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Biophys J, April 1999, p. 1972-1987, Vol. 76, No. 4
Department of Physiology and Cell Biology, University of Nevada School of Medicine, Reno, Nevada 89557-0046 USA
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ABSTRACT |
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We investigated the regulation of cardiac cystic fibrosis
transmembrane conductance regulator (CFTR) Cl
channels by
protein kinase C (PKC) in Xenopus oocytes injected with
cRNA encoding the cardiac (exon 5
) CFTR Cl
channel
isoform. Membrane currents were recorded using a two-electrode voltage
clamp technique. Activators of PKC or a cAMP cocktail elicited robust
time-independent Cl
currents in cardiac CFTR-injected
oocytes, but not in control water-injected oocytes. The effects of
costimulation of both pathways were additive; however, maximum protein
kinase A (PKA) activation occluded further activation by PKC. In
oocytes expressing either the cardiac (exon 5
) or epithelial (exon
5+) CFTR isoform, Cl
currents activated by PKA were
sustained, whereas PKC-activated currents were transient, with initial
activation followed by slow current decay in the continued presence of
phorbol esters, the latter effect likely due to down-regulation of
endogenous PKC activity. The specific PKA inhibitor, adenosine
3',5'-cyclic monophosphothioate (Rp-cAMPS), and various protein
phosphatase inhibitors were used to determine whether the stimulatory
effects of PKC are dependent upon the PKA phosphorylation state of
cardiac CFTR channels. Intraoocyte injection of
1,2-bis(2-aminophenoxy)ethane-N,N,N,N-tetraacetic acid
(BAPTA) or pretreatment of oocytes with BAPTA-acetoxymethyl-ester (BAPTA-AM) nearly completely prevented dephosphorylation of CFTR currents activated by cAMP, an effect consistent with inhibition of
protein phosphatase 2C (PP2C) by chelation of intracellular Mg2+. PKC-induced stimulation of CFTR channels was
prevented by inhibition of basal endogenous PKA activity, and phorbol
esters failed to stimulate CFTR channels trapped into either the
partially PKA phosphorylated (P1) or the fully PKA
phosphorylated (P1P2) channel states.
Site-directed mutagenesis of serines (S686 and S790) within two
consensus PKC phosphorylation sites on the cardiac CFTR regulatory domain attentuated, but did not eliminate, the stimulatory effects of
phorbol esters on mutant CFTR channels. The effects of PKC on cardiac
CFTR Cl
channels are consistent with a simple model in
which PKC phosphorylation of the R domain facilitates PKA-induced
transitions from dephosphorylated (D) to partially (P1)
phosphorylated and fully (P1P2) phosphorylated channel states.
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INTRODUCTION |
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Cardiac protein kinase A (PKA)-regulated
Cl
channels play an important role in the regulation of
action potential duration and resting membrane potential (Harvey and
Hume, 1989
; Bahinski et al., 1989
). It has become apparent that many
biophysical and pharmacological properties of these channels resemble
those of cystic fibrosis transmembrane conductance regulator (CFTR)
Cl
channels in epithelium (see Gadsby et al., 1995
), and
recent molecular studies have confirmed that these channels are due to cardiac expression of an alternately spliced isoform (exon 5
) of the
epithelial CFTR Cl
channel (Horowitz et al., 1993
; Hart
et al., 1996
). Exon 5 represents a 30-amino acid segment in the first
cytoplasmic loop of CFTR, the functional significance of which is
currently unknown. Outside of the exon 5 region, cardiac and epithelial
CFTR cDNA exhibit ~91% nucleotide sequence homology with numerous
putative PKA and PKC phosphorylation sites highly conserved in the two
isoforms. However, the fact that exon 5 contains two putative PKC
phosphorylation sites suggests the possibility that there may be
characteristic differences in the PKC regulation of the cardiac (exon
5
) and epithelial (exon 5+) isoforms. It is also unclear at this time whether other differences outside the exon 5 spliced region of the
cardiac or epithelial isoforms may be important for channel regulation
or expression. For example, it has been reported that an engineered
epithelial exon 5
CFTR isoform fails to express functional
Cl
channels in Hela cells because of defective
intracellular processing (Delaney et al., 1993
), but may be
functionally expressed in intracellular membranes in 293 HEK cells with
a reduced single-channel conductance (Xie et al., 1996
). Molecular
studies of mammalian cardiac cells in nearly all nonprimate species yet
examined reveal exclusive expression of the exon 5
transcript
(Horowitz et al., 1993
; Hume and Horowitz, 1995
), and yet
single-channel studies in sarcolemmal membrane patches from most
cardiac myocytes examined (Ehara and Ishihara, 1990
; Nagel et al.,
1992
) reveal CFTR single-channel properties nearly identical to those
reported for the exon 5+ epithelial isoform.
In native cardiac cells, PKC has been shown to stimulate
Cl
currents, which exhibit macrosopic properties similar
to (Zhang et al., 1994
; Shuba et al., 1996
) or distinct from (Walsh,
1991
; Walsh and Long, 1994
) those of CFTR. The possibility that
PKC-activated Cl
currents in heart might be mediated by
the same population of PKA-regulated CFTR Cl
channels is
suggested by previous findings that recombinant epithelial CFTR
Cl
channels are activated by PKC phosphorylation
(Tabcharani et al., 1991
; Berger et al., 1993
), as well as by the
report that PKC and PKA activate unitary Cl
channels in
native cardiac cells with nearly identical conductance and
rectification properties (Collier and Hume, 1995
).
Xenopus oocytes have previously been used as an expression
system for functional studies of epithelial CFTR Cl
channels (Bear et al., 1991
; Drumm et al., 1991
), and the recent demonstration of robust expression of cardiac (exon 5
) CFTR
Cl
channels in Xenopus oocytes (Hart et al.,
1996
) suggests that this may be a useful expression system for
examination of protein kinase regulation of cardiac CFTR
Cl
channels. The purposes of the present study were 1) to
compare the regulation of cardiac (exon 5
) CFTR Cl
channels by PKA and PKC, 2) to determine whether PKC regulation of
cardiac CFTR Cl
channels is dependent upon the PKA
phosphorylation state of CFTR channels, and 3) to determine whether
mutations at two R domain putative PKC phosphorylation sites, S686 and
S790, in the cardiac isoform of CFTR alter the functional response of
expressed CFTR Cl
channels to PKA or PKC stimulation. A
preliminary report of these results has been published as an abstract
(Yamazaki et al., 1997
).
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MATERIALS AND METHODS |
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cRNA preparation and injection of oocytes
cRNA encoding the full-length CFTR (exon 5
) coding sequence
from rabbit ventricle was prepared as previously described (Hart et
al., 1996
); cRNA encoding the full-length human epithelial CFTR (exon
5+) coding sequence was kindly provided by Dr. Johanna Rommens
(Hospital for Sick Children, Toronto, Ontario, Canada). Adult
Xenopus laevis were anesthetized by immersion in a solution of tricaine methanesulfonate (1 g/liter), and oocytes were surgically removed. To remove follicular cells, the oocytes were incubated in ND
96 solution (mM: 96 NaCl, 2 KCl, 1.8 CaCl2, 1.0 MgCl2, 5.0 HEPES; pH 7.4) containing collagenase (Sigma,
type 1A) at room temperature for 2-3 h with gentle shaking, and then
stored in ND 96 solution containing 2.5 mM sodium pyruvate and
gentamycin (1 mg/ml). Injection pipettes with tips ~20 µm in
diameter were baked at >150°C for 3-4 h to destroy RNases. The
pipettes were mounted in a Drummound Nanoject autoinjector (Drummound
Scientific, Broomall, PA), and oocytes were injected with 46 nl of cRNA
of cardiac or epithelial CFTR, or distilled water. Oocytes were then stored in ND 96 plus pyruvate and gentamycin at 18°C.
Site-directed mutagenesis
The serine at position 686 and/or 790 was modified by polymerase
chain reaction-based site-directed mutagenesis (Jones and Howard, 1991
)
to alanine to create S686A, S790A, and S686 + 790A cardiac CFTR cDNA.
The mutations were confirmed by nucleotide sequencing of both strands
of the mutated cDNA.
Whole-cell current recording from oocytes
Membrane currents were recorded at room temperature from oocytes
3-5 days after injection, using a two-microelectrode voltage clamp
system (TEV-200; Dagan, Minneapolis, MN). Microelectrodes were
filled with 3 mol/liter KCl and had resistances of 0.5-5 M
.
Voltages are reported with reference to the bath. Cl
currents were recorded in either nominally Ca2+-free ND96
solution or Ca2+-containing (1.8 mM) ND96 solutions
including 100 µM niflumic acid to prevent the activation of
endogenous Cl
channels. Membrane currents were filtered
at 2.0 kHz, digitized on-line, and stored on a computer. Data analysis
was performed with pCLAMP 5.5.1 (Axon Instruments, Foster City, CA). In
some experiments, Cl
dependence was determined by
replacing bath NaCl with Na aspartate (total [Cl
] was
24 mM). In 0 mM Ca2+ solution, Ca2+ was
replaced with Mg2+ (total [Mg2+] was 2.8 mM),
and 1 mM EGTA was added. The external solution used to elevate cAMP
(cAMP cocktail (1×)) included 8-bromo-cAMP (100 µM), forskolin (1 µM), and 3-isobutyl-1-methylxanthine (IBMX) (500 µM) to activate
PKA and adenylate cyclase and inhibit phosphodiesterase activity, respectively. cAMP cocktail (5× and 10×), which contained a
5 and 10 times higher concentration of each component, was used to
maximally stimulate CFTR Cl
channels. The flow rate was
usually 1.5 ml/min.
PDBu, 4
-phorbol, DiC8, niflumic acid (Sigma, St. Louis, MO),
1,2-bis(2-aminophenoxy)ethane-N,N,N,N-tetraacetic
acid-acetoxymethyl-ester (BAPTA-AM), staurosporine,
bisindolylmaleimide, microcystin LR, and okadaic acid (Calbiochem, La
Jolla, CA) were prepared as stock solutions in dimethylsulfoxide
(DMSO). Forskolin (Sigma) was prepared as a stock solution in
polyethylene glycol. These stock solutions were diluted to the desired
final concentration immediately before use. The final concentration of
DMSO and polyethylene glycol was less than 0.1%, which, by themselves,
did not affect Cl
currents. Adenosine 3',5'-cyclic
monophos-phothioate Rp-isomer (Rp-cAMPS) (Calbiochem) was dissolved in
distilled water. All other compounds were purchased from Sigma. Some
oocytes were superfused with BAPTA-AM (100 µM) in nominally
Ca2+-free solutions.
In some experiments, okadaic acid, microcystin LR, calmidazolium chloride, cyclosporin A, Rp-cAMPS, BAPTA tetrapotassium salt, and MgSO4 were directly injected into oocytes (Drummond Nanoject autoinjector) with glass pipettes (25 µm diameter) after the pH was adjusted to 7.2-7.3. The intracellular concentration of these compounds was estimated from the injection volume (~46 nl) and the approximate volume of the oocytes (1000 nl). Most other compounds were applied directly to the perfusion solution.
Data analysis
The concentration-response curve for PDBu was analyzed by
fitting the logistic equation R = ((Rmax
Rmin) × An)/(EC50n + An) + Rmin, where
R is the amplitude of the current,
Rmax is the maximum current,
Rmin is the minimum current, A is the
concentration of PDBu, EC50 is the dose of PDBu giving the
half-maximum current, and n is the slope factor.
Data are expressed as arithmetic means ± SEM. Statistical analysis between two groups was made by unpaired Student's or Welch's t-test. When values before and after treatments were compared, a paired t-test was used. In the case of more than three groups, one-way analysis of variance (ANOVA) and post hoc Bonferroni's multiple t-tests were performed. When values of three treatments in each preparation were compared, one-way ANOVA with repeated measures and the post hoc multiple t-test were used. p < 0.05 was considered to be statistically significant.
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RESULTS |
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PKA- and PKC-induced Cl
currents in cardiac
CFTR-injected oocytes
To compare the regulation of cardiac CFTR chloride channels by PKA
and PKC, we examined the effects of a cAMP cocktail (1×) and a PKC
activator, phorbol-12,13-dibutylate (PDBu) or
1,2-dioctanoyl-sn-glycerol (DiC8). To abolish endogenous
Ca2+-activated Cl
currents and
Ca2+-inactivated Cl
currents (Weber et al.,
1995
), niflumic acid (100 µM) was included in the superfusion
solutions. Before the addition of any drugs, background currents were
small over the potential range of
110-70 mV examined. The cAMP
cocktail elicited typical time-independent Cl
currents in
oocytes injected with cRNA encoding the cardiac CFTR exon 5
splice
transcript (Hart et al., 1996
), but not in water-injected control
oocytes (Fig. 1 A). After
washout of the cAMP cocktail, a subsequent application of PDBu (100 nM)
elicited similar but smaller time-independent currents in cardiac
CFTR-injected oocytes. The current-voltage relationship for
PDBu-induced currents exhibited some slight outward rectification under
these asymmetrical Cl
conditions and exhibited a mean
reversal potential (
14.8 ± 4.0 mV, n = 5)
similar to that of cAMP-induced Cl
currents (
17.8 ± 5.6 mV, n = 5; Fig. 1 B). PDBu did not
alter the background current in water-injected oocytes.
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Fig. 1 C shows the concentration-response relationship for
PDBu. PDBu caused maximum current activation at 100 nM in CFTR-injected oocytes. The EC50 value was estimated as 10.5 nM. The PDBu
(100 nM)-induced currents were smaller in amplitude than cAMP
cocktail-induced currents; the current ratio (PDBu/cAMP) was constant
over the potential range from
110 to 70 mV: 66.3 ± 7.7% (
110
mV), 74.4 ± 8.1% (
50 mV), and 63.9 ± 5.1% (70 mV,
n = 4). In eight oocytes sequentially exposed to the
cAMP cocktail and then to PDBu after washout, the cAMP- and
PDBu-induced currents during the voltage pulses to 70 mV were 5.1 ± 0.5 µA and 3.4 ± 0.5 µA, respectively. DiC8 (100 µM), a
diacylglycerol analog, mimicked PDBu in activating time-independent
currents in cardiac CFTR-injected oocytes (Fig. 1 D). cAMP
cocktail- and DiC8-induced currents at 70 mV were 6.3 ± 1.6 µA
and 1.6 ± 0.3 µA, respectively (n = 3).
Although the DiC8 effect appeared to be smaller than that of PDBu
(DiC8/cAMP was 25.2% at 70 mV), DiC8-induced currents also exhibited
slight outward rectification, and the current-voltage relationship
exhibited a mean reversal potential of
20.3 ± 0.7 mV
(n = 3). An inactive analog, 4
-phorbol (100 nM), or
0.1% DMSO, the solvent for PDBu and DiC8, had little effect on the
background currents in cardiac CFTR-injected oocytes (data not shown).
The experiments in Fig. 2, A
and B, examined the Cl
sensitivity of the
PDBu-induced currents. Outward PDBu-induced currents were reduced upon
as external Cl
was changed from 104 to 24 mM. The
reversal potentials were
19.3 ± 1.7 and +10.5 ± 2.8 mV in
104 mM Cl
and 24 mM Cl
bath solutions
(n = 4), respectively, a shift of ~30.5 mV, close to
the predicted 35-mV shift of the estimated Cl
equilibrium
potential under these conditions. Fig. 2 C shows the
inhibition of the PDBu-induced current by the nonspecific protein
kinase inhibitor, staurosporine (1 µM), and by a specific PKC
inhibitor, bisindolylmaleimide (1 µM). Staurosporine significantly inhibited the PDBu-induced current by 60% at 70 mV.
Bisindolylmaleimide significantly inhibited the PDBu-induced current by
over 90% at 70 mV. These results suggest that PKA or PKC stimulation
activates time-independent Cl
currents in oocytes
expressing cardiac CFTR, but not in water-injected control oocytes.
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Ca2+ is known to be required to activate some isozymes of
PKC, in addition to diacylglycerol or phorbol ester (Nishizuki, 1988
). We therefore tested whether the ability of PKC stimulation to activate
CFTR Cl
currents in oocytes was Ca2+
dependent. We compared the effects of the cAMP cocktail and PDBu in
cardiac CFTR-injected oocytes (Fig. 2 D) that were perfused with either 1.8 mM Ca2+-containing external solutions
(open columns) to those that were perfused with
Ca2+-free external solutions containing EGTA (1 mM)
(hatched columns). Whereas the mean amplitude of the
cAMP-activated current at 70 mV was almost the same under these
conditions, the PDBu-induced Cl
currents were
significantly smaller in oocytes in Ca2+-free external
solutions compared to oocytes in solutions containing 1.8 mM
Ca2+. These results suggest a possible role of some
Ca2+-dependent step in the PKC pathway regulating cardiac
CFTR Cl
channels in oocytes.
To confirm that both PKA and PKC activate the same population of
cardiac CFTR Cl
channels, we examined the additivity of
currents activated by both pathways. If the same channels are activated
by both pathways, it is expected that submaximum concentrations of
either agonist should be additive, but a supramaximum concentration of
either agonist should occlude the response to the other agonist. Fig. 3 A shows typical time courses
of the outward currents at 70 mV during stimulation by PKA alone, or in
combination with stimulation of PKC (mean current normalized with the
response to cAMP cocktail). The PDBu-induced current alone was
65.3 ± 10.3% (n = 4) of the cAMP cocktail
(1×)-induced current (Fig. 3 B). Subsequent addition of
cAMP cocktail during the peak of the PDBu-induced current further increased the Cl
current by 21.6 ± 5.5% more than
the cAMP cocktail-induced current alone. In Fig. 3 B, it can
also be seen that PDBu also further increased the Cl
current activated by cAMP cocktail (1×) by 34.9 ± 8.6%
(n = 4). These results suggest that the stimulatory
effects of submaximum concentrations of either agonist are additive
with respect to the amplitude of Cl
current activated.
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We next tested whether supramaximum stimulation by the cAMP cocktail
would occlude the stimulatory effects of PDBu. cAMP cocktail (10×)
gave the same degree of activation of Cl
currents as cAMP
cocktail (5×), which was ~20% greater than the effect of cAMP
cocktail (1×; Fig. 3 D), suggesting that cAMP cocktail (5×
and 10×) maximally activates the available Cl
channels.
As shown in Fig. 3, C and D, PDBu failed to
increase Cl
current further once they were maximally
activated by cAMP cocktail (10×); instead it decreased the currents
slightly. These results are consistent with the interpretation that the
effects observed with PKA and PKC stimulation are both mediated by the
same population of recombinant cardiac CFTR Cl
channels.
Biphasic response of CFTR Cl
channels to PKC
stimulation
The time courses and duration of activation of cardiac CFTR
channels by cAMP cocktail, PDBu, and DiC8 are compared in Fig. 4 A. The PKA-activated
Cl
currents usually reached a steady-state level after
~12 min and were well sustained for more than 30 min. In contrast,
the PDBu and DiC8-induced currents exhibited a biphasic time course.
PDBu- or DiC8-induced Cl
currents usually reached their
maximum level after 7.5 ± 1.6 min (n = 4), and
prolonged exposure resulted in a dramatic decline of the currents in
the continued presence of either compound. Such a decline was observed
at all membrane potentials examined. Fig. 4 B summarizes
these data for normalized current amplitudes evoked by PKA and PKC
stimulation as a function of time of exposure. Currents activated by
both PKA and PDBu were nearly at maximum (~90%) within 10 min, and
the cAMP-induced currents were stable for more than 30 min in the
continued presence of the cAMP cocktail (100.1 ± 1.9% at 30 min,
n = 4). In contrast, the PDBu-induced currents were
reduced to 17.3 ± 11.0% (n = 4) of their maximum value within 30 min in the continued presence of PDBu. Such a biphasic
response to PDBu was also observed in oocytes bathed in
Ca2+-free solutions.
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The most obvious explanation for the observed decline in PDBu- or
DiC8-induced Cl
currents in the maintained presence of
either agonist is possible desensitization of some component of the PKC
pathway. Alternatively, the observed current decline might reflect
PKC-induced modulation, resulting in channel dephosphorylation or
channel inactivation. In the case of inactivation, one might expect
that PKC would also alter subsequent channel activation by other
intracellular pathways, for example, the activation by PKA. In Fig.
5 A (left), the
cAMP cocktail was perfused initially to obtain the control response to
PKA activation (the first response). After washout of cAMP cocktail,
PDBu (100 nM) was perfused, and the PDBu-activated currents were
allowed to decline to ~20% of the peak PDBu response (~30 min).
Immediately after PDBu-induced current decline, in the continued presence of PDBu, the response to PKA stimulation was retested. A
significantly smaller response to the cAMP cocktail was observed compared to the control (Fig. 5 A, right;
34.5 ± 9.9%, n = 4). In the absence of PDBu,
repeated application of the cAMP cocktail after a similar interval of
60 min failed to reveal any significant change in the amplitude of the
PKA-induced current (Fig. 5 A, right). Thus prior
inactivation of cardiac CFTR Cl
channels by PKC
stimulation reduces the ability of PKA to subsequently activate the
channels. We also verified that the PDBu-induced inhibition of
Cl
channels can be attributed to PKC stimulation. In
oocytes pretreated with the specific PKC inhibitor bisindolylmaleimide
(5 µM), PDBu failed to cause an increase in Cl
current
and failed to inhibit Cl
currents activated by subsequent
exposure to cAMP cocktail (data not shown).
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To investigate the possibility of functional differences in PKC
regulation between cardiac and epithelial isoforms of CFTR Cl
channels, the protocol that was employed in Fig. 5
A was performed with epithelial (exon 5+) CFTR-injected
oocytes. cAMP cocktail (1×) and PDBu (100nM) elicited
Cl
-dependent outwardly rectifying currents (under
asymmetrcial Cl
conditions) in epithelial (exon 5+)
CFTR-injected oocytes, but not in water-injected control oocytes. Like
cardiac (exon 5
) CFTR-injected oocytes, the peak PDBu-induced current
amplitude at 70 mV was 55.7 ± 10.5% (n = 4) of
the peak cAMP-induced current amplitude in epithelial (exon 5+)
CFTR-injected oocytes. As shown in Fig. 5 B
(left), cAMP cocktail was initially perfused to obtain the
response to PKA stimulation. Prolonged perfusion of PDBu resulted in an
initial current activation followed by inactivation. As in the case of
cardiac CFTR channels, epithelial channels inactivated by exposure to
PDBu exhibited a significantly smaller subsequent response to PKA
stimulation, compared to the control cAMP response (Fig. 5
B, right). It appears, therefore, that epithelial
(exon 5+) CFTR Cl
channels respond to PKC stimulation in
a manner similar to that of cardiac (exon 5
) CFTR Cl
channels: an initial transient activation, followed by slow inactivation.
Role of endogenous protein kinases and phosphatases
It is well known that the activity of CFTR Cl
channels is regulated by phosphorylation of its regulatory domain (R
domain) by PKA. Thus channels are believed to require PKA
phosphorylation and ATP hydrolysis to open (Gadsby et al., 1995
;
Foskett, 1998
); however, the role of PKC phosphorylation is less clear.
To investigate whether PKC modulation of cardiac CFTR channels involves
basal PKA activity in oocytes, we examined the effect of a specific PKA
inhibitor, Rp-cAMPS on PDBu-induced Cl
currents.
Injection of Rp-cAMPS (5 µM) was effective in attenuating the
cAMP-induced Cl
conductance when it was injected during
perfusion with cAMP cocktail (Fig. 6
A). Prior injection of oocytes with Rp-cAMPS greatly
attentuated the ability of PDBu (100nM) to stimulate cardiac CFTR
currents (Fig. 6 B). Fig. 6 C shows the time
course of PDBu-induced currents at 70 mV. Rp-cAMPS (5 and 10 µM)
inhibited the peak amplitude of the PDBu-induced CFTR currents from the
control level of 58.8 ± 8.1% of the peak cAMP-induced current to
30.2 ± 6.6% and 16.8 ± 6.5%, respectively. Thus the
ability of PDBu to stimulate cardiac CFTR channels seems to be highly
dependent upon basal PKA activity, suggesting that PKC phosphorylation
per se does not open CFTR Cl
channels.
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We also tested the hypothesis that endogenous PKC activity may regulate
CFTR activation by PKA (Jia et al., 1997
). Oocytes were first exposed
to the cAMP cocktail to obtain the control response to PKA activation.
After washout of cAMP cocktail, the specific PKC inhibitor
bisindolylmaleimide (5 µM) was perfused, and then the response to the
cAMP cocktail was retested in the continued presence of
bisindolylmaleimide. As illustrated in Fig. 6 D, the
subsequent response to PKA stimulation was significantly attentuated
after inhibition of endogenous PKC activity by bisindolylmaleimide. In
three oocytes, the subsequent response to PKA stimulation was reduced
to 53.7 ± 10.2% of the control response after exposure to
bisindolylmaleimide (inset). These data support the
hypothesis that PKC phosphorylation of CFTR significantly potentiates
PKA activation of CFTR (Jia et al., 1997
; Middleton and Harvey, 1998
).
Although the PKC-mediated decline in CFTR Cl
currents may
be due to PKC desensitization or PKC-induced channel inactivation, other possible explanations remain. It is possible that the stimulatory effects of PKC are due to a direct phosphorylation of CFTR, whereas the
inhibitory effects might be due to dephosphorylation of CFTR channels,
possibly from PKC stimulation of an endogenous protein phosphatase. To
examine the role of endogenous phosphatases in PKC-induced
inactivation, we first investigated the effects of okadaic acid (OA), a
protein phosphatase 1 and 2A (PP1 and PP2A) inhibitor, on the peak
amplitude and rate of decline of the PDBu-induced current. The rate of
deactivation of Cl
current upon removal of the cAMP
cocktail is believed to reflect the rate of dephosphorylation of CFTR
channels by endogenous phosphatases (Gadsby et al., 1993
), and in
native cardiac cells, differential sensitivity to phosphatase
inhibitors revealed that PKA regulation of CFTR involves
phosphorylation of the R domain at at least two distinct sites:
P1, which is essential for channel activation, and
P2, which controls the open probability of activated
channels (Hwang et al., 1993
). The okadaic acid (OA)-sensitive protein phosphatase 2A (PP2A) is believed to dephosphorylate the activation site P1, whereas an okadaic acid-insensitive protein
phosphatase (possibly PP2C) is believed to dephosphorylate the
modulatory site P2 (Hwang et al., 1993
; see Fig. 11).
Fig. 7 A shows an experiment
in which intraoocyte injection of OA (~1 mM) alone elicited some
small activation of basal Cl
current, which could be
further enhanced by exposure to the cAMP cocktail (1×). The rate of
current deactivation after withdrawal of the cAMP cocktail in oocytes
injected with OA or superfused with OA (100 nM and 1 µM) was
significantly prolonged with
1/2 of deactivation changed
from 7.4 ± 1.3 min to 12.0 ± 1.6 min (n = 4) and to 15.3 ± 1.9 min, respectively (n = 3;
Fig. 7 B). Furthermore, in the continued presence of OA,
PDBu still elicited a biphasic response (Fig. 7 C). The
amplitude of the PDBu-induced currents was not significantly different
in the presence or absence of okadaic acid (100 nM or 1 µM; Fig.
7 D), and the
1/2 for PDBu-induced current inactivation was not
significantly different in the absence (10.88 ± 0.97 min,
n = 4) or presence (100 nM, 8.00 ± 0.74 min, n = 4; 1 µM, 8.83 ± 1.45 min, n = 3; p > 0.05) of okadaic acid. These results indicate
that OA, as in native cardiac myocytes (Gadsby et al., 1993
), can
inhibit endogenous PP1 and 2A, which causes some prolongation of the
rate of dephosphorylation of cAMP-activated CFTR currents in this
expression system, but phosphatases 1 and 2A are unlikely to be
involved in the PKC-mediated inactivation of cardiac CFTR
Cl
channels.
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In native cardiac myocytes, both OA-sensitive and OA-insensitive
dephosphorylation of CFTR Cl
channels has been
demonstrated, and it has been proposed that the OA-insensitive
phosphatase involved may be protein phosphatase 2C (PP2C) (Gadsby and
Nairn, 1994
). Although PP2C has recently been directly shown to
dephosphorylate epithelial CFTR channels in cell-free membrane patches
(Travis et al., 1997
; Luo et al., 1998
), there are no known effective
inhibitors of PP2C. Another OA-insensitive phosphatase, the
Ca2+-dependent protein phosphatase 2B (PP2B), has recently
been shown to dephosphorylate epithelial CFTR channels in NIH 3T3
fibroblasts (Fischer et al., 1998
). To initially test whether a
Ca2+-sensitive phosphatase, possibly protein phosphatase 2B
(PP2B), might also be involved in regulating the dephosphorylation of cardiac CFTR channels in oocytes, we examined the effects of
intracellular chelation of Ca2+, by injection of BAPTA
tetrapotassium salt (1.25 mM) or pretreatment of oocytes with BAPTA-AM
(100 µM), on the rate of deactivation of Cl
current
upon removal of the cAMP cocktail. As shown in Fig. 8 A,
injection of BAPTA alone caused a small activation of CFTR Cl
current, which could be further enhanced by exposure
to the cAMP cocktail (1×). Interestingly, in contrast to OA, BAPTA
injection appeared to nearly completely prevent deactivation of CFTR
channels upon washout of the cAMP cocktail. A similar effect was
observed in oocytes pretreated with BAPTA-AM (Fig. 8 B).
Deactivation of CFTR channels was nearly completely prevented for
periods of 30 min to 1 h after washout of the cAMP cocktail. This
striking effect suggests that a Ca2+-sensitive PP (PP2B)
may be a potent regulator of CFTR dephosphorylation in oocytes.
However, injection of two known inhibitors of PP2B, calmidazolium and
cyclosporin A (Gietzen et al., 1981
; Liu et al., 1991
), at a
concentration of 1 µM, failed to modify the deactivation of CFTR
channels upon washout of the cAMP cocktail (data not shown). Because
this concentration effectively inhibits PP2B in 3T3 cells (Fischer et
al., 1998
), it would appear that the ability of BAPTA injection or
BAPTA-AM pretreatment to prevent deactivation of CFTR after cAMP
washout may be unrelated to inhibition of PP2B. Because the
concentrations of cAMP cocktail used in these experiments (1×) appear
to activate at least 80% of the maximum CFTR Cl
current
available under control conditions (cf. Fig. 3 D), and BAPTA
appears to prevent channel dephosphosphorylation, it is possible that
channels activated under these conditions become locked into the fully
phosphorylated (P1P2) state (Hwang et al., 1993
; Fig. 11). It was previously shown that under normal conditions, CFTR channels activated by cAMP cocktail immediately dephosphorylate in
response to injection of the specific PKA inhibitor Rp-cAMPS (Fig. 6
A). If, in fact, BAPTA treatment causes CFTR channels to
become locked into the fully phosphorylated
(P1P2) state, then channels under these
conditions would not be expected to dephosphorylate in response to
inhibition of PKA by Rp-cAMPS. In agreement with this prediction, CFTR
Cl
currents activated by cAMP cocktail in
BAPTA-AM-pretreated oocytes were nearly completely insensitive to
injection of Rp-cAMPS (Fig. 8 C).
Although many serine/threonine PPs are known to require metals for
catalytic activity, PP2C may be a potential target for BAPTA, because
PP2C, in contrast to other PPs, requires high (mM) Mg2+ for
activity (Stemmer and Klee, 1991
), and the ability of PP2C to directly
dephosphorylate epithelial CFTR channels has been shown to require
cytoplasmic Mg2+ in the millimolar range (Travis et al.,
1997
). To test whether the ability of BAPTA-AM pretreatment to nearly
completely prevent CFTR channel dephosphorylation might be due to
chelation of [Mg2+]i and subsequent
inhibition of endogenous PP2C activity, we tested whether direct
intraoocyte injection of Mg2+ might reverse the effects of
BAPTA-AM. As shown in Fig. 8 D, intraoocyte injection of
Mg2+ (estimated final intracellular concentration 1 mM)
effectively stimulated dephosphorylation of CFTR channels after washout
of cAMP cocktail in an oocyte pretreated with BAPTA-AM. Similar results were observed in three additional BAPTA-AM-treated oocytes, suggesting that BAPTA-AM pretreatment prevents CFTR channel dephosphorylation by
chelation of [Mg2+]i and possibly inhibition
of endogenous PP2C activity. Although additional studies are certainly
required to unequivocally establish exactly which PP activity might be
inhibited by BAPTA, there is little doubt that in BAPTA-treated
oocytes, strong cAMP stimulation irreversibly activates CFTR
Cl
channels, which become locked into a fully
phosphorylated state.
CFTR channels locked into partially or fully PKA-phosphorylated states are unresponsive to stimulation by PKC
We first tested whether locking CFTR channels into a partially
phosphorylated (P1) state would affect their response to
PKC stimulation. Channels activated by unmasking basal PKA activity by
inhibition of PP1 and 2A are expected to partition into both the
partially (P1) and fully (P1P2)
phosphorylated states, in contrast to channels activated by strong PKA
stimulation, which are expected to become more fully phosphorylated
(Hwang et al., 1993
; Fig. 11). Injection of oocytes with the
membrane-impermeant PP1 and 2A inhibitor microcystin (5 µM) alone
caused activation of cardiac CFTR channels, presumably by unmasking
basal PKA activity (Fig. 9 A).
These effects were not observed in water-injected control oocytes.
Under this condition, subsequent exposure to PDBu still elicited the
usual stimulatory and inhibitory effects. However, if some of the
channels activated by microcystin are forced to dephosphorylate from
the fully phosphorylated state (P1P2) by
subsequent injection of Rp-cAMPS, then all channels are expected to
become trapped into the partially phosphorylated (P1)
state. Remarkably, channels trapped in the P1 state under these conditions failed to be stimulated by 100 nM PDBu (Fig. 9
B). These data show that PKC stimulation of cardiac CFTR
Cl
channels is highly dependent upon the PKA
phosphorylation state of the channels.
|
To examine the effects of PDBu on channels in the fully (P1P2) phosphorylated state, oocytes were pretreated with BAPTA-AM and initially exposed to cAMP cocktail (1×) to irreversibly activate CFTR channels. After the washout of cAMP cocktail, when CFTR channels fail to dephosphorylate and currents are sustained, exposure to PDBu (100 nM) caused inactivation but produced little or no stimulation of CFTR currents (Fig. 9, C and D).
Functional effects of mutagenesis of two PKC phosphorylation sites in the R domain
Epithelial CFTR protein has previously been shown to be directly
phosphorylated by PKC (Berger et al., 1993
). Serines 686 and 790 are
believed to represent two major consensus PKC phosphorylation sites in
the R domain, and these have been shown to be phosphorylated by agents
that activate PKC (Picciotto et al., 1992
; Dulhanty and Riordan, 1994
).
However, the effects of mutations of these sites on functional
regulation of CFTR Cl
channels by PKC have not yet
been examined in cardiac or epithelial CFTR isoforms.
We examined cAMP and PDBu regulation of cardiac (exon 5
) CFTR
channels in oocytes injected with mRNA encoding three mutant constructs: S686A, S790A, and the double mutant S686A-S790A. Fig. 10, A and B,
shows representative currents at 70 mV for the S686A and S686A-S790A
mutants during exposure to the cAMP cocktail, PDBu, and then a
subsequent cAMP cocktail in the continued presence of PDBu. In these
mutants, cAMP cocktail (1×) stimulated the Cl
conductance, as well as in the wild-type cardiac (Fig. 5 A)
or epithelial CFTR (Fig. 5 B). PDBu (100 nM) still activated
CFTR currents in these mutants, although the amplitude appeared to be
less than in the wild-type channels. Fig. 10 C shows a
comparison of the absolute current amplitudes activated by cAMP in
Xenopus oocytes injected with 47 ng of mRNA encoding
S686A(card), S790A(card), S686A-S790A(card), wild-type cardiac (card),
or wild-type epithelial CFTR. There were no significant differences in
cAMP-induced current amplitudes in the three mutants and two CFTR
wild-type channels. This is consistent with a previous report that
showed no significant differences in PKA activation sensitivity for the
S686A mutant in epithelial CFTR channels (Wilkinson et al., 1996
). In
contrast, the relative peak current amplitude elicited by 100 nM PDBu
was significantly less in the three mutants compared to either
wild-type channel (Fig. 10 D). Normalized PDBu-induced
current amplitudes were 55.2 ± 8.8% (n = 4) for
wild-type channels, 27.6 ± 5.5% (n = 5) for
S686A, 29.0 ± 3.6% (n = 4) for S790A, and
25.1 ± 2.4% (n = 4) for the S686A-S790A double
mutant.
|
Finally, to assess the degree and extent of PDBu-induced inactivation
of CFTR currents in the mutant channels, current amplitudes elicited by
a second exposure to cAMP cocktail, after PDBu-induced current
inactivation in the continued presence of PDBu, were measured and
compared to the control cAMP-induced current amplitudes (Fig. 10,
A and B). There were no apparent differences in
the extent of PDBu-induced inactivation of CFTR, measured this way, for
the three mutants and two CFTR wild-type channels. These results
suggest that the stimulatory effects of PKC on cardiac CFTR
Cl
channels are significantly reduced by mutations in the
two R domain consensus PKC phosphorylation sites, S686 and S790, but these mutations have very little effect on the extent of PKC-induced slow inactivation of CFTR Cl
channels.
| |
DISCUSSION |
|---|
|
|
|---|
The present experiments provide direct evidence that stimulation
of PKC results in modulation of the cardiac isoform (exon 5
) of CFTR
(Hart et al., 1996
). This evidence includes the following: 1) Both PDBu
and cAMP cocktail activated Cl
current in cardiac
CFTR-injected oocytes, but not in water-injected oocytes. 2)
PDBu-induced currents were time independent and exhibited a linear
current-voltage relationship (with symmetrical Cl
)
similar to that of endogenous cAMP-activated Cl
channels
in native cardiac myocytes (Harvey et al., 1990
; Collier and Hume,
1995
). 3) The shift of reversal potential of the PDBu-induced currents,
when external Cl
was reduced, was close to the predicted
shift of the estimated Cl
equilibrium potential,
indicating a significant Cl
permeability, similar to
PKA-activated Cl
currents in cardiac CFTR-injected
oocytes (Hart et al., 1996
). 4) PDBu-induced currents were inhibited by
the kinase inhibitor staurosporine and by a specific PKC inhibitor,
bisindolylmaleimide. 5) The effects of PDBu were mimicked by the
diacylglyerol analog DiC8, but not by the inactive analog 4a-phorbol.
Finally, the findings that submaximum concentrations of PDBu and cAMP
cocktail were additive in terms of the overall magnitude of current
activated, whereas maximum stimulation by one agonist occluded the
effects of the other agonist, support the conclusion that stimulation by PKA and PKC results in activation of the same population of CFTR
Cl
channels.
In oocytes perfused with Ca2+-containing solutions,
PDBu-activated CFTR Cl
current amplitudes were
~55-65% of those of PKA-activated currents. However, in oocytes
perfused with Ca2+-free solutions, PDBu-activated CFTR
Cl
current amplitudes were only 20-30% of those of
PKA-activated currents. This Ca2+ dependence seems specific
for CFTR currents activated by PKC, because the presence or absence of
Ca2+ had no significant effect on the magnitude of currents
activated by PKA stimulation. This Ca2+ dependence of
PDBu-induced CFTR Cl
currents can be explained by
endogenous expression of Ca2+-dependent PKC isozymes in
oocytes (Ohno et al., 1988
; Nishizuki, 1988
). It is noteworthy that
even in the absence of Ca2+, PDBu still caused both
activation and inactivation of CFTR currents, suggesting the presence
of Ca2+-independent PKC isozymes in this preparation as
well. That expression patterns of Ca2+-dependent and
-independent PKC isozymes vary considerably between different cell
types (Newton, 1996
) may account for some of the variability reported
for the efficacy of phorbol esters in activating CFTR in both native
cells (Zhang et al., 1994
; Walsh and Long, 1994
; Shuba et al., 1996
;
Oleksa et al., 1996
), as well as heterologous expression systems
(Tabcharani et al., 1991
; Berger et al., 1993
). Other factors as well
may be expected to influence the efficacy of activation of CFTR
Cl
channels by PKC stimulation. Our results indicate that
the ability of phorbol esters to activate cardiac CFTR channels is
highly dependent upon the level of basal PKA activity in oocytes. Thus preexposure of oocytes to the specific PKA inhibitor Rp-cAMPS nearly
completely eliminates the ability of phorbol esters to subsequently
activate the channels (cf. Fig. 6). Therefore, PKC phosphorylation
alone seems unable to open CFTR channels, but requires basal PKA
activation. The ability of PP inhibitors to cause substantial
activation of CFTR channels expressed in oocytes (cf. Fig. 11) also
indicates that there is a considerable level of basal PKA activity in
this preparation, which may explain the ability of PDBu alone to cause
robust activation of these channels in oocytes. However, the basal
level of endogenous PKA and PP activities may be expected to vary
considerably between different cell types and experimental conditions.
This may account for some of the differences reported in the observed
sensitivity of CFTR channels to PKC stimulation in different tissues.
Possible differences in the regulation of cardiac and epithelial CFTR
channels by PKC phosphorylation were examined, because two putative PKC
phosphorylation sites on exon 5 are missing in the rabbit cardiac
isoform (Horowitz et al., 1993
; Hart et al., 1996
). However, functional
analysis of both expressed CFTR channel isoforms in our experiments
failed to reveal any significant differences in the general pattern of
regulation by phorbol esters, suggesting that the two PKC
phosphorylation sites on exon 5 play little, if any, role in the normal
regulation of the channel by PKC phosphorylation. Site-directed
mutagenesis of two serine residues (S686 and S790) in the cardiac CFTR
isoform did reveal, however, the importance of two putative PKC
phosphorylation sites in the R domain for channel regulation by phorbol
esters. PDBu-induced CFTR current amplitudes were reduced by
approximately half in the S686A, S790A, and the double mutant
S686A-S790A constructs examined. These results provide the first
functional confirmation of the importance of these PKC phosphorylation
sites, which were predicted from earlier phosphorylation studies
(Picciotto et al., 1992
; Dulhanty and Riordan, 1994
). The fact that
these mutations failed to completely eliminate CFTR activation by
phorbol esters suggests that other PKC phosphorylation sites, in
addition, are also important for CFTR channel regulation.
A characteristic difference in the effects of the cAMP cocktail and
PDBu on cardiac recombinant CFTR channels was the slow decay of
currents observed in the continued presence of PDBu or DiC-8, compared
to those activated by cAMP, which were well maintained in the continued
presence of cAMP cocktail. Both current activation and current decay
induced by phorbol esters can be attributed to PKC stimulation, because
they were both prevented by the specific PKC inhibitor
bisindolylmaleimide. A slow phase of PKC-induced down-regulation of
L-type Ca2+ channels and Na/K ATPase expressed in oocytes
has been reported and attributed to phorbol ester activation of
endocytosis, triggering internalization of membrane proteins (Vasilets
et al., 1990
; Bourinet et al., 1992
). However, we failed to detect any
changes in oocyte membrane capacitance over the time period of
PDBu-induced current decline with concentrations of PDBu as high as 500 nM (data not shown).
The most likely explanation for the PKC-induced current decline is
desensitization of some component of the PKC pathway (Mond et al.,
1991
; Parker et al., 1995
. This explanation is supported by the recent
report that phorbol esters cause a similar slow inhibition of
minK-KvLQT1 channels expressed in Xenopus oocytes (Lo and
Neumann, 1998
). In these experiments, the stimulatory effects of
phorbol esters on IKs could be separated from
their inhibitory effects by using lower doses and briefer exposure
times, which were attributed to PKC phosphorylation at separate,
distinct sites on the channel protein. However, the present
experiments, which show a very similar slow, inhibitory effect of
phorbol esters on a completely different membrane protein, CFTR, also
expressed in oocytes, strongly suggest that this may be due to an
alteration of the intracellular PKC signaling pathway, rather than to
phosphorylation of a distinct site on the channel protein. This
interpretation is also supported by our mutagenesis experiments that
showed that mutations of S686 and S790 significantly reduced
PKC-induced stimulation of CFTR channels but failed to affect
PKC-induced CFTR channel decay. Because PKC phosphorylation appears to
dramatically influence the PKA sensitivity of CFTR channels and may
even be required for acute activation by PKA (Dechecchi et al., 1992
;
Jia et al., 1997
; Middleton and Harvey, 1998
), desensitization of the
PKC pathway, in this way, could also be expected to reduce the
responsiveness of CFTR channels to activation by PKA. Future studies
are required to definitively interpret this effect.
In native cardiac cells, differential sensitivity to phosphatase
inhibitors was the basis for the sequential PKA phosphorylation model
of CFTR proposed by Hwang et al. (1993)
. In the present experiments, we
used various PP inhibitors and the specific PKA inhibitor Rp-cAMPS to
directly assess the effects of PKC stimulation on CFTR channels
partially (P1 state) or fully (P1P2
state) phosphorylated by PKA (Fig. 11, top). The regulation
of CFTR Cl
channels by PKC phosphorylation can be
explained within the context of this model. Channels can exist in the
PKA-dephosphorylated (D) state, a partially PKA-phosphorylated
(P1) state, or the fully PKA-phosphorylated
(P1P2) state. Channels in the D state or in either of the PKA-phosphorylated states can be further phosphorylated by PKC (designated by asterisks). The role of endogenous PPs
in dephosphorylation of PKC sites is unknown (?). Because PKC
stimulation alone does not lead to channel activation (cf. Fig. 6), we
assume that channel openings require PKA phosphorylation of distinct sites on the R domain, whereas ATP hydrolysis of the two nucleotide binding domains is directly coupled to channel gating (Gadsby and
Nairn, 1994
; Gadsby et al., 1995
).
|
Exposure of oocytes to the PP1 and 2A inhibitors okadaic acid or
microcystin, is expected to cause channels to eventually accumulate
into the partially phosphorylated P1 state, and under these
conditions, PDBu still activated CFTR currents (Figs. 7 C
and 9 A). Yet channels under these conditions are not really locked into the P1 state, because some probably reside in
the P1P2 state as well (depending upon the mode
of activation, i.e., exogenous cAMP cocktail or endogenous basal PKA
activity). Furthermore, channels in the P1 state, once
phosphorylated by PKC into the P*1 state, can
escape into the P1P*2 state, because of
the presence of rather large endogenous basal PKA activity in oocytes.
Therefore, to examine the effects of PDBu on channels, in which only
P1
P*1 transitions are allowed, PP1
and 2A need to be inhibited and endogenous PKA needs to be inhibited to
prevent any possible P*1
P1P*2 transitions. The results of such
experiments are illustrated in Fig. 9 B. CFTR channels were
first activated by intraoocyte injection of microcystin, and at the
peak of the response, Rp-cAMPS injection caused channels to
dephosphorylate and become trapped in the P1 state.
Subsequent exposure to PDBu, which should only allow P1
P*1 transitions to occur, failed to cause further
channel activation.
In our studies of cardiac CFTR channels expressed in oocytes, we found
that injection of BAPTA or preincubation of oocytes in BAPTA-AM
significantly attenuated deactivation of currents on removal of cAMP
cocktail, suggesting that BAPTA may be a potent inhibitor of endogenous
phosphatases. Because the effects of BAPTA were not mimicked by two
known inhibitors of Ca2+-sensitive phosphatases,
calmidazolium and cyclosporin A, BAPTA must be exerting its inhibitory
effects on another PP. Because the deactivation of CFTR currents in
BAPTA-treated oocytes was much more significantly attenuated than in
the presence of OA or microcystin alone, the effects of BAPTA may
instead involve the inhibition of an OA-insensitive phosphatase,
possibly PP2C. Although many serine/threonine PPs are known to require
metals for catalytic activity, PP2C seems to be a likely target for
BAPTA, because PP2C, in contrast to other PPs, requires high (mM)
Mg2+ for activity (Stemmer and Klee, 1991
; Travis et al.,
1997
). BAPTA is known to exhibit high selectivity for Ca2+
over Mg2+, but its Kd for
Mg2+ has been reported to be ~17 mM (Tsien, 1980
). It
therefore seems likely that injection of millimolar concentrations of
BAPTA into oocytes or prolonged exposure of oocytes to BAPTA-AM may
inhibit PP2C by direct chelation of intracellular Mg2+.
Consistent with this interpretation, intraoocyte injection of Mg2+ did reverse the effects of BAPTA and stimulated
channel dephosphorylation (Fig. 8 D).
Alternatively, the ability of BAPTA to chelate intracellular Mg may
interfere with Mg as a cofactor for ATP hydrolysis at nucleotide
binding domain 2 (NBD2), which would cause channels to deactivate very
slowly, like CFTR channels with mutations in the Walker motif in NBD2
(Wilkinson et al., 1996
). Although Dousmanis et al. (1996)
showed that
such a slowing in channel closure can be effected by chelation of Mg,
chelation of Mg also prevented channel activation by interfering with
ATP hydrolysis at NBD1 as well. If the effects of BAPTA that we observe
are due to interference with the Mg dependence of ATP hydrolysis at the
NBDs, then BAPTA should also prevent or greatly attenuate the
activation of CFTR by cAMP, an effect clearly not seen in our
experiments, in which CFTR channel activation remained robust (or was
even accentuated) in the presence of BAPTA (Fig. 8). In addition, if
the effects of BAPTA are due to interference with Mg as a cofactor for
ATP hydrolysis at nucleotide binding domain 2 (NBD2), channels would still be expected to dephosphorylate in response to PKA inhibition. Exposure of BAPTA-pretreated oocytes to the cAMP cocktail caused strong
activation and forced nearly all CFTR channels to become locked in the
fully phosphorylated P1P2 state,