A review for Developmental Cell

Stuck in Division or Passing Through: When Cells CannotSatisfy the Spindle Assembly Checkpoint.

Conly L. Rieder1-3 and Helder Maiato1

1Division of Molecular Medicine, N.Y.S. Dept. of Health, Wadsworth Center, Albany,New York 12201-0509

2Dept. of Biomedical Sciences, State Univ. of New York, Albany, N.Y. 122223Marine Biology Laboratory, Woods Hole, MA 02543

Correspondence:Dr. Conly L. Rieder, Lab. of Cell Regulation, Wadsworth Center, P.O. Box 509, Albany,N.Y. 12201-0509

Ph = 518-474-6774; fax = 518-486-4901; e-mail = Rieder@Wadsworth.org

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Abstract:The spindle assembly checkpoint (SAC) delays cells in mitosis when one or more kinetochore(s) cannot form

a normal dynamic connection with microtubules (MTs). This occurs when spindle formation fails, or if it forms in

the presence of one pole, aberrant centromeres/kinetochores, or MTs exhibiting abnormal dynamics. In the case of

spindle poisons, the duration of the delay is influenced by the type of poison, its concentration, the cell species and

type, and its resistance to the poison. When the SAC cannot be satisfied it is usually overridden. In yeast, this

“adaptation” occurs via a pathway that inhibits cyclin B/CDK1. It is unknown if vertebrate cells adapt to the SAC

by a similar process. The fate of a cell delayed in mitosis because it cannot satisfy the SAC varies depending on the

type of drug (if a spindle poison was used), its concentration, the duration of the delay, when the cell was exposed to

the insult and its genotype. Under extreme conditions cells that cannot satisfy the SAC die in mitosis by apoptosis or

necrosis. However, under most conditions they exit mitosis and enter the next G1 as single 4N cells. Depending on

the genotype, these cells can then either die by apoptosis, remain viable but undergo senescence, or re-enter the cell

cycle. In the presence of functional spindles formed, e.g., when cells are delayed in mitosis by DNA damage or just

one spindle pole, cells may divide to produce two or more aneuploidy progeny. Some of these may survive to

generate neoplastic cells.

Abbreviations: APC, anaphase promoting complex; FACS, fluorescence activated cell sorting; IMF, indirect

immunofluorescence microscopy; LM, light microscopy; MAPK, mitogen-activated protein kinase; MTs,

microtubules; NEB, nuclear envelope breakdown; SAC, spindle assembly checkpoint.

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Introduction

The somatic cell cycle culminates in the process of mitosis. To ensure that the two progeny produced by a

division are genetically equivalent, cells have evolved elaborate signal transduction pathways, called checkpoint

controls. These checkpoints delay cells from entering and exiting mitosis under conditions which can compromise

genome integrity. The first set of checkpoints guard entry into mitosis (the G2/M transition), and in response to

DNA damage (Pearce and Humphrey, 2001) or other deleterious influences (Mikhailov and Rieder, 2002), work by

delaying activation of the master mitotic regulator, cyclin B/CDK1. Once in mitosis, exit from mitosis is then

controlled by the SAC which delays securin and cyclin B destruction in response to perturbations in kinetochore

microtubule attachment (Zhou et al., 2002).

Mitosis is the most vulnerable period of the cell cycle: relative to interphase, the reproductive capacity of

cells is more easily abolished, and they are more easily killed, when irradiated (Stobbe et al., 2002), heat shocked

(Westra and Dewey, 1971), or exposed to various chemicals (Hughes, 1950) during mitosis. There are several

reasons for this. Some of these insults produce DNA damage that can be repaired during interphase, but not during

mitosis when the chromosomes are condensed. Also, as a rule these insults delay progress through division by

impeding satisfaction of the SAC. Since gene transcription is silenced during mitosis (Gottesfeld and Forbes, 1997)

prolonging division leads to decreased viability because the cell cannot carry out its vital functions. Finally, in cases

where cells exit a prolonged mitosis, they often produce one or more G1 cells containing altered genomes. Under

this condition, pathways are normally triggered to ensure that these cells either do not reproduce or die.

The fact that cells are easily “arrested” in mitosis has proven useful in the treatment of cancer. Several key

classes of clinical agents, including ionizing radiation, work by triggering checkpoints that inhibit entry into, or

progression through, mitosis (Jallepalli and Lengauer, 2001). The ability of paclitaxel (Taxol®) and the vinca

alkaloids, which act directly on spindle MTs, to induce a protracted mitotic arrest is thought to be a major factor in

their cytotoxicity (Mollinedo and Gajate, 2003). Indeed, the development of resistance to these drugs correlates

with the ability of a cell to ultimately escape mitosis and enter the next G1 as a viable entity (Roberts et al., 1990).

Other clinically important drugs like topoisomerase inhibitors (Kellner et al., 2002) work by damaging DNA. Their

therapeutic effectiveness also relies in part to their impact on mitosis. These drugs delay normal cells at G2 before

mitosis. However, in the presence of topoisomerase inhibitors cells lacking functional G2 checkpoints, which

include many tumor cells, enter and are delayed in mitosis with broken DNA. The resultant “mitotic catastrophe”

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often proves lethal to the cell (Castedo et al., 2004). Clearly, it is important to understand the factors that delay

mitosis and control its duration, as well as those that influence the fate of a prolonged mitosis.

The focus of this review is on the “mitotic arrest”, “mitotic block”, or “mitotic delay” seen in vertebrate

cells when they are impeded or inhibited from satisfying the SAC. Unfortunately, all of these terms are misleading

or are commonly misused. “Arrest” and “block” imply a permanent condition, yet many cells that cannot satisfy the

SAC exit mitosis, some very quickly. “Mitotic delay” no longer means a prolongation of mitosis, but denotes instead

a delayed entry into mitosis caused, e.g., by DNA damage. Even the term C-mitosis is heavily misused. This term

was originally coined to describe the structure of cells attempting to divide in the absence of spindle MT formation

(Eigsti and Dustin, 1955). Now, however, it is used as a functional term to characterize any delay in division

produced by a “spindle poison”, including drugs that prevent or depress microtubule assembly (nocodazole,

vinblastine, chloral hydrate, colcemid, etc.), as well as those that promote their stability (paclitaxel, epothilone B,

etc.). To minimize confusion we will use the term “D-mitosis”, for delayed in mitosis, throughout this review. This

delay results whenever satisfaction of the SAC is impeded, which occurs in the absence of spindle MTs and often

even in their presence.

Although the cytostatic factor-mediated arrest in mammalian oocytes has been reviewed recently (Tunquist

and Maller, 2003), the factors that cause a D-mitosis, influence its duration, and determine the fates of the affected

cells, have not. Here we review what the SAC monitors as well as the various conditions that prohibit SAC

satisfaction. This analysis supports the conclusion that all known delays in mitosis are caused by a failure to satisfy

the SAC. Next we examine the factors that determine whether a cell can “slip” through mitosis when the SAC

cannot be satisfied, as well as what ultimately happens to such cells. The focus here is on drugs that perturb MT

function, although the “mitotic catastrophe” seen when cells enter mitosis with DNA damage is also considered.

Solid data on some of these topics are sparse. Regardless, it is clear that the duration a cell remains in mitosis when

it cannot satisfy the SAC varies between cells, even from the same organism. It is similarly evident that we are just

beginning to understand the factors that determine whether a cell ultimately lives, or dies, when it cannot satisfy the

SAC.

Progression through Mitosis is controlled by a Constitutive Spindle Assembly Checkpoint

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Progress through mitosis is regulated by the SAC (Zhou et al., 2002). This control mechanism uses Cdc 20

(Hwang et al., 1998) and Cdh1(Lindon and Pines, 2004), as well as various Mad (Li and Murray, 1991) and Bub

(Hoyt et al., 1991) proteins present on unattached but not attached kinetochores, to prevent the activation of

anaphase promoting complexes (APCs). The activity of these large ubiquitin-ligase assemblies is, in turn, required

for targeting securin (Nasmyth et al., 2000) and cyclin B (Hagting et al., 2002) for proteolysis. The respective

destruction of these proteins then allows the chromatids to separate (anaphase) and the cell to exit mitosis

(telophase). Although many view the SAC as an inducible pathway “triggered” during mitosis when spindle

assembly is perturbed, in reality it is a constitutive pathway. Since all kinetochores start mitosis unattached, the

checkpoint signal is constitutively present until the checkpoint is satisfied, at which time it is shut off.

The Spindle Assembly Checkpoint Detects Unattached Kinetochores and Perturbations in the Dynamic

Behavior of Kinetochore-Associated Microtubules

In vertebrates, chromosomes attach to the forming mitotic spindle as their “sister” kinetochores come into

contact with two growing radial arrays of centrosome MTs. Given this mechanism, several outcomes are seen during

the initial stages of chromosome attachment. When the asters are separated at nuclear envelope breakdown (NEB),

both sister kinetochores often attach simultaneously to the opposing centrosomes, so that each kinetochore is

attached to only one centrosome (pole). This amphitelic attachment (or biorientation; Fig. 1) is the preferred and

most stable attachment, and it shuts down production of the SAC signal by both sister kinetochores. This is the only

orientation that will ensure accurate chromatid segregation during the ensuing anaphase.

There are different opinions regarding the precise aspect of kinetochore attachment that turns off

production of the checkpoint signal (Zhou et al., 2002),(Logarinho et al., 2004). The sudden appearance of tension

on a kinetochore as it acquires MTs, generated by forces acting through the centromere or directly on the

kinetochore, is an attractive candidate. (Li and Nicklas, 1995b). However, it is evident from theoretical (Hill and

Kirschner, 1982) and experimental grounds (Nicklas, 1988) that the stability of a kinetochore-associated MTs is

enhanced by tension on the kinetochore, i.e., that tension promotes the accumulation of MTs by the kinetochore.

Thus, the more immediate event monitored by the checkpoint may be the accumulation of MTs (Rieder et al.,

1994),(Waters et al., 1998). In this view tension becomes a positive feed-back mechanism, created during

attachment, that promotes MT accumulation until the kinetochore is saturated (McEwen et al., 1997),(Nicklas et al.,

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2001). This model draws support from the observation that the distribution of many checkpoint proteins in the

kinetochore changes in a MT but not tension-dependent fashion (Hoffman et al., 2001).

Fig. 1. Schematic showing normal and errant kinetochore attachments, and how they effect the SAC.

In many cases one kinetochore attaches to the forming spindle before its sister. This “monotelic

attachment” (or monoorientation; Fig. 1) persists for variable periods, and all the while the unattached kinetochore

produces a checkpoint signal (Rieder et al., 1995) In vertebrates, just one unattached kinetochore can delay

anaphase for hours (Rieder et al., 1994), even in large multi-polar spindles (Sluder et al., 1997). However,

unattached kinetochores on one spindle do not delay anaphase in a neighboring spindle, in the same cytoplasm, in

which all kinetochores are attached (Rieder et al., 1997). This means that the checkpoint signal works locally on the

spindle containing the unattached kinetochore, rather than throughout the cell. As for other checkpoints, the

checkpoint signal produced by a kinetochore is likely amplified so that it can inhibit anaphase through the spindle.

The mechanism behind this amplification process is unknown.

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Sometimes one kinetochore becomes attached to two spindle poles . This “merotelic attachment” (Fig. 1)

can happen when more than two centrosomes are present (i.e., multipolar spindles (Sluder et al., 1997) or during a

recovery from drugs that inhibit MT assembly (Cimini et al., 2001). A merotelically attached kinetochore does not

produce a checkpoint signal, and will lead directly to aneuploidy if it is not corrected. Fortunately, an efficient but

vague mechanism exists to correct this mal-orientation before anaphase, at least in cells containing bipolar spindles.

It appears to involve the loss of attachment to one of the spindle poles during the normal turnover of kinetochore

MTs (Cimini et al., 2003b).

Both sister kinetochores can also attach simultaneously to MTs emanating from the same pole. This

“syntelic attachment” (Fig. 1) is prevalent when centrosome separation is delayed until after NEB (Kapoor et al.,

2000). Like a merotelic attachment, syntelic attachments lead to aneuploidy if not corrected. Most assume that

kinetochores attached to the same pole continue to produce a checkpoint signal. However, this assumption is based

on the behavior of non-natural univalents in meiotic systems like insect spermatocytes (Li and Nicklas, 1995a). Yet,

in these systems, syntelically oriented natural univalents are not seen by the checkpoint. The scant data that exists

on this topic suggest that, as with natural univalents, syntelically attached chromosomes in somatic cells are not

detected by the SAC (Kisurina-Evgenieva et al., 2003). As for merotelic orientations, mechanisms exist to correct

syntelic orientations. Recent evidence suggests that the aurora B kinase is necessary for this process (Andrews et al.,

2003), which appears to involve the disassembly of one kinetochore fiber (Lampson et al., 2004). Here it is

noteworthy that the correction process produces a monooriented chromosome with an unattached kinetochore,

which is again free to produce the checkpoint signal.

The SAC is also sensitive to the behavior of kinetochore MTs. This is evident from the fact that nM

(Jordan et al., 1992),(Vasquez et al., 1997) and even pM (Jones et al., 2004) concentrations of spindle poisons, that

modify MT behavior without appreciably effecting spindle structure, prevent satisfaction of the SAC . Two

outcomes are observed when cells enter mitosis in the presence of a spindle poison: depending on the poison and its

concentration either no MTs are formed for the kinetochores to attach to, or their numbers and/or dynamics are

altered so that one or more kinetochores form incomplete or unstable attachments. In the D-mitosis induced by

pacitaxel, which “stabilizes” MTs, one or more kinetochores are positive for Mad2 at all times (Waters et al., 1998).

Further, 3D electron microscopic studies reveal that such cells contain at least one kinetochore that is not saturated

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with MTs (McEwen et al., 1997). One interpretation of these data is that even when MT dynamics is compromised,

kinetochores that are saturated with MTs are depleted of Mad2, and therefore not capable of checkpoint signaling.

All Known Delays in Mitosis Are Mediated by the Spindle Assembly Checkpoint

The Mad/Bub-mediated SAC appears to be the only pathway that operates in vertebrates to delay progression

through mitosis (Shannon et al., 2002): cells in which SAC checkpoint proteins like Mad2, BubR1 or Cdc20 are

mutated (Dai et al., 2004) or inhibited by antibodies (Gorbsky et al., 1998),(Mikhailov et al., 2002),(Sihn et al.,

2003) fail to delay in mitosis in response to unattached kinetochores, spindle poisons or extensive DNA damage. It

has been reported that a delay in mitosis also requires the activity of other pathways, including those involving p53

and the ATM and p38 kinases. However, all of these claims are based on indirect data and can be challenged. For

example, the reports that the SAC involves p53 (Cross et al., 1995) or ATM (Shigeta et al., 1999) are based on

artifacts of fluorescent activated cell sorting (FACS). Instead, in response to drug treatments, p53 activity is required

to prevent 4N G1 restitution nuclei, formed in cells after they leak through a mitotic arrest, from cycling into the

next S phase (Sablina et al., 1999). Similarly, DNA damage during mitosis appears to delay mitotic progression by

its effects on kinetochores/ centromeres, and thus the SAC (Mikhailov et al., 2002),(Searle et al., 2004), and not via

a separate ATM/DNA damage checkpoint. Although exit from mitosis in fission yeast is regulated by a checkpoint

that monitors spindle positioning independent of the SAC (Muhua et al., 1998), evidence that such a pathway

contributes to the SAC in vertebrates is unconvincing (Khodjakov and Rieder, 2001). Finally, mitogen activated

protein kinases (MAPK) like p38 are reported to be required for the SAC (Wang et al., 1997), (Takenaka et al.,

1998). However, these claims are not supported by recent live cell studies (Tsuiki et al., 2001), (Mikhailov et al.,

2004). Yet, although p53 and MAPKs do not appear to be involved in the SAC, there is some evidence that they

mediate the outcome of a D-mitosis. This issue will be discussed in more detail later.

In the absence of a spindle, cells lacking a functional SAC exit mitosis shortly after NEB (Michel et al.,

2001),(Dai et al., 2004). In these cells the duration of mitosis represents the time it normally takes to ubiquitinate

and destroy cyclin B and/or securin in the absence of a checkpoint signal. In untreated cells this time frame can be

estimated from when the last kinetochore attaches to the spindle until the chromatids separate. In PtK1 (rat kangaroo

kidney) cells this takes ~20 minutes at 32-34oC (Rieder et al., 1994). However, this timing is extremely temperature

sensitive since it takes several hours in PtK1 at 21-23oC (Shannon et al., 2002) but only ~ 10 minutes at 37oC. [In

PtK1 the duration between NEB and anaphase at 25oC, 32oC and 37oC is (in hrs:min) 2:11 ± 11 (N = 20), 0.32 ± 02

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(N = 14), and 0.24 ± 02 (N =18), respectively. C.L. Rieder and R.W. Cole, unpublished]. Indeed, when PtK1 cells

are injected at 37oC with antibodies against Mad2, after entering a nocodazole (Gorbsky et al., 1998) or paclitaxel

(Waters et al., 1998) induced D-mitosis, they separate their chromatids and exit mitosis 8-12 minutes later. This

means that when treated with spindle poisons, the mitotic index in cultures of cells that lack a functional SAC will

show no change over time, and will be similar to or slightly less than non-drug treated controls.

Many Conditions Delay or Prevent Satisfaction of the Spindle Assembly Checkpoint

Satisfaction of the SAC is delayed, but not prevented, under several “natural” conditions. The most obvious

is low temperature: at 23oC the duration of mitosis in PtK1 is > 10X longer than at 37oC (Rieder and Cole, 2002)

with metaphase lasting on average 101 minutes versus 21 minutes (Shannon et al., 2002),. Microinjection studies

confirm that the SAC is involved in the D-mitosis induced by hypothermia (Shannon et al., 2002). The delay is

likely due to the depression of enzymatic reaction kinetics: at 23oC prometaphase cells injected with dominant

negative MAD enter anaphase after 32 min, but require only 12 min to do so at 37oC (Shannon et al., 2002). It may

also be due to the dampening of MT turnover and dynamics. Progression through mitosis is also delayed by high

temperatures (42-44oC), which appears to impede satisfaction of the SAC by damaging MTs and chromatin

structure (Erenpreisa et al., 2000).

Based on how spindles form in vertebrates, it is likely that anaphase is also delayed in extremely flat cells.

In flat cells spindle assembly occurs in two instead of three dimensions and, working under this constraint, cells

should require more time to attach all of their kinetochores. In support of this view, the interval between NEB and

anaphase onset in Taricha (newt) lung epithelia cells, which remain very flat during mitosis, averages > 2 hrs at

23oC (Washio and Sato, 1982); this interval is ~ 30 min in Taricha coracoid bone fibroblasts (C.L. Rieder,

unpublished observation) and other newt fibroblasts (Hughes and Preston, 1949) which round during prometaphase.

Physical treatments (e.g., high pressure) or drugs that depress MT assembly or that alter the dynamic

behavior of MTs, delay progression through mitosis by preventing satisfaction of the SAC. Based on existing data,

the D-mitosis induced by these agents can be attributed to a failure of one or more kinetochores to form stable

and/or mature kinetochore-to-spindle attachments (see above).

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Treatments that delay or prevent the centrosomes from separating also prevent satisfaction of the SAC.

These include, e.g., diazepam (Andersson et al., 1981), monastrol (Kapoor et al., 2000), and low concentrations of

MT inhibitors (Brinkley et al., 1967). All of these agents produce “monopolar” spindles that contain a variable ratio

of syntelic and monotelic chromosomes, and there are always unattached kinetochores to impede satisfaction of the

checkpoint. Obviously, mutations in proteins required for centrosome separation (e.g., mgr, aurora and KLP61f in

Drosophila; (Gonzalez et al., 1988),(Glover et al., 1995),(Wilson et al., 1997) also prevent satisfaction of the SAC,

even though they play no direct role in SAC function. Here it is noteworthy that the presence of >2 spindle poles

does not prolong mitosis. Instead, the duration of mitosis in cells containing multipolar spindles depends on when

the last kinetochore attaches (Sluder et al., 1997).

Any condition that disrupts the normal anchorage of spindle (kinetochore) MTs leads to changes in their

stability and/or behavior, and also prevents satisfaction of the SAC. These include, e.g., blocking the cyclin

B/CDK1-mediated phosphorylation of NuMa (Compton and Luo, 1995), mutations in the centrosomal protein ASP

(Avides and Glover, 1999), and inhibiting cytoplasmic dynein (Echeverri et al., 1996), or spindle-associated kinesins

like HSET (Gordon et al., 2001).

Treatments that modify kinetochore structure, by acting directly on the kinetochore or on the underlying

centromeric chromatin, can also impede satisfaction of the SAC even though they do not prevent spindle assembly.

Good examples here include chromatin damage caused by radiation (Mikhailov et al., 2002), and inhibitors of

topoisomerase II (Illidge et al., 2000),(Mikhailov et al., 2004) or histone deacetylase (Cimini et al., 2003a), that

delay the formation of stable microtubule-kinetochore attachments by globally perturbing chromatin structure. One

often neglected consideration is that mutating or depleting some chromosome proteins can lead to a D-mitosis, even

though they are not involved in the SAC pathway. For example, depleting the centromere of important structural

(e.g., CENP-A, (Figueroa et al., 1998); CENP-C, (Tomkiel et al., 1994)) or functional (survivin, (Lens et al., 2003);

borealin, (Gassmann et al., 2004)) proteins delays cells in mitosis, as does knocking down some kinetochore

proteins (CENP-F, (Zhu et al., 1995)), especially those involved in attaching MTs to the kinetochore (e.g., CENP-E,

(Yao et al., 2000); Nuf-2/Hec1, (DeLuca et al., 2003)) or in controlling their dynamics (e.g., CLASP1, (Maiato et

al., 2003)). In essence, any treatment that compromises the ability of one or more kinetochores to acquire a full set

of dynamic MTs, which does not also disrupt production of the checkpoint signal, delays satisfaction of the SAC.

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Metaphase is also prolonged 3-5X in many transformed cells (Sisken et al., 1985),(de la Hoz and Baroja,

1993). Therman and Kuhn (Therman and Kuhn, 1989) state that “the most characteristic mitotic change in

malignant cells, and also the first to appear, is an increase in the relative frequencies of metaphases compared with

prophases.. …which naturally reflects their relative duration’s”. It remains to be determined if delayed satisfaction

of the SAC is a feature of all or just some cancer cells. The D-mitosis seen in malignant cells was originally ascribed

to differences in how they regulate Ca++ relative to normal cells (Sisken et al., 1985). However, the sudden increase

in Ca++ at anaphase onset occurs after the SAC has been satisfied (Tombes and Borisy, 1989). A more plausible

explanation is that in some malignant cells one or more kinetochores have a difficult time establishing a stable

connection to the spindle. This could arise, e.g., as cells accumulate DNA damage over repeated cycles because they

lack functional G1 and G2 DNA damage checkpoints (e.g., via mutations in p53 and ATM).

As mentioned previously, physical treatments [X and γ-radiation, (Ruth and Roninson, 2000); laser

microsurgery, (Mikhailov et al., 2002); heat shock, (Erenpreisa et al., 2000)] or drugs (topoisomerase II or histone

deacetylase inhibitors), that damage DNA induce a D-mitosis. In an extreme example, anaphase is considerably

delayed when rodent cells are forced into mitosis from S phase by inhibiting ATM with caffeine (Schlegel and

Pardee, 1986). Similarly, when chromosomes in PtK1 or human cells are damaged during mitosis, the duration of

metaphase is prolonged up to 8X (Mikhailov et al., 2002). Microinjection studies reveal that this delay is due to the

Mad2-mediated SAC. It likely occurs because global DNA damage compromises the proper stable attachment of

one or more kinetochores.

The D-mitosis induced by DNA damage is commonly referred to by the misleading term “mitotic

catastrophe”. This term was coined to characterize the catastrophic fate of fission yeast that enter mitosis with DNA

damage because they lack a functional G2 DNA damage checkpoint [see (Molz et al., 1989)]. Now it is frequently

used to characterize the unequal segregation of chromosomes caused by aberrant spindle formation in response, e.g.,

to too few or too many spindle poles or spindle poisons. Some even view mitotic catastrophe as a distinct form of

cell death (Castedo et al., 2004). Regardless, as originally defined, the term describes a D-mitosis and its outcome,

which occurs when cyclin B/CDK1 is activated in the presence of extensive DNA damage.

Finally, any treatment or condition that prevents cyclin B/CDK1 inactivation, independent of kinetochore,

spindle, or SAC function, produces a D-mitosis. These include, e.g., preventing APC function by inhibiting the

Polo-like kinase (Seong et al., 2002), or mutations in components that prevent proteolysis (Gordon et al., 1993).

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As for All Checkpoints, Satisfying the Spindle Assembly Checkpoint is not required for Viability or continued

Cell Cycle Progression.

Before defining the factors that influence the duration of a D-mitosis, lets first examine what happens when

cells enter mitosis without a functional SAC. In the absence of a SAC most mitoses produce two normal cells,

because the SAC only improves the chances for, but is not essential to, a successful mitosis. However, knocking the

SAC (Mad2) out of mice produces a higher than normal incidence of aneuploidy which is fatal to the embryo

(Dobles et al., 2000). Haploinsufficiency for SAC components (like Mad2, BubR1) leads to a defective SAC in

human cancer cells and murine primary embryonic fibroblasts, as well as a high rate of tumor production in mice

(Michel et al., 2001),(Dai et al., 2004). Clearly, at the level of the cell, the absence of a SAC is seldom fatal.

However, it will lead to the production of genetically unstable progeny.

If spindle assembly is disrupted in the absence of a SAC the cell quickly exits mitosis (see above), cytokinesis

usually fails, and a single G1 cell containing numerous micronuclei or a 4N restitution nucleus is formed (Taylor

and McKeon, 1997),(Waters et al., 1998),(Sihn et al., 2003),(Dai et al., 2004) . Little is known about the post-mitotic

fate of these drug-induced 4N “SAC-free” cells. Normally the H261derivative of HeLa cells arrests in a drug-

induced D-mitosis for ~ 18 hrs, after which it exits mitosis and dies. However, if the SAC is eliminated by inhibiting

Bub1, H261 quickly exit a D-mitosis and begin a new cell cycle (Taylor and McKeon, 1997). Originally this was

interpreted to mean that Bub1 is essential for inducing apoptosis during G1. However, it more apoptosis occurs in

H261 whenever mitosis is extensively prolonged regardless of their Bub1 status (see next section below). In contrast

to what is seen for H261, FACS studies suggest that HeLa or U2OS (human osteosarcoma) cells lacking a SAC

rapidly exit a D-mitosis and die in G1 by apoptosis (Sihn et al., 2003). The fate of non-transformed cells that

prematurely exit a D-mitosis because they lack a SAC is unknown, and an important area for work. [Here it is

noteworthy that the highly variable outcomes seen during a D-mitosis in cultured cells, which range from death by

apoptosis during mitosis to continued cell cycle progression, reflect the highly variable genotypes of the cells. This

will be discussed later in more detail.]

Many cancer cells are reported to have mutated “mitotic checkpoint genes” and an “impaired” SAC, as

determined by the effect of spindle poisons on their mitotic index in culture (Cahill et al., 1998),(Takahashi et al.,

1999), (Weitzel and Vandre, 2000),(Ouyang et al., 2002), (Kasai et al., 2002),(Saeki et al., 2002), (Masuda et al.,

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2003),(Minhas et al., 2003). However, a closer analysis reveals that most of these cultures still show a significant

increase in their mitotic index in response to the poisons—which would not be expected if the cells contained a non-

functional SAC (see above). Checkpoint controls are all or nothing pathways that cannot be “partly” activated or

inactivated. As a result, the data strongly suggest that these cells actually contain a functional SAC but, relative to

non-transformed counterparts, they have lost the ability to remain arrested in mitosis for prolonged periods.

The Time it takes to override an Unsatisfied Spindle Assembly Checkpoint Varies between Organisms

One factor that defines how long a cell can spend in a D-mitosis is the organism it comes from. At one

extreme, most plant cells quickly escape conditions that inhibit spindle assembly: e.g., colcemid-treated Haemanthus

endosperm spend only 0.5X longer in mitosis than non-treated cells (Mole-Bajer, 1958) whereas Tradescantia

staminal hair cells spend ~ 2.5 X longer (Wada, 1940). After exiting a D-mitosis, plant cells enter the next G1 with a

4N restitution nucleus, and many then continue into the next cell cycle. This feature formed the basis of “plant

breeding with non-Mendelian methods” early in the 20th century (Nebel and Ruttle, 1938).

Some animal cells also quickly escape mitosis when spindle assembly is inhibited. This is particularly true

for embryonic cells, most of which lack a persistent SAC (e.g., Drosophila (Glover, 1991), sea urchins (Sluder,

1979), C. elegans (Dncalada et al., 2004)). As a rule, however, in the absence of a spindle mitosis is significantly

prolonged in animal somatic cells. This delay may be permanent and fatal but more often it is transient and

survivable. Thus, as is characteristic for all checkpoint controls, somatic cells need not satisfy the SAC to pass

through mitosis (above). This process is commonly termed checkpoint “adaptation”, “slippage” or “leakage”.

Among vertebrates, the primary factor in determining how long a cell spends in a D-mitosis, when it cannot

satisfy the SAC, is the species the cell comes from. Compared to primates, rodents are naturally resistant to spindle

poisons and this is mediated at the level of the cell (Medgley et al., 1959),(Ling and Thompson, 1974). As a result,

rodent cells can divide normally in concentrations of spindle poisons that produce a D-mitosis in humans (Gupta,

1985). At higher drug concentrations, this resistance in rodents is further reflected by a decrease in the duration of a

D-mitosis relative to human cells: at 37oC mouse embryonic fibroblasts (Lanni and Jacks, 1998) and PtK1 (Fig. 2A)

spend 3-5 hrs in a D-mitosis induced by 1-10 µM nocodazole whereas, as a rule, human cells that are exposed to 0.1

µM nocodazole require the duration of a cell cycle (~18-20 hrs) or more to escape mitosis (Sherwood et al.,

1994),(Woods et al., 1995),(Jordan et al., 1996) (Fig. 2B)

14

Fig. 2. (A) Selected frames from a time-lapse recording of a PtK1 cell entering and escaping a D-mitosis aftertreatment with 10 µM nocodazole at 37°C. (B) Similar to (A) except a human hTERT-RPE1 cell is followed aftertreatment with 100 nM nocodazole. Note that the normal human cell exhibits a prolonged (~ 18 hr) D-mitosis inresponse to 100 nM nocodazole, whereas the rodent cell quickly escapes after a treatment with 10 µM nocodazole.Time in hrs:min in lower right corner.

Schimke and colleagues (Schimke et al., 1991) referred to cells that readily escape a D-mitosis as having a

“relaxed mitotic control”, whereas those that cannot escape the block, or do so only after a protracted period (> 18

hrs), were considered to have a “stringent mitotic control”. Relaxed versus stringent mitotic controls equate to

SACs that can, or cannot, be overridden in a reasonable (several hour) period. Our understanding of how cells exit

mitosis when they cannot satisfy the SAC comes from work on budding yeast. In this system, cells become less

sensitive to the checkpoint signal over time. In yeast, adaptation to the SAC is not due to the destruction of cyclin B,

as normally occurs when the SAC is satisfied. Instead, in the presence of a persistent checkpoint signal caused, e.g.,

by defective spindles (Minshull et al., 1996) or malfunctioning kinetochores (Wells and Murray, 1996), yeast exit a

D-mitosis by inhibiting cyclin B/CDK1. This appears to occur by the down regulation of protein phosphatase 2A

pathway via its B-type regulatory subunit, Cdc55 (Wang and Burke, 1997). During this adaptation process the

chromatids separate, but it is not clear if this is due to declining cyclin B/CDK1 activity or APC-mediated

proteolysis. [Reports of anaphase-like events in the absence of chromatid disjunction in various yeast

kinetochore/centromere mutants [e.g., Duo1p/Dam1p (Cheeseman et al., 2001), cohesin (Michaelis et al., 1997), or

15

ipl1 (Biggins et al., 1999)] are likely based on prometaphase cells in which all chromosomes have monooriented to

one or the other spindle poles (i.e., anaphase-like prometaphase spindles (Waters et al., 1993).]

Little is known about how cells from other organisms escape an active SAC. The key problem is to resolve

how cyclin B/CDK1 is inactivated to allow escape from a D-mitosis. The disappearance of MPM2 staining, histone

H1 phosphorylation, or the formation of micronuclei, are common assays for mitotic exit, but all occur whether

cyclin B is degraded or cyclin B/CDK1 is inhibited. The assumption of some FACS studies, that drug-treated cells

are still in mitosis if they are cyclin B positive, is similarly problematic: as in yeast, mammalian cells may exit a D-

mitosis and enter the next G1 with high cyclin B levels via an adaptation pathway. Also, in humans cyclin B

synthesis is initiated in early G2 (Steinmann et al., 1991). The protein can accumulate to very high levels before

mitosis, especially when cells are delayed in G2 (Narayanan et al., 1997).

When the kinetochore protein MAST is depleted from Drosophila S2 cells a monopolar spindle is formed

(Maiato et al., 2002). After > 24 hrs the chromosomes in these cells achieve a random distribution around the

spindle poles, chromosome disjunction fails, the centrosomes separate, the spindle elongates, stem-bodies form, and

histone H3 is dephosphorylated (Fig. 3). Surprisingly, these events take place in the presence of high cyclin B levels

as assayed by IMF! Since all of these events mark a normal telophase, which does not occur in the presence of

active cyclin B/CDK1, it appears that flies can undergo a process of SAC adaptation similar to that of yeast.

Not unexpectedly, serine/threonine kinase inhibitors like 2-aminopurine (Andreassen and Margolis, 1994) or

staurosporine (Hall et al., 1996) accelerate slippage through a D-mitosis. However, it is unclear if these drugs

promote slippage by inhibiting cyclin B/CDK1 (Swe and Sit, 1997) or by inducing the destruction of cyclin B

(Tsuiki et al., 2001). It is even unclear if their primary target is CDK1 or another kinase like Aurora B. Aurora B

inhibitors also promote slippage through the SAC (Hauf et al., 2003) because the activity of this kinase is required

for destabilizing errant kinetochore-MT interactions (Andrews et al., 2003). Some FACS data support the notion

that escape from a D-mitosis in vertebrates occurs via an adaptation pathway (Barboule et al., 1997),(Deacon et al.,

2003). However, other FACs studies report that leakage coincides with cyclin B degradation (Schimke et al.,

1991),(Panvichian et al., 1998). As during adaptation in yeast, the D-mitosis in vertebrates often culminates in sister

chromatid disjunction (C-anaphase) followed by telophase and micronuclei formation (Rieder and Palazzo, 1992).

Whether this is due to the APC-mediated proteolysis of securin or another route tied to declining cyclin B/CDK1

16

activity remains unknown. Considering the redundancy of mitotic processes, multiple mechanisms may exit in

vertebrates for escaping an active SAC. This is an important area for future work.

Other Factors Independent of the Organism also Influence the Duration of a D-mitosis

Our understanding of the factors that influence the duration of a D-mitosis is hampered by a glut of FACS

data, on mostly transformed cells, that lead to less-than-precise terminology (e.g., G2/M) and conclusions. Many

early FACS-based claims on this issue are suspect because of poor temporal resolution, and because the technique

failed to distinguish between G2, mitosis, or even cells that cycled through a D-mitosis into the next G1—all of

which are 4N.

Fig. 3. Drosophila S2 cells in D-mitosis afterdepleting the cell of MAST (a kinetochore protein)by RNAi. (A,B) Control metaphase (A) and anaphase(B) cells showing the degradation of cyclin B fromthe centrosomes and cytoplasm at the metaphase-anaphase transition. (C) Formation of monopolarspindles after MAST RNAi causes a mitotic delay ofat least 24 hr. Cyclin B levels are comparable tocontrol prometaphase/metaphase cells. (D-E)Anaphase (D) and telophase (E)-like cells that appearto arise in the cultures by adaptation after a 24-48 hrdelay. Note the high cyclin B levels on centrosomesand cytoplasm, the formation of stem bodymicrotubules. Cyclin B staining at the centrosome isshown as inserts at the upper right corner of eachfigure. On each figure, a neighbor interphase cell isshown for comparison of cyclin B levels duringmitosis and adaptation. (F) Adaptation in DrosophilaS2 cells does not lead to sister-chromatid disjunctionor SAC inactivation as evidence by the continuouspresence of BuBR1 at kinetochore pairs (insert).Scale bar is 5 µm.

17

As with untreated cells in mitosis, the duration of a D-mitosis is influenced by temperature. In the only

published study on this topic, Evans and Savage (Evans and Savage, 1959) concluded from fixed material that the

duration of a colchicine-induced D-mitosis in plant meristem cells decreases with increasing temperature. We find

that the same is true for mammals (C.L. Rieder and R.W. Cole, unpublished): the duration of a D-mitosis induced by

10-µM nocodazole in rat kangaroo kidney (PtK1) cells at 37oC is slightly over 2 hrs (2:16 ± 20 min; N = 11: Fig.

2A), whereas at 32oC a D-mitosis lasts almost 7 hours (6:43 ± 55 min; N = 12). Clearly, comparing the duration of a

D-mitosis between labs, even in the same cell type, must consider the stringency of temperature control.

In seminal work, Gupta (Gupta, 1985) reported that cells from humans accumulate spindle poisons to much

higher intracellular concentrations than those of rodents. He also noted that this 3-5X difference [see also (Parekh

and Simpkins, 1996)] is not due to species-specific changes in drug binding to MTs. This prompted him to

hypothesize that the differential sensitivity between rodent and human cells to spindle poisons (see above) results

because cells from different organisms accumulate different drugs to different extents. Indeed, after 20 hrs in 3-nM

vinblastine or 3-nM paclitaxel the intercellular concentration of these drugs in HeLa is 60 and 600X, respectively,

greater than in the surrounding medium (Jordan et al., 1991),(Jordan et al., 1996). The degree to which cells

concentrate spindle poisons can also vary between different cell types from the same organism. After 24 hrs in 3-

nM paclitaxel the drug concentration in Caov-3 (human ovarian carcinoma) cells is 1200X higher than in the

surrounding medium; whereas A498 (human kidney carcinoma) cells accumulate the drug to only 330X that of the

medium (Yvon et al., 1999). [The fact that human cells continuously accumulate spindle poisons explains why, after

long but not short treatments with drugs that bind tightly to MTs like taxol, cells fail to recover from the block

despite numerous washes (Jordan et al., 1996).] The mechanism that prevents rodent cells from accumulating

spindle poisons to the degree that humans do is complex and involves, among other processes, the p-glycoprotein

multi-drug resistant system which dampens drug influx while increasing efflux (Parekh and Simpkins, 1996).

The duration of a D-mitosis can differ dramatically between cells from the same organism that accumulate

spindle poisons to widely different degrees. After 20 hrs in 100-nM paclitaxel, A-498 cells have an intercellular

concentration of ~20 µM, but they escape the D-mitosis and enter the next G1 as a multinucleated 4N cell which can

then survive for days (Yvon et al., 1999). By contrast, a 24 hr treatment of Caov-3 or HeLa cells with 100-nM

paclitaxel leads to an intercellular concentration of 40-45 µM, and produces a terminal mitotic arrest (Jordan et al.,

1993),(Woods et al., 1995). This raises the question of whether the difference in the duration of a D-mitosis between

18

rodents and humans is due simply to differences in their ability to concentrate spindle poisons. Although this issue

has not been addressed experimentally, the existing data suggests not: a 20 hr treatment with 0.1 µM nocodazole

reduces the number of spindle MTs formed during mitosis in HeLa and hTERT-REP1 (telomerase immortalized

human retinal pigment epithelia) by only 30%, yet it delays the cells in a D-mitosis for at least ~ 18 hrs (Jordan et

al., 1992),(Fig. 2B). By contrast, rodent cells readily escape a D-mitosis induced by concentrations of nocodazole

100X higher (10 µM), which completely prevent MT assembly (Kung et al., 1990),(Labidi et al., 1985) (Fig. 2A).

Thus, human cells arrest in a D-mitosis at intercellular drug concentrations that allow most MTs to assemble,

whereas rodent cells rapidly escape a D-mitosis under concentrations that prevent the formation of MTs. It is

possible, of course, that the progressive concentration of spindle poisons in human cells (up to 5X those seen in

rodents) prevents some from leaking through the SAC by triggering pathways that are not normally active under

threshold concentrations of the drug, or that are not active in rodents.

The duration of a D-mitosis also depends on the initial concentration of the poison used. In hamster cell

cultures, for example, the mitotic index rises uniformly during the first 12 hr of exposure to 0.04-µg/ml or 0.2-µg/ml

nocodazole, but then quickly drops in cultures containing the lower concentrations (Andreassen and Margolis,

1994). This is also true for many human cells: after 20 hr in 10-nM epothilone B (a paclitaxel-like substance) the

mitotic index of MCF7 (breast adenocarcinoma) cells it is 35-45%, whereas after 20 hrs in 1-nM epothilone B it is

only 10% (Kamath and Jordan, 2003). Indeed, as a rule, when exposed to spindle poisons for 18-20 hrs the mitotic

index in most human cell cultures increases with increasing drug concentrations. These data reveal that cells

exposed to lower drug concentrations spend less time in a D-mitosis than those exposed to higher concentrations,

since in growing cultures changes in the duration of mitosis are reflected as changes in the mitotic index. [Although

it has not been systematically studied, the duration of a D-mitosis probably also depends on the duration of drug

treatment, and when the drug is applied, especially in cells that accumulate spindle poisons to very high levels

(Mollinedo and Gajate, 2003).]

Why is the ability to escape a D-mitosis in a reasonable period related to the drug concentration? We know

that MTs are always present at lower concentrations even after prolonged treatments (Brinkley et al., 1967), (Jordan

et al., 1992). This is true even though high concentrations of MT inhibitors completely suppress spindle MT

assembly. MTs are also always present after paclitaxel treatment, but their behavior is progressively retarded at

higher concentrations (Derry et al., 1995). This raises the possibility that the duration of a D-mitosis is influenced by

19

the number of spindle MTs the cell forms, and/or the degree to which their dynamics is suppressed (Andreassen and

Margolis, 1994). There is some evidence for this view: in response to 2-aminopurine, hamster cells quickly escape a

D-mitosis induced by paclitaxel or low concentrations of nocodazole, but not a D-mitosis induced by high

concentrations of nocodazole (Andreassen and Margolis, 1994). Similarly, inhibiting aurora B induces paclitaxel

and monastrol treated HeLa cells to escape a D-mitosis, but not cells treated with high concentrations of nocodazole

(Hauf et al., 2003). Finally, treating A549 (human lung carcinoma) cells with MT-stabilizing drugs leads to D-

mitotic cells that exit mitosis to produce aneuploid cells. Treating them with MT destabilizing agents produces a

permanent mitotic arrest (Chen and Horwitz, 2002). Thus, in rodents and humans there is a positive correlation

between the number of MTs during a D-mitosis (and/or their dynamic behavior) and the duration of the block.

However, the real significance of this correlation, if any, remains unknown. One possibility is that APCs are less

sensitive to the checkpoint signal when bound to MTs.

Another possible reason why the duration of a D-mitosis is related to spindle poison concentration is that the

higher the initial concentration, the greater the drug is concentrated within the cell (Gupta, 1985). When HeLa,

CAOV-3 or A498 cells are treated for 20 hrs with 3-nM or 100-nM taxol, the intercellular drug concentration is 15-

20X higher in cells exposed to the 100-nM concentration (Jordan et al., 1993),(Yvon et al., 1999). Likewise,

treating HeLa cells for 20 hr with 3-nM or 100-nM vinblastine leads to differences in the intercellular drug

concentration > 30X (Jordan et al., 1991). Depending on the cell, once they exceed a threshold intracellular level,

these drugs may trigger pathways that further delay or prevent SAC adaptation, leakage and/or trigger apoptosis.

Although many human cells (e.g., HeLa, U2OS, MCF7) become terminally arrested in mitosis when

exposed to moderately high concentrations of colcemid (Sherwood et al., 1994) or paclitaxel (Woods et al., 1995),

(Jordan et al., 1996), others do not. A-498 and Caov-3 cells ultimately escape a 100 nM paclitaxel-induced D-

mitosis to form micronucleated 4N G1 cells that die days later (Yvon et al., 1999). Such a behavioral difference

implies that different types of cells are differentially resistant to the drug (Barlow et al., 2002),(Hari et al., 2003).

As discussed previously, this is likely due partly to differences in the degree that different cells concentrate the drug.

This resistance may be an intrinsic normal feature of the cell type, or it may be acquired in culture via several routes

(Cabral and Barlow, 1989). In many cases, long-term exposure to a drug up-regulates multidrug resistance and other

membrane transport genes, which enable the cell to accumulate less drug at steady-state than the parental cell

(Mollinedo and Gajate, 2003). In other cases, resistance is conferred through mutations in α or β tubulin that

20

positively or negatively affect drug binding but not MT function (Cabral and Barlow, 1989),(Drukman et al., 2002;

Cabral and Barlow, 1989; Drukman et al., 2002). In response to selection pressure, human cell lines can be

established that exhibit normal growth and mitosis despite very high drug concentrations, e.g., 4 µM taxol (Parekh

et al., 1997).

Early FACS studies on several human cancer cells concluded that exit from a paclitaxel-induced D-mitosis is

accelerated in the absence of p53. However, live cell studies have repeatedly show no difference between the

duration of a nocodazole-induced D-mitosis in murine (Lanni and Jacks, 1998) or rat-embryonic (Andreassen et al.,

2001b) fibroblasts in the presence or absence of functional p53. Carefully controlled FACS analyses of limited

temporal resolution suggest that the same is also true for isogenic human cells that differ only in their p53 status

(Khan and Wahl, 1998),(Casenghi et al., 1999). Here it is noteworthy the p53 status may define whether some cells

ultimately die in mitosis by apoptosis or survive to enter the next G1 (Burns et al., 2003) (next section).

Several kinase pathways are reported to influence the duration of a D-mitosis. By inducing the

transcription and translation of specific gene sets mitogen-activated protein kinases (MAPKs), like Erk and p38,

regulate a variety of cellular processes including the G2/M transition and apoptosis. IMF studies suggested that Erk

is activated during mitosis, and its location in kinetochores and centrosomes led to the notion that its activity is

important for the SAC (Shapiro et al., 1998),(Zecevic et al., 1998). Indeed, subsequent microinjection studies

concluded that Erk activity is required for maintaining a nocodazole-induced block in Xenopus tadpole (STC) cells

(Wang et al., 1997). However, these studies are inconclusive, since inhibiting Erk activity before mitosis does not

prevent a subsequent nocodazole-induced D-mitosis. Indeed, although the Erk activating kinase (MEK) is active

during a normal mitosis, recent biochemical analyses of synchronized HeLa cells report that Erk itself is not (Laird

et al., 1999),(Harding et al., 2003).

P38 (but not Erk) has also been reported to be activated during mitosis in nocodazole treated, but not in

untreated, 3T3 and HeLa cells (Takenaka et al., 1998). Drug recovery studies suggested that the activity of this

MAPK is required to maintain the SAC during a D-mitosis. This conclusion is not, however, supported by more

recent live cell studies which report that inhibiting p38 has no effect on the duration of a D-mitosis (Tsuiki et al.,

2001),(Mikhailov et al., 2004).. Clearly, the role of MAPKs in modulating the SAC in vertebrates remains

controversial, and is an area for further research.

21

The p38-activated casein kinase 2 is also reported to influence the duration of a D-mitosis in mammals

(Sayed et al., 2001). However, the indirect nature of this study makes it more likely that this kinase is involved in

regulating the G2/M transition and not mitotic progression. In contrast, recent live cell dominant-negative

experiments with WARTS suggests that the activity of this serine-threonine kinase is important for timely mitotic

progression in untreated rat cells, but the reason remains unknown (Iida et al., 2004).

Finally, the factors that influence the duration of a D-mitosis induced by DNA damage remain to be

defined. If this delay is due to kinetochore/centromere damage (see above), its duration may depend on the drug

concentration or radiation dose, since the less the damage the fewer kinetochores affected. After 6-10 hrs in a D-

mitosis induced by damaging the chromosomes during prometaphase, HeLa, HTERT-RPE1 and CFPAC1 (cystic

fibrosis pancreatic adenocarcinoma) cells exhibit a normal anaphase which indicates securin destruction via APCs

and a satisfied checkpoint (Mikhailov et al., 2002). However, it is also possible that these cells leak through or adapt

to an unsatisfied SAC.

To Live or Die: The Fate of Cells that Cannot Satisfy the Spindle Assembly Checkpoint

A cell undergoing a D-mitosis in the absence of MTs can never satisfy the SAC. Depending on its molecular

profile and the factors discussed previously, such cells will either (Fig 4): a) die in mitosis; b) exit mitosis as a 4N

cell that dies in G1 via apoptosis; c) exit mitosis as a reproductively dead but viable 4N cell; or d) exit mitosis as a

4N cell that enters another cell cycle. The outcomes of a D-mitosis in the presence of a spindle include all of those

seen in the absence of MTs. However, some cells will abnormally segregate their chromosomes into two or more

aneuploid progeny. This is especially true for the D-mitosis induced by DNA damage (mitotic catastrophe) which

has little impact on spindle function.

Many studies on the fate of a D-mitosis are clouded by imprecise terminology. For example, the term

“mitotic death” is often used to describe an unsuccessful division due to extensive chromosome damage (Hendry

and West, 1997),(DeLuca et al., 2002). Despite the insinuation that death occurs during mitosis, this radiobiological

concept really defines cells that, upon exiting a D-mitosis, remain metabolically active but are reproductively dead

(Erenpreisa and Cragg, 2001),(Shinomiya, 2001). Although such cells may live for a long period, as a rule they

ultimately die in G1 via senescence or apoptosis.

Many of the claims that cells can die directly in a D-mitosis via apoptosis are based on chromatin

morphology, and could well be describing necrosis. Nevertheless, there is evidence that some cells can undergo

22

apoptosis during a D-mitosis. Inhibiting caspase greatly increases the survival of paclitaxel-treated HeLa and PC-3

(prostate cancer) cells. In the absence of caspase activity cells acquire a multinucleated phenotype instead of

undergoing apoptosis in a rounded (mitotic?) state. This implies that “paclitaxel-induced caspase activation occurs

before the formation of multimininucleation”, i.e., during mitosis (Panvichian et al., 1998). Treating HeLa, MCF7

and Hs578Bst cells with 25 nM paclitaxel arrests the majority in mitosis. In situ DNA end-labeling (TUNEL) assays

revealed that DNA nicking occurred within 30 minutes in the mitotically arrested cells, which subsequently died by

a p53 independent apoptosis 9-18 hrs later in mitosis (Woods et al., 1995). A similar “mitotic apoptosis” was

reported after depleting the serum inducible polo-like kinase Snk/Plk2 from (p53+) U2OS cells: when exposed to

paclitaxel or nocodazole these cells died in mitosis by apoptosis many hours later as suggested by the FACS finding

that “80% of the active caspase 3-positive cells with a 4N DNA content were positive for cyclin B1” (Burns et al.,

2003). There is also direct live cell evidence for apoptosis during a D-mitosis (DeLuca et al., 2002), (Fig. X). At

least in the case of a mitotic catastrophe (Castedo et al., 2004) death is independent of p53 and involves the

activation of caspase-2. In turn, this leads to mitochondrial membrane permeability and the activation of caspase 3.

How caspase-2 is activated during a D-mitosis remains unknown.

Fig. 4 Diagram depicting the potential fates of a cell that cannot satisfy the SAC after entering mitosis in thepresence or absence of microtubules (MTs).

23

In general the longer a cell spends in a D-mitosis, the more likely it is to die by apoptosis. Some human lung

cancer cells which would normally die by apoptosis shortly after leaking through a D-mitosis, can be saved by

prematurely chasing them out of D-mitosis with staurosporine, but only if they were in division for less than 6-12

hrs (Masuda et al., 2003). Similarly, HL-69 (human leukemic) cells can recover if a colchicine analogue is washed

out after 6-9 hrs in a D-mitosis but not longer (Gajate et al., 2000). Taylor and McKeon (1997) report that various

nocodazole-treated cells that lack a functional SAC rapidly enter the next G1 and continued to live and grow;

whereas those that entered a D-mitosis in the presence of a functional SAC died by apoptosis after exiting division

many hours later. Finally, treating HeLa cells with 500 nM paclitaxel leads to a prolonged arrest and death in a D-

mitosis, whereas the same treatment in the presence of caspase inhibitors produces multinucleated 4N cells

(Panvichian et al., 1998). Together these studies suggest that for cells that cannot readily escape a D-mitosis, a

switch is thrown at some point during mitosis (caspase 2 activation?) after which the cell is destined to die. This

switch is likely to be independent of transcription/translation and to involve zymogen activation.

The initial spindle poison concentration is also important in defining the fate of a D-mitosis because it

influences the duration of mitosis (Torres and Horwitz, 1998),(Wang et al., 2000),(Torres and Horwitz, 1998). In

response to low poison concentrations, most cells escape a D-mitosis to form 4N G1 cells that remain viable for long

periods. In contrast, when exposed to high drug concentrations, the same cells die in or shortly after exiting mitosis.

Woods and colleagues (Woods et al., 1995) report that continuously exposing several human cancer cells to 100 nM

taxol kills them in mitosis within 24-36 hrs. However, in response to 10 nM taxol these same cells exit mitosis after

~ 18 hrs and form multinucleated cells that survive for 3-6 days [see also (Kung et al., 1990), (Jordan et al., 1996)].

Likewise, treating HeLa cells with 10 ng/ml colcemid leads to the production of micronucleated interphase cells that

survive for many hours, whereas higher (20 ng/ml) concentrations of the same substance leads to a terminal mitotic

arrest (Sherwood et al., 1994).

Rudner and Murray (1996) posited that, unlike in yeast cells, in animals “where aneuploidy can initiate

tumorgenesis, apoptosis may replace adaptation as the fate of cells that cannot correct their spindle defects”.

Although some vertebrate cells die during or shortly after a D-mitosis, this is the exception and not the rule. When

continuously exposed to colcemid (0.1 µg/ml), nocodazole (0.1 µg/ml), taxol (5-100 nM) or vincristine (10-100 nM)

many normal (e.g., primary foreskin and WI38 lung fibroblasts, WSI embryonic skin fibroblasts, and hTERT-RPE

24

1) and transformed (K562, erythroleukemia; HCT116, colon carcinoma) human cells leak through the SAC and

enter the next G1 as viable 4N cells (Di Leonardo et al., 1997), (Khan and Wahl, 1998),(Casenghi et al.,

1999),(Stewart et al., 1999). The same is true for mouse and rat embryo fibroblasts (Trielli et al., 1996),(Lanni and

Jacks, 1998),(Di Leonardo et al., 1997). In these cases the primary determinant in the fate of these cells is whether

they have a functional p53 pathway (Andreassen et al., 2003). In culture, drug-induced 4N cells with functional p53,

produced by leakage through a D-mitosis, arrest in G1 and undergo senescence days later. By contrast those lacking

p53 continue cycling. The same result is true of 4N cells generated by inhibiting cytokinesis—which does not

require adaptation to or leakage through the SAC (Kurimura and Hirano, 1980),(Andreassen et al., 2001b). This

p53-mediated G1 arrest of drug-induced 4N cells is commonly referred to as the “tetraploidy” arrest.

Recent data reveal that cells with a functional p53 pathway (e.g., hTERT-RPE1, REF52, human primary

fibroblasts), that are made 4N by inhibiting cytokinesis with very low concentrations of cytochalasin or blebbistatin,

continue to cycle into the next mitosis especially if grown on fibronectin (Uetake and Sluder, 2004). The most

straightforward interpretation of these data is that the “tetraploidy” arrest is due to residual activity of the drug used

to produce the 4N cell. When retained in cells, low levels of these drugs can inhibit cyclin D synthesis (Ellinger-

Ziegelbauer et al., 1999), perhaps via substrate/adhesion-dependent signals that work through K-Ras (Weitzel and

Vandre, 2000) and several kinases, including WARTS (Iida et al., 2004) and p38 (Ailenberg and SIlverman, 2003).

How this scheme ties into the p53/p21 pathway is unknown. Regardless of the arrest mechanism, 4N G1 cells that

continue to cycle usually die from chromosome instability generated when the genome is segregated randomly

between 2 or more cells (hyperploid progression; (Hong et al., 1999),(Tsuiki et al., 2001)). Unfortunately, some

progeny will no doubt be viable and potentially tumorgenic (Nigg, 2002),(Sluder and Nordberg, 2004).

While many normal cells remain reproductive or at least viable for long periods after escaping a drug-

induced D-mitosis, many cancer cells quickly die. The most extensive data on this topic comes from work on

paclitaxel. As a rule, in low paclitaxel concentrations, human tumor cells arrest in mitosis for > 18 hours before

leaking through and entering the next G1 as 4N cells. In many cases, these cells then undergo apoptosis, sometimes

many hours or days later (Jordan et al., 1996),(Lieu et al., 1997),(Panvichian et al., 1998). This apoptosis does not

require p53 (Vikhanskaya et al., 1998),(Bacus et al., 2001), but in MCF7 and HeLa cells it depends on an active

p38 pathway (Bacus et al., 2001),(Deacon et al., 2003).

25

Another important consideration in the fate of a D-mitosis is when the insult was applied. Cells can activate

fate pathways requiring transcription, e.g., p53/p21, when treated with drugs or DNA-damaging agents during G2,

but not during mitosis when the chromosomes are condensed (Mollinedo and Gajate, 2003). Recent work on the fate

of D-mitotics has focused on the balance between activating promoters and suppressors of cell death prior to entry

into mitosis. Mistry and colleagues (Mistry et al., 2004) report that treating exponentially growing HeLa cultures

with nocodazole activates the transcription factor NF-κB, and induces NF-κB-dependent gene expression during G2.

This, in turn, this appears to protect cells entering a D-mitosis from subsequent apoptosis. Deacon and co-workers

(Deacon et al., 2003) report that treating HeLa during G2 with nocodazole or paclitaxel produces mitotically

arrested cells containing active P38 MAPK (however, see above) and p21-activated kinase (PAK). Inhibitor

experiments suggest that p38 activity is required for apoptotic cell death during mitosis, which is suppressed by

PAK activity.

In this regard, in some cancer cells paclitaxel and other spindle poisons are reported to upregulate anti-

apoptotic Bcl-2 family members [e.g., Bcl-2, Bcl-XL (Minn et al., 1996)] and/or the downregulate pro-apoptotic

genes like Bax (Wang et al., 2000) during G2. No doubt once synthesized these factors influence the subsequent fate

of a D-mitosis. Protection can also be conferred, e.g., by mutations in caspases (Panvichian et al., 1998). One

unexplored but interesting approach would be to systematically compare the fates of individual normal cells treated

with spindle poisons in late G2 with those treated after they condense their chromosomes and can no longer

transcribe genes.

The apoptotic response induced by spindle poisons can sometimes be prevented by inhibiting protein

synthesis with cycloheximide (Tsukidate et al., 1993). This supports the idea that apoptosis can arise from gene

translation in the G1 following an aborted mitosis. In this regard A549 show no increased gene expression for

apoptotic factors or p21 during a D-mitosis induced by 45 nM paclitaxel. However, those that slip into G1 (and thus

remained adherent to the coverslip after a 15 hr arrest) show an increased expression of early apoptotic indicators

(Chen et al., 2003). An important caveat to how paclitaxel induces apoptosis is that in addition to its effects on

mitosis, this drug is also known to induce apoptosis during GO/G1 by a mechanism independent of a previous D-

mitosis (Yeung et al., 1999).

Like other forms of D-mitosis, cells undergoing a mitotic catastrophe can die in mitosis from caspase-2

activation and subsequent mitochondrial damage (Castedo et al., 2004). Alternatively, they can also exit mitosis to

26

form a single 4N G1 cell which, depending on the extent of DNA damage and e.g., its p21 (Andreassen et al.,

2001a) or Bcl-2 (Lock and Stribinskiene, 1996) status, arrests in G1 or continues to cycle. Mitotic catastrophe can

also end in the production of two or more G1 cells which may or may not be viable. In general the fate of a mitotic

catastrophe depends on the molecular profile of the cell and extent of DNA damage.

Future Prospects:We have a rudimentary knowledge of the mechanisms that allow vertebrate cells to escape a D-mitosis, and

the factors that influence their ultimate fate. In the past these issues were largely intractable for two reasons. First,

most of the popular approaches used to study these issues generated indirect data that lead to vague and confusing

interpretations (and terminology). Second, data pertinent to these problems was collected largely on transformed or

cancer cells in culture, which are poorly characterized molecularly. The availability of automated time-lapse LM

systems, that generate high resolution live cell data on significant sample sizes, provides an exciting alternative to

less direct approaches. Similarly, isogenic cell lines (Khan and Wahl, 1998),(Stewart et al., 1999) and convenient

methods for knocking down selected proteins(e.g., siRNA), are now widely available. When combined in

systematic studies, these modern tools should allow researchers to better characterize the molecules and pathways

that influence the duration of a D-mitosis, the mechanisms by which cells escape this condition, and the factors that

ultimately determine the fate of the cell.

Acknowledgments: We thank Mr. R. Cole and Ms. K. Hust for providing data on the duration of mitosis in normal

and nocodazole-treated cells. We also thank Dr. A. Khodjakov and Ms. S. Nowogrodzki for editorial comments and

Dr. W. Earnshaw for permission to use the data in Fig. 2. The work in our lab is supported by NIH GMS 40198 to

CLR. HM is supported by a post-doctoral Fellowship from the FCT of Portugal.

27

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