mda-7/IL-24 has significant potential as an anti-cancer therapeutic because of its multiplicity of antitumor properties, its non-toxic effects to normal cells and tissues, and its safety and efficacy as observed in a clinical trial (
5–
8). In the present study, we document that Ad.
mda-7-induced ER stress and ceramide production lead to early autophagy that subsequently switches to apoptosis in human prostate cancer cells (). Our experimental evidences indicate that autophagy induced by Ad.
mda-7 might initially serve a cytoprotective function and inhibition of autophagy by 3-MA augments apoptosis-induction by Ad.
mda-7. Accordingly, by combining Ad.
mda-7 with autophagy inhibitors it may be possible to augment the antitumor properties of Ad.
mda-7 resulting in an improved therapeutic index for patients with prostate cancer. Although potential protective functions of autophagy with respect to Ad.
mda-7 action have been observed in specific malignant glioma and leukemia cells (
21,
44), the mechanism by which this process switches to apoptosis has until now not been mechanistically resolved.
Our experiments demonstrate that Ad.
mda-7 first induces autophagy selectively in different types of human prostate cancer cells, without promoting this effect in immortal normal human prostate epithelial cells (;
Supplementary Fig. 2). We presently demonstrate that autophagy in prostate cancer cells is a consequence of ER stress and ceramide generation, two processes also induced by Ad.
mda-7 (
20,
45). The reason Ad.
mda-7 does not induce these changes in normal cells even in the presence of abundant levels of MDA-7/IL-24 protein remains an enigma. Efforts to decipher this phenomenon will provide further insights into the molecular mechanism of
mda-7/IL-24 action.
Ceramide is an important second messenger molecule involved in signaling pathways that control cell proliferation, differentiation, death and autophagy (
34,
35). Ceramide induced by Ad.
mda-7 controls autophagy by interfering with two pathways encompassing PI3Ks. Class I PI3K and class III PI3K products have been reported to paradoxically inhibit and stimulate autophagy, respectively (, ). Ceramide reverts the inhibition of the class I PI3K signaling pathway on autophagy by interfering with IL-13-dependent activation of protein kinase B (PKB) and stimulation of beclin 1 expression (
34). Additionally, low doses of radiation induce protective autophagy in breast cancer cells (
46). From these results, it is possible that ceramide could be involved in triggering an autophagic response to protect cells during the initial 24 h of Ad.
mda-7 treatment, whereas a more intense stimulus (48 h after treatment) causes prostate cancer cell death by apoptosis. These findings differ from the effect of high doses of GST-MDA-7 in glioma and renal cells where it induces toxic autophagy (
21,
22). A possible explanation might be cell type-specificity of action of
mda-7/IL-24. Alternatively, the disparate response may reflect subtle differences in the mechanism of antitumor action of GST-MDA-7 (versus secreted MDA-7/IL-24 protein) that does not induce autocrine induction of endogenous
mda-7/IL-24 (
18,
19) and exerts its anti-cancer activity without dependence on canonical MDA-7/IL-24 receptors (
47).
Cellular stress can promote autophagy and apoptosis in multiple ways including induction of autophagy/apoptosis sequentially, simultaneously, or in a mutually exclusive manner (
29,
48). Interestingly, our data demonstrates that Ad.
mda-7-induced autophagy and apoptosis occur in a sequential manner and are mutually exclusive with an initial induction of autophagy followed by apoptosis. The switch between autophagy and apoptosis is a complicated process that is currently poorly defined. It was shown that calpain-mediated cleavage of ATG5 is a critical pro-apoptotic event, which activates caspase-dependent cell death (
43). Recently, Beclin-1 has been shown to be a substrate for caspases and down-regulation of Beclin-1 expression sensitizes cells to apoptotic cell death (
49). In another study, stimulation of the cell death signal by ceramide degrades the autophagy-related proteins Beclin-1 and ATG5 (
50), which subsequently induces caspase-dependent apoptosis. We presently demonstrate that 48 h after Ad.
mda-7 infection protective autophagy shifts to apoptosis that is regulated by Beclin-1 and ATG5. During this predominantly apoptotic phase of Ad.
mda-7-treatment the interaction between Beclin-1 and MDA-7/IL-24 might inhibit autophagy. At this time, Ad.
mda-7 increased calpain activity leads to the cleavage of ATG5 and production of a 24-kDa molecular weight product, which might translocate from the cytosol to the mitochondria and be involved in apoptosis (
43). Taken together, this study provides new insights into the complex nature of ER stress and ceramide response that may be involved in switching Ad.
mda-7-induced protective autophagy to apoptosis by regulation of autophagy-related proteins ().
Our study suggests a novel role for Beclin-1 and ATG5 in mediating a switch between protective autophagy and apoptosis in prostate cancer cells infected with Ad.mda-7. These studies implicate calpain activation, which can cleave ATG5 resulting in a 24-kDa truncated protein, as a major contributor to this physiological switch between protective autophagy and apoptosis both of which are promoted by mda-7/IL-24 in prostate cancer cells. They also raise a number of intriguing questions. Does the interaction between MDA-7/IL-24 and Beclin-1, or ATG5 cleavage play a role in immune cell development and maturation? Do these interactions or changes in pro-autophagic molecules play any role in inflammatory responses? Further studies aimed at unraveling these newer aspects of MDA-7/IL-24 function would appear valuable. Moreover, based on our present observations, employing strategies to block autophagy through promoting ER stress and ceramide production may represent a viable tactic for enhancing the antitumor activity of mda-7/IL-24 toward prostate and potentially other cancers.