1. Introduction
Upregulation of hypoxia-inducible factor 1, alpha subunit (HIF-1𝛼) under the hypoxic condition has been observed in a variety of solid cancers; HIF-1𝛼 serves as a direct master controller of the expressions of many genes related to tumor growth and vascularization [
1,
2]. Programmed death-ligand 1 (PD-L1) allows tumor cells to escape immune surveillance through interferon-𝛾 (INF-𝛾) activation in cancers [
3,
4]; PD-L1 expression is also known to be upregulated in a HIF-1𝛼- dependent manner [
5]. Furthermore, HIF-1𝛼 has been shown to be capable of inducing tumor resistance to the topoisomerase (topo) I inhibitor SN-38 [
6], gemcitabine [
7], and various other cytotoxic agents [
8]. However, under severe hypoxia, replication stress in regions of single-strand DNA leads to accumulation of HIF-1𝛼 and p53 through ataxia-telangiectasia mutated (ATM) and RAD3-related (ATR) activation [
9,
10]. In the presence of high p53 activation, p53 destroys the HIF-1𝛼 protein, and elimination of the HIF-1𝛼 promoter activity results in downregulated expressions of many genes, resulting in growth arrest/apoptosis [
11,
12,
13]. Although HIF-1𝛼 serves as a major direct transcriptional regulator of the expressions of hypoxia-inducible genes under hypoxia, rat sarcoma viral oncogene-extracellular regulated kinase (Ras-ERK) and tens in homolog of chromosome 10-serine-threonine protein kinase-Akt (PTEN-Akt) lie upstream of HIF1α and can control HIF-1α accumulation [
14,
15]. Hematologic mantle cell lymphoma, which harbors activated Ras-ERK and aberrant activation of PI3k/Akt, shows upregulated expression of HIF-1𝛼 through these factors [
16].
Recently, it has been reported that inhibition of ATR can also increase tumor cell killing in cancer cells that exhibit high levels of replication stress [
17]. However, for ATR inhibition, combined use of an ATR inhibitor and DNA damage agent is necessary, so that the effects of combined administration of ATR inhibitors with DNA damage agents have been investigated [
18]. Use of a DNA damage agent alone or in combination with ATR inhibition is limited by the dose-limiting toxicities associated with DNA damage agents on normal proliferating tissues [
19,
20]. Furthermore, pancreatic cancers [
21] and mantle cell lymphoma [
22] with cyclin D1 accumulation are insensitive or resistant to DNA damage drugs. They were sensitive to 3EZ, 20Ac-ingenol, irrespective of the mechanism of cyclin D1 accumulation, via decrease in the cellular accumulation of cyclin D1[
23,
24]. 3EZ, 20Ac-ingenol is a catalytic inhibitor-type topoisomerase I (topo I) with less cytotoxicity [
25], and we reported that it promotes activation of the ATR-dependent p53 pathway through DNA damage response (DDR) activation during the S phase and upregulates PTEN expression, which specifically induces apoptosis in cancer cells showing cyclin D1 accumulation [
23,
24]. 3EE, 20Ac-ingenol, a stereoisomer of 3EZ, 20Ac-ingenol which is also a catalytic inhibitor-type topo 1 [
26], showed the same effects of inhibition of cell proliferation and decreased cellular cyclin D1 accumulation in Jeko-1 and Panc-1 cells, and cellular apoptosis induced via ATR-dependent p53 activation [
23,
24]. In this study, we investigated apoptosis induction in these cell lines under the hypoxic condition through ATR- and HIF-1α-dependent p53 accumulation via cooperative activation of ATR by two DNA replication stresses induced by 3EE, 20Ac-ingenol and hypoxia.
3. Discussion
Although, 3EE, 20Ac-ingenol effectively inhibited cell proliferation in both Jeko-1 and Panc-1 cells under the normoxic condition, the sensitivity of the cells to hypoxia varied between the two cell lines (Figures 1A,B). Under the hypoxic condition, HIF-1𝛼 accumulation is reported as being capable of inducing resistance to various anticancer agents [
6,
7,
8], but treatment of the cells with 3EE, 20Ac-ingenol under this condition restored the sensitivity of the cells to anticancer agents, attenuated the cellular resistance to hypoxia (
Figure 1B), and induced apoptosis through ATR-dependent and HIF-1𝛼-dependent p53 accumulation in the Panc-1 cells overexpressing of cyclin D1 (Figures 3C,D,E). However, no such attenuation of the resistance to cell proliferation by restoration of the sensitivity to hypoxia (
Figure 1A) or ATR activation and p53 accumulation (
Figure 2A) as an adaptive response to hypoxia was observed following 3EE, 20Ac-ingenol treatment in the hematologic cancer cell line, Jeko-1. The mechanisms of cancer cell survival against hypoxia differ among hematological cancers, Jeko-1cells [
14,
15,
16], and solid cancers, Panc-1 cells [
1,
2]. In the Jeko-1 cells [
16], slight HIF-1𝛼 accumulation was observed in the absence of ATR activation under the hypoxic condition, and the mechanism of HIF-1𝛼 expression was different from that occurring via ATR activation as an adaptive response to hypoxia in the Panc-1 cells (
Figure 2A) [
9,
10]. These findings could be explained by the differences in the mechanisms of cell survival against hypoxia.
Under severe hypoxia, HIF-1𝛼 promotes stabilization of p53 through control of ATR activation, although accumulation of p53 also downregulates HIF-1𝛼 expression [
9,
10]. With prolonged exposure to severe hypoxia (< 0.1% O
2 or anoxia), the amount of p53 in the cells increases, resulting in the degradation of HIF-1𝛼. Progressive decrease of HIF-1𝛼 and accumulation of p53 with time may contribute to cell death by progressing ones [
11,
12,
13,
31]. In Panc-1 cells overexpressing cyclin D1, under the mild hypoxic condition, the cells showed HIF-1𝛼 accumulation (
Figure 3D) and p53 phosphorylation and p53 stabilization (
Figure 2B) through ATR activation. p53 serine 15 is phosphorylated by both ATR and ATM activations in response to hypoxia in an ATR-dependent manner, leading to p53 accumulation [
35]. HIF-1𝛼 promotes p53 phosphorylation at serine 15 in response to hypoxia, inducing HIF-1𝛼 and p53-dependent apoptosis [
36]. The p53 activated (p-p53) by 3EE, 20Ac-ingenol through the various responses (
Figure 2B, lane 2) decreased the amount of HIF-1𝛼 translated initially (control;
Figure 3D, lane 1) at 24 h after addition of 3EE, 20Ac-ingenol (
Figure 3D, lane 2). After 48 h, the subsequently translated HIF-1𝛼 expressed in the Panc-1 cells after 3EE, 20Ac-ingenol treatment and translocated to the nuclei (
Figure 3D, lane 3) also began to decrease in the same way as the initially translated HIF-1𝛼 (
Figure 3D, lane 4), with further increase of p53 accumulation (
Figure 2B, lanes 3,4 and
Figure S2). High p-p53 and p53 accumulation was observed in the Panc-1 cells, which show cyclin D1 overexpression, through the high HIF-1𝛼 translation following 3EE, 20Ac-ingenol treatment under the hypoxic condition, which resulted in HIF-1𝛼 degradation and cellular apoptosis through caspase-3 activation (
Figure 3E, lanes 3,4).
PD-L1 expression is upregulated through HIF-1𝛼 activation in response to replication-associated stress upon exposure to hypoxia and/or DNA damage (DNA-double strand breaks) by chemotherapeutic agents [
5,
28]; We consider that the DNA replication stress induced by hypoxia and 3EE, 20Ac-ingenol induces PD-L1 expression in the Panc-1 cells (
Figure 4B, lanes 1, 2), but only transiently induces PD-L1 expression following only 3EE, 20Ac-ingenol treatment in the Jeko-1 cells (
Figure 4A, lane 2). PD-L1 not only serves as an immune checkpoint inhibitor, but also promotes chemoresistance and cell growth, and exerts anti-apoptotic effects on the cancer cells [
3,
4,
37,
38]. However, knockdown of HIF-1𝛼 inhibits hypoxia-induced PD-L1 expression [
32], and suppression of PD-L1 is known to block cell proliferation [
39] and induce apoptosis in cancer cells [
31,
32,
40]. Although the DNA replication stress induced in Panc-1 cells by 3EE, 20Ac-ingenol treatment may lead to the HIF-1𝛼 dependent (
Figure 3C, lane 2) PD-L1 expression, similar to that following exposure of the cells to hypoxia (
Figure 3D lane 1), the amount of activated PD-L1 decreased (
Figure 4B, lane 4) with the early disappearance of HIF-1𝛼 through p53 accumulation (
Figure 3D, lane 4), resulting in inhibition of cell growth (
Figure 1B) and induction of apoptosis (
Figure 3E) in the Panc-1 cells. HIF-1𝛼 activated through ATR activation in the Jeko-1 cells was not observed under hypoxia, and the increase of PD-L1 expression might be activated by 3EE, 20Ac-ingenol treatment instead of the HIF-1𝛼. The activated PD-L1 expression decreased over time as normoxia (
Figure S1C).
ATR which is activated by replication stress induced by exposure of the cells to severe hypoxia controls efficient adaptation of the cells to hypoxia through regulating HIF-1𝛼 expression and p53 accumulation [
9,
10,
11]. In addition to the initial ATR activation elicited by hypoxia, more intense ATR activation was detected in the Panc-1 cells that show cyclin D1 accumulation as part of the enhanced DDR induced by 3EE, 20Ac-ingenol treatment under the hypoxic condition (
Figure 2B, lane 1 vs. 2-4). The first translation peak of HIF-1𝛼 associated with hypoxic stress (first ATR activation pathway) was observed in the nuclei of control Panc-1 cells as an adaptive response to mild hypoxia (0.5%-1.3% O
2) (
Figure 3D, lane 1). Under the hypoxic condition, the subsequently translated HIF-1𝛼 associated with the DNA replication stress induced by 3EE, 20Ac-ingenol (
Figure 3C, lane 2) combines with the DNA replication stress induced by hypoxia, and the summation of HIF-1𝛼 is translocated in to nuclei, which forms the second peak (
Figure 3D, lane 3). The characteristic of HIF-1𝛼 expression by 3EE, 20Ac-ingenol under hypoxia could show to be shared in the nuclei by the two peaks derived from hypoxia alone and by 3EE, 20Ac-ingenol plus hypoxia by examining its changes of the localization (
Figure 3D, lanes 1,3). The HIF-1𝛼 accumulated by the two pathways contributed to p53 stabilization under mild hypoxia. In experiments using transfection of a p53-expressing plasmid, hypoxic translation of HIF-1𝛼 was attenuated by p53, and high p53 expression degraded the HIF-1𝛼 protein [
13]. Transient expression of HIF-1𝛼 is observed with the overexpression of p53 under anoxia, followed by a rapid decrease in the amount of HIF-1𝛼 protein. Although HIF-1𝛼 disappears more rapidly under anoxiaas compared with that under normoxia, under both normoxia and anoxia, HIF-1𝛼 completely disappeared by 24 h with plasmid-induced p53 overexpression [
13]. The cooperative effect of the ATR activations occurring in response to similar replication stresses induced by 3EE, 20Ac-ingenol and hypoxia (
Figure 2B, lane 1 vs. 2-4) resulted in accumulation of p53 phosphorylated at serine 15 (
Figure 2B, lanes 1,2) and p53 stabilization (
Figure 2B, lanes 3,4) through HIF-1𝛼 accumulation in the Panc-1 cells (
Figure 3D, lanes 1,3). Transient expression and early disappearance of HIF-1𝛼 in the Panc-1 cells was promoted by higher activation of p53 (
Figure 3D, lane 1 vs. 2, lane 3 vs. 4). The p-p53 and p53 accumulation associated with ATR activation was observed at 24 h and 72 h. Many topo 1 catalytic inhibitors that induce a decatenation checkpoint causing G2 phase arrest are less toxic and, therefore, cannot induce apoptosis [
25]. 3EZ, 20Ac-ingenol was also shown, in a previous study, to induce G2/M phase arrest in DT40 cells
[26]. How does the catalytic-type topoisomerase inhibitor 3EE, 20Ac-ingenol activate the ATR/p53 pathway through S phase arrest under the mild hypoxic condition in cells overexpressing cyclin D1? It has been reported that stabilization of Cdt1 produced by inhibition of proteasome in cells showing nuclear cyclin D1 accumulation continually primes DNA re-replication during the S phase and compromises the intra S phase checkpoint [
41]. As one function, cyclin D1 led to activation of the downstream biochemical events, including the expressions of cyclin A and proliferating cell nuclear antigen, and cyclin E- and cyclin A-associated kinase activation, which initiates DNA replication [
42]. In the Panc-1 cells that progressed to the S phase through cyclin D1 overexpression, replication forks become stalled due to decatenation inhibition of the topo 1 catalytic activity caused by 3EE, 20Ac-ingenol, which may induce the intra S phase checkpoint. We consider that the 3EE, 20Ac-ingenol causes the DNA replication stress to activate ATR, which results in phosphorylation of p53 and strong HIF-1𝛼 dependent p53 accumulation under mild hypoxia. However, the detailed mechanisms remain unknown, and further studies are needed to examine how DNA replication stresses activate ATR at the S phase checkpoint.
The accumulated p53 also activates PTEN expression [
43], which inhibits PI3K/Akt [
44] and ERK [
45]. Under normoxia, PD-L1 expression is regulated by inhibition of ERK [
46]. Higher levels of PD-L1 protein are seen in cells with genetic deletion of PTEN than in cells with wild-type PTEN under normoxia, which can be attenuated by inhibition of PI3K/Akt; thus, PD-L1 expression is inhibited by PTEN activation [
33,
47,
48]. 3EZ, 20Ac-ingenol induces downregulation of p-Akt through upregulation of PTEN [
23]. PD-L-1 was highly expressed (27.8%) in pancreatic ductal adenocarcinoma under normoxia, and the cell-intrinsic PD-L1 facilitates in tumor growth through Hippo signaling pathway by independence of the immune system [
49]. In this study, under normoxia, 3EE, 20Ac-ingenol upregulated the expression of PTEN in the Panc-1 cells (
Figure S3A,B) and also inhibited p-ERK (
Figure S4). Under the hypoxic condition, upregulation of PD-L1 expression depends on increased expression of HIF-1𝛼. [
5]. Hypoxia-induced PD-L1 expression is inhibited by knockdown of HIF-1𝛼 [
32]. Furthermore, HIF-1𝛼 is inhibited by activation of the PTEN/Akt pathway [
15,
34]. Under the hypoxic condition also, 3EE, 20Ac-ingenol upregulated PTEN expression in the Panc-1 cells (Figures 4B and S3B), and under this condition, the PTEN/Akt pathway activated by 3EE, 20Ac-ingenol not only decreases the accumulation of HIF-1𝛼, but may also decrease PD-L1 expression. PD-L1 expression in Panc-1 cells that occurred under both the normoxic (
Figure S1D, lane 4) and hypoxic condition (
Figure 4B, lane 4) was clearly decreased by 3EE, 20Ac-ingenol treatment. Furthermore, PD-L1 is upregulated through INF-𝛾 activation, which serves as an immune inhibitor [
3,
5,
50]. Ingenol-type diterpenoil compaounds isolated from
Euphorbia kausui exert a wide range of pharmacological activities, including tumor inhibitory activities, immune regulatory activities, and modulatory effects on INF-γ [
51,
52]. It has been reported previously that 3EZ, 20Ac-ingenol more specifically inhibited the proliferation of cancer cells overexpressing cyclin D1 which showed resistance to irinotecan as compared with that of cancer cells that did not show cyclin D1 accumulation [
22,
53]. In this study, we showed that 3EE, 20Ac-ingenol treatment effectively inhibited both HIF-1𝛼 and PD-L1 upregulations that occurred under the hypoxic condition to induce apoptosis and may also offer promise for boosting antitumor immunity.