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(The FASEB Journal. 2001;15:1006-1013.)
© 2001 FASEB

Cyclin D1 is an early target in hepatocyte proliferation induced by thyroid hormone (T3)

MONICA PIBIRI*, GIOVANNA M. LEDDA-COLUMBANO*, COSTANZA COSSU*, GABRIELLA SIMBULA*, MARTA MENEGAZZI{dagger}, HISASHI SHINOZUKA{ddagger} and AMEDEO COLUMBANO*1

* Department of Toxicology, Oncology and Molecular Pathology Unit, University of Cagliari, Italy;
{dagger} Department of Neurological Sciences, University of Verona, Italy; and
{ddagger} Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

1Correspondence: Dipartimento di Tossicologia, Sezione di Oncologia e Patologia Molecolare, Via Porcell 4, 09124 Cagliari, Italy. E-mail: columbano{at}unica.it


   ABSTRACT
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES
 
The thyroid hormone (T3) affects cell growth, differentiation, and regulates metabolic functions via its interaction with the thyroid hormone nuclear receptors (TRs). The mechanism by which TRs mediate cell growth is unknown. To investigate the mechanisms responsible for the mitogenic effect of T3, we have determined changes in activation of transcription factors, mRNA levels of immediate early genes, and levels of proteins involved in the progression from G1 to S phase of the cell cycle. We show that hepatocyte proliferation induced by a single administration of T3 to Wistar rats occurred in the absence of activation of AP-1, NF-{kappa}B, and STAT3 or changes in the mRNA levels of the immediate early genes c-fos, c-jun, and c-myc. These genes are considered to be essential for liver regeneration after partial hepatectomy (PH). On the other hand, T3 treatment caused an increase in cyclin D1 mRNA and protein levels that occurred much more rapidly compared to liver regeneration after 2/3 PH. The early increase in cyclin D1 expression was associated with accelerated onset of DNA synthesis, as demonstrated by a 20-fold increase of bromodeoxyuridine-positive hepatocytes at 12 h after T3 treatment and by a 20-fold increase in mitotic activity at 18 h. An early increase of cyclin D1 expression was also observed after treatment with nafenopin, a ligand of a nuclear receptor (peroxisome proliferator-activated receptor {alpha}) of the same superfamily of steroid/thyroid receptors. T3 treatment also resulted in increased expression of cyclin E, E2F, and p107 and enhanced phosphorylation of pRb, the ultimate substrate in the pathway leading to transition from G1 to S phase. The results demonstrate that cyclin D1 induction is one of the earlier events in hepatocyte proliferation induced by T3 and suggest that this cyclin might be a common target responsible for the mitogenic activity of ligands of nuclear receptors.—Pibiri, M., Ledda-Columbano, G. M., Cossu, C., Simbula, G., Menegazzi, M., Shinozuka, H., Columbano, A. Cyclin D1 is an early target in hepatocyte proliferation induced by thyroid hormone (T3).


Key Words: nuclear receptor • cell cycle • liver


   INTRODUCTION
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES
 
THE THYROID HORMONES influence a variety of physiological processes, including cell growth and metabolism in mammals, metamorphosis in Amphibia, and development of the vertebrate nervous system (1) . T3 has been shown to be a powerful inducer of hepatocyte proliferation in rats (2 3) , and its mitogenic capacity has been used for experiments on gene therapy and repopulation of hepatocytes (4 , 5) . Most, if not all, of these actions are mediated by thyroid hormone (L-triiodothyronine T3) nuclear receptors (TRs). The TRs are encoded by two genes ({alpha} and ß) and are expressed as several isoforms (6 , 7) . The TRs are ligand-dependent transcription factors that are members of the steroid hormone/retinoic acid receptor family of nuclear hormone receptors, which includes the retinoic acid receptor, the retinoid X receptors, the vitamin D receptor, the peroxisome proliferator-activated receptors (PPARs), and some orphan receptors (8) . However, the exact mechanisms by which TRs mediate hepatocyte proliferation remain elusive.

A key role in the control of the cell cycle is played by a complex formation between cyclins and cyclin-dependent kinases (cdks). Activation through phosphorylation of cyclin–cdk complexes leads to progression into the cell cycle (9 , 10) . With its cdk partner, each cyclin acts at a different step of the cell cycle, the D-type cyclins in association with its main partner cdk4 or cdk6 being important in the early G1 phase and cyclin E, in association with cdk2, acting in the late phase of G1 (11 12 13) . The ultimate substrate in this pathway is pRb, which is the major target of the cyclin D1/cdk4 complex (14) . Phosphorylation of pRb by the cyclin D1/cdk4 complex frees the E2F transcription factors, enabling them to trans-activate target genes responsible for the progression from G1 to S phase of the cell cycle. The phosphorylation of pRb is triggered initially by cyclin D1/cdk4, but is then accelerated by the cyclin E/cdk2 complex (14) . Synthesis of the various cell cycle-regulatory proteins is believed to take place because of rapid changes occurring immediately after the mitogenic stimulus. In the case of compensatory regeneration such as after partial hepatectomy (PH), hepatocyte proliferation is mediated by several growth factors (hepatocyte growth factor and transforming growth factor {alpha}). After binding to their cell surface receptors, these growth factors evoke a cascade of signal transduction that leads to induction of immediate early genes and activation of G1 cyclins (15 16 17) . However, hepatocytes in vivo have a low sensitivity to growth factors and, to effectively respond to them, have to be modified (primed) by cytokines such as tumor necrosis factor {alpha} (TNF-{alpha}) and interleukin 6 (IL-6), which are known to activate several key transcription factors such as NF-{kappa}B and STAT3 (18 , 19) . These changes are considered essential for the transition of hepatocytes from G0 to G1 in the model of liver regeneration after 2/3 surgical partial hepatectomy or after liver cell necrosis induced by hepatotoxins (20 21 22) . In the past few years, however, it has become increasingly clear that hepatocytes can be induced to proliferate after treatment with agents (primary mitogens) in the absence of cell loss/death (23) . Liver hyperplasia induced by these agents is independent of changes in immediate early genes, growth factors/cytokines, and transcription factors (24 25 26 27) . Agents that induce direct hyperplasia include ligands of nuclear receptors (23) .

To determine the pathways by which T3 promotes hepatocyte proliferation, we examined changes in activation of transcription factors, hepatic levels of immediate early genes mRNA, and induction of G1 and S cyclins and their respective kinases partners after a single dose of T3. Levels of the CDKs inhibitor p21 were also investigated. Here we report that T3-induced hepatocyte proliferation is associated with a rapid increase in cyclin D1 mRNA and protein levels that occurs in the absence of significant changes in activation of the transcription factors, NF-{kappa}B and AP-1, or in the levels of c-fos, c-jun, and c-myc mRNA. Increased levels of cyclin D1 were accompanied by an increase in cyclin E and E2F content and by enhanced phosphorylation of pRb and p107. The hepatomitogen nafenopin, a peroxisome proliferator and a ligand of nuclear receptors (PPARs) of the superfamily of steroid/thyroid receptors (28 29 30) , also caused a rapid increase in cyclin D1 expression. The results suggest that T3-induced hepatocyte proliferation occurs through a pathway different from that of compensatory regeneration and that direct activation of cyclin D1 is a common event in nuclear receptor-mediated liver cell proliferation.


   MATERIALS AND METHODS
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES
 
Animals
Male Wistar and Fischer F-344 rats (175–200 g) purchased from Charles River (Milano, Italy) were maintained on a standard laboratory diet purchased from Ditta Mucedola (Milano, Italy). The animals were provided food and water ad libitum with a 12 h light/dark daily cycle and were acclimated for 1 wk before the start of the experiment. We followed Guidelines for the Care and Use of Laboratory Animals during the investigation. T3 (Sigma Chemical Co., St. Louis, Mo.) was administered intraperitoneally (i.p.) as a single dose of 20 µg/100 g body weight dissolved in 0.001N NaOH. Nafenopin (a gift from V. Preat), was given intragastrically at a dose of 200 mg/kg, dissolved in corn oil. Two-thirds PH was performed according to Higgins and Anderson (31) . Immediately after death, sections of the liver were fixed in 10% buffered formalin and processed for staining with hematoxylin-eosin or immunohistochemistry. The remaining liver was snap-frozen in liquid nitrogen and kept at -80°C until use.

Northern blot analysis
For the extraction of RNA, at each time point frozen livers were homogenized in 4 M guanidine thiocyanate buffer, layered over a 5.7 M CsCl, 0.1 M NaAc cushion, and centrifuged for 18 h at 130,000 g. Thirty micrograms of heat-denatured total RNA per lane was loaded on a 1% agarose/formaldehyde gel containing ethidium bromide for RNA detection at a UV lamp and blotted on Hybond-N+ membrane (Amersham, Buckingamshire, U.K.). RNA concentration was determined spectrophotometrically at 260 nm and by ethidium bromide staining. No differences were recorded. The following 32P-labeled probes were used for hybridization: c-fos and c-myc were purchased from Oncor Inc. (Gaithersburg, Md.); the murine probe of c-jun was obtained from Oncogene Sciences (Uniondale, N.Y.). For cyclin D1, pBluescript plasmid containing a 900 bp EcoRI fragment was used. DNA probes were labeled with ({alpha}32P)dCTP by random priming (Random Priming DNA labeling Kit, Boehringer Mannheim, Mannheim, Germany). Membranes were exposed to radiographic film (Eastman Kodak, Rochester, N.Y.).

Western blot analysis
Total cell extracts were prepared from frozen livers powdered in liquid nitrogen cold mortar. Equal amounts of powder (~50 mg) from three different animals were pooled per each sample point and resuspended in 1 ml Triton lysis buffer (1% Triton X-100, 50 mM Tris-HCl pH 7.4, 140 mM NaCl, 1 mM EDTA, 1 mM EGTA, 1 mM DTT, 1 mM PMSF, 5 mM iodoacetic acid, 10 µg/ml each of aprotinin, pepstatin, leupeptin). Several protease inhibitors were added to the isolation buffer to minimize protein degradation during the isolation protocol. After vortexing, extracts were incubated 30 min on ice, centrifuged at 12000 rpm at 4°C, and the supernatants were recovered. All inhibitors used were purchased from Boehringer Mannheim except for PMSF, NaF, and DTT, which were purchased from Sigma, and iodoacetic acid, which was from ICN Biomedicals (Irvine, Calif.). For p21, E2F, Rb, p130, and p107, nuclear extracts were prepared according to Timchenko et al. (32) . The protein concentration of the resulting total extracts were determined according to the method of Bradford using bovine serum albumin as standard (DC Protein Assay, Bio-Rad Laboratories, Hercules, Calif.). For immunoblot analysis, equal amounts (from 50 to 200 µg/lane) of proteins were electrophoresed on SDS-12% or -8% polyacrylamide gels. Acrylamide and bis-acrylamide were purchased from ICN Biomedicals. After gel electrotransfer onto nitrocellulose membranes (MSI) at 300 mA overnight or 800 mA for 2–4 h to ensure equivalent protein loading and transfer in all lanes, the membranes and gels were stained with 0.5% (w/v) Ponceau S red (ICN Biomedicals) in 1% acetic acid for 5 min, and with Coomassie blue (ICN Biomedicals) in 10% acetic acid for 30 min, respectively. Before staining, gels were fixed in 25% (v/v) isopropanol and 10% (v/v) acetic acid (Sigma). After blocking in TBS containing 0.5% Tween 20 (Sigma) and 5% non-fat dry milk for 1 h at room temperature or overnight at 4°C, membranes were washed in TBS-T and incubated with appropriate primary antibodies diluted in blocking buffer. Whenever possible, the same membrane was used to detect the expression of different proteins. Depending on the origin of primary antibody, filters were incubated with either anti-mouse or anti-rabbit horseradish peroxidase-conjugated IgG (Santa Cruz Biotechnology, Santa Cruz, Calif.). Immunoreactive bands were identified with chemiluminescence detection system, as described by the manufacturer (Supersignal Substrate, Pierce, Rockford, Ill.). When necessary, antibodies were removed from filters by 30 min incubation at 60°C in stripping buffer (100 mM 2-mercaptoethanol, 2% SDS, 62.5 mM Tris-HCl pH 7.6) and the membranes were reblotted as above.

Antibodies
For immunoblotting experiments, we used mouse monoclonal antibodies directed against cyclin D1 (72–13 G) and CDK2 (D-12) (Santa Cruz Biotechnology); pRb (Ser 795) (New England Biolabs, Beverly, Mass.), p21 (Powerclonal, Upstate Biotech, Lake Placid, N.Y.). The goat monoclonal antibody-directed anti-p107 (C-18) was purchased from Santa Cruz Biotechnology. The following rabbit polyclonal antibodies were from Santa Cruz: CDK4 (H-303), cyclin A (C-19), CDK6 (C-21), cyclin D3 (C-16), cyclin E (M-20), E2F-1 (C-20), and p130 (C-20).

Electrophoretic mobility shift assay
Nuclear extracts were prepared from 200 mg of liver tissue according to Schreiber et al. (33) in the presence of 10 µg/ml leupeptin, 5 µg/ml antipain and pepstatin, and 1 mM PMSF (Sigma). Protein concentration in the nuclear extracts was determined using the method of Bradford (34) . Eight micrograms of nuclear extracts were incubated at room temperature for 30 min with (2–5x104) of the [32P]-labeled double-stranded oligonucleotide containing the consensus NF-{kappa}B DNA binding site from the IL-6 gene promoter (IL-6-{kappa}B) (5' GATCATGTGGGATTTTCCCATGT 3'), the Sif binding element of c-fos promoter (Sie-m67) (5' GTCGACATTTCCCGTAAATCG 3'), or the AP-1 DNA binding site (5' CTAGTGATGAGTCAGCCGGATC 3') in a 15 µl reaction mixture containing 20 mM HEPES, pH 7.9, 50 mM KCl, 10% glycerol, 0.5 mM DTT, 0.1 mM EDTA, 2 µg poly(dI-dC), and1 µg salmon sperm DNA. Products were fractionated on a nondenaturing 5% polyacrylamide gel in TBE 0.5x buffer. In competition assays, a 100x oligonucleotide competitor was added 15 min before the labeled probe. The intensity of the retarded bands was measured by PhosphorImager.

Immunohistochemistry
Rats treated with T3 or subjected to 2/3 PH were killed 12, 18, 24, or 30 h after treatment. Two hours before death, all rats received an i.p. injection of BrdU (50 mg/kg, dissolved in distilled water). We obtained mouse monoclonal anti-BrdU antibody from Becton Dickinson (San Jose, Calif.) and used the peroxidase method to stain BrdU-positive hepatocytes. Peroxidase goat anti-mouse immunoglobulin was from Dako (Dako EnVision+TM Peroxidase Mouse, Dako Corporation, Carpinteria, Calif.). Four micron-thick sections were deparaffinized, treated with HCl 2N for 20 min, then with 0.1% trypsin type II (crude from porcine pancreas, Sigma) for 20 min, and treated sequentially with normal goat serum 1:10 (Dako), mouse anti-BrdU 1:200 for 1 h and 30' and Dako EnVision+TM Peroxidase Mouse ready-to-use. The sites of peroxidase binding were detected by 3,3'-diaminobenzidine. The labeling index (L.I.) was expressed as number of BrdU-positive hepatocyte nuclei/100 nuclei. Mitotic activity was determined as a percentage of mitoses/1000 hepatocytes. Results are expressed as means ± SE of 3 to 4 rats per group. At least 2000 hepatocyte nuclei per liver were scored.

Statistical analysis
Comparison between treated and control group was performed by Student’s t test.


   RESULTS
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES
 
Initial studies were undertaken to determine the onset and the extent of liver cell proliferation induced by T3 and compare the kinetics of T3-induced DNA synthesis with that elicited by 2/3 PH. The results in Fig. 1A and Fig. 2A show that although no hepatocytes entering S phase are found 12 h after PH (L.I. of 0.3%), a significant number of hepatocytes are BrdU positive at the same time point after T3 administration (L.I. of 7.1%), with a peak of DNA synthesis at 18 and 24 h after T3 and PH, respectively. A striking increase in mitotic activity was observed 18 h after T3 (Fig. 2B ). Quantitation of mitotic activity 18 h after T3 revealed a 20- and 25-fold increase over control and PH rats, respectively (Fig. 1B ); no mitoses were observed 18 h after PH (Fig. 1B ), indicating that T3-induced DNA synthesis did occur faster than after PH. The accelerated entry of hepatocytes into DNA synthesis after treatment with T3 was confirmed by the increase of the levels of cyclin A, a marker of S phase, 18 h after treatment (Fig. 3 ).



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Figure 1. Labeling index (A) and mitotic index (B) of rat hepatocytes after T3 and 2/3 PH. Rats treated with a single dose of T3 (20 µg/100 g, i.p.), subjected to 2/3 PH, or controls were given a single i.p. injection of BrdU (50 mg/kg) 2 h before death at 10, 16, and 22 h after treatment. At least 5000 hepatocyte nuclei per liver were scored. The labeling index was expressed as number of BrdU-positive hepatocyte nuclei/100 nuclei. The mitotic index was expressed as number of mitoses/1000 hepatocyte nuclei. Results are expressed as means ± SE of 3–6 rats per group.



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Figure 2. Representative microphotography that illustrates the presence of A) BrdU-positive hepatocytes (x200, section counterstained with hematoxylin) and B) mitotic figures (H&E, x400) in the liver of rats killed 18 h after T3 treatment. BrdU was given as indicated in legend to Fig. 1 .



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Figure 3. Expression of cyclin A in T3-induced mouse hepatocyte proliferation and liver regeneration after 2/3 PH. Protein extracts (50 µg/lane) were prepared from the livers and Western analysis was performed as described in Materials and Methods. Appropriate loading was confirmed by staining the gel with Coomassie blue; efficiency of transfer was monitored by staining the blots with Ponceau S red. Each lane represents pool of three livers; C, control.

To examine the molecular mechanisms responsible for mediating the growth-promoting effect of T3, we measured changes in activation of the transcription factor NF-{kappa}B, a target of TNF-{alpha} that recently has been considered to be essential for liver regeneration after cell loss/death (16 , 17) . According to previously published results, gel shift analysis revealed a rapid and transient increase in binding activity of NF-{kappa}B soon after PH (Fig. 4 ). On the contrary, hepatocyte proliferation induced by T3 occurred in the complete absence of modification in the binding capacity of this transcription factor. Similarly, whereas activation of AP-1 occurred after 2/3 PH, no change in binding activity of this transcription factor was observed after T3 treatment (Fig. 4) . Moreover, though the hepatic levels of mRNA of the immediate early genes c-fos and c-myc showed a rapid and transient increase after 2/3 PH, no significant change was found after T3 administration (Fig. 5 ). No change in the hepatic expression of c-jun was observed in T3 treated rats (data not shown).



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Figure 4. DNA binding activity of NF-{kappa}B and AP-1 transcription factors in the liver of rats treated with T3 or subjected to PH. Nuclear extracts from liver of rats killed 30 min or 1, 2, or 4 h after T3 or PH were incubated with 32P-labeled double-stranded oligonucleotide containing the consensus sequence for NF-{kappa}B or AP-1 binding site. The specificity of the bands was demonstrated by competing with 100-fold excess of either specific (SP) or nonspecific (NS) unlabeled oligonucleotides; C, control.



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Figure 5. Northern blot analysis of changes in c-fos and c-myc mRNA levels in rat liver after T3 or PH or in controls. Lanes represent individual samples. Northern blot analysis was done as outlined in Materials and Methods. The bottom panels show the ethidium bromide staining of the same gel; C, control.

Next we measured the mRNA levels of a key regulator of G1 to S phase progression in mammalian cells, namely, cyclin D1. As shown in Fig. 6A , treatment with T3 led to an increase in cyclin D1 mRNA levels that was evident as early as 2 h after treatment and reached its maximum at 4 h; however, no change of cyclin D1 mRNA could be observed in the liver of rats subjected to PH. Consistent with the changes in mRNA levels, cyclin D1 protein content was found to be increased soon after T3 treatment (4 h); its content was further elevated at 12 h and was maintained for up to 24 h (Fig. 6B ). On the other hand, the increase in cyclin D1 protein content after PH was much delayed, being evident only 12 h after PH. A very rapid increase in cyclin D1 content by T3 was also observed in a different rat strain: Fischer F-344 (data not shown).



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Figure 6. Expression of cyclin D1 in T3-induced rat hepatocyte proliferation and liver regeneration. A) Northern blot analysis of changes in cyclin D1 mRNA levels in rat liver after PH or treatment with T3 (20 µg/100 g). Lanes represent individual samples. Northern blot analysis was done as outlined in Materials and Methods. The bottom panel shows the ethidium bromide staining of the same gel. B) Western blot analysis of cyclin D1 in rat liver after PH or treatment with T3 (20 µg/100 g). Protein extracts (50 µg/lane) were prepared from the livers and Western blot analysis was performed as described in Materials and Methods. Appropriate loading was confirmed by staining the gel with Coomassie blue and efficiency of transfer was monitored by staining the membranes with Ponceau S red. Each lane represents a pool of three livers; C, control. C) Western blot analysis of cyclin D1 from the liver of rats treated with a single intragastrical dose of nafenopin (NAF, 200 mg/kg, in oil) or subjected to 2/3 PH. Analysis was performed as described above. Each lane represent a pool of three livers; C, control.

To determine whether early induction of cyclin D1 is a specific effect of T3 or could represent a common target for other liver growth inducers, we examined cyclin D1 expression after administration of the mitogen nafenopin, a peroxisome proliferator that, similar to T3, is a ligand of a receptor (PPAR-{alpha}) of the superfamily of steroid/thyroid nuclear receptors (30) . As shown in Fig. 6C , a single treatment with nafenopin did cause a rapid enhancement in cyclin D1 protein content, the increase being evident as early as 2 h after treatment. Consistent with the results presented in Fig. 6B , increased cyclin D1 content in PH animals was observed only between 12 and 18 h after surgery, suggesting that cyclin D1 might be an early and common target of ligands of nuclear receptors acting as liver mitogens.

T3 also caused increased expression of another member of cyclin D family, D3, and of cyclin E, a G1 protein working downstream of D-type cyclins. However, unlike cyclin D1, no major difference in the kinetics of increase in the expression of cyclin D3 and cyclin E was observed between T3 and PH rats (Fig. 7 ). Protein content of cdks partner of G1 cyclins, cdk2, cdk4, and cdk6 was also examined. As shown in Fig. 7 , no major differences in cdk content was observed between T3 and PH rats. During progression of the G1 phase, the activation of cyclin D1–cdk4 complex is responsible for the phosphorylation of the retinoblastoma protein (pRb) and other members of the pocket family (p107, p130). Hyperphosphorylation of these proteins releases transcription factors of the E2F family, which trans-activate the expression of S phase genes. Therefore, we next examined whether the T3-induced increase in cyclin D1 could lead to a change in the phosphorylation state of pRb, as well as p107 and p130. As shown in Fig. 8 , treatment with T3 led to hyperphosphorylation of pRb, which was evident as early as 12 h after treatment. T3 administration also led to increased p107 content 12 h after treatment; on the other hand, no significant change in pRb and p107 was observed in PH rats until 24 h. No modification of p130 could be observed in the liver from either T3- or PH-treated rats (Fig. 8) . The increased phosphorylation of pRb caused by T3 was also associated with a strong increase in the expression of the transcription factor E2F-1 (Fig. 8) .



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Figure 7. Western blot analysis of cell cycle proteins in T3 and PH-induced rat hepatocyte proliferation. Protein extracts (50 to 100 µg/lane) were prepared from the livers and Western analysis was performed as described in Materials and Methods. Appropriate loading was confirmed by staining the gel with Coomassie blue and the efficiency of transfer was monitored by staining the membranes with Ponceau S red. Each lane represents pool of three livers; C, control.



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Figure 8. Western blot analysis of pRb, p107, p130, E2F and p21 in T3- and PH-induced rat hepatocyte proliferation. Nuclear extracts (100 to 200 µg/lane) were prepared from the livers and Western analysis was performed as described in Materials and Methods. Appropriate loading was confirmed by staining the gel with Coomassie blue and the efficiency of transfer was monitored by staining the membranes with Ponceau S red. Each lane represents pool of three livers; C, control.

Finally, to determine whether hyperphosphorylation of pRb could depend entirely on enhanced cyclin-associated cdk activities or could also be due to inhibition by T3 of the cdk inhibitor p21, we measured the level of this protein in nuclear extracts from T3-treated PH animals and control rat liver. As shown in Fig. 8 , p21 content strongly increases concomitant with the peak in S phase (18 h after T3), still being elevated at 24 h. Moreover, no change in the expression of another cdk inhibitor, p27, could be observed in the liver from T3-treated and PH rats (data not shown). These results suggest that T3-induced modification of pRb and p107 is most likely due to an increase in cyclin D1-associated kinase activities and not to a decrease in the protein level of the cdk inhibitors p21 and p27.


   DISCUSSION
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES
 
The present study shows that increased expression of cyclin D1 is one of the earlier events during rat hepatocyte proliferation induced by T3. Increased expression of cyclin D1 is followed by enhanced phosphorylation of pRb, a key event in the transition from G1 to S phase, and by an increased expression of the transcription factor E2F. Together with D2 and D3, cyclin D1 regulates cell cycle progression by forming complexes with cdk4 and cdk6 and phosphorylating critical cellular substrate proteins. Expression of cyclin D1 is rapidly induced upon exposure of cells to mitogens and its expression declines when mitogens are withdrawn or antiproliferative agents are added (35) . In many types of human tumors, the expression of cyclin D1 is deregulated, favoring the phosphorylation of pRb, the major target of this cyclin. Indeed, the cyclin D1 gene was originally cloned as an oncogene, termed PRAD1, which was found to be activated by chromosomal translocations present in the genomes of parathyroid adenoma cells (36) . Consistent with the oncogenic role of cyclin D1 are observations that transgenic mice overexpressing this cyclin in their breast tissue are prone to mammary adenocarcinomas (37) whereas coexpression of cyclin D1 and myc genes in the lymphoid tissue of transgenic mice leads to rapid development of lymphomas (38 , 39) . Enhanced expression of cyclin D1 before the onset of DNA synthesis has been reported in the liver regeneration after 2/3 PH; in this model, an increase in cyclin D1 expression occurs late in G1 (12 h in rat liver and 24–30 h in mouse liver) (40 41 42) and is preceded by a series of changes involving activation of transcription factors. In turn, these factors induce the expression of immediately early genes (22) , some of which (i.e., c-myc) transcriptionally regulate the gene encoding cyclin D1 (43) . Even though both compensatory regeneration and mitogen-induced direct hyperplasia activate cyclin D1, there were distinct differences in the patterns of its induction between these two models of hepatocyte proliferation. As shown in the present study, activation of cyclin D1 by T3 and nafenopin was very rapid as compared to PH (Fig. 6) , the onset of hepatocyte DNA synthesis and the appearance of mitoses being greatly accelerated after treatment with mitogens. Our results in rat liver agree with recent in vitro studies showing that T3-induced cell proliferation in GC cells is associated with a shortening of G1 phase of cell cycle, an early induction of cyclin D1 expression, and hyperphosphorylation of pRb (44) .

It is also clear from the present study that activation of cyclin D1 after T3 is not the result of induction of immediate early genes expression (c-fos, c-jun, and c-myc) or activation of transcription factors (AP-1 and NF-{kappa}B), which are believed to be critical for liver regeneration after PH. In vitro studies have shown that TR transcriptionally decreases the expression of c-fos proto-oncogene and AP-1 activity under conditions that stimulate cell proliferation (45) ; more recent studies demonstrated that the silencing mediator of retinoic and thyroid hormone receptors (SMRT) represses trans-activation of AP-1 and NF-{kappa}B (46) .

Based on these observations, it is tempting to suggest that the activation of cyclin D1 by T3 may be a direct action of TRs on this gene rather than the consequence of a series of gene activation as seen in the model of PH; in addition, the early activation of cyclin D1 by nafenopin, a ligand of the nuclear receptor PPAR{alpha} shown to be an essential mediator of PPs-induced hepatocyte proliferation (47) , also suggests a direct action of PPARs on cyclin D1 gene. More recently we demonstrated that in the mouse liver, TCPOBOP, a putative ligand of the orphan nuclear receptor, CAR (48) , caused a rapid induction of cyclin D1 that was associated with an accelerated entry of hepatocytes into S phase (42) . Thus, a unified concept is emerging regarding the possible mechanisms of hepatocyte proliferation induced by several ligands of the nuclear receptors. Further studies to characterize molecular interactions between cyclin D1 gene and TRs, PPARs, CAR, and possibly other nuclear hormone receptors may be critical to verify the validity of this concept.


   ACKNOWLEDGMENTS
 
Supported by grants from the Associazione Italiana Ricerca sul Cancro and Ministero Università e Ricerca Scientifica (Cofin ex-40% and 60%), Italy. M.P. is the recipient of a fellowship from Fondazione Italiana Ricerca sul Cancro.

Received for publication July 12, 2000. Revision received October 5, 2000.
   REFERENCES
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES
 

  1. Samuels, H. H., Forman, B. M., Horowitz, Z. D., Ye, Z.-S. (1988) Regulation of gene expression by thyroid hormones. J. Clin. Invest. 81,957-967
  2. Short, J., Brown, R. F., Husakova, A., Gilbertson, J. R., Zemel, R., Lieberman, I. (1972) Induction of deoxyribonucleic acid synthesis in the liver of intact animal. J. Biol. Chem. 247,1757-1766[Abstract/Free Full Text]
  3. Francavilla, A., Carr, B. I., Azzarone, A., Polimeno, L., Wang, Z., Van Diehl, D. H., Subbotin, V., Prelich, J. G., Starzl, T. E. (1994) Hepatocyte proliferation and gene expression induced by triiodothyronine in vivo and in vitro. Hepatology 20,1237-1241[Medline]
  4. Forbes, S., Themis, M., Alison, M. R., Selden, C., Coutelle, C., Hodgson, H. J. F. (1998) Retroviral gene transfer to the liver in vivo during tri-iodothyronine induced hyperplasia. Gene Therapy 5,552-555[Medline]
  5. Oren, R., Dabeva, M. D., Karnezis, A. N., Petkov, P. M., Rosencrantz, R., Sandhu, J. P., Moss, S. E., Wang, S., Hursyton, E., Laconi, E., Holt, P. R., Thung, S. N., Zhu, L., Shafritz, D. A. (1999) Role of thyroid hormone in stimulating liver repopulation in the rat by transplacental hepatocytes. Hepatology 30,903-913[Medline]
  6. Lazar, M. A. (1993) Thyroid hormone receptors: multiple forms, multiple possibilities. Endocr. Rev. 14,184-193[Medline]
  7. Oppenheimer, J. H., Schwartz, H. L., Strait, K. A. (1996) The molecular basis of thyroid hormone action. Braverman, L. E. Utiger, R. D. eds. Werner and Ingbar’s. The Thyroid: a Fundamental and Clinical Text ,162-184 Lippincott-Raven New York.
  8. Mangelsdorf, D. J., Umesono, K., Evans, R. M. (1984) The retinoid receptors. Sporn, M. B. Goodman, D. S. eds. The Retinoids: Biology, Chemistry and Medicine ,319-349 Raven Press New York.
  9. Morgan, D. O. (1997) Cyclin dependent kinase: engines, clocks, and microprocessors. Annu. Rev. Cell Dev. Biol. 13,261-291[Medline]
  10. Grana, X., Reddy, P. E. (1995) Cell cycle control in mammalian cells: role of cyclins, cyclin-dependent kinases (CDKs), growth suppressor genes and cyclin dependent kinase inhibitors (CKIs). Oncogene 11,211-219[Medline]
  11. Sherr, C. J. (1996) Cancer cell cycles. Science 274,1672-1677[Abstract/Free Full Text]
  12. Pines, J. (1995) Cyclins and cyclin dependent kinases: a biochemical view. Biochem. J. 308,697-711
  13. Martin-Castellanos, C., Moreno, S. (1997) Recent advances on cyclins, CDKs and CDK inhibitors. Trends Cell Biol 7,95-98[Medline]
  14. Herwig, S., Strauss, M. (1997) The retinoblastoma protein: a master regulator of cell cycle, differentiation and apoptosis. Eur. J. Biochem. 15,581-601[Medline]
  15. Michalopoulos, G. K., DeFrances, M. C. (1997) Liver regeneration. Science 276,60-66[Abstract/Free Full Text]
  16. Fausto, N., Laird, A. D., Webber, E. M. (1995) Role of growth factors and cytokines in hepatic regeneration. FASEB J 9,1527-1536[Abstract]
  17. Taub, R. (1996) Transcriptional control of liver regeneration. FASEB J 10,413-427[Abstract]
  18. Kishimoto, T., Akira, S., Taga, T. (1992) Interleukin-6 and its receptor: a paradigm for cytokines. Science 258,593-597[Abstract/Free Full Text]
  19. Trautwein, C., Boker, K., Manns, M. P. (1994) Hepatocyte and immune system: acute phase reaction as a contribution to early defence mechanisms. Gut 35,1163-1166[Free Full Text]
  20. Akerman, P., Cote, P., Yang, S.-Q, McClain, C., Nelson, S., Bagby, G. J., Diehl, A. M. (1992) Antibodies to tumor necrosis factor-{alpha} inhibit liver regeneration after partial hepatectomy. Am. J. Physiol. 263,G579-G585[Abstract/Free Full Text]
  21. Cressman, D. E., Greenbaum, L. E., DeAngelis, R. A., Ciliberto, G., Furth, E. E., Poli, V., Taub, R. (1996) Liver failure and defective hepatocyte regeneration in interleukin-6-deficient mice. Science 274,1379-1383[Abstract/Free Full Text]
  22. Yamada, Y., Kirillova, I., Peschon, J. J., Fausto, N. (1997) Initiation of liver growth by tumor necrosis factor: deficient liver regeneration in mice lacking type I tumor necrosis factor receptor. Proc. Natl. Acad. Sci. USA 94,1441-1446[Abstract/Free Full Text]
  23. Columbano, A., Shinozuka, H. (1996) Liver regeneration versus direct hyperplasia. FASEB J 10,1118-1128[Abstract]
  24. Ledda-Columbano, G. M., Curto, M., Piga, R., Zedda, A. I., Menegazzi, M., Sartori, C., Shinozuka, H., Bluethmann, H., Poli, V., Ciliberto, G., Columbano, A. (1998) In vivo hepatocyte proliferation is inducible through a TNF and IL-6-independent pathway. Oncogene 17,1039-1044[Medline]
  25. Columbano, A., Ledda-Columbano, G. M., Pibiri, M., Piga, R., Shinozuka, H., DeLuca, V., Cerignoli, F., Tripodi, M. (1997) Increased expression of c-fos, c-jun and LRF-1 is not required for in vivo priming of hepatocytes by the mitogen TCPOBOP. Oncogene 14,857-863[Medline]
  26. Menegazzi, M., Carcereri, A., Suzuki, H., Shinozuka, H., Pibiri, M., Piga, R., Columbano, A., Ledda-Columbano, G. M. (1997) Liver cell proliferation induced by nafenopin and cyproterone acetate is not associated with increases in activation of transcription factors NF-{kappa}B and AP-1 or expression of tumor necrosis factor-{alpha}. Hepatology 25,585-592[Medline]
  27. Skrtic, S., Ekberg, S., Wallenius, V., Enerback, S., Hedin, L., Jansson, J. O. (1997) Changes in expression of CCAAT/enhancer binding protein alpha (C/EBP alpha) and C/EBP beta in rat liver after partial hepatectomy but not after treatment with cyproterone acetate. J. Hepatol. 27,903-911[Medline]
  28. Rao, M. S., Reddy, J. K. (1996) Hepatocarcinogenesis of peroxisome proliferators. Ann. N.Y. Acad. Sci. 804,573-587[Medline]
  29. Levine, W. G., Ord, M. G., Stocken, L. A. (1977) Some biochemical changes associated with nafenopin-induced liver growth in the rat. Biochem. Pharmacol. 26,939-942[Medline]
  30. Tugwood, J. D., Issemann, I., Anderson, R. G., Bundell, K. R., McPheat, W. L., Green, S. (1992) The mouse peroxisome proliferator activated receptor recognizes a response element in the 5' flanking sequence of the rat acyl CoA oxidase gene. EMBO J 11,433-439[Medline]
  31. Higgins, G. M., Anderson, R. M. (1931) Experimental pathology of the liver. I. Restoration of the liver of the white rat following partial surgical removal. Arch. Pathol. 12,186-202
  32. Timchenko, N. A., Wilde, M., Nakanishi, M., Smith, J. R., Darlington, G. J. (1996) CCAAT/enhancer-binding protein {alpha} (C/EBP{alpha}) inhibits cell proliferation through the p21 (WAF-1/Cip-1/SDI-1) protein. Genes Dev 10,804-815[Abstract/Free Full Text]
  33. Schreiber, E., Matthias, P., Muller, M. M., Schaffner, W. (1989) Rapid detection of octamer binding proteins with ‘miniextracts’prepared from a small number of cells. Nucleic Acids Res 17,6419A
  34. Bradford, M. (1976) A rapid and sensitive method for the quantitation of microgram quantities of protein using the principle of protein-dye binding. Anal. Biochem. 72,248-254[Medline]
  35. Sherr, G. J. (1994) G1 phase progression: cycling on cue. Cell 79,551-556[Medline]
  36. Motokura, T., Bloom, T., Kim, H. G., Juppner, H., Ruderman, J. V., Kronenberg, H. M., Arnold, A. (1991) A novel cyclin encoded by a bcl-1 linked candidate oncogene. Nature (London) 350,512-515[Medline]
  37. Wang, T. C., Cardiff, R. D., Zukerberg, L., Lees, E., Arnold, A., Schmidt, E. V. (1994) Mammary hyperplasia and carcinoma in MMTV-cyclin D1 transgenic mice. Nature (London) 369,669-671[Medline]
  38. Bodrug, S. E., Warner, B. J., Bath, M. L., Lindeman, G. J., Harris, A. W., Adams, J. M. (1994) Cyclin D1 transgene impedes lymphocytes maturation and collaborates in lymphomagenesis with myc gene. EMBO J 13,2124-2130[Medline]
  39. Lovec, H., Grzeschiczek, A., Kowalski, M. B., Moroy, T. (1994) Cyclin D1/bcl-1 cooperates with myc genes in the generation of B-cell lymphoma in transgenic mice. EMBO J 13,3487-3495[Medline]
  40. Albrecht, J. H., Meyer, A. H., Hu, M. Y. (1997) Regulation of cyclin-dependent kinase inhibitor p21(WAF1/Cip1/Sdi1) gene expression in hepatic regeneration. Hepatology 25,557-563[Medline]
  41. Albrecht, J. H., Poon, R. Y. C., Ahonen, C. L., Rieland, B. M., Deng, C., Crary, G. S. (1998) Involvement of p21 and p27 in the regulation of CDK activity and cell cycle progression in the regenerating liver. Oncogene 16,2141-2150[Medline]
  42. Ledda-Columbano, G. M., Pibiri, M., Loi, R., Perra, A., Shinozuka, H., Columbano, A. (2000) Early increase in cyclin D1 expression and accelerated entry of mouse hepatocytes into S phase after administration of the mitogen 1,4-Bis[2-(3,5-dichloropyridyloxy)]benzene. Am. J. Pathol. 156,91-97[Abstract/Free Full Text]
  43. Daksis, J. I., Lu, R. Y., Facchini, L. M., Marhin, W. W., Penn, L. J. (1994) Myc induces cyclin D1 expression in the absence of de novo protein synthesis and links mitogen-stimulated signal transduction to cell cycle. Oncogene 9,3635-3645[Medline]
  44. Barrera-Hernandez, G., Park, K. S., Dace, A., Zhan, Q., Cheng, S.-Y. (1999) Thyroid hormone-induced cell proliferation in GC cells is mediated by changes in G1 cyclin/cyclin-dependent kinase levels and activity. Endocrinology 140,5267-5274[Abstract/Free Full Text]
  45. Perez, P., Schontal, A., Aranda, A. (1993) Repression of c-fos gene expression by thyroid hormone and retinoic acid receptors. J. Biol. Chem. 268,135-140
  46. Lee, S.-K., Kim, J.-H., Lee, Y. C., Cheong, J, Woon Lee, J. (2000) Silencing mediator of retinoic acid and thyroid hormone receptors as a novel transcriptional corepressor molecule of activating protein-1, nuclear factor-{kappa}B and serum response factor. J. Biol. Chem. 275,12470-12474[Abstract/Free Full Text]
  47. Peters, J. M., Cattley, R. C., Gonzalez, F. J. (1997) Role of PPAR alpha in the mechanism of action of the nongenotoxic carcinogen and peroxisome proliferator Wy-14,643. Carcinogenesis 18,2029-2033[Abstract/Free Full Text]
  48. Honkakoski, P., Zelko, I., Sueyohi, T., Negishi, M. (1998) The nuclear orphan receptor CAR-retinoid X receptor heterodimer activates the phenobarbital-responsive enhancer module of the CIP2B. Mol. Cell. Biol. 18,5652-5658[Abstract/Free Full Text]



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