-Mei Zhuang; Xiaohong Zhuang; Elio Ziparo; Christos E Zois; Teresa Zoladek; Wei-Xing Zong; Antonio Zorzano; Susu M Zughaier
Journal:  Autophagy       Date:  2016       Impact factor: 16.016

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  7 in total

Review 1.  Autophagy in health and disease: From molecular mechanisms to therapeutic target.

Authors:  Guang Lu; Yu Wang; Yin Shi; Zhe Zhang; Canhua Huang; Weifeng He; Chuang Wang; Han-Ming Shen
Journal:  MedComm (2020)       Date:  2022-07-10

Review 2.  Reinventing the Penumbra - the Emerging Clockwork of a Multi-modal Mechanistic Paradigm.

Authors:  Jakob Walther; Elena Marie Kirsch; Lina Hellwig; Sarah S Schmerbeck; Paul M Holloway; Alastair M Buchan; Philipp Mergenthaler
Journal:  Transl Stroke Res       Date:  2022-10-11       Impact factor: 6.800

3.  Interplay between exosomes and autophagy machinery in pain management: State of the art.

Authors:  Hamidreza Morteza Bagi; Sajjad Ahmadi; Faezeh Tarighat; Reza Rahbarghazi; Hassan Soleimanpour
Journal:  Neurobiol Pain       Date:  2022-06-09

4.  Autophagy in asthma and chronic obstructive pulmonary disease.

Authors:  Peter J Barnes; Jonathan Baker; Louise E Donnelly
Journal:  Clin Sci (Lond)       Date:  2022-05-27       Impact factor: 6.876

5.  Leucyl-tRNA synthetase deficiency systemically induces excessive autophagy in zebrafish.

Authors:  Masanori Inoue; Hiroaki Miyahara; Hiroshi Shiraishi; Nobuyuki Shimizu; Mika Tsumori; Kyoko Kiyota; Miwako Maeda; Ryohei Umeda; Tohru Ishitani; Reiko Hanada; Kenji Ihara; Toshikatsu Hanada
Journal:  Sci Rep       Date:  2021-04-16       Impact factor: 4.379

Review 6.  Crosstalk between autophagy inhibitors and endosome-related secretory pathways: a challenge for autophagy-based treatment of solid cancers.

Authors:  Martina Raudenska; Jan Balvan; Michal Masarik
Journal:  Mol Cancer       Date:  2021-10-27       Impact factor: 27.401

7.  The Histone Deacetylase Inhibitor ITF2357 (Givinostat) Targets Oncogenic BRAF in Melanoma Cells and Promotes a Switch from Pro-Survival Autophagy to Apoptosis.

Authors:  Adriana Celesia; Antonietta Notaro; Marzia Franzò; Marianna Lauricella; Antonella D'Anneo; Daniela Carlisi; Michela Giuliano; Sonia Emanuele
Journal:  Biomedicines       Date:  2022-08-17
  7 in total

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