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Vol. 8, Issue 11, 2267-2280, November 1997




Departments of
*Genetics and
Pharmacology, and the
Howard Hughes Medical Institute, Duke University Medical
Center, Durham, North Carolina 27710;
Biochemisches
Laboratorium, Universität Bayreuth, D-95440 Bayreuth, Germany;
and
§Department of Biochemistry, Biozentrum, Basel,
Switzerland CH-4056
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ABSTRACT |
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Cyclophilin and FK506 binding protein (FKBP) accelerate cis-trans peptidyl-prolyl isomerization and bind to and mediate the effects of the immunosuppressants cyclosporin A and FK506. The normal cellular functions of these proteins, however, are unknown. We altered the active sites of FKBP12 and mitochondrial cyclophilin from the yeast Saccharomyces cerevisiae by introducing mutations previously reported to inactivate these enzymes. Surprisingly, most of these mutant enzymes were biologically active in vivo. In accord with previous reports, all of the mutant enzymes had little or no detectable prolyl isomerase activity in the standard peptide substrate-chymotrypsin coupled in vitro assay. However, in a variation of this assay in which the protease is omitted, the mutant enzymes exhibited substantial levels of prolyl isomerase activity (5-20% of wild-type), revealing that these mutations confer sensitivity to protease digestion and that the classic in vitro assay for prolyl isomerase activity may be misleading. In addition, the mutant enzymes exhibited near wild-type activity with two protein substrates, dihydrofolate reductase and ribonuclease T1, whose folding is accelerated by prolyl isomerases. Thus, a number of cyclophilin and FKBP12 "active-site" mutants previously identified are largely active but protease sensitive, in accord with our findings that these mutants display wild-type functions in vivo. One mitochondrial cyclophilin mutant (R73A), and also the wild-type human FKBP12 enzyme, catalyze protein folding in vitro but lack biological activity in vivo in yeast. Our findings provide evidence that both prolyl isomerase activity and other structural features are linked to FKBP and cyclophilin in vivo functions and suggest caution in the use of these active-site mutations to study FKBP and cyclophilin functions.
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INTRODUCTION |
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Anfinsen's classic studies established that protein primary amino
acid sequences can be sufficient to direct folding into tertiary
structures (Anfinsen, 1973
). During the last several years, two types
of proteins have been discovered that facilitate protein folding both
in vitro and in vivo (Gething and Sambrook, 1992
). Chaperones bind to
folding proteins and inhibit aggregation of folding intermediates. In
addition, enzymes have been discovered that accelerate rate-limiting
steps during protein folding in vitro. Examples include protein
disulfide isomerase and peptidyl-prolyl isomerase. Protein disulfide
isomerase catalyzes reactions between sulfhydryl groups, accelerating
the process by which correct disulfide bonds are formed. Prolyl
isomerases, which include cyclophilins and FKBPs, catalyze
cis-trans peptidyl-prolyl isomerization, are highly
conserved from bacteria and yeast to humans, and are found in multiple
cellular compartments (Dolinski and Heitman, 1997
). These features
suggested prolyl isomerases might play a general essential role in
protein folding. This role would be distinct from the well-established
roles of cyclophilin A and FKBP12 in mediating toxic and
immunosuppressive effects of the natural products cyclosporin A (CsA),
FK506, and rapamycin, which involve inhibition of calcineurin and TOR
functions by immunophilin-drug complexes (Heitman et al.,
1992
; Schreiber and Crabtree, 1992
; Schmid, 1993
; Schmid et
al., 1993
;Fischer, 1994
).
Although the enzymatic and immunosuppressive activities of the
immunophilins have been known for quite some time, their biological functions are largely unknown. It has been widely assumed that the
prolyl isomerase activity of the cyclophilins and FKBPs is relevant to
in vivo function given that 1) isomerase activity is conserved in
diverse cyclophilins and FKBPs (Gething and Sambrook, 1992
;
Heitman et al., 1992
; Fischer, 1994
), 2) cyclophilins and FKBPs catalyze rate-limiting steps during protein refolding in vitro
(Kiefhaber et al., 1990a
; Tropschug et al., 1990
;
Schonbrunner et al., 1991), and 3) immunosuppressants bind
to the isomerase active sites, potently inhibiting enzyme activity and,
in some cases, impairing de novo protein folding (Lodish and Kong,
1991
; Steinmann et al., 1991
; Stein, 1993
; Matouschek
et al., 1995
; Rassow et al., 1995
; Rospert
et al., 1996
). Cyclophilins and FKBPs are nonessential,
however, and have few subtle mutant phenotypes in microorganisms,
arguing against an essential general role in protein folding (Heitman
et al., 1991a
,b
; Davis et al., 1992
; Nielsen
et al., 1992
; Frigerio and Pelham, 1993
; Manning-Krieg et al., 1994
). In addition, cyclophilins and FKBPs are
abundant proteins, expressed at levels higher than might be expected of enzymes. Furthermore, because spontaneous prolyl isomerization is
accelerated in hydrophobic solvents (Eberhardt et al.,
1992
), binding in a hydrophobic protein environment could contribute to
catalysis (Schreiber and Crabtree, 1992
).
Two recent studies suggest that the enzymatic activity of cyclophilins
may be dispensible for their physiological functions. The first notable
example is the Drosophila cyclophilin homologue, ninaA, an
endoplasmic reticulum membrane anchored protein required for proper
maturation of rhodopsins (Schneuwly et al., 1989
; Shieh et al., 1989
; Colley et al., 1991
; Stamnes
et al., 1991
). In ninaA mutant flies, rhodopsins misfold and
accumulate in the endoplasmic reticulum, resulting in visual system
defects. NinaA forms a stable complex with rhodopsin, and subtle
decreases in ninaA levels significantly impair function (Baker et
al., 1994
). Thus, ninaA may act stoichiometrically rather than
catalytically (Baker et al., 1994
).
A second well-studied example involves the complex between human
cyclophilin A and the human immunodeficiency virus 1 (HIV-1) GAG
protein (Luban et al., 1993
), which enables cyclophilin A to
be packaged into HIV virions (Franke et al., 1994
). CsA
disrupts the cyclophilin A-GAG interaction, resulting in the
production of HIV virions lacking cyclophilin A. The resulting virions
have defects at an early stage after viral entry into the infected cell
(Braaten et al., 1996b
). Mutation of the cyclophilin A
binding pocket/active site prevent GAG binding (Braaten et
al., 1997
), and the recent solution of the x-ray crystal structure
of a cyclophilin A-GAG complex reveals a proline-rich turn bound in
the cyclophilin A active site with the peptidyl-prolyl bond in a
trans configuration (Gamble et al., 1996
; Zhao
et al., 1997
). This region of GAG had been previously
implicated in cyclophilin binding and was found to be mutated in
CsA-resistant cyclophilin-independent HIV mutants (Aberham et
al., 1996
; Braaten et al., 1996a
). Thus, these studies have led to a model in which cyclophilin A serves a structural rather
than a catalytic role for HIV function (Luban, 1996
).
Other studies, however, have suggested that other prolyl isomerases do
require enzymatic activity in vivo. Studies of the human prolyl
isomerase PIN1, a member of the parvulin family (Lu et al.,
1996
), have been interpreted to suggest that prolyl isomerase activity
is the essential function of PIN1. ESS1, the yeast homologue of PIN1,
is essential, and expression of human PIN1 restores viability in yeast
ess1 mutant strains (Lu et al., 1996
). Because a
PIN1 mutant altered in three conserved C-terminal residues lacked
prolyl isomerase activity in vitro and failed to complement
ess1 in vivo, it was concluded that prolyl isomerase
activity is the essential PIN1 function (Lu et al., 1996
).
These mutations, however, could perturb some other essential feature of
PIN1, such as protein binding or conformational stability, and further
study will be necessary to establish this point. Another example is the
recently identified cyclophilin RanBP2 that is involved in the
biogenesis of retinal opsins (Ferreira et al., 1996
).
Active-site mutations prevent binding and alteration of opsin by the
RanBP2 cyclophilin, and these findings were interpreted to suggest the
function of this interaction is prolyl isomerization of opsin by RanBP2
cyclophilin (Ferreira et al., 1996
).
Our studies have investigated in detail the prolyl isomerase activity
of FKBP12 and mitochondrial cyclophilin in yeast and its link to
biological function. We found that several previously reported active
site mutants (Aldape et al., 1992
; Zydowsky et al., 1992
; Timerman et al., 1995
; Ferreira et
al., 1996
) of both cyclophilin and FKBP12 were fully functional in
vivo. Although these mutant enzymes do lack activity in the standard
prolyl isomerase assay, which is based on isomer-specific cleavage of a
tetrapeptide by chymotrypsin, we discovered that this is a secondary
consequence of increased protease sensitivity of the mutant enzymes.
Indeed, these mutant enzymes exhibit readily detectable activity in a protease-free peptide folding assay, and near wild-type activity with
two different protein substrates (dihydrofolate reductase [DHFR] and
ribonuclease T1) in the absence of protease. Our studies provide
evidence that prolyl isomerase activity and other structural features
of mitochondrial cyclophilin and FKBP12 are linked to in vivo function
and suggest caution in the use of these mutations to determine in vivo
functions of cyclophilin and FKBP prolyl isomerase activity.
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MATERIALS AND METHODS |
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Site-directed Mutagenesis of Yeast FKBP12 and Mitochondrial Cyclophilin
The R73A and H144Q mutations in cyclophilin Cpr3 are analogous
to R55A and H126Q in human cyclophilin A (Zydowsky et al., 1992
) and were engineered by polymerase chain reaction (PCR) overlap mutagenesis as described (Ho et al., 1989
) by using the
following mutagenic primers: 1) R73A (5
-CTTTCCACGCAATCATCCCAGACTTC-3
and 5
-GGGATGATTGCGTGGAAAGGGACACC-3
) and 2) H144Q
(5
-GATGGAAAACAGTGGGTCTTTGGTGAG-3
and
5
-AAAGACAACCTGTTTTCCATCCAACC-3
).
Flanking primers for the R73A and H144Q mutations were
5
-CCTTGGATCCAATAACCAATAAGAATTATTTTAGTCC-3
(where the
BamHI site is in boldface type) and
5
-ATATAAGCTTAAAAGTTGGTTGATTTTTTATGAGCC-3
(where the
HindIII site is in boldface type). PCR products were cleaved
with BamHI/HindIII and cloned in the CEN
URA3 plasmid pRS316 (Sikorski and Hieter, 1989
).
The D44V and F106Y mutations in yeast FKBP12 were engineered by
PCR overlap mutagenesis (Ho et al., 1989
) as described for the F43Y mutation (Lorenz et al., 1995
) with the following
mutagenic primers: 1) D44V (5
-CCAAAAATTCGTCTCCTCCGTTGACAGG-3
and
5
-CAACGGAGGAGACGAATTTTTGGCCGTTC-3
) and 2) F106Y
(5
-CTTTGGTTTACGACGTCGAATTGTTG-3
and
5
-ACAATTCGACGTCGTAAACCAAAGTACTGTTTGG-3
). Flanking primers were
5
-CGGGTTAGATGATATCCCACAG-3
and 5
-GGAATTCATAAGCATTTCCACATG-3
. The resulting PCR products were cleaved with EcoRI, cloned
in CEN LEU2 plasmid YCplac111 (Gietz and Sugino, 1988
), and
expressed in FKBP12 mutants JHY2-1c or CHY516.
Epitope Tagging CPR3 and Mitochondrial Fractionation
The wild-type and mutant CPR3 genes were amplified
from the plasmids described above using the following primers:
5
-ATATATGGATCCTCTACTTACCATGTTTAAACG-3
(where the BamHI
site is in boldface type) and
5
-GCGCTATAGCGGCCGCGTAACTCACCAGCTTCTTCGAT-3
(where the
NotI site is in boldface type). PCR products were gel purified, digested with BamHI/NotI, and cloned
into the BamHI/NotI sites of pYeF2 to
hemagglutinin-epitope tag the CPR3 protein at the carboxyl terminus
(Cullin and Minvielle-Sebastia, 1994
). Total cell extracts and
mitochondrial fractions were prepared as described (Yaffe, 1991
).
Protein Purification
The genes encoding the F43Y, D44V, and F106Y FKBP12
mutants described above were PCR amplified, cloned in bacterial His6
expression plasmids pV2a or pTrcHisB (Invitrogen, San Diego, CA), as
described for wild-type yeast FKBP12 (Cardenas et al.,
1994
). The wild-type and R73A and H144Q mutant CPR3 genes
from yeast expression plasmids described above were PCR amplified with
primers: 5
-TATATAGGATCCGGGTAAAAAAGTGTTCTTTGATCC-3
(where
the BamHI site is in boldface type) and
5
-ATATAAGCTTAAAAGTTGGTTGATTTTTTATGAGCC-3
(where the
HindIII site is in boldface type). PCR products were gel
purified, digested with BamHI/HindIII, and
ligated in pTrcHisB (Invitrogen). The resulting His6-Cpr3 proteins lack
the mitochondrial leader sequence. All plasmids were confirmed by DNA
sequencing. The wild-type and mutant FKBP12 and mitochondrial
cyclophilin proteins were purified by Ni2+-affinity
chromatography (Cardenas et al., 1994
; Heitman et
al., 1993
).
Measurements of Prolyl Isomerase Activity in the Peptide Assays
In both the protease-coupled and the protease-free assay the
chromogenic peptide succinyl-Ala-Phe-Pro-Phe-4-nitroanilide was used as
the substrate. The traditional coupled assay with chymotrypsin (Fischer
et al., 1984
) was performed as described in detail by Scholz
et al. (1997b)
. In all experiments the FKBP12 proteins were
coincubated with the protease for 5 min before the peptide was added to
initiate the assay reaction. The cis-trans isomerization of
the Phe-Pro imide bond, coupled with the chymotryptic cleavage of the
trans peptide, was followed by the increase in absorbance at
390 nm of the liberated 4-nitroaniline in a HP 8452 diode array spectrophotometer. The peptide concentration in the protease-linked assay was 78 µM. Monoexponential functions were fit to the progress curves and the activity was calculated from the observed rate constants
(Fischer et al., 1984
).
In the protease-free assay the cis-trans isomerization of the Phe-Pro peptide bond in the intact assay peptide is followed by the small decrease of the absorbance at 330 nm of the uncleaved nitroanilide moiety (G. Fischer, personal communication). In the spectrophotometer cell, 955 µl of 0.1 M Tris(hydroxymethyl)aminomethane hydrochloride (Tris-HCl), pH 8.0, and 30 µl of the FKBP12 variant were mixed and incubated for 10 min to allow thermal equilibration. The assay was initiated by adding 15 µl of the assay peptide (7.8 mM in trifluoroethanol/0.45 M LiCl). During the assay the trans:cis equilibrium changes from 60:40 to 90:10. Peptide concentration in the protease-free assay was 120 µM.
Isolation of Mitochondria and Preparation of Radiolabeled Denatured Su9-DHFR
Yeast cells were cultured in synthetic lactate medium at 30°C.
Nycodenz-gradient-purified mitochondria (Glick and Pon, 1995
) were
isolated from strain JHY80-2B expressing wild-type CPR3 or the CPR3
H144Q mutant protein. Su9-DHFR consists of the first 69 residues of
subunit 9 of the Neurospora crassa
F1F0-ATPase fused to mouse DHFR (Pfanner
et al., 1987
). Synthesis of
[35S]methionine-labeled Su9-DHFR was carried out in a
reticulocyte lysate (Stueber et al., 1984
). After
translation, the lysate was depleted of ATP by incubation with 40 U/ml
apyrase for 5 min at 30°C. Ribosomes were removed by centrifugation
for 15 min at 100,000 × g, the precursor protein was
precipitated with 67% ammonium sulfate for 30 min on ice, and
precipitated protein was collected by centrifugation for 10 min at
15,000 × g. To obtain denatured Su9-DHFR the pellet
was resuspended in 8 M urea, 20 mM Tris-HCl (pH 7.5), and 20 mM
dithiothreitol, and incubated for 15 min at room temperature.
DHFR Folding Assay
The folding kinetics of Su9-DHFR in intact mitochondria were
determined essentially as described (Matouschek et al.,
1995
). In the absence of ATP, Su9-DHFR accumulates as unfolded
"ATP-depletion intermediate" in the mitochondrial intermembrane
space (Manning-Krieg et al., 1991
). After another addition
of ATP, this intermediate rapidly imports into the matrix space where
it folds into a protease-resistant conformation. To deplete
intramitochondrial ATP, mitochondria corresponding to 1 mg of total
protein were incubated at 25°C in 3 ml of import buffer (0.6 M
sorbitol, 50 mM HEPES, 50 mM KCl, 10 mM MgCl2, 2 mM
KH2PO4, 5 mM methionine, 1 mg/ml fatty
acid-free bovine serum albumin) containing 10 U/ml apyrase (grade VIII, Sigma, St. Louis, MO), 2 µg/ml efrapeptin (kind gift from Eli Lilly,
Indianapolis, IN), and 5 µg/ml oligomycin. After 5 min, NADH was
added to a final concentration of 2 mM and 100 µl of denatured
Su9-DHFR was added. The ATP-depletion intermediate was allowed to
accumulate for 10 min at 25°C. Unimported precursor was digested with
100 µg/ml trypsin for 25 min on ice. Trypsin inhibitor was added to a
final concentration of 200 µg/ml and mitochondria were reisolated by
centrifugation at 12,000 × g. The mitochondrial pellet
was resuspended in 3 ml of import buffer lacking apyrase but
supplemented with 50 µg/ml trypsin inhibitor. The mixture was split,
and one half was supplemented with 2.5 µg/ml CsA (Sandoz, Basel,
Switzerland) in Tetrahydrofuran (THF) with 0.47 M LiCl and the other
was supplemented with solvent alone. Both aliquots were incubated 5 min
on ice and then 5 min at 30°C. Chase into the matrix was initiated by
addition of 150 µl of chase buffer containing 20 mM ATP and 50 mM
-ketoglutarate. Aliquots of 100 µl were taken before and at
various times after addition of chase buffer. The fraction of folded
DHFR was determined by diluting the aliquots with 100 µl of ice-cold
20 mM HEPES-KOH, pH 7.4, containing 1% Triton X100 and 200 µg/ml
proteinase K. After 10 min on ice, proteinase K was inactivated by
addition of 1 mM phenylmethylsulfonyl fluoride, protein was
precipitated by addition of 5% trichloroacetic acid and the samples
were analyzed by SDS-PAGE. To determine the total amount of Su9-DHFR
that had reached the matrix space (total import), a sample was taken
after the last time point and trichloroacetic acid-precipitated without proteinase K. Folding was determined by fluorography of dried gels and
quantified with a Molecular Dynamics model 300A densitometer. The
fraction of folded Su9-DHFR is given as percentage of Su9-DHFR present
in the matrix (total import). The kinetics of folding were analyzed by
assuming a first-order process. Folding half-times (t1/2) were calculated from the rate constants by
using the equation t1/2 = ln 2/k
(Matouschek et al., 1995
).
Prolyl Isomerase Activity Measured in a Protein Folding Reaction
RCM-(S54G/P55N)-RNase T1 was used as a substrate in these
assays. (S54G,P55N)-RNase T1 was purified and carboxymethylated as
described (Mücke and Schmid, 1993
, 1994
). The concentrations of
RCM-(S54G/P55N)-RNaseT1 were determined spectrophotometrically by using
an absorption coefficient of
278 = 21,060 M
1·cm
1 (Takahashi et al.,
1970
).
Refolding at 15°C was initiated by a 1:40 dilution of the unfolded
protein (in 0.1 M Tris-HCl, pH 8.0) to final conditions of 2.0 M NaCl
and the desired concentrations of the wild-type protein or the mutant
forms of FKBP12 or mitochondrial cyclophilin. The folding reaction was
followed by the increase in protein fluorescence at 320 nm (10-nm band
width) after excitation at 268 nm (1.5-nm band width). The experimental
procedures of Scholz et al. (1997b)
were used. Under the
given conditions slow refolding of RCM-(S54G/P55N)-RNase is a
monoexponential process in the absence and in the presence of the
catalyst FKBP12 or mitochondrial cyclophilin. The rate constants of
folding were determined by using the program Grafit 3.0 (Erithacus
Software, Staines, United Kingdom). Fluorescence was measured in a
Hitachi F4010 fluorescence spectrophotometer.
Yeast Strains
Two strains used herein are isogenic derivatives of
Saccharomyces cerevisiae strain JK9-3d (leu2-3, 112 ura3-52 rme1 trp1 his4 HMLa; Heitman et al., 1991b
)
with the following changes indicated: JHY2-1c, MATa
ade2 fpr1::ADE2; JHY80-2b, MAT
cpr3::HIS3. Strains MB11-3 (Davis et
al., 1992
) also used were as follows: MAT
ade2-101 trp1-
1 ura3-52 his3-
200
lys2-801 can1 cpr3::HIS3; CHY516, MATa
vph6
::TRP1 fpr1::ADE2 ura3-52
his3
200 leu2-3,112 trp1
101 (Hemenway
and Heitman, 1996
).
Heterologous Expression of FKBP Domains with Yeast FKBP12 Gene Regulatory Sequences
The human FKBP12 open reading frame was fused to the 5
and 3
untranslated regions of yeast FKBP12 by a three-part PCR overlap with the following primers: 1)
5
-AGTTTCAACTTGAACACCCATTATTACTTGTTTTGATTGATT-3
(792), 2)
5
-AATCAATCAAAACAAGTAATAATGGGTGTTCAAGTTGAAACT-3
(793), 3)
5
-TCAATTGATAGTACTTTGCAATCATTCCAGTTTCAGGAGCTCAAC-3
(794), and 4)
5
-GTTGAGCTCCTGAAACTGGAATGAAAGCAAAGTACTATCAATTGA-3
(795).
Flanking primers were 5
-CGGGTTAGATGATATCCCACAG-3
(713) and
5
-GGAATTCATAAGCATTTCCACATG-3
(714). First-round PCR products using
primers 713/792, 793/794, and 795/714 were purified and amplified by
PCR with flanking primers 713/714. First-round PCR conditions were 3 min at 72°C; 35 cycles of 30 s at 94°C, 30 s at 55°C,
and 60 s at 72°C; followed by 5 min at 72°C. Second-round PCR
conditions were 3 min at 72°C; 35 cycles of 30 s at 94°C, 30 s at 55°C, and 2 min at 72°C; followed by 5 min at 72°C.
The resulting ~2-kb PCR product was cleaved with EcoRI,
cloned in YCplac111 (Gietz and Sugino, 1988
), and expressed in the
fpr1 mutant strains JHY2-1c and CHY516.
The yeast FKBP13 open reading frame was fused to the 5
and 3
untranslated regions of yeast FKBP12 as above with the following primers: 1) 5
-TTCCAAATCTGACAGGGAACCCATTATTACTTGTTTTGATTGATT-3
(796), 2) 5
-AATCAATCAAAACAAGTAATAATGGGTTCCCTGTCAGATTTGGAA-3
(797), 3)
5
-TCAATTGATAGTACTTTGCAACTAGGCGGCTGATTTCACGTC-3
(798), and 4)
5
-GACGTGAAATCAGCCGCCTAGAAGCAAAGTACTATCAATTGA3
(799). In this
case, first-round PCRs were with primers 713/796, 797/798, and 799/714.
PCR products were purified, mixed, amplified with flanking primers, and
subcloned as above.
The yeast/human and human/yeast FKBP12 hybrid genes were constructed by
cleaving the human or yeast FKBP12 YCplac111 plasmid with
HpaI/SphI, purifying the gapped plasmid, and
inserting the corresponding HpaI-SphI fragment
from the yeast or human FKBP12 gene. All hybrid genes were confirmed by
DNA sequencing with primers 5
-GGCCTTTCACCTAAACTCGA-3
(818) and
5
-TCAGATACTTACCATAAACA-3
(819) that hybridize to 5
and 3
regions
common to all of the hybrid genes.
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RESULTS |
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Mitochondrial Cyclophilin "Active-Site" Mutants
To test the role of prolyl isomerase activity in cyclophilin
function, we introduced previously described active-site mutations and
tested whether the resulting mutants complement a yeast cyclophilin mutation. The yeast mitochondrial cyclophilin Cpr3 is essential for
growth at 37°C on medium containing lactate as the sole carbon source
because the Cpr3 enzyme is essential for mitochondrial metabolism at
elevated temperature and lactate is used via respiration (Davis
et al., 1992
). On the basis of previous crystallographic and
genetic studies of human cyclophilin A (Kallen and Walkinshaw, 1992
;
Zydowsky et al., 1992
; Ke et al., 1993
; Mikol
et al., 1993
; Zhao and Ke, 1996
), two point mutations that
would be predicted to abolish prolyl isomerase activity, R73A and
H144Q, were engineered into the Cpr3 protein. These correspond to
mutations in human cyclophilin A, R55A and H126Q, previously shown to
inactivate the human enzyme based on the standard in vitro
isomer-specific peptide cleavage assay (Zydowsky et al.,
1992
).
Cpr3 Active-Site Mutant Cyclophilins Are Inactive in Peptide Cleavage Assay but Catalyze Protein Folding In Vitro
To address the in vitro enzymatic activities of the mutant
enzymes, the wild-type and mutant yeast Cpr3 proteins were tagged at
the amino terminus of the mature protein (minus the mitochondrial leader sequence) with hexahistidine, expressed in bacteria, and purified via Ni2+ affinity chromatography (see MATERIALS
AND METHODS). Both the R73A and the H144Q mutant Cpr3 proteins lacked
detectable prolyl isomerase activity (with a detection limit of
~0.5% specific activity of the wild-type enzyme) in the in vitro
peptidyl-prolyl isomerization assay that involves chymotrypsin cleavage
of the trans isomer of tetrapeptide substrates
Suc-Ala-X-Pro-Phe-p-nitroanilide (where Suc is succinyl and
X is Ala, Leu, Glu, or Lys) to release the chromogenic group (our
unpublished results). In addition, neither the R73A nor the H144Q
mutant protein bound appreciably to CsA in an LH-20 drug binding assay
(our unpublished results). We conclude that the R73A and H144Q
mutations have a similar effect on the prolyl isomerase activity of the
yeast mitochondrial cyclophilin and human cyclophilin A, as detected
with the in vitro peptide cleavage assay. As will be described in
detail below for FKBP12 mutations, and elsewhere for these cyclophilin
mutants (Scholz et al., 1997b
), these active-site mutations
result in a loss of activity in the protease-coupled peptide assay
because they render the cyclophilin mutant enzymes sensitive to
digestion by the chymotrypsin present in the protease-coupled peptide
isomerization assay.
In vitro the Cpr3 enzyme catalyzed the prolyl isomerization
limited refolding of reduced and S-carboxymethylated
S54G/P55N ribonuclease T1 (RCM-S54G/P55N-RNase T1) very well (Scholz
and Schmid, unpublished results). This protein contains a single
cis peptidyl-prolyl bond
(Tyr38-Pro39). In the unfolded state, 85% of
the molecules contain an incorrect trans
Tyr38-Pro39 bond and refold slowly with a
half-time of about 400 s (Kiefhaber et al., 1990a
).
This refolding reaction is limited in rate by the trans to
cis isomerization of the Tyr38-Pro39
peptide bond. The two Cpr3 active site mutant enzymes R73A and H144Q
were also active and accelerated the folding of the ribonuclease T1
variant with about two-thirds the efficiency of the wild-type Cpr3
enzyme (Scholz and Schmid, unpublished results). Thus, both the R73A
and the H144Q Cpr3 mutant enzymes retain prolyl isomerase activity
toward a protein substrate whose folding is rate-limited by a single
trans to cis peptidyl-prolyl isomerization.
Cpr3 Active-Site Mutant Cyclophilin Catalyzes Protein Folding in Mitochondria
To further address whether these Cpr3 active-site mutants retain
activity toward another protein substrate, we took advantage of the
previous finding that, in conjunction with mitochondrial hsp70, the
mitochondrial cyclophilin Cpr3 promotes refolding of a chimeric
protein, Su9-DHFR, after import into the mitochondrial matrix
(Matouschek et al., 1995
; Rassow et al., 1995
;
Rospert et al., 1996
). The Su9-DHFR protein consists of the
mouse DHFR protein fused to the mitochondrial matrix targeting sequence
of subunit 9 of the F1F0-ATPase. In these
experiments, radiolabeled Su9-DHFR protein was denatured and incubated
with purified mitochondria. After incubation, mitochondria were
repurified and lysed with detergent, and the folding state of DHFR was
assessed by protease K digestion. In mitochondria expressing the
wild-type Cpr3 protein, the half-time of folding was 1.1 min, and
~80% of the imported Su9-DHFR folded into a protease-resistant
conformation (Figure 1A and Table
1). In accord with
previous reports, addition of CsA inhibited DHFR refolding by about
threefold (t1/2 = 2.9 min; Figure 1A and
Table 1; Matouschek et al., 1995
; Rassow et al.,
1995
). In mitochondria expressing the H144Q Cpr3 mutant protein, the
half-time of DHFR folding was only slightly reduced compared with
wild-type (t1/2 = 1.4 min; Figure 1B and
Table 1). The acceleration of DHFR refolding by the H144Q mutant
protein was largely insensitive to CsA
(t1/2 = 1.6 min; Figure 1B and Table 1),
consistent with the finding that this mutant does not bind CsA in
vitro. In conclusion, the H144Q cyclophilin mutant enzyme retains
activity with a protein substrate.
|
|
The cyclophilin active-site mutants lack activity in the protease
coupled peptide cleavage assay not because they are inactive but rather
because they have been rendered protease sensitive by the active-site
mutation. This interpretation is supported both by our finding that
these mutant enzymes retain near wild-type activity in two different
protein folding assays with either ribonuclease T1 or DHFR as substrate
(this article), and that these mutants exhibit low but substantial
levels of prolyl isomerase activity in a modified peptide assay that
avoids coupling with proteolyic cleavage (Scholz et al.,
1997b
).
Mitochondrial Cyclophilin H144Q Mutant Is Functional In Vivo
The genes encoding wild-type and the R73A and H144Q mutant Cpr3 proteins were cloned into low-copy-number centromeric plasmids (MATERIALS AND METHODS) and tested for complementation of the cpr3 growth defect on lactate medium at 37°C. Wild-type Cpr3 and the H144Q mutant protein complemented and restored growth, whereas the R73A mutant protein did not (Figure 2A). As determined by Western blot analysis, epitope-tagged versions of wild-type Cpr3 and the R73A and the H144Q proteins were expressed at comparable levels (Figure 2B). In addition, Western blot analysis of mitochondrial fractions revealed that the wild-type and both mutant Cpr3 proteins cofractionated with the mitochondrial protein, cytochrome c oxidase (COX2; Figure 2B). Thus, the failure of the R73A mutant protein to complement is not attributable to instability or mislocalization and may result from an inability to effectively interact with a target protein. The ability of the H144Q mutant enzyme to complement is in accord with the finding that this mutant enzyme retains wild-type activity with two different protein substrates.
|
FKBP12 Active-Site Mutants Are Protease Hypersensitive and Active with a Protein Substrate
We next tested whether our observations with cyclophilin
active-site mutants also apply to FKBP12 active site mutants. Single amino acid substitutions in human FKBP12 (F36Y, D37V, and F99Y) have
been described that perturb the active site and reduce prolyl isomerase
activity in the in vitro peptide cleavage assay (Aldape et
al., 1992
; Timerman et al., 1995
). Yeast and human
FKBP12 share 54% identity and have nearly superimposable x-ray crystal
structures (Heitman et al., 1991a
,b
; Van Duyne et
al., 1991
; Rotonda et al., 1993
). On the basis of this
high degree of conservation, analogous active site mutations (F43Y,
D44V, and F106Y) were introduced into yeast FKBP12. The wild-type and
mutant FKBP12 proteins were tagged at their amino termini with
hexahistidine, overexpressed in bacteria, and purified via
Ni2+ affinity chromatography (see MATERIALS AND METHODS).
The activity of the mutant proteins was first assessed in the standard
prolyl isomerase assay (Fischer et al., 1984
), as described above for the cyclophilin mutant enzymes. Wild-type FKBP12 shows a high
activity in the protease-coupled assay (Figure
3A); isomerization is accelerated about
10-fold by 100 nM FKBP12. From the slope of the plot in Figure 3A a
value of kcat/Km of
740,000 M
1·s
1 can be determined. The
F106Y mutation reduces prolyl isomerase activity about 10-fold, and the
kcat/Km value for the
F106Y variant is 85,000 M
1·s
1, 11.5% the
activity of wild-type FKBP12 (Figure 3A). In contrast, activity of the
F43Y and the D44V mutant enzymes was barely detectable in the
protease-linked activity assay (Figure 3B), and their
kcat/Km values are
smaller than 2000 and 3000 M
1·s
1,
respectively, which corresponds to <0.3 and <0.4% the activity of
wild-type FKBP12 (Table
2).
|
|
To test whether the FKBP12 mutants might also be protease sensitive, we
measured the activities of the wild-type and mutant FKBP12 enzymes in a
protease-free peptide assay. The absorbance at 330 nm of the
4-nitroanilide moiety of the intact assay peptide decreases slightly
upon cis to trans isomerization of the Phe-Pro imide bond. In the protease-free assay, a jump in the solvent conditions is used to shift the trans:cis
equilibrium from 60:40 to 90:10. The concomitant change in absorbance
is used to monitor the kinetics of Phe-Pro isomerization in the
uncleaved assay peptide (Fischer, personal communication). The
sensitivity of the assay is limited because the decrease in absorbance
is very small. It probably originates from a differential interaction
between the 4-nitroanilide moiety and the phenylalanine residues in the
cis and trans forms of the assay peptide. As
expected, wild-type FKBP12 shows similar activities toward the assay
peptide when measured either in the presence or the absence of the
coupled protease. The apparent
kcat/Km value determined
in the absence of chymotrypsin is 810,000 M
1·s
1 (Figure 3A), which is 10% larger
than the kcat/km of
740,000 M
1·s
1 measured in the presence of
the protease (Table 2). This difference is expected because in the
irreversible protease-coupled assay the measured activity is determined
solely by the rate of the cis to trans reaction,
whereas in the reversible protease-free assay the rates of both the
cis to trans and the trans to
cis reactions contribute to the activity measured. Although
the activity of the F106Y mutant enzyme is 10-fold reduced relative to
the wild-type protein, this mutant is resistant to proteolysis in the
assay and yields nearly identical
kcat/Km values of 85,000 M
1·s
1 and 111,000 M
1·s
1 in the presence and absence of
protease, respectively. However, the F43Y and the D44V mutants, which
were virtually inactive in the protease-coupled assay, exhibit
kcat/Km values of 34,000 M
1·s
1 and 46,000 M
1·s
1 in the protease-free assay (Figure
3B and Table 2). This indicates that their lack of activity in the
presence of the coupled protease is caused by an inactivation by
proteolytic degradation. It also indicates that these two mutants show
a low but significant residual activity of ~5% toward the Phe-Pro
bond in the peptide substrate.
We next measured the prolyl isomerase activity of the mutant FKBPs in a
protein folding assay that uses as substrate the reduced and
carboxymethylated variant of ribonuclease T1 RCM-(S54G/P55N)-RNase T1,
as described above for the cyclophilin mutant enzymes. In the absence
of enzyme, this folding reaction shows a time constant of 570 s,
and 200 nM wild-type FKBP12 accelerates the reaction sevenfold. A
kcat/Km value of 49,000 M
1·s
1 can be calculated from the increase
in the folding rate as a function of the FKBP12 concentration (Figure
4). For folding protein substrates the
kcat/Km values are
generally smaller than for peptides because the prolyl bonds are
partially shielded in folding intermediates (Schmid, 1993
) and because
nonproductive binding may occur. The D44V mutation did not affect the
prolyl isomerase activity of FKBP12 in the folding assay, and virtually
the same kcat/Km value of
51,000 M
1·s
1 was observed as with the
wild-type enzyme (Figure 4 and Table 2). This is in marked contrast to
both the protease-linked and the protease-free peptide assays (Figure
3B and Table 2), in which the relative activities of the D44V mutant
enzyme were less than 1 and 5%, respectively. The F106Y and the F43Y
mutants were 60% and 30%, respectively, as active as wild-type FKBP12
in the protein folding assay. Again, the relative activities of these two mutants toward a protein substrate were much higher than their relative activities toward a peptide substrate in the protease-free assays (Table 2). The activities of all FKBP12 forms in the three assays are compared in Table 2. We conclude that all of these FKBP12
active-site mutants retain near wild-type levels of activity with a
protein substrate and that the F43Y and D44V mutations render the
enzyme protease hypersensitive and thus artifactually inactive in the
protease-coupled peptide isomerization assay.
|
FKBP12 Active-Site Mutants Are Functional In Vivo
We next tested whether these FKBP12 active-site mutants provide
FKBP12 functions in vivo. Yeast mutants lacking FKBP12 (encoded by the
FPR1 gene) are viable but exhibit slow growth, with a
doubling time increased by 15-30% compared with an isogenic wild-type
strain (Heitman et al., 1991a
,b
). In addition, FKBP12 is the
cellular receptor for the macrolides FK506 and rapamycin; thus,
fpr1 mutants are resistant to rapamycin (Heitman et
al., 1991a
,b
) and also to FK506 under conditions, such as cation
stress, or in mutant strains (vph6) in which the target of
FKBP12-FK506, calcineurin, is essential (Nakamura et
al., 1993
; Breuder et al., 1994
; Hemenway et al., 1995
).
The genes encoding wild-type and the mutant FKBP12 proteins were
expressed from a low-copy-number centromeric plasmid and tested for
complementation of fpr1 mutant phenotypes (see MATERIALS AND
METHODS). By Western blot, the F43Y, D44V, and F106Y mutant proteins
were expressed at a slightly reduced level compared with wild-type
FKBP12 expressed from a centromeric plasmid or the chromosome (Figure
5). In accord with previous studies
(Aldape et al., 1992
; Lorenz and Heitman, 1995
), wild-type
FKBP12 and the F43Y, D44V, and F106Y mutant proteins restored
sensitivity to rapamycin, indicating sufficient rapamycin binding to
FKBP12 and FKBP12-rapamycin binding to TOR1/TOR2 to inhibit yeast
growth. Wild-type and the F43Y mutant proteins restored FK506
sensitivity (Figure 5) and thus bind FK506 and calcineurin, whereas the
D44V and F106Y mutant enzymes did not, in accord with previous findings
that the corresponding residues of human FKBP12, D37 and F99, are
critical for FK506 binding (DeCenzo et al., 1996
). More
importantly, wild-type FKBP12 and the F43Y, D44V, and F106Y mutant
proteins all complemented and restored normal growth rate in yeast
FKBP12 null mutant cells (Figure 5). That these FKBP12 mutant enzymes
are active in vivo is in full accord with our finding that all retain
activity with a protein substrate in vitro.
|
Heterologous FKBP Prolyl Isomerases Lack FKBP12 In Vivo Function
As a complementary approach to assess the importance of the prolyl
isomerase activity of FKBP12 for its functions in yeast, we tested
whether human FKBP12 or yeast FKBP13 lacking its signal sequence could
complement a yeast FKBP12 null mutation. To ensure that each enzyme was
expressed at a similar level, the 5
and 3
untranslated regulatory
regions of the yeast FKBP12 gene FPR1 were fused to the
start and stop codons of each open reading frame by PCR overlap (see
MATERIALS AND METHODS). The resulting chimeric genes express human
FKBP12 and yeast FKBP13 lacking the signal sequence. Both human FKBP12
and yeast FKBP13 lacking the signal sequence complemented FKBP12 mutant
strains and restored sensitivity to rapamycin (Figure
6). In contrast, human FKBP12 partially
restored sensitivity to FK506, whereas the FKBP13 prolyl isomerase did not (Figure 6), consistent with previous findings that FKBP12 surface
residues required to inhibit calcineurin are altered in FKBP13 (Aldape
et al., 1992
). Most importantly, human FKBP12 and the FKBP13
prolyl isomerase domains did not complement the growth defect of yeast
FKBP12 mutants. The heterologous FKBP domains were expressed, based on
restoration of drug sensitivities, as described above. Thus, expression
of an active FKBP prolyl isomerase is not sufficient to provide FKBP12
function(s) required for normal growth.
|
To address FKBP12 structural features required for in vivo function,
chimeras were constructed between yeast and human FKBP12. As shown in
Figure 6, the amino-terminal two-thirds of human FKBP12 were fused to
the carboxyl-terminal one-third of yeast FKBP12 (human-yeast FKBP12),
and the amino-terminal two-thirds of yeast FKBP12 were fused to the
carboxyl-terminal one-third of human FKBP12 (yeast-human FKBP12). As
above, the chimeric genes contained the 5
and 3
regulatory regions of
the yeast FKBP12 gene. Both human-yeast FKBP12 and yeast-human FKBP12
restored rapamycin sensitivity, and the human-yeast FKBP12 hybrid
restored FK506 sensitivity, but neither complemented the growth defect
of FKBP12 mutant strains (Figure 6). We conclude that additional
structural features of yeast FKBP12 important for in vivo function lie
in both the amino-terminal two-thirds and the carboxyl-terminal
one-third of the protein.
| |
DISCUSSION |
|---|
|
|
|---|
Our original aim was to test whether FKBP and cylophilin prolyl isomerase activity was required for in vivo function. The approach was to introduce active-site mutations previously shown to result in a loss of in vitro isomerase activity and to test whether these mutants would complement FKBP12 and cyclophilin null mutations when expressed in yeast. Somewhat to our surprise, we found that these active-site mutants were, with one exception, fully functional in vivo. This finding prompted us to reexamine the original premise that these active-site mutations result in a loss of isomerase activity. In a reciprocal approach, we tested whether heterologous FKBP domains can restore function in the FKBP12 null strain. We found that different FKBP prolyl isomerase domains, derived from human FKBP12 and yeast FKBP13, do not provide FKBP12 biological function in yeast. Hence, FKBP prolyl isomerase activity alone is not sufficient for FKBP12 function in vivo.
To reexamine the active-site mutations in mitochondrial cyclophilin and FKBP12, we measured the isomerase activity of mitochondrial cyclophilin (wild-type and R73A and H144Q active-site mutants) and FKBP12 (wild-type and F43Y, D44V, and F106Y active-site mutants) in the standard peptide assay for prolyl isomerase activity. The mutants of both the Cpr3 and the FKBP12 enzyme had dramatically reduced activity in this chymotrypsin-coupled peptide assay. In contrast, by using a protease-free peptide assay, we found that the R73A and H144Q Cpr3 mutant enzymes and also the F43Y and D44V FKBP12 mutant enzymes had demonstrable levels of activity.
The H144Q active-site mutant is almost as active as the wild-type Cpr3
enzyme in an assay that measured folding of murine DHFR in purified
mitochondria expressing wild-type or mutant Cpr3 enzymes. Furthermore,
all of the Cpr3 (wild-type or active-site mutant) and FKBP12 (wild-type
or active-site mutant) enzymes catalyzed the in vitro refolding of
RCM-(S54G/P55N)-ribonuclease T1, which is limited in rate by the
trans to cis isomerization of the
Tyr38-Pro39 peptidyl-prolyl bond. This folding
reaction can be catalyzed by many different cyclophilins and FKBPs
(Kiefhaber et al., 1990a
,b
; Tropschug et al.,
1990
; Schönbrunner et al., 1991
; Schmid, 1993
; Mayr
et al., 1996
; Scholz et al., 1997a
). The R73A and
the H144Q active-site mutants of the mitochondrial cyclophilin Cpr3
showed about 70% of the activity of the wild-type protein in the
catalysis of this folding reaction. Similarly, the three active-site
mutants of FKBP12 showed between 30 and 100% of the folding activity
of the wild-type protein. These findings indicate that it will be necessary to test candidate active-site mutants for FKBPs,
cyclophilins, and parvulins by using protein-folding assays with
ribonuclease T1 or other substrates.
Why are these active-site mutants inactive in an in vitro
protease-coupled peptide assay but retain activity in a protease-free peptide assay and with two protein substrates? First, the R73A and
H144Q cyclophilin mutant enzymes and the F43Y and D44V FKBP12 mutant
enzymes are markedly sensitive to proteolysis by chymotrypsin, possibly
as a consequence of conformational changes or decreased stability, and
thus are rapidly destroyed in the protease-coupled peptide assay. Even
in protease-independent assays, however, the active-site mutants were
still 3- to 20-fold less active than with a protein substrate in the
folding assays (Table 2). One possible explanation is that large
substrates can use additional contacts to the enzyme and that these
contacts mitigate the deleterious effects of active site mutations.
Another possible explanation for the higher activity in the protein
folding assay compared with the peptide assay is that the protein
substrate may preorganize the prolyl-peptide bond in a conformation
more favorable for catalysis (Fischer et al., 1993
).
Our findings are relevant to earlier studies that addressed the roles
of FKBP and cyclophilin prolyl isomerase activity in other systems.
Human FKBP12 is a subunit of the ryanodine and inositol
1,4,5-trisphosphate (IP3) receptors and is required for proper Ca2+ channel activity (Brillantes et al.,
1994
; Cameron et al., 1995
). The finding that FKBP12 mutants
with reduced prolyl isomerase activity in the in vitro peptide cleavage
assay support channel function has been interpreted to mean that prolyl
isomerase activity is not required for this FKBP12 function (Timerman
et al., 1995
). Alternatively, these FKBP12 mutant enzymes
may retain activity toward this large substrate, as our findings
clearly demonstrate is the case with ribonuclease T1 as a substrate.
The study identifying the novel cyclophilin RanBP2 is worth revisiting
(Ferreira et al., 1996
). The active-site mutations used in
the RanBP2 study are analogous to those studied herein. Because the
RanBP2 active-site mutants prevented binding and alteration of opsin by
the RanBP2, it was suggested that prolyl isomerization of opsin by
RanBP2 cyclophilin was critical for function (Ferreira et
al., 1996
). Our findings that the analogous active-site mutants do
not effect the ability of mitochondrial cyclophilin to refold ribonuclease T1 argue that these mutations may instead perturb some
other feature of the opsin-cyclophilin complex. We note that while the
R73A Cpr3 mutant protein folds ribonuclease T1 in vitro, this mutant
failed to provide Cpr3 function in yeast, and hence the residues within
the active sites of both yeast mitochondrial cyclophilin and the RanBP2
cyclophilin are clearly implicated in function. The defects of these
mutant enzymes could result from loss of activity for specific
substrates or from a loss of another function of their active-site
binding pockets, such as the ability to form stable protein-protein
complexes with target molecules.
R55 (analogous to R73 in Cpr3) was originally implicated as a critical
active-site residue of human cyclophilin A by the mutagenic and
biochemical studies of Zydowsky et al. (1992)
. In addition, the x-ray crystal structure of human cyclophilin A in complex with the
tetrapeptide substrate Ala-Ala-Pro-Phe revealed the guanidine group of
Arg55 is hydrogen bonded to the carbonyl oxygen of the
substrate proline (Zhao and Ke, 1996
). On the basis of this structure,
it was proposed that during catalysis the guanidine nitrogen of
Arg55 might hydrogen bond with the peptide nitrogen,
weakening the partial double-bond properties of the peptide bond and
facilitating catalysis. Although we cannot exclude that
Arg73 might play some role in catalyzing cis to
trans isomerization of peptide substrates, our finding that
Arg73 of mitochondrial cyclophilin can be replaced by
alanine without loss of catalytic activity excludes an obligate role
for the Arg73 side chain in catalysis of trans
to cis isomerization in ribonuclease T1.
What is the role of the enzymatic activity of FKBP12 and mitochondrial
cyclophilin for biological function? Recent studies of ninaA and of
human cyclophilin A with their interaction partners rhodopsin and HIV-1
GAG protein, respectively, reveal that these interactions may involve
stoichiometric protein-protein complexes rather than catalytic
enzyme-substrate interactions (Baker et al., 1994
; Gamble
et al., 1996
; Luban, 1996
). These abundant proteins may have
originally served a catalytic function for partner proteins but later
in evolution been conscripted to serve as subunits independent of
catalytic activity. Other functions may require enzymatic activity. Prolyl isomerases could still participate in protein folding, either by
isomerizing a limited number of substrates or as chaperones, independent of prolyl isomerase activity. A recent report, however, that human cyclophilin A exhibits chaperone activity has been controversial (Freskgard et al., 1992
; Kern et
al., 1994
). Alternatively, prolyl isomerases might not fold
proteins but rather serve specialized roles yet to be revealed.
Finally, because cyclophilins and FKBPs serve as the intracellular
receptors for natural product immunosuppressive ligands and mediate the
ability of these compounds to inhibit target proteins, the binding
pockets of cyclophilin and FKBP may regulate the function of other
proteins in response to binding of as yet unknown endogenous ligands.
Further insights into the roles of the prolyl isomerases in yeast and
other organisms will require the identification of additional target
proteins, studies that are now in progress.
| |
ACKNOWLEDGMENTS |
|---|
We thank Peter Model, Robin Wharton, Tony Means, Mike Lorenz, and Steve Michnick for comments on the manuscript; Charles Hemenway for plasmids; and Thomas Schindler for help and advice in protein purification. S.R. was supported by an European Molecular Biology Organization postdoctoral fellowship. This work was supported in part by National Institutes of Health grant PO1-HL-50985-01 and Council for Tobacco Research grant 4050 to M.C. and the Deutsche Forschungsgemeinschaft. J.H. is an assistant investigator of the Howard Hughes Medical Institute.
| |
FOOTNOTES |
|---|
Corresponding author: 322 Carl Building,
Research Drive, Box 3546, Duke University Medical Center, Durham, NC
27710.
| |
REFERENCES |
|---|
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