Abstract
Diabetes is frequently associated with hypoxia and is known to impair ischaemia-induced neovascularisation and other forms of adaptive cell and tissue responses to low oxygen levels. Hyperglycaemia appears to be the driving force of such deregulation. Recent data indicate that destabilisation of hypoxia-inducible factor 1 (HIF-1) is most likely the event that transduces hyperglycaemia into the loss of the cellular response to hypoxia in most diabetic complications. HIF-1 is a critical transcription factor involved in oxygen homeostasis that regulates a variety of adaptive responses to hypoxia, including angiogenesis, metabolic reprogramming and survival. Thus, destabilisation of HIF-1 is likely to have a negative impact on cell and tissue adaptation to low oxygen. Indeed, destabilisation of HIF-1 by high glucose levels has serious consequences in various organs and tissues, including myocardial collateralisation, wound healing, renal, neural and retinal function, as a result of poor cell and tissue responses to low oxygen. This review aims to integrate and summarise some of the most recent developments, including new proposed molecular models, on this research topic, particularly in terms of their implications for potential therapeutic approaches for the prevention or treatment of some of the diabetic complications characterised by impaired cellular and tissue responses to hypoxia.
Similar content being viewed by others
Regulation of hypoxia inducible factor-1
At low oxygen levels, cells activate a number of critical pathways to cope and survive under hypoxic conditions. Most of these pathways are regulated by the transcription factor hypoxia-inducible factor 1 (HIF-1), and this regulation appears to largely rely on the ability of cells to use oxygen deprivation as a signal to control HIF-1 stability and transcriptional activity. Active HIF-1 is a heterodimer composed of a constitutively produced HIF-1β subunit, which is stable irrespective of the oxygen level, and a labile HIF-1α subunit [1]. Canonically, it is assumed that regulation of HIF-1α is indeed the critical event implicated in the HIF-mediated cellular response to low oxygen, as HIF-1α is highly induced by hypoxia [2, 3]. The HIF-1α subunit is virtually undetectable under normoxic conditions, since it is rapidly degraded by the ubiquitin–proteasome pathway [4, 5]. Under normoxic conditions, HIF-1α has a very short half-life of less than 5 min, being continuously synthesised and degraded [6, 7]. It is well established that under normal oxygen levels, HIF-1α is hydroxylated on proline residues 402 and 564 in the oxygen-dependent degradation domain by specific prolyl hydroxylases (PHDs) [8–12] that require oxygen and 2-oxoglutarate, as co-substrates, and iron (Fe2+) and ascorbate, as co-factors [13–15]. The use of iron by these enzymes explains the hypoxia-mimetic effects of iron antagonists and chelators, such as desferrioxamine (DFO) and cobalt chloride [14, 15]. Although 2-oxoglutarate, a tricarboxylic acid (TCA) cycle intermediate, is essential for the activity of PHDs because of its role in the coordination of iron in the catalytic core, other TCA cycle intermediates such as succinate and fumarate appear to inhibit PHDs by competing with 2-oxoglutarate for binding to the active site [16, 17]. Once hydroxylated, HIF-1α is recognised by the von Hippel–Lindau protein (VHL), which is part of an ubiquitin ligase complex known as E3 ligase complex that targets HIF-1α for polyubiquitination and subsequent proteasomal degradation [18–21]. In addition to VHL, the E3 ligase complex is formed by the RING-finger protein RBX1, which is thought to recognise a cognate E2, as well as several adaptor proteins, such as elongin B, elongin C and cullin 2 [22, 23] (Fig. 1). The asparagine 803 residue of HIF-1α is also hydroxylated under normoxic conditions by a specific asparagine hydroxylase named factor-inhibiting HIF-1 (FIH-1), which impairs the interaction of the transcriptional co-activators p300/CREB binding protein (CBP) with the HIF-1α C-terminal transactivation domain [24–26] (Fig. 1). This leads to further repression of the transcriptional activity of HIF-1. Like PHDs, FIH-1 requires 2-oxoglutarate, iron, ascorbate and dioxygen to induce hydroxylation; however, as opposed to PHDs, FIH-1 is not inhibited by intermediates of the TCA cycle [16, 27, 28]. When oxygen becomes limited, the proline residues are no longer hydroxylated and HIF-1α escapes degradation, accumulating in the cell. Subsequently, HIF-1α is translocated into the nucleus, where it dimerises with HIF-1β and binds to a core pentanucleotide sequence (5′-RCGTG-3′) in hypoxia-responsive elements of the promoter or enhancer sequences of target genes [3, 29]. Ultimately, HIF-1 activates the expression of numerous genes that help cells to survive at low oxygen levels. In addition, p300/CBP interact with HIF-1α, due to inhibition of Asn803 hydroxylation, increasing the transcriptional activity of HIF-1 (Fig. 1).
Changes in gene expression directly or indirectly regulated by HIF-1 extend to more than 100 genes, which are involved in a plethora of adaptation and survival mechanisms, such as angiogenesis, anaerobic glucose metabolism, erythropoiesis, cell growth, differentiation, survival and apoptosis. One of the best-known target genes induced by HIF-1 is VEGF, which encodes vascular endothelial growth factor [29–31], a potent endothelial cell mitogen that is crucial for the angiogenic process. In addition, HIF-1 also induces the expression of the genes for nitric oxide synthase (NOS), haem oxygenase and endothelin [32–34], which play a role in the maintenance of vascular tone and integrity. For example, increased production and activation of endothelial NOS (eNOS) results in increased levels of NO, which triggers mobilisation of bone marrow endothelial progenitor cells (EPCs) into the circulation [35, 36]. Other genes induced by HIF-1 include those for multiple enzymes responsible for shifting the metabolism toward anaerobic glycolysis, such as phosphoglycerate kinase-1, lactate dehydrogenase A and pyruvate dehydrogenase kinase, since oxidative phosphorylation is compromised by reduced oxygen availability. Moreover, HIF-1 also upregulates a more efficient isoform of cytochrome oxidase and increases the expression of GLUT1 (also known as SLC2A1) and GLUT3 (also known as SLC2A3). Interestingly, the glucose metabolite pyruvate appears to regulate the levels of HIF-1α in cancer cell lines by inhibiting PHD-mediated hydroxylation of HIF-1α, contributing to a positive feedback control mechanism (reviewed in [37]). Other crucial proteins upregulated by HIF-1 are C-X-C chemokine receptor type 4 (CXCR4) and the CXCR4-ligand stromal cell-derived factor-1 (SDF-1) that control adhesion, migration and homing of EPCs, required for the formation of new blood vessels [38, 39] (Fig. 1).
Although the canonical pathway for HIF-1α regulation is reliant upon the PHD- and VHL-dependent degradation of the protein, there is evidence to suggest that the degradation of HIF-1α may also occur through alternative pathways. For example, receptor of activated protein kinase C 1 (RACK1) binds to HIF-1α and elongin C, competing with heat-shock protein (HSP) 90 which stabilises HIF-1α, thereby promoting HIF-1α ubiquitination and degradation in an oxygen-independent manner [40]. Additionally, histone deacetylase inhibitors also appear to induce VHL-independent proteasomal degradation of HIF-1α via a mechanism that involves hyperacetylation of HSP90, disruption of the interaction of HSP90 with HIF-1α and formation of immature HIF-1α–HSP70 complexes [41]. More recently, the ubiquitin ligase known as carboxy terminus of HSP70-interacting protein (CHIP) was also implicated in HIF-1α ubiquitination and degradation by the proteasome during prolonged hypoxia [42] and in conditions of increased availability of methylglyoxal [43], through a mechanism dependent on molecular chaperones. Methylglyoxal is a highly reactive α-oxoaldehyde, formed mainly as a by-product of glycolysis [44], which suggests that its availability is increased under conditions of high glucose or prolonged hypoxia. Some reports have further suggested that p53 may also target HIF-1α for Mdm2-mediated ubiquitination and proteasomal degradation [45, 46]. SMAD-specific E3 ubiquitin protein ligase 2 (SMURF2) [47] and hypoxia-associated factor [48] have also been suggested to regulate oxygen- and VHL-independent HIF-1α degradation mechanisms.
HIF-1α has also been shown to be regulated by deubiquitination mechanisms by the VHL-interacting deubiquitinating enzyme 2 (VDU2 or Usp20). In contrast to VDU1 (Usp33), VDU2 can specifically deubiquitinate and stabilise HIF-1α and induce expression of HIF-1 target genes [49].
SUMOylation, a post-translational modification that corresponds to covalent conjugation of SUMO (small ubiquitin-like modifier) to target proteins in a manner similar to ubiquitination, has also been implicated in the regulation of HIF-1α and the response to hypoxia, as well as in many other cellular processes, such as nuclear-cytosolic transport, transcriptional regulation, apoptosis, protein stability and stress responses. Findings suggest that under hypoxic conditions, HIF-1α might be deSUMOylated by the SUMO-specific isopeptidase SENP1, preventing HIF-1α degradation and leading to activation of its target genes [50]. However, the role of SUMO in HIF-1α regulation is still controversial, as it has also been shown that modification of HIF-1α by SUMO may be involved in its stabilisation. Indeed, RWD-containing SUMOylation Enhancer (RSUME) has been shown to induce SUMO conjugation and stabilisation of HIF-1α [51]. It has also been reported that hypoxia-induced SUMOylation of HIF-1α reduces its transcriptional activity without affecting its half-life [52]. Thus, the precise function of SUMO in the regulation of HIF-1α remains to be elucidated.
Phosphorylation signalling cascades regulate HIF-1α in an oxygen-independent manner. Both phosphoinositol 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways can regulate HIF-1α protein levels and transactivation. For example, increased expression of HIF-1α via PI3K pathway may occur by gain-of-function mutations in upstream positive regulators, such as receptor tyrosine kinases (RTKs) and Ras, or loss-of-function mutations in tumour suppressors, such as phosphatase and tensin homologue (PTEN) (reviewed in [53]). Of significance, MAPK-induced phosphorylation of HIF-1α further recruits p300/CBP to HIF-1α, increasing HIF-1 activity [54]. Moreover, phosphorylation of HIF-1α also appears to protect the protein from exportin-dependent nuclear export [55].
These and other findings clearly indicate that control of HIF-1α is very complex and many important questions regarding its regulation remain unanswered.
Loss of the cellular response to hypoxia in diabetes
Both hyperglycaemia and hypoxia are important hallmarks of diabetic complications and appear to elicit several deleterious effects, leading to complications such as diabetic retinopathy, poor wound healing, neuropathies, cardiovascular and renal diseases. A feature that characterises many of these complications is endothelial dysfunction, mainly resulting from impaired ischemia-driven neovascularisation. It has consistently been observed that diabetic animals have decreased vascular density following hind limb ischaemia [56–58] and impaired wound healing [59, 60]. Indeed, it has been extensively shown that ischaemia-induced production of eNOS, SDF-1, CXCR4, VEGF and other growth factors is decreased in diabetic tissues and in hyperglycaemia [38, 60, 61]. This is likely to contribute to decreased function, mobilisation and recruitment of EPCs and other circulating angiogenic cells to injured areas, as well as to poor growth, proliferation and adhesion of endothelial cells [57, 61–66] (Fig. 2). Of significance, these findings were mostly derived from analysis of samples from type 1 and type 2 diabetic patients [63, 64, 66], as well as from studies using in vitro culture systems [61, 67] and diabetic animal models, such as db/db [57, 59, 63, 68] and streptozotocin-treated animals [61, 62].
In coronary heart disease, mRNA and protein levels of VEGF and its receptors VEGFR1 and VEGFR2 in the myocardium were found to be decreased by 40–70% both in diabetic rats and in insulin-resistant non-diabetic rats. Moreover, a twofold reduction in VEGF and VEGFR2 was observed in ventricles from diabetic patients compared with levels in ventricles from non-diabetic donors [69]. In addition, decreased levels of VEGF in the renal glomeruli were correlated with podocyte cell death, diminished tissue repair and progression of renal disease in diabetic patients [70]. In animal models, low levels of VEGF have also been associated with diabetic peripheral neuropathy [71] (Fig. 2).
Importantly, induction and release of growth factors was found to reduce the clinical symptoms and tissue damage that occur in many ischaemia-associated diabetic complications, such as in coronary artery and peripheral limb diseases, as well as to improve wound healing in diabetic patients (reviewed in [72]). Indeed, local VEGF supply was shown to decrease apoptosis, as well as to improve EPC function, migration and capillary density in diabetic cardiomyopathy [73]. In addition, VEGF-based gene therapy protects nerve conduction [74], improves sensory perception [75], preserves autonomic function and reduces nerve fibre loss [76]. Several gene therapy approaches known to indirectly increase VEGF production improve hypoxia-induced wound healing and angiogenic responses in diabetic animals [57, 63, 77].
A number of independent reports have suggested that cellular adaptation to low oxygen is compromised in the presence of hyperglycaemia, culminating in increased cell death and tissue dysfunction. For example, blood glucose levels showed a linear relationship with fatal outcome in response to an acute hypoxic challenge (i.e. acute myocardial infarction) [67, 78]. It was further shown that AGEs, formed from dicarbonyls such as methylglyoxal, attenuate the angiogenic response in vitro [79], while in diabetic mice, inhibition of the formation of AGEs can restore ischaemia-induced angiogenesis in peripheral limbs [80]. The importance of methylglyoxal in key regulatory events is illustrated by the observation that the reduction of hypoxia-induced SDF-1, CXCR4 and VEGF production under high glucose conditions depends on the increased availability of methylglyoxal [43, 61, 81]. Indeed, overexpression of GLO1, which encodes glyoxalase 1, the rate-limiting enzyme in the detoxification of methylglyoxal, prevents the reduction of CXCR4 and VEGF levels observed in those conditions [61, 81]. Consistently, silencing of GLO1 mimicked the methylglyoxal-induced effects on VEGF production [81].
These and other observations strongly suggest that the cell and tissue dysfunction associated with many diabetic complications is related, at least in part, to the loss of the cellular response to hypoxia. However, the molecular mechanisms underlying this dysfunction are still poorly understood.
Impairment of HIF-1 regulation in diabetes
Since HIF-1 is the master regulator of the cellular response to hypoxia, it is not surprising that HIF-1 deregulation is directly associated with the loss of cellular adaptation to low oxygen in diabetes. Indeed, there is a large body of evidence supporting this hypothesis and showing that HIF-1α is destabilised at low oxygen levels by high glucose concentrations. For example, Catrina et al. showed that high glucose decreases hypoxia-induced stabilisation and function of HIF-1α in human dermal fibroblasts and human dermal microvascular endothelial cells in culture. This destabilisation was not prevented by a prolyl hydroxylase inhibitor (ethyl 3,4-dihydroxybenzoate or EDBH) [67], suggesting that other non-canonical mechanisms may be involved in the regulation of HIF-1α protein turnover in the presence of high glucose. In addition, HIF-1α production was found to be impaired during healing of large cutaneous wounds in young db/db mice and upregulation of HIF-1α by gene-based therapy was shown to accelerate wound healing and angiogenesis in this model [63, 68]. Moreover, levels of HIF-1α were found to be decreased in biopsies from foot ulcers of diabetic patients as compared with venous ulcers that share the same hypoxic environment but are not exposed to hyperglycaemia [67]. Downregulation of HIF-1 in response to hyperglycaemia also appears to account for the decreased arteriogenic response triggered by myocardial ischaemia in diabetic patients [82, 83]. In rats, myocardial infarct size increases in response to hyperglycaemia and is associated with reduced production of the HIF-1α protein [84]. As mentioned above, endothelial dysfunction in diabetes is related to impairment of hypoxia-induced production of eNOS, SDF-1, CXCR4 and VEGF. This impairment can presumably be ascribed to destabilisation of HIF-1α, since overexpression of Hif-1α normalises VEGF levels, improves development of myocardial capillary network and inhibits cardiomyocyte hypertrophy and cardiac fibrosis following myocardial injury [85]. In addition, increased expression or stabilisation of HIF-1α is critical to improve wound healing [59, 63, 68] and it enhances the vascular response to critical limb ischaemia in diabetic mice. This mechanism appears to involve an increase in limb perfusion and function, an increase in the number of circulating EPCs, vessel density and luminal area and a decrease in tissue necrosis [57].
Of significance, we and others have shown that impairment of the HIF-1 pathway under high glucose conditions may result from the increased availability of methylglyoxal. Indeed, GLO1 overexpression is able to stabilise HIF-1α [43], as well as augment HIF-1 transactivation in response to hypoxia and high glucose levels [61]. In addition, under these conditions, Glo1 overexpression was found to increase levels of eNOS, VEGF, CXCR4 and SDF-1 [61], which might contribute to increased mobilisation of EPCs and improve the ischaemia-induced neovascularisation.
Other important findings include the observation that, compared with non-diabetic patients, patients with type 2 diabetes have decreased HIF-1β mRNA levels in pancreatic islets, suggesting that changes in the function of HIF-1 can contribute to the development of diabetes [86]. A human HIF-1α genetic polymorphism that results in P582S is associated both with type 2 diabetes [87, 88] and the absence of coronary collaterals in patients with ischaemic heart disease [89]. These observations highlight a critical link between diabetes, the HIF-1 pathway and endothelial dysfunction.
Despite the vast number of studies supporting a role for high glucose in HIF-1 destabilisation, it should also be noted that some reports have shown activation of HIF-1 in response to hyperglycaemia. For example, both mesenglial cells treated with high glucose [90] and glomerular cells from mice with streptozotocin-induced diabetes [91] showed increased production of HIF-1α and increased expression of hypoxia-induced genes, including Vegf and Glut1. It was further shown that glucose upregulates HIF-1α levels in primary cortical neurons exposed to hypoxia [92]. However, it should be noted that in some of these studies cells were treated with high levels of glucose for short periods of time, ranging from 3–5 h [92] to 48 h [90], which might explain the apparent discrepancy between these results and those of studies in which longer periods of incubation with high glucose were used. Additionally, one should not dismiss the fact that different animal models and different cell culture systems may produce different effects on HIF-1 activation following treatment with high glucose.
Proposed models for the loss of the cellular response to hypoxia in diabetes
Although the molecular mechanisms that underlie impairment of HIF-1 in diabetes remain poorly understood, some recent studies envision pathways whereby diabetes may lead to the downregulation of HIF-1. For example, Gurtner and collaborators reported two different mechanisms, both relying on the effect of increased availability of methylglyoxal in diabetes [61, 77]. Indeed, the authors showed that methylglyoxal modifies HIF-1α in hypoxic mouse dermal fibroblasts on two specific residues, arginine 17 and arginine 23, both of which belong to the basic helix-loop-helix domain that is critical for the interaction with HIF-1β and formation of an active heterodimer [61]. These modifications consistently reduced HIF-1 heterodimer formation (Fig. 3) and Glo1 overexpression prevented this impairment, emphasising the role of methylglyoxal in the loss of the cellular response to hypoxia in diabetes [61]. In a more recent study, the same group suggested that high glucose decreases the interaction between p300 and HIF-1α as a result of increased modification of p300 by methylglyoxal (Fig. 3). Mutation of arginine 354 of p300 completely prevented high-glucose-induced methylglyoxal modification of p300 and restored the interaction with HIF-1α [77]. The authors noted that methylglyoxal-induced modification of HIF-1α did not impair HIF-1α–p300 binding; however, a decrease in VEGF production was still observed, suggesting that impairment of associations between both HIF-1α–HIF-1β and HIF-1α–p300 might underlie the diabetes-induced defect in HIF-1 transcriptional activity [77]. The authors further observed that the iron chelator DFO improves HIF-1α–p300 binding and augments HIF-1 activity and VEGF production at high glucose levels, by preventing p300 modification by methylglyoxal via a mechanism dependent on the decreased production of reactive oxygen species [77]. Dimethyloxalylglycine (DMOG), an oxoglutarate analogue known to be a potent inhibitor of PHDs, did not show the same effects as DFO, suggesting that DFO-induced effects are not likely to be dependent on PHDs and to influence HIF-1α protein stability. Alternatively, DFO appears to normalise the high glucose-induced defect in HIF-mediated transactivation, by a mechanism dependent on the decreased production of reactive oxygen species. The physiological significance of this mechanism is indicated by the observation that DFO enhances wound healing and neovascularisation in diabetic mice [77].
A recent study by our group proposes a different mechanism for the regulation of HIF-1 under high glucose and hypoxic conditions, which also relies on methylglyoxal-induced modifications. We showed that methylglyoxal is capable of inducing modifications on HIF-1α (such as the formation of methylglyoxal-derived hydroimidazolone 1, also referred to as MG-H1, adducts), leading to the increased association of HIF-1α with the molecular chaperones HSP40 and HSP70. These molecular chaperones subsequently recruit CHIP, which induces the polyubiquitination of HIF-1α and its degradation [43] (Fig. 3). This mechanism of degradation appears to be mostly dependent on the proteasome, although other proteolytic pathways might also be involved in the degradation of methylglyoxal-modified HIF-1α. Canonically, CHIP has a key role in protein quality control by inducing ubiquitination of damaged proteins. The ability of CHIP to ubiquitinate HIF-1α under these conditions unravels an unanticipated role for CHIP in the loss of the cellular response to hypoxia under high glucose conditions such as diabetes. Interestingly, CHIP was also found to induce HIF-1α proteasomal degradation by a mechanism dependent on HSP70 in response to prolonged hypoxia [42]. Hypoxia is well known to increase the glycolytic rate and, most likely, the generation of reactive by-products of glycolysis, such as methylglyoxal. Thus, it is tempting to speculate that perhaps the CHIP-dependent degradation of HIF-1α under prolonged hypoxic conditions is associated with an increased availability of methylglyoxal. We further observed that GLO1 overexpression was able to prevent methylglyoxal- and high glucose-induced destabilisation of HIF-1α under hypoxic conditions [43]. Furthermore, GLO1 overexpression prevents the methylglyoxal-induced decrease of VEGF levels and silencing of GLO1 mimics the effects of methylglyoxal on the release of VEGF [81]. These data were obtained using cell culture systems and require physiological validation in animal models of diabetes, opening new avenues for future studies.
It is interesting to note that the two models proposed by Gurtner et al. and our CHIP-dependent model of HIF-1 deregulation are not inconsistent. Indeed, it is plausible that the decreased interaction between HIF-1α–p300 and HIF-1α–HIF-1β in the presence of methylglyoxal increases the amounts of modified and monomeric HIF-1α that are available to undergo degradation through a CHIP-mediated pathway. This hypothesis has not been confirmed nor addressed before, although it appears to be a promising possibility.
Other studies have suggested a role for HIF hydroxylases in impairment of the HIF-mediated cellular response to hypoxia in hyperglycaemia. Indeed, Catrina and collaborators found that inhibition of hydroxylases by DMOG or DFO prevents the repressive effects of high glucose levels on HIF-1α protein stability and activity and the expression of HIF-1 target genes [59]. This preventive effect was ablated in renal carcinoma cells producing functionally inactive VHL, suggesting a role for VHL in the destabilisation of HIF-1α at high glucose levels. Furthermore, local inhibition of HIF hydroxylases by DMOG and DFO improved the wound healing process in db/db diabetic animals and increased the stability of HIF-1α (Fig. 3). However, stabilisation of HIF-1α by DMOG and DFO in wounds of db/db mice was only partial compared with that in controls [59], suggesting that other mechanisms are likely to be involved in the destabilisation of HIF-1α under high glucose conditions.
These and other studies clearly show that further investigation is needed to clarify the mechanisms implicated in HIF-1 deregulation in diabetes. Some discrepancies may be due to cell- and tissue-specific regulatory mechanisms and further experimentation with animal models is required to corroborate the majority of data gathered in cell culture systems.
Conclusions and future directions
This review summarises some of the most recent developments accomplished in the area of the loss of the cellular response to hypoxia and impairment of HIF-1 regulation in diabetes. It has been clearly established that HIF-1α stability and function are compromised by high glucose concentrations and a few molecular models have been proposed to explain this impairment. Some of these models rely on methylglyoxal-induced modifications on HIF-1α or other components of the HIF-1 regulation pathway, which appear to compromise both the protein stability and function [43, 61]. Other groups have suggested a role for VHL and enzymatic hydroxylation in HIF-1α destabilisation at high glucose levels [59], which led to the hypothesis that therapeutic approaches based on the use of hydroxylase inhibitors might prevent many of the maladaptive responses derived from impairment of HIF-1 regulation by hyperglycaemia. Other therapeutic opportunities might be based on the overexpression of GLO1 (to increase detoxification of methylglyoxal and, as a consequence, to increase the stability and function of HIF-1α) [43, 61, 77, 81], inhibition or silencing of CHIP (to diminish the degradation of HIF-1α modified by methylglyoxal) [43] or overexpression of the gene encoding superoxide dismutase or other enzymes that may favour the decreased production of reactive oxygen species in diabetic tissues (to prevent methylglyoxal-induced modification of p300) [61]. Additionally, it should be noted that insulin can stimulate HIF-1α expression through a signalling pathway dependent on the activation of PI3K and the target of rapamycin (TOR) [93]. This could be of great significance since administration of insulin may ameliorate diabetic complications arising from a poor cellular response to low oxygen levels.
Unfortunately some of the approaches described above may be subject to limitations. For example, silencing or inhibition of CHIP may compromise several crucial cellular pathways and does not reverse the loss of function associated with direct modification of HIF-1α induced by methylglyoxal. Additionally, GLO1 function appears to be compromised in diabetes, since GLO1 is a GSH-dependent enzyme (reviewed in [94]) and GSH levels are decreased in diabetic tissues [95]. Thus, GLO1 overexpression would probably require a concomitant strategy to increase GSH levels in cells. On the other hand, insulin, for example, was found to exacerbate the breakdown of the blood–retinal barrier via upregulation of HIF-1α and VEGF levels [96], which may lead to the worsening of diabetic retinopathy.
Taken together, these data indicate that further biological, pharmacological and clinical work is needed to better understand the mechanisms and molecular players involved in the loss of the cellular response to low oxygen in diabetes. These may contribute to the development of new therapeutic approaches for the treatment of diabetic complications associated with hypoxia.
Abbreviations
- CBP:
-
CREB Binding Protein
- CHIP:
-
Carboxy terminus of HSP70-interacting protein
- CXCR4:
-
C-X-C chemokine receptor type 4
- DMOG:
-
Dimethyloxalylglycine
- DFO:
-
Desferrioxamine
- eNOS:
-
Endothelial NOS
- EPC:
-
Endothelial progenitor cell
- FIH-1:
-
Factor-inhibiting HIF-1
- GLO1:
-
Glyoxalase 1
- HIF-1:
-
Hypoxia-inducible factor 1
- HSP:
-
Heat-shock protein
- MAPK:
-
Mitogen-activated protein kinase
- NOS:
-
Nitric oxide synthase
- PHD:
-
Prolyl hydroxylase
- PI3K:
-
Phosphoinositol 3-kinase
- SDF-1:
-
Stromal cell-derived factor-1
- SUMO:
-
Small ubiquitin-like modifier
- TCA:
-
Tricarboxylic acid cycle
- VHL:
-
von Hippel–Lindau protein
- VEGF:
-
Vascular endothelial growth factor
References
Wang GL, Jiang BH, Rue EA, Semenza GL (1995) Hypoxia-inducible factor 1 is a basic-helix-loop-helix-PAS heterodimer regulated by cellular O2 tension. Proc Natl Acad Sci USA 92:5510–5514
Semenza GL, Nejfelt MK, Chi SM, Antonarakis SE (1991) Hypoxia-inducible nuclear factors bind to an enhancer element located 3′ to the human erythropoietin gene. Proc Natl Acad Sci USA 88:5680–5684
Semenza GL, Wang GL (1992) A nuclear factor induced by hypoxia via de novo protein synthesis binds to the human erythropoietin gene enhancer at a site required for transcriptional activation. Mol Cell Biol 12:5447–5454
Huang LE, Gu J, Schau M, Bunn HF (1998) Regulation of hypoxia-inducible factor 1alpha is mediated by an O2-dependent degradation domain via the ubiquitin-proteasome pathway. Proc Natl Acad Sci USA 95:7987–7992
Salceda S, Caro J (1997) Hypoxia-inducible factor 1α (HIF-1α) protein is rapidly degraded by the ubiquitin-proteasome system under normoxic conditions. Its stabilization by hypoxia depends on redox-induced changes. J Biol Chem 272:22642–22647
Huang LE, Arany Z, Livingston DM, Bunn HF (1996) Activation of hypoxia-inducible transcription factor depends primarily upon redox-sensitive stabilization of its alpha subunit. J Biol Chem 271:32253–32259
Yu AY, Frid MG, Shimoda LA, Wiener CM, Stenmark K, Semenza GL (1998) Temporal, spatial, and oxygen-regulated expression of hypoxia-inducible factor-1 in the lung. Am J Physiol 275:L818–826
Berra E, Benizri E, Ginouves A, Volmat V, Roux D, Pouyssegur J (2003) HIF prolyl-hydroxylase 2 is the key oxygen sensor setting low steady-state levels of HIF-1α in normoxia. EMBO J 22:4082–4090
Hon WC, Wilson MI, Harlos K et al (2002) Structural basis for the recognition of hydroxyproline in HIF-1α by pVHL. Nature 417:975–978
Bruick RK, McKnight SL (2001) A conserved family of prolyl-4-hydroxylases that modify HIF. Science 294:1337–1340
Ivan M, Kondo K, Yang H et al (2001) HIFα targeted for VHL-mediated destruction by proline hydroxylation: implications for O2 sensing. Science 292:464–468
Jaakkola P, Mole DR, Tian YM et al (2001) Targeting of HIF-α to the von Hippel–Lindau ubiquitylation complex by O2-regulated prolyl hydroxylation. Science 292:468–472
Salnikow K, Donald SP, Bruick RK, Zhitkovich A, Phang JM, Kasprzak KS (2004) Depletion of intracellular ascorbate by the carcinogenic metals nickel and cobalt results in the induction of hypoxic stress. J Biol Chem 279:40337–40344
Wang GL, Semenza GL (1993) Desferrioxamine induces erythropoietin gene expression and hypoxia-inducible factor 1 DNA-binding activity: implications for models of hypoxia signal transduction. Blood 82:3610–3615
Yuan Y, Hilliard G, Ferguson T, Millhorn DE (2003) Cobalt inhibits the interaction between hypoxia-inducible factor-α and von Hippel–Lindau protein by direct binding to hypoxia-inducible factor-α. J Biol Chem 278:15911–15916
Hewitson KS, Lienard BM, McDonough MA et al (2007) Structural and mechanistic studies on the inhibition of the hypoxia-inducible transcription factor hydroxylases by tricarboxylic acid cycle intermediates. J Biol Chem 282:3293–3301
Selak MA, Armour SM, MacKenzie ED et al (2005) Succinate links TCA cycle dysfunction to oncogenesis by inhibiting HIF-α prolyl hydroxylase. Cancer Cell 7:77–85
Maxwell PH, Wiesener MS, Chang GW et al (1999) The tumour suppressor protein VHL targets hypoxia-inducible factors for oxygen-dependent proteolysis. Nature 399:271–275
Cockman ME, Masson N, Mole DR et al (2000) Hypoxia inducible factor-alpha binding and ubiquitylation by the von Hippel–Lindau tumor suppressor protein. J Biol Chem 275:25733–25741
Kamura T, Sato S, Iwai K, Czyzyk-Krzeska M, Conaway RC, Conaway JW (2000) Activation of HIF1alpha ubiquitination by a reconstituted von Hippel–Lindau (VHL) tumor suppressor complex. Proc Natl Acad Sci USA 97:10430–10435
Ohh M, Park CW, Ivan M et al (2000) Ubiquitination of hypoxia-inducible factor requires direct binding to the β-domain of the von Hippel–Lindau protein. Nat Cell Biol 2:423–427
Iwai K, Yamanaka K, Kamura T et al (1999) Identification of the von Hippel–Lindau tumor-suppressor protein as part of an active E3 ubiquitin ligase complex. Proc Natl Acad Sci USA 96:12436–12441
Stebbins CE, Kaelin WG Jr, Pavletich NP (1999) Structure of the VHL-ElonginC-ElonginB complex: implications for VHL tumor suppressor function. Science 284:455–461
Mahon PC, Hirota K, Semenza GL (2001) FIH-1: a novel protein that interacts with HIF-1α and VHL to mediate repression of HIF-1 transcriptional activity. Genes Dev 15:2675–2686
Hewitson KS, McNeill LA, Riordan MV et al (2002) Hypoxia-inducible factor (HIF) asparagine hydroxylase is identical to factor inhibiting HIF (FIH) and is related to the cupin structural family. J Biol Chem 277:26351–26355
Lando D, Peet DJ, Gorman JJ, Whelan DA, Whitelaw ML, Bruick RK (2002) FIH-1 is an asparaginyl hydroxylase enzyme that regulates the transcriptional activity of hypoxia-inducible factor. Genes Dev 16:1466–1471
Linke S, Stojkoski C, Kewley RJ, Booker GW, Whitelaw ML, Peet DJ (2004) Substrate requirements of the oxygen-sensing asparaginyl hydroxylase factor-inhibiting hypoxia-inducible factor. J Biol Chem 279:14391–14397
Safran M, Kaelin WG Jr (2003) HIF hydroxylation and the mammalian oxygen-sensing pathway. J Clin Invest 111:779–783
Kimura H, Weisz A, Ogura T et al (2001) Identification of hypoxia-inducible factor 1 ancillary sequence and its function in vascular endothelial growth factor gene induction by hypoxia and nitric oxide. J Biol Chem 276:2292–2298
Carmeliet P, Dor Y, Herbert JM et al (1998) Role of HIF-1α in hypoxia-mediated apoptosis, cell proliferation and tumour angiogenesis. Nature 394:485–490
Forsythe JA, Jiang BH, Iyer NV et al (1996) Activation of vascular endothelial growth factor gene transcription by hypoxia-inducible factor 1. Mol Cell Biol 16:4604–4613
Hu J, Discher DJ, Bishopric NH, Webster KA (1998) Hypoxia regulates expression of the endothelin-1 gene through a proximal hypoxia-inducible factor-1 binding site on the antisense strand. Biochem Biophys Res Commun 245:894–899
Lee PJ, Jiang BH, Chin BY et al (1997) Hypoxia-inducible factor-1 mediates transcriptional activation of the heme oxygenase-1 gene in response to hypoxia. J Biol Chem 272:5375–5381
Palmer LA, Semenza GL, Stoler MH, Johns RA (1998) Hypoxia induces type II NOS gene expression in pulmonary artery endothelial cells via HIF-1. Am J Physiol 274:L212–L219
Aicher A, Heeschen C, Mildner-Rihm C et al (2003) Essential role of endothelial nitric oxide synthase for mobilization of stem and progenitor cells. Nat Med 9:1370–1376
Thum T, Fraccarollo D, Schultheiss M et al (2007) Endothelial nitric oxide synthase uncoupling impairs endothelial progenitor cell mobilization and function in diabetes. Diabetes 56:666–674
Weidemann A, Johnson RS (2008) Biology of HIF-1α. Cell Death Differ 15:621–627
Ceradini DJ, Kulkarni AR, Callaghan MJ et al (2004) Progenitor cell trafficking is regulated by hypoxic gradients through HIF-1 induction of SDF-1. Nat Med 10:858–864
Zagzag D, Krishnamachary B, Yee H et al (2005) Stromal cell-derived factor-1α and CXCR4 expression in hemangioblastoma and clear cell-renal cell carcinoma: von Hippel–Lindau loss-of-function induces expression of a ligand and its receptor. Cancer Res 65:6178–6188
Liu YV, Baek JH, Zhang H, Diez R, Cole RN, Semenza GL (2007) RACK1 competes with HSP90 for binding to HIF-1α and is required for O2-independent and HSP90 inhibitor-induced degradation of HIF-1α. Mol Cell 25:207–217
Kong X, Lin Z, Liang D, Fath D, Sang N, Caro J (2006) Histone deacetylase inhibitors induce VHL and ubiquitin-independent proteasomal degradation of hypoxia-inducible factor 1alpha. Mol Cell Biol 26:2019–2028
Luo W, Zhong J, Chang R, Hu H, Pandey A, Semenza GL (2009) Hsp70 and CHIP selectively mediate ubiquitination and degradation of hypoxia-inducible factor (HIF)-1α but not HIF-2α. J Biol Chem 285:3651–3663
Bento CF, Fernandes R, Ramalho J et al (2010) The chaperone-dependent ubiquitin ligase CHIP targets HIF-1α for degradation in the presence of methylglyoxal. PLoS ONE 5:e15062
Phillips SA, Thornalley PJ (1993) The formation of methylglyoxal from triose phosphates. Investigation using a specific assay for methylglyoxal. Eur J Biochem 212:101–105
Chen D, Li M, Luo J, Gu W (2003) Direct interactions between HIF-1α and Mdm2 modulate p53 function. J Biol Chem 278:13595–13598
Hansson LO, Friedler A, Freund S, Rudiger S, Fersht AR (2002) Two sequence motifs from HIF-1α bind to the DNA-binding site of p53. Proc Natl Acad Sci USA 99:10305–10309
Tang TT, Lasky LA (2003) The forkhead transcription factor FOXO4 induces the down-regulation of hypoxia-inducible factor 1α by a von Hippel–Lindau protein-independent mechanism. J Biol Chem 278:30125–30135
Koh MY, Darnay BG, Powis G (2008) Hypoxia-associated factor, a novel E3-ubiquitin ligase, binds and ubiquitinates hypoxia-inducible factor 1α, leading to its oxygen-independent degradation. Mol Cell Biol 28:7081–7095
Li Z, Wang D, Messing EM, Wu G (2005) VHL protein-interacting deubiquitinating enzyme 2 deubiquitinates and stabilizes HIF-1α. EMBO Rep 6:373–378
Cheng J, Kang X, Zhang S, Yeh ET (2007) SUMO-specific protease 1 is essential for stabilization of HIF1α during hypoxia. Cell 131:584–595
Carbia-Nagashima A, Gerez J, Perez-Castro C et al (2007) RSUME, a small RWD-containing protein, enhances SUMO conjugation and stabilizes HIF-1α during hypoxia. Cell 131:309–323
Berta MA, Mazure N, Hattab M, Pouyssegur J, Brahimi-Horn MC (2007) SUMOylation of hypoxia-inducible factor-1α reduces its transcriptional activity. Biochem Biophys Res Commun 360:646–652
Maynard MA, Ohh M (2007) The role of hypoxia-inducible factors in cancer. Cell Mol Life Sci 64:2170–2180
Sang N, Stiehl DP, Bohensky J, Leshchinsky I, Srinivas V, Caro J (2003) MAPK signaling up-regulates the activity of hypoxia-inducible factors by its effects on p300. J Biol Chem 278:14013–14019
Mylonis I, Chachami G, Samiotaki M et al (2006) Identification of MAPK phosphorylation sites and their role in the localization and activity of hypoxia-inducible factor-1α. J Biol Chem 281:33095–33106
Rivard A, Silver M, Chen D et al (1999) Rescue of diabetes-related impairment of angiogenesis by intramuscular gene therapy with adeno-VEGF. Am J Pathol 154:355–363
Sarkar K, Fox-Talbot K, Steenbergen C, Bosch-Marce M, Semenza GL (2009) Adenoviral transfer of HIF-1α enhances vascular responses to critical limb ischemia in diabetic mice. Proc Natl Acad Sci USA 106:18769–18774
Schatteman GC, Hanlon HD, Jiao C, Dodds SG, Christy BA (2000) Blood-derived angioblasts accelerate blood-flow restoration in diabetic mice. J Clin Invest 106:571–578
Botusan IR, Sunkari VG, Savu O et al (2008) Stabilization of HIF-1α is critical to improve wound healing in diabetic mice. Proc Natl Acad Sci USA 105:19426–19431
Gallagher KA, Liu ZJ, Xiao M et al (2007) Diabetic impairments in NO-mediated endothelial progenitor cell mobilization and homing are reversed by hyperoxia and SDF-1α. J Clin Invest 117:1249–1259
Ceradini DJ, Yao D, Grogan RH et al (2008) Decreasing intracellular superoxide corrects defective ischemia-induced new vessel formation in diabetic mice. J Biol Chem 283:10930–10938
Fadini GP, Sartore S, Schiavon M et al (2006) Diabetes impairs progenitor cell mobilisation after hindlimb ischaemia–reperfusion injury in rats. Diabetologia 49:3075–3084
Liu L, Marti GP, Wei X et al (2008) Age-dependent impairment of HIF-1α expression in diabetic mice: correction with electroporation-facilitated gene therapy increases wound healing, angiogenesis, and circulating angiogenic cells. J Cell Physiol 217:319–327
Loomans CJ, de Koning EJ, Staal FJ et al (2004) Endothelial progenitor cell dysfunction: a novel concept in the pathogenesis of vascular complications of type 1 diabetes. Diabetes 53:195–199
Tamarat R, Silvestre JS, Le Ricousse-Roussanne S et al (2004) Impairment in ischemia-induced neovascularization in diabetes: bone marrow mononuclear cell dysfunction and therapeutic potential of placenta growth factor treatment. Am J Pathol 164:457–466
Tepper OM, Galiano RD, Capla JM et al (2002) Human endothelial progenitor cells from type II diabetics exhibit impaired proliferation, adhesion, and incorporation into vascular structures. Circulation 106:2781–2786
Catrina SB, Okamoto K, Pereira T, Brismar K, Poellinger L (2004) Hyperglycemia regulates hypoxia-inducible factor-1alpha protein stability and function. Diabetes 53:3226–3232
Mace KA, Yu DH, Paydar KZ, Boudreau N, Young DM (2007) Sustained expression of Hif-1α in the diabetic environment promotes angiogenesis and cutaneous wound repair. Wound Repair Regen 15:636–645
Chou E, Suzuma I, Way KJ et al (2002) Decreased cardiac expression of vascular endothelial growth factor and its receptors in insulin-resistant and diabetic states: a possible explanation for impaired collateral formation in cardiac tissue. Circulation 105:373–379
Baelde HJ, Eikmans M, Lappin DW et al (2007) Reduction of VEGF-A and CTGF expression in diabetic nephropathy is associated with podocyte loss. Kidney Int 71:637–645
Wirostko B, Wong TY, Simo R (2008) Vascular endothelial growth factor and diabetic complications. Prog Retin Eye Res 27:608–621
Duh E, Aiello LP (1999) Vascular endothelial growth factor and diabetes: the agonist vs antagonist paradox. Diabetes 48:1899–1906
Yoon YS, Uchida S, Masuo O et al (2005) Progressive attenuation of myocardial vascular endothelial growth factor expression is a seminal event in diabetic cardiomyopathy: restoration of microvascular homeostasis and recovery of cardiac function in diabetic cardiomyopathy after replenishment of local vascular endothelial growth factor. Circulation 111:2073–2085
Price SA, Dent C, Duran-Jimenez B et al (2006) Gene transfer of an engineered transcription factor promoting expression of VEGF-A protects against experimental diabetic neuropathy. Diabetes 55:1847–1854
Murakami T, Arai M, Sunada Y, Nakamura A (2006) VEGF 164 gene transfer by electroporation improves diabetic sensory neuropathy in mice. J Gene Med 8:773–781
Chattopadhyay M, Krisky D, Wolfe D, Glorioso JC, Mata M, Fink DJ (2005) HSV-mediated gene transfer of vascular endothelial growth factor to dorsal root ganglia prevents diabetic neuropathy. Gene Ther 12:1377–1384
Thangarajah H, Yao D, Chang EI et al (2009) The molecular basis for impaired hypoxia-induced VEGF expression in diabetic tissues. Proc Natl Acad Sci USA 106:13505–13510
Malmberg K, Norhammar A, Wedel H, Ryden L (1999) Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation 99:2626–2632
Teixeira AS, Andrade SP (1999) Glucose-induced inhibition of angiogenesis in the rat sponge granuloma is prevented by aminoguanidine. Life Sci 64:655–662
Tamarat R, Silvestre JS, Huijberts M et al (2003) Blockade of advanced glycation end-product formation restores ischemia-induced angiogenesis in diabetic mice. Proc Natl Acad Sci USA 100:8555–8560
Bento CF, Fernandes R, Matafome P, Sena C, Seica R, Pereira P (2010) Methylglyoxal-induced imbalance in the ratio of vascular endothelial growth factor to angiopoietin 2 secreted by retinal pigment epithelial cells leads to endothelial dysfunction. Exp Physiol 95:955–970
Abaci A, Oguzhan A, Kahraman S et al (1999) Effect of diabetes mellitus on formation of coronary collateral vessels. Circulation 99:2239–2242
Larger E, Marre M, Corvol P, Gasc JM (2004) Hyperglycemia-induced defects in angiogenesis in the chicken chorioallantoic membrane model. Diabetes 53:752–761
Marfella R, D’Amico M, Di Filippo C et al (2002) Myocardial infarction in diabetic rats: role of hyperglycaemia on infarct size and early expression of hypoxia-inducible factor 1. Diabetologia 45:1172–1181
Xue W, Cai L, Tan Y et al (2010) Cardiac-specific overexpression of HIF-1α prevents deterioration of glycolytic pathway and cardiac remodeling in streptozotocin-induced diabetic mice. Am J Pathol 177:97–105
Gunton JE, Kulkarni RN, Yim S et al (2005) Loss of ARNT/HIF1β mediates altered gene expression and pancreatic-islet dysfunction in human type 2 diabetes. Cell 122:337–349
Nagy G, Kovacs-Nagy R, Kereszturi E et al (2009) Association of hypoxia inducible factor-1 α gene polymorphism with both type 1 and type 2 diabetes in a Caucasian (Hungarian) sample. BMC Med Genet 10:79
Yamada N, Horikawa Y, Oda N et al (2005) Genetic variation in the hypoxia-inducible factor-1α gene is associated with type 2 diabetes in Japanese. J Clin Endocrinol Metab 90:5841–5847
Resar JR, Roguin A, Voner J et al (2005) Hypoxia-inducible factor 1α polymorphism and coronary collaterals in patients with ischemic heart disease. Chest 128:787–791
Isoe T, Makino Y, Mizumoto K et al (2010) High glucose activates HIF-1-mediated signal transduction in glomerular mesangial cells through a carbohydrate response element binding protein. Kidney Int 78:48–59
Makino H, Miyamoto Y, Sawai K et al (2006) Altered gene expression related to glomerulogenesis and podocyte structure in early diabetic nephropathy of db/db mice and its restoration by pioglitazone. Diabetes 55:2747–2756
Guo S, Bragina O, Xu Y et al (2008) Glucose up-regulates HIF-1α expression in primary cortical neurons in response to hypoxia through maintaining cellular redox status. J Neurochem 105:1849–1860
Treins C, Giorgetti-Peraldi S, Murdaca J, Semenza GL, Van Obberghen E (2002) Insulin stimulates hypoxia-inducible factor 1 through a phosphatidylinositol 3-kinase/target of rapamycin-dependent signaling pathway. J Biol Chem 277:27975–27981
Thornalley PJ (2003) Glyoxalase I—structure, function and a critical role in the enzymatic defence against glycation. Biochem Soc Trans 31:1343–1348
Dinçer Y, Alademir Z, Ilkova H, Akçay T (2002) Susceptibility of glutatione and glutathione-related antioxidant activity to hydrogen peroxide in patients with type 2 diabetes: effect of glycemic control. Clin Biochem 35:297–301
Poulaki V, Qin W, Joussen AM et al (2002) Acute intensive insulin therapy exacerbates diabetic blood–retinal barrier breakdown via hypoxia-inducible factor-1α and VEGF. J Clin Invest 109:805–815
Acknowledgements
The work of the authors was supported by the PhD fellowship SFRH/BD/15229/2004 (to C. F. Bento) and the grant PDTC/SAU-OBS/67498/2006 funded by Fundação para a Ciência e a Tecnologia (FCT), Portugal.
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Bento, C.F., Pereira, P. Regulation of hypoxia-inducible factor 1 and the loss of the cellular response to hypoxia in diabetes. Diabetologia 54, 1946–1956 (2011). https://doi.org/10.1007/s00125-011-2191-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00125-011-2191-8