Aberrant redox chemistry
Protein toxicity
could also enhance the release of copper and zinc, and
trigger copper and/or zinc-mediated neurotoxicity.
The concept that mutant SOD1 provokes aberrant
oxyradical reactions has been controversial. Some of
the key findings have not been consistently detected; for
example, increased levels of oxidative markers are evi-
dent in transgenic ALS G93A-SOD1 mice and patients
with SALS
58,59
but not in transgenic G37R mice
60
.
Another inconsistency is the impact of forced expression
of wild-type SOD1 jointly with mutant SOD1 transgenes.
In G85R mice, genetic manipulations of levels of wild-
type SOD1 (elimination or forced expression at high
levels) do not affect the age of onset, the survival or the
rate of progression; these findings could be used to argue
against a direct role of heightened oxygen-mediated tox-
icity in the degeneration of motor neurons
61
. By contrast,
the forced expression of high levels of wild-type SOD1
in G93A, L126Z and A4V-SOD1 mice accelerates the
onset of the disease
62,63
. This effect has been attributed
to the enhanced formation of mitochondrial aggregates
containing both mutant and wild-type SOD1
(REF. 63)
.
Also of note is evidence that transgenic mice that lack
a protein required to load copper into SOD1 possess only
minute levels of SOD1-bound copper and have drasti-
cally reduced dismutation activity but still develop motor
neuron disease
64
. Moreover, mice that harbour mutations
in the histidines that bind copper in the SOD1 active site,
which leads to loss of dismutase activity, also develop
motor neuron disease
65
. Similarly, the G86R mutated
murine form of SOD1 causes motor neuron disease in
mice, even though a possible alternative copper-loading
site, Cys111, is absent
66
. The most plausible interpreta-
tion is that copper-mediated oxyradical chemistry is not
required for the motor neuron pathology provoked by
mutant SOD1; a caveat is that the mutant SOD1 might
exert aberrant catalysis through copper loaded in a
copper chaperone for SOD1 (CCS)-independent fashion
on the surface of the protein
67
.
Protein instability and SOD1 aggregation. Another
set of hypotheses propose that the conformational
instability of mutant SOD1 induces the formation of
harmful aggregates. In transgenic rodents with SOD1-
mediated ALS (including copper-binding-site-null
mice) and in some human ALS cases, aggregates that
are immunoreactive for SOD1 are detected in motor
neurons, the neuropil and astrocytes
61,68
. In these trans-
genic mice, these aggregates become evident by the time
of disease onset
69,70
, and increase in abundance with
disease progression
61,69,70
.
In vitro studies have shown that, in contrast to
stable, dimeric wild-type SOD1, the mutant proteins
oligomerize over time to form small pore-like structures
that are similar to some forms of
β-amyloid protein
71,72
.
Whether such protein structures in vitro correspond
to structures in human ALS neural tissue in vivo is not
known. In the transgenic animal models, the formation
of non-native, sub-microscopic, detergent-insoluble
SOD1 species is a common feature of all mutant SOD1
proteins. Because this is not the case for the large, intra-
cellular aggregates, it could be that the less evident
microscopic aggregates are the vital aggregated
protein component in mutant SOD1-mediated ALS. Are
SOD1-associated protein inclusions toxic? If so, why are
they toxic? As in other neurodegenerative disorders, it
remains unclear whether protein aggregates that are
detected in the CNS are harmful. As in
Huntington’s
disease
, it might be that protein inclusions are favour-
able, perhaps because they sequester the mutant protein.
By contrast, studies have reported a correlation between
protein aggregation and a clinical phenotype of trans-
genic SOD1 mice: mutations that cause a more severe
disease (gauged by shortened survival) have a shorter
half-life and the protein products are more likely to form
aggregates
73,74
. There is considerable speculation about
the potential toxicity of inclusions. It has been proposed
that inclusions could both mediate oxyradical chemistry
(see above) and overwhelm the proteasome. The latter
is predicted to impair protein degradation and recycling
(not only of mutant SOD1 but also of other proteins
normally processed by proteasomes) and sequester
proteins that are crucial for cellular processes, such
as heat-shock proteins (HSPs). Mutant SOD1 directly
interacts with HSPs, such as HSP70, HSP40, HSP27 and
Figure 1 | Models of mutant SOD1-mediated toxicity. The instability of the mutant
protein contributes to its toxicity, sometimes enhanced by the release of Zn. In the
aberrant redox chemistry model, mutant superoxide dismutase 1 (SOD1) is unstable and
the active channel opens, permitting aberrant chemistry through promiscuous
interaction with non-conventional substrates. Hydrogen peroxide (H
2
O
2
) or nitronium
ion (ONOO
–
) can react with reduced SOD1 (SOD1
–
Cu
+
). Molecular oxygen (O
2
) can react
aberrantly with Zn-deficient SOD1 to generate an excess of superoxide anion (O
2
.-
). The
unstable protein could also release free copper and/or zinc, which might be toxic. In the
protein toxicity model, unstable, conformationally altered mutant SOD1 could form
toxic, proteinaceous deposits. Aggregated SOD1 could inhibit chaperone and/or
proteasome activity, with subsequent misfolding and insufficient clearance of numerous
proteins. Alternatively, these aggregates could sequester, inactivate or enhance the
toxicity of other proteins crucial for cellular processes.
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Astrocyte
Microglia
Glutamate
Caspase
activation
Caspase
activation
EAAT2
Cytokines
(for example, TNF
α)
Nucleus
Proteasome
stress
Mitochondrial
stress
ER stress
Golgi
Cell body
Microtubule
Neurofilaments
Axon
Synapse
Cell death
Δ
DNA/RNA
metabolism
ATP
Ca
++
CytC
Δ
Vesicle
trafficking
Mutant SOD1
Toxicity
Glutamate
receptor
Synaptic vesicle
Altered axonal
transport
Axonal transport
motor
Mutant
SOD1
Mutant SOD1
Presynaptic
neuron terminal
BCL2
The founding member of a
family of apoptosis-regulating
proteins. Many BCL2 family
members regulate
mitochondria-dependent steps
in cell death pathways, with
some suppressing and others
promoting the release of
apoptogenic proteins from
these organelles.
Apoptosis
A mode of cell death in which
the cell triggers its own
destruction by activating pre-
programmed intracellular
suicide machinery.
Caspases
A family of intracellular
cysteine endopeptidases that
have a key role in mammalian
apoptosis. They cleave proteins
at specific aspartate residues.
Astrogliosis
Proliferation and ramification
of glial cells in response to
brain damage.
Microgliosis
Proliferation and activation of
microglial cells, which are the
primary immune effector cells
in the brain.
αβ-crystallin
75
, perhaps impairing the chaperone and/or
the anti-apoptotic function of these proteins. It is likely
that mutant SOD1 also sequesters the anti-apoptotic
protein
BCL2
at the surface of mitochondria
76
.
Apoptosis in ALS. Biochemical markers of
apoptosis
can
be detected in the terminal stages of human and trans-
genic ALS
77–85
. Early reports suggested that SOD1 muta-
tions transform SOD1 from an anti- to a pro-apoptotic
protein. Cultured neuronal cells either transfected or
microinjected with mutant SOD1 cDNAs die by apop-
tosis
78,79
. Mutant SOD1 protein is also pro-apoptotic
in an ALS transgenic mouse model
79–83
. Additional
evidence linking SOD1 to apoptosis comes from the
impairment of the association of cytochrome c (an
intermediate in the apoptosis pathway) with the inner
membrane of the mitochondrion in ALS transgenic
mice, and from the finding that a gradual reduction
in intra-mitochondrial cytochrome c correlates with
disease progression
84
.
Activation of
caspase 1
(
CASP1
) is the earliest molec-
ular abnormality in the SOD1-G85R mice, occurring
months before
CASP3
activation, motor neuron death
and clinical onset
79–89
. In the spinal cord, activated CASP3
is found in both motor neurons and astrocytes
80
, where it
cleaves the astroglial excitatory amino acid transporter 2
(
EAAT2
)
85
. In the G93A-SOD1 mice at least, the activa-
tion of another downstream caspase (
CASP7
) also
coincides with disease onset
86
. In agreement with the
hierarchical order of caspase activation, in the G93A-
SOD1 mice, cytochrome c translocation to the cytosol
and concomitant
CASP9
activation follow CASP1 and
precede CASP3 and CASP7 activation
86
. Because the
activation of CASP1 has been involved in both apoptosis
and inflammation, it is possible that prolonged activa-
tion is a consequence of (and exacerbates) chronic neural
inflammation (
astrogliosis
and
microgliosis
) in these mice.
Alternatively, in contrast to developmental apoptosis
in which cell death proceeds rapidly, mutant SOD1-
mediated early caspase activation might initiate a slowly
Figure 2 | Mutant SOD1 impairs multiple cellular functions. The toxicity of mutant superoxide dismutase 1 (SOD1) is
multi-factorial, operating through diverse, interrelated pathways. Within the motor neuron, mutant SOD1 adversely
affects DNA/RNA metabolism, mitochondria (diminishing ATP production and calcium buffering, increasing the release of
free calcium), neurofilaments and axonal transport, and the function of the endoplasmic reticulum (ER), the Golgi
apparatus and proteasomes. In turn, ER stress and apoptotic cascades are activated. Through an interaction with
chromogranin (a secretory glycoprotein), mutant SOD1 could be secreted from the motor neuron. The pathological
process also involves the activation and dysfunction of astrocytes and microglia. Astroglial uptake of glutamate is reduced,
contributing to excessive extracellular glutamate and excitotoxicity. Microglia secrete cytokines such as tumour necrosis
factor-
α (TNFα) that could be toxic and cause cellular damage. So, the death process in motor neurons reflects a complex
interplay between intrinsic (autonomous) and extrinsic (non-cell autonomous) phenomena. CytC, cytochrome c;
EAAT2, excitatory amino acid transporter 2. Modified, with permission, from
REF. 187
© (2006) Taylor and Francis.
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a
Cytoplasm
b
Mutant SOD1
Toxicity
Matrix
Outer membrane
PTP
BCL2
TOM
Activation of
apoptotic pathway
Altered
mitochondrial
permeability
CytC
Inhibition of
protein import
Intermembrane space
Toxic interaction
with BCL2
Inner membrane
Spinal cord
Liver
CytC release
ATP depletion
BCL2
WT
SOD1
Mutant
SOD1
Aggregates of
Mutant SOD1
Toxic mitochondrial
SOD1/BCL2 aggregates
Cell death
progressive cell death process that kills motor neurons
and the surrounding cells over months and years.
Is this slow apoptotic process directly triggered by
mutant SOD1? The gradual activation of an apoptotic
pathway in ALS, and the anti-apoptotic influence of
wild-type SOD1
(REF. 87)
, indicate that mutant SOD1 is
directly involved in the initiation of caspase activation
and cell death. The observations that both wild-type and
mutant SOD1 bind the anti-apoptotic BCL2 and, more
importantly, in so doing trap BCL2 into detergent resist-
ant aggregates, are consistent with this view
76
(FIG. 3a,b)
.
When entrapped in inclusions, BCL2 could be directly
rendered non-functional. To the extent that BCL2 functions
by binding other pro- and anti-apoptotic proteins, such
segregation might also indirectly block BCL2 function.
Yet another possibility is that, on binding to mutant
SOD1, BCL2 undergoes conformational modification
and becomes toxic. Entrapment and depletion of BCL2 is
supported by studies that show reduced levels of BCL2
in SOD1 mice and patients with ALS. However, this is
only pertinent to mutant SOD1 and does not explain the
observed changes in BCL2 expression and function in
non-SOD1 ALS cases.
Once the pro-apoptotic death signal has been gen-
erated, secondary events in the spinal cord amplify the
disease process. These include the activation of microglia
and T cells and the release of inflammatory factors and
cytokines such as interleukin 1
β, COX2 and tumour
necrosis factor-
α (TNFα)
88–91
. TNF
α, which activates
CASP8
in late stages of the disease in ALS transgenic
mice
92,93
, and its receptor are part of a superfamily of
proteins that includes Fas. Cultured embryonic motor
neurons are selectively sensitive to Fas-induced apop-
tosis, which suggests that these inflammatory/pro-
apoptotic molecules mediate a motor neuron-specific
apoptotic pathway and thereby selectively intoxicate
motor neurons in ALS
92
. Another intriguing mechanism
signalling neuroinflammation and toxicity is predicated
on the accumulation of mutant but not wild-type SOD1
in the endoplasmic reticulum
94
. Results from recent stud-
ies show that mutant SOD1 interacts with proteins such
as chromogranin in the endoplasmic reticulum and is
thereby retained within that compartment, to be traf-
ficked to the cell surface and secreted extracellularly
95
.
According to this provocative model, once secreted,
mutant SOD1 activates microglial and astrocytic cells
to provoke a neuroinflammatory response around the
motor neuron
95
.
Mitochondrial dysfunction in ALS. Numerous
studies have focused on the role of the mitochon-
drion in the pathogenesis of neurodegenerative
diseases like ALS. Evidence of mitochondrial dysfunc-
tion in ALS patients includes clusters of abnormal mito-
chondria and morphological defects identified within
mitochondria in skeletal muscles and intramuscular
nerves in human SALS cases
96,97
. In such cases biochemical
analyses have delineated defects in the respiratory
chain complexes I and IV in muscle
98
and elevated
levels of mitochondrial calcium
99
in muscle and spinal
cord. In ALS mice, the main morphological evidence
for mitochondrial pathology is the presence of vacuolated
mitochondria (for example, in the G93A and G37R trans-
genic lines). In the G93A-SOD1 mice, mitochondrial
Figure 3 | The mitochondrion as a target of mutant SOD1. Long considered a cytoplasmic protein, superoxide
dismutase 1 (SOD1) also localizes to the mitochondrion; its precise localization (outer membrane, intermembrane
space or matrix) is not fully defined. a | Mutant SOD1 forms insoluble aggregates that could directly damage the
mitochondrion through: swelling, with expansion and increased permeability of the outer membrane and
intermembrane space, leading to release of cytochrome c (CytC) and caspase activation; inhibition of the translocator
outer membrane (TOM) complex, preventing mitochondrial protein import; and aberrant interactions with
mitochondrial proteins such as BCL2. b | Aggregates of mutant SOD1 and BCL2 are found specifically in spinal cord but
not liver mitochondria, a finding that might relate to the motor neuronal specificity of mutant SOD1 phenotypes.
Codeposition of mutant SOD1 with BCL2 might eliminate BCL2 function, disrupt the mitochondrial membrane,
deplete energy, deregulate mitochondrial bioenergetics and activate the mitochondrial apoptotic pathway. WT, wild-
type. Modified, with permission, from
REF. 76
© (2004) Elsevier Science.
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Nucleus
ER
Vesicle
Axon
Microtubules
Mitochondrion
Neurofilaments
Anterograde
cargo
Synthesis and trafficking
of vesicles and proteins
Cell body
Dynein–dynactin complex
(retrograde motor)
Kinesin
(anterograde motor)
Retrograde transport
Anterograde transport
Synapse
Uptake
Release
Neurotrophic
factors
Retrograde
cargo
Kinesins
A class of motor proteins that
attach to microtubules and
transport vesicles along the
tubule.
vacuoles derived from a detachment between the
inner and the outer membrane
100
are evident early, and
drastically increase in both number and volume as the
disease progresses
101–103
.
In vitro and in vivo studies further define mitochon-
drial defects in ALS mice. The expression of mutant
SOD1 in neuronal cell lines or in cultured primary
motor neurons depolarizes mitochondria
104,105
, impairs
calcium homeostasis
106
and reduces ATP production
107
.
Similarly, G93A-SOD1 mice show reduced respiratory
chain activity and reduced ATP synthesis; these increase
in severity as disease progresses.
Whether mitochondrial dysfunction and pathology
represent primary or secondary pathological events is
unknown, as mitochondrial abnormalities can both
result from and cause oxidative toxicity. In either
circumstance, the pathological mitochondria can
mediate cell death by releasing calcium into the
cytoplasm, producing inadequate levels of ATP and
triggering apoptosis
(FIG. 3b)
. It is likely that mitochon-
drial function modifies the course of motor neuron
degeneration. In ALS mice, inhibition of manganese super-
oxide dismutase (a mitochondrial dismutase) accelerates
disease progression. Conversely, the disease is slowed
by interventions that improve mitochondrial function
— for example, creatine, which inhibits opening of the
mitochondrial transition pore, and minocycline, which
blocks the egress of cytochrome c
108,109
.
During the past five years, several observations have
indicated that mutant SOD1 could directly damage mito-
chondria. It is evident that a fraction of SOD1 is localized
in the mitochondrion
76,110–113
.
Studies of differentially
targeted SOD1 in vitro reveal that mutant SOD1 more
potently triggers cell death when localized to mitochon-
dria and, once so targeted, forms intra-mitochondrial
protein aggregates
114
. Several interlocking mechanisms
explain how mutant SOD1 impairs mitochondria from
within
(FIG. 3a)
. In G93A-SOD1 mice, mutant SOD1
colocalizes with cytochrome c and the peroxisomal
membranes associated with the vacuoles
100
. Therefore,
mutant SOD1 could be involved in fusing the peroxi-
somes and the outer mitochondrial membrane, a process
that could form pores in the mitochondrial membrane
allowing the release of cytochrome c and the initiation of
an apoptotic cascade. A second hypothesis is that mutant
SOD1 is selectively recruited to the outer mitochondrial
membrane, where it forms aggregates that slowly disrupt
the protein translocation machinery (the translocator
outer membrane (TOM) complex) of the mitochon-
drion and limits the import of functional proteins into
the mitochondrion
112
. Two studies suggest that mutant
SOD1 is selectively recruited to mitochondria only in
affected tissues
76,112
. It has therefore been proposed that
the selective loss of TOM function in spinal cord mito-
chondria might form the basis for the tissue specificity
of ALS. Finally, mutant SOD1 aggregates could damage
the mitochondrion through abnormal interaction with
other mitochondrial proteins such as BCL2
(REF. 76)
.
A recent paper challenged the notion of a toxic mito-
chondrial mutant SOD1, suggesting that mitochondrial
load ing of mutant SOD1 is simply the result of over-
expression of the mutant SOD1 that normally does not
associate with mitochondria
115
.
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