Abstract
Inactivation of APC is a strongly predisposing event in the development of colorectal cancer1,2, prompting us to search for vulnerabilities specific to cells that have lost APC function. Signalling through the mTOR pathway is known to be required for epithelial cell proliferation and tumour growth3-5 and the current paradigm suggests that a critical function of mTOR activity is to upregulate translational initiation through phosphorylation of 4EBP16,7. This model predicts that the mTOR inhibitor rapamycin, which does not efficiently inhibit 4EBP18, would be ineffective in limiting cancer progression in APC deficient lesions. Here we show that mTORC1 activity is absolutely required for the proliferation of APC deficient (but not wild type) enterocytes, revealing an unexpected opportunity for therapeutic intervention. Although APC deficient cells show the expected increases in protein synthesis, our studies reveals that it is translation elongation, and not initiation, which is the rate-limiting component. Mechanistically, mTORC1 mediated inhibition of eEF2 kinase is required for the proliferation of APC deficient cells. Importantly, treatment of established APC deficient adenomas with rapamycin (which can target eEF2 through the mTORC1 – S6K – eEF2K axis) causes tumour cells to undergo growth arrest and differentiation. Taken together our data suggest that inhibition of translation elongation using existing, clinically approved drugs such as the Rapalogs, would provide clear therapeutic benefit for patients at high-risk of developing colorectal cancer.
The ability of the intestinal epithelium to regenerate following challenge has been well described9-11. We have shown that this is a Wnt-driven process that mimics the proliferation observed following Apc deletion11,12 and is a valuable model of the early stages of intestinal cancer. However, the underlying mechanisms controlling these processes are largely unknown. The serine/threonine kinase mTOR, particularly the mTOR Complex 1 (mTORC1), is a known mediator of cell growth and proliferation13. Previous studies have suggested that mTORC1 may be important in both the intestinal stem-cell niche and for intestinal tumourigenesis4,5,14. We therefore queried the role of mTORC1 in intestinal proliferation following Wnt activation. Following Apc deletion there was an increase in the phosphorylation status of mTORC1 effectors rpS6 and 4EBP1 that was dependent on MYC expression. Increased phosphorylation of these proteins was also seen during crypt regeneration (Fig. 1a,b,c, Extended Data Fig. 1a). Importantly, the mTOR inhibitor rapamycin blocked intestinal regeneration, demonstrating that mTOR signalling is required for this process (Fig. 1d,e). Given that rapamycin did not affect apoptosis nor proliferation in the normal intestine (Extended Data Fig. 1b,c), these data suggest that there may be a potential therapeutic window, between normal intestinal enterocytes and those with a high level of Wnt activity. Therefore Raptor (an essential component of mTORC1) was deleted in the intestinal epithelium (Extended Data Fig. 1d). Surprisingly, normal gut homeostasis was unaffected by Raptor loss 4 days post-Cre induction, when using an epithelium-specific Cre-Recombinase (VillinCREER Rptorfl/fl) (Extended Data Fig. 1e,f). Furthermore, 400 days after induction, no phosphorylation of rpS6 or 4EBP1 was observed, showing that Raptor deletion was sustained (Extended Data Fig. 2a). Raptor loss caused no change in either levels of mitosis or apoptosis (Extended Data Fig. 2b,c) but proved to be essential for the proliferative phenotype observed during regeneration or following Apc deletion (Fig. 1a,b,d,e,f). Nuclear localisation of β-catenin and high levels of MYC could be demonstrated by IHC, showing that Wnt-activation is still present (Extended Data Fig. 3a,b).
Given that rapamycin treatment and Raptor deletion had similar effects, we examined whether rapamycin treatment was sufficient to modify intestinal tumourigenesis, either prophylactically, or chemotherapeutically. First we assessed whether rapamycin could suppress a model of intestinal tumourigenesis, in which Apc deletion is targeted to LGR5-positive stem cells using the LGR5CREER (LGR5CREER Apcfl/fl). Mice were treated starting 10 days post-Cre induction, and in contrast to controls, remained tumour free for the duration of the experiment (Fig. 2a,b). Next we treated mice (ApcMin/+ or LGR5CREER Apcfl/fl) with established adenomas. Remarkably, the mice lost their clinical symptoms of disease and survived significantly longer than controls (Fig. 2c,d; Extended Data Fig. 3c). We next analysed the tumours from these mice over a time-course post-rapamycin treatment. Treatment caused a loss of proliferation specifically within the tumours by 72-hours, and an increase in the number of Lysozyme-positive paneth cells (Fig. 2e; Extended Data Fig. 3d,e). By 30 days, most tumours had shrunk considerably to small non-proliferative lesions that no longer contained paneth cells (Fig. 2f; Extended Data Fig. 3f). Within the normal intestine there are two main cell populations that show high levels of Wnt-signalling; the label-retaining/progenitor population and the paneth cell population15. Our data suggest that treatment of mice with rapamycin causes the differentiation of the tumour’s Wnt-high progenitor cells into the other Wnt-high fate in the intestine; namely non-proliferative paneth-like cells. The cell-cycle arrest in these cells was examined by staining for p21, p16, p53. No increase in these markers was observed, suggesting a classical cell cycle arrest pathway had not been engaged (Extended Data Fig. 4a). We reasoned that if mice were removed from rapamycin the tumours would regain proliferative capacity. Indeed, when rapamycin treatment was halted, signs of intestinal neoplasia were observed approximately 40–60 days later (Extended Data Fig. 3c). This suggested that intestinal adenoma stem cells were still present. Tumours from LGR5-GFP-CREER mice were stained to detect LGR5-GFP positivity. We found that following rapamycin treatment, numerous LGR5-positive cells were still present, indicating that, while rapamycin treatment causes a regression of the lesions, the tumour initiating cells remain (Extended Data Fig. 4b).
We next examined the mechanism of mTORC1 requirement following Apc loss. mTORC1 is known to regulate protein synthesis on multiple levels and most research has focused on two downstream effectors: 4EBP1 and S6K. A number of studies have suggested that translation initiation, via the 4EBP1 – eIF4E axis, is the critical effector of mTOR in cancer6,16. However, it has been shown that rapamycin preferentially inhibits the phosphorylation of S6K over 4EBP18, suggesting that 4EBP1-mediated inhibition of translation initiation may not be limiting in the context of Apc loss. To assess the changes in translational control in response to mTORC1 inhibition, we measured the polysomal distribution in WT, Apc-deficient and Apc/Raptor-deficient intestinal epithelial cells 4-days post gene deletion. Apc deletion resulted in a decrease in the number of polysomes, whereas Apc/Raptor co-deletion reversed this effect (Fig. 3a). The decrease in the number of polysomes following Apc deletion could suggest either reduced translation initiation (and consequently a lower overall level of translation) and/or a faster rate of translational elongation. Global translation rates were measured using an in vitro intestinal crypt 3d-culture model17. The Apc-deficient cells were shown to have increased 35S-labelled methionine/cysteine incorporation compared to WT, showing higher overall levels of protein synthesis (Fig. 3b). Unfortunately, Raptor deletion prevented the growth of crypts in vitro so this could not be assayed (Extended Data Fig. 5).
To measure the rate of translational elongation, an in vitro harringtonine run-off assay was performed18, as described in Methods. There was a >2.5-fold increase in ribosome run-off in crypts with Apc deletion compared to wild-type (Fig. 3c; Extended Data Fig. 6a-d). This suggests that following Wnt activation, elongation, rather than initiation, is rate limiting for protein synthesis and mTORC1 must be activated to overcome this.
Cycloheximide (an inhibitor of elongation19) reduced proliferation associated with Apc deletion, to a similar level to rapamycin (Extended Data Fig. 6e,f). While cycloheximide is acknowledged to inhibit elongation19, it must be emphasised that 72hr treatment could result in broad alterations in protein synthesis. However, the Apcfl/fl-specific loss of proliferation observed here provides “proof of principle” to demonstrate that modulation of protein synthesis may be useful as a chemotherapeutic strategy.
As most previous work has suggested translation initiation downstream of 4EBP1 is limiting to cancer20, it was important to probe known effectors of mTORC1 in this system. Given the alteration of elongation rates, the elongation factor 2 kinase (eEF2K), a known target of S6K21,22 was of particular interest. eEF2K is a negative regulator of the elongation factor 2 (eEF2), giving mTORC1 the ability to promote translational elongation via S6K23. Using multiple mouse knockout and knock-in alleles, we further dissected the downstream effectors of mTORC1 in intestinal regeneration. S6k1/2 knockout decreased intestinal regeneration, whilst knockout of Eif4ebp1/2 had no effect. As the 4EBP proteins are negative regulators of eIF4E, an increase (rather than decrease) in regeneration may have been predicted, but this was not found. Moreover these intestines were still sensitive to rapamycin, demonstrating that rapamycin was acting via the mTORC1-S6K branch rather than 4EBP1-eIF4E (Extended Data Fig. 7). We then used an Eef2k-null mouse and showed that following irradiation and treatment with rapamycin, these mice were now resistant to mTORC1 inhibition, confirming the importance of translational elongation (Fig. 4a). To ensure that S6K was not also acting through its more established effector, rpS6, we used an rpS6 phospho-mutant that cannot be phosphorylated by S6K. This was unable to phenocopy Raptor deletion (Fig. 4a), showing that Wnt-driven regeneration requires increased translational elongation, mediated through mTORC1.
To prove that inhibition of eEF2K by S6K is required to allow increased eEF2 activity following Apc loss, we intercrossed VillinCREER Apcfl/fl to Eef2k−/− mice and treated these with rapamycin. In contrast to VillinCREER Apcfl/fl mice, these intestines were now resistant to growth inhibitory effects of rapamycin (Fig. 4b,c). Tellingly, these mice no longer show an increase in the inhibitory phosphorylation of eEF2 following rapamycin treatment (Extended Data Fig. 8).
To assess whether the increased elongation following Apc deletion had differential affects on cell cycle regulating proteins, RNA and protein levels of several key cell cycle regulators were tested (Fig. 4d,e). This analysis revealed that whilst there were increased RNA and protein levels of Cyclin D1, D2, CDK4 and CDK6, Cyclin D3 had increased protein levels in the absence of increased mRNA levels. Cyclin D3 protein levels were sensitive to rapamycin exposure, and this sensitivity depends on eEF2K (Extended Data Fig. 9). Additionally, ribosomes were shown to elongate approximately 4-times faster on Cyclin D3 messages in Apc-deficient cells than WT cells. No differences were detected in other messages tested (Extended Data Fig. 10). Taken together, these data suggest that Cyclin D3 is translationally regulated at the level of elongation, consistent with previous reports24,25. The contribution of Cyclin D3 to the proliferative phenotype remains to be elucidated.
In summary, we report that mTORC1 is an essential downstream effector of Wnt-signalling in the intestine. We show that intestinal proliferation associated with Wnt-signalling requires the mTORC1 – S6K – eEF2K – eEF2 axis, and that the resulting increase in the rate of elongation of specific polypeptides overcomes a limiting translational step. Our work highlights key functional roles for eEF2K and translational elongation in the control of the initiation of cancer and adenomatous proliferation. The importance of elongation in this context has been suggested in a small number of publications, but this study provides definitive in vivo evidence26-28. Finally, we have also shown that targeting mTOR and translational control may be a viable strategy for chemoprevention of CRC in high risk patients, and treatment of early stage disease. Indeed, recent studies have suggested that the chemopreventative agents aspirin and mesalazine also target mTOR29,30.
METHODS
Mouse colonies
All experiments were performed according with UK Home Office regulations (licence 60/4183) which undergoes local ethical review at Glasgow University. Outbred male mice from 6 to 12 weeks of age were used. The majority of the work was performed on C57BL/6 mice: AhCre, Apcfl/fl, ApcMin/+, Rptorfl/fl, S6k1/2 knockout and Rps6mut mice were all C57BL/6J. Some treatment experiments were performed on mice that were only three generations C57BL/6 (Lgr5CreER Apcfl/fl).
The alleles used were as follows: VillinCreER (ref. 31). AhCre (ref. 11), Lgr5CreER (ref. 32), Apc580 (ref. 33), ApcMin/+ (ref. 34), Mycfl/fl (ref. 35), Rptor fl/fl (ref. 36), ROSA-tdRFP (ref. 37), Eif4ebp1 knockout (ref. 38), Eif4ebp2 knockout (ref. 39), S6k1 knockout (ref. 40), S6k2 knockout (ref. 41), Eef2k knockout (ref. 42), Rps6mut (ref. 43). Recombination by VillinCreER was induced with one intraperitoneal (i.p.) injection of 80 mg kg−1 tamoxifen on day 0 and day 1. Analysis of VillinCreER-induced mice was at day 4 after induction. Red fluorescent protein (RFP) analysis was carried out by inducing recombination by AhCre using a single i.p. injection of 80 mg kg−1 β-napthoflavone. RFP visualization was carried out on day 4. Mice carrying the Lgr5CreER transgene were given one i.p. injection of 120 mg kg−1 tamoxifen.
For regeneration experiments, mice were exposed to γ-irradiation from caesium-137 sources. This delivered γ-irradiation at 0.423 Gy min−1.
Rapamycin treatment was performed using a daily i.p. injection of 10 mg kg−1 (refs 43, 44) in 5% Tween80 and 5% polyethylene glycol in PBS. Cycloheximide treatment was performed using a daily i.p. injection of 35 mg kg−1 in PBS.
In accordance with the 3Rs, the smallest sample size was chosen that could give a significant difference. Given the robust phenotype of the Apcfl/fl, and our prediction that mTOR was essential, the minimum sample size assuming no overlap in control versus experimental is three animals.
No randomization was used and the experimenter was blinded to drugs and genotypes.
IHC
Standard IHC techniques were used throughout this study. Antibody concentrations used were as follows: phospho-rpS6Ser235/236 (1:800; Cell Signaling 4858), phospho-4EBP1Thr37/46 (1:500; Cell Signaling 2855), phospho-eEF2Thr56 (1:500; Novus Biologicals NB100-92518), c-MYC (1:200; Santa Cruz sc-764), β-catenin (1:50; BD Biosciences 610154), BrdU (1:200; BD Biosciences 347580), lysozyme (1:150; Dako A099), GFP (1:1,000; Abcam ab6556), p21 (1/4; CNIO Madrid), p16 (1:400; Santa Cruz sc1661), p53 (1/150; Vector Laboratories VPP956). For each antibody, staining was performed on at least three mice of each genotype. Representative images are shown for each staining.
Assaying apoptosis, mitosis and proliferation in vivo
Apoptosis and mitotic index were scored from H&E-stained sections as previously described11. Proliferation levels were assessed by measuring BrdU incorporation. Mice were injected with 250 μl of BrdU (Amersham Biosciences) 2 h before being killed. Immunohistochemical staining for BrdU was then performed using an anti-BrdU antibody. For each analysis, 25 full crypts were scored from at least three mice of each genotype.
Intestinal epithelium extraction
To generate tissue for polysomal profile analysis, 10-cm portions of intestine were flushed with 0.1 mg ml−1 cycloheximide (Sigma) in PBS and inverted over a glass rod to expose the epithelial surface. Intestines were incubated in 0.1 mg ml−1 cycloheximide in HBSS (Gibco) with 10 mM EDTA for 5 min at 37 °C followed by 5 min of vigorous shaking. Intestines were transferred to 0.1 mg ml−1 cycloheximide in PBS and incubated for a further 5 min at 4 °C, followed by 5 min of vigorous shaking. This fraction contained intestinal crypts and was used for downstream analysis.
Sucrose density ultracentrifugation
Intestinal epithelial cells were lysed in ice-cold 300 mM NaCl, 15 mM MgCl2, 15 mM Tris (pH 7.5) containing 500 units ml−1 RNAsin, 1 mg ml−1 heparin sulphate and 0.1 mg ml−1 cycloheximide supplemented with 0.1% (v/v) Triton X-100. Post-nuclear lysates were layered on 10 ml 10–50% (w/v) sucrose gradients of the same buffer omitting Triton X-100. Gradients were centrifuged at 38,000 r.p.m. for 2 h at 4 °C in a SW40Ti rotor (Beckman Coulter) and separated through a live OD254nm ultraviolet spectrometer (Isco). Comparison of peak abundance was based on the area under the curve.
Crypt culture
Mouse small intestines were opened longitudinally and washed with PBS. Crypts were isolated as previously described17. Isolated crypts were mixed with 50 μl of Matrigel (BD Bioscence), plated in 24-well plates in Advanced DMEM/F12 with Noggin (100 ng ml−1, Peprotech). Wild-type crypts were also supplemented with R-spondin (500 ng ml−1; R&D Systems). Growth factors were added every other day. Sphere formation was scored 7 days after plating, by counting the number of spheres present per well.
Determination of protein synthesis rates
Cells were treated with 30 μCi ml−1 35S-methionine label (Hartmann Analytic) for 30 min then harvested and lysed. Protein was precipitated onto filter paper (Whatmann) by addition of trichloroacetic acid to 12.5% and washed with 70% ethanol then acetone. Scintillation was read from dried filter paper in triplicate for each experimental condition (National Diagnostics). Total protein content was determined by bicinchoninic acid (BCA) assay (Pierce) for standardization between conditions.
Harringtonine run-off assay
Harringtonine inhibits de novo translational initiation, allowing ribosomes engaged in elongation to run-off their messages while limiting re-initiation post-termination. Harringtonine was added for 0 or 180 s and the increase in sub-polysomes relative to polysomes was calculated. This run-off rate represents the shift in S:P between the two time points, which is proportional to elongation speed. Crypt cultures were treated with 2 μg ml−1 Harringtonine (Insight Biotechnology) and at set time periods (0 and 180 s) 0.1 mg ml−1 cycloheximide was added. Cells were scraped into PBS at 4 °C and prepared for sucrose gradient ultracentrifugation as previously described.
Western blotting
Snap-frozen intestinal epithelial tissue (50–100 mg) was homogenized using the Precellys 24 (Stretton Scientific) in 500 μl of Ripa-lysis buffer. Protein concentrations were determined using a BCA Protein Assay Kit (Pierce). Equal amounts of cellular protein (30 μg) were separated on a 4–12% gradient gel (Novex) and subsequently transferred to a PVDF membrane (Amersham). Total protein was visualized with Poinceau (Sigma). After blocking the membranes in TBS containing 5% BSA (Sigma), 0.02% Triton X-100 for 1 h, primary antibodies were added in block solution at the following dilutions: CDK4 (Santa Cruz SC-260, 1:1,000), CDK6 (Cell Signaling 3136, 1:1,000), cyclin D1 (Cell Signaling 2926, 1:2,000), cyclin D2 (Cell Signaling 3741, 1:1,000), cyclin D3 (Cell Signaling 2936, 1:2,000), eEF2K (Cell Signaling 3692, 1:1,000) and β-actin (Sigma A2228, 1:5,000). After washing, the appropriate HRP-conjugated secondary goat antibodies (Dako) were added diluted 1:10,000 in block for 1 h. Antibody binding was detected using ECL Western Blotting Substrate (Pierce). Primary antibody incubations were carried out at 4 °C overnight. Remaining incubations were carried out at room temperature.
RNA isolation
Snap-frozen intestinal epithelial tissue was homogenized and RNA was extracted using the TRIzol method (Ambion).
qPCR
One microgram of RNA was reverse transcribed to cDNA using a Quantitect Reverse Transcription Kit (Qiagen) in a reaction volume of 20 μl. qPCR was performed on each sample in triplicate in a 20 μl reaction mixture containing 10 μl of 2× DyNAmo HS master mix (Thermo Scientific), 0.5 μM of each of the primers (detailed later) and 2 μl cDNA generated previously. The reaction mixture without a template was run in triplicate as a control. The reaction conditions were as follows: 95 °C for 15 min, followed by 40 cycles of three steps consisting of denaturation at 94 °C for 15 s, primer annealing at 60 °C for 30 s, and primer extension at 72 °C for 30 s. A melting curve analysis was performed from 70 °C to 95 °C in 0.3 °C intervals. Gapdh was used to normalize for differences in RNA input.
qRT–PCR primers
qRT–PCR primers were as follows. Ccnd1 forward, 5′-GAGA AGTTGTGCATCTACACTG-3′; Ccnd1 reverse, 5′-AAATGAACTTCACATCTGTGGC-3′; Ccnd2 forward, 5′-CTACCGACTTCAAGTTTGCC-3′; Ccnd2 reverse, 5′-GCTTTGAGACAATCCACATCAG-3′; Cdk4 forward, 5′-AATGTTGTACGGCTGATGGA-3′; Cdk4 reverse, 5′-AGAAACTGACGCATTAGATCCT-3′; Cdk6 forward, 5′-GGCGTACCCACAGAAACCATA-3′; Cdk6 reverse, 5′-AGGTAAGGGCCATCTGAAAACT-3′; Ccnd3 forward, 5′-CGAGCCTCCTACTTCCAGTG-3′; Ccnd3 reverse, 5′-GGACAGGTAGCGATCCAGGT-3′; Rps6 forward, 5′-AGCTCCGCACCTTCTATGAGA-3′; Rps6 reverse, 5′-GGGAAAACCTTGCTTGTCATTC-3′;Rps21 forward,5′-GTCCATCCAGATGAACGTGG-3′;Rps21 reverse, 5′-CCATCAGCCTTAGCCAATCGG-3′.
Extended Data
Supplementary Material
Acknowledgements
WJF is funded by AICR. OJS is funded by CRUK, ERC Investigator Grant (COLONCAN) and the European Union Seventh Framework Programme FP7/2007-2013 under grant agreement number 278568. MB is an MRC Senior Fellow. Authors acknowledge Patrizia Cammareri, Jennifer Morton and Claudio Murgia for proof reading of the manuscript.
Footnotes
Extended Data is linked to the online version of the paper at www.nature.com/nature.
Competing financial interests
The Authors declare no competing financial interests.
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