Myotonic dystrophy type 1 (DM1) is a complex neuromuscular disease characterized by skeletal muscle wasting, weakness, and myotonia. DM1 is caused by the accumulation of CUG repeats, which alter the biological activities of RNA-binding proteins, including CUG-binding protein 1 (CUGBP1). CUGBP1 is an important skeletal muscle translational regulator that is activated by cyclin D3-dependent kinase 4 (CDK4). Here we show that mutant CUG repeats suppress Cdk4 signaling by increasing the stability and activity of glycogen synthase kinase 3β (GSK3β). Using a mouse model of DM1 (HSA LR ), we found that CUG repeats in the 3′ untranslated region (UTR) of human skeletal actin increase active GSK3β in skeletal muscle of mice, prior to the development of skeletal muscle weakness. Inhibition of GSK3β in both DM1 cell culture and mouse models corrected cyclin D3 levels and reduced muscle weakness and myotonia in DM1 mice. Our data predict that compounds normalizing GSK3β activity might be beneficial for improvement of muscle function in patients with DM1.
IntroductionMyotonic dystrophy type 1 (DM1) is a complex disease affecting primarily skeletal muscle, causing myotonia, skeletal muscle weakness, and wasting (1). DM1 is caused by the expansion of polymorphic, noncoding CTG repeats in the 3′ untranslated region (UTR) of the dystrophia myotonica protein kinase (DMPK) gene (2, 3). The severity of DM1 correlates with the length of CTG expansions. The longest CTG expansions are observed in patients with a congenital form of DM1 that affects newborn children (1). Congenital DM1 is characterized by a delay in skeletal muscle development, leading to extreme muscle weakness and a weak respiratory system, which has been associated with a high mortality rate (4, 5). Expanded CTG repeats cause the disease through RNA CUG repeats that misregulate several CUG RNA-binding proteins, including CUGBP1 (CUGBP Elav-like family member 1, CELF1) and muscleblind 1 (MBNL1) (6-24). The mutant CUG aggregates sequester MBNL1, reducing splicing of MBNL1-regulated mRNAs (11,12,17). A portion of the mutant CUG repeats bind to CUGBP1 and elevate CUGBP1 protein levels through an increase in its stability (14). Phosphorylation of CUGBP1 by PKC also contributes to the increase in CUGBP1 stability (24).CUGBP1 is a highly conserved, multifunctional protein that regulates RNA processing on several levels, including translation, RNA stability, and splicing (9, 14-16, 18, 20-22, 25-32). The increase in CUGBP1 to the levels observed in the congenital DM1 leads to the delay of myogenesis in the CUGBP1 transgenic mouse model (18). Multiple functions of CUGBP1 are tightly regulated by phosphorylation at distinct sites (21,22,24). Phosphorylation of CUGBP1 by AKT at S28 controls nucleus-cytoplasm distribution of CUGBP1 and increases CUGBP1 affinity toward certain mRNA targets (21,22). Translational activity of CUGBP1 is regulated by cyclin D3/CDK4 phosphorylation at S302 (21,22,29,32).