Although ATM is stimulated in response to a variety of oncogenic signals and DNA damage (
29), we show that elevated levels of ODC activity stimulate ROS production and the ATM-DNA damage response pathway leading to apoptotic cell death of nontumorigenic epithelial cells. Our studies with primary keratinocytes isolated from p53
−/− null mice demonstrate that a loss of p53 function confers increased survival in Ker/ODC, suggesting that the ODC-induction of cell death in primary keratinocytes is p53-dependent. Normal cells are well protected against malignant transformation by the tumor suppressive activity of p53 that regulates the transcription of genes required for cell cycle arrest, DNA repair, and apoptosis. In addition to DNA damage, oncogenic signaling activates p53 through ARF, which interacts with MDM2 to inhibit its p53 ubiquitin ligase activity (
19). However, we found no evidence of increased expression of p19
Arf in primary keratinocytes with elevated ODC. Our studies show that the activation of ATM and phosphorylation of the ATM substrates p53 and γH2AX are induced in both K6/ODC transgenic skin and in ODC overexpressing primary keratinocytes. In addition, previous studies have shown that levels of the Tip60 HAT enzyme, reported to acetylate and activate ATM (
30), are also substantially elevated in the skin of ODC-overexpressing mice (
31).
Since oncogenes such as c-Myc can transactivate and upregulate ODC expression (
32), it is possible that activation of ATM by oncogenes such as c-Myc (
15) is, at least in part, due to increased polyamine metabolism and production of ROS and DNA damage. This study adds ODC to the list of growth promoting stimuli, including oncogenes such as Myc or E2F1, that have been reported to induce the ATM signaling pathway (
13,
15). DNA replication stress has been suggested to be a trigger for the ATM response pathway, which has been found to be activated in precancerous lesions (
33,
34). Oncogenic activation may generate DNA damage through the production of reactive oxygen species and/or through the aberrant firing of replication origins (
13,
35,
36). That elevated polyamine biosynthesis acts as a strong proliferative and tumor promoting stimulus while also inducing p53-mediated tumor suppressive activity presents a seeming paradox. However, a similar precedence has been reported for a variety of proliferative signals including the oncogenes c-Myc, Ras, and E2F1 (
13,
15,
37). Although the immediate result is protective via cell cycle arrest and apoptosis of aberrantly growing cells that still retain a functional p53 (), it can also create a selection pressure for inactivation of ATM or p53, thus leading to genetic instability and tumor progression (
14,
33,
34). It is likely that elevated ODC activity in primary cultures of proliferating keratinocytes is a greater stress than in relatively quiescent keratinocytes in intact skin. Although ATM is activated and p53 levels accumulate in both ODC-overexpressing keratinocyte cultures and in ODC transgenic skin, massive apoptosis is only observed in Ker/ODC cultured at subconfluent density. Thus, p53-dependent apoptotic cell death eliminates cells that have acquired ROS-induced damage that is too severe to be repairable or that may be oncogenic. Since ODC overexpressing keratinocytes exhibit both increased ROS production as well as increased DNA damage, ODC-induced apoptosis of cells with a functional p53 may play an important role in promoting tumorigenesis by contributing to a mutator phenotype. Indeed Wallon et al. (
38) reported that overexpression of ODC enzyme targeted to the skin of K6/ODC transgenic mice may increase susceptibility to mutation following carcinogen exposure. In addition, recent studies have shown that while DNA damage-induction of p53 can produce a strong apoptotic response, it is not necessary for p53-mediated tumor suppression which requires ARF signaling in response to oncogene activation (
7,
39). Thus, the lack of signaling through the ARF pathway, which is critical for p53-mediated tumor suppression, may leave the tissue more susceptible to genetic instability and tumor progression.
With increased ODC activity, stimulation of polyamine biosynthesis and subsequent increased intracellular polyamine levels induce the activity of normal polyamine catabolic pathways. We have shown that elevated ODC activity in normal keratinocytes results in the early induction of spermine oxidase that generates both 3-aminopropanal/acrolein and H
2O
2, leads to increased DNA damage, and activates ATM signaling. This novel activation of ATM and stabilization of p53 is dependent upon polyamine biosynthesis since specific inhibition of ODC activity with DFMO prevents both the generation of ROS and the subsequent activation of the ATM-DNA damage response pathway. Moreover, inhibition of spermine oxidase activity with MDL 72,527 treatment also inhibits ROS generation and subsequent cell death in ODC overexpressing keratinocytes. We found no evidence for ODC induction of polyamine catabolism via the SSAT/APAO pathway since there was no increase in SSAT activity, no acetylated polyamines detected, and no increase in APAO mRNA or protein levels in Ker/ODC. Indeed, a recent report (
6) that SSAT overexpression leads to DNA damage and G
2 arrest concluded that the primary driving mechanism was due to the depletion of cellular polyamines with increased H
2O
2 production playing only a secondary role in the reduced cell proliferation. Furthermore, they found that spermine oxidase activity was not induced with SSAT overexpression, and the cells did not undergo apoptotic cell death despite the presence of damaged DNA (
6). The decreased spermine levels detected in ODC overexpressing keratinocytes and skin likely results from the increased spermine oxidase activity. Although increased activity of polyamine catabolic oxidases, including both APAO and SMO, have been shown to lead to oxidative stress (
21,
22,
25), our data suggest that induction of SMO is primarily responsible for the increased H
2O
2 and acrolein accumulation in Ker/ODC. Igarashi et al. (
28,
40) have shown that acrolein is the major toxic compound produced from spermine by spermine oxidase. We have shown by a direct ELISA assay that there is a significant increase in acrolein-conjugated lysine in Ker/ODC cell lysates compared to Ker/Norm and that this can be blocked with DFMO. Since acrolein has been reported to cause DNA damage and cell damage in a variety of cell types (
40,
41), it is likely that both H
2O
2 and aldehyde/acrolein produced via spermine oxidase activity are responsible for the induction of the DNA damage response observed in keratinocytes with elevated ODC activity.
Previous reports have also shown that alterations in intracellular polyamine levels can lead to apoptotic cell death. In particular, accumulation of putrescine, as a result of increased ODC activity or increased uptake from the medium, can provoke apoptosis in various cell types (
42,
43). Putrescine induction of oxidative stress has been implicated to mediate apoptotic cell death induced by ODC (
44), but the signaling pathways involved have not been defined prior to this study. Conversely, DFMO depletion of polyamines has also been reported by Wang et al.(
45) to induce p53 gene expression and growth inhibition but not apoptosis in intestinal epithelial cells. Similarly, treatment of cells with polyamine analogues also results in decreased intracellular polyamines but, in some cases, cells undergo apoptosis (
46,
47). However, unlike DFMO depletion of polyamines, polyamine analogues induce the activity of polyamine catabolic enzymes including spermine oxidase and polyamine oxidase, that generate H
2O
2 and toxic aldehyde/acrolein (21{Sakata, 2003 #1597, 48)}. The induction of polyamine catabolic oxidases and its associated H
2O
2 generation appears to be responsible for the anti-tumor activity of a variety of polyamine analogues (
21). We have observed that treatment of ODC-overexpressing primary keratinocytes with the polyamine analogues, BENSpm or CPENSpm, accelerates their apoptotic cell death (data not shown). Thus, ODC-overexpressing keratinocytes are more sensitive to agents, such as the polyamine analogues, that cause additional ROS generation.
In summary, we demonstrate that apoptotic cell death is induced in normal keratinocytes with elevated ODC activity via the induced generation of reactive aldehydes and H
2O
2, at least in part due to induction of spermine oxidase, followed by the subsequent activation of the ATM-DNA damage response pathway. Since elevated ODC is a common characteristic of tumor cells, it is possible that cells with high ODC activity will be selectively sensitized to die when exposed to further oxidative insults by radiation or agents that cause further ROS stress. On the other hand, further studies are needed to explore the possibility that ODC-upregulation of polyamine catabolic oxidation and production of mutagenic ROS contributes to a malignant phenotype. Recent studies have shown that ROS production by inflammatory cells and its association with tumor development appears to be mediated in some cases by the induction of spermine oxidase either in response to pathogens such as
H. pylori (
49) or via a direct induction of spermine oxidase by TNFα (
50). Accordingly, spermine oxidase may be a promising target for anti-neoplastic intervention in premalignant tissue with elevated ODC activity.