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Departments of Pediatrics and Physiology, Steele Memorial Children's Research Center, University of Arizona Health Sciences Center, Tucson, Arizona 85724
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ABSTRACT |
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The
Na+/H+
exchanger (NHE-2) has
been implicated in osmoregulation in the kidney, because it transports
Na+ across the cell membrane and
efficiently alters intracellular osmolarity. On hyperosmotic stress,
NHE-2 mRNA increases in abundance in
mouse inner medullary collecting duct (mIMCD-3) cells, suggesting possible transcriptional regulation. To investigate the molecular mechanism of potential transcriptional regulation of
NHE-2 by hyperosmolarity, we have
functionally characterized the 5'-flanking region of the gene in
mIMCD-3 cells. Transient transfection of luciferase reporter gene
constructs revealed a novel cis-acting element, which we call OsmoE (osmotic-responsive element, bp
808 to
791, GGGCCAGTTGGCGCTGGG), and a TonE-like element
(tonicity-responsive element, bp
1201 to
1189,
GCTGGAAAACCGA), which together are shown to be responsible for
hyperosmotic induction of the NHE-2 gene. Electrophoretic mobility shift assays suggest that different DNA-protein interactions occur between these two osmotic response elements. However, both DNA sequences were shown to specifically bind
nuclear proteins that dramatically increase in abundance under
hyperosmotic conditions. Isolation of
trans-acting factors and
characterization of their specific interaction with these osmotic
response elements will further elucidate the transcriptional mechanisms
controlling NHE-2 gene expression
under hyperosmolar conditions.
mouse inner medullary collecting duct cells; gel mobility shift; transcriptional regulation; kidney; OsmoE
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INTRODUCTION |
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HYPEROSMOLAR STRESS CAUSES initial cell shrinkage
followed by gradual intracellular volume recovery. Activation of the
Na+/H+
exchanger (NHE) and the
Na+-K+-2Cl
cotransporter are two principal pathways that are activated when shrunken cells undergo recovery (11, 15), with the result being net
uptake of NaCl and water, which restores original cell volume (4). Six
NHE isoforms
(NHE-1-NHE-6) have been
identified (6, 23), and four of them
(NHE-1-NHE-4) have been
investigated under hyperosmolar conditions.
NHE-1, when overexpressed in PS120 fibroblasts, was activated in response to short-term (13) or long-term
hyperosmotic stress (28). NHE-4
overexpressed in PS120 fibroblasts was also increased by
hyperosmolarity (2). In contrast, NHE-3 was found to be markedly
inhibited by hyperosmolarity in several cell lines (16, 26, 33).
Additionally, functional NHE-2 levels
were shown to be increased by hyperosmolarity in mouse inner medullary
collecting duct (mIMCD-3) cells (27) and AP-1 cells (16). Conversely,
however, the inhibition of NHE-2 by
hyperosmolarity in PS120 fibroblasts was also recently reported (21).
Although the hyperosmotic stress response of four NHE isoforms has been characterized, the precise molecular mechanism underlying osmotic regulation is largely unknown. A phosphorylation-dependent mechanism was previously shown to be involved in the activation of NHE-1 by hyperosmotic stress (12). However, a phosphorylation-independent mechanism was also suggested for NHE-1 (14). The mechanism of transcription or mRNA stability has been implicated in osmotic regulation of renal NHE-2. NHE-2 mRNA was shown to be expressed in mIMCD-3 cells, and the mRNA expression was increased by hyperosmotic shock (27). The inner medulla of the kidney is under an extremely high osmolar load during normal physiological conditions. Also, NHE-2 is known to be the only NHE isoform expressed in the apical membranes of epithelial cells of the renal collecting ducts. Therefore, it seems likely that NHE-2 plays an important physiological role in the cellular response to hyperosmolarity in the renal medulla.
Transcriptional regulation of renal genes by hyperosmolarity has been
shown for two genes encoding organic molecule transporters and for
aldose reductase (32). Tonicity-responsive element (TonE), the first
identified hyperosmolality cis-acting
element, was shown to mediate increased transcription of the
Na+-Cl
-betaine
transporter gene in response to hypertonic stress (31). More recently,
TonE-like osmotic response elements were identified in the
Na+-myo-inositol
cotransporter (24, 34) and the aldose reductase (10, 17) genes. The
hyperosmolarity-induced increase in the transcription of the genes
coding for these proteins was shown to be preceded by increases in
intracellular Na+ and
K+. Thus
NHE-2 could be implicated as an early
activation gene that functions to increase intracellular
Na+ on osmotic stress and, thus,
leads to a secondary increase in transcriptional expression of these
other genes (and most likely additional unidentified genes).
We recently cloned the 5'-flanking region of the rat NHE-2 gene and showed that it functions as a promoter of gene transcription in mIMCD-3 cells (20). This work put us in a unique position to be able to decipher the transcriptional component of increased NHE-2 mRNA expression by hyperosmolarity. Here we describe the identification of a novel cis-acting element, osmotic-responsive element (OsmoE), and a TonE-like sequence, both of which are necessary for the osmotic response of the rat NHE-2 gene. The osmotic response is reduced when each of these sequences is mutated individually and completely abolished when they are both mutated, suggesting that these two sequences work in concert to provide maximal transcriptional induction.
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MATERIAL AND METHODS |
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Isolation of mRNA and semiquantitative RT-PCR analysis.
Messenger RNA was purified from mIMCD-3 cells incubated with isosmotic
medium (300 mosmol/kgH2O) or
hyperosmotic medium (400 mosmol/kgH2O) for 36 h, as
described previously (8, 9). RT-PCR was performed with
NHE-2-specific primers (upstream:
5'-CAGCGCACATTGTCCTACAA-3', 2,041-2,061 bp;
downstream: 5'-TGTCCGATCGCTGCTATTA-3', 2,273-2,293 bp)
and
-actin-specific primers (upstream:
5'-TGACGGGGTCACCCACACTGTGCCCATCTA-3', 1,038-1,068 bp;
downstream: 5'-CTAGAAGCATTTGCGGTGGACGATGGAGGG-3', 1,846-1,876 bp) by use of standard methods (5, 7). Subsaturation levels of cDNA templates that were needed to produce a dose-dependent amount of PCR products were defined in initial experiments by testing a
range of template concentrations. Subsequent PCR was carried out with
subsaturation levels of RT reaction with
NHE-2 and
-actin primers in
separate PCR reactions with identical parameters.
Assembly of reporter gene constructs.
A series of progressively shorter
NHE-2 promoter constructs in the
pGL-3/basic luciferase reporter vector (Promega, Madison, MI) were made
by restriction enzyme digestion by using restriction sites found in the
NHE-2 gene or introduced by
site-directed mutagenesis. Briefly, constructs
2630/+116 and
1271/+116 were made by subcloning a
Hind
III-Apa I fragment and an
Sac
I-Apa I fragment into the pGL-3/basic
vector, respectively (20). Other reporter constructs, except
1271/
881 and
788/+116 (see Fig. 2), were made by
introducing a Kpn I restriction site
into different regions of the
271/+116 construct by PCR-based
site-directed mutagenesis (1) and then removing the
Kpn I fragment. The
1271/
808 and the
791/+116 constructs were made by
introducing two EcoR I restriction
sites at
808 and
791 bp, respectively, and removing 18 bp
between these two EcoR I sites. The T
mutant series (T, TL, and TR) and the O mutant series (OL, O1, O2, O3,
O, and OR) were made by site-directed mutagenesis (Quantum). Mutant (T + O) contains the mutant T and mutant O sequence.
1201 to
1189, GCTGGAAAACCGG),
reverse TonE-like sequence (construct Re-TonE + SV40, GGCCAAAAGGTCG), two tandem copies of TonE-like sequence (construct 2× TonE + SV40), OsmoE (construct OsmoE + SV40, bp
810 to
790,
AAGGCCAGTTGGCGCTGGGA), reverse OsmoE (construct Re-OsmoE + SV40,
AGGGTCGCGGTTGACCGGAA), two tandem copies of OsmoE (construct 2×
OsmoE + SV40), and a tandem sequence of TonE and OsmoE with different
order (constructs TonE/OsmoE and OsmoE/TonE) were synthesized and
inserted into the Mlu
I/Bgl II site immediately upstream of
the SV40 promoter in the pGL-3/promoter vector. Constructs TonE-OsmoE
and 2× TonE-OsmoE contain one and two copies of the DNA fragment
between the identified TonE and OsmoE (
1203 to
789 bp),
respectively. These fragments were amplified by PCR by use of
overhanging primers carrying Mlu II/Bgl II and
Bgl
II/Nco I sequences, respectively, and
then subcloned into Mlu
I/Bgl II and
Mlu
I/Nco I site immediately
upstream of the SV40 promoter in the pGL-3/promoter vector. All
constructs were confirmed by DNA sequencing, and PCR-generated
constructs were sequenced in their entirety to identify
Taq polymerase-induced mutations.
Cell culture, transient transfection, osmotic shock, and luciferase assay. mIMCD-3 cells (passages 8-18) were seeded in six-well plates and maintained in a defined medium (20). The same batch of FCS was used in all experiments. When cells were 70% confluent, they were cotransfected with 1 µg of reporter vector DNA and 0.1 µg of pRL-cytomegalovirus (CMV) vector (as an internal standard to control for transfection efficiency) in serum-free medium. Twelve hours after transfection, one-half of the wells received fresh isosmotic medium and the other half received hypertonic medium (made by adding 100 mM mannitol to isosmotic growth medium; equals 400 mosmol/kgH2O). Osmolality of both media was confirmed by measuring on a wide-range osmometer. After 36 h the cells were harvested for dual luciferase assays (20). A minimum of three independent transfections were done for each construct with different populations of cells.
Preparation of nuclear extracts for electrophoretic mobility shift
assay.
Whole cell extracts were prepared by a standard method (29). Nuclear
extracts were isolated from mIMCD-3 cells cultured in isosmotic medium
(300 mosmol/kgH2O) or hyperosmotic
medium (400 mosmol/kgH2O) for 36 h
in 100-mm-diameter dishes. Two synthetic double-stranded
oligonucleotides were designed that were identical to the
NHE-2 TonE-like sequence and to the
OsmoE sequence. The oligonucleotides used were
1203-bp
AAGCTGGAAAACCGATAGATTCGACCTTTTGGCTATCT-1185 bp (probe T, TonE-like) and
810-bp AAGGGCCAGTTGGCGCTGGGATTCCCGGTCAACCGCGACCCT-789 bp (probe
O, OsmoE). These DNA fragments were 3'-end labeled with digoxigenin-11-ddUTP (DIG). Nuclear extracts (4 µg of protein) were
incubated with 0.1 pmol of DIG-labeled probe in electrophoretic mobility shift assay (EMSA) binding buffer containing 20 mM HEPES (pH
7.6), 1 mM EDTA, 10 mM
(NH4)2SO4,
1 mM dithiothreitol, 0.2% (wt/vol) Tween 20, 30 mM KCl, 5 µg/ml
poly-L-lysine, and 50 µg/ml poly[d(I-C)]. After incubation at room temperature for 15 min, the mixture was electrophoresed on a 6% polyacrylamide gel in 0.25× Tris-boric acid-EDTA buffer and electroblotted to a nylon membrane. Chemiluminescent detection was performed according to the
standard protocol (electrophoretic mobility shift kit, Boehringer Mannheim, Indianapolis, IN). For the competition experiments, a
100-fold molar excess of unlabeled probe was added to the reaction mixture before the addition of DIG-labeled probe.
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RESULTS |
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Induction of NHE-2 mRNA by hyperosmolarity.
The expression of NHE-2 mRNA in
mIMCD-3 cells after exposure to control or hyperosmolar medium was
assessed by semiquantitative RT-PCR by use of
NHE-2- and
-actin-specific primers
(Fig. 1). The purpose of this experiment
was to confirm previous observations that
NHE-2 mRNA was increased in mIMCD-3
cells by hyperosmolar shock (27). The expression of
NHE-2 mRNA was significantly increased by hyperosmolarity in accordance with the previous investigation (27).
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Identification of regions controlling the osmotic response of the
rat NHE-2 promoter.
To test the induction of the NHE-2
promoter by hyperosmolarity, three luciferase reporter constructs,
2630/+116,
1271/+116, and
289/+116, were initially
transfected into mIMCD-3 cells to measure reporter gene expression
under normal and hyperosmotic conditions. As shown in Fig.
2, cells transfected with the
2630/+116 and
1271/+116 constructs showed 3.2- to
3.4-fold higher luciferase activity under hyperosmolar conditions than
under isosmotic conditions, whereas cells transfected with the
289/+116 construct did not shown any induction of luciferase
activity by hyperosmotic treatment. These results indicate that the
NHE-2 promoter is upregulated by
hyperosmolarity and that the putative osmotic response element(s) is
located between
1271 and
289 bp upstream of the
transcriptional initiation site.
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1006/+116 and
817/+116
constructs showed a diminished response (~1.7-fold) to
hyperosmolality (compared with the negative control). Further deletion
to bp
784 completely abolished the induction of luciferase activity by hyperosmolarity. These data indicated that two regions are
responsible for hyperosmotic induction, with one between bp
1271
and
817 and another between bp
817 and
784 of the
promoter. Another construct,
1271/
808 +
791/+116,
which contains all the sequences of construct
1271/+116, except
18 bp, significantly reduces the hyperosmotic induction to 1.7-fold.
Overall, these data suggested that two regions are responsible for the
hyperosmolarity regulation of the
NHE-2 promoter, a 265-bp region from
1271 to
1006 bp and an 18-bp region from
808 to
791 bp.
Characterization of NHE-2 osmotic response
elements.
Analysis of the 265-bp region (
1271 to
1006)
revealed a TonE-like sequence that has only 1-bp mismatch
with the TonE consensus sequence (TGGAAAnnYnY; Y indicates pyrimidine)
(25). Sited-directed mutagenesis was utilized to mutate this TonE-like
sequence and an 18-bp region between
808 and
791. As
shown in Table 1, when five of the key
residues (19) of the TonE-like sequence (bp
1197 to
1193)
were mutated, the hyperosmotic induction of luciferase activity was
decreased from 3.3- to 2-fold (which was not different from the
1.7-fold induction with the
1006/+116 construct). However, mutations of both flanking regions of the TonE-like sequence, mutant TL
and mutant TR, had no effect on luciferase expression. These results
suggest that the TonE-like sequence between
1201 and
1189
bp is responsible for the hyperosmotic induction found in the 265-bp
region (
1271 to
1006) and contributes at least partially
to hyperosmotic induction of the NHE-2
promoter.
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808 and
791 (a region we have named OsmoE for osmolality element), we made five mutants in this region and its flanking regions.
As shown in Table 1, the hyperosmotic induction of luciferase activity
was significantly reduced by three mutants, mutant O1, mutant O2, and
mutant O3, which span the 18-bp sequence. These three mutants still
maintained about 1.5-fold hyperosmotic induction. To eliminate the
possibility that the remaining hyperosmotic induction of these three
mutants was caused by incomplete mutation of the response element,
mutant O, a 12-bp mutant of OsmoE, was tested and shown to maintain the
same hyperosmotic induction as the other three mutants in this region
(~1.5-fold). Two flanking region mutants, mutants OL and OR, had the
same hyperosmotic induction as a wild-type mutant (~3-fold),
indicating that only the 18-bp sequence between bp
808 and
791 is necessary for maximal induction by hyperosmolarity. On
the basis of the above findings, a double mutant that contains mutant O
(12 bp) and mutant T (5 bp) was tested. This mutant completely
abolished the hyperosmotic induction of luciferase activity (Table 1),
indicating that the osmotic response elements in the rat
NHE-2 gene consists of two specific sequences, a TonE-like element and the novel OsmoE.
To evaluate the OsmoE and the TonE-like elements further, one or two
tandem copies of OsmoE or the TonE-like element were inserted
immediately upstream of an SV40 promoter in pGL-3/promoter plasmid and
were tested for luciferase activity. Figure
3 shows that two copies of the OsmoE or the
TonE-like elements, but not one copy of the forward or reverse
sequence, induced 2.9- and 1.8-fold luciferase activity by
hyperosmolarity, respectively. To further decipher hyperosmotic
induction by these DNA sequences, constructs TonE-OsmoE + SV40 and
2× TonE-OsmoE + SV40, containing one or two tandem copies of the
DNA fragment between the TonE-like sequence and OsmoE (bp
1203
to
789) were tested for luciferase induction. One copy of the
TonE-OsmoE fragment induced 3.1-fold luciferase activity by
hyperosmolarity, which is the same as construct
1271/+116.
Interestingly, two tandem copies of the TonE-OsmoE fragment
dramatically increased the hyperosmotic induction to 6.0-fold. However,
tandem sequence of TonE and OsmoE with different order (constructs
TonE/OsmoE and OsmoE/TonE) did not induce luciferase activity by
hyperosmolarity. In addition, cotransfection of the separate OsmoE and
TonE constructs did not show any additivity of luciferase induction by
hyperosmolarity. These results confirm the observation that the
fragment
1203/
789 that contains the OsmoE and TonE-like
elements is responsible for the hyperosmotic induction of luciferase
activity. It also suggests that the spatial orientation of OsmoE and
the TonE-like element are likely necessary for maximal induction.
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Interaction of NHE-2 osmotic response elements with nuclear
proteins.
To test the interaction of the OsmoE and the TonE-like elements with
osmotically induced nuclear proteins, we performed EMSA using
double-stranded oligonucleotides corresponding to OsmoE and the
TonE-like element and nuclear protein extracts prepared from cells
maintained in isosmotic or hyperosmotic medium for 36 h. As shown in
Fig. 4, probe O, corresponding to the OsmoE sequence, produced a shifted band of high molecular weight when the
probe was incubated with nuclear extracts from mIMCD-3 cells exposed to
hyperosmotic medium (Fig. 4, lane
3). The shifted band was barely detectable with
nuclear extracts from cells maintained in isosmotic medium
(lane 2). This binding could be
abolished by competition with a 100-fold molar excess of unlabeled
probe O (lanes 4 and
5), while the binding was unaffected
by a 100-fold molar excess of unlabeled probe T, corresponding to the
TonE-like sequence (lanes 6 and
7). These data indicated that
protein binding was specific for the OsmoE sequence.
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DISCUSSION |
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The transcriptional regulation of an
Na+ transport gene by osmolarity
in the mammalian kidney is of great interest, but the mechanism(s) of
gene induction is not well understood. Our study presents the first
evidence that transcriptional regulation of the
NHE-2 gene by hyperosmolarity in
mIMCD-3 cells is mediated by two osmotic response elements, the novel
OsmoE (bp
808 to
791) and a TonE-like element (bp
1201 to
1189). Our data suggest that each of these
elements is functional alone under hyperosmotic stress but that both
elements work in concert to provide maximal transcriptional induction.
Furthermore, EMSA revealed unique interactions with osmotically induced
nuclear proteins between the OsmoE and the TonE-like element. Most
importantly, the present investigation has identified a novel
cis-acting element involved in
regulation of gene transcription by hyperosmolarity in the renal medulla.
Increased osmolarity of the environment surrounding cells induces a
rapid increase in expression of various genes. The increased expression
of several ion transporters, including different
NHE isoforms, the
Na+-K+-2Cl
cotransporter, and K+ and
Cl
channels, could modify
the activity of key metabolic enzymes through alteration of the
intracellular ion composition. These changes in ion concentration may
then secondarily affect the transcription of other genes
such as the
Na+-Cl
-betaine
transporter, the
Na+-myo-inositol
cotransporter, and aldose reductase, which are involved in the cellular
response to osmolar shock (3). TonE was the first identified
cis-acting element responsible for
hyperosmotic regulation in these genes (31). The consensus sequence of
TonE, TGGAAAnnYnY, has been suggested on the basis of known TonE
sequences in different genes at the time and analysis of TonE mutants,
where each mutant has a single nucleotide mutated in a different
position (19, 24). The identified TonE-like sequence of the
NHE-2 gene (GCTGGAAAACCGA) has only
1-bp mismatch with the TonE consensus sequence in which the last Y
(pyrimidine) is instead a purine (adenosine). Functional studies
indicated that this TonE-like sequence is partially responsible for
hyperosmotic induction of the NHE-2
gene. The specific DNA-protein interaction shown by EMSA further
confirmed that the TonE-like sequence is a critical cis-acting element for hyperosmotic
induction of the NHE-2 gene.
Although the deletion and mutation of the TonE-like element in
NHE-2 reduced the induction of gene
expression by hyperosmolarity, the remaining sequences, as shown by
constructs
1006/+116 and
817/+116, still showed
significant hyperosmotic induction. This suggested the presence of
another osmotic response element downstream of the TonE-like element.
Transfection of further deletion and mutant constructs revealed OsmoE,
the second osmotic response element in the
NHE-2 promoter. Further studies showed
that although one copy of OsmoE or TonE-like element failed to produce
significant osmotic induction in a heterologous promoter (i.e., SV40),
tandem repeats of two OsmoE or TonE-like elements produced a
significant osmotic induction of 2.9- and 1.8-fold, respectively.
Furthermore, one or two copies of a DNA fragment containing both OsmoE
and the TonE-like element and the sequence between them produced 3.1- and 6.0-fold osmotic induction, respectively. This suggests that either
OsmoE or the TonE-like element alone is sufficient to generate an
osmotic response. The observation of no additivity of luciferase induction by cotransfection of the TonE and OsmoE constructs suggested that the spatial relationship between these two
cis-acting elements is important for
maximal osmotic induction.
The OsmoE and the TonE-like element in the NHE-2 promoter produced less induction of gene expression (3.3-fold) than the betaine transporter (31) and aldose reductase (10) genes (10- to 20-fold). However, previous studies showed that 2,900 bp of immediate upstream sequence of the Na+-myo-inositol transporter gene containing TonE induce reporter gene expression of only twofold in response to hyperosmolarity (18, 25, 34). Later, five TonEs spread over 50,000 bp of the 5'-flanking region were located that increased gene expression by three- to fourfold with osmolar shock (24). Thus the TonE in the Na+-myo-inositol transporter gene and the osmotic response elements of the NHE-2 gene may represent a group that has a lower osmotic inducibility. Alternatively, a threefold induction of the NHE-2 gene may be sufficient to increase intracellular Na+ to produce the necessary physiological response, and this may explain why the osmotic stimulation of NHE-2 gene expression is lower than that reported for other genes.
Isolation of new cis-acting elements is an important step for identifying signal transduction pathways of gene transcription. OsmoE is thought to be a novel osmotic response element for the following reasons. 1) It is an 18-bp sequence with no nucleotide sequence homology to any known osmotic response element, although it has a 15-bp identical nucleotide with some regulator genes of bacteria (22, 30). It is unclear now whether OsmoE of the NHE-2 promoter has any relation to those bacterial genes, because such short regions of sequence identity may be found in many unrelated genes. 2) EMSA, using OsmoE sequence as a probe, showed a specific hyperosmolarity-induced nuclear binding complex. 3) The TonE-like probe is unable to inhibit OsmoE probe binding to nuclear proteins. All these facts suggest that the OsmoE of the NHE-2 gene and the putative OsmoE binding protein(s) are unique and have not been previously reported. At this time, however, we do not know precisely how the OsmoE and TonE-like elements work in concert to direct the induction of the NHE-2 gene by osmotic shock. Identification of trans-acting factors that bind OsmoE and TonE should allow elucidation of specific transcriptional mechanisms that regulate NHE-2 under the condition of osmotic stress.
In conclusion, we have identified a novel cis-acting element, OsmoE, and a TonE-like element, which together are responsible for the increased transcription of the NHE-2 gene induced by hyperosmolarity. Under hyperosmotic conditions, each of them can increase gene expression alone, and when working in concert, they provide maximal transcriptional induction. Our data on OsmoE and considering the fact that TonEs have been found in other osmotic-responsive genes suggest that multiple cis-acting elements are involved in control of the osmotic stress response in different genes. Identification of trans-acting factors that bind to these cis-acting elements in different genes should enable us to better understand the molecular mechanisms of gene regulation by hyperosmotic stress.
Perspectives
We have presented the identification and characterization of osmotic response elements of the rat NHE-2 gene promoter. The increased NHE-2 mRNA expression leads to an increase in renal medullary Na+ uptake necessary to meet the increasing cellular demands under hyperosmotic conditions. The data we present indicate that hyperosmotic stress induces the formation of nuclear protein complexes bound to the OsmoE and TonE-like sequences in mIMCD-3 cells. Future investigations should enable us to understand the interaction between these cis-acting elements and their trans-acting factor(s) during hyperosmotic stress. Furthermore, the identification of osmotic response elements provides fundamental information for isolation of these trans-acting factor(s). The investigation of signaling pathways that activate trans-acting factor(s) should elucidate more precisely the process of cellular osmoregulation.| |
ACKNOWLEDGEMENTS |
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This work was supported by National Institute of Diabetes and Digestive and Kidney Diseases Grant 2R01-DK-41274-10.
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FOOTNOTES |
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The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. §1734 solely to indicate this fact.
Address for reprint requests and other correspondence: F. K. Ghishan, Dept. of Pediatrics, Steele Memorial Children's Research Center, University of Arizona Health Sciences Center, 1501 N. Campbell Ave., Tucson, AZ 85724 (E-mail: fghishan{at}peds.arizona.edu).
Received 18 February 1999; accepted in final form 25 May 1999.
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