Alzheimer's Disease and Frontotemporal Dementias

A Review with Particular Reference to Pin1 Protein

 

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Compiled by: Julian Thorpe

 

Online Review Paper

Please Note: This review article was submitted (to a quality Journal) around September, 2001 and rejected in February, 2002 after a very lengthy review process. To paraphrase the reviewers' comments, it was considered rather 'long-winded and speculative', which may well be true (!) as my intention was to draw together all the possible points of involvement (known and potential) of Pin1 in the progression of AD. Since the submission of this article things have moved on with regard to Pin1 (e.g. the beta-catenin connection) and the manuscript would have to be amended (taking into account the constructive criticisms of the reviewers) and updated considerably before I resubmitted elsewhere. I have therefore decided to make this available on-line to anyone with an interest. Hopefully, it represents the 'state of play' of Pin1 in regard to AD at the time of its writing and, who knows, some of the speculation within it may be borne out by future research? Time will tell. I would much appreciate any comments or suggestions about this review. Indeed, if anyone goes so far as to wanting to refer to any of its content, I would much appreciate a citation (e.g. if the journal concerned has on-line links to refs).

The Peptidyl-Prolyl Cis-Trans Isomerase Protein Pin1: 

a key player in the molecular pathogenesis of Alzheimer’s disease?

Julian Robert Thorpe
School of Biological Sciences, University of Sussex, Falmer, Brighton BN1 9QG, East Sussex, U.K.

Abstract
1. Pin1 Protein
Table 1
2. Involvement of Pin1 Protein in Alzheimer’s Disease
2.1 Molecular pathogenic events leading to plaque and tangle formation
Figure 1
2.2  Pin1 provides a link between plaques and tangles
Figure 2
Figure 3
Figure 4
Figure 5
2.3 Tau Hyperphosphorylation in AD
2.3.1 Kinases
2.3.2 Phosphatases
2.4 Pin1 and mitotic events in AD
2.5 Pin1 depletion as a contributory factor in neuronal apoptosis
3. Conclusions and Future Perspectives
Acknowledgments
Literature Cited

Abstract

Pin1 protein is a peptidyl-prolyl cis-trans isomerase that binds to a specific motif of a phosphorylated serine or threonine preceding a proline. Its target proteins include a subset of mitotic and nuclear proteins involved in cell cycle control and transcriptional regulation, and others with roles in endocytosis, translation and control of cell size, and apoptosis. The isomerising action of Pin1 can modulate target protein conformation and mediate their dephosphorylation, so its influence at the interface of specific kinase and phosphatase activities may therefore exert a control over a range of cellular activities. Pin1 has recently been implicated in Alzheimer’s disease (AD); it has been demonstrated to bind to the amyloid protein precursor and to phosphorylated tau in tangles. In binding to the latter in the neuronal cytoplasm, nuclear Pin1 levels are depleted. This review seeks to draw together the various demonstrated and potential interactions of Pin1 protein with its upregulated target proteins in the progression of AD. An attempt is made to suggest how nuclear Pin1 depletion and mitotic activation in AD might lead to nuclear instability and apoptosis and that this depletion might be a unifying, contributory factor towards neuronal cell death in both AD and the tauopathies.

1. Pin1 Protein

          Pin1 is a member of the parvulin family within the peptidyl-prolyl cis-trans isomerase (PPIase) group of proteins and was the first human parvulin to be found (88). PPIases are chaperone proteins with a range of functions that include modulating the assembly, folding, activity and transport of essential cell proteins (49,124) at different subcellular sites, reflecting their target protein diversity (68,121). They can additionally regulate intracellular signalling, direct intracellular transport, influence transcription, cell cycle progression and apoptosis by altering protein bioactivity or stability (58,159).
          Pin1 is an 18kDa protein with a C-terminal PPIase domain and an N-terminal WW domain (88).  The latter domain binds a specific motif of a phosphorylated serine or threonine residue preceding a proline (Ser/Thr-Pro; 91,125,147) and can catalyse the cis-trans isomerisation of such proline-containing peptides (133). It is predominantly nuclear (88,140) and is a mitotic regulator (87,88) whose activity is required for the DNA replication checkpoint (153). In addition to binding to targets of the mitotic phosphoprotein monoclonal-2 antibody (MPM-2), Pin1 interacts specifically with, and regulates the activity of, a subset of mitotic and nuclear proteins in a phosphorylation-dependent manner (127,159). Pin1 targets not only include nuclear proteins involved in control of the cell cycle, transcription and DNA supercoiling, but also other non-nuclear targets with roles in apoptosis, endocytosis, translation and control of cell size, maintenance of the cytoskeleton and neuronal function  (see Table 1). In yeast and mammalian cells, the interaction of Pin1 with its phosphorylated mitotic targets regulates entry and progression of cells through the cell cycle (44,88,89). Indeed, in HeLa cells, Pin1 depletion causes mitotic arrest and apoptosis, whilst overexpression results in G2 phase arrest (88). Additionally, very recent work has revealed that Pin1 is overexpressed in breast cancer (157); it was suggested that this overexpression promotes oncogenesis through the interaction of Pin1 with c-Jun, thereby increasing the latter’s transcriptional activity, resulting in increased cellular levels of cyclin D1.

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Table 1

Pin1 Target Proteins

Target Role Ref.
NIMA kinase (never in mitosis, gene a) cell-cycle kinase 88
Wee1 cell-cycle kinase 127
Plk1 (polo-like kinase 1) cell-cycle kinase 25, 127
Myt1 cell-cycle kinase 127, 152 
Cdc25 cell-cycle protein phosphatase 25, 127
Cdc27 cell cycle protein: anaphase initiation 127
Topoisomerase IIa affects DNA supercoiling 159
RNA polymerase II transcription initiator 3, 100
c-Jun mediates transcriptional regulation 157
NFAT (nuclear factor of activated T cells) transcription factor 86
Bcl-2 suppressor of apoptosis 110
Rab4 endocytotic protein transport regulator 45
p70/p85S6K (ribosomal protein S6 kinases) control of cell size; translation 159
APP (amyloid protein precursor) neuronal cell surface protein 29
tau microtubule-associated protein 90

          The phosphorylation-dependent prolyl isomerization by Pin1 has been suggested to be a novel post-translational cell cycle regulatory mechanism which organises the phosphorylated proteins into a defined set of mitotic structural modifications (87). Zhou and colleagues have recently demonstrated an example of this organisational influence of Pin1. They have shown that the PPIase activity of Pin1 introduces kinks into the peptide chains of its targets (166) and, more specifically (165), that the cis-trans isomerase action of Pin1 upon Cdc25C (and tau: see Section 2.2) facilitates its dephosphorylation by the protein phosphatase 2A (PP2A). Indeed, the latter’s activity is conformation-specific for the trans-phosphorylated Ser/Thr-Pro isomer in target proteins.
          Thus, the isomerising action of Pin1 may take place at the interface of specific kinase and phosphatase activities. This may provide a novel mechanism regulating the dephosphorylation of specific targets in subcellular compartments, thereby mediating the control of a range of cellular activities. The potential role of Pin1 in Alzheimer’s disease (AD) is discussed below.

2. Involvement of Pin1 Protein in Alzheimer’s Disease

           AD is a progressive neurodegenerative disease that affects the higher order processing cortical regions of the brain, leading to a slow but progressive deterioration in cognitive ability (dementia). Recently, Pin1 protein has been shown to have an intimate involvement in the formation of the two hallmark lesions of AD, the extracellular neuritic plaques which contain dystrophic neurites and aggregates of beta-amyloid (A beta) protein (29) and the intraneuronal neurofibrillary tangles (90).

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2.1 Molecular pathogenic events leading to plaque and tangle formation

          Although the majority of research evidence appears to suggest that deposition of (extracellular) beta-amyloid plaques precedes (intraneuronal) tangle formation in AD-affected neocortical areas, there is still some debate about how plaques and tangles interrelate. Many researchers hold the view that fibrillar amyloid plaques are directly toxic to neurons and thereby initiate a cascade of events leading to cytoskeletal disruption, tangle development, loss of synapses and, ultimately, neuronal cell death and dementia. This is the so-called ‘beta-amyloid cascade theory’ of AD (59,126). However, others dispute this notion of such a ‘linear’ chain of events as, for example, tangles may occur in the absence of plaques in the class of neurodegenerative diseases known as ‘tauopathies’ (79). Additionally, some AD studies have revealed no correlation between these two lesions: for example, a thorough systematic study of the olfactory bulb in AD and normal brain yielded no correlation between A beta deposition and tangle formation (70). Furthermore, very recently, a view has emerged that the neurotoxicity of A beta may be plaque-independent (53,102,104), an observation which might serve to clarify this latter dispute. Such studies indicate that AD is not always necessarily as linear and uni-directional as the ‘cascade’ theory implies; future research on the recently-discovered tau mutations (26) should shed important new light on our understanding of the progression of the disease.
          The following description (and see Fig.1) is nonetheless based upon the ‘beta-amyloid cascade’ theory of AD. As stated, although not all subscribe to this theory, it is a useful framework on which to base a description of the various aspects and events of the disease. AD is initiated by factors that may be genetic or environmental in nature. The former include mutations in the amyloid protein precursor (APP) gene on chromosome 21 and in the two presenilin genes on chromosomes 14 (presenilin-1) and  1 (presenilin-2) which give rise to the familial early-onset forms of the disease (23). In the vast majority of cases, however, AD is of the sporadic, late-onset form brought about by the so-called  ‘susceptibility’ apolipoprotein E gene (allelic variant 4 on chromosome 19; 95) or by mitochondrial mutations and polymorphisms (108). Environmental risk factors are generally considered to be more contentious, but may include head trauma (116) and heavy metals such as aluminium (21,40,67), iron (115) and zinc (109).
          All the above risk factors, either directly or indirectly, give rise to effects upon the proteolysis of the APP protein. APP is a neuronal cell surface protein, the precise function of which is presently unknown. While it is usually rapidly degraded in healthy neurons (76), aberrant proteolysis and/or reduced clearance of the proteolytic products of APP occurs in AD. This latter leads to the production of novel proteolytic products which include the A beta peptides (51). APP proteolysis is mediated by alpha-, beta- and gamma-secretases (proteases), on which much recent research attention has been focused (14,57,60,61,73,105,144,151), especially in regard to the hypothesis that the gamma-secretases might actually be the presenilins (82,154,155,158).
          A build-up of secreted A beta peptide then accumulates extracellularly and subsequent fibrillogenesis of the peptide results in plaque formation. Oxidative stress effects of the soluble and fibrillar A beta (117,145) elicit an inflammatory response (17). Activated microglial cells (20,156) and the release of proinflammatory cytokines (137) promote inflammation and invasion of the plaques by astrocytes (2) that ‘mature’ the plaques into the ‘neuritic’ plaques symptomatic of AD brain.
          Within the neurons (Fig. 2), the deleterious effects of oxidative stress, cytokine release by microglia and, also perhaps, intra-neuronal effects of APP misprocessing (10) and physically-damaging effects of adjacent neuritic plaques (31,148), combine to produce aberrant (increased) kinase and (decreased) phosphatase activities. The ensuing hyperphosphorylation of the microtubule (Mt)-associated protein tau results in its dissociation from the Mt (65). The maintenance and assembly of the latter, normally mediated by tau, is compromised so that Mt fragmentation follows. The overall end-product of this cytoskeletal breakdown are the cytoplasmic (perikaryal) neurofibrillary tangles, which are ultimately composed predominantly of hyperphosphorylated tau (p-tau). Synaptic loss and cell death follow, eventually leading to dementia.

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Figure 1:   Molecular Pathogenic Events of AD
A diagrammatic representation of the molecular pathogenic events associated with AD.

2.2  Pin1 provides a link between plaques and tangles

          The recent finding that Pin1 binds to APP (29), alongside the earlier demonstration of its binding to p-tau in the neurofibrillary tangles of AD-affected neurons (90), means that the protein provides a link between the development of the two major histopathological hallmark features of this disease, the plaques and tangles. As outlined above, aberrant proteolytic processing of APP leads to the secretion and ultimate aggregation of A beta peptides into extracellular plaques in AD brain, whilst p-tau is the major component of the tangles within the perikaryon of affected neurons.

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Figure 2:  Involvement of Pin1 in Neurofibrillary Tangle Formation and Apoptosis
Diagrammatic representation of the probable biochemical pathways and interactions associated with Pin1 involvement in tangle formation within AD-affected neurons. Phosphorylation of tau (p-tau) leads to its dissociation from tubulin (crossed black arrows). Cis-trans isomerisation of p-tau by Pin1 normally mediates its dephosphorylation by (trans p-tau specific) PP2A and thence its ability to re-associate with tubulin; however, insufficient levels of soluble Pin1 (and down-regulation of PP2A) creates a pool of p-tau which results in tangle formation. Redirection of Pin1 to the neuronal cytoplasm might contribute to apoptosis through depletion of nuclear Pin1 (e.g. through lack of binding to Cdc25 [see 2.4]; crossed black arrows) or binding to cytoplasmic Bcl-2 (see 2.5). (Numbers in parentheses refer to References)

          In binding to the large accumulations of p-tau in tangles, Lu et al. showed that Pin1 is redirected from the nucleus to the cytoplasm of AD neurons (90; and see Fig. 2). In vitro methods revealed that Pin1 bound to the phosphorylated threonine 231 (pThr 231) of p-tau and tissue extractions of Pin1 protein showed that it becomes sequestered within tangles. Furthermore, this leads to a shortfall of available soluble Pin1 protein. Results from this author’s laboratory have confirmed the redirection, shortfall and binding to tangles of Pin1 at the transmission electron microscope level (141). Quantification of endogenous Pin1 immunolabelling (Fig. 3, white bars) corroborated that the protein is less preferentially nuclear and becomes more cytoplasmic in distribution in AD-affected neurons; it is also associated with tangles (Fig. 4A & B).

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Figure 3:  Endogenous Pin1 Immunolabelling and Exogenous Pin1 Binding to Normal and AD Neurons
Immunogold labelling transmission electron microscopy results from normal and AD (frontal lobe) neurons. Sections incubated either in buffer alone (to reveal endogenous Pin1 levels: white bars [End]) or in 20mg/ml recombinant Pin1 protein (to reveal endogenous plus exogenous Pin1 binding levels: black bars [End+Exo]) before being immunolabelled with goat anti-Pin1 antibody followed by rabbit-anti-goat 10nm gold probe. The grey bars represent net levels of exogenous Pin1 binding (derived by subtracting label density after buffer incubation from the label density after recombinant Pin1 protein incubation). Nu = nucleus; Cyt = cytoplasm; Tau = tau-immunoreactive tangles. Data = gold particles/mm2 (Data from Thorpe et al., 2001).

Figure 4:  Examples of Tau-Immunoreactive Neurofibrillary Tangles
Examples of neurofibrillary tangles in AD (A and B) and frontotemporal dementia (FTD) brain (C). AD brain immunolabelled with a polyclonal anti-tau antibody followed by 10nm goat anti-rabbit gold probe. B is an enlarged view of the tau-positive tangle region within the neuron in A (marked by * ) (A and B reproduced, with permission, from Thorpe JR, Morley SJ, Rulten SL: Utilising the Peptidyl-Prolyl Cis-Trans Isomerase Pin1 as a Probe of its Phosphorylated Target Proteins: Examples of Binding to Nuclear Proteins in a Human Kidney Cell Line and to Tau in Alzheimer’s Diseased Brain. Journal of Histochemistry and Cytochemistry 49: p.104, 2001). FTD brain immunolabelled with AT8 monoclonal anti-human paired helical filament (PHF)-tau antibody followed by 10nm goat anti-mouse gold probe. Note complete absence of non-specific labelling over the nucleus (Cairns NJ, Thorpe JR, unpublished data). N = nucleus; bars = 100nm.

        Increased levels of immunolabelling (compared with endogenous Pin1 levels and with normal brain) after exogenous Pin1 binding reflect the  greater amounts of (unbound) phosphorylated Pin1 target proteins in these neurons (especially in the tangles; Fig. 3, black bars). Net levels of Pin1 binding derived from these results show greatly-increased amounts of binding to AD (compared to normal) neurons and evidences a shortfall of available Pin1 protein in all subcellular compartments (Fig. 3, grey bars). Lu et al. suggested that depletion of nuclear Pin1 might contribute to cell death (as in HeLa cells; 88). Significantly, they also showed that Pin1 could restore the ability of p-tau to bind Mt and promote their assembly in vitro: a possible future therapeutic use of Pin1 was therefore postulated (90).
          On reporting the binding of Pin1 to APP, Davies et al. (29) suggested that pathogenic changes to APP and tau might both be triggered by a single underlying event: pThr 231 on tau has a conformation that is similar to that of pThr 668 on APP. Additional experimental corroboration was provided by immunostaining of AD brain tissues which showed that pThr 668 APP occurred in the lysosomal compartment specifically of those hippocampal and cortical neurons which were also positive for pThr 231 tau. Importantly, it was speculated that Pin1 binding to APP might result in increased A beta production. Indeed, NMR spectroscopy has shed new light on the interactions of the cytoplasmic tail of APP with intracellular signalling and A beta peptide proteolytic factors (119). The serine residue at 655 and the threonine residues at 654 and 668 are known to be phosphorylated in vivo and may be involved with regulating these interactions. Backbone dihedral angle changes were symptomatic of hydrogen bond formation and the biggest conformational change occurred upon phosphorylation of Thr 668, the Pin1-binding motif (29); they concluded that the most likely candidate kinase for this phosphorylation in vivo was cdk5. Their results showed that the unphosphorylated T668 is in a stable trans conformation and that its phosphorylation produced an equilibrium of cis and trans isomers. They proposed a model whereby this could initiate a regulatory mechanism in which cytosolic binding factors were isomer-specific. This opens up a situation whereby the isomerase action of Pin1 could mediate increased APP proteolysis by trans-conformation specific secretases (in similar manner to the trans-conformation specific dephosphorylation of tau and Cdc25C by PP2A [165; and see Section 1.]; see Fig. 5).

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Figure 5:  The Involvement of Pin1 in Plaque Formation
Diagrammatic representation of a proposed mechanism whereby the cis-trans isomerisation of phosphorylated APP (at T668) by Pin1 might mediate increased A beta production through elevated proteolysis by trans-phosphorylation conformation-specific secretases. Pin1 interactions with phosphorylated rab4-GTP might also contribute to APP misprocessing (see Section 2.2). (Numbers in parentheses refer to References)

          Another Pin1 target protein that is upregulated in AD and might influence APP proteolytic processing is the endocytotic protein transport regulator, rab4 (22). Rab4 is phosphorylated by p34/cdc2 and regulates protein transport through the early endosomes when activated by GTP binding. As endocytotic protein transport is inhibited during mitosis, when phosphorylated rab4(-GTP) has been shown to be bound by Pin1 (45), this might well have implications with regard to the spurious mitotic activation in AD-affected neurons; see Section 2.4). The distribution of rab4 was found to be more cytosolic and these authors suggested that phosphorylation of rab4 inhibits both the recruitment of rab4 effector proteins to early endosomes and the docking of rab4-containing transport vesicles.

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2.3 Tau Hyperphosphorylation in AD

          In AD, perturbations to the balance of kinase and phosphatase activities lead to the inappropriate hyperphosphorylation of various proteins. Hyperphosphorylated tau proteins have been shown to accumulate in neurons prior to tangle formation, suggesting that an imbalance of protein kinase and phosphatase activities is an early event in the disease progression (16). This latter would therefore also create a cytoplasmic ‘sink’ for nuclear Pin1 protein early in AD.

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2.3.1 Kinases
          The consensus view in the literature suggests that the protein kinases most predominantly involved in AD-specific tau phosphorylation are cyclin-dependent kinase 5 (Cdk5), glycogen synthase kinase-3 beta (GSK-3 beta) and the mitogen-activated protein kinases (MAP kinases [ERK1 and ERK2]). All these are involved in cellular signal transduction pathways and appear to be physically-associated with microtubules and tangles (114). Some researchers, however, have suggested that the MAP kinases may have a lesser role in the specific AD-type tau phosphorylation (39,160).
          Cyclin-Dependent Kinase 5 (Cdk5; 94,130) is abundant in brain tissue and has been shown to associate with tau (and neurofilament and tubulin proteins; 146). With its neuron-specific activator p35, Cdk5 is required for neuritic outgrowth, cortical lamination and synaptogenesis in cultured rat brain neurons (142). In AD, p25, a neuron-specific proteolytic cleavage product of p35, accumulates in the brain and promotes activation and mislocalization of Cdk5 (111). It should be noted, however, that others have recently suggested that the conversion of p35 to p25 is a post-mortem degradation event mediated by calpain (138). Other experiments on cultured primary cortical neurons have revealed that A beta, excitotoxins, hypoxic stress and calcium influx induce p25 production; calpain (a calcium-dependent cysteine protease) was found to cleave p35 to release a product corresponding precisely to p25, while inhibition of Cdk5 or calpain reduced cell death in A beta-treated neurons (78).
          The p25/Cdk5 kinase has been demonstrated to hyperphosphorylate tau (81), leading to cytoskeletal disruption and the apoptosis of primary neurons (78,94). It has subsequently been shown that phosphorylation of serine residues 396 and 404 by Cdk5 is primarily responsible for the mediation of tau's inability to polymerise tubulin (36). Cdk5 has been shown to be preferentially and consistently associated with tangles (160). Also, increases in its immunoreactivity within pre-tangle and early stage tangle-containing neurons in AD brain have been reported (113). Examination of neuronal Cdc2-like kinase (p25/Cdk5) activity in prefrontal and cerebellar cortex from AD and control subjects (77) has provided further corroboration. The ratio of p25/Cdk5 activity in prefrontal versus cerebellar cortex was higher in AD than control, a finding consistent with a role for this kinase in the pathogenesis of tangles in AD (prefrontal regions being tangle-rich and cerebellar regions almost tangle-free in AD).
          Work on model systems has also pointed to a role for Cdk5 in AD tau hyperphosphorylation. The tau protein kinase II system (TPK II; involving Cdk5 and p35) has been studied in cultured rat hippocampal cells (6). This work showed that fibrillary A beta increased Cdk5 activity, while a Cdk5 inhibitor and an (Cdk5) antisense probe protected the cells from A beta-induced neurotoxic damage. This group’s later work (5) has correlated the increased Cdk5 activity with changes in both the phosphorylation patterns and intraneuronal distribution of tau protein. The effects on Cdk5 were shown to be post-translational. They therefore concluded that Cdk5 plays a major role in the molecular path leading to the neurodegenerative process. Also, a transgenic mouse model overexpressing human p25 showed a resultant hyperphosphorylation of tau (and neurofilament proteins) by Cdk5 (1). This latter was accompanied by cytoskeletal disruption.
          Glycogen Synthase Kinase-3 (GSK-3; also known as tau protein kinase I [TPKI]) is a kinase with a well-known role in glycogen metabolism and activation of transcription factors that can also phosphorylate tau (66). GSK-3 beta  (but not GSK-3 alpha) has been shown to be increased in pre-tangle (112) and closely-associated with the p-tau of tangle-bearing neurons (160). GSK-3 beta has been shown to be equivalent  to TPKI and, with TPKII (consisting of a novel 23 kDa protein activator and CDK5), could account for most major phosphorylation sites of fetal and PHF(paired helical filament)-tau (64). GSK-3 beta (and TPKII) was associated with tangles in vivo and it was suggested to be important in the formation of neural networks in the neonatal brain. Using primary cultures of embryonic rat hippocampus, it was also demonstrated that A beta treatment induced GSK-3 beta activity, extensive phosphorylation of tau and cell death. GSK-3 beta also interacted with pyruvate dehydrogenase (PDH), thereby reducing levels of acetyl-CoA, essential for (the neurotransmitter) acetylcholine synthesis. Further corroborating in vivo evidence of GSK-3 beta’s potential role in AD has come from research on transgenic mouse models overexpressing this kinase (92,132), which evidenced tau hyperphosphorylation and associated astrocytosis, microglial activation and cell death in hippocampal neurons.
          The MAP kinase pathway is one branch of the complex cellular regulatory machinery, the aberrant activation of which may contribute to the hyperphosphorylation of tau associated with AD. MAP kinases (24) are serine-threonine kinases that have a significant role in hormonal signal transduction. They are activated by MAP kinase kinase (MAP kinase/ERK kinase: MEK). MEKs are highly specific for ERK1 and 2. MEKs are themselves activated by MEK kinase. The latter and MAP kinases are highly-expressed in the brain, with ERK1 mRNA apparently enriched in astrocytes and glia. ERK2 has been found in neuronal processes, tangles and plaques (143).
          The MAP kinases phosphorylate many key regulatory proteins such as other protein kinases, transcription factors (e.g. Egr1; 54), membrane enzymes and cytoskeletal proteins (including tau; 38). It has also now been demonstrated  (in PC12 cells; 54) that activation of the MAP kinase pathway by nerve growth factor induces p35, the neuron-specific activator of Cdk5. This induction is mediated via the transcription factor Egr1. Significantly, MAP kinases can phosphorylate tau in up to 15 of the 17 Ser-Pro or Thr-Pro motifs of the largest human isoform and have been seen to be associated with complexes of tau (and neurofilament and tubulin proteins; 146). A secreted fragment of the amyloid protein precursor (APP) can stimulate MAP kinase in a ras-dependent manner, leading to tau phosphorylation (69). The results suggested an interaction of tau with actin in addition to microtubules. On this note, it has been suggested (164) that, in AD, amyloid fibrils may activate cell death signalling pathways involving the neurotrophins which regulate apoptosis via protein kinase cascades (inc. the MAP kinase pathway).
          Another potential route for tau phosphorylation is via activation of protein kinase cascades by the 14-3-3 protein family. The latter are highly conserved and exist as seven isoforms, which regulate diverse cellular processes (42). They have been shown to be present in tangles (75), while the 14-3-3 zeta isoform is associated with tau in brain extract and profoundly stimulates cAMP-dependent protein kinase-catalysed in vitro phosphorylation on Ser(262)/Ser(356) located within the microtubule-binding region of tau (56). It was suggested that 14-3-3 (zeta) is a tau protein effector involved in abnormal tau phosphorylation.

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2.3.2 Phosphatases

          As well as the upregulation of the protein kinases, a concomitant downregulation of protein phosphatases (PP) during AD progression has also been demonstrated, which would contribute to the aberrant hyperphosphorylation of neuronal proteins. In regard to research on human brain, a neuron-specific reduction in the levels of both catalytic and regulatory PP2A mRNA in the hippocampus of AD brain has been shown  (150). Also, reduced activity (but not protein levels) of PP2B (calcineurin) in AD frontal cortex has been correlated with the presence of tangle pathology but not with (diffuse or neuritic) plaques (83). Expression data for PP2B in prefrontal cortical AD tissue has also revealed a great reduction compared with control brain tissue (122). Additionally, and significantly, the PP2B inhibitory gene known as DSCR1 (“Down Syndrome Candidate Region”; 43) is chronically overexpressed in AD compared with normal brain; these data were reinforced by cell culture experiments, which revealed that A beta could directly induce this increased expression (35).
          Iqbal and co-workers (11,13,47,48) have carried out a series of investigations on a rat model system (forebrain or metabolically-active brain slices). PP2A and PP2B were both shown to regulate the dephosphorylation of tau at Ser262, 356, 396 and 404, with PP2A alone dephosphorylating Ser198, 199, and 202. PP1 was demonstrated to indirectly upregulate tau dephosphorylation via regulating the activities of GSK-3, Cdk5 and cdc2 kinases. Selective inhibition of PP2A activity led to the AD-like hyperphosphorylation and accumulation of tau (in pyramidal cortical and hippocampal neurons), while inhibition of PP2B had no such effects. Their most recent work has implicated CaMKII activity in the process of tau hyperphosphorylation at Ser262 and 356. CaMKII was shown to be regulated mainly by PP2A, so that decreased activity of the latter (and PP1) increases tau pathology via the resultant promotion of CaMKII activity (12).

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2.4 Pin1 and mitotic events in AD

          Neurons of the adult brain are normally considered to be in a ‘terminally-differentiated’ state. However, accumulation of mitotic phosphoepitopes, via the spurious re-expression and activation of Cdc2/cyclin B (the mitotic phase regulating kinase), and associated cell cycle-related proteins has been shown in AD and has attracted much research interest (8,9,19,22,32,33,46,55,62,63,103,149). It has been described as an ‘interrupted’ mitotic process which leads to associated cytoskeletal abnormalities (including tangle formation) and, ultimately, apoptosis (7,34,98).
          The cellular signal transduction pathways initiating these cell-cycle events are triggered by the various deleterious effects of AD upon the neurons (outlined in Section 2.1; Fig. 1). The upregulation of the MAP kinase phosphorylation cascade (described in Section 2.3.1) is an obvious example, being a state, which would normally imply activation by mitogens and signal entry into the cell cycle. Specific examples of cell-cycle proteins that have been demonstrated to be elevated in AD, and which are also known Pin1 targets, are Cdc25A (32) and Plk1 (55). The Cdc25 phosphatases play a key role in cell-cycle progression by activating the cyclin-dependent kinases, including cdc2/cyclin B. Plk1 (74) is a regulator of Cdc25. Cdc25A is associated with both neuritic plaques and tangles and its tyrosine dephosphorylating activity is elevated (32). Also, as this phosphatase is activated by phosphorylation by cdc2/cyclin B, the Cdc25A exhibited increased mitotic phosphoepitope-specific antibody (MPM-2)-reactivity, and colocalized with the MPM-2 immunoreactivity in AD neurons. These data suggest that Cdc25A participates in mitotic activation during neurodegeneration.
          It has been shown that Pin1 may modulate Cdc2/cyclin B, and thus cell cycle control, through its interactions with Cdc25 and Plk1 (25). Although the mitotic activation of Cdc25 is not fully understood, certain conclusions have been drawn by Stukenberg and Kirschner (133) from their most recent work, including, of particular relevance to this review, the effect of (>95%) Pin1 (immuno-)depletion. This study demonstrated that Pin1 could produce conformational changes in Cdc25 (as previously reported; 165), but, additionally, they showed that it was acting catalytically. Pin1 could either activate or inhibit Cdc25 phosphatase activity, dependent upon its phosphorylation status: if phosphorylated by Cdc2 alone (as in lag phase), Cdc25 is inhibited by Pin1, but, if phosphorylated by both Cdc2 and Plx (as in G2/M transition), Pin1 increases the phosphatase activity of the protein.  It was this latter activation that was suggested to be mediated by a conformational change in the Cdc25 protein, with the experimental data indicating a cis-trans isomerization of proline residues in the folded Cdc25 protein. Depletion of Pin1 halted the full activation of Cdc25, with a resultant slower, less-concerted action of Cdc2. If this scenario occurred within similarly nuclear Pin1-depleted AD-affected neurons, then an ensuing aberrant, interrupted mitosis might follow, giving rise to nuclear instability and ultimately to cell death (and see Fig. 2).
          Other Pin1 targets such as RNA polymerase II (15), rab4 (22) and c-Jun (129) have been similarly shown to be upregulated in AD and, quite probably, future research will reveal further examples. Overall, increased expressions of such proteins would create more potential Pin1 binding motifs and an additional reason why insufficient levels of available, soluble Pin1 protein in the neurons (especially in the nucleus) could have a potentially damaging effect on their ultimate fate.

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2.5 Pin1 depletion as a contributory factor in neuronal apoptosis

          Several lines of evidence support a role for apoptosis in the neuronal loss observed in AD (7,27). A recent review (164) concludes that neuronal apoptosis has a potentially important role in neurodegenerative diseases (in addition to its involvement in the 'sculpturing' of the developing brain) and that the precise elucidation of such neuronal cell death might provide additional points for therapeutic interventions.
          The stimulation of mitotic events in AD-affected neurons may well contribute to this apoptosis (see Section 2.4; 85,98,107,164). Pin1 may have a key role in this apoptosis for the following reasons. Depletion of Pin1 activity in HeLa cells causes mitotic arrest and apoptosis (88). The upregulated kinase (see Section 2.3.1) and downregulated phosphatase (see section 2.3.2) activities and associated 'spurious' mitotic events in affected neurons would create numerous nuclear Pin1 targets. If these latter are not bound by Pin1, due to depletion of nuclear Pin1 protein (see Section 2.2), then this would be likely to contribute to nuclear instability and thence apoptosis. Examples of these would include Cdc25, as detailed above (Section 2.4), and also, perhaps, c-Jun. Intracellular A beta-activation of c-Jun N-terminal kinase (JNK) has been demonstrated in presenilin 1-linked AD brain (129). This would result in increased levels of phosphorylated (activated) c-Jun. The authors hypothesised that this JNK activation might lead to neuronal death.
          Another, possibly direct, mechanism whereby Pin1 nuclear depletion and redirection to neuronal cytoplasm in AD might invoke apoptosis is offered up by the recent suggestion (110) that Bcl-2, a potent inhibitor of apoptosis (71,128) might be a Pin1 target protein. Bcl-2 has been shown to be located on cytosol-facing membranes of the nucleus, endoplasmic reticulum and the mitochondria (in transgenic mouse cell lines; 84), although others have suggested that the mitochondrial localisation is more predominantly at the inner membrane and cristae (in rat liver; 101). In regard to AD, Bcl-2 expression has been found to become up-regulated in neurons containing damaged DNA but down-regulated in those containing tangles (135). Also, treatment of neuronal cell cultures with A beta peptide has been shown to promote the up-regulation (of both mRNA and protein levels) of Bcl-xL, a member of the Bcl-2 family (93).
          Phosphorylation of Bcl-2 is induced at serine residues when microtubule-targeted drugs are used to arrest tumour cells (110). This phosphorylation leads to the inactivation of the Bcl-2 protein’s anti-apoptotic role (161). Pin1 was found to associate with phosphorylated Bcl-2 in these M-phase-arrested cells and it was suggested that Pin1 might have a role in modulating its conformation, and thence its function (110). Phosphorylation of a proline-rich loop region (probably by Cdc2) within the Bcl-2 protein creates potential Pin1-binding motifs, and it was suggested (110) that Pin1 binding might block the conformational changes required for Bcl-2’s normal, cytoprotective, ion-channel forming activities (123). There is evidence that Bcl-2 is phosphorylated transiently during mitosis (161), thereby presumably creating an ‘apoptotic opportunity’ should aberrant chromosomal segregation or cytokinesis occur.
          During neurodegeneration, increased (neuronal ‘cdc2-like’) Cdk5 activity and elevated cytoplasmic levels of Pin1 would create a cellular situation akin to mitosis with regard to potential prolonged admixing of phosphorylated Bcl-2 and Pin1 protein. In this way, redirection of Pin1 to the cytoplasm in itself (apart from the effects of concomitant nuclear depletion; 90,141) and binding to phosphorylated Bcl-2 could initiate a cascade of events leading ultimately to apoptosis (and see Fig. 2).

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3. Conclusions and Future Perspectives

          Pin1 protein is apparently a ‘key player’ in the pathogenesis of AD: it has been shown to bind to both APP (29) and p-tau (90) in affected neurons and, by so doing, is thereby intimately involved in the development of the two classical, histopathological features of the disease, the extracellular neuritic plaques and the intraneuronal neurofibrillary tangles. Additionally, as Pin1 protein is a mitotic regulator, it will also, implicitly, have a role in the spurious re-expression and activation of cell cycle proteins in AD. Finally, because of all the above, Pin1 will have a role in neuronal apoptosis, either indirectly, via depletion of levels of nuclear Pin1 (resulting from redirection of nuclear Pin1 to tangle-bearing cytoplasm), or directly, via association with specific upregulated phosphoprotein targets.
         Pin1’s role in AD appears to be, potentially at least, rather ambivalent, reflecting the promiscuous nature of its binding to a broad range of phosphorylated target proteins: on the one hand it may contribute to increased proteolytic production of neurotoxic A beta peptide molecules, yet, on the other, if present in sufficient quantities, could seemingly redress the dissociation of hyperphosphorylated tau protein from the microtubules and thus prevent tangle formation. Both of these latter influences are mediated by the same mechanism: the isomerase action of Pin1 upon APP and p-tau renders them targets themselves for trans-phosphorylation conformation-specific proteolysis (by secretases in the case of APP) or dephosphorylation  (by PP2A in the case of p-tau). In either case, the net result of the redirection of Pin1 to these cytoplasmic target proteins is its depletion from the nucleus, with concomitant nuclear instability which could, at the least, contribute to eventual neuronal cell death in AD.
          While there is no doubt that death is the ultimate fate of at least a significant proportion of AD-affected neurons, there is still much debate about the nature of this death. There are those (30) who dispute that the involvement of apoptosis in AD has been truly confirmed, as the more terminal phases, such as chromatin condensation, apoptotic bodies, and blebbing, are rarely (134) seen in AD. However, most researchers appear to agree that some sort of apoptosis occurs, albeit, perhaps, in a different form from that occurring in normal tissues.
        What appears certain is that the spurious reactivation of cell cycle proteins in AD-affected neurons is closely-involved with this apoptosis. The combined deleterious effects of AD trigger cellular signal transduction pathways that result in the inappropriate phosphorylation of a range of proteins. The spurious re-expression and activation of cell cycle proteins also appears to follow from the reactivation of these pathways and an ‘interrupted’ neuronal mitosis may result (106). Very recently, evidence that AD-affected neurons actually replicate DNA and complete most of S-phase before death has been reported (162). Presumably, the latter occurs because the neurons lack the full capability to divide.
          There are those who take the view that the ensuing neuronal apoptosis is similarly interrupted, or at least proceeds very slowly. This latter has been termed ‘abortosis’ by Raina et al. (118), who have shown that while upstream caspase activation (e.g. caspases 8 and 9) is associated with affected neurons, downstream caspase activation is not. These authors surmise that this might represent neuronal exit from apoptosis and is thus a survival mechanism. Other recent research, however, has provided conflicting data. For example, decreases in caspases 3, 8 and 9 have been reported (34), and associated increases in ARC (apoptosis repressor with caspase recruitment domain) and RICK (Receptor-interacting protein [RIP]-like interacting CLARP kinase) were taken as evidence of an involvement of apoptotic protein dysregulation in AD neuropathology. Conversely, other work (136) has shown an elevation of caspase 3 expression in AD that correlated with both (senile) plaques and tangles, while, in cultured cerebellar granule cells treated with A beta, the ensuant neuronal apoptosis was associated with increases in caspases 2, 3 and 6 activities (4).
          Other work has shown a correlation between tau phosphorylation, tangle formation and apoptosis. For example, hippocampal tissue slices immunostained with an antibody recognising a caspase-cleavage product of fodrin (a cytoskeletal protein) revealed that increased levels of anti-fodrin reactivity paralleled, and colocalised with, increases in levels of (the tangle marker antibody) PHF-1 reactivity (120). Also, in neuroblastoma SK-N-SH cells, abnormal tau phosphorylation, which is similar to AD, has been induced by an anticancer drug (paclitaxel). The use of an ERK inhibitor, which also inhibited apoptosis, showed that the tau phosphorylation resulted from sustained ERK activation and led to apoptosis (52).
         There is clearly much that needs to be clarified with regard to the precise mechanisms involved in regard to neuronal cell death in AD (and other neurodegenerative diseases). Although the consensus appears to be that some form of apoptosis takes place, the latter is but one of an apparently increasing number of programmed cell death (PCD) mechanisms that can occur in cells and that may be triggered concurrently. These latter have recently been reviewed (80) with the conclusion that, specifically in regard to neurons, there appear to be extra controls for caspase activation and that caspase-independent death pathways may be preferentially-activated. Other recent reviews (28,96,97,98,99) have sought to address these issues in regard to neuropathology, with the authors concluding that a better understanding of neuronal cell death mechanisms would not only expand the general knowledge of cell death biology but could lead to new therapeutic approaches.
          Whatever the precise form of apoptosis that occurs in AD-affected neurons may be, an important involvement of Pin1 protein would seem to be highly probable. In normal dividing cells Pin1 would help to ‘orchestrate’ the mitotic phosphoproteins and regulate entry and progression through the cell cycle (159). In AD-affected cells, where levels of nuclear Pin1 are depleted, these events would not be able to proceed normally. Of particular importance in this regard would be the absence of Pin1’s normal modulating action upon CdC25 (25,127,133,165) when the latter is phosphorylated and is targeted to the nucleus (72; and see Section 2.4).

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          In regard to this nuclear Pin1 depletion and the potential detrimental effects upon neuronal cell survival, hyperphosphorylation and aggregation of tau also occurs in the tauopathies. These latter include Down’s syndrome, Pick’s disease, corticobasal degeneration, frontotemporal dementia and parkinsonism linked to chromosome 17 (Fig. 4C) and progressive supranuclear palsy (18,26,41,79). Also as in AD, spurious cell cycle events have been reported in these tauopathies (62). There is thus every likelihood that depletion of nuclear Pin1 will also occur in these diseases and might therefore be a unifying, contributory factor in neuronal cell death in this class of neurodegenerative disorder. Future studies on Pin1 protein distributions during the progression of these diseases would clarify the validity of this hypothesis. A useful adjunct to the latter would be the acquisition of Pin1 protein expression data for different (affected/non-affected) brain regions in these various diseases. One study has already revealed that the deranged expression of certain chaperone proteins does occur in AD (163); a similar approach using Pin1 could further unveil its potential importance in AD and the tauopathies.
          This review has sought to bring together the various demonstrated and possible involvements of Pin1 protein in the molecular pathogenesis of AD. There is clearly much further research suggested by, and required to build upon, that published so far. In vitro research on Pin1 has elucidated much about the manner and range of its potential interactions with other proteins within living cells. Pin1 protein is abundant within cells (88) and, although preferentially nuclear, is also found in the cytoplasm. It has also been shown to have a measurable in vitro affinity for perhaps hundreds of mitotic phosphoproteins (127). Thus, any hypotheses concerning putative functions of Pin1 within AD-affected (and normal) cells must take into account this widespread cellular distribution and the promiscuous nature of its binding to other proteins. The cellular regulation of Pin1 effects (apart from possible differential expression of Pin1 itself) must therefore depend upon the subcellular juxtaposition of target and associated proteins (e.g. kinase, phosphatase, protease) and their phosphorylation status, levels and activities. Only after acquisition of such in vivo data could a role for Pin1 at the interface of specific kinases and phosphatases/proteases be ascribed with any certainty. The recent emergence of microarray technologies and the increasing availability of the relevant phosphorylation-specific antibodies should help immensely in this regard.
          This author believes that future work on Pin1 (and other proteins of interest) in AD should utilise the increasingly wide range of available and suitable transgenic mouse models (1,50,102,131,132,139).  However, it would seem paramount that any results from such work should be correlated with those from AD brain tissue and with confirmatory in vitro biochemical approaches where required.  Such research should reveal important insights into the involvement of Pin1, and its associated target and other proteins, in lesion formation and neuronal cell death in AD and the tauopathies. Such studies should also provide important basic data on the cellular control of mitosis and apoptosis.

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Acknowledgments

The author is indebted to a number of colleagues without whose collaboration this review would not have been possible. I would like to thank John Kay, whose established research and reputation in the field of the PPIase proteins first led me into the area of Pin1 protein research, and also Stuart Rulten, who collaborated extensively, enthusiastically and with excellent and wide-ranging expertise with myself during the course of my research on Pin1. I am also very grateful to Simon Morley for his enthusiastic support and freely-given experienced biochemical input whenever requested. Finally, I should like to acknowledge the indispensable support of Nigel Cairns who provided brain samples and neuropathological advice.

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