Use of hormonal therapy in senior breast cancer patients treated with or without radiotherapy.

PURPOSE: Breast cancer treatment guidelines state that radiotherapy (rt) can reasonably be omitted in selected women 70 years of age and older if they take adjuvant endocrine therapy (aet) for 5 years. We aimed to assess persistence and adherence to aet in women 70 years of age and older, and to examine differences between rt receivers and non-receivers. METHODS: Quebec's medical service and pharmacy claims databases were used to identify seniors undergoing breast-conserving surgery (1998-2005) and initiating aet. Cox proportional hazards models were used to identify predictors of aet non-persistence. RESULTS: Of 3180 women who initiated aet (mean age: 77.5 years), 28% did not receive rt. During the subsequent 5 years, 32% of patients who initiated aet did not persist, 2% filled only a single prescription, and 22% switched medications. Compared with rt receivers, non-receivers discontinued more often (35.5% vs. 30.1%) and earlier (1.4 years vs. 1.6 years). They also became nonadherent earlier (medication possession ratio < 80% at year 3 vs. at year 5). Predictors of nonpersistence included rt omission [hazard ratio (hr): 1.26; 95% confidence interval (ci): 1.09 to 1.46]; age (hr per decade increase: 1.15; 95% ci: 1.01 to 1.31); new medications (hr per medication: 1.01; 95% ci: 1.00 to 1.02); and hospitalizations during aet, (hr per hospitalization: 1.08; 95% ci: 1.05 to 1.11). In a subanalysis of rt non-receivers, significant predictors included hospitalizations (hr: 1.07; 95% ci: 1.02 to 1.12) and medications at aet start (hr: 0.94; 95% ci: 0.91 to 0.97). CONCLUSIONS: Suboptimal use of aet was observed in at least one third of women. In rt non-receivers, aet use was worse than it was in rt receivers. Initiation of new medications and hospitalizations increased the risk of non-persistence.

Upregulation of two BH3-only proteins, Bmf and Bim, during TGF beta-induced apoptosis.

Transforming growth factor-beta (TGFbeta)-activated signalling pathways can lead to apoptosis, growth arrest or promotion of malignant behaviour, dependent on cellular context. The molecular mechanisms involved in TGFbeta-induced apoptosis remain controversial; although changes in gene expression are thought to be pivotal to the process, several different candidate apoptotic initiators and mediators have been proposed. Smad4, a critical component of the TGFbeta-induced transcriptional machinery, is shown here to be essential for induction of apoptosis. Gene expression analysis identified the proapoptotic Bcl-2 family members, Bmf and Bim, as induced by TGFbeta, dependent on both Smad4 and p38 function and the generation of reactive oxygen species. TGFbeta-induced Bmf and Bim localize to cellular membranes implicated in apoptosis. Inhibition of the TGFbeta-induced expression of both these proteins together provides significant protection of cells from apoptosis. The TGFbeta-triggered cell death programme thus involves induction of multiple BH3-only proteins during the induction of apoptosis.

Endophilin regulates JNK activation through its interaction with the germinal center kinase-like kinase.

The endophilin family of proteins function in clathrin-mediated endocytosis. Here, we have identified and cloned the rat germinal center kinase-like kinase (rGLK), a member of the GCK (germinal center kinase) family of c-Jun N-terminal kinase (JNK) activating enzymes, as a novel endophilin I-binding partner. The interaction occurs both in vitro and in cells and is mediated by the Src homology 3 domain of endophilin I and a region of rGLK containing the endophilin consensus-binding sequence PPRPPPPR. Overlay analysis of rat brain extracts demonstrates that endophilin I is a major Src homology 3 domain-binding partner for rGLK. Overexpression of full-length endophilin I activates rGLK-mediated JNK activation, whereas N- and C-terminal fragments of endophilin I block JNK activation. Thus, endophilin I appears to have a novel function in JNK activation.

The N terminus of amphiphysin II mediates dimerization and plasma membrane targeting.

Amphiphysin I and II are nerve terminal-enriched proteins containing SH3 domains that interact with dynamin and synaptojanin. The amphiphysins may function in synaptic vesicle endocytosis by targeting synaptojanin and dynamin to emerging endocytic buds through SH3 domain-independent interactions with clathrin and AP2. We have recently identified and cloned several amphiphysin II splice variants that differentially incorporate clathrin-binding domains. To determine whether these domains function in membrane targeting, we used immunofluorescence to examine the potential localization of amphiphysin II variants to clathrin-coated pits on plasma membranes purified from transfected COS-7 cells. Full-length amphiphysin II targets to the plasma membrane where it partially co-localizes with clathrin. However, splice variants and deletion constructs lacking clathrin-binding domains still target to the plasma membrane, and removal of clathrin from the membrane does not affect amphiphysin II distribution. Surprisingly, plasma membrane targeting was dependent on the presence of a 31-amino acid alternatively spliced sequence at the N terminus of amphiphysin II, a result confirmed using subcellular fractionation. In binding assays, the 31-amino acid sequence was also found to facilitate amphiphysin dimerization mediated through the N terminus. Taken together, these data support a role for the N terminus of amphiphysin II in membrane targeting during endocytosis.

Confocal microscopy reveals thimet oligopeptidase (EC 3.4.24.15) and neurolysin (EC 3.4.24.16) in the classical secretory pathway.

Thimet oligopeptidase (EC 3.4.24.15; EP24.15) and neurolysin (EC 3.4.24.16; EP24.16) are closely related enzymes involved in the metabolic inactivation of bioactive peptides. Both of these enzymes were previously shown to be secreted from a variety of cell types, although their primary sequence lacks a signal peptide. To investigate the mechanisms responsible for this secretion, we examined by confocal microscopy the subcellular localization of these two enzymes in the neuroendocrine cell line AtT20. Both EP24.15 and EP24.16 were found by immunohistochemistry to be abundantly expressed in AtT20 cells. Western blotting experiments confirmed that the immunoreactivity detected in the soma of these cells corresponded to previously cloned isoforms of the enzymes. At the subcellular level, both enzymes colocalized extensively with the integral trans-Golgi network protein, syntaxin-6, in the juxtanuclear region. In addition, both EP24.15 and EP24.16 were found within small vesicular organelles distributed throughout the cell body. Some, but not all, of these organelles also stained positively for ACTH. These results demonstrate that both EP24.15 and EP24.16 are present within the classical secretory pathway. Their colocalization with ACTH further suggests that they may be targeted to the regulated secretory pathway, even in the absence of a signal peptide.

Splice variants of intersectin are components of the endocytic machinery in neurons and nonneuronal cells.

We recently identified and cloned intersectin, a protein containing two Eps15 homology (EH) domains and five Src homology 3 (SH3) domains. Using a newly developed intersectin antibody, we demonstrate that endogenous COS-7 cell intersectin localizes to clathrin-coated pits, and transfection studies suggest that the EH domains may direct this localization. Through alternative splicing in a stop codon, a long form of intersectin is generated with a C-terminal extension containing Dbl homology (DH), pleckstrin homology (PH), and C2 domains. Western blots reveal that the long form of intersectin is expressed specifically in neurons, whereas the short isoform is expressed at lower levels in glia and other nonneuronal cells. Immunofluorescence analysis of cultured hippocampal neurons reveals that intersectin is found at the plasma membrane where it is co-localized with clathrin. Ibp2, a protein identified based on its interactions with the EH domains of intersectin, binds to clathrin through the N terminus of the heavy chain, suggesting a mechanism for the localization of intersectin at clathrin-coated pits. Ibp2 also binds to the clathrin adaptor AP2, and antibodies against intersectin co-immunoprecipitate clathrin, AP2, and dynamin from brain extracts. These data suggest that the long and short forms of intersectin are components of the endocytic machinery in neurons and nonneuronal cells.

Multiple amphiphysin II splice variants display differential clathrin binding: identification of two distinct clathrin-binding sites.

Amphiphysin I and II are nerve terminal-enriched proteins that display src homology 3 domain-mediated interactions with dynamin and synaptojanin. It has been demonstrated that the amphiphysins also bind to clathrin, and we have proposed that this interaction may help to target synaptojanin and dynamin to sites of synaptic vesicle endocytosis. To understand better this potential functional role, we have begun to characterize clathrin-amphiphysin interactions. Using PCR from adult human cortex cDNA, we have cloned a number of amphiphysin II splice variants. In in vitro binding assays, the amphiphysin II splice variants display differential clathrin binding and define a 44-amino acid region mediating the interaction. Amphiphysin II truncation and deletion mutants identify two distinct clathrin-binding domains within this region: one with the sequence LLDLDFDP, the second with the sequence PWDLW. Both domains are conserved in amphiphysin I, and saturation binding analysis demonstrates that both sites bind clathrin with approximately equal affinity. The elucidation of clathrin as a splice-specific binding partner for amphiphysin II begins to address the potential functional role(s) for the multiple amphiphysin II splice variants and further supports an important function for clathrin-amphiphysin interactions in protein targeting during endocytosis.

Sensory presynaptic and widespread somatodendritic immunolocalization of central ionotropic P2X ATP receptors.

Recent evidence suggests that extracellular ATP plays a neurotransmitter role in the central nervous system. Its fast ionotropic effects are exerted through a family of P2X ATP-gated channels expressed in brain and spinal cord. To determine the physiological significance of central ATP receptors, we have investigated the localization of a major neuronal P2X receptor at the cellular and subcellular levels using affinity-purified antibodies directed against the C-terminal domain of P2X4 subunit. Subunit-specific anti-P2X4 antibodies detected a single band of 57,000 +/- 3000 mol. wt in transfected HEK-293 cells and in homogenates from adult rat brain. The strongest expression of central P2X receptors was observed in the olfactory bulb, lateral septum, cerebellum and spinal cord. P2X4 immunoreactivity was also evident in widespread areas including the cerebral cortex, hippocampus, thalamus and brainstem. In all regions examined, P2X receptors were associated with perikarya and dendrites where they were concentrated at the level of afferent synaptic junctions, confirming a direct involvement of postsynaptic ATP-gated channels in fast excitatory purinergic transmission. Moreover, P2X4-containing purinoceptors were localized in axon terminals in the olfactory bulb and in the substantia gelatinosa of nucleus caudalis of the medulla and dorsal horn of the spinal cord, demonstrating an important selective presynaptic role of ATP in the modulation of neurotransmitter release in central sensory systems.

SH3 domain-dependent interactions of endophilin with amphiphysin.

Amphiphysin I and II are nerve terminal-enriched proteins thought to function in synaptic vesicle endocytosis. In addition to a C-terminal SH3 domain, the proteins contain a highly conserved putative SH3 binding site and numerous consensus phosphorylation sites. We now demonstrate that amphiphysin I but not amphiphysin II is a phosphoprotein which undergoes dephosphorylation during nerve terminal depolarization. Further, both amphiphysin I and II interact with the SH3 domain of endophilin, a synaptically enriched protein implicated in synaptic vesicle endocytosis. The interaction is direct and mediated through a 43 amino acid region of amphiphysin containing the putative SH3 binding site. These data further support a role for amphiphysin I, II and endophilin in synaptic vesicle endocytosis.

Identification and characterization of a nerve terminal-enriched amphiphysin isoform.

Amphiphysin is a nerve terminal-enriched protein thought to function in synaptic vesicle endocytosis, in part through Src homology 3 (SH3) domain-mediated interactions with dynamin and synaptojanin. Here, we report the characterization of a novel amphiphysin isoform (termed amphiphysin II) that was identified through a homology search of the data base of expressed sequence tags. Antibodies specific to amphiphysin II recognize a 90-kDa protein on Western blot that is brain-specific and highly enriched in nerve terminals. Like amphiphysin (now referred to as amphiphysin I), amphiphysin II binds to dynamin and synaptojanin through its SH3 domain. Further, both proteins bind directly to clathrin in an SH3 domain-independent manner. Taken together, these data suggest that amphiphysin II may participate with amphiphysin I in the regulation of synaptic vesicle endocytosis.

Identification of the major synaptojanin-binding proteins in brain.

Synaptojanin is a nerve-terminal enriched inositol 5-phosphatase thought to function in synaptic vesicle endocytosis, in part through interactions with the Src homology 3 domain of amphiphysin. We have used synaptojanin purified from Sf9 cells after baculovirus mediated expression in overlay assays to identify two major synaptojanin-binding proteins in rat brain. The first, at 125 kDa, is amphiphysin. The second, at 40 kDa, is the major synaptojanin-binding protein detected, is highly enriched in brain, is concentrated in a soluble synaptic fraction, and co-immunoprecipitates with synaptojanin. The 40-kDa protein does not bind to a synaptojanin construct lacking the proline-rich C terminus, suggesting that its interaction with synaptojanin is mediated through an Src homology 3 domain. The 40-kDa synaptojanin-binding protein was partially purified from rat brain cytosol through a three-step procedure involving ammonium sulfate precipitation, sucrose density gradient centrifugation, and DEAE ion-exchange chromatography. Peptide sequence analysis identified the 40-kDa protein as SH3P4, a member of a novel family of Src homology 3 domain-containing proteins. These data suggest an important role for SH3P4 in synaptic vesicle endocytosis.

Tissue-specific alternative splicing generates two synaptojanin isoforms with differential membrane binding properties.

Synaptojanin is an Src homology 3 domain-binding inositol 5-phosphatase that is thought to function in synaptic vesicle endocytosis. It is encoded by a cDNA with two open reading frames separated by an in-frame stop codon. The first open reading frame encodes a 145-kDa form of the protein, whereas a 170-kDa isoform appears to be composed of both open reading frames and contains additional Src homology 3 domain-binding consensus sequences. Here, we demonstrate that the two synaptojanin isoforms are generated by the alternative use of an exon containing the stop codon. Whereas the 145-kDa isoform is highly enriched in adult brain, the 170-kDa isoform is excluded from this tissue and has a widespread distribution in non-neuronal cells. Unlike the 145-kDa isoform, which can be removed from membranes by a low salt wash, the 170-kDa isoform remains membrane-associated, even in the presence of 1 salt. Further, the 170-kDa form, but not the 145-kDa form, can be isolated from membranes as part of a large molecular weight complex. These properties may allow the 170-kDa isoform of synaptojanin to play a unique and perhaps more general role in endocytosis as compared with the 145-kDa isoform.