The results presented here show that HepG2 cells exposed to cisplatin quickly developed resistance to the drug. This unwanted side effect is seen in patients and the magnitude of increase in IC50 from 4 to 19 µM in chemoresistant cells after 48 h places this model system firmly within the clinically relevant range. As expected, fluorescence measurements of labelled cisplatin showed that chemoresistant cells took up less fluorescently labelled cisplatin than non-chemoresistant cells, suggesting that lower cellular uptake and, thus, restriction of intracellular concentrations of cisplatin are an important factor and possibly the key reason for the development of the chemoresistant phenotype in these cells.
We have reported previously that, when normal (non-chemoresistant) cultured HepG2 cells are toxified by cisplatin, they typically lose 30-50% of both their TG2-L expression and transamidating activity and this could account for an increase in uptake of cisplatin with the consequent increase of drug toxicity and metastatic potential [
42]. We therefore expected that the development of chemoresistance might be associated with a greater total TG2 expression compared to parental cells, and that TG2 overexpression would be accompanied by a decreased intracellular uptake of cisplatin, as this seems the most likely basis for the development of the chemoresistant phenotype [
13].
Counterintuitively, however, we found that rather than increasing TG2 expression the development of chemoresistance to cisplatin in hepatocellular carcinoma cells was accompanied by a marginal decline in the levels of total TG2 mRNA and protein compared to parental cells (
Figure 5B), though the TG2 activity was relatively unaffected and may even have slightly increased (
Figure 5C). Moreover, unlike the previous study [
42], where the antibody used was only capable of measuring TG2-L expression, the antibody used in the current study proved to be cross-reactive to both TG2-L and TG2-S isoforms, and confirmed that TG2-S levels were also unchanged during development of chemoresistance (
Figure 5A).
Despite the lack of change in expression of TG2 protein during development of chemoresistance, support for a TG2 role in modulation of cisplatin uptake came from two sources. Firstly, by specifically downregulating gene expression of TG2 using anti-TG2 siRNA, it was possible to largely eliminate TG2 protein expression without causing significant toxic effects to these cells. This is in line with the evidence that gene knock-out animals are capable of survival [
25] and showed that specific targeting of TG2 expression was accompanied by a large increase in cisplatin uptake in both parental and chemoresistant cells. Secondly, treatment of cells with the non-toxic broad-range TG2 enzyme inhibitor 2 mM cystamine – a treatment that is likely to inhibit both TG2 isoforms – showed a similar pattern of effects to that of TG2 silencing (
Figure 7), where an overall 40% loss of TG2 activity correlated with almost a doubling of cisplatin uptake after 2-hour treatment, an effect that was almost twice as great in parental cells compared to their chemoresistant counterparts.
Although confirming a role for TG2 in chemoresistance, the lack of difference in TG2 expression and catalytic activity between parental and chemoresistant cells was initially puzzling and collectively suggested that, if TG2 is indeed an important factor in restricting cisplatin uptake during chemoresistance, then this effect must be conferred by some form of post-translational compensatory mechanism. For instance, it cannot be ruled out that the activation of the cellular pool of TG2 may contribute to survival of chemoresistant cells following re-exposure to cisplatin, a process presumably not fully operational in the non-chemoresistant parental cells. Only following subcellular isolation of lysates obtained from parental and chemoresistant cells did it become apparent that it was not the differential expression of TG2 isoforms that was responsible for the development of cisplatin chemoresistance but it was, in fact, the differential localisation of TG2 isoforms that appeared to confer the TG2-mediated chemoresistant effects. The data obtained in this study showed that TG2-L appears to be cytoplasmically distributed in the cell, whereas most of the TG2-S appears to be associated with subcellular membranous structures. The release of the membrane-associated TG2-S in the cytosol that occurred in response to cisplatin toxicity in parental HepG2 cells appears to mediate cell death, an effect not seen in the chemoresistant cells, where the TG2-S was retained in the membrane fraction (
Figure 9).
If this were the case for parental HepG2 cells, then it might reasonably follow that, in contrast, anything that favours retention of TG2-S in its membrane-sequestered form might also suppress apoptosis, thus, delaying cell death and promoting cell survival and chemoresistance [
49,
50]. In this scenario, the TG2-dependent blocking effect on drug uptake and cell death will persist in chemoresistant cells, as re-treatment with cisplatin has little effect on TG2-S membrane association (
Figure 9A). As a result, calcium-dependent levels of cross-linking may be lower in chemoresistant cells compared to parental cells, resulting in inhibition of apoptosis, and thus promoting survival. Hence, the intracellular location and activity state of transglutaminase differentially impacts on cell death and the role of TG2 in cellular function [
49,
50,
51,
52,
53,
54].
4.1. Translocation of TG2 from the cytoplasm to the ECM may contribute to chemoresistance
We cannot say at this point whether the membrane association of TG2-S is mediated by membrane-associated protein-protein interaction, or whether it operates via direct interaction with membrane lipids of the plasma membrane, or indeed other membranous structures in cells. However, it is perhaps of interest that TG2 is known to associate with plasma membrane proximal exosomes that are released by cancer cells in response to stress [
50] and which may contribute to fibrosis - a common pathological sequelae to hepatocellular carcinoma.
Translocation of cytosolic TG2 (TG2-L) from the cytoplasm to the extracellular space takes place by fusion of exosomes with the outer cell membrane. It has been shown that the transamidation activity of TG2 results in protease-resistant intermolecular or intramolecular isopeptide bonds that effectively crosslink extracellular matrix (ECM) fibrils, stiffening the ECM and, thus, protecting the cell from the cytotoxic damage exerted by cisplatin [
55]. This is in line with the observation that resistance to the anti-cancer drug doxorubicin in breast cancer cells seems to be dependent upon the action of TG2 on ECM proteins, thereby promoting the interaction between integrins and fibronectin [
49]. Unblocking of drug uptake using inhibitors of TG2 enzyme activity may, therefore, offer a strategy for increasing susceptibility of cancer cells to chemotherapeutic drugs in order to induce apoptosis in cancer cells. Interestingly, as previously reported, cystamine derivatives are clinically well-tolerated and so it may present a route to cisplatin/cystamine co-treatment of patients with hepatocellular carcinoma to overcome or limit the development of chemoresistance [
42,
54,
56].
4.3. TG2-S role in cell survival and chemoresistance following cisplatin treatment
The uptake of cisplatin caused the majority of sensitive HepG2 cells (90%) to undergo apoptosis, with a small proportion of cells surviving cisplatin cytotoxicity and acquiring resistance to the drug. In these cells TG2-S was found to be retained in the membranous fraction, thus suggesting that the localisation of this protein in sub-cellular compartments is a critical factor in determining drug resistance and cell survival.
Drug resistance ensues owing to a variety of mechanisms, such as increased drug inactivation, drug efflux from cancer cells, enhanced repair of chemotherapy-induced damage, activation of pro-survival pathways and inactivation of cell death pathways [
58]. For instance, increased glutathione S-transferase (GST) expression has been associated with resistance to cisplatin-based chemotherapy [
59]. The conjugation of cisplatin to endogenous glutathione (GSH) by GST has been reported to mediate the extrusion of the GSH-conjugate by specialised transmembrane efflux pumps, such as the multidrug resistance-associated protein 2 (MRP2) [
58]. However, the GHS-mediated detoxification process appears to be impaired in HepG2 cells, where the expression or the catalytic activity of GST has been shown to be relatively low [
60,
61], thus suggesting that alternative mechanisms may be responsible for chemoresistance. We postulate that the membrane-associated TG2-S isoform is directly or indirectly involved in the dynamic autophagy pathway that can gradually lead to decreased cisplatin cytotoxicity in HepG2-Cr cells, thus promoting cell survival.
In a normal stress-free environment TG2 is maintained in the closed conformation state acting as a G-protein inside the cell and only rarely is TG2 found to adopt a catalytically active open conformation, as this enzyme requires levels of Ca
2+ well above the physiological range for its activation [
62]. The TG2-S splice variant lacks the C-terminal GTP-binding regulatory domain, which controls the response of TG2 to Ca
2+ activation. As a consequence, TG2-S displays a deregulated transamidation activity in the cytosol, because of the predominant role of the desensitisation to GTP. The absence of the C-terminal domain causes TG2-S to adopt a conformation in solution, resembling the open state of the full-length TG2 that facilitates CL3 binding as shown in
Figure 10 [
63,
64].
Although the association of TG2 with membrane structures is not completely understood, several studies have advanced the idea that TG2 can interact with specific membrane-associated proteins during autophagy. For example, the interaction of TG2 with the membrane-bound microtubule-associated protein light chain 3 (LC3 II) via the autophagy adaptor protein p62 has been shown to facilitate cross-linking of misfolded protein inside the autophagosome [
65,
66,
67]. In a separate study, TG2 bound to the p62-LC3 heterodimer protein complex was shown to associate with the tumour protein 53 (p53) in the autophagosome, thus suggesting that TG2 may function as a molecular chaperone and facilitate the translocation of ‘client’ proteins to the autophagosome [
68]. Given that TG2 protein contains several functional regions [
31], it would not be surprising to find that several other ‘client’ proteins could be recruited by the ternary TG2 complex in the same way for transfer to the autophagy-mediated degradation pathway.
The association of TG2 with the autophagosome membrane has been reported to occur through protein-protein interactions between the C-terminal domain of TG2 and the N-terminal domain of p62 [
68]. As the C-terminal domain of TG2 is absent in TG2-S, any potential interaction with the p62-LC3 II heterodimer protein complex must be ruled out. In our study, however, it appears that TG2 may be able to interact with LC3 through the C-terminal 27-residue region located on the β-barrel domain B1, which is present on TG2-L and TG2-S, and multiple short linear motifs harbored on the exposed flexible loops of LC3 (
Figure 10). Hence, it is possible that TG2-S may associate with the autophagosome membrane by directly interacting with LC3/LC3 homologues or other autophagy-related proteins without the requirement for an additional adaptor protein. Similarly, it is tempting to speculate that TG2-S may also function as a molecular chaperone and facilitate the recruitment of a diverse range of ‘client’ proteins for delivery to the autophagosome (
Figure 11, left panel). The association of TG2-S with LC3/LC3 homologues could also explain the mechanism by which TG2-S is retained in its membrane-sequestered form in cisplatin-treated chemoresistant HepG2/cr cells.
Figure 11.
Diagram illustrating the postulated dual role of TG2-S following cisplatin uptake in chemoresistant HepG2/cr cells (left panel) and parental HepG2 cells (right panel). The cellular uptake of cisplatin has been widely reported to be mediated by several membrane transporters, such as the copper transporter 1 (CTR1) and by passive diffusion [
54]. Left panel: TG2-S may participate in multiple cellular events such as (1) recruitment and chaperoning of client proteins, such as p53 or BAX, for delivery to the autophagosome, (2) cross-linking of protein cargo and aggregate formation during autophagy, and (3) assisting the intracellular trafficking of autophagosomes and their fusion with endolysosomal vesicles by modulating the actin cytoskeleton dynamics. Right panel: TG2-S may be involved in BAX-induced Cytochrome
C release and caspase activation, leading to apoptosis. The domains of TG2-S (in blue) are the core domain (central circle), the N-terminal domain (oval shape) and the C-terminal domain (rectangular shape). The aggresome is depicted in purple.
Figure 11.
Diagram illustrating the postulated dual role of TG2-S following cisplatin uptake in chemoresistant HepG2/cr cells (left panel) and parental HepG2 cells (right panel). The cellular uptake of cisplatin has been widely reported to be mediated by several membrane transporters, such as the copper transporter 1 (CTR1) and by passive diffusion [
54]. Left panel: TG2-S may participate in multiple cellular events such as (1) recruitment and chaperoning of client proteins, such as p53 or BAX, for delivery to the autophagosome, (2) cross-linking of protein cargo and aggregate formation during autophagy, and (3) assisting the intracellular trafficking of autophagosomes and their fusion with endolysosomal vesicles by modulating the actin cytoskeleton dynamics. Right panel: TG2-S may be involved in BAX-induced Cytochrome
C release and caspase activation, leading to apoptosis. The domains of TG2-S (in blue) are the core domain (central circle), the N-terminal domain (oval shape) and the C-terminal domain (rectangular shape). The aggresome is depicted in purple.
TG2 is also involved in the homeostasis of the actin cytoskeleton, the regulation of which is essential for proper intracellular trafficking of autophagic vesicles and their fusion with lysosomes [
69,
70]. In fact, TG2 can post-translationally modify the major components of the cytoskeleton network, such as tubulin, vimentin and actin, and significantly influence its dynamics [
15,
16]. Thus, it seems plausible to speculate that the catalytically-competent TG2-S isoform could act at the interface between the actin cytoskeleton and the autophagosome, by interacting with key cytoskeleton regulators and LC3/LC3 homologues situated on the outside of the vesicle membrane (
Figure 11, left panel). While the actin cytoskeleton has been reported to be involved in cisplatin chemoresistance by physically disrupting the drug uptake [
71], mounting evidence supports the view that copper homeostasis proteins ATP7A and ATP7B are directly involved in the intracellular sequestration and transport of cisplatin outside the cell [
72]. Unlike ATP7A, which is ubiquitously expressed in various cells and tissues, ATP7B has a more limited expression pattern, with the highest expression level in the liver. It has recently been reported that ATP7B co-localises with LC3 in HepG2 cells, suggesting that copper and, presumably, cisplatin clearance could be mediated by autophagy [
72]. Hence, TG2-S could directly or indirectly contribute to cisplatin detoxification by facilitating the intracellular trafficking of autophagosomes and their fusion with endolysosomal vesicles by modulating the actin cytoskeleton dynamics (
Figure 11, right panel).
4.4. TG2-S role in apoptic cell death following cisplatin treatment
So far, we have described a theoretical model wherein the membrane-associated TG2-S effector isoform may be expressed as an adaptation to the metabolic stress induced by the cytotoxic drug cisplatin. The protective role of the membrane-associated TG2-S isoform in chemoresistant HepG2/Cr cells may be conferred by its direct or indirect involvement in the autophagy pathway and potential contribution to detoxification, thus promoting cell survival. When cellular damage is too severe, apoptosis is triggered in order to eliminate irreparable cells and maintain tissue homeostasis.
The involvement of TG2 in apoptosis has been widely reported in literature, although the specific role of the TG2-S isoform in this process remains elusive. In particular, the mechanism by which the membrane-associated TG2-S isoform is not retained in the membrane and, instead, is released to the cytosol following exposure to cisplatin, is not known. It is possible that the expression or the post-transcriptional regulation of the membrane scaffold protein LC3/LC3 homologue is/are affected by multiple cytotoxicity events, which have the effect of hampering or weakening the interaction between TG2-S and LC3/LC3 homologue.
Most cells undergo apoptosis through the intrinsic pathway. This is dependent on mitochondrial outer membrane permeabilisation, which is mediated by the pro-apoptotic Bcl-2 family proteins, BAX and BAK [
73]. During apoptosis, BAX translocates from the cytosol to the outer mitochondrial membrane, wherein it contributes to the formation of pores to release cytochrome
C. The analysis of the TG2 primary sequence shows the presence of an eight amino acid domain highly homologous to the Bcl-2 family BH3 domain [
74]. It has been postulated that TG2-BH3 can directly interact with BAX and direct cell death via pore formation on the mitochondrial outer membranes triggering the release of Cytochrome C in the cytosol. This process requires the presence of a catalytically active open form of TG2 that allows free access to the catalytic triad – cysteine
277, histidine
335 and aspartate
358 – responsible for transamidating activity, while simultaneously allowing access to the BH3 domain, located at position 204-211 of the catalytic core of TG2 [
74]. We suggest that cisplatin-induced DNA damage triggers the release of TG2-S isoform to the cytosol of cisplatin sensitive HepG2 cells.
Therefore, in addition to its transamidation-competent open conformation, TG2-S would also allow the interaction between the BH3 domain and the cytosolic BAX monomers, a process which is essential for the insertion of BAX oligomers in the mitochondrial membrane and the consequent oligomerization of BAX proteins [
73,
74]. The release of cytochrome
C through BAX oligomeric pores formed in the mitochondrial membrane is the key event initiating the apoptotic cascade (
Figure 11). This mechanism appears to unravel at least in part the puzzle posed by a pro-survival protein inducing cell death when held in its open state.