Abstract
Peptidyl-prolyl isomerization is an important post-translational modification of protein because proline is the only amino acid that can stably exist as cis and trans, while other amino acids are in the trans conformation in protein backbones. This makes prolyl isomerization a unique mechanism for cells to control many cellular processes. Isomerization is a rate-limiting process that requires a peptidyl-prolyl cis/trans isomerase (PPIase) to overcome the energy barrier between cis and trans isomeric forms. Pin1, a key PPIase in the cell, recognizes a phosphorylated Ser/Thr-Pro motif to catalyze peptidyl-prolyl isomerization in proteins. The significance of the phosphorylation-dependent Pin1 activity was recently highlighted for isomerization of ATR (ataxia telangiectasia- and Rad3-related). ATR, a PIKK protein kinase, plays a crucial role in DNA damage responses (DDR) by phosphorylating hundreds of proteins. ATR can form cis or trans isomers in the cytoplasm depending on Pin1 which isomerizes cis-ATR to trans-ATR. Trans-ATR functions primarily in the nucleus. The cis-ATR, containing an exposed BH3 domain, is anti-apoptotic at mitochondria by binding to tBid, preventing activation of pro-apoptotic Bax. Given the roles of apoptosis in many human diseases, particularly cancer, we propose that cytoplasmic cis-ATR enables cells to evade apoptosis, thus addicting cancer cells to cis-ATR formation for survival. But in normal DDR, a predominance of trans-ATR in the nucleus coordinates with a minimal level of cytoplasmic cis-ATR to promote DNA repair while preventing cell death; however, cells can die when DNA repair fails. Therefore, a delicate balance/equilibrium of the levels of cis- and trans-ATR is required to ensure the cellular homeostasis. In this review, we make a case that this anti-apoptotic role of cis-ATR supports oncogenesis, while Pin1 that drives the formation of trans-ATR suppresses tumor growth. We offer a potential, novel target that can be specifically targeted in cancer cells, without killing normal cells, to significantly reduce the adverse effects usually seen in cancer treatment. We also raise important issues regarding the roles of phosphorylation-dependent Pin1 isomerization of ATR in diseases and propose areas of future studies that would shed more understanding on this important cellular mechanism.
Peptidyl-Prolyl Isomerization of Proteins and Pin1
Individual proteins may perform multiple functions and have evolved to evade unnecessary degradation. These differing functions and survival skills involve posttranslational modifications of proteins. Apart from protein function, post-translational modifications (PTMs) of proteins also can affect their sub-cellular location, stability and inter-molecular interactions with other proteins (; ; ). Of the various types of PTMs such as phosphorylation, ubiquitination, acetylation, and so on, peptidyl isomerization of a protein is a unique type of PTM (Tanford, 1968). Peptidyl isomerization is the reversible transformation of a molecule between cis and trans isomeric forms, such that the peptide or protein can exist in two distinct geometric conformations, cis and trans (Figure 1). This modification causes no change in the molecular weight of the peptide or protein; hence, the inability to detect this change by mass spectrometry; however, isomerization, especially of a proline residue, alters the affected protein’s structure. The biological significance of prolyl isomerization, as compared to the other 19 non-proline amino acids, is that all non-proline amino acids are naturally stable in trans isomeric form whereas proline can be in either the cis or the trans isoform at the amide bond of proline with the preceding amino acid (; ; Song et al., 2006; ; Figure 1). Thus, peptidyl isomerization of protein refers mostly to peptidylprolyl isomerization.
FIGURE 1
Most amino acid residues within a folded protein are thermodynamically more stable in the trans form (Stewart et al., 1990; Schmidpeter and Schmid, 2015). However, proline has the unique ability to exist as a cis or a trans residue in a protein’s structural backbone as the side chain of proline forms part of the backbone of protein (; ; Song et al., 2006; ). This potential to switch between isomeric forms (Figure 1) via isomerization allows proline to act as a molecular switch that affects the protein’s structure and, hence, its physiological functions. The isomerization naturally occurs slowly and is rate limiting in the protein folding process. Hence, enzymes, such as peptidyl-prolyl cis/trans isomerases (PPIases) are required to overcome existing high-energy barriers between these protein isomers and to stabilize the transition between cis/trans isoforms. Protein isomerization is involved in many cellular processes such as apoptosis (; ), mitosis (; Yaffe et al., 1997; Rippmann et al., 2000; Zhou et al., 2000; Yang et al., 2014), cell signaling (; Sarkar et al., 2007; Toko et al., 2013), ion channel gating (), amyloidogenesis (), DNA damage repair (Steger et al., 2013), and neurodegeneration (Pastorino et al., 2006; ; Nakamura et al., 2012; Sorrentino et al., 2014).
Pin1 is a member in the parvulin family of peptidyl prolyl isomerases (PPIases); it can catalyze proline isomerization only at a phosphorylated Ser/Thr-Pro (pSer/pThr-Pro) motif (, ; ). Structurally, Pin1 consists of an N-terminal WW protein interaction domain which binds its substrate at the pSer/pThr-Pro motif, a central flexible linker and a C-terminal PPIase domain to catalyze proline isomerization (). Pin1’s activity, stability, subcellular location and substrate binding can be regulated by its own PTMs, including Serine 71 phosphorylation by DAPK1 (inactivates Pin1; ; ), ubiquitination () oxidation (), and sumoylation (). Pin1 is involved in regulating multiple cellular processes including cell cycle transit and division (Rippmann et al., 2000), differentiation and senescence (; Toko et al., 2014) and apoptosis (Pinton et al., 2007; ; ). To perform these cellular functions, Pin1 binds to many substrates within the cell (Figure 2). These substrates include proteins involved in cell cycle regulation (p53, cyclin E), transcriptional regulation (E2F, Notch1), DNA damage responses (DDR), and so forth (; ). Pin1 expression and activity have been implicated in many diseases from neurodegenerative disorders such as Alzheimer disease and amyotrophic lateral sclerosis (Pastorino et al., 2006; ; Nakamura et al., 2012, 2013), autoimmune diseases like systemic lupus erythematosus (Wei et al., 2016), to cancer (; Ryo et al., 2003; ; Yeh and Means, 2007; ; Nakamura et al., 2013; ; ; Zhou and Lu, 2016; ; ; Nakatsu et al., 2019), etc. ATR (ataxia telangiectasia- and Rad3-related) protein, a master regulator and phosphatidylinositol 3-kinase (PI3K-like) protein kinase in DDR (Zou and Elledge, 2003; ; ), was recently reported to be a substrate of Pin1 for prolyl isomerization (). Given that ATR phosphorylates hundreds of proteins in response to DNA damage (), isomerization of ATR by Pin1 represents a new paradigm in understanding Pin1’s biological activities, which is the focus of this article (Figures 2, 3).
FIGURE 2
FIGURE 3

Graphical representation of the proposed mechanism by which ATR plays a direct anti-apoptotic function at the mitochondria. UV damage inactivates Pin1’s isomerization of ATR in the cytoplasm. Cis-ATR (ATR-H) then accumulates and binds to and sequesters t-Bid at the outer mitochondria membrane. Without tBid, Bax and Bak fail to polymerize, thus cis-ATR inhibits cytochrome c release and apoptosis. Trans-ATR (ATR-L) is the dominant isomer in the nucleus where it interacts with ATRIP, RPA and chromatin in the DNA damage repair (DDR) response. PPs (protein phosphatases) can dephosphorylate the Pin1 recognition motif and promote formation of cis-ATR (to be published elsewhere). Modified from
Posttranslational Modifications of ATR for Its Respective Nuclear and Cytoplasmic Functions
ATR is a key DDR protein kinase that the cell employs to sense replicative stress and DNA damage. Following replication arrest and formation of single-stranded DNA (ssDNA), RPA coats the ssDNA and recruits ATR-ATRIP complex via ATRIP (ATR interacting protein). ATRIP is the nuclear partner of ATR and carries bound ATR along to the DNA damage site, where ATR is autophosphorylated at its T1989 residue (
Recently, ATR was found to function in the cytoplasm and was described to play an important anti-apoptotic role directly at the mitochondria, independent of nuclear ATR and its kinase activity (
Phosphorylation-Dependent Isomerization of Atr by Pin1
Pin1 has a high degree of phosphate specificity (Zhou et al., 1999;
FIGURE 4

A brief summary of the mechanism by which the levels of cytoplasmic cis- and trans-ATR isoforms are mediated by phosphorylation and dephosphorylation before and after UV irradiation. The red X stands for inhibition or inactivation of Pin1.
The level at Ser428 phosphorylation in ATR can be determined by two important classes of proteins: protein kinases and phosphatases. The former phosphorylates Ser428 while the latter dephosphorylates this residue. The balance between the two opposing activities is critical to controlling the cis/trans balance of ATR isomers and, thus, the health of the cells. Identification of the phosphatases which have activities at Ser428 is particularly important to cancer treatment as dephosphorylation of this residue leads to an increase of anti-apoptotic cis-ATR formation (
Cis-Atr’s Anti-Apoptotic Function May Support an Oncogenic Process in Dividing Cells
Cancer is characterized with deregulated cell growth, where there is an imbalance in the inherent cell cycle regulation to check the rate and integrity of cell division and growth. In addition, given that cis-ATR is antiapoptotic, we hypothesize that cis-ATR may perform an oncogenic role, while Pin1 might be tumor suppressive in terms of ATR’s anti-apoptotic activity at the mitochondria. If cis-ATR is the dominant cytoplasmic form, it may block mitochondrial apoptosis and allow damaged cells to survive and mutate, even when DNA damage repair is insufficient and the abnormal cells are supposed to die via apoptosis. This evasion of apoptosis is an important hallmark of cancer cells that, over time, allows them to accumulate the mutations that define genome instability and, eventually, leads to carcinogenesis. However, if Pin1’s action is increased and trans-ATR is the dominant form of ATR in the cytoplasm, before mutations can be propagated, programmed death will occur in those cells that are too severely damaged for proper DNA repair. Thus, reduction of cytosolic cis-ATR discourages accumulation of cells with DNA damage that could be passed on to daughter cells and would promote carcinogenesis.
This hypothesis is interesting in and of itself, but is inconsistent with the existing literature which suggests other roles of Pin1 in cancer development (Figure 2). The current understanding stems primarily from observations that Pin1 is overexpressed/has increased activity in most cancers and cancer stem cells, with corresponding negative prognostic outcomes (
TABLE 1
| Cancer type | Male/female (n/n) | Max post- diagnosis years | Pin1 expression | ||||||
| Survival probability | 5-year survival (%) | ||||||||
| Expression | Prognosis | ||||||||
| Low | High | Level | status | ||||||
| Lower | Higher | expression | expression | cut-off | P score | (Prognosability) | |||
| Renal | 591/286 | 16 | Low | High | 64% | 82% | 9.65 | 0.000078 | Yes |
| Pancreatic | 96/80 | 7 | Low | High | 7% | 48% | 8.72 | 0.00032 | Yes |
| Glioma | 99/54 | 7 | Low | High | 5% (∗) | 12% (∗) | 15.74 | 0.022 | No |
| Thyroid | 135/366 | 15 | Low | High | 91% | 100% | 9.19 | 0.031 | No |
| Lung | 596/398 | 20 | Low | High | 40% | 47% | 6.16 | 0.029 | No |
| Stomach | 229/125 | 10 | Low | High | 26% | 50% | 8.03 | 0.022 | No |
| Breast | 12/1063 | 23 | Low | High | 81% | 82% | 7.16 | 0.25 | No |
| Cervical | 0/291 | 17 | Low | High | 59% | 74% | 10.81 | 0.0061 | No |
| Endometrial | 0/541 | 19 | Low | High | 70% | 80% | 8.61 | 0.044 | No |
| Ovarian | 0/373 | 15 | Low | High | 27% | 38% | 13.22 | 0.0072 | No |
| Urothelial | 299/107 | 14 | Low | High | 33% | 43% | 7.49 | 0.012 | No |
| Head and Neck | 366/133 | 17 | Low | High | 39% | 57% | 8.75 | 0.0065 | No |
| Melanoma | 60/42 | 5 | High | Low | 37% (∗) | 0 (∗) | 15.17 | 0.27 | No |
| Prostate | 494/0 | 14 | High | Low | 100% | 97% | 11.77 | 0.094 | No |
| Testis | 134/0 | 20 | High | Low | 100% | 97% | 8.63 | 0.26 | No |
| Liver | 246/119 | 10 | Non-determined | 53% | 46% | 5.4 | 0.190 | No | |
| Colorectal | 322/275 | 12 | Non-determined | 63% | 60% | 8.76 | 0.065 | No | |
| Total Cases | 3679/4253 | Low:High=3:12 | (∗): 3-year Survival | ||||||
Pin1 RNA expression in caner patients analyzed by Kaplan-Meier Plot (Human Protein Atlas).
While it is logical to target Pin1 or the many processes that Pin1 regulates directly or indirectly via its substrates involved in carcinogenesis (see Figure 2), we propose that it would be significantly more effective to target the control of apoptosis, a common pathway always deregulated in carcinogenesis with uncontrolled proliferation. This is because apoptosis is the ultimate terminator and always has the final say in determining the fate, death or survival, of cells. This would tie in with the emerging idea of oncogene addiction, where the so-called “Achilles heel” of a cancer is used to deal a deathblow to that cancer (Weinstein, 2002; Weinstein and Joe, 2006, 2008). Oncogene addiction is one of the themes that has evolved in the study of tumor progression. There are innumerable causes of cancer, hence the difficulties in identifying suitable treatment targets for developing effective therapies. Research has shown that oncogenes and tumor suppressor genes are constantly undergoing mutations in the background of genetic instability that can drive tumor progression. Oncogene addiction attempts to simplify the essence of carcinogenesis to a single, most important oncogenic protein that a tumor depends on for its survival, while the counterpart normal protein has little or no negative effects on normal cell survival. If this oncogenic pathway is targeted and switched off, cancer cells that are addicted to this pathway will be disproportionately affected, sparing normal cells (Weinstein, 2002; Weinstein and Joe, 2006, 2008). This is the ideal cancer treatment, with a surgical precision in its action, leaving negligible side effects that biomedical researchers have been working toward for decades.
Potential Targeting of Atr Isomerization in Cancer Therapies
Prior to the elucidation of this anti-apoptotic role of cis-ATR in the cytoplasm, a wealth of knowledge already existed about the nuclear kinase roles of ATR which is a trans isomer and several cancer therapies have taken advantage of this by targeting the kinase function of ATR to promote cancer cell killing. ATR inhibitors, in combination with chemo- and radio-therapy, have been utilized in a synthetic lethality approach to sensitize cancer cells for cell death with varied results (Wagner and Kaufmann, 2010; Toledo et al., 2011;
It should be pointed out that the current ATR inhibitors used in cancer clinical trials are specific inhibitors of ATR kinase activity which is pivotal to the hallmark ATR’s DNA damage checkpoint functions in the nucleus. Since the new anti-apoptotic activity of cis-ATR at mitochondria is independent of ATR kinase activity (
FIGURE 5

An appropriate balance between cytoplasmic levels of cis- and trans- ATR is critical for the wellbeing of cells.
Given the critical role of Pin1 in maintaining the balance between cis- and trans-ATR in the cytoplasm, manipulation of Pin1 subcellular level or activity could be another means to control cis-ATR formation for cancer therapeutics. Ibarra et al. recently reported different subcellular distribution of Pin1 in different cell types in zebrafish in vivo, suggesting specific mechanisms for regulating Pin1 subcellular activity are cell-type dependent (
Prospective
There are still important questions remaining to be answered to validate the hypotheses put forward in this review, including a better understanding of (1) how the Ser428 residue is phosphorylated or dephosphorylated under different physiological and biological conditions. Phosphorylation status plays a critical role in the regulation of ATR isomerization and, thus, its antiapoptotic activities; (2) the structural differences between the cis and trans isomers; and (3) their specific folding for substrate recognition and binding. Are there specific binding partners of cis- and trans-ATR in the cytoplasm and nucleus, respectively, which help to energetically stabilize ATR in their isoforms? If so, what are these proteins and how are they regulated. Understanding the mechanisms of each isomer’s formation and stabilization can help to define whether cis-ATR fulfils the criteria to be termed an oncoprotein. It also should be possible to develop drugs that can selectively increase or reduce the specific ATR isoform that is needed in the management of a disease, as elucidated earlier for cancer, for example.
The quest for an ideal cancer therapy began when cancer itself was described as a disease and many promising targets have been investigated in the past with varying results. Since a cancer cell starts as a normal cell that has become deregulated, the ability to selectively target only cancer cells by identification of proteins/processes unique to cancer cells remains elusive for many cancer types and stages. Such targeting should minimize adverse effects while obtaining an effective treatment. As a further complication, the pathways that lead to cancer are numerous and varied, with confounders like immunoediting, persistence of cancer stem cells, etc. Here we propose a target common to all cells: isomerization-mediated apoptosis, but in such a specifically targeted way that normal cells are spared. The isomerization of ATR by Pin1 is an important biological process that should be studied further since the existing evidence points to exciting possibilities for drug/genetic regulation of this singular process. There would be significant potential translational implications in disease diagnosis and treatment.
Finally, the ability to induce or prevent apoptosis in select groups of cells can be of importance in other diseases such as ischemia and inflammation where cell death is the major issue. Moreover, it is worth investigating if cis-ATR plays a role in elongating the life of a cell in the context of aging since more cells would be able to successfully evade apoptosis by increasing the mitochondrial health of the cell.
Statements
Author contributions
YM wrote the draft of the manuscript based on the outlines made by YZ. YZ oversaw the process. All authors read and participated in revising the manuscript.
Funding
Part of the work described in this article was supported by NIH grants R01CA86927, R15GM112168, and R01CA219342 (to YZ).
Acknowledgments
We would like to thank the editors for their patience.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Summary
Keywords
cytoplasmic ATR, Pin1, antiapoptotic ATR, apoptosis, prolyl isomerization, cancer, cis and trans
Citation
Makinwa Y, Musich PR and Zou Y (2020) Phosphorylation-Dependent Pin1 Isomerization of ATR: Its Role in Regulating ATR’s Anti-apoptotic Function at Mitochondria, and the Implications in Cancer. Front. Cell Dev. Biol. 8:281. doi: 10.3389/fcell.2020.00281
Received
17 December 2019
Accepted
31 March 2020
Published
30 April 2020
Volume
8 - 2020
Edited by
Tae Ho Lee, Fujian Medical University, China
Reviewed by
Alessandra Rustighi, National Laboratory of the Interuniversity Consortium of Biotechnology (LNCIB), Italy; Eric W. C. Tse, The University of Hong Kong, Hong Kong
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© 2020 Makinwa, Musich and Zou.
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*Correspondence: Yue Zou, yue.zou@utoledo.edu
This article was submitted to Cell Growth and Division, a section of the journal Frontiers in Cell and Developmental Biology
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