Tissue regeneration in humans is extremely limited, which constitutes a major challenge to the repair of damaged organ and tissue function. Humans and other mammals do not regenerate large portions of lost muscles or other mesenchymal structures after traumatic injury or surgical excision. By contrast, some vertebrates such as the urodele amphibians and the teleost fish have a remarkable capacity to regenerate entire limbs, the lens of the eye, and portions of the heart (
Poss et al. 2002;
Brockes and Kumar 2008;
Tanaka and Weidinger 2008). Although classically defined resident stem cells clearly play a role in tissue regeneration, their relatively low frequency in a given tissue may be insufficient to account for the massive regeneration observed in some lower vertebrates. In zebrafish, heart regeneration results from dedifferentiation and subsequent proliferation of cardiomyocytes (
Poss et al. 2002). Substantial evidence from studies of newts and axolotls supports a similar regenerative mechanism, in which postmitotic limb tissues including muscles lose their differentiation markers, re-enter the cell cycle, proliferate and then recapitulate differentiation in the blastema. (
Hay and Fischman 1961;
Lentz 1969;
Kintner and Brockes 1984;
Lo et al. 1993;
Gardiner and Bryant 1996;
Echeverri et al. 2001). Recent observations strongly suggest that dedifferentiated cells of the limb remain lineage-committed during this process (
Kragl et al. 2009). In marked contrast, there is no evidence that dedifferentiation occurs as a natural part of tissue regeneration in mammals. This raises the possibility that a mechanism of regeneration involving reversal of differentiation of mesenchymal tissues, such as muscle, may have been lost or suppressed during evolution of higher vertebrates that, if elucidated, could significantly impact regenerative medicine.
Muscle differentiation in mammals occurs by a stepwise progression. This process entails morphological and functional changes driven by the expression of a series of muscle regulatory factors (MRFs), which induce expression of differentiation-specific genes such as creatine kinase and myosin heavy chain (MHC) (
Molkentin and Olson 1996). In particular, myogenin heralds a transition from proliferative myoblast to committed post-mitotic muscle cell (
Walsh and Perlman 1997;
Charge and Rudnicki 2004). Of critical importance to this transition is the expression of the retinoblastoma protein (Rb) (
Gu et al. 1993;
Lassar and Munsterberg 1994;
Novitch et al. 1996;
Huh et al. 2004). The role of Rb in differentiation is multi-faceted, including not only the orchestration of mitotic arrest and prevention of cell cycle reentry, but also inhibition of apoptosis, and enforcement of stable tissue-specific gene expression (
Burkhart and Sage 2008). Since the differentiated state requires continuous active control (
Blau et al. 1985;
Blau and Baltimore 1991), (Yamanaka and Blau, 2010) ongoing expression of Rb or possibly redundant pocket proteins would be predicted to be necessary for the maintenance of the specialized muscle cell phenotype.
Attempts to reverse differentiation and postmitotic arrest in mammalian skeletal muscle cells by either acute suppression or permanent elimination of
Rb have produced conflicting results. In newt muscle cells, cell cycle reentry and DNA synthesis occur when Rb is inactivated by phosphorylation, (
Tanaka et al. 1997). Similarly, the inactivation of Rb by viral oncoproteins in immortalized mammalian myoblast cell lines, such as C2C12, readily results in BrdU incorporation and S-phase reentry in nuclei of differentiated myotubes (
Gu et al. 1993;
Crescenzi et al. 1995), in agreement with more recent studies using siRNA to suppress
Rb (
Blais et al. 2007). In marked contrast, in similar experiments using primary muscle cells isolated directly from mammalian muscle tissues,
Rb reduction or elimination by Cre-mediated excision, failed to result in significant S-phase reentry (
Sacco et al. 2003;
Camarda et al. 2004;
Huh et al. 2004). These data suggest that
Rb loss in primary differentiated skeletal muscle cells is not sufficient to induce reversal of the post-mitotic state in mammals, in stark contrast to the situation in urodeles.
We reasoned that components of the mammalian cell cycle machinery known to be absent in lower organisms could have evolved at the expense of regeneration. A prime candidate is the
Ink4a locus, which encodes the structurally and functionally unrelated products, p16 and ARF (Alternative Reading Frame). Both of these proteins are potent tumor suppressors that are frequently inactivated in human and mouse cancers. p16 specifically inhibits cdk4 and is thought to function upstream of Rb, while ARF binds MDM2 which results in p53 stabilization, in addition to having p53 independent functions (
Sherr et al. 2005). Notably, ARF responds to oncogenic stimuli, including the inactivation of Rb, by inducing p53-dependent growth arrest or apoptosis (
Sharpless and DePinho 1999;
Sherr et al. 2005). While the Rb and p53 pathways are evolutionarily ancient, their regulation by the
Ink4a locus is a relatively new phenomenon. Homologs of
p16 exist in fish (
Kazianis et al. 1999;
Gilley and Fried 2001). But the earliest identified
ARF ancestor is in chickens, with no candidates in databases of lower organisms (
Gilley and Fried 2001;
Kim et al. 2003;
Brookes et al. 2004). Thus, the absence of
ARF relatives could underlie certain fundamental differences in growth control in lower vertebrates.
Here we test the hypothesis that reversal of differentiation of mammalian skeletal muscle cells can be induced by inactivation of Rb in conjunction with ARF. Specifically, we postulated that upon loss of Rb, growth arrest and differentiation are maintained by induction of expression of the tumor suppressor ARF. Our data show that transient suppression of both Rb and ARF results in the ability of skeletal muscle cells to lose their differentiated properties, cycle, and then redifferentiate in a manner that mimics urodele cells. We used both genetic and biochemical approaches in primary cells and monitored single cell behavior by time lapse microscopy, which enabled a rigorous analysis of the intrinsic control of muscle cell proliferation and modulation of the differentiated phenotype. The use of photoactivated laser microdissection (PALM) and laser pressure catapulting (LPC) to isolate single, morphologically intact, adherent, primary differentiated cells (myocytes) allowed the unambiguous identification of clones from individual cells. Based on our findings we propose a molecular mechanism whereby evolutionary loss of ARF explains differences between urodele and mammalian skeletal muscle regeneration. The results suggest a means of replicating in mammals the robust regenerative response typical of urodeles, demonstrating that the transient induction of dedifferentiation could serve as an adjunct to classical tissue specific stem cells.