Kyun Ha Kim1, Ji Yeon Lee1, Wan Yi Li2, Sangwoo Lee3, Han-Sol Jeong1, Jun-Yong Choi4, Myungsoo Joo5. 1. School of Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea. 2. Institute of Medicinal Plants, Yunnan Academy of Agricultural Sciences, Kunming, Yunnan, 650224, China. 3. International Biological Material Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, 34141, Republic of Korea. 4. Lung Cancer Clinic, Pulmonary Medicine Center, Korean Medicine Hospital, Pusan National University, Yangsan, 50612, Republic of Korea. 5. School of Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea. mjoo@pusan.ac.kr.
Abstract
BACKGROUND: Garcinia subelliptica Merr. is a multipurpose coastal tree, the potential medicinal effects of which have been studied, including cancer suppression. Here, we present evidence that the ethanol extract of G. subelliptica Merr. (eGSM) induces autophagy in human lung adenocarcinoma cells. METHODS: Two different human lung adenocarcinoma cell lines, A549 and SNU2292, were treated with varying amounts of eGSM. Cytotoxicity elicited by eGSM was assessed by MTT assay and PARP degradation. Autophagy in A549 and SNU2292 was determined by western blotting for AMPK, mTOR, ULK1, and LC3. Genetic deletion of AMPKα in HEK293 cells was carried out by CRISPR. RESULTS: eGSM elicited cytotoxicity, but not apoptosis, in A549 and SNU2292 cells. eGSM increased LC3-II production in both A549 and, more extensively, SNU2292, suggesting that eGSM induces autophagy. In A549, eGSM activated AMPK, an essential autophagy activator, but not suppressed mTOR, an autophagy blocker, suggesting that eGSM induces autophagy by primarily activating the AMPK pathway in A549. By contrast, eGSM suppressed mTOR activity without activating AMPK in SNU2292, suggesting that eGSM induces autophagy by mainly suppressing mTOR in SNU2292. In HEK293 cells lacking AMPKα expression, eGSM increased LC3-II production, confirming that the autophagy induced by eGSM can occur without the AMPK pathway. CONCLUSION: Our findings suggest that eGSM induces autophagy by activating AMPK or suppressing mTOR pathways, depending on cell types.
BACKGROUND: Garcinia subelliptica Merr. is a multipurpose coastal tree, the potential medicinal effects of which have been studied, including cancer suppression. Here, we present evidence that the ethanol extract of G. subelliptica Merr. (eGSM) induces autophagy in human lung adenocarcinoma cells. METHODS: Two different human lung adenocarcinoma cell lines, A549 and SNU2292, were treated with varying amounts of eGSM. Cytotoxicity elicited by eGSM was assessed by MTT assay and PARP degradation. Autophagy in A549 and SNU2292 was determined by western blotting for AMPK, mTOR, ULK1, and LC3. Genetic deletion of AMPKα in HEK293 cells was carried out by CRISPR. RESULTS: eGSM elicited cytotoxicity, but not apoptosis, in A549 and SNU2292 cells. eGSM increased LC3-II production in both A549 and, more extensively, SNU2292, suggesting that eGSM induces autophagy. In A549, eGSM activated AMPK, an essential autophagy activator, but not suppressed mTOR, an autophagy blocker, suggesting that eGSM induces autophagy by primarily activating the AMPK pathway in A549. By contrast, eGSM suppressed mTOR activity without activating AMPK in SNU2292, suggesting that eGSM induces autophagy by mainly suppressing mTOR in SNU2292. In HEK293 cells lacking AMPKα expression, eGSM increased LC3-II production, confirming that the autophagy induced by eGSM can occur without the AMPK pathway. CONCLUSION: Our findings suggest that eGSM induces autophagy by activating AMPK or suppressing mTOR pathways, depending on cell types.
Garcinia subelliptica Merr. is a coastal tree species found in Japan, China, Taiwan, India, Sri Lanka, and the Philippines [1]. G. subelliptica Merr. has been known to contain various chemical constituents regulating bacterial infection, inflammation, and cancer [2]. For example, garcinielliptones were reported to inhibit the release of β-glucuronidase and lysozyme [3]. They also suppress superoxide formation from activated neutrophils and peripheral mast cells [4]. Xanthone isolated from the plant is cytotoxic to cancer cells [5], and benzophenonoids exhibit cytotoxicity to A549 non-small lung carcinoma cell, DU145 prostate carcinoma cell, and KB nasopharyngeal carcinoma cells [6]. These results suggest that the potential pharmacological significance of the plant is high. However, the use of plant extract as an herbal remedy appears relatively limited. A recent report showed that the ethanol extract of the leaf of G. subelliptica has anti-inflammatory activity [7]. The leaf extract reduced nitric oxide production, cyclooxygenase-2, and proinflammatory cytokines in RAW264.7 cells stimulated with lipopolysaccharide. These results are in accord with the reports that the plant contains numerous constituents contributing to anti-inflammatory effects. Given the cytotoxicity of some constituents of the plant to several cancer cells, it would be worth exploring the plant extract as a potential herbal remedy to treat cancer.Cytotoxicity could trigger autophagy, a cellular system that enables cells to cope with a constantly changing environment [8]. Autophagy is now considered a process of homeostasis that involves the digestion of self-proteins and organelles, by which cells can deal with various environmental challenges such as starvation [9] and infectious and other diseases [10]. Detailed molecular processes for autophagy are well-documented [11]. Mechanistically, autophagy is primarily regulated by two essential kinases, the mechanistic target of rapamycin (mTOR) and the AMP-activated protein kinase (AMPK). In a metabolically favorable environment, mTOR becomes phosphorylated at Ser2448 and active [12]. The activated mTOR senses energy-rich environmental cues, prompting anabolism and suppressing autophagy by phosphorylating ULK1 at S757 [13]. On the other hand, in a metabolically adverse environment where glucose or amino acids are limited and catabolism is required for cell survival [14], AMPK becomes activated and increases autophagy while suppressing mTOR activity, resulting in enhanced catabolism [15]. When sensing the lack of ATP, AMPK phosphorylates several serine residues in ULK1 [16], including S317 and S777 [17]. ULK1 phosphorylated at these sites triggers autophagosome formation, making autophagy start [14]. Concurrently, AMPK suppresses mTOR activity to stop anabolism. For suppressing mTOR activity, AMPK phosphorylates and activates TSC2, an mTOR upstream regulator, while phosphorylating and inactivating RAPTOR, a subunit of mTORC1 [13]. Phosphorylating both TSC2 and RAPTOR contributes to the decrease of mTOR activity. Reduced mTOR activity results in decreased phosphorylation of ULK1 at S757 [17]. Phosphorylation at S757 in ULK1 is known as inactivating phosphorylation because it blocks autophagosome formation [17]. Once ULK1 becomes active, as indicated by phosphorylation at S317 and but not at S757, autophagy process initiates to form autophagosomes [18]. During autophagosome formation, microtubule-associated protein 1A/1B-light chain 3 (LC3) in the cytosol is truncated to LC3-I and subsequently conjugated with phosphatidylethanolamine to form LC3-II [19]. Since LC3-II is mainly found in autophagosomes, LC3-II serves as a critical biomarker for autophagy formation [20].Given the cytotoxicity exerted by several constituents of G. subelliptica Merr., we set out to explore the possible usage of the plant extract as herbal medicine to treat cancer. In this study, we show that the leaf ethanol extract of G. subelliptica Merr. (eGSM) exhibited cytotoxicity to two different lung cancer cells, A549 and SNU2292. The cytotoxicity by eGSM appeared to be related to autophagy but not apoptosis. Furthermore, we present evidence that eGSM induced autophagy by activating AMPK and suppressing mTOR activity. Our results provide additional ethnopharmacological significance of G. subelliptica Merr., which could be a scientific basis for developing a possible herbal remedy using G. subelliptica Merr. extract.
Materials and methods
Reagents and antibodies
The ethanol extract of the leaf of Garcinia subelliptica Merr. (catalog # FBM124-035) was purchased from the Korea Research Institute of Bioscience and Biotechnology (Daejeon, Korea). Doxorubicin (D1515), E-64 (E8640), pepstatin A (P4265), and hydroxychloroquine (H0915) were purchased from Sigma-Aldrich (St. Louis, MO, USA), and rapamycin (#13346) was from Cayman (Ann Arbor, MI, USA). Antibodies against PARP (#9532), mTOR (#2972), phosphor-mTOR (S2448, #2971), ULK1 (#8054), phospho-ULK1(S757, #6888), and phospho-ULK (S317, #12753) were procured from Cell signaling (Danvers, MA, USA). Anti-p62/SQSTM1 antibody was obtained from Abcam (Cambridge, UK). Antibodies against β-actin (sc-477,778) and AMPKα (sc-25,792) were obtained from Santa Cruz Biotechnology (Santa Cruz, CA, USA), and LC3 (L7543) was from Sigma-Aldrich.
Assessment of cytotoxicity
Cytotoxicity was determined using a Vybrant® MTT assay kit (Thermo Fisher Scientific, Waltham, MA, USA). Cell culture plates of A549 and SNU2292 were treated with various amounts of eGSM dissolved in PBS for 16 h and measured by a plate reader (BioTeK, VT, USA), as instructed by and the manufacturer. The percentage of live cells was calculated over untreated cells. The assay was conducted in triplicate and repeated three times.
Cells
A549 and HEK293 cells were purchased from American Type Culture Collection (Rockville, MD, USA) and SNU2292 cells [21] from Korean Cell Line Bank (Seoul, Korea). Cells were cultured in Dulbecco’s Modified Eagle’s Medium (DMEM) containing L-glutamine (200 mg/L), 10% (v/v) heat-inactivated fetal bovine serum (FBS), and 100 U/ml penicillin and 100 μg/ml streptomycin in a humidified incubator at 37 °C and 5% CO2.
Genetic deletion of AMPKα by CRISPR
AMPKα1/2 genes were genetically ablated by using the CRISPR-Cas9 system. The guide sequences were designed using the CRISPR design tool (http://www.rgenome.net/cas-designer/). Guide sequences for AMPKα1 were as follows: 5′-GCGAGCTTCGTCCTCA TGCAGGG-3′ and 5′-TACTCAATCGACAGAAGATT-3′. Those for AMPKα2 were 5′-GAAGATCGGACACTACGTGC-3′ and 5′-CTACGTGCTGGGCGACACGC-3′. The annealed AMPKα1 or α2 guide sequences were inserted into the pX459 vector (plasmid No. 62988, Addgene, Watertown, MA, USA). AMPKα1 and AMPKα2 guide sequences were transfected into the HEK293A cells (Thermo Scientific). After the transfected cells were treated with puromycin (1 μg/ml) for 3 days, the HEK293A cell was individually seeded into 96 well plates by BD FACS Aria™ III sorter (BD, San Jose, CA, USA). A clone that lacks expression of AMPKα protein was screened by western blot.
Western blot analysis
Total proteins were prepared by Pierce™ IP lysis buffer (Thermo Fisher Scientific), the amount of which was determined by Bradford (Bio-Rad, Hercules, CA, USA). Equal amounts of proteins loaded onto each lane were separated on NuPAGE gel (Thermo Fisher Scientific) and blotted to PVDF membrane (Bio-Rad). After blocked with 5% non-fat dry milk, the membrane was incubated with appropriate primary antibodies and then with HRP-conjugated secondary antibodies. Proteins of interest were revealed by using SuperSignal®West Femto (Thermo Fisher Scientific). Membranes were stripped with Restore™ Western Blot Stripping Buffer per the manufacturer’s protocol (Thermo Fisher Scientific).
Statistical analysis
One-way analysis of variance (ANOVA) tests was used, along with Tukey’s post hoc test (InStat, Graphpad Software, Inc., San Diego, CA). Data are shown in the mean ± SEM (Std. Error) of three measurements. P (≥0.05) was considered statistically significant.
Results
Cytotoxicity of eGSM
Since some of the chemical constituents in GSM were reported to show anti-cancer effects, including cytotoxicity and apoptosis of cancer cells [2], we hypothesized that GSM has similar activity. To test our hypothesis, we used the ethanol extract of GSM leaves (eGSM) and tested whether eGSM has a cytotoxic effect using lung carcinoma cells. One million A549 cells were treated with increasing amounts of eGSM for 16 h, and then the cytotoxicity elicited by eGSM was determined by MTT assay. As shown in Fig. 1A, eGSM decreased the cell viability as low as 10 μg/ml in a statistically significant fashion. The viability of A549 cells was further reduced as the amount of eGSM increased; the cytotoxicity at 200 μg/ml was comparable to doxorubicin (2 μg/ml). Similar effects of eGSM were observed in SNU2292 cells (Fig. 1B). As in A549, eGSM decreased the viability of SNU2292 as the amount of eGSM increased. Together, these results suggest that eGSM has a cytotoxic effect on the two different lung carcinoma cell lines.
Fig. 1
Cytotoxicity of eGSM. Human lung adenocarcinoma A549 (A) or SNU2292 (B) was treated with indicated amounts of eGSM for 16 h. Cytotoxicity was determined by MTT assay. Doxorubicin (2 μg/ml) was included as a positive control for cytotoxicity. Rapamycin (10 μM), the inhibitor of mTOR, was also tested for its cytotoxicity. The experiment was performed three times, and the representative results are shown here. Data are shown in the mean ± SEM of three measurements. *P was less than 0.05, compared to untreated controls
Cytotoxicity of eGSM. Human lung adenocarcinoma A549 (A) or SNU2292 (B) was treated with indicated amounts of eGSM for 16 h. Cytotoxicity was determined by MTT assay. Doxorubicin (2 μg/ml) was included as a positive control for cytotoxicity. Rapamycin (10 μM), the inhibitor of mTOR, was also tested for its cytotoxicity. The experiment was performed three times, and the representative results are shown here. Data are shown in the mean ± SEM of three measurements. *P was less than 0.05, compared to untreated controls
Cytotoxicity of eGSM is associated with autophagy
The possibility that apoptosis is responsible for the cytotoxicity of eGSM was tested by measuring the proteolytic cleavage of poly (ADP-ribose) polymerase (PARP), which occurs by caspases activated during apoptosis [22]. A549 cells were treated with increasing amounts of eGSM. At 16 h after treatment, total proteins were extracted and analyzed by Western blotting for PARP. As shown in Fig. 2A, while doxorubicin, a cancer drug that promotes apoptosis, generated a cleaved PARP fragment (arrow), eGSM did not cleave PARP in A549 cells. A similar experiment was performed with SNU2292 cells (Fig. 2B). As in A549, while doxorubicin triggered apoptosis, as evidenced by the cleaved PARP, eGSM failed to do it in SNU2292 cells. These results suggest that the cytotoxicity by eGSM is not associated with apoptosis of the cancer cells.
Fig. 2
eGSM did not induce apoptosis. A A549 cells were treated with indicated amounts of eGSM for 16 h (lanes 2 to 5). Total proteins were extracted and measured by Western blotting for PARP. Cleaved PARP produced during apoptosis was indicated by an arrow. Similar experiments were performed with SNA2292 cells (B). The membranes blotted for PARP were stripped and blotted with an anti-β actin antibody for equal loading of samples
eGSM did not induce apoptosis. A A549 cells were treated with indicated amounts of eGSM for 16 h (lanes 2 to 5). Total proteins were extracted and measured by Western blotting for PARP. Cleaved PARP produced during apoptosis was indicated by an arrow. Similar experiments were performed with SNA2292 cells (B). The membranes blotted for PARP were stripped and blotted with an anti-β actin antibody for equal loading of samplesSince no apoptosis seemed involved in the cytotoxicity of eGSM, we then tested the possibility that eGSM induces autophagy known to be closely associated with cancer [23]. To determine autophagy, we analyzed the level of LC3-II protein, a well-characterized autophagy marker found in autophagosomes [20]. A549 cells were treated with different amounts of eGSM for 16 h; total proteins were extracted and analyzed by Western blotting for LC3 proteins. As shown in Fig. 3A, eGSM treatment increased the level of LC3-II in A549 cells. Similarly, eGSM increased the production of LC3-II in SNU2292, the level of which appeared to be much higher than A549 (lane 4 in Fig. 3A and B). In a parallel experiment, eGSM decreased the level of p62/SQSTM1 (Supplement Fig. 1). Given the level of p62 tends to be diminished because of incorporation into autophagosome and degradation during autophagy [24], these results suggest eGSM induces autophagy. To confirm that eGSM inducing LC3-II is related to autophagy, we examined the transit nature of autophagy by blocking the autophagy flux [25]. Cells were treated as above and treated with E-64 (5 μM) and pepstatin A (5 μM) 3 h before cell harvest. As shown in Fig. 3C, the level of LC3-II induced by eGSM (lane 2) was further increased by treating these protease inhibitors (lane 5). In SNU2292 (Fig. 3D), which showed a robust LC3-II expression upon eGSM treatment, the protease inhibitors failed to increase the expression of LC3-II by eGSM (lane 2) (lane 5). To further confirm these observations, we treated cells with hydroxychloroquine (5 μM) that blocks the fusion between autophagosomes and lysosomes [26]. As shown in Fig. 3E and F, the results with chloroquine were consistent with those in Fig. 3C and D. It would be possible if autophagy in SNU2292 occurs robustly and rapidly upon eGSM treatment, which outpaces degradation of LC3-II. Regardless of detailed mechanisms, these results strongly suggest that eGSM induces autophagy in A549 and SNU2292 cells.
Fig. 3
eGSM induced autophagy. A549 cells (A) or SNU2292 cells (B) were treated with indicated amounts of eGSM for 16 h (lanes 2 to 4), along with rapamycin (10 μM, 6 h). A549 (C) or SNU2292 (D) was treated with 10 μg of the mixture of E-64 and pepstatin A (EP) (1:1 ratio) 3 h prior to eGSM treatment as indicated (lanes 4 to 6). Additionally, A549 (E) or SNU2292 (F) was treated with 5 μM of hydroxychloroquine for 3 h before eGSM treatment. Total proteins were extracted, fractionated, and blotted for LC3 with anti-LC3 antibody. Two modified forms of LC3 proteins, LC3-I and LC3-II, are indicated by arrows. Blotted membranes were stripped and probed with anti-β actin antibody
eGSM induced autophagy. A549 cells (A) or SNU2292 cells (B) were treated with indicated amounts of eGSM for 16 h (lanes 2 to 4), along with rapamycin (10 μM, 6 h). A549 (C) or SNU2292 (D) was treated with 10 μg of the mixture of E-64 and pepstatin A (EP) (1:1 ratio) 3 h prior to eGSM treatment as indicated (lanes 4 to 6). Additionally, A549 (E) or SNU2292 (F) was treated with 5 μM of hydroxychloroquine for 3 h before eGSM treatment. Total proteins were extracted, fractionated, and blotted for LC3 with anti-LC3 antibody. Two modified forms of LC3 proteins, LC3-I and LC3-II, are indicated by arrows. Blotted membranes were stripped and probed with anti-β actin antibody
eGSM induces autophagy in A549 and SNU2292 in divergent pathways
Since autophagy occurs when mTOR is suppressed or AMPK is activated [13], we first tested whether eGSM inducing autophagy in lung carcinoma cells is associated with suppressing mTOR. A549 cells were treated with different amounts of eGSM, and the phosphorylation of mTOR at S2448, indicative of activated mTOR, was examined by Western blotting (Fig. 4A). Unlike rapamycin, an inhibitor of mTOR, that decreases the phosphorylation at S2448 (lane 5 in Fig. 4A and 5th column in Fig. 4B), eGSM did not significantly suppress the phosphorylation at the S2448 of mTOR (Fig. 4B), suggesting that eGSM inducing autophagy in A549 is unrelated to the suppression of mTOR. However, when similar experiments were performed with SNU2292 cells (Fig. 4C), eGSM significantly suppressed the phosphorylation at the S2448 of mTOR (4th column in Fig. 4D), suggesting that, unlike A549, eGSM inducing autophagy in SNU2292 is associated with suppressing mTOR activity. To verify the differential suppression of mTOR by eGSM, we examined the phosphorylation of ULK1 at S757, a serine residue targeted by active mTOR. Consistent with the results in Fig. 4, while eGSM not affecting the phosphorylation of ULK1 at S757 in A549 cells (Fig. 5A and B), eGSM suppressed the phosphorylation of ULK1 at S757 in SNU2292 (Fig. 5C and D). Together, these results suggest that eGSM inducing the autophagy of SNU2292 but not of A549 cells is associated with the suppression of mTOR activity.
Fig. 4
eGSM decreased the phosphorylated mTOR in SNU2292, not in A549. A549 cells (A) or SNU2292 cells (C) were treated with indicated amounts of eGSM for 16 h (lanes 2 to 5), along with rapamycin (10 μM, 6 h). Total proteins were extracted and measured by Western blotting for mTOR phosphorylated at S2448. The blotted membrane was stripped and reprobed for mTOR to ensure equal loading. The bands were analyzed by ImageJ and the relative levels of the phosphorylated mTOR over mTOR in A549 (B) and SNU2292 (D) are shown. Three measurements of each band are presented as in the mean ± SEM. *P was less than 0.05, compared to untreated controls
Fig. 5
eGSM decreased mTOR activity in SNU2292, not in A549. From A549 cells (A) or SNU2292 cells (C) treated with indicated amounts of eGSM for 16 h (lanes 2 to 4), total proteins were extracted and analyzed for ULK1 phosphorylated at S757, a target of mTOR kinase activity. Rapamycin (10 μM, 6 h) was included as a negative regulator of mTOR kinase activity (lane 5). The blotted membrane was stripped and reprobed for ULK1 to ensure equal loading. The bands were analyzed by ImageJ, and the relative levels of the phosphorylated ULK1 over ULK1 in A549 (B) and SNU2292 (D) are shown, where each band was measured three times and shown as in the mean ± SEM. *P was less than 0.05, compared to untreated controls
eGSM decreased the phosphorylated mTOR in SNU2292, not in A549. A549 cells (A) or SNU2292 cells (C) were treated with indicated amounts of eGSM for 16 h (lanes 2 to 5), along with rapamycin (10 μM, 6 h). Total proteins were extracted and measured by Western blotting for mTOR phosphorylated at S2448. The blotted membrane was stripped and reprobed for mTOR to ensure equal loading. The bands were analyzed by ImageJ and the relative levels of the phosphorylated mTOR over mTOR in A549 (B) and SNU2292 (D) are shown. Three measurements of each band are presented as in the mean ± SEM. *P was less than 0.05, compared to untreated controlseGSM decreased mTOR activity in SNU2292, not in A549. From A549 cells (A) or SNU2292 cells (C) treated with indicated amounts of eGSM for 16 h (lanes 2 to 4), total proteins were extracted and analyzed for ULK1 phosphorylated at S757, a target of mTOR kinase activity. Rapamycin (10 μM, 6 h) was included as a negative regulator of mTOR kinase activity (lane 5). The blotted membrane was stripped and reprobed for ULK1 to ensure equal loading. The bands were analyzed by ImageJ, and the relative levels of the phosphorylated ULK1 over ULK1 in A549 (B) and SNU2292 (D) are shown, where each band was measured three times and shown as in the mean ± SEM. *P was less than 0.05, compared to untreated controlsSince eGSM inducing autophagy in A549 appeared not associated with mTOR, we tested whether eGSM activates AMPK instead for autophagy. A549 cells were treated with different amounts of eGSM, and total proteins were extracted and analyzed by Western blotting for the phosphorylation of ULK1 at S317, a serine residue targeted by AMPK to prompt autophagy. As shown in Fig. 6A, eGSM induced the phosphorylation at the S317 of ULK1, suggesting that eGSM activates AMPK. In similar experiments with SNU2292, eGSM failed to phosphorylate it at S317 (Fig. 6B). Together, these results indicate that eGSM activates AMPK to induce autophagy in SNU2292 but not in A549 cells.
Fig. 6
eGSM increased AMPK activity in A549 but not in SNU2292. A A549 cells were treated with indicated amounts of eGSM for 16 h. Total proteins were extracted and analyzed for ULK1 phosphorylated at S317, a target of AMPK kinase activity. The blot of ULK1 phosphorylated at S317 was stripped and reblotted for ULK1 to ensure equal loading. B SNU2292 cells were treated with eGSM, as in (A). ULK1 and phosphorylated ULK1 at S317 were similarly examined
eGSM increased AMPK activity in A549 but not in SNU2292. A A549 cells were treated with indicated amounts of eGSM for 16 h. Total proteins were extracted and analyzed for ULK1 phosphorylated at S317, a target of AMPK kinase activity. The blot of ULK1 phosphorylated at S317 was stripped and reblotted for ULK1 to ensure equal loading. B SNU2292 cells were treated with eGSM, as in (A). ULK1 and phosphorylated ULK1 at S317 were similarly examined
eGSM induces autophagy without AMPK
Our findings that eGSM suppressed mTOR in SNU2292 while activating AMPK in A549 for autophagy induction suggest that eGSM inducing autophagy is achievable by either suppressing the mTOR or activating the AMPK pathway. To test this possibility, we genetically nulled the expression of AMPKα by CRISPR in HEK293 cells and tested whether eGSM induces the autophagy of this AMPKα knockout (KO) cell. As shown in Fig. 7A, eGSM produced LC3-II in both wild type (WT) and AMPKα KO cells, suggesting that, similar to the two lung adenocarcinoma cells, eGSM induces autophagy in HEK293 cells and eGSM induces autophagy even in the absence of AMPKα (lanes 4 to 6). To verify these observations, we further determined the lack of AMPK activity in AMPKα KO cells (Fig. 7B). WT or AMPKα KO cells were treated with eGSM, and total cell extracts were analyzed by Western blotting of ULK1 phosphorylated at S317, a serine residue targeted by active AMPK. As in A549 cells, eGSM induced the phosphorylation at the S317 of ULK1 in WT cells (lanes 2 and 3), suggesting that eGSM activates AMPK in HEK293 cells. In AMPKα KO cells, where AMPK activity was expected to be none, eGSM failed to phosphorylate ULK1 at S317, suggesting no induction of AMPK activity by eGSM in AMPKα KO cells (lanes 5 and 6). Combined with the results showing the production of LC3-II in AMPKα KO cells after eGSM treatment, these results suggest that eGSM induces autophagy without AMPK activity.
Fig. 7
eGSM induced autophagy in the absence of AMPK activity. A The expression of AMPKα1/2 genes was inactivated by CRISPR in HEK293 cells (lanes 4 to 6, bottom panel). Along with WT (lanes 1 to 3), AMPKα KO cells were treated with two different amounts of eGSM for 16 h. Total proteins were isolated and analyzed by western blotting for LC3-1 and LC3-II (top panel), the membrane of which was stripped and reblotted for β-actin (middle panel). B WT (lanes 1 to 3) and AMPKα KO cells (lanes 4 to 6) were treated as in (A), and ULK1 phosphorylated at S317 (top panel), a serine phosphorylated by activated AMPK, and ULK1 (2nd panel) and were analyzed by Western blot. AMPKα and β-actin were similarly analyzed with stripped membranes
eGSM induced autophagy in the absence of AMPK activity. A The expression of AMPKα1/2 genes was inactivated by CRISPR in HEK293 cells (lanes 4 to 6, bottom panel). Along with WT (lanes 1 to 3), AMPKα KO cells were treated with two different amounts of eGSM for 16 h. Total proteins were isolated and analyzed by western blotting for LC3-1 and LC3-II (top panel), the membrane of which was stripped and reblotted for β-actin (middle panel). B WT (lanes 1 to 3) and AMPKα KO cells (lanes 4 to 6) were treated as in (A), and ULK1 phosphorylated at S317 (top panel), a serine phosphorylated by activated AMPK, and ULK1 (2nd panel) and were analyzed by Western blot. AMPKα and β-actin were similarly analyzed with stripped membranes
Discussion
This study shows that the ethanol extract of GSM (eGSM) can induce autophagy in adenocarcinoma lung cancer cells A549 and SNU2292. eGSM treatment induced a robust production of LC3-II in both A549 and SNU2292, the accumulation of which was further enhanced by treatment of lysosomal proteases inhibitors, suggesting that eGSM induces autophagy. Induction of autophagy appeared to be caused by eGSM activating AMPK in A549 cells or eGSM suppressing mTOR in SNU2292 cells. Furthermore, we show that eGSM could induce autophagy in the absence of AMPK activity, suggesting that suppressing mTOR is sufficient for eGSM to induce autophagy. Together, our findings suggest that eGSM can trigger autophagy by either activating AMPK or suppressing mTOR, depending on cell type.At the outset, we explored a possible anti-cancer effect of the ethanol extract of GSM (eGSM) using A549 and SNU2292. Our initial goal was set on the publications showing that some of the chemical constituents of GSM have a possible anti-tumor effect [5, 6, 27]. In those studies, potential anti-cancer effects of chemicals were proposed mostly based on cytotoxicity measured by MTT assays [5, 27, 28]. Consistent with these reports, our MTT assays showed that eGSM exhibited cytotoxicity in A549 and SNA2292 cells. However, given our results that eGSM induced autophagy, we would like to point out a caveat when interpreting cytotoxicity measured by MTT assays. It is well-documented that during autophagy, mitochondria population decreases, as mitochondria are wrapped in autophagosomes and digested after fusion with lysosomes [15]. As a result, oxidoreductase activity in a cell is likely decreased during autophagy, which leads to MTT poorly reduced [29]. Since a low level of formazan, a reduced form of MTT, is routinely interpreted as senescence or dying of cells, a high degree of autophagy induced by eGSM could be construed as high cytotoxicity and thus an anti-cancer effect.Rapamycin treatment can result in cell death in certain cell types [30], suggesting that inhibiting mTOR activity alone can be sufficient for apoptosis. However, the concentration of rapamycin used in the study was only enough to induce autophagy but not cytotoxicity in both lung cancer cell lines, while eGSM induced both autophagy and cytotoxicity but not apoptosis. Given this result, eGSM inducing cytotoxicity to the cancer cells may be due to unknown mechanisms other than autophagy, per se, and apoptosis. We observed that inhibiting lysosomal proteases by E64/pepstatin A was less effective in accumulating LC3-II in eGSM-treated cells than in rapamycin-treated ones (Fig. 3C and D). This could happen if eGSM induced autophagosome formation robustly and abundantly so that autophagosome newly formed outnumbered lysosomes or lysosomal activities. Alternatively, if eGSM could slow down the fusion between autophagosome and lysosome, it is possible that the level of LC3-II would be steady, not substantially affected by lysosome inhibitors, although we don’t have evidence to back these possibilities. Regardless of the mechanisms, it is conceivable that eGSM generated autophagosomes unresolved by lysosomes within a cell, which could be toxic to the cell. In support of our hypothesis, there is a report showing that a high level of autophagosome within the cytoplasm is toxic to the cell [31]. This finding could help explain why eGSM showed cytotoxicity to lung cancer cells, along with autophagy.There are several ways to measure autophagy, one of which is to detect LC3-II proteins. Since LC3-II is a well-characterized marker for autophagy, we chose to measure LC3-II to determine whether autophagy occurred. Our data show that eGSM increased LC3-II level in two different cancer cell lines, suggesting eGSM inducing autophagy. To understand how eGSM induces autophagy, we examined whether eGSM activates AMPK or suppresses mTOR. Since activated AMPK phosphorylates ULK1 at S317, triggering autophagosome formation [17], we tested whether eGSM phosphorylates ULK1 at S317. On the other hand, since active mTOR phosphorylates ULK1 at S757, blocking autophagosome formation [17], we examined whether eGSM decreases the phosphorylation at the S757 of ULK1. Our results show that eGSM increased the phosphorylation of ULK1 at S317 in SNU2292, suggesting that eGSM activates AMPK to promote autophagy. However, in A549 cells, eGSM suppressed the phosphorylation of ULK1 at S757, suggesting that eGSM suppresses mTOR instead in A549 cells. These results suggest that eGSM activates AMPK or suppresses mTOR, depending on cell type. Nevertheless, together with increased LC3-II, these results clearly show that eGSM induced autophagy in the two human adenocarcinoma lung cancer cell lines.Intriguing results observed in this study are that, depending on cell types, eGSM appeared to use either AMPK or mTOR pathways to induce autophagy. This finding suggests that either activating AMPK or inactivating mTOR is sufficient for inducing autophagy. The data in Fig. 7, where a lack of AMPK activity did not deter autophagy caused by eGSM, also supported the notion that eGSM induced autophagy even in the absence of active AMPK. To our knowledge, there is no definite study about whether or not AMPK is requisite for autophagy, and our results show that autophagy can take place without AMPK activity involved.It is clear that the mTOR pathway in both A549 and SNU2292 was intact. As shown in Fig. 4, mTOR in both cell types was phosphorylated at S2248, indicative of active mTOR [12]. In line with this, ULK1 was phosphorylated at S757, a serine residue targeted by active mTOR, as shown in Fig. 5. Additionally, rapamycin suppressed mTOR activity in both cell lines, suggesting that mTOR in both cell lines behaves as expected. Despite intact mTOR, however, eGSM failed to suppress mTOR in A549 while successfully suppressing mTOR in SNU2292. It remains unknown how the two different cancer cells chose different pathways for inducing autophagy when treated with eGSM. It is conceivable that eGSM could be metabolized differently in the two cancer cells. For instance, A549 cell metabolized eGSM to generate a metabolite that could activate AMPK but not the metabolite that suppresses mTOR activity (Fig. 8). Conversely, SNU2292 metabolized eGSM differently so that a metabolite generated could suppress mTOR, increasing autophagy, but no metabolite was available that would activate AMPK in SNU2292 cells. Based on these results, we could speculate that the two cancer cells have developed different enzymatic make-ups during the divergent cancer process, making cells respond differently to eGSM.
Fig. 8
Schematics for eGSM to induce autophagy. Either activating AMPK or suppressing mTOR can induce autophagy. eGSM induced autophagy in A549 and SNU2298. Interestingly, eGSM activated AMPK while not affecting mTOR activity in A549 cells. By contrast, eGSM suppressed mTOR while not affecting AMPK activity in SNU2292 cells. How the two cells respond differently to eGSM warrants further studies. Given that eGSM triggered the both pathways resulting in autophagy, our results suggest that eGSM has a capability of inducing autophagy by activating AMPK activity and suppressing mTOR activity
Schematics for eGSM to induce autophagy. Either activating AMPK or suppressing mTOR can induce autophagy. eGSM induced autophagy in A549 and SNU2298. Interestingly, eGSM activated AMPK while not affecting mTOR activity in A549 cells. By contrast, eGSM suppressed mTOR while not affecting AMPK activity in SNU2292 cells. How the two cells respond differently to eGSM warrants further studies. Given that eGSM triggered the both pathways resulting in autophagy, our results suggest that eGSM has a capability of inducing autophagy by activating AMPK activity and suppressing mTOR activityIn this study, we show that eGSM induced autophagy in two different lung adenocarcinoma cells, A549 and SNU2292. eGSM activated the AMPK pathway for autophagy of A549, but suppressed mTOR for autophagy of SNU2292. In the absence of AMPK activity, eGSM induced autophagy. Together, our results suggest that eGSM can induce autophagy by activating AMPK or suppressing mTOR.Additional file 1: Supplement Fig. 1. A549 (A) or SNU2292 (B) cells were treated with indicated amounts of eGSM for 16 h. Total proteins were extracted, fractionated, and analyzed by western blot with α-p62 antibody. The membranes were stripped and reblotted with α-β-actin antibody. Supplement Fig. 2. Original figures for Fig. 2A and B. Supplement Fig. 3. Original figures for Fig. 3A-F. Supplement Fig. 4. Original figures for Fig. 4A and C. Supplement Fig. 5. Original figures for Fig. 5A and C. Supplement Fig. 6. Original figures for Fig. 6A and B. Supplement Fig. 7. Original figures for Fig. 7A and B. Supplement Fig. 8. Original figures for supplementary Fig. 1A and B.
Authors: Daniel F Egan; David B Shackelford; Maria M Mihaylova; Sara Gelino; Rebecca A Kohnz; William Mair; Debbie S Vasquez; Aashish Joshi; Dana M Gwinn; Rebecca Taylor; John M Asara; James Fitzpatrick; Andrew Dillin; Benoit Viollet; Mondira Kundu; Malene Hansen; Reuben J Shaw Journal: Science Date: 2010-12-23 Impact factor: 47.728
Authors: Daniel J Klionsky; Kotb Abdelmohsen; Akihisa Abe; Md Joynal Abedin; Hagai Abeliovich; Abraham Acevedo Arozena; Hiroaki Adachi; Christopher M Adams; Peter D Adams; Khosrow Adeli; Peter J Adhihetty; Sharon G Adler; Galila Agam; Rajesh Agarwal; Manish K Aghi; Maria Agnello; Patrizia Agostinis; Patricia V Aguilar; Julio Aguirre-Ghiso; Edoardo M Airoldi; Slimane Ait-Si-Ali; Takahiko Akematsu; Emmanuel T Akporiaye; Mohamed Al-Rubeai; Guillermo M Albaiceta; Chris Albanese; Diego Albani; Matthew L Albert; Jesus Aldudo; Hana Algül; Mehrdad Alirezaei; Iraide Alloza; Alexandru Almasan; Maylin Almonte-Beceril; Emad S Alnemri; Covadonga Alonso; Nihal Altan-Bonnet; Dario C Altieri; Silvia Alvarez; Lydia Alvarez-Erviti; Sandro Alves; Giuseppina Amadoro; Atsuo Amano; Consuelo Amantini; Santiago Ambrosio; Ivano Amelio; Amal O Amer; Mohamed Amessou; Angelika Amon; Zhenyi An; Frank A Anania; Stig U Andersen; Usha P Andley; Catherine K Andreadi; Nathalie Andrieu-Abadie; Alberto Anel; David K Ann; 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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; 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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; 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