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Roelof Koster, Alessandra di Pietro, Hetty Timmer-Bosscha, Johan H. Gibcus, Anke van den Berg, Albert J. Suurmeijer, Rainer Bischoff, Jourik A. Gietema, Steven de Jong
Published in Volume 120, Issue 10
J Clin Invest. 2010; 120(10):3594–3605 doi:10.1172/JCI41939
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Figure 8
Proposed simplified model showing the mechanisms through which cytoplasmic p21 can inhibit cisplatin-induced apoptosis in EC cells.

Cisplatin-induced DNA damage activates p53, which in turn transcribes CDKN1A (p21) and activates the Fas apoptosis pathway and the mitochondrial apoptosis pathway. Activated Akt is important for dynamic shuttling of p21 from the nucleus toward the cytoplasm, where p21 can block apoptosis. miR-106b seed family members (miR-106b fam.) are involved in regulating p21 expression levels. Oct4 regulates the expression levels of the miR-106b seed family members. Cisplatin-sensitive cells are characterized with high levels of Oct4 and miR-106b family members and as a consequence low amounts of cytoplasmic p21, resulting in cisplatin-induced apoptosis. Cisplatin-resistant cells have lower levels of Oct4 and miR-106b family members and high amounts of cytoplasmic p21, resulting in CDK2 inhibition and concomitantly moderate levels of cisplatin-induced apoptosis. Interestingly, deactivation of Akt with LY294002 (LY), triciribine (TR), or siRNA against Akt sensitized cisplatin-resistant cells. Deactivation of Akt leads to nuclear localization of p21, which in turn is no longer capable of blocking cisplatin-induced apoptosis. Overexpression of pre–miR-17-5p in cisplatin-resistant cells resulted in lower p21 levels and an increase in cisplatin-induced apoptosis. Dotted lines indicate interaction, whereas solid lines indicate (p53-induced) transcription.