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The Journal of Neuroscience, June 1, 1998, 18(11):4083-4095
Purification of a Multipotent Antideath Activity from Bovine
Liver and Its Identification as Arginase: Nitric Oxide-Independent
Inhibition of Neuronal Apoptosis
Fred
Esch1,
Kuo-I
Lin4,
Anna
Hills1,
Khalequz
Zaman4,
Jay M.
Baraban3,
Sukalyan
Chatterjee4,
Lee
Rubin1,
David E.
Ash2, and
Rajiv R.
Ratan4, 5
1 Eisai London Research Laboratories, London, England,
2 Department of Biochemistry, Temple University School of
Medicine, Philadelphia, Pennsylvania, 3 Department of
Neuroscience, The Johns Hopkins University School of Medicine,
Baltimore, Maryland, and 4 Department of Neurology and
5 Program in Neuroscience, Harvard Medical School and The
Beth Israel-Deaconess Medical Center, Boston, Massachusetts
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ABSTRACT |
Catalase is an antioxidant enzyme that has been shown to inhibit
apoptotic or necrotic neuronal death induced by hydrogen peroxide. We
report the purification of a contaminating antiapoptotic activity from
a commercial bovine liver catalase preparation by following its ability
to inhibit apoptosis when applied extracellularly in multiple death
paradigms. The antiapoptotic activity was identified by protein
microsequencing as arginase, a urea cycle and nitric oxide
synthase-regulating enzyme, and confirmed by demonstrating the presence
of antiapoptotic activity in a >97% pure preparation of recombinant
arginase. The pluripotency of recombinant arginase was demonstrated by
its ability to inhibit apoptosis in multiple paradigms including rat
cortical neurons induced to die by glutathione depletion and oxidative
stress, by 100 nM staurosporine treatment, or by Sindbis
virus infection. The protective effects of arginase in these apoptotic
paradigms, in contrast to previous studies on excitotoxic neuronal
necrosis, are independent of nitric oxide synthase inhibition. Rather,
arginase-induced depletion of arginine leads to inhibition of protein
synthesis, resulting in cell survival. Because inhibitors of nitric
oxide synthesis and of protein synthesis have been shown to decrease
necrotic and apoptotic death, respectively, in animal models of stroke
and spinal cord injury, arginine-depleting enzymes, capable of
simultaneously inhibiting protein synthesis and nitric oxide
generation, may be propitious therapeutic agents for acute neurological
diseases. Furthermore, our results suggest caution in attributing the
cytoprotective effects of some catalase preparations to catalase.
Key words:
apoptosis; glutathione; neurons; oxidative stress; arginase; nitric oxide; staurosporine
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INTRODUCTION |
Apoptosis is a morphologically
distinct type of cell death characterized by nuclear and cytoplasmic
condensation, clumping of nuclear chromatin, and membrane blebbing
(Wyllie et al., 1980 ). The transduction of apoptosis in neurons often
requires new protein synthesis (Martin et al., 1988 ; Pittman et al.,
1993 ; Ratan et al., 1994a ,b ; Serghini et al., 1994 ; Dreyer et al.,
1995 ; Koh et al., 1995 ) and involves both positive and negative
regulators such as the Bcl-2/Bax family of proteins (Garcia et al.,
1992 ; Levine et al., 1993 ; Mah et al., 1993 ; Miller et al., 1997 ; Oh et
al., 1997 ), the retinoblastoma (Clarke et al., 1992 ; Jacks et al.,
1992 ; Lee et al., 1992 ) and p53 gene products (Wood and Youle, 1995 ),
and others (Freeman et al., 1994 ). Interleukin 1- converting
enzyme-like cysteine proteases, known as caspases, seem to form part of
a common final effector pathway leading to degradation of repair
proteins (Casciola-Rosen et al., 1996 ) and, ultimately, to controlled
destruction of the cell (Gagliardini et al., 1994 ; Nicholson and
Thornberry, 1997 ).
Although classically associated with physiological processes such as
nervous system development (Johnson et al., 1980 ; Oppenheim, 1991 ;
Clarke, 1994 ), apoptosis can be induced in neurons in vitro by many pathological stimuli including oxidative stress (Ratan et al.,
1994a ,b ; Rothstein et al., 1994 ; Troy and Shelanski, 1994 ; Bonfoco et
al., 1995 ), viral infection (Levine et al., 1993 ), mitochondrial toxins
(Behrens et al., 1995 ), and -amyloid (Loo et al., 1993 ). These
observations correlate well with recent evidence demonstrating that
apoptosis is a mechanism of neuronal loss in a variety of
neurodegenerative states including stroke (Linnik et al., 1993 ; Gwag et
al., 1995 ; Li et al., 1995 ; Du et al., 1996a ), spinal cord injury
(Crowe et al., 1997 ; Liu et al., 1997 ), Alzheimer's disease (Cotman
and Anderson, 1995 ), amyotrophic lateral sclerosis (Mu et al., 1996 ),
and Huntington's disease (Portera-Calliau et al., 1995 ). However, the
precise signals that activate apoptosis in these pathological
conditions remain unclear.
Among the candidate second messenger molecules that may activate
pathological neuronal apoptosis, reactive oxygen species such as
hydrogen peroxide have been hypothesized to play an important role
(Bredesen, 1995 ). Indeed, addition of peroxide to neurons can lead to
apoptosis (Whittemore et al., 1994 ; Satoh et al., 1996 ; Tong and
Perez-Polo, 1996 ; Hoyt et al., 1997 ), and peroxide has been implicated
as a mediator of -amyloid apoptosis (Loo et al., 1993 ; Behl et al.,
1994 ). Additionally, sympathetic neurons induced to undergo apoptosis
by removal of nerve growth factor experience a transient increase in
reactive oxygen species as measured by the free radical reporter
6-carboxy-2',7'-dichlorofluorescein diacetate (Greenlund et al., 1995 ;
Bae et al., 1997 ); drugs such as N-acetylcysteine with
peroxide-scavenging ability (Aruoma et al., 1989 ) can inhibit apoptosis
of growth factor-deprived sympathetic neurons (Ferrari et al., 1995 ).
Finally, peroxide can activate apoptosis-related transcription factors
such as activator protein-1 (Estus et al., 1994 ; Ham et al., 1995 ) and
NF- B (Lin et al., 1995 ; Clemens et al., 1997 ) in neuron-like
pheochromocytoma PC12 cells (Tong and Perez-Polo, 1996 ), suggesting
that peroxide may act as a trigger for the expression of "death"
gene products in response to some neuronal apoptotic stimuli.
To examine further the role of hydrogen peroxide in activating neuronal
apoptosis, we added the enzymatic peroxide scavenger catalase to the
extracellular bathing medium of neurons induced to die apoptotically by
depletion of the antioxidant glutathione (Ratan et al., 1994a ), by
exposure to low doses of the protein kinase inhibitor staurosporine
(Koh et al., 1995 ; Prehn et al., 1997 ), or by infection with the
alphavirus Sindbis virus (Levine et al., 1993 ). Because peroxide is a
noncharged species capable of diffusing through lipid membranes, we
reasoned that extracellular catalase should reduce intracellular
peroxide by decreasing extracellular peroxide concentrations and
thereby drawing peroxide out of the cell. Here, we report that a crude
commercial bovine liver "catalase" preparation added to the
extracellular medium is able to block neuronal apoptosis in multiple
death paradigms. However, we demonstrate that an antiapoptotic activity
inherent in this extract is not catalase but rather a contaminant that
we identified as the urea cycle and nitric oxide synthase-regulating
enzyme arginase (Jenkinson et al., 1996 ; Morris, 1998 ). Moreover, we
demonstrate that the protective effects of arginase cannot be
attributed to nitric oxide synthase inhibition but rather result from
arginine depletion and inhibition of protein synthesis. These
observations define a novel pathway by which arginine participates in
neuronal cell death and identify amino acid-degrading enzymes such as
arginase as a new class of neuronal antiapoptotic agents.
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MATERIALS AND METHODS |
Primary neurons. Cell cultures were obtained from the
cerebral cortex of fetal Sprague Dawley rats (day 17 of gestation) as described previously (Murphy et al., 1990 ). All experiments were initiated 24-72 hr after plating. These young cultures do not express
significant receptor-mediated responses to glutamate and thus do not
seem to be susceptible to excitotoxicity. For cytotoxicity studies, the
cells were rinsed once with warm PBS and then changed to medium
[Minimum Essential Medium (MEM; Gibco BRL) with 5.5 gm/l glucose, 10%
FCS, 2 mM L-glutamine, and 100 µM
cystine] containing the glutamate analog homocysteate (HCA; 1 mM), the protein kinase inhibitor staurosporine (STS; 100 nM), or Sindbis virus (SV; strain AR339) added at a
multiplicity of infection (MOI) of 1-5 plaque-forming units (PFU) per
cell. Homocysteate was diluted from 100-fold concentrated solutions
that were adjusted to pH 7.5. Media containing staurosporine were made
by diluting at least 1000-fold concentrated solutions prepared in
dimethylsulfoxide (DMSO vehicle, 0.1% v/v, had no protective effect
alone). Viability was assessed by phase contrast microscopy, by lactate
dehydrogenase (LDH) release (Ratan et al., 1994a ,b ), or by using
calcein AM/ethidium homodimer-1 staining (Molecular Probes, Eugene, OR)
and fluorescence microscopy. To evaluate the effects of extracellular
catalase on cytotoxicity, we added bovine liver catalase (2100 units/ml; #C6665; Sigma, St. Louis, MO) at the time cortical neurons
were exposed to HCA, STS, or SV, and viability was assessed as
described above at 24, 60, or 48 hr, respectively. In parallel, purer
preparations of catalase from bovine liver (1-30,000 units/ml),
Aspergillus niger (1-30,000 units/ml), or human
erythrocyte (1-30,000 units/ml), all from Calbiochem (La Jolla, CA),
recombinant arginase (100-8000 ng/well) (Cavalli et al., 1994 ), or
NG-nitro-L-arginine methyl
ester hydrochloride (L-NAME; 100 µM-1 mM; Calbiochem) were tested against HCA-, STS-, or
SV-induced cytotoxicity.
Mouse N18 neuroblastoma cells. Cells were grown as described
(Levine et al., 1993 ) in MEM media containing 10% FCS, 2 mM L-glutamine, penicillin (50 units/ml), and
streptomycin (50 µg/ml). Cells were trypsinized, plated in 24 well
dishes at a density of 80,000 cells/ml and in 96 well dishes at a
density of 5000 cells per well, and allowed to adhere overnight for
bioassays. After addition of fresh media, cells were preincubated for 2 hr with crude bovine liver catalase (Sigma), purer preparations of
catalase (Calbiochem), NG-methyl-L-arginine
(L-NMA; 100 µM; Calbiochem),
guanidinoethyldisulfide (GED; 100 µM; Calbiochem),
arginine decarboxylase (0-4000 µg/ml; Sigma),
asparaginase-polyethylene glycol (1-5 units/ml; Sigma), catalase-polyethylene glycol (1-3000 units/ml; Sigma), superoxide dismutase-polyethylene glycol (1-3000 units/ml; Sigma), or the antiapoptotic activity (AAA) at various stages of purification and then
exposed to SV at a MOI of 1-5. Antiapoptotic activity was defined by
suppression of nuclear morphological changes characteristic of
apoptosis (Ratan et al., 1994a ) as monitored by Hoechst 33452 staining
and fluorescence microscopy and quantitated by a viability index. The
viability index was defined as the ratio of LDH activities (Cytotox LDH
assay kit; Promega, Madison, WI) in the cell lysates of cells exposed
to both the AAA and virus versus that in cell lysates of cells exposed
to AAA alone. One unit of AAA was established as the amount of protein
per well giving rise to 50% viability according to the index defined
above.
Inactivation of catalase in the bovine liver catalase
preparation. The catalase activity in crude bovine liver catalase
was inactivated by exposure to 40 mM 3-amino-1,2,4-triazole
or 0.5 mM phenylhydrazine (Ortiz de Montellano and Kerr,
1983 ; Kingma et al., 1996 ) as described in . Inactivation of catalase
activity was verified with a Clark oxygen electrode (Yellow Springs
Instruments, Yellow Springs, OH) (Rorth and Jensen, 1967 ) fitted to a
1.5 ml glass cell (Gilson Medical Electric, Middleton, WI) and was
standardized against a solution of pure bovine liver catalase
(Calbiochem). Similar catalase activity results were obtained using a
spectrophotometric assay based on the disappearance of exogenously
added peroxide (Brannan et al., 1981 ).
Replication in vitro. N18 cells were grown to
near confluence in 12 well plates and were infected as described above.
Supernatant fluid was removed from three wells at 48 hr after infection
plus or minus varying concentrations of crude bovine liver catalase, virus from each well was quantitated by plaque formation in baby hamster kidney-21 cells (PFU/ml), and the geometric mean was determined for each time point.
Purification of AAA from commercial bovine liver
catalase. Preliminary purification steps were performed at 4°C
on a Bio-Rad BioLogic FPLC system; subsequent electrophoresis steps
were used to achieve final protein homogeneity. Crude bovine liver
catalase (1 gm; Sigma) was dissolved in 30 ml of 20 mM
Tris-HCl, pH 7.5, plus 1 M NaCl and chromatographed at 5 ml/min on a Pharmacia chelating Sepharose column (2.5 × 5 cm;
charged with ZnSO4 according to the manufacturer's
recommendations) equilibrated in the same buffer; the AAA was not
retained. After equilibration with 50 mM sodium borate at
pH 9.5 (Buffer A) by dialysis at 4°C, the "Zn-AAA" was loaded
onto a Bio-Rad Bioscale Q20 anion exchange column and washed with 35 ml
of Buffer A at 5 ml/min. "Q20-AAA" eluted as a sharp peak during
the initial phase of a 200 ml 0-50% linear gradient using 50 mM sodium borate, pH 9.5, plus 1 M NaCl as
Buffer B. Bioactive fractions were pooled and concentrated using
CentriPrep-30 filtration units (Amicon, Beverly, MA) to 5 ml and were
applied to a Superdex 200 HR (26/60) size exclusion column (Pharmacia, Piscataway, NJ) equilibrated in Dulbecco's PBS. "S200-AAA" was eluted at 3 ml/min with an apparent molecular weight of ~69 kDa. The
bioactive fractions were pooled, concentrated via CentriPrep-30 filtration units, and filter sterilized.
S200-AAA (6.8 mg) was equilibrated at room temperature in 8 M urea, 0.5% Triton X-100, and 2 mM Tris by
dialysis overnight and then was concentrated via MicroCon-30 filtration
to ~0.1 ml; 5.4 mg of the concentrated S200-AAA was loaded onto a
2-cm-wide lane of a 0.5-mm-thick Immobiline pH 5.6-6.6 isoelectric
focusing gel (IEF; Pharmacia) previously equilibrated in 2.5% pH 3-10
pharmalytes, 8 M urea, 20 mM dithiothreitol, 2 mM Tris, and 0.5% Triton X-100. After 6 hr of focusing at
3500 V, the sample lane in the gel was cut into 0.5-cm-wide strips
between the cathode and anode (22 strips across the 11-cm-wide gel).
The individual gel strips were electroeluted in a Centrilutor (Amicon)
electroelutor using CentriCon-30 filtration units at 200 V for 2 hr at
room temperature in a 1× Laemmli buffer lacking SDS (25 mM
Tris, 192 mM glycine, pH 8.3). The electroeluted fractions
were subsequently concentrated to "dryness" in the CentriCon-30
filtration unit and redissolved in 0.1 ml of PBS.
Twenty-five percent of each bioactive "IEF-AAA" fraction was
subjected to 10% SDS-PAGE on a 1-mm-thick minigel and electroblotted onto polyvinylidene fluoride (PVDF; Bio-Rad transblot membrane) in 10 mM 3-(cyclohexylamino)-1-propanesulfonic acid, pH 11, 1% methanol, and 0.01% SDS for 90 min at 0.75 A. The blot was stained for
5 min in 0.1% amido black/10% acetic acid and then destained in
dH2O.
Protein sequencing. The 36 kDa protein band from the
electroblotted IEF-AAA fractions was excised into 1 × 1 mm PVDF
squares and washed in 100 ml of methanol to remove excess dye. For each sample, the PVDF squares were suspended in 20 µl of digestion buffer
(5 mM Tris-HCl, pH 8.5, 0.1 mM EDTA, 1%
N-octyl- -D-glucopyranoside, and 10%
acetonitrile) and incubated at 37°C for 30 min. Then 0.2 mg of
lysylendopeptidase c was added, and the sample was digested overnight
at 37°C. The digest was sonicated for 5 min and microfuged to recover
soluble peptides. This process was repeated first with 20 µl of
digestion buffer and then with 100 µl of 0.1% trifluoroacetic acid
to enhance peptide fragment recoveries. The soluble peptide fractions
were pooled, dried to 5-10 µl in a vacuum centrifuge, and
chromatographed on a Reliasil C18 (1 × 150 mm) reversed-phase column. Microsequencing of the purified peptides was performed on a
Hewlett Packard G1000A protein sequencer using version 3.0 chemistry.
Preparation of recombinant arginase and arginase enzymatic
assays. Recombinant rat liver arginase was expressed and purified as described previously (Cavalli et al., 1994 ). Arginase enzymatic activity was assessed by the isonitrosopropriophenone-based assay as
described by Kuhn et al. (1995) except that the enzymatic reaction buffer contained 1 mg/ml bovine serum album and was adjusted to pH 9.5 or 7.4.
[35S]cysteine and methionine
incorporation studies. Radioactive labeling experiments were
performed using EasyTag express protein labeling mix (New England
Nuclear, Boston, MA) as described previously (Ratan et al., 1994b ) with
the following modifications. N18 cells were plated into 6 well dishes
at a density of 5 × 104 cells per well. Before
labeling, the media were changed and replaced with media containing
arginase (0-4000 ng/well) for 4 hr; 2 µCi of
[35S]cysteine/methionine was then added to each
well for 4 hr. The labeling was stopped by three rapid washes with 4 ml
of ice-cold PBS supplemented with 1 mM CaCl2.
Immediately after the washes, the cells were lysed with 3% perchloric
acid, scraped, and transferred to microfuge tubes. The samples were
spun at 12,000 rpm in a microfuge at 4°C for 20 min, and the
radioactivity of an aliquot of the supernatant was determined by
liquid scintillation counting as a measure of the acid-soluble
[35S]cysteine/methionine. The acid-precipitable
pellet containing the labeled, newly synthesized protein was washed
and then repelleted. The supernatant was discarded, and the pellet was
dissolved in 0.1 M NaOH. The radioactivity in this NaOH
solute was measured, and the protein was determined by the
bicinchoninic acid reagent method (Pierce, Rockford, IL). Viability
assays were performed in parallel as described above.
Effects of arginase on tumor necrosis factor- -induced
cytotoxicity of 3T3 cells. Immortalized mouse embryo fibroblasts
were grown as described (Beg and Baltimore, 1996 ) at a density of 2000 cells per well in 96 well plates, allowed to adhere overnight, and
treated with 10 ng/ml mouse tumor necrosis factor (TNF)- (Boehringer
Mannheim, Indianapolis, IN) plus or minus recombinant arginase
(100-5000 ng/ml). Viability was assessed 24 hr later using MTT or LDH
assay and the viability index described above.
Statistics. Results are presented as the mean ± SEM
for three to five experiments unless otherwise noted. Experimental
groups with multiple treatments were analyzed by ANOVA.
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RESULTS |
Bovine liver catalase inhibits apoptosis induced by
multiple stimuli
In previous studies, we demonstrated that exposure of immature
cortical neurons to glutamate or to the glutamate analog HCA results in
depletion of glutathione- and oxidative stress-induced cell death with
morphological and biochemical features characteristic of apoptosis
(Ratan et al., 1994a ,b ). To determine whether peroxide mediates
glutathione depletion-induced apoptosis, we examined the protective
effects of extracellular catalase in this paradigm. At a concentration
of 2100 units/ml, extracellular catalase inhibits glutathione
depletion-induced death (Fig.
1A). The ability of catalase to suppress the chromatin condensation and nuclear
fragmentation characteristic of apoptosis was verified by Hoechst 33258 staining and fluorescence microscopy (data not shown).

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Figure 1.
Bovine liver catalase prevents cell death induced
by glutathione depletion (GD), STS
treatment, or SV infection. A, At 24-72
hr after plating, cultures were exposed to 1 mM HCA to
inhibit competitively neuronal cystine transport and to induce
glutathione depletion, exposed to 100 nM staurosporine, or
infected with SV (MOI, 1-5). All of these treatments
have been shown previously to induce morphological and biochemical
features characteristic of apoptosis (Levine et al., 1993 ; Ratan et
al., 1994a ; Koh et al., 1995 ; Prehn et al., 1997 ). In parallel,
exposure to each of these apoptosis inducers was conducted in the
presence of 2100 units/ml of bovine liver catalase. Bovine liver
catalase was added at the same time that cytotoxic agents were added.
The cells were harvested at 24 hr (GD), 60 hr
(STS), or 48 hr (SV) and processed
for calcein AM and ethidium homodimer-1 (live/dead) staining. Briefly,
calcein AM (2 µM) and ethidium homodimer (1 µM) are added to the bathing medium for 30-45 min.
Membrane-permeant calcein AM is cleaved by esterases in live cells to
yield cytoplasmic green fluorescence, and ethidium homodimer-1 labels
nucleic acids of membrane-compromised cells with red fluorescence.
Fluorescence was visualized using a fluorescein long-pass filter set.
Approximately 250 cells were counted in four fields per well. The ratio
of live cells to live plus dead cells defines the percentage of cell
viability. Data (bars) are mean ± SEM values from
three to five experiments performed in triplicate wells;
*p < 0.05 by ANOVA. Catalase did not enhance
viability of control (CON) cultures.
B, Concentration response of bovine liver catalase
protection 48 hr after SV infection in mouse N18
neuroblastoma cells is shown. Cells were plated in 0.5 ml of MEM medium
containing either no additive or the indicated concentrations of bovine
liver catalase. Viability was assessed by trypan blue exclusion (Levine
et al., 1993 ). Similar results were obtained with the live/dead
staining described in A. Error bars represent SEM
(n = 5). C, Cumulative
SV production is unaltered by bovine liver catalase in
N18 cells. At 48 hr after infection, the media of infected cells (± bovine liver catalase) were collected, and viral titers were measured
in PFU per ml as described in Materials and Methods. Error bars
represent SEM (n = 5).
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To investigate whether extracellular catalase can act as a
multipotent inhibitor of neuronal apoptosis, we investigated the effects of this agent on apoptosis induced by exposure of rat cortical
neurons to 100 nM staurosporine or apoptosis induced by
Sindbis virus infection of rat cortical neurons (Lewis et al., 1996 ) or
mouse N18 neuroblastoma cells (Levine et al., 1993 ). Addition of
extracellular catalase to the bathing medium at the time of
staurosporine treatment or SV infection inhibits cell death (Fig.
1A,B). The protective effects of
catalase were seen in the absence of effects on Sindbis virus entry or
replication (Fig. 1C).
The antiapoptotic activity in a bovine liver catalase preparation
is not catalase
To verify that the protective effects of our catalase
preparation were indeed attributable to catalase, we treated the
preparation with irreversible inhibitors of catalase, aminotriazole
(Margoliash et al., 1960 ) or phenylhydrazine (Ortiz de Montellano and
Kerr, 1983 ), and inhibited the catalase activity, respectively, by 99 and 96% (Table 1)Table 1. Unexpectedly,
the catalase-inactivated extracts remained protective (Table 1).
Moreover, purer catalase preparations from bovine liver, other
organs, or other species were not protective (data not shown).
Altogether, our observations suggested that catalase itself was not
responsible for the antiapoptotic activity observed. Hence, we
initiated a program to purify and identify the factor responsible for
this protective effect. Because N18 cells represent a self-replenishing
supply of neuron-like cells, we used SV-induced apoptosis of N18 cells
as the bioassay in the purification program. Of note, the crude
catalase had an antiproliferative effect on N18 cells, and indeed, the
antiproliferative and antiapoptotic activities were found to be
inseparable throughout the purification process (F. Esch and R. Ratan,
unpublished observations), suggesting that a single molecular species
was responsible for both activities.
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Table 1.
Irreversible inhibition of catalase activity in the bovine
liver catalase preparation does not inhibit its antiapoptotic activity
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Purification of an antiapoptotic activity from a bovine liver
catalase preparation
SDS-PAGE analysis of the crude commercial bovine liver catalase
preparation indicated that up to 70% of the protein content could be
accounted for by catalase itself. The AAA in the crude catalase extract
was not retained by zinc-chelating Sepharose chromatography, whereas
catalase was completely adsorbed by the matrix (data not shown). These
results confirmed that the antiapoptotic activity was not catalase.
Subsequent anion exchange and size exclusion chromatography on Bioscale
Q20 and Superdex 200 columns, respectively, further enhanced the purity
of the antiapoptotic activity (Fig.
2A-C), resulting in
recovery of 9 mg of protein from 1 gm of starting material.
Purification to homogeneity was achieved in two electrophoretic steps
involving isoelectric focusing and SDS-PAGE. IEF in pH 5.6-6.6 Immobiline gradient polyacrylamide gels under denaturing conditions greatly resolved the complex mixture obtained from size exclusion chromatography. Analytical SDS-PAGE analyses showed that a 36 kDa
protein was enriched in three bioactive IEF fractions (Fig. 2D). Aliquots of these bioactive fractions were
purified by SDS-PAGE on a 10% acrylamide gel, electroblotted onto
PVDF, and stained with amido black. Direct N-terminal sequence analysis
of the 36 kDa protein failed, suggesting that the protein was
N-terminally blocked. Thus, two of these 36 kDa protein bands were
excised from the electroblot and digested with lysylendopeptidase c,
and the digestion fragments were purified by reverse-phase liquid chromatography (RPLC). The RPLC peptide maps of the two digests were
essentially superimposable, suggesting that similar if not identical
proteins had been digested. Polypeptide microsequencing of all peptide
peaks from one digest generated 206 amino acids of sequence data that
showed high homology with the sequence of human liver arginase (Fig.
2E). Three peptide fragments from another digest were
also sequenced and shown to contain arginase-related peptides.
Virtually all experimentally derived peptide sequence data could be
attributed to arginase, suggesting that the purified protein was
homogeneous.

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Figure 2.
Purification of an antiapoptotic activity in crude
bovine liver catalase and its identification as arginase.
A-C, Staining with the nucleic acid stain Hoechst 33258 demonstrates that the catalase-deficient extract (S200-AAA) inhibits
SV-induced apoptosis in N18 mouse neuroblastoma cells. Forty-eight
hours after infection, cultured cells were stained with Hoechst 33258 at a concentration of 1 µg/ml for 30 min at 37°C. A,
Mock-infected N18 cells stained with Hoechst 33258 and visualized under
fluorescence microscopy. B, SV-infected N18 cells 48 hr
after the onset of infection stained and visualized as in
A. The arrow points to a cell with
radially organized hypercondensed chromatin, characteristic of a cell
undergoing early apoptosis with chromatin condensed at the nuclear
envelope. The arrowhead points to a cell with
hypercondensed, fragmented chromatin characteristic of apoptosis.
C, SV-infected N18 cells exposed to catalase-deficient
S200-AAA (135 µg/ml) stained and visualized as in A.
Note that the normal nuclear morphology seen in A is
preserved in the majority of cells. D, A 4-20%
SDS-PAGE analysis of bioactive S200-AAA loaded onto a pH 5.6-6.6
Immobiline IEF gel as described in Materials and Methods and the
resulting IEF-AAA fractions (4, 7, 11 indicate the fraction numbers)
stained with colloidal Coomassie brilliant blue. E,
Human arginase I and lysylendopeptidase c fragments of bovine liver
AAA. The complete 322 amino acid sequence of human arginase I
(hArginase) is shown in the upper line.
Amino acid sequences obtained from the bovine liver
AAA/lysylendopeptidase c digestion fragments (AAA) are
underlined and shown below the human
arginase sequence. Tentative sequence identifications are indicated by
lowercase letters. Italicized sequences
were identified using digests from two different IEF fractions. Two
hundred six of 322 amino acids of bovine liver arginase were sequenced,
comprising 64% of the entire sequence.
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An antiapoptotic activity in a bovine liver catalase preparation is
attributable to arginase
Arginase hydrolyzes arginine to urea and ornithine and has a
manganese cofactor requirement. EDTA, a compound capable of chelating manganese, deactivates arginase during incubations at acidic pH values
(pH 5.5), but full enzymatic activity can be restored by subsequent
treatment with manganese chloride (MnCl2) (Kuhn et al., 1995 ). Using a >97% pure preparation of recombinant rat liver arginase (Fig. 3A), we found
that arginase enzymatic (Fig. 3B) and antiapoptotic
activities (Fig. 3C) were dramatically decreased on
exposure to EDTA and primarily restored with MnCl2.
Moreover, the competitive inhibitor of arginase
N -hydroxyl-L-arginine
(L-NOHA; 100 µM) (Daghigh et al., 1994 )
decreased the survival responses of recombinant arginase by
approximately fivefold in response to Sindbis virus infection in N18
cells (Fig. 3D). Altogether, these results suggest that
arginase itself is responsible for the antiapoptotic activity and not
some contaminant in the recombinant preparation.

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Figure 3.
Recombinant rat liver arginase prevents
SV-induced death. A, A 4-20% SDS-PAGE analysis of
recombinant rat liver arginase. Densitometry of the colloidal Coomassie
blue-stained gel suggested that the 36 kDa arginase preparation was
>97% pure. B, Arginase (5 mg/ml) was deactivated in
0.1 M sodium acetate, pH 5.5, plus 5 mM EDTA
for 90 min at 37°C. Reactivation was induced by the addition of an
equal volume of 0.2 M Tris-HCl, pH 8.1, plus 0.75 mM MnCl2. Arginase activity, measured as the
amount of urea liberated from arginine in a 30 min period, was
determined as described in Materials and Methods. C,
Concentration response of EDTA-deactivated (ED50 = 17.5 µg/ml) and Mn2+-reactivated (ED50 = 2 µg/ml) recombinant rat liver arginase protection 48 hr after SV
infection in N18 neuroblastoma cells. Viability was determined by LDH
assay as described in Materials and Methods. D,
Concentration response of recombinant rat liver arginase protection
[added with (ED50 = 2.0 µg/ml) and without
(ED50 = 0.4 µg/ml) the arginase inhibitor
L-NOHA (100 µM)] 48 hr after SV infection in
N18 neuroblastoma cells. E, Concentration response of
arginine decarboxylase protection (1.0 units/mg) 48 hr after SV
infection in N18 neuroblastoma cells.
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Because arginase converts arginine to ornithine and urea, we next
wanted to know whether the protective effects of arginase were because
of depletion of arginine or an increase in ornithine and urea. To
address this question, we used arginine decarboxylase, an enzyme that
degrades arginine by cleaving its carboxyl group (Li et al., 1995 )
rather than its guanidino group (as arginase does). Arginine
decarboxylase prevented SV-induced death in N18 cells (Fig.
3E), suggesting that it is depletion of arginine and not the
generation of ornithine or urea that accounts for the protective
effects of arginase. In support of this notion, we found no protective
effect of ornithine (10 µM-1 mM) or urea (10 µM-1 mM) added separately or in combination
to the bathing medium of N18 cells induced to die by SV infection (data
not shown).
Arginase is protective in multiple neuronal
apoptosis paradigms
To investigate whether, like the crude commercial catalase,
recombinant arginase is a multipotent inhibitor of neuronal apoptosis, we evaluated the effects of recombinant arginase added to the bathing
medium of cortical neurons induced to undergo apoptosis by glutathione
depletion-induced oxidative stress, by exposure to 100 nM
staurosporine, or by infection with Sindbis virus. In each of these
paradigms, arginase was protective (Fig.
4). Neurons exposed to these apoptotic
stimuli revealed dramatic preservation of cell body and neurite
morphology in the presence of arginase as monitored by phase contrast
microscopy (Fig. 5; staurosporine data
not shown).

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Figure 4.
Recombinant rat liver arginase is a multipotent
inhibitor of cell death in embryonic cortical neurons. At 24-72 hr
after plating, cultures were exposed to 1 mM HCA to inhibit
competitively neuronal cystine transport and induce GD,
exposed to 100 nM STS, or infected with
SV (MOI, 1-5). In parallel, exposure to each of these
cytotoxic agents was conducted in the presence of recombinant arginase
at 1 µg/ml (GD) or 0.5 µg/ml (STS and
SV). Recombinant arginase was added to the
bathing medium at the same time that cytotoxic agents were added. The
cells were harvested at 24 hr (GD), 60 hr
(STS), or 48 hr (SV) and processed
for LDH activity as described in Materials and Methods. Data
(bars) are mean ± SEM values from three to five
experiments performed in triplicate wells; *p < 0.05 by ANOVA.
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Figure 5.
Phase contrast micrographs of cultured primary
cortical neurons. A, Control [2 d in
vitro (DIV)]. B, Twenty-four hours after 1 mM HCA exposure to induce GD (2 DIV). C, One
millimolar HCA plus recombinant rat arginase at 1 µg/ml (2 DIV).
D, Mock-infected control (3 DIV). E,
Forty-eight hours after SV infection (MOI = 5; 3 DIV).
F, SV infection plus recombinant rat arginase at 0.5 µg/ml. Magnification, 200×.
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Arginase can act as a nitric oxide-independent inhibitor
of apoptosis
Because previous evidence has established that arginase can
prevent excitotoxic necrosis in cortical cultures by inhibiting nitric
oxide generation (Dawson et al., 1991 ), we considered the possibility
that arginase was acting to prevent apoptosis by a similar mechanism.
Pre- or cotreatment of N18 neuroblastoma cells with the general nitric
oxide synthase inhibitor L-NMA (100 µM) (Dawson et al., 1991 ; Schmidt et al., 1994 ) or the inducible nitric oxide synthesis inhibitor GED (100 µM) had no effect on
SV-induced cytotoxicity (Fig.
6A). Additionally,
treatment of cortical neurons with the general nitric oxide synthase
inhibitor L-NAME (100-500 µM) did not
influence cell death induced by glutathione depletion (Fig.
6B) or low doses of staurosporine (data not shown).
Moreover, in each of these paradigms, nitric oxide synthase inhibitors
were not toxic to control cultures. These results, along with previous observations that the inhibitors of nitric oxide synthase used herein
do not significantly inhibit arginase activity (Fig.
6A) [also for review, see Morris (1998) ], suggest
that arginase can prevent apoptosis independent of nitric oxide
synthase inhibition.

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Figure 6.
Protection by arginase is not mimicked by
inhibitors of nitric oxide synthesis. A, The nitric
oxide synthase inhibitors L-NMA (100 µM) or GED (100 µM) do not
significantly attenuate SV-induced cytotoxicity
(assessed 48 hr after infection) in N18 cells, nor do they inhibit the
protective effects of recombinant arginase (2.5 µg/ml). Each
bar represents the mean ± SD for three to five
experiments performed in triplicate. B, The nitric oxide
synthase inhibitor L-NAME (100 or 500 µM) does not significantly attenuate glutathione
depletion-induced death in embryonic cortical neurons. Each
bar represents the mean ± SEM for three to five
experiments performed in triplicate. An asterisk denotes
a statistical difference from control (p < 0.05 by ANOVA).
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In considering other possible mechanisms of protection mediated by
arginase, we noted that in addition to being a precursor for nitric
oxide synthesis, arginine is also used for protein synthesis. Indeed,
small molecule inhibitors of protein synthesis have been shown to
abrogate neuronal apoptotic death in response to a host of stimuli
(Martin et al., 1988 ; Ratan et al., 1994a ,b ; Serghini et al., 1994 ;
Dreyer et al., 1995 ; Koh et al., 1995 ). To determine whether
arginase-induced arginine depletion leads to suppression of protein
synthesis, we measured the incorporation of radioactive cysteine and
methionine into the perchloric acid (PCA)-precipitable (protein)
fractions. Treatment of N18 neuroblastoma cells with arginase for 8 hr
reduced incorporation of methionine/cysteine into protein in a
concentration-dependent manner. Moreover, the degree of protein
synthesis inhibition is directly correlated with enhanced survival
(Fig. 7A).

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Figure 7.
Protection by arginase correlates with its ability
to inhibit protein synthesis. A, Arginase decreases
acid-precipitable [35S]cysteine/methionine in N18
neuroblastoma cells in a concentration-dependent manner. Cultures were
exposed to varying concentrations of arginase for 4 hr at 37°C. They
were then labeled with [35S]cysteine/methionine
for 4 hr as described in Materials and Methods. The labeling was
stopped by three rapid cold washes. The cells were resuspended in 3%
PCA and separated into acid-soluble and -precipitable fractions by
centrifugation. Squares indicate incorporation of
radiolabel into acid-precipitable fractions (protein) expressed as cpm
of [35S]cysteine/methionine per milligram of
protein per 4 hr of labeling at varying concentrations of recombinant
rat arginase. In parallel, percentage viability
(diamonds) was measured 48 hr after SV infection in N18
cells cotreated with varying concentrations of recombinant arginase.
Actinomycin-D (2 µg/ml), an inhibitor of transcription, inhibits
incorporation of radioactive amino acids into protein by 80% and
prevents SV-induced apoptosis in N18 cells (data not shown).
B, In addition to arginase, another amino acid-degrading
enzyme, asparaginase, prevents SV-induced death in N18
neuroblastoma cells. PEG-conjugated asparaginase (5 units/ml, a more
stable form of asparaginase) was added to the bathing medium of N18
cells at the time of SV infection (MOI = 5), and
viability was assessed as described in Materials and Methods after 48 hr. In parallel, N18 cells infected with SV were
similarly treated with PEG-catalase (2100 units/ml) and
PEG-SOD (100 units/ml) as controls. Each
bar represents the mean ± SEM for three to five
experiments performed in triplicate. An asterisk denotes
a statistical difference from SV-infected N18 cells
(p < 0.05).
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If arginase-induced arginine depletion leads to suppression of protein
synthesis and enhanced cell survival, then depletion of other amino
acids required for protein synthesis should also be protective.
Asparaginase degrades asparagine to aspartate and ammonia. To determine
whether depletion of asparagine, like arginine, prevents neuronal
apoptosis, we treated SV-infected N18 neuroblastoma cells with a
polyethylene glycol (PEG)-conjugated form of the enzyme
(PEG-asparaginase). PEG-asparaginase (5 units/ml) diminished SV-induced death in N18 cells, whereas PEG-catalase (1-5000 units/ml) and PEG-superoxide dismutase (PEG-SOD; 1-5000 units/ml) had no effect (Fig. 7B).
To verify that inhibition of protein synthesis is a mechanism by which
arginase can prevent neuronal apoptosis, we examined the effects of
arginase in an apoptosis paradigm in which the inhibition of protein
synthesis potentiates cell death: TNF- (10 ng/ml) treatment of 3T3
mouse embryo fibroblasts (Beg and Baltimore, 1996 ). Consistent with the
ability of arginase to suppress protein synthesis, arginase (1-5
µg/ml) potentiated TNF- -induced apoptosis (data not shown).
Taken together, our observations are consistent with the notion that
arginase depletes arginine, leading to inhibition of protein synthesis
and enhanced survival in neurons exposed to a host of apoptotic stimuli
(Fig. 8).

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Figure 8.
Diagram of proposed mechanisms by which
extracellular arginine depletion (induced by arginase or arginine
decarboxylase) can enhance cell survival. Extracellular arginase has
been shown to inhibit nitric oxide generation and excitotoxic necrosis
in mature primary cortical neurons exposed to glutamate (Dawson et al.,
1991 ). We propose that extracellular arginase can inhibit cell death in
neurons via an additional mechanism. Arginase depletes extracellular
arginine, leading to intracellular arginine depletion. The
intracellular arginine depletion results in an accumulation of
uncharged tRNAs, leading to eIF-2 phosphorylation and repression of
global protein synthesis. Repression of protein synthesis can lead to
suppression of apoptosis in response to some stimuli.
NO, Nitric oxide; iNOS, inducible nitric oxide synthase;
nNOS, neuronal nitric oxide synthase.
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 |
DISCUSSION |
A multipotent antiapoptotic activity in a bovine liver catalase
preparation is arginase not catalase
We report the purification of a multipotent neuronal antideath
activity from a commercial bovine liver "catalase" preparation and
its identification as the urea cycle and nitric oxide
synthase-regulating enzyme arginase.
Although extracellular catalase has been shown to abrogate serum
deprivation-induced apoptosis in a human T cell line (Sandstrom and
Buttke, 1993 ) and to support survival of cultured CNS neurons (Walicke
et al., 1986 ), several observations herein argue that the protective
factor in our extracellularly applied catalase preparation is not
catalase. First, inhibition of catalase activity in the extract by
>95% using pharmacological inhibitors does not abrogate the
protective effects of the preparation (Table 1). Second, purer
preparations of catalase from a variety of sources do not inhibit
oxidative stress-induced death in cortical neurons or Sindbis
virus-induced death in cortical neurons or N18 neuroblastoma cells
(data not shown). Third, adsorption of catalase from our catalase
preparation onto a zinc-chelating Sepharose column removes catalase
from the preparation but does not remove its antiapoptotic activity
(Fig. 2A-C). Although these results seem
to exclude extracellular catalase as a regulator of some types of
neuronal apoptosis, they do not exclude the possibility that
intracellular catalase or other intracellular peroxide scavengers such
as glutathione peroxidase or pyruvate may be neuroprotective (Behl et
al., 1994 ). Additionally, we found that extracellular catalase, but not
arginase, could abrogate cytotoxicity of N18 cells induced by 2 mM peroxide (data not shown).
Because we had excluded catalase as the active agent in our
antiapoptotic preparation, a purification program was initiated, and
after the final isoelectric focusing step, a 36 kDa protein was found
to be enriched in three bioactive fractions (Fig.
2D). This 36 kDa protein was microsequenced and
identified as arginase (Fig. 2E). Indeed, the ability
of recombinant arginase to abrogate neuronal apoptosis in response to
glutathione depletion and oxidative stress, low doses of staurosporine,
or Sindbis virus infection is consistent with the notion that this is
the relevant biological activity in our crude catalase preparation
(Figs. 3-5).
Arginase-induced arginine depletion is neuroprotective
Arginase is an abundant liver enzyme that hydrolyzes arginine into
ornithine and urea. The ability of arginine decarboxylase, which
decarboxylates arginine to form agmatine and CO2 (Li et al., 1995 ), to mimic the protective effects of arginase (Fig. 3E) suggests that arginine depletion rather than generation
of urea and ornithine accounts for the antiapoptotic effects of
arginase. Of note, removal of arginine from the extracellular medium
was not protective (data not shown), suggesting that an extracellular enzymatic sink is required to deplete intracellular arginine pools.
Arginase can act as a nitric oxide-independent inhibitor of
neuronal apoptosis
By what mechanism(s) does arginase prevent neuronal apoptosis?
Dawson and coworkers have established that extracellular arginase can
abrogate excitotoxic necrosis in cortical neuronal cultures by
inhibiting neuronal nitric oxide generation (Dawson et al., 1991 ). In
this paradigm, arginase depletes arginine and prevents it from being
oxidized by nitric oxide synthase to nitric oxide and citrulline.
Furthermore, previous studies by Nicotera, Lipton, and colleagues have
established that addition of nitric oxide to primary neurons is
sufficient to induce apoptosis or necrosis depending on the
concentration of nitric oxide donor used (Bonfoco et al., 1995 ). These
findings, in conjunction with recent observations that arginase and
inducible nitric oxide synthase are coordinately regulated in a number
of cell types, including macrophages (Sonoki et al., 1997 ), are
consistent with the notion that extracellular arginase may prevent
neuronal apoptosis by removing arginine for use in nitric oxide
synthesis. However, we were unable to detect a pro- or antiapoptotic
effect for a broad array of nitric oxide synthase inhibitors in
cortical neurons or N18 cells (Fig. 6), suggesting that although
arginase may regulate survival via its effects on nitric oxide
generation in some systems, nitric oxide is not a mediator of apoptosis
in the paradigms examined here.
Several observations suggest that the antiapoptotic effects of arginase
in the present study can be attributed to amino acid depletion and
consequent suppression of protein synthesis. First, the ability of
arginase to prevent Sindbis virus-induced death in N18 cells is
directly proportional to its ability to inhibit the incorporation of
radiolabeled amino acids into protein, a measure of protein synthesis
(Fig. 7A). Second, another amino acid-depleting enzyme,
asparaginase, which has been shown to suppress protein synthesis and
proliferation in lymphocytes (Chuang et al., 1990 ), prevents SV-induced
apoptosis in N18 cells (Fig. 7B). Third, arginase protects
cortical neurons from glutathione depletion-induced or
staurosporine-induced apoptosis, two paradigms in which inhibitors of
macromolecular synthesis are known to be protective (Ratan et al.,
1994b ; Koh et al., 1995 ). Finally, arginase potentiates TNF-induced
death of 3T3 mouse embryo fibroblasts, a type of apoptosis that is
potentiated by inhibitors of macromolecular synthesis (Beg and
Baltimore, 1996 ). Taken together, these observations define protein
synthesis inhibition as a novel pathway by which arginine depletion can
abrogate neuronal death (Fig. 8). Of course, the precise mechanism by
which inhibition of protein synthesis leads to cell survival remains
unclear, and several distinct schemes involving the inhibition of
"killer" gene products (Martin et al., 1988 ) and the upregulation
of antioxidant defenses (Ratan et al., 1994b ; Furukawa et al., 1997 ) or
antiapoptotic proteins (Furukawa et al., 1997 ) have been proposed.
Arginase is an antiexcitotoxic and an antiapoptotic agent
The ability of arginase to inhibit nitric oxide generation
associated with excitotoxic necrosis (Dawson et al., 1991 ) and protein
synthesis associated with apoptosis (Figs. 1, 4-7) suggests that
arginine-depleting enzymes [infused directly into the CSF to avoid
depletion of endothelial arginine (Huang et al., 1994 ; Samdani et al.,
1997 )] may be useful therapeutic agents in the treatment of acute
neurological diseases such as stroke and spinal cord injury. In these
disease states, nitric oxide-dependent cell death mediated by neuronal
or inducible nitric oxide synthase is seen hours to days (Huang et al.,
1994 ; Wu et al., 1994 ; Iadecola et al., 1995 ; Samdani et al., 1997 )
after the initial insult, and protein synthesis-dependent apoptosis is
seen days to weeks after the onset of injury (Linnik et al., 1993 ; Bhat
et al., 1996 ; Liu et al., 1997 ). That the antinecrotic and
antiapoptotic effects of arginase may be therapeutically additive is
supported by recent data from Choi and coworkers demonstrating that
combined antiexcitotoxic and antiapoptotic measures are more effective
in treating focal brain ischemia than either agent alone (Du et al.,
1996a ,b ) (see Fig. 8).
Arginase is expressed in the CNS
The ability of extracellular bovine and rat liver arginase to
regulate multiple pathways of neuronal death raises the possibility that arginase may be expressed in the CNS where it would be poised to
function as a intracellular or extracellular regulator of cell survival
and/or nitric oxide generation (Morris, 1998 ). Indeed, previous studies
have established the presence of arginase activity, protein, and
message in the CNS (Spector et al., 1985 ; Jenkinson et al., 1996 ).
Fifty percent of the arginase activity in rat brain seems to be
accounted for by the product of one gene (arginase I), the dominant
gene product in bovine liver. The remaining 50% of brain arginase
seems to be accounted for by a second, nonhepatic locus (arginase II)
(Jenkinson et al., 1996 ; Morris et al., 1997 ). In addition to their
distinct tissue distributions, arginase I and arginase II differ in
several important aspects including immunological cross-reactivities,
charge, and subcellular localization. For example, arginase I is
primarily cytosolic, whereas arginase II is located within the
mitochondrial matrix (Gotoh et al., 1996 ). Precisely how these enzymes
differ in their biological function and regulation remains an area of
active investigation.
With respect to regional localization in brain,
immunocytochemical studies using an antibody to rat liver arginase
(arginase I) indicate that not all CNS neurons contain arginase and
that it is highly expressed under basal conditions in a number of brain regions, including the mitral cells and tufted cells of the olfactory bulb, the Purkinje cell somata of the cerebellum, and the facial motoneurons in the brainstem (Nakamura et al., 1990 ). Whether arginase
also localizes to apoptosis-resistant (NADPH diaphorase/neuronal nitric
oxide synthase) neurons in the cortex or striatum is unknown but is an
intriguing possibility in light of our results demonstrating the
antiapoptotic capacity of arginase.
In summary, we demonstrate that extracellularly applied arginase can
inhibit neuronal apoptosis induced by multiple stimuli. Furthermore, we
show that the protective effects of arginase in the paradigms examined
here cannot be reproduced by an array of nitric oxide synthase
inhibitors but rather seem to depend on depletion of arginine,
resulting in protein synthesis inhibition. These studies identify amino
acid depletion as a novel biological strategy to prevent pathological
neuronal apoptosis and suggest that additional insight into the
localization and regulation of arginase in the CNS will elucidate novel
approaches to regulate cell death and nitric oxide synthesis in
physiology and disease.
 |
FOOTNOTES |
Received Dec. 15, 1997; revised Feb. 20, 1998; accepted March 13, 1998.
This work was supported by the National Institutes of Health Grant
DK44841 to D.E.A. and by the Eisai Company of Japan (F.E., A.H., and
L.R.). We would like to thank Carol Doherty, Rick Huganir, and Bill
Bishai for assistance and helpful discussions.
Correspondence should be addressed to Dr. Rajiv R. Ratan, Neurology
Laboratories at The Beth Israel-Deaconess Medical Center, Harvard
Institutes of Medicine, Room 857, 77 Avenue Louis Pasteur, Boston, MA
02115.
 |
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