Pro-survival Bcl-2 proteins prevent apoptosis by inhibiting Bax and Bak. They block Bax translocation from the cytosol to the mitochondria, Bax oligomerization and MOMP. Paradoxically, pro-survival Bcl-2 proteins on the mitochondria stabilize Bax localization in the cytosol, without forming stable heterodimeric complexes. Bax regulation by Bcl-2 thus creates a spatial paradox that has been addressed by previous models of Bax activation (
Kim et al., 2006;
Willis et al., 2007).
We propose a new model of continuous Bax retrotranslocation from mitochondria that is consistent with results from numerous labs. We find that Bax translocates constantly to the mitochondria in healthy cells, where pro-survival Bcl-2 proteins, such as Bcl-x
L, bind Bax and retrotranslocate it back into the cytoplasm thereby stabilizing the inactive Bax conformation (). Bcl-x
L and Bax both retrotranslocate from mitochondria and accelerate the rate of each other’s retrotranslocation after transient interaction on mitochondria, perhaps through trans-sequestration of the C-terminal tails (
Jeong et al., 2004). Evidence for direct interaction is based on the inhibition of Bax retrotranslocation when the Bax-Bcl-x
L binding is disrupted by i) the G138A mutation in the hydrophobic groove of Bcl-x
L (
Sedlak et al., 1995), ii) the D68R mutation in the BH3 domain of Bax (
Fletcher et al., 2008), and iii) the Bcl-x
L inhibitor ABT-737 (
Oltersdorf et al., 2005). The interaction between Bax and Bcl-x
L requires prior conformational changes in the N-terminal part of Bax because preventing these conformational changes by intramolecular tethers disrupts interaction with Bcl-x
L in detergents and Bax retrotranslocation.
The absence of retrotranslocation results in Bax 1–2/L-6 accumulation on the mitochondria in healthy cells. Wild-type Bax, however, only accumulates on mitochondria when the activities of pro-survival Bcl-2 proteins are blocked by BH3-only proteins, such as Bim, or by ABT-737. Bax accumulated on mitochondria upstream of MOMP can dissipate by retrotranslocation if pro-survival Bcl-2 proteins become available again, as observed when cells reattach to substrate following transient anoikis (
Gilmore et al., 2000).
Conformational changes of Bax on the mitochondria during apoptosis involve the N-terminus of Bax and can be detected using the monoclonal antibody 6A7. Despite its reduced apoptotic activity tethered Bax eventually adopts a 6A7-positive fold, but does not form mitochondrial foci. Although in cell free assays tethered Bax completely lacks tBID activated MOMP, consistent with the lack of apoptosis induced activation in cells, tethered Bax can spontaneously induce some degree of MOMP within cells even in the presence of Bcl-x
L, likely though this 6A7 positive form. Since the 6A7 antibody can compete for Bcl-x
L binding to Bax (
Hsu and Youle, 1998), a 6A7-positive conformation of wt Bax may normally exist circumscribing mitochondria that remains undetectable because 6A7 binding is sterically blocked by Bcl-x
L bound to Bax. Bax conformational changes in α helices 1 and 2 could be a normal consequence of Bax binding to the mitochondria perhaps stimulated by lipid interactions (
Kuwana et al., 2002). If not retrotranslocated, mitochondrial wt Bax becomes active due to further conformational changes and oligomerization to cause MOMP ().
In addition to a reduced Bax retrotranslocation (off rate), mitochondrial Bax accumulation could also result from an increase in the Bax translocation (on rate), which may depend on direct Bax activation by BH3-only proteins (
Kuwana et al., 2005). Even the steady state binding of Bax to mitochondria in healthy cells may result from the activity of residual levels of BH3-only proteins in healthy cells. Bax binding to the MOM appears to be influenced by the exposure of the C-terminal membrane anchor (
Gavathiotis et al., 2010), which may also depend on isomerisation of the prolyl bond preceding P168 and its acceleration by the PPIase Pin1 (
Shen et al., 2009). Bax translocation to the MOM, however, seems not to be influenced by Bcl-x
L.
Despite the robust interaction of Bax and Bcl-x
L in detergents (
Hsu and Youle, 1998) and in membranes (
Dlugosz et al., 2006), increased concentrations of pro-survival mitochondrial bound Bcl-2 proteins in cells do not result in Bax accumulation on mitochondria. In contrast, Bax can be directly bound and inhibited by the viral protein vMIA that accumulates Bax on the mitochondria as it inhibits apoptosis (
Arnoult et al., 2004). In healthy cells the sub-cellular location of Bax depends on constant retrotranslocation of mitochondrial Bax into the cytosol by pro-survival Bcl-2 proteins. Minimization of a mitochondrial Bax pool that is susceptible for activation is likely to prevent apoptosis and explains the spatial paradox of Bcl-2 protein inhibition of Bax.