Skeletal muscle atrophy is a common and often debilitating complication of diverse stresses including muscle disuse, fasting, aging, critical illness and many chronic illnesses. However, the pathogenesis of muscle atrophy is still poorly understood. The thesis herein describes my studies investigating the molecular mechanisms of skeletal muscle atrophy. Using mouse skeletal muscle and cultured skeletal myotubes as experimental systems, I discovered a novel stress-induced pathway in skeletal muscle that causes muscle atrophy. The pathway begins with stress-induced expression of ATF4, a basic leucine zipper (bZIP) transcription factor with an evolutionarily ancient role in cellular stress responses. I found that diverse stresses including fasting and muscle disuse increase expression of ATF4 in skeletal muscle. ATF4 then activates the growth arrest and DNA damage-inducible 45a (Gadd45a) gene, leading to increased expression of Gadd45a protein, an essential and inducible subunit of DNA demethylase complexes. Gadd45a localizes to skeletal myonuclei where it interacts with and stimulates demethylation of a specific region in the promoter of the cyclin dependent kinase inhibitor 1a (Cdkn1a) gene. By demethylating the Cdkn1a promoter, Gadd45a activates the Cdkn1a gene, leading to increased expression of Cdkn1a protein, also known as p21WAF1/CIP1. Cdkn1a stimulates protein breakdown (a critical pro-atrophy process) and inhibits anabolic signaling, protein synthesis and PGC-1&agr; expression (processes that maintain healthy skeletal muscle and protect against atrophy). As a result, Cdkn1a causes skeletal muscle fibers to undergo atrophy. Importantly, interventions that reduce any one component of this pathway (ATF4, Gadd45a or Cdkn1a) reduce skeletal muscle atrophy during fasting, muscle disuse, and perhaps other skeletal muscle stresses such as illness and aging. Conversely, forced expression of any one component of this pathway is sufficient to cause skeletal muscle fiber atrophy in the absence of upstream stress. These data suggest the ATF4/Gadd45a/Cdkn1a pathway as a potential therapeutic target. Collectively, my studies demonstrate that the sequential, stress-induced expression of ATF4, Gadd45a and Cdkn1a is a critical process in the pathogenesis of skeletal muscle atrophy. This significantly advances our understanding of how muscle atrophy occurs and it opens up new avenues of investigation into the causes and treatment of muscle atrophy.
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