# The REDD1/TXNIP Complex Accelerates Oxidative Stress-Induced Apoptosis of Nucleus Pulposus Cells through the Mitochondrial Pathway

Authors: Huipeng Yin; Kun Wang; Abhirup Das; Gaocai Li; Yu Song; Rongjin Luo; Jason Pui Yin Cheung; Teng Zhang; Shuai Li; Cao Yang
Journal: Oxidative Medicine and Cellular Longevity
 (2021)

---

## Abstract

The death of nucleus pulposus (NP) cells is an important cause of intervertebral disc (IVD) degeneration. Redox disturbance caused by dysfunctional mitochondria has been considered as a vital risk for NP cell survival. It is valuable to identify key proteins maintaining mitochondrial function in NP cells. A previous study found that regulated in development and DNA damage response 1 (REDD1) are upregulated during intervertebral disc degeneration and that REDD1 can cause NP cell apoptosis. Thus, the present study further explores the effect of REDD1 on IVD degeneration. Our results showed that REDD1 promotes NP cell apoptosis via the mitochondrial pathway. Importantly, REDD1 formed a complex with TXNIP to strengthen its own action, and the combination was consolidated under H2O2-induced oxidative stress. The combined inhibition of the REDD1/TXNIP complex was better than that of REDD1 or TXNIP alone in restoring cell proliferation and accelerating apoptosis. Moreover, p53 acts as the transcription factor of REDD1 to regulate the REDD1/TXNIP complex under oxidative stress. Altogether, our results demonstrated that the REDD1/TXNIP complex mediated H2O2-induced human NP cell apoptosis and IVD degeneration through the mitochondrial pathway. Interferences on these sites to achieve mitochondrial redox homeostasis may be a novel therapeutic strategy for oxidative stress-associated IVD degeneration.


---

## Body

## 1. Introduction

Low back pain (LBP) is one of the most critical causes of disability around the world which has contributed to large economic and social costs [1, 2]. It is reported that up to 80% of people will suffer from LBP during their lifetime [3]. Many factors associated with LBP have been found. Degeneration of the intervertebral disc (IVD) is one major cause [4, 5]. Although there is plenty of research done in relation to IVD and LBP, the pathogenesis of IVD degeneration is not fully defined.IVD is the largest avascular structure that comprises of a central nucleus pulposus (NP), peripheral annulus fibrosus (AF), and cartilage endplates (CEPs) connecting the upper and lower vertebrae. Anaerobic glycolysis is the main metabolic mode of NP cells since poor vascularization to the IVD leads to a hypoxic microenvironment [6]. As the important intermediate metabolite, reactive oxygen species (ROS) has been proven to be a key mediator during the occurrence and progression of IVD degeneration. The balance is between ROS generation and scavenging control intracellular redox homeostasis of NP cells [7]. Indeed, excessive ROS has been reported in IVD degeneration [8]. When the redox homeostasis is broken, ROS accumulates resulting in cytotoxicity and triggering apoptotic signals through the mitochondrial apoptosis pathway [9].ROS generation mainly occurs in the mitochondria. Increasing evidence support that oxidative stress and subsequent mitochondrial dysfunction participate in NP cell apoptosis and IVD degeneration [7]. Redox homeostasis disorder induced by various risk factors serves a critical role in the pathogenesis of IVD degeneration. Besides, by-products of oxidative stress, such as advanced glycation end products (AGEs) and advanced oxidation protein products (AOPP), accumulate in degenerative discs and further destroy redox homeostasis [10, 11]. Multifarious interventions have been shown to prevent oxidative stress damage and restore mitochondrial function and with significant beneficial effects on the survival of NP cells [9, 10, 12]. Despite these facts, a better understanding of oxidative stress and mitochondrial dysfunction will give novel insight into the pathogenesis and treatment of IVD degeneration.Regulated in development and DNA damage response 1 (REDD1) is an evolutionary conserved protein which has a low expression at basal conditions but is apparently overexpressed at various cellular stimulations, including oxidative damage, endoplasmic reticulum stress, and hypoxia [13–16]. REDD1 is first reported as a target gene of hypoxia-inducible factor 1 (HIF-1) to regulate ROS levels [14] and is concurrently identified as a transcriptional target of p53 to implicate ROS production in p53-dependent DNA damage response [13]. The following studies have found REDD1 to be involved in various diseases, including diabetic retinopathy, myocardial ischemia/reperfusion injury, and osteoarthritis [17–19]. Our previous study showed that REDD1 expression was increased with the process of IVD degeneration, and REDD1 acted as a proapoptotic factor promoting NP cell apoptosis [20]; however, the specific mechanism of REDD1 in regulating ROS and NP cell apoptosis is unknown.In the present study, we show that REDD1 promotes the apoptosis of NP cells via the mitochondrial pathway. Both REDD1 and thioredoxin binding protein (TXNIP) are induced by oxidative stimulation, and REDD1 formed a complex with TXNIP to enhance its effect. Inhibition of the REDD1/TXNIP complex will be more powerful than inhibition of either REDD1 or TXNIP separately to alleviate oxidative stress-induced NP cell apoptosis. Furthermore, p53 is found to be involved in the expression regulation of REDD1 and TXNIP, and a positive feedback may exacerbate NP cell oxidative damage. These findings bring new insights into the relationship between oxidative stress and apoptosis of NP cells, with a novel therapeutic strategy for IVD degeneration.


## 2. Material and Methods

### 2.1. Tissue Sample Collection and NP Cell Culture

Human NP tissues were obtained from 16 patients (8 males and 8 females, aged 16-54 years) who underwent spinal surgery due to lumbar disc herniation (n=7), lumbar spinal stenosis (n=5), or idiopathic scoliosis (n=4). Medical records of patients were collected, and magnetic resonance images (MRI) were used to assess the IVD degenerative level based on the modified Pfirrmann grading system [21]. The degenerative levels were classified as mild of grades II-III to severe of grades IV-V. The isolation and culture of NP cells from four tissue samples were described in our previous study [10]. Once isolated, the NP tissue samples were separated into two parts and handled according to their intended use. One part was immersed in RNA and later frozen in liquid nitrogen for protein and RNA analysis, and the other part was fixed in buffered formaldehyde (4%, pH 7.4) for histological analysis. All experimental protocols were approved by the Ethics Committee of the Tongji Medical College, Huazhong University of Science and Technology (No. S214).In particular, NP tissue samples from idiopathic scoliosis patients were generally regarded as healthy because the degenerative level of these usually was grade II. Thus, a third part was preserved and immersed in phosphate-buffered saline (PBS) to isolate NP cells forin vitro experiments. After isolation, NP cells were cultured in Dulbecco’s modified Eagle medium (DMEM) containing 15% fetal bovine serum (Gibco, Waltham, MA, USA) at 37°C under 5% CO2. The second or third passage was used in the following in vitro experiments. Plasmid containing the REDD1 expression vector and REDD1 small interfering RNA vector and their empty control were used as noted from our previous study [20]. To knock down TXNIP, short interfering RNA against TXNIP designed and synthesized by RiboBio (Guangzhou, China) was used. Target sequence for TXNIP was as follows: CATCCTTCGAGTTGAATAT-3. NP cells were transfected using Lipofectamine 2000 (Invitrogen) according to the manufacturer’s instructions.


### 2.2. RNA Extraction and Quantitative Real-Time PCR (qRT-PCR)

RNA extraction and qRT-PCR were performed as previously described [22]. Total RNA was extracted from NP tissues with a TRIzol reagent (Invitrogen, USA), and cDNA was obtained by reverse transcription according to the manufacturer’s instructions. A SYBR Green Kit Master Mix (Applied Biosystems, Foster City, CA, USA) was used to perform qPCR; β-actin was used as an endogenous control. Primer sequences were as follows: homo TXNIP, 219 bp, F: 5′-TGTCATCAGTCAGAGGCAATC-3′, R: 5′-ATGTTCTGCTGCTTAGACCTG-3′; homo β-actin, 285 bp, F: 5′-AGCGAGCATCCCCCAAAGTT-3′, R: 5′-GGGCACGAAGGCTCATCATT-3′. All experiments were carried out in triplicate.


### 2.3. Western Blotting

Total proteins of the cells were extracted using RIPA with 1 mM phenylmethanesulfonyl fluoride (PMSF), and protein concentration was measured using the BCA protein assay kit (Beyotime Biotechnology, Jiangsu, China). 40μg of proteins from each group was electrophoresed on SDS-PAGE (Bio-Rad, Hercules, CA, USA) and transferred to a polyvinylidene difluoride membrane (Bio-Rad). The membranes were incubated with diluted primary antibodies (1 : 800–1 : 2000) against REDD1 (ab191871), TXNIP(ab188865), p53(ab131442), Bax (ab32503), Bcl-2 (ab32124), cytochrome c (Cyt-c, ab110325), and GAPDH (ab9484) (Abcam, Cambridge, UK) at 4°C overnight and secondary antibodies at 37°C for 2 h. GAPDH was used as the loading control. Finally, immunoreactive bands were quantified using ImageQuant LAS 400 software (GE Healthcare Life Sciences, Logan, UT, USA) and normalized to the reference band of GAPDH.


### 2.4. Cell Counting Kit-8 Assay

NP cell viability was assessed by a Cell Counting Kit-8 (CCK-8; CK04, Dojindo, Japan). NP cells were plated onto 96-well plates, 10μl of CCK-8 reagent was added to each well, and the cells were further cultured for 4 h at 37°C. The absorbance at 450 nm was measured using a spectrophotometer (BioTek, Winooski, VT, USA).


### 2.5. Apoptosis Incidence Detection

Human NP cell apoptosis was measured by an Annexin V-FITC/PI Apoptosis Detection Kit (KGA108; KeyGEN BioTECH, Nanjing, China) as previously described [10]. In brief, after centrifugation and washing by PBS, resuspended NP cells were stained with propidium iodide and fluorescein isothiocyanate-conjugated Annexin-V and incubated at 25°C for 15 min in the dark. Each sample was analyzed using a FACSCalibur Flow Cytometer (BD Biosciences, San Jose, CA, USA).


### 2.6. Determination of Caspase Activity

The activities of caspase-3 and caspase-9 were measured using a colorimetric assay kit (Beyotime Biotechnology) according to the manufacturer’s protocols. The assay was based on the catalysis of caspase-specific chromogenic substrates DEVD-pNA and LEHD-pNA by caspase-3 and caspase-9, respectively. Briefly, cells were treated with a cell lysis buffer on ice for 15 min. After centrifugation, a Bradford reagent was used to measure protein concentrations. Following this, the supernatant (100μg of protein) was incubated with dithiothreitol and each caspase-specific substrate at 37 °C for 2 h. The activities were measured by a microplate reader at 405 nm.


### 2.7. ROS Detection

The intracellular ROS level was detected by 2,7-dichlorofluorescin diacetate (DCFH-DA, Beyotime Biotechnology). Briefly,5×105/ml NP cells were collected in each group and stained with DCFH-DA (10 μM) for 20 min at 37°C. After that, NP cells were washed twice with PBS for measurement. The mean fluorescence intensity (MFI) in each group was analyzed by flow cytometry (BD Biosciences).


### 2.8. Detection of Mitochondrial Membrane Potential

Mitochondrial membrane potential was determined by 5,5′,6,6′-tetrachloro-1,1′,3,3′tetraethyl-benzimidazolycarbocyanine iodide (JC-1, Beyotime Biotechnology) staining following the manufacturer’s instructions. After centrifugation, NP cells were resuspended and incubated with 5 μM JC-1 at 37°C for 30 min. After washing with ice-cold staining buffer twice by centrifugation, NP cells were resuspended in 500 μl JC-1 staining buffer and analyzed by a flow cytometer (BD Biosciences). Mitochondrial membrane potential was calculated as the ratio of red fluorescence intensity over green fluorescence intensity.


### 2.9. Thioredoxin Activity Detection

Thioredoxin activity was detected by a Thioredoxin Activity Fluorescent Assay Kit (Cayman Chemical, Ann Arbor, MI, USA) according to the manufacturer’s instructions. After cell lysis and centrifugation, the reaction mixture contained 5μl β-NADPH, 10 μl recombinant thioredoxin reductase, 20 μl fluorescent substrate, assay buffer with 1 mM EDTA, and samples or 1 μM human recombinant thioredoxin-1 to a total volume of 100 μl. The mixture was incubated for 30 min at 37°C in an incubator covering the plate with a lid. The emission at 545 nm after 520 nm excitation for 60 minutes was recorded in a fluorescent plate reader. The increasing fluorescence intensity for the time of the reaction from the background was calculated by a standard curve within a linear range.


### 2.10. Coimmunoprecipitation

Coimmunoprecipitation (co-IP) was performed as previously described [23], with an antibody against REDD1 (Abcam, Ab191871) and TXNIP (Novus, Nbp1-54578). IP-antibody complexes were captured on protein A/G beads (Santa Cruz Biotechnology, Santa Cruz, CA). Then, the beads were washed with ice-cold lysis buffer and resuspended in SDS gel loading buffer for blotting analysis.


### 2.11. Immunofluorescence

For immunofluorescence, NP cells were incubated with MitoTracker Red (Invitrogen, USA) at the concentration of 500 nM for 45 min at 37°C. After rinsing three times in PBS, cells were fixed with 4% paraformaldehyde for 15 min followed by permeation with 0.5% Triton X-100 for 20 min. Cells then were blocked with a goat serum at 25°C for 30 min and incubated with diluted primary antibody REDD1 (Abcam, Ab191871, 1 : 100) overnight at 4°C. On the next day, NP cells were washed three times and incubated with fluorescent Cy3-conjugated secondary goat anti-rabbit antibody for 1 h and DAPI for 5 min. Images were captured using a fluorescence microscope (Olympus Inc., Tokyo, Japan).


### 2.12. Animal Model andVivo Experiments

SD rats (250±10g) were used to construct the animal model. Three consecutive segments of rats were injected with PBS, H2O2, and Pifithrin-α (PFT-α, S1816, Beyotime Biotechnology) with 20 G needle maintained for one month. Rats underwent MRI to evaluate their degenerative disc levels in a previously described method [10]. The rats were then euthanized, and the discs were dissected for histological and cellular analyses.


### 2.13. Statistical Analysis

Data are presented as themean±SD of at least three independent experiments and were analyzed using SPSS software, version 17.0 (IBM, Chicago, IL, USA). A t test was used to evaluate differences between groups. p<0.05 was considered as statistically significant.


## 2.1. Tissue Sample Collection and NP Cell Culture

Human NP tissues were obtained from 16 patients (8 males and 8 females, aged 16-54 years) who underwent spinal surgery due to lumbar disc herniation (n=7), lumbar spinal stenosis (n=5), or idiopathic scoliosis (n=4). Medical records of patients were collected, and magnetic resonance images (MRI) were used to assess the IVD degenerative level based on the modified Pfirrmann grading system [21]. The degenerative levels were classified as mild of grades II-III to severe of grades IV-V. The isolation and culture of NP cells from four tissue samples were described in our previous study [10]. Once isolated, the NP tissue samples were separated into two parts and handled according to their intended use. One part was immersed in RNA and later frozen in liquid nitrogen for protein and RNA analysis, and the other part was fixed in buffered formaldehyde (4%, pH 7.4) for histological analysis. All experimental protocols were approved by the Ethics Committee of the Tongji Medical College, Huazhong University of Science and Technology (No. S214).In particular, NP tissue samples from idiopathic scoliosis patients were generally regarded as healthy because the degenerative level of these usually was grade II. Thus, a third part was preserved and immersed in phosphate-buffered saline (PBS) to isolate NP cells forin vitro experiments. After isolation, NP cells were cultured in Dulbecco’s modified Eagle medium (DMEM) containing 15% fetal bovine serum (Gibco, Waltham, MA, USA) at 37°C under 5% CO2. The second or third passage was used in the following in vitro experiments. Plasmid containing the REDD1 expression vector and REDD1 small interfering RNA vector and their empty control were used as noted from our previous study [20]. To knock down TXNIP, short interfering RNA against TXNIP designed and synthesized by RiboBio (Guangzhou, China) was used. Target sequence for TXNIP was as follows: CATCCTTCGAGTTGAATAT-3. NP cells were transfected using Lipofectamine 2000 (Invitrogen) according to the manufacturer’s instructions.


## 2.2. RNA Extraction and Quantitative Real-Time PCR (qRT-PCR)

RNA extraction and qRT-PCR were performed as previously described [22]. Total RNA was extracted from NP tissues with a TRIzol reagent (Invitrogen, USA), and cDNA was obtained by reverse transcription according to the manufacturer’s instructions. A SYBR Green Kit Master Mix (Applied Biosystems, Foster City, CA, USA) was used to perform qPCR; β-actin was used as an endogenous control. Primer sequences were as follows: homo TXNIP, 219 bp, F: 5′-TGTCATCAGTCAGAGGCAATC-3′, R: 5′-ATGTTCTGCTGCTTAGACCTG-3′; homo β-actin, 285 bp, F: 5′-AGCGAGCATCCCCCAAAGTT-3′, R: 5′-GGGCACGAAGGCTCATCATT-3′. All experiments were carried out in triplicate.


## 2.3. Western Blotting

Total proteins of the cells were extracted using RIPA with 1 mM phenylmethanesulfonyl fluoride (PMSF), and protein concentration was measured using the BCA protein assay kit (Beyotime Biotechnology, Jiangsu, China). 40μg of proteins from each group was electrophoresed on SDS-PAGE (Bio-Rad, Hercules, CA, USA) and transferred to a polyvinylidene difluoride membrane (Bio-Rad). The membranes were incubated with diluted primary antibodies (1 : 800–1 : 2000) against REDD1 (ab191871), TXNIP(ab188865), p53(ab131442), Bax (ab32503), Bcl-2 (ab32124), cytochrome c (Cyt-c, ab110325), and GAPDH (ab9484) (Abcam, Cambridge, UK) at 4°C overnight and secondary antibodies at 37°C for 2 h. GAPDH was used as the loading control. Finally, immunoreactive bands were quantified using ImageQuant LAS 400 software (GE Healthcare Life Sciences, Logan, UT, USA) and normalized to the reference band of GAPDH.


## 2.4. Cell Counting Kit-8 Assay

NP cell viability was assessed by a Cell Counting Kit-8 (CCK-8; CK04, Dojindo, Japan). NP cells were plated onto 96-well plates, 10μl of CCK-8 reagent was added to each well, and the cells were further cultured for 4 h at 37°C. The absorbance at 450 nm was measured using a spectrophotometer (BioTek, Winooski, VT, USA).


## 2.5. Apoptosis Incidence Detection

Human NP cell apoptosis was measured by an Annexin V-FITC/PI Apoptosis Detection Kit (KGA108; KeyGEN BioTECH, Nanjing, China) as previously described [10]. In brief, after centrifugation and washing by PBS, resuspended NP cells were stained with propidium iodide and fluorescein isothiocyanate-conjugated Annexin-V and incubated at 25°C for 15 min in the dark. Each sample was analyzed using a FACSCalibur Flow Cytometer (BD Biosciences, San Jose, CA, USA).


## 2.6. Determination of Caspase Activity

The activities of caspase-3 and caspase-9 were measured using a colorimetric assay kit (Beyotime Biotechnology) according to the manufacturer’s protocols. The assay was based on the catalysis of caspase-specific chromogenic substrates DEVD-pNA and LEHD-pNA by caspase-3 and caspase-9, respectively. Briefly, cells were treated with a cell lysis buffer on ice for 15 min. After centrifugation, a Bradford reagent was used to measure protein concentrations. Following this, the supernatant (100μg of protein) was incubated with dithiothreitol and each caspase-specific substrate at 37 °C for 2 h. The activities were measured by a microplate reader at 405 nm.


## 2.7. ROS Detection

The intracellular ROS level was detected by 2,7-dichlorofluorescin diacetate (DCFH-DA, Beyotime Biotechnology). Briefly,5×105/ml NP cells were collected in each group and stained with DCFH-DA (10 μM) for 20 min at 37°C. After that, NP cells were washed twice with PBS for measurement. The mean fluorescence intensity (MFI) in each group was analyzed by flow cytometry (BD Biosciences).


## 2.8. Detection of Mitochondrial Membrane Potential

Mitochondrial membrane potential was determined by 5,5′,6,6′-tetrachloro-1,1′,3,3′tetraethyl-benzimidazolycarbocyanine iodide (JC-1, Beyotime Biotechnology) staining following the manufacturer’s instructions. After centrifugation, NP cells were resuspended and incubated with 5 μM JC-1 at 37°C for 30 min. After washing with ice-cold staining buffer twice by centrifugation, NP cells were resuspended in 500 μl JC-1 staining buffer and analyzed by a flow cytometer (BD Biosciences). Mitochondrial membrane potential was calculated as the ratio of red fluorescence intensity over green fluorescence intensity.


## 2.9. Thioredoxin Activity Detection

Thioredoxin activity was detected by a Thioredoxin Activity Fluorescent Assay Kit (Cayman Chemical, Ann Arbor, MI, USA) according to the manufacturer’s instructions. After cell lysis and centrifugation, the reaction mixture contained 5μl β-NADPH, 10 μl recombinant thioredoxin reductase, 20 μl fluorescent substrate, assay buffer with 1 mM EDTA, and samples or 1 μM human recombinant thioredoxin-1 to a total volume of 100 μl. The mixture was incubated for 30 min at 37°C in an incubator covering the plate with a lid. The emission at 545 nm after 520 nm excitation for 60 minutes was recorded in a fluorescent plate reader. The increasing fluorescence intensity for the time of the reaction from the background was calculated by a standard curve within a linear range.


## 2.10. Coimmunoprecipitation

Coimmunoprecipitation (co-IP) was performed as previously described [23], with an antibody against REDD1 (Abcam, Ab191871) and TXNIP (Novus, Nbp1-54578). IP-antibody complexes were captured on protein A/G beads (Santa Cruz Biotechnology, Santa Cruz, CA). Then, the beads were washed with ice-cold lysis buffer and resuspended in SDS gel loading buffer for blotting analysis.


## 2.11. Immunofluorescence

For immunofluorescence, NP cells were incubated with MitoTracker Red (Invitrogen, USA) at the concentration of 500 nM for 45 min at 37°C. After rinsing three times in PBS, cells were fixed with 4% paraformaldehyde for 15 min followed by permeation with 0.5% Triton X-100 for 20 min. Cells then were blocked with a goat serum at 25°C for 30 min and incubated with diluted primary antibody REDD1 (Abcam, Ab191871, 1 : 100) overnight at 4°C. On the next day, NP cells were washed three times and incubated with fluorescent Cy3-conjugated secondary goat anti-rabbit antibody for 1 h and DAPI for 5 min. Images were captured using a fluorescence microscope (Olympus Inc., Tokyo, Japan).


## 2.12. Animal Model andVivo Experiments

SD rats (250±10g) were used to construct the animal model. Three consecutive segments of rats were injected with PBS, H2O2, and Pifithrin-α (PFT-α, S1816, Beyotime Biotechnology) with 20 G needle maintained for one month. Rats underwent MRI to evaluate their degenerative disc levels in a previously described method [10]. The rats were then euthanized, and the discs were dissected for histological and cellular analyses.


## 2.13. Statistical Analysis

Data are presented as themean±SD of at least three independent experiments and were analyzed using SPSS software, version 17.0 (IBM, Chicago, IL, USA). A t test was used to evaluate differences between groups. p<0.05 was considered as statistically significant.


## 3. Results

### 3.1. REDD1 Attenuates Cell Viability and Promotes the Apoptosis of NP Cells

Our recent study has showed that REDD1 expression was increased with the progression of IVD degeneration, and REDD1 deletion could dwindle serum deprivation-induced NP cell apoptosis [20]. To further investigate the specific effect of REDD1 on apoptosis, human NP cells were transfected with plasmid to overexpress REDD1 (REDD1) or knock down by specific siRNA (si-REDD1). Transfection efficiency was confirmed by Western blotting (Figure 1(a)). First, a CCK-8 assay was used to determine NP cell viability. As shown in Figure 1(b), NP cell viability was inhibited when REDD1 was overexpressed but promoted when REDD1 was knocked down. Then, we assessed the apoptosis response of the NP cells by Annexin V-FITC/PI dual staining using flow cytometry. Results showed that overexpressed REDD1 led to a higher apoptosis rate while suppressed REDD1 led to a lower apoptosis rate (Figure 1(c)). These results showed that REDD1 attenuated cell viability and promoted apoptosis of NP cells.Figure 1
REDD1 attenuates cell viability and promotes the apoptosis of NP cells. To overexpress REDD1, human NP cells were transfected with a plasmid encoding REDD1 or its vector control. To suppress REDD1, human NP cells were transfected with si-REDD1 or its negative control. (a) Representative Western blotting assay and quantitation of the level of REDD1. GAPDH was used as an internal control. (b) Cell viability was examined by the absorbance of CCK-8. (c) Cell apoptosis was detected by Annexin V-FITC/PI dual staining.∗p<0.05.
(a)(b)(c)


### 3.2. REDD1 Promotes NP Cell Apoptosis via Mitochondrial Pathway

Since REDD1 could promote NP cell apoptosis, we were curious about which pathway was involved in this process. Subcellular localization of a protein is a principal step to understand its function. REDD1 is predicted to be localized to the mitochondria by multiple protein sequence analysis algorithms, and following cellular experiments, it has confirmed that endogenous REDD1 is localized to the mitochondria [24, 25]. Thus, it was reasonable to speculate that the mitochondrial pathway might be involved in REDD1-induced apoptosis.To verify this, we first examined the protein location of REDD1. The colocalization of the REDD1 protein and mitochondria was demonstrated by immunofluorescent staining, and the fluorescence intensity of MitoTracker Red significantly dwindled after REDD1 overexpression but increased after REDD1 inhibition (Figure2(a)). To further investigate the effect of REDD1 on mitochondrial function, JC-1 staining and flow cytometric analysis were used to clarify the mitochondrial membrane potential (MMP). The decreased ratio of red to green in the REDD1-transfected group but increased in the si-REDD1-transfected group indicated that REDD1 would cause MMP loss in human NP cells (Figure 2(b)). We then examined the intracellular ROS level by DCFH-DA. As shown in Figure 2(c), REDD1 transfection accelerated ROS production, while si-REDD1 transfection alleviated its production. The Trx system is a key antioxidant system in defense against cell oxidative stress through regulating protein dithiol/disulfide balance [26]. REDD1 overexpression could reduce Trx activity while low expression could increase Trx activity (Figure 2(d)). The protein levels of Bax and Bcl-2, which worked together to regulate the outer mitochondrial membrane permeabilization, were detected. Results showed that upregulated REDD1 increased Bax expression but decreased Bcl-2 expression, while downregulated REDD1 performed the opposite (Figure 2(e)). Next, we measured the level of cytochrome c (Cyt-c), which is critical to activate caspases, and we found that REDD1 promoted Cyt-c while the knockdown of REDD1 led to Cyt-c suppression (Figure 2(e)). After release from the mitochondria, Cyt-c associated with procaspase-9 and Apaf-1-activated caspase-9. It was consistent with the elevated activity of caspase-9 following REDD1 overexpression (Figure 2(f)). Caspase-3 is known as an apoptotic marker protein that plays an irreplaceable role during the process of apoptosis. Thus, we evaluated the activities of caspase-3 in transfected NP cells, and we found that the caspase-3 activity was increased with REDD1 overexpression but decreased with REDD1 inhibition (Figure 2(g)). These findings suggest that REDD1 enhanced oxidative damage and destroyed mitochondrial function, eventually leading to the apoptosis of human NP cells.Figure 2
REDD1 promoted NP cell apoptosis via mitochondrial pathway. To overexpress REDD1, human NP cells were transfected with a plasmid encoding REDD1 or its vector control. To suppress REDD1, human NP cells were transfected with si-REDD1 or its vector control. (a) Representative fluorescence images with REDD1 (green) and MitoTracker (red) double-staining (magnification: 400x). (b) The ratios of red fluorescence to green fluorescence for MMP were detected by flow cytometry with JC-1 staining. (c) Intracellular ROS levels were measured by flow cytometry using DCFH-DA dye. (d) Trx activities were measured by a fluorescent assay kit. (e) Representative Western blotting assay and quantitation of the levels of Bax, Bcl-2, and Cyt-c. GAPDH was used as an internal control. (f, g) Caspase-3 and caspase-9 activities were measured by colorimetric assay.∗p<0.05.
(a)(b)(c)(d)(e)(f)(g)


### 3.3. REDD1 Forms an Enhanced Complex with TXNIP under Oxidative Stress

Previous studies have reported that REDD1 is an important stress-regulated protein in response to various cell stresses including oxidative damage [13, 15, 27]. However, the REDD1 reaction of NP cells under oxidative damage is yet unknown. Thus, we introduced oxidative damage to NP cells using H2O2. To figure out the optimum working conditions, a series of CCK-8 were conducted at different concentrations and times, and 200 μM for 24 h was chosen for the following experiments. Under this condition, the cell viability was notably decreased, and the apoptosis rate was increased (Figures 3(a) and 3(b)). Then, REDD1 protein levels were detected, and the results showed that the REDD1 expression was indeed elevated under oxidative stress (Figure 3(c)). It means that REDD1 is a positive effect factor, which is upregulated under oxidative stress and in turn accelerates oxidative damage, leading to the mitochondrial dysfunction and eventually the apoptosis of NP cells. When we further investigated the relationship between REDD1 and ROS, we found that TXNIP might be an involved regulation part because TXNIP had been reported to interact with REDD1 triggering endogenous ROS production under cellular stress conditions [23]. TXNIP expression of NP cells therefore was detected, and results showed that TXNIP was also upregulated under H2O2 (Figure 3(c)). Then, we examined the integration between REDD1 and TXNIP by coimmunoprecipitation. Indeed, REDD1 and TXNIP interacted with each other, and this combination was enhanced under H2O2 but then relieved with NAC (Figure 3(d)).Figure 3
REDD1 forms an enhanced complex with TXNIP under oxidative stress. Human NP cells were treated with 200μM H2O2 for 24 h. (a) Cell viability was examined by the absorbance of CCK-8. (b) Cell apoptosis was detected by Annexin V-FITC/PI dual staining. (c) Representative Western blotting assay and quantitation of the levels of REDD1 and TXNIP. GAPDH was used as an internal control. (d) The interaction between REDD1 and TXNIP was detected by coimmunoprecipitation. ∗p<0.05.
(a)(b)(c)(d)


### 3.4. Suppression of REDD1/TXNIP Complex Dwindles H2O2-Induced NP Cell Apoptosis via Mitochondrial Pathway

To further investigate the relationship among REDD1, TXNIP, and apoptosis, human NP cells were transfected with specific siRNA of REDD1 or TXNIP separately or cotransfected with si-REDD1 and si-TXNIP. The transfection efficiency of si-TXNIP was confirmed by Western blot (Figure4(a)). First, REDD1 and TXNIP expressions were further verified in an oxidative damage NP cell model with their specific suppression (Figure 4(b)). NP apoptosis rates and cell viabilities were detected to figure out the effect of REDD1/TXNIP on H2O2-induced apoptosis. When REDD1 or TXNIP was suppressed alone, both apoptosis rates were decreased and would be further decreased with cotransfection (Figure 4(c)). Cell viabilities were both increased in the si-REDD1 or si-TXNIP group and further increased in a coinhibited group (Figure 4(d)). Then, the activities of caspase-3 and caspase-9 were determined. As we expected, the combined knockdown of REDD1 and TXNIP resulted in a further reduction of the activities of caspase-3 and caspase-9 (Figures 4(e) and 4(f)). These results suggested that REDD1 worked with TXNIP together to inhibit H2O2-induced NP cell apoptosis.Figure 4
Suppression of the REDD1/TXNIP complex dwindles H2O2-induced NP cell apoptosis and cell viabilities. Human NP cells were transfected with si-REDD1 or si-TXNIP separately or together and then cultured under 200 μM H2O2 for 24 h. (a, b) Representative Western blotting assay of TXNIP and REDD1. GAPDH was used as an internal control. (c) Cell apoptosis was detected by Annexin V-FITC/PI dual staining. (d) Cell viability was examined by the absorbance of CCK-8. (e, f) Caspase-3 and caspase-9 activities were measured by colorimetric assay. ∗p<0.05 versus control group; #p<0.05.
(a)(b)(c)(d)(e)(f)Considering the existing evidence, we were eager to see whether REDD1/TXNIP took actions through the mitochondrial pathway. Mitochondria were dyed with red fluorescence. H2O2 would significantly lower fluorescence intensity, while these lowered intensities would resume after REDD1 and TXNIP inhibition (Figure 5(a)). Cosuppression of REDD1 and TXNIP could further recover the MMP damaged by H2O2 compared with suppression of REDD1 or TXNIP alone (Figure 5(b)). The intracellular ROS level was also found to be significantly reduced with the knockdown of both REDD1 and TXNIP (Figure 5(c)) while Trx activities were observed in the opposite way (Figure 5(d)). Finally, apoptotic proteins involved in the mitochondrial pathway were examined, and the expected results were observed (Figure 5(e)). Collectively, these data reveal the fact that the REDD1/TXNIP complex is necessary for mitochondrial apoptotic pathways in response to H2O2-induced NP cell damage.Figure 5
Inhibition of REDD1/TXNIP complex alleviated H2O2-induced NP cell apoptosis via the mitochondrial pathway. Human NP cells were transfected with si-REDD1 or si-TXNIP separately or together and then cultured under 200 μM H2O2 for 24 h. (a) Representative fluorescence images of MitoTracker staining (magnification: 400x). (b) The ratios of red fluorescence to green fluorescence for MMP were detected by flow cytometry with JC-1 staining. (c) Intracellular ROS levels were measured by flow cytometry using DCFH-DA dye. (d) Trx activities were measured by fluorescent assay kit. (e) Representative Western blotting assay of Bax, Bcl-2, and Cyt-c. GAPDH was used as an internal control. ∗p<0.05 versus control group; #p<0.05.
(a)(b)(c)(d)(e)


### 3.5. p53 Mediates Exquisite Regulation of REDD1/TXNIP Complex

Next, we want to figure out which factor responds to the regulation of the REDD1/TXNIP complex. Previous studies have proven that REDD1 is a direct transcriptional target of p53, and its promoter contains a consensus p53 family binding element [13]. p53 mainly functions as a transcription factor. It determines cell survival or death by promoting growth arrest, DNA repair, or cell death in response to different cellular stresses, which can translocate to mitochondria and contribute to NP cell programmed necrosis [28, 29]. Here, the p53 expression was also increased with H2O2 treatment, and p53 inhibition by PFT-α significantly suppresses the expression of REDD1 and TXNIP (Figure 6(a)) and the combination of them (Figure 4(d)). The expressions of p53 and TXNIP were promoted by exogenous overexpressed REDD1 (Figure 6(b)) but inhibited by NAC (Figure 6(c)). Finally, REDD1 knockdown also decreased the H2O2-induced upregulation of p53 and TXNIP (Figure 6(d)). These results suggested that a loop involves three factors to regulate NP cell response under oxidative stress.Figure 6
p53 mediates exquisite regulation of the REDD1/TXNIP complex. Representative Western blotting assay and quantitation of the levels of p53, REDD1, and TXNIP. GAPDH was used as an internal control. (a) Human NP cells were treated with 200μM H2O2 for 24 h with or without 10 μM PFT-α. (b) NP cells were transfected with a plasmid encoding REDD1 or si-REDD1 and its vector control. (c) NP cells were transfected with exogenous REDD1 and treated with NAC. (d) Human NP cells were transfected with si-REDD1 and then cultured under 200 μM H2O2 for 24 h.
(a)(b)(c)(d)


### 3.6. p53 Inhibition Suppresses REDD1 and Postpones IVD Degeneration Process in Rat ModelsIn Vivo

To further investigate the regulation effect of p53 on REDD1in vivo, we constructed an animal model of IVD degeneration using Sprague-Dawley rats, described in a previous study [10]. Magnetic resonance imaging (MRI, 7.0 T) examination was used to identify different levels of IVD degeneration. The T2-weighted signal observed in the H2O2-injected group at one month after intervention was lower than that in the PBS-injected group but recovered with PFT-α treatment (Figure 7(a)). Then, IVD specimens from all groups were collected for histopathological analysis. As seen in Figure 7(b), the NP of the control group was well organized in a normal oval shape with a large volume of the disc height, and an annulus fibrosus layer showed clear lamellar sheets of collagen in the midsagittal cross-section, as detected by HE staining. In H2O2-injected groups, the disc height was collapsed, and most cells were lost whose space was occupied by fibrillation tissue. An ordered structure of the annulus fibrosus disappeared, and the whole layer of the annulus fibrosus was disrupted. Conversely, additional PFT-α administration reduced the IVD degenerative changes compared to that in H2O2-injected groups, although some degenerative phenotype still existed (Figure 7(b)). To investigate the effect of PFT-α on REDD1, the protein level of REDD1 was also examined. As expected, Western blotting results showed that PFT-α administration would attenuate H2O2-induced REDD1 upregulation (Figure 7(c)). Finally, TUNEL staining was performed to measure the apoptosis levels of NP cells in IVD specimens. H2O2 injection notably increased the ratio of positive staining cells compared with the control group, but this increment could be alleviated by PFT-α administration (Figure 7(d)). Taken together, our in vivo studies proved that p53 inhibition by PFT-α suppresses REDD1 and postpones H2O2-induced NP cell apoptosis and IVD degeneration.Figure 7
PFT-α administration ameliorated IVD degeneration in vivo. Three segments of rat tail discs were injected with PBS, H2O2, the mixture of H2O2, and 10 μM PFT-α for one month. (a) Representative T2-weighted MRI images of rat tail with white squares labeling the operated segments. (b) HE staining of tail discs. (c) Representative Western blotting assay and quantitation of the levels of REDD1. GAPDH was used as an internal control. (d) TUNEL staining was used to detected apoptosis in rat tail discs. ∗p<0.05.
(a)(b)(c)(d)


## 3.1. REDD1 Attenuates Cell Viability and Promotes the Apoptosis of NP Cells

Our recent study has showed that REDD1 expression was increased with the progression of IVD degeneration, and REDD1 deletion could dwindle serum deprivation-induced NP cell apoptosis [20]. To further investigate the specific effect of REDD1 on apoptosis, human NP cells were transfected with plasmid to overexpress REDD1 (REDD1) or knock down by specific siRNA (si-REDD1). Transfection efficiency was confirmed by Western blotting (Figure 1(a)). First, a CCK-8 assay was used to determine NP cell viability. As shown in Figure 1(b), NP cell viability was inhibited when REDD1 was overexpressed but promoted when REDD1 was knocked down. Then, we assessed the apoptosis response of the NP cells by Annexin V-FITC/PI dual staining using flow cytometry. Results showed that overexpressed REDD1 led to a higher apoptosis rate while suppressed REDD1 led to a lower apoptosis rate (Figure 1(c)). These results showed that REDD1 attenuated cell viability and promoted apoptosis of NP cells.Figure 1
REDD1 attenuates cell viability and promotes the apoptosis of NP cells. To overexpress REDD1, human NP cells were transfected with a plasmid encoding REDD1 or its vector control. To suppress REDD1, human NP cells were transfected with si-REDD1 or its negative control. (a) Representative Western blotting assay and quantitation of the level of REDD1. GAPDH was used as an internal control. (b) Cell viability was examined by the absorbance of CCK-8. (c) Cell apoptosis was detected by Annexin V-FITC/PI dual staining.∗p<0.05.
(a)(b)(c)


## 3.2. REDD1 Promotes NP Cell Apoptosis via Mitochondrial Pathway

Since REDD1 could promote NP cell apoptosis, we were curious about which pathway was involved in this process. Subcellular localization of a protein is a principal step to understand its function. REDD1 is predicted to be localized to the mitochondria by multiple protein sequence analysis algorithms, and following cellular experiments, it has confirmed that endogenous REDD1 is localized to the mitochondria [24, 25]. Thus, it was reasonable to speculate that the mitochondrial pathway might be involved in REDD1-induced apoptosis.To verify this, we first examined the protein location of REDD1. The colocalization of the REDD1 protein and mitochondria was demonstrated by immunofluorescent staining, and the fluorescence intensity of MitoTracker Red significantly dwindled after REDD1 overexpression but increased after REDD1 inhibition (Figure2(a)). To further investigate the effect of REDD1 on mitochondrial function, JC-1 staining and flow cytometric analysis were used to clarify the mitochondrial membrane potential (MMP). The decreased ratio of red to green in the REDD1-transfected group but increased in the si-REDD1-transfected group indicated that REDD1 would cause MMP loss in human NP cells (Figure 2(b)). We then examined the intracellular ROS level by DCFH-DA. As shown in Figure 2(c), REDD1 transfection accelerated ROS production, while si-REDD1 transfection alleviated its production. The Trx system is a key antioxidant system in defense against cell oxidative stress through regulating protein dithiol/disulfide balance [26]. REDD1 overexpression could reduce Trx activity while low expression could increase Trx activity (Figure 2(d)). The protein levels of Bax and Bcl-2, which worked together to regulate the outer mitochondrial membrane permeabilization, were detected. Results showed that upregulated REDD1 increased Bax expression but decreased Bcl-2 expression, while downregulated REDD1 performed the opposite (Figure 2(e)). Next, we measured the level of cytochrome c (Cyt-c), which is critical to activate caspases, and we found that REDD1 promoted Cyt-c while the knockdown of REDD1 led to Cyt-c suppression (Figure 2(e)). After release from the mitochondria, Cyt-c associated with procaspase-9 and Apaf-1-activated caspase-9. It was consistent with the elevated activity of caspase-9 following REDD1 overexpression (Figure 2(f)). Caspase-3 is known as an apoptotic marker protein that plays an irreplaceable role during the process of apoptosis. Thus, we evaluated the activities of caspase-3 in transfected NP cells, and we found that the caspase-3 activity was increased with REDD1 overexpression but decreased with REDD1 inhibition (Figure 2(g)). These findings suggest that REDD1 enhanced oxidative damage and destroyed mitochondrial function, eventually leading to the apoptosis of human NP cells.Figure 2
REDD1 promoted NP cell apoptosis via mitochondrial pathway. To overexpress REDD1, human NP cells were transfected with a plasmid encoding REDD1 or its vector control. To suppress REDD1, human NP cells were transfected with si-REDD1 or its vector control. (a) Representative fluorescence images with REDD1 (green) and MitoTracker (red) double-staining (magnification: 400x). (b) The ratios of red fluorescence to green fluorescence for MMP were detected by flow cytometry with JC-1 staining. (c) Intracellular ROS levels were measured by flow cytometry using DCFH-DA dye. (d) Trx activities were measured by a fluorescent assay kit. (e) Representative Western blotting assay and quantitation of the levels of Bax, Bcl-2, and Cyt-c. GAPDH was used as an internal control. (f, g) Caspase-3 and caspase-9 activities were measured by colorimetric assay.∗p<0.05.
(a)(b)(c)(d)(e)(f)(g)


## 3.3. REDD1 Forms an Enhanced Complex with TXNIP under Oxidative Stress

Previous studies have reported that REDD1 is an important stress-regulated protein in response to various cell stresses including oxidative damage [13, 15, 27]. However, the REDD1 reaction of NP cells under oxidative damage is yet unknown. Thus, we introduced oxidative damage to NP cells using H2O2. To figure out the optimum working conditions, a series of CCK-8 were conducted at different concentrations and times, and 200 μM for 24 h was chosen for the following experiments. Under this condition, the cell viability was notably decreased, and the apoptosis rate was increased (Figures 3(a) and 3(b)). Then, REDD1 protein levels were detected, and the results showed that the REDD1 expression was indeed elevated under oxidative stress (Figure 3(c)). It means that REDD1 is a positive effect factor, which is upregulated under oxidative stress and in turn accelerates oxidative damage, leading to the mitochondrial dysfunction and eventually the apoptosis of NP cells. When we further investigated the relationship between REDD1 and ROS, we found that TXNIP might be an involved regulation part because TXNIP had been reported to interact with REDD1 triggering endogenous ROS production under cellular stress conditions [23]. TXNIP expression of NP cells therefore was detected, and results showed that TXNIP was also upregulated under H2O2 (Figure 3(c)). Then, we examined the integration between REDD1 and TXNIP by coimmunoprecipitation. Indeed, REDD1 and TXNIP interacted with each other, and this combination was enhanced under H2O2 but then relieved with NAC (Figure 3(d)).Figure 3
REDD1 forms an enhanced complex with TXNIP under oxidative stress. Human NP cells were treated with 200μM H2O2 for 24 h. (a) Cell viability was examined by the absorbance of CCK-8. (b) Cell apoptosis was detected by Annexin V-FITC/PI dual staining. (c) Representative Western blotting assay and quantitation of the levels of REDD1 and TXNIP. GAPDH was used as an internal control. (d) The interaction between REDD1 and TXNIP was detected by coimmunoprecipitation. ∗p<0.05.
(a)(b)(c)(d)


## 3.4. Suppression of REDD1/TXNIP Complex Dwindles H2O2-Induced NP Cell Apoptosis via Mitochondrial Pathway

To further investigate the relationship among REDD1, TXNIP, and apoptosis, human NP cells were transfected with specific siRNA of REDD1 or TXNIP separately or cotransfected with si-REDD1 and si-TXNIP. The transfection efficiency of si-TXNIP was confirmed by Western blot (Figure4(a)). First, REDD1 and TXNIP expressions were further verified in an oxidative damage NP cell model with their specific suppression (Figure 4(b)). NP apoptosis rates and cell viabilities were detected to figure out the effect of REDD1/TXNIP on H2O2-induced apoptosis. When REDD1 or TXNIP was suppressed alone, both apoptosis rates were decreased and would be further decreased with cotransfection (Figure 4(c)). Cell viabilities were both increased in the si-REDD1 or si-TXNIP group and further increased in a coinhibited group (Figure 4(d)). Then, the activities of caspase-3 and caspase-9 were determined. As we expected, the combined knockdown of REDD1 and TXNIP resulted in a further reduction of the activities of caspase-3 and caspase-9 (Figures 4(e) and 4(f)). These results suggested that REDD1 worked with TXNIP together to inhibit H2O2-induced NP cell apoptosis.Figure 4
Suppression of the REDD1/TXNIP complex dwindles H2O2-induced NP cell apoptosis and cell viabilities. Human NP cells were transfected with si-REDD1 or si-TXNIP separately or together and then cultured under 200 μM H2O2 for 24 h. (a, b) Representative Western blotting assay of TXNIP and REDD1. GAPDH was used as an internal control. (c) Cell apoptosis was detected by Annexin V-FITC/PI dual staining. (d) Cell viability was examined by the absorbance of CCK-8. (e, f) Caspase-3 and caspase-9 activities were measured by colorimetric assay. ∗p<0.05 versus control group; #p<0.05.
(a)(b)(c)(d)(e)(f)Considering the existing evidence, we were eager to see whether REDD1/TXNIP took actions through the mitochondrial pathway. Mitochondria were dyed with red fluorescence. H2O2 would significantly lower fluorescence intensity, while these lowered intensities would resume after REDD1 and TXNIP inhibition (Figure 5(a)). Cosuppression of REDD1 and TXNIP could further recover the MMP damaged by H2O2 compared with suppression of REDD1 or TXNIP alone (Figure 5(b)). The intracellular ROS level was also found to be significantly reduced with the knockdown of both REDD1 and TXNIP (Figure 5(c)) while Trx activities were observed in the opposite way (Figure 5(d)). Finally, apoptotic proteins involved in the mitochondrial pathway were examined, and the expected results were observed (Figure 5(e)). Collectively, these data reveal the fact that the REDD1/TXNIP complex is necessary for mitochondrial apoptotic pathways in response to H2O2-induced NP cell damage.Figure 5
Inhibition of REDD1/TXNIP complex alleviated H2O2-induced NP cell apoptosis via the mitochondrial pathway. Human NP cells were transfected with si-REDD1 or si-TXNIP separately or together and then cultured under 200 μM H2O2 for 24 h. (a) Representative fluorescence images of MitoTracker staining (magnification: 400x). (b) The ratios of red fluorescence to green fluorescence for MMP were detected by flow cytometry with JC-1 staining. (c) Intracellular ROS levels were measured by flow cytometry using DCFH-DA dye. (d) Trx activities were measured by fluorescent assay kit. (e) Representative Western blotting assay of Bax, Bcl-2, and Cyt-c. GAPDH was used as an internal control. ∗p<0.05 versus control group; #p<0.05.
(a)(b)(c)(d)(e)


## 3.5. p53 Mediates Exquisite Regulation of REDD1/TXNIP Complex

Next, we want to figure out which factor responds to the regulation of the REDD1/TXNIP complex. Previous studies have proven that REDD1 is a direct transcriptional target of p53, and its promoter contains a consensus p53 family binding element [13]. p53 mainly functions as a transcription factor. It determines cell survival or death by promoting growth arrest, DNA repair, or cell death in response to different cellular stresses, which can translocate to mitochondria and contribute to NP cell programmed necrosis [28, 29]. Here, the p53 expression was also increased with H2O2 treatment, and p53 inhibition by PFT-α significantly suppresses the expression of REDD1 and TXNIP (Figure 6(a)) and the combination of them (Figure 4(d)). The expressions of p53 and TXNIP were promoted by exogenous overexpressed REDD1 (Figure 6(b)) but inhibited by NAC (Figure 6(c)). Finally, REDD1 knockdown also decreased the H2O2-induced upregulation of p53 and TXNIP (Figure 6(d)). These results suggested that a loop involves three factors to regulate NP cell response under oxidative stress.Figure 6
p53 mediates exquisite regulation of the REDD1/TXNIP complex. Representative Western blotting assay and quantitation of the levels of p53, REDD1, and TXNIP. GAPDH was used as an internal control. (a) Human NP cells were treated with 200μM H2O2 for 24 h with or without 10 μM PFT-α. (b) NP cells were transfected with a plasmid encoding REDD1 or si-REDD1 and its vector control. (c) NP cells were transfected with exogenous REDD1 and treated with NAC. (d) Human NP cells were transfected with si-REDD1 and then cultured under 200 μM H2O2 for 24 h.
(a)(b)(c)(d)


## 3.6. p53 Inhibition Suppresses REDD1 and Postpones IVD Degeneration Process in Rat ModelsIn Vivo

To further investigate the regulation effect of p53 on REDD1in vivo, we constructed an animal model of IVD degeneration using Sprague-Dawley rats, described in a previous study [10]. Magnetic resonance imaging (MRI, 7.0 T) examination was used to identify different levels of IVD degeneration. The T2-weighted signal observed in the H2O2-injected group at one month after intervention was lower than that in the PBS-injected group but recovered with PFT-α treatment (Figure 7(a)). Then, IVD specimens from all groups were collected for histopathological analysis. As seen in Figure 7(b), the NP of the control group was well organized in a normal oval shape with a large volume of the disc height, and an annulus fibrosus layer showed clear lamellar sheets of collagen in the midsagittal cross-section, as detected by HE staining. In H2O2-injected groups, the disc height was collapsed, and most cells were lost whose space was occupied by fibrillation tissue. An ordered structure of the annulus fibrosus disappeared, and the whole layer of the annulus fibrosus was disrupted. Conversely, additional PFT-α administration reduced the IVD degenerative changes compared to that in H2O2-injected groups, although some degenerative phenotype still existed (Figure 7(b)). To investigate the effect of PFT-α on REDD1, the protein level of REDD1 was also examined. As expected, Western blotting results showed that PFT-α administration would attenuate H2O2-induced REDD1 upregulation (Figure 7(c)). Finally, TUNEL staining was performed to measure the apoptosis levels of NP cells in IVD specimens. H2O2 injection notably increased the ratio of positive staining cells compared with the control group, but this increment could be alleviated by PFT-α administration (Figure 7(d)). Taken together, our in vivo studies proved that p53 inhibition by PFT-α suppresses REDD1 and postpones H2O2-induced NP cell apoptosis and IVD degeneration.Figure 7
PFT-α administration ameliorated IVD degeneration in vivo. Three segments of rat tail discs were injected with PBS, H2O2, the mixture of H2O2, and 10 μM PFT-α for one month. (a) Representative T2-weighted MRI images of rat tail with white squares labeling the operated segments. (b) HE staining of tail discs. (c) Representative Western blotting assay and quantitation of the levels of REDD1. GAPDH was used as an internal control. (d) TUNEL staining was used to detected apoptosis in rat tail discs. ∗p<0.05.
(a)(b)(c)(d)


## 4. Discussion

NP tissues are the most important structure in IVD, and completed functions of NP cells are basic guarantees to support the IVD. Recent evidences have proven that NP cell death caused by apoptosis is able to induce IVD degeneration, while intervention specificity targets NP cell apoptosis to rescue the process of IVD degeneration [30–33]. Oxidative stress induced by various risk factors has been suggested to keep a closer relationship with NP cell apoptosis, excessive oxidative stress results in accelerated IVD degeneration, but interrupted oxidative stress delays IVD degeneration [34, 35]. Thus, it is meaningful to find a key point during the signal pathway of apoptosis and to interfere with that. In our previous study, we found that REDD1 plays a vital role in NP cell apoptosis [20]. The current work further confirmed that REDD1 promoted NP cell apoptosis by increasing oxidative stress, and this process was intermediated by the mitochondrial pathway. High oxidative stress status stimulated by H2O2 resulted in high expression of REDD1, while suppression of REDD1 could retrieve H2O2-induced NP cell apoptosis. Interestingly, REDD1 toiled on this work not alone but with TXNIP. REDD1 formed a complex with TXNIP, and its functions were enhanced. Finally, p53 acted as a transcription factor participating in this pathway (Figure 8).Figure 8
Signaling pathway schematic.Oxidative stress and subsequent mitochondrial dysfunction are a major component within the degenerating disc. Mitochondria are not only the target of many apoptosis signal transduction molecules but also the integrated element of cell death. Damage of mitochondrial DNA and complex enzymes enlarges mitochondrial outer membrane permeability; then, apoptosis-related proteins in the mitochondria spread into cytoplasm. After diffusion, cytochrome c binds with an apoptosis protease activating factor forming a complex. This complex then activates procaspase-9 and procaspase-3 resulting in cellular apoptosis [36]. Several studies have shown that a certain number of REDD1 proteins are located on the mitochondria as in NP cells [25, 37]. Although a definite conclusion has not yet been reached whether REDD1 produces or eliminates ROS, REDD1 is a harmful factor that promotes ROS production in NP cells. REDD1 expression initiates the endogenous apoptosis pathway, activates the release of Cyt-c from mitochondria to the cytoplasm, then promotes to cleave caspases and finally cellular apoptosis. Besides ROS, the PKB/Akt pathway may also mediate the regulation of REDD1 on mitochondrial function. REDD1 overexpression enhances the PKB/Akt activity to impair the mitochondrial function through downstream effectors, for example, FOXO and Pim-1 [38–40].In different cell types and in response to different stressors, REDD1 shows a bifunctional role as an antiapoptotic or proapoptotic factor. Exogenous REDD1 expression in MCF7 and undifferentiated PC12 cells reduces the intracellular ROS level. These cells also are notably resistant to serum deprivation, hypoxia, hydrogen peroxide, and glucocorticoid [14]. In REDD1-/- articular chondrocytes, cleaved caspase-3 is significantly increased and cell death rates are significantly higher. Key antioxidant genes, such as FoxO3, Hmox1, and Sesn2, are reduced in REDD1-deficient chondrocytes treated by tBHP [37]. On the other hand, REDD1 is also demonstrated to promote ROS levels in TP63-null fibroblasts, and overexpressed REDD1 in neuron-like PC12 cells increases sensitivity to oxidative stress and causes cell death [13, 14]. Considering these facts, the inconsistent function of REDD1 may be influenced by its expression. For example, abundant REDD1 expression is observed in human and mouse knee articular cartilage, and its expression will be decreased during aging and osteoarthritis [17]. However, REDD1 expression is only at a low level in normal NP cells but increases with the process of IVD degeneration. Our results showed that REDD1 expression decreased NP cell viability and promoted the apoptosis of NP cells.REDD1 acts as an endogenous mTORC1 inhibitor and activates autophagy. REDD1 is notably required for activating Kinase 1- (ULK1-) induced autophagy initiation in chondrocytes, skeletal muscles, and lymphocytes after glucose deprivation, glucocorticoid treatment, and other cellular stress [23, 37, 41]. The current belief is that autophagy has a complex role in the process of IVD degeneration. Appropriate autophagy scavenges ROS and other harmful substances in NP cells to protect the IVD. However, excessive autophagy will cause normal NP cells to lose functionality and even death [7]. Our previous study found that REDD1 mediates NP cell autophagy under hypoxia and serum deprivation [20]. Furthermore, REDD1 could also trigger autophagy through binding to TXNIP, REDD1/TXNIP interaction results in ROS production, and autophagy activation. Interestingly, both mTORC1-dependent and mTORC1-independent pathways were reported [17, 18, 23].The dynamic stability of the redox system can be ensured by the change of ROS content in a reasonable range. TXNIP, a negative regulator of Trx, suppresses the ROS scavenging activity and leads to cellular oxidative stress. Under normal conditions, TXNIP is presented in the cytoplasm, while in response to extracellular stimulation such as oxidative stress, TXNIP may transfer to mitochondria [42]. A former study revealed that REDD1 could interact with TXNIP to suppress ATG4B under cellular stress. An overexpressed REDD1/TXNIP complex was beneficial for ROS production. However, TRX-reducing capacity, cytosolic ROS level, and number of dysfunctional mitochondria were increased in REDD1-/- and TXNIP-/- cells [23]. Recent evidence further confirmed that the REDD1/TXNIP complex controlled cellular activities through ROS in response to different stressors [18, 43]. In addition, TXNIP overexpression would increase the REDD1 level, and N-terminal-truncated TXNIP was occupied to stabilize REDD1 [44]. In the present study, REDD1 aggregated with TXNIP into a complex and the combination was enhanced under oxidative stress using H2O2. Inhibition of the REDD1/TXNIP complex together exhibited higher efficiency of mitochondrial function and cellular apoptosis than suppression of either REDD1 or TXNIP alone.p53 can protect NP cells against cellular damage by inducing antiapoptotic and antioxidant genes [45, 46]. REDD1 has been identified as a direct transcriptional target gene of p53, a consensus p53 family binding element found in the REDD1 promoter area. REDD1 participates in ROS regulation in response to p53-dependent DNA damage [13]. In our study, inhibition of p53 indeed suppressed both REDD1 and TXNIP expression; meanwhile, inhibition of REDD1 would also suppress p53 expression. Besides, TXNIP interacts with human ecdysoneless (hEcd) to interfere with the combination between p53 and mouse double minute 2 (MDM2) and increases p53 transcriptional activity [47, 48]. This means a loop exists between p53 and the REDD1/TXNIP complex in response to oxidative stress.It should be noted that our study only proved the effect of REDD1 on mitochondrial function. Subcellular localization of the REDD1 protein has been found in the nucleus, cytosol, plasma membrane, autolysosome, and mitochondrial compartments [13, 25, 49–51]. Besides, REDD1 is observed partly localized in the mitochondria-associated ER membrane (MAM) fraction of the skeletal muscle [52]. These may explain why REDD1 shows a dual function in a cell-type manner. The subcellular localization of REDD1 in NP cells should be further investigated to better understand its roles.


## 5. Conclusion

Our previous work has proven that REDD1 was highly expressed in IVD degeneration and accelerated this progress [20]. Collectively, this study further clarified that REDD1 promoted the apoptosis of NP cells through the mitochondrial pathway. Oxidative stress increased the expression of REDD1 and TXNIP in NP cells, which aggravated mitochondrial damage. The interaction between REDD1 and TXNIP formed a functional complex, and the binding would enhance by oxidative stress. The REDD1/TXNIP complex promoted oxidative stress-induced NP cell apoptosis by the mitochondrial pathway. Moreover, p53 mediated the function of the REDD1/TXNIP complex under oxidative stress. Thus, considering the function of the REDD1/TXNIP complex, it may serve as a new and vital therapeutic target for oxidative stress-associated IVD degeneration.



---

*Source: 7397516-2021-09-22.xml*