Forkhead Box Proteins: Tuning Forks for Transcriptional Harmony
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REVIEWS Forkhead box proteins: tuning forks for transcriptional harmony Eric W.‑F. Lam1, Jan J. Brosens2, Ana R. Gomes1 and Chuay-Yeng Koo1 Abstract | Forkhead box (FOX) proteins are multifaceted transcription factors that are responsible for fine-tuning the spatial and temporal expression of a broad range of genes both during development and in adult tissues. This function is engrained in their ability to integrate a multitude of cellular and environmental signals and to act with remarkable fidelity. Several key members of the FOXA, FOXC, FOXM, FOXO and FOXP subfamilies are strongly implicated in cancer, driving initiation, maintenance, progression and drug resistance. The functional complexities of FOX proteins are coming to light and have established these transcription factors as possible therapeutic targets and putative biomarkers for specific cancers. Pioneer factors Forkhead box (FOX) proteins constitute an extended functional redundancy exists, certain FOX proteins, such Transcription factors that can family of transcriptional regulators that are related as FOXM1 and FOXO3A (also known as FKHRL1), not recognize specific DNA through the presence of an evolutionary conserved ‘fork- only compete for binding to the same DNA motif in target sequences and that actively head’ or ‘winged-helix’ DNA-binding domain (DBD)1. promoters but also produce opposing transcriptional out- open up compacted 5–7 pioneer factors chromatin, rendering it The founding member of the FOX family was identified puts . FOX transcription factors are also competent for other factors to in the fruitfly (Drosophila melanogaster) more than two that are capable of directly decondensing chromatin, bind. decades ago. Mutation of the region-specific homeotic thus facilitating the binding of other sequence-specific gene forkhead (fkh) resulted in ectopic head structures in transcription factors to target enhancers, repressors and the embryos, thus coining the family name2. Fifty fork- promoters8. head proteins have since been identified in the human genome3. They are further categorized into 19 subgroups FOXs in pro- and anti-oncogenic pathways (FOXA to FOXS) on the basis of sequence homology The expression and activity of FOX proteins are tightly inside and outside the forkhead domain1,4. controlled both during development and in adult tissues. The human FOX superfamily is too large for us to In order to modulate distinct gene networks in response embark on a meaningful discussion of each member to specific environmental cues, the activity of FOX here. Instead, we focus on key constituents of five sub- proteins must also be finely tuned. Post-translational families that are, often for very different reasons, impli- modifications (PTMs) represent a dynamic mechanism 1Department of Surgery and cated in the inception, maintenance and/or progression to coordinate environmental signals and the functional Cancer, Imperial Centre for of malignancies. Here, we discuss recent insights into the properties of various family members9,10. For example, Translational and mechanistic complexities that control these transcrip- acetylation modifies the DNA-binding and transcrip- Experimental Medicine (ICTEM), Imperial College tional regulators and their functions, and how these tional activities of FOXO proteins, whereas the same London, Hammersmith findings open up new avenues for cancer prevention, modification affects the subcellular localization and Hospital Campus, Du Cane diagnosis and treatment1. stability of FOXP family members9–11. Perhaps with the Road, London W12 0NN, UK. The ability to coordinate temporal and spatial gene exception of FOXO and FOXM1, a precise definition 2Division of Reproductive Health, Warwick Medical expression underpins the pleiotropic roles of FOX pro- of the nature and functional consequences of PTMs of School, Clinical Sciences teins during embryonic development and homeostasis other FOX proteins is currently lacking. This is a cru- Research Laboratories, of adult tissues. Despite high sequence conservation in cial level of regulation as it is encumbered on FOX pro- University Hospital, Coventry the core forkhead motifs, FOX proteins control divergent teins to produce a high-fidelity transcriptional response CV2 2DX, UK. and even opposing cell fate decisions by regulating gene to ensure cellular, tissue and organismal homeostasis. Correspondence to E.W.-F.L. e-mail: networks that are involved in cell cycle progression, pro- Consequently, the deregulation of FOX proteins is heav- [email protected] liferation and differentiation, as well as in metabolism, ily implicated in cancer initiation and progression, as well doi:10.1038/nrc3539 senescence, survival and apoptosis. Although some as cellular resistance to chemotherapy1 (FIG. 1). 482 | JULY 2013 | VOLUME 13 www.nature.com/reviews/cancer © 2013 Macmillan Publishers Limited. All rights reserved REVIEWS Key points arginine methyltransferase PRMT1 antagonizes phos- phorylation by AKT26. FOXO proteins are also acetylated • Forkhead box (FOX) proteins are a superfamily of transcriptional regulators that have a by the histone acetyltransferase p300, which promotes key role both during development and in adult tissue homeostasis. Fifty human FOX cytoplasmic translocation and degradation. Conversely, proteins related through their ‘forkhead’ or ‘winged-helix’ DNA-binding domain (DBD) deacetylation of FOXOs by class III histone deacetylases have been discovered, and they are further divided into 19 subfamilies (FOXA to FOXS) 27 on the basis of sequence homology within and outside their forkhead domain. (sirtuins; also known as SIRTs) and class IIa histone • Forkhead transcription factors, in particular FOXA, FOXC, FOXM, FOXO and FOXP deacetylaces (HDACs) enhances the targeting and acti- proteins, are essential components of oncogenic and tumour suppressive pathways. vation of specific genes that confer resistance to oxidative 28 • Deregulation of FOX proteins has a direct role in cancer initiation, maintenance, stress and cytotoxic anticancer agents . Consequently, progression and drug resistance. deregulation of these PTMs inevitably affects the activity • Control of various FOX family members is not only achieved through cell-specific of FOXO transcription factors and, in some cases, directly expression, but is also fine-tuned by a myriad of post-translational modifications and contributes to tumour initiation, progression and drug through interactions with specific cofactors. resistance1,29. • Besides being conventional transcriptional activators, FOX proteins also function as FOXOs are negative regulators of cell proliferation. transcriptional repressors, pioneer factors, and they modulate and cooperate with Besides repressing the activity of cyclin D1 and cyclin D2, other transcription factors and epigenetic effectors. FOXOs also induce the expression of specific cell cycle • A better understanding of the mechanistic complexities that govern the regulation inhibitors (p21 (also known as WAF1 and CIP1), p27 and functions of these FOX transcription factors should help us to realize their (also known as KIP1), p15 (also known as INK4B) and potential as therapeutic targets, as well as reliable predictive markers for cancer. p19 (also known as INK4D)), thus stalling G1/S phase transition30–34 (TABLE 1). FOXO proteins further serve as gatekeepers for G2 and M phase entry and transition by FOXOs in tumour suppression. The ‘O’ subclass is per- regulating G2/M checkpoint genes, such as DNA damage- haps the most well-studied of all FOX subfamilies. These inducible protein 45A (GADD45A), cyclin G2 (CCNG2) FOXO proteins are key negative regulators of cell pro- and polo-like kinase 1 (PLK1)35–37. If required, FOXOs liferation and survival1. Four members constitute this ensure tissue homeostasis by inducing programmed cell group: FOXO1 (also known as FKHR), FOXO3A, FOXO4 death. Again, this function of FOXOs is implemented (also known as AFX and MLLT7)1 and FOXO6 (REF. 12). through specific PTMs that are responsive to environ- In addition, several as yet poorly characterized splice mental stressors, and these lead to the activation of key variants have been described13. Mammalian FOXOs are pro-apoptotic genes, including BAD, CASP9 (encod- widely expressed in a variety of tissues throughout the ing caspase 9), FASLG (encoding Fas ligand), BCL2L11 body, with the exception of FOXO6, which is reportedly (encoding BIM), TNFSF10 (encoding tumour necrosis present only in adult brain tissue12. FOXO transcription factor-related apoptosis-inducing ligand (TRAIL)) and factors are bona fide tumour suppressors. Simultaneous BCL6 (REFS 18,38–41). FOXO proteins also cooperate with broad somatic deletion of all Foxo1, Foxo3 and Foxo4 nuclear transcription factor Y (NFY) and the SP1 tran- alleles generates thymic lymphomas and systemic scription factor to promote the expression of the tumour haemangiomas in mice14. In humans, loss of FOXO1 suppressor LKB1 (also known as STK11)42. Another expression as a result of chromosomal deletion (13q14) tumour suppressive mechanism used by FOXOs involves also promotes androgen- and androgen receptor (AR)- the inhibition of the transcription that is dependent independent prostate tumorigenesis15. FOXO proteins, on the proto-oncogene MYC through the induction of the and particularly FOXO3A, function downstream of sev- functional antagonist MXI1 (REF. 43). eral oncogenic pathways9, including the ERK16, nuclear FOXOs are also relevant to cancer progression in ways factor-κB (NF‑κB)–inhibitor