Bcl-2 Proteins Regulate Mitophagy in Lipopolysaccharide-Induced Acute Lung Injury via PINK1/Parkin Signaling Pathway

Mitophagy is involved in sepsis-induced acute lung injury (ALI). Bcl-2 family proteins play an important role in mitochondrial homeostasis. However, whether targeting Bcl-2 proteins (Bcl-2 and Bad) could influence mitophagy in ALI remains unclear. In this study, lipopolysaccharide (LPS) was used to induce injury in A549 cells and ALI in mice. LPS treatment resulted in elevated cell apoptosis, enhanced mitophagy, decreased Bcl-2 expression, increased Bad expression, and activation of PINK1/Parkin signaling in cells and lung tissues. Both Bcl-2 overexpression and Bad knockdown attenuated LPS-induced injury, inhibited cell apoptosis and mitophagy, and improved survival. Atg5 knockout (KO) inhibited LPS-induced cell apoptosis. Furthermore, Bcl-2 proteins regulated mitophagy by modulating the recruitment of Parkin from the cytoplasm to mitochondria via direct protein-protein interactions. These results were further confirmed in Park2 KO cells and Park2−/− mice. This is the first study to demonstrate that Bcl-2 proteins regulated mitophagy in LPS-induced ALI via modulating the PINK1/Parkin signaling pathway, promoting new insights into the mechanisms and investigation of therapeutic strategies for a septic patient with ALI.


Introduction
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) contribute to mortality and morbidity in critically ill patients. ALI is a type of diffuse alveolar-capillary membrane injury characterized by pulmonary edema and atelectasis, and ARDS is a serious and life-threatening condition [1,2]. Studies showed that inflammation, mitochondrial damage, and apoptosis are involved in the etiology of ALI/ARDS [3]. Despite recent progress, the mortality rate associated with ALI/ARDS patients remains high [4].
Mitophagy plays an important role in cell homeostasis by the degradation and removal of damaged mitochondria [5,6].
However, excessive mitophagy may promote mitochondrial dysfunction and cause cell injury and death [7]. The phosphatase and tension homolog deleted on chromosome 10-induced kinase 1 (PINK1)/Parkin signaling pathway plays a key role in the process of mitophagy. PINK1 shuttles between the cytosol and mitochondria to interact with Parkin, a ubiquitin (Ub) E3 ligase encoded by the Park2 gene [8]. Under normal conditions, PINK1 is degraded by presenilin-associated rhomboidlike protease (PARL). During mitophagy with mitochondrial membrane potential dissipation, the activity of PARL is inhibited, promoting Parkin phosphorylation in the cytoplasm and recruitment to the mitochondria [9]. Polyubiquitinated proteins in the mitochondrial outer membrane trigger the migration of Ub and the LC3 binding adaptor protein p62. This molecule functions to link the damaged mitochondria and mitolysosomes [10,11], which are formed by the fusion of mitophagosomes and lysosomes to mediate the degradation of the damaged mitochondria [12].
Bcl-2 has been well studied to exert antiapoptotic effects in various apoptotic cell and animal models [13,14]. Bcl-2 may also regulate autophagy. Hollville et al. showed that Bcl-2 family proteins suppressed mitophagy by inhibiting Parkin translocation to depolarized mitochondria in Hela and HEK293T cells [15]. Bad, an upstream member of the Bcl-2 family, functions as a sensor of cell stress, damage, infection, growth factor deprivation, and apoptotic process [16]. Bad is a BH3-like protein that interacts with Bcl-2. The BH1-BH4 domain of Bcl-2 forms a hydrophobic groove structure and binds to Bad [17].
In this study, we evaluated the role of Bcl-2 proteins in the regulation of mitophagy in lipopolysaccharide-(LPS-) treated A549 cells and LPS-induced ALI in mice. We also investigated cell apoptosis and its relationship with mitophagy in LPS-induced ALI. The effects of Bcl-2 overexpression and Bad knockdown on mitophagy and apoptosis were assessed in vitro and in vivo. Furthermore, Park2 knockout (KO) cells, Agt5 KO cells, and Park2 -/mice were used to investigate the underlying mechanisms.

Results
2.1. LPS-Induced Injury in A549 Cells and ALI in Mice. CCK-8 and LDH assays showed significantly decreased cell viability and increased cell toxicity in A549 cells treated with 50 and 100 μg/ml LPS for 8 and 16 h (Figure 1(a)). We selected 50 μg/ml LPS exposure of 16 h for the following experiments. Next, we found LPS treatment led to elevated cell apoptosis ( Figure 1(b)). The ratio of cleaved caspase3 to procaspase3 protein expression was significantly increased 8 and 16 h after LPS exposure (Figure 1(c)).
In mice, LPS induced inflammatory cell infiltration in the alveolar and connective tissue of the alveolar septum, with significant neutrophil aggregation around the pulmonary vessels and bronchi (Figure 1(d)). Lung tissues showed hyperemia, edema, alveolar diaphragm thickening, and early transparent membrane formation in the alveolar wall surface. In addition, increased inflammatory cells were found in the alveolar lavage fluid in LPS mice (Figure 1(d)). Lung injury scores were then calculated using the pathological ALI scoring system according to the American Thoracic Association criteria [18]. Compared with the control group, the LPS group showed significantly a higher lung injury score (Figure 1(e)), BALF protein content (Figure 1(f)), and wet/dry ratio (Figure 1(g)).

LPS-Induced Mitophagy in A549 Cells and Mouse Lung
Tissues. In LPS-treated cells, we observed increased colocalization of LC3GFP and MitoTracker red (MTR) (Figure 2(a)). LPS resulted in deceased expression of mitochondrial outer membrane protein Tom20, mitochondrial inner membrane protein COX IV, and P62, with an increased LC3-II/LC3-I ratio (Figure 2(b)). Electron microscopic images showed increased mitophagy induced by LPS [19] (Figure 2(c)). We also found that LPS caused remarkable damage to the mitochondrial network and structure (Figure 2(d)). Under stress conditions, damaged mitochondria are isolated from the rest of the mitochondrial network or repaired via mitochondria fusion [20], which was regulated by a number of mitophagy-related proteins [21]. Mitofusin-2 (Mfn2) plays a critical role in mitochondrial fusion [22], while dynaminrelated protein 1 (Drp1) promotes mitochondrial fission [21]. In this study, the protein expression of Mfn2 was reduced and Drp1 expression was increased by LPS (Figure 2(e)). In addition, LPS exposure significantly increased reactive oxygen species (ROS) levels ( Figure 2(f)) and decreased ATP levels ( Figure 2(g)) and resulted in decreased mitochondrial membrane potential (Figure 2(h)). These findings suggest that the activation of mitophagy plays a critical role in LPSinduced ALI.
Moreover, we used CRISPR-Cas9 gene editing technology to knock out the Atg5 gene, an important factor of mitophagy, in A549 cells ( Figure S1A). Knockout of Atg5 has been indicated to inhibit mitophagy [23]. Our results showed that apoptosis induced by LPS was alleviated in Atg5 KO cells compared to wild-type cells (Figures S1B and S1C). Therefore, inhibition of mitophagy could attenuate apoptosis in LPS-induced ALI.
2.3. Bcl-2 Family Proteins and PINK1/Parkin Signaling during LPS Exposure. Western blot and RT-qPCR analyses showed that LPS exposure led to decreased Bcl-2 expression and increased expression of Bad and PINK1 at 4 and 8 h in A549 cells (Figures 3(a) and 3(b)). We also found downregulated Bcl-2 expression and upregulated Bad expression in LPS-induced ALI tissues (Figure 3(c)). By isolating the mitochondrial and cytoplasmic components of A549 cells, LPStreated cells showed decreased Parkin expression in the cytoplasm and increased Parkin expression in the mitochondria (Figure 3(d)). In addition, we found increased expression and colocalization of Parkin and Tom20 during LPS treatment ( Figure 3(e)). The colocalization of Parkin and Tom20 was evaluated by the calculation of Pearson's correlation coefficient [24]. In line with our results, a previous study showed that Parkin is recruited from the cytoplasm to the dysfunctional mitochondria during mitochondrial depolarization [25]. Besides, the protein expression of other members of Bcl-2 family proteins including Bcl-xl, Bcl-w, and Bim was assessed. LPS treatment significantly decreased Bcl-xl and Bcl-w expression and increased Bim expression ( Figure S2). These findings suggest the involvement of Bcl-2 family proteins and enhanced PINK1/Parkin-mediated mitophagy during LPS treatment.   (Figure 4(f)) indicated that LPS-induced apoptosis was significantly alleviated by Bcl-2 overexpression. Bcl-2 overexpression also restored the expression of Tom20, COX IV, and mitofusin-2 (Mfn2) and inhibited dynamin-related protein 1 (Drp1) expression and LC3-II/LC3-I ratio (Figure 4(e)). Moreover, the reduced apoptosis was reversed by the use of mitophagy inducer antimycin A (500 nM) or CCCP (5 μM) (both from Selleck Chemicals, Houston, TX, USA) ( Figure 4(f)). These findings suggest that Bcl-2 attenuates LPS-induced injury by inhibiting mitophagy. Bcl-2 family members have been shown to be associated with the remodeled mitochondrial networks [21]. JC-1 assays showed that Bcl-2 overexpression alleviated LPS-induced mitochondrial membrane potential dissipation, which was blocked by antimycin A or CCCP (Figure 4(g)).
The effects of Bcl-2 overexpression were also investigated in mice (Figure 4(h)). HE staining showed that Bcl-2 overexpression significantly reduced the inflammatory cell infiltration in lung tissues (Figure 4(i)) and improved lung injury scores (Figure 4(j)) during LPS-induced ALI. Furthermore, transmission electron microscopy showed fewer mitophagosomes in the Bcl-2 overexpression group compared to the control group (Figure 4(k)). Bcl-2 overexpression also reduced the wet/dry weight ratio in LPSinduced ALI tissues (Figure 4(l)). These findings suggest that LPS resulted in mitochondrial dysfunction, apoptosis, and excessive mitophagy, which was attenuated by Bcl-2 overexpression.

Bad Knockdown Attenuated Cell Injury In Vitro and ALI
In Vivo by Inhibiting Mitophagy. To evaluate the role of Bad in LPS-induced ALI, Bad knockdown was achieved by transfection with shBad lentivirus (Figure 5(a)). Bad knockdown increased cell viability ( Figure 5(b)) and total ATP ( Figure 5(c)) and reduced ROS levels ( Figure 5(d)). Bad knockdown also reduced the LC3-II/LC3-I ratio and the expression of cleaved caspase3 and Drp1 and restored the expression of Tom20, COX IV, and Mfn2 during LPSinduced cell injury ( Figure 5(e)). In addition, Bad knockdown reduced the apoptosis rate ( Figure 5(f)) and restored mitochondrial membrane potential during LPS treatment ( Figure 5(g)).
In LPS-treated mice, Bad knockdown reduced the lung injury score ( Figure 5(i)) and the wet/dry weight ratio ( Figure 5(j)). Transmission electron microscopy revealed fewer mitophagosomes in the shBad group compared with the control group ( Figure 5(k)). In the survival analysis, both Bcl-2 overexpression and Bad knockdown improved the survival of LPS-treated mice ( Figure 5(l)). These findings suggest that Bad protein modulates mitophagy and that Bad knockdown could produce similar protection against LPSinduced mitochondrial dysfunction as Bcl-2 overexpression.
2.6. Bcl-2 Proteins Regulate Parkin Recruitment from the Cytoplasm to Mitochondria. To further verify the role of Bcl-2 family proteins in mitophagy, we performed immunofluorescence analysis of Parkin and Tom20 in A549 cells. Both Bcl-2 overexpression and Bad knockdown decreased colocalization of Parkin and Tom20 in LPS-treated cells ( Figure 6(a)). In addition, both Bcl-2 overexpression and Bad knockdown reduced mitochondrial expression of Parkin in cells during LPS ( Figure 6(b)). However, the PINK1 protein expression was unaffected by Bcl-2 overexpression or Bad knockdown ( Figure 6(c)).
CRISPR/cas9-mediated Park2 KO in A549 cells was confirmed by Western blot analysis ( Figure 6(d)). To investigate the role of Bcl-2 proteins in Parkin recruitment from the cytoplasm to the mitochondria, we used ABT-737 which acts as a Bad mimic to antagonize Bcl-2 [26]. WT and Parkin KO A549 cells with Bcl-2 overexpression were treated with

Oxidative Medicine and Cellular Longevity
ABT-737 (5 μM) for 8 h prior to LPS stimulation. In mice, after Bcl-2 transfection, intraperitoneal ABT-737 (20 mg/kg) was given, followed by intratracheal LPS administration. The results showed that ABT-737 reversed the effects of Bcl-2 overexpression on mitophagy in vitro ( Figure 6(e)) and in vivo ( Figure 6(g)) in wild-type cells and mice, but not in Park2 KO cells and Park2 -/mice. Parkin interacts with proteins that regulate mitochondrial fission and fusion, such as Drp1 and Mfn1/2, via pathways that depend on the ubiquitin-proteasome system (UPS) [27]. Compared to wild-type A549 cells, Park2 KO induced Mfn2 upregulation and Drp1 downregulation ( Figure 6(f)). These findings

Discussion
In this study, we used LPS to establish ALI models in cells and mice. LPS has been widely used to induce sepsis and systemic inflammation during ALI [27]. Mitochondria play a crucial role in cell metabolism, growth, proliferation, differentiation, and cellular responses to stress. The functional status of mitochondria determines cell survival and death [28].
Mitophagy is an autophagic process to maintain mitochondrial hemostasis [29][30][31]. In LPS-induced ALI, damaged mitochondria were removed by mitophagy, reducing ROS production and attenuating ALI [32,33]. However, excessive mitophagy may also be detrimental [28], and the detailed mechanisms are still unclear. In our previous study, we found that inhibition of mitophagy with mitochondrial division inhibitor 1 significantly reduced ALI in rats [34]. In this study, we showed that excessive mitophagy resulted in impaired ATP production, insufficient cell energy supply, and increased ROS levels, which have been reported to damage mitochondrial membrane permeability and the electron transport chain (ETC) [29][30][31]. Moreover, in Atg5 KO cells, we found that cell apoptosis was significantly alleviated by inhibition of mitophagy. The mitochondrial membrane potential dissipation and ETC inhibition lead to decreased mitochondrial ATP production and increased mito-ROS release, promoting mitophagy. Therefore, mitophagy promoted LPS-induce ALI in our study, but not maintaining the normal mitochondrial function or cell homeostasis. In addition to a scattered distribution of small and beanshaped mitochondria in the cytoplasm, long tubular mitochondria interconnect to form mitochondrial networks in various cell types [35]. The intact mitochondrial reticular structure is crucial for mitochondrial and cellular function [21]. Highly dynamic remodeling of mitochondrial networks induced by stress has been observed [22]. Under mild stress conditions, damaged mitochondria are separated from the network and eliminated by mitophagy. Under conditions of severe injury, such as sepsis, mitochondrial reticular structure disorder leads to mitochondrial membrane potential dissipation and cell death [36]. Mfn2 and Drp1 which participate in the process of mitochondrial division and fusion play an important regulatory role in the dynamic balance of the mitochondrial network structure [21,37]. In this study, we observed that the mitochondrial network was severely disrupted during LPS-induced ALI, with downregulation of Mfn2 and upregulation of Drp1. Our results for the first time showed that LPS-induced mitophagy caused disrupted mitochondrial network structure, a sharp decrease in ATP supply, and increased mito-ROS production, while these changes are alleviated by inhibition of excessive mitophagy.
Bcl-2 family proteins play a key role in mitochondrial homeostasis [35]. Bcl-2, containing four highly conserved domains BH 1-4, functions as an antiapoptotic protein by regulating mitochondrial membrane permeability and cytochrome C release [17,38]. Voehringer and Meyn reported that Bcl-2 overexpression reduced intracellular ROS levels and oxidative stress-related cell damage [17,38]. In addition, Bcl-2 family proteins have been shown to regulate mitochon-drial morphogenesis, autophagy, and ROS elimination [39][40][41]. Other studies revealed that Bcl-2 regulates calcium homeostasis and endoplasmic reticulum stress [39][40][41]. However, the role of Bcl-2 and Bad (two Bcl-2 family proteins) in the regulation of mitophagy in LPS-induced ALI is unclear. To further investigate the mechanism, we established the LPS-induced in vitro and in vivo ALI model to show the involvement of Bcl-2 and Bad in this process. Furthermore, we demonstrated that both Bcl-2 overexpression and Bad knockdown attenuated LPS-induced cell injury and mice ALI by inhibiting mitophagy. Bcl-2 family proteins are involved in the fission and fusion of mitochondria [21]. In this study, we have shown that Bcl-2 upregulation and Bad downregulation participate in the maintenance of the integrity of the mitochondrial reticular structure during LPS-induced ALI. In addition, we also found that the other members of the Bcl-2 family including Bcl-xl, Bcl-w, and Bim took part in this process.
The mitochondrial serine/threonine protein kinase PINK1 is stabilized on impaired mitochondria during mitochondrial depolarization, recruiting Parkin from the cytoplasm to the mitochondrial membrane to initiate mitophagy [21]. As expected, we found increased PINK1 protein expression in LPS-treated A549 cells. Furthermore, immunofluorescence analysis revealed colocalization of Parkin and Tom20 after LPS treatment and analysis of isolated mitochondria confirmed the location of the upregulated Parkin. These results suggest that Parkin is recruited from the cytoplasm to mitochondria in LPS-induced ALI and mitophagy is activated by LPS via the PINK1/Parkin pathway. To further explore the roles of Bcl-2 and Bad, we generated Park2 KO A549 cells using the CRISPR-Cas9 gene editing technique. We found reduced mitophagy of KO cells than that of wild-type cells following LPS treatment regardless of the presence or absence of Bcl-2 upregulation. Moreover, the antimitophagy function of Bcl-2 was antagonized by treatment with the Bad mimic ABT-737. Conversely, mitophagy was reduced in Park2 KO A549 cells in the presence or absence of ABT-737-mediated Bcl-2 antagonism. Letsiou et al. reported that Parkin KO mice were protected against LPS-mediated ALI compared to wild-type mice and that Parkin modulated mitochondrial autophagy by regulating inflammation-related protein expression and signaling pathways [42]. In this study, we have revealed for the first time that PINK/Parkin-mediated mitophagy is involved in LPSinduced ALI. Similarly, we observed that the number of mitochondrial autophagosomes in Parkin KO mice was significantly lower than that in WT mice. These findings provide evidence that Bcl-2 regulates mitophagy via the PINK1/Parkin signaling pathway in LPS-induced ALI. Interestingly, neither Bcl-2 nor Bad influenced PINK1 stability. On the other hand, Parkin catalyzes the ubiquitination of Mfn2, targeting it for degradation [42]. We found that Mfn2 expression was upregulated in Parkin KO cells. Combining this finding with our previous results indicated that upregulated Bcl-2 caused Mfn2 recovery, possibly by Bcl-2-mediated regulation of Parkin. Parkin ubiquitinates Drp1 for proteasome-dependent degradation [43]; however, it has also been reported that Drp1 expression is

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Oxidative Medicine and Cellular Longevity downregulated following Parkin KO [44]. Therefore, it can be speculated that Parkin mediates bidirectional regulation of Drp1. In this study, we found that Drp1 expression was downregulated by Parkin KO. In this case, Parkin might induce Drp1 degradation via ubiquitination [45] or promote the recruitment of Bax to the mitochondria [46] to promote mitochondrial fission [21]. We also propose another hypoth-esis in which Parkin knockdown protects the mitochondrial network structure and membrane potential by inhibiting excessive mitophagy, thereby inhibiting Drp1 expression; however, the specific mechanism remains to be elucidated. Coimmunoprecipitation studies showed that Bad binds directly to Bcl-2 and the latter binds directly to Parkin. Taken together, our findings demonstrate the involvement of Bcl-2    family proteins in regulating mitophagy during LPS-induced ALI through targeting the PINK1/Parkin signaling pathway. We found that both Bcl-2 overexpression and Bad knockdown reduced mitophagy via the PINK1/Parkin signaling pathway in LPS-induced ALI. However, the potential regulatory effects of other Bcl-2 family proteins on mitophagy induced by LPS and whether the PINK1/Parkin pathway is also involved need to be investigated. Besides, it should be noted that the Bad mimic ABT-737 may antagonize other Bcl-2 protein family proteins and related signaling pathways [47]. In addition, our results obtained in the A549 cell line and mouse models may not be fully extrapolated to humans.
In conclusion, this is the first study to demonstrate that the Bcl-2 proteins regulate mitophagy in LPS-induced cell injury and mice ALI via direct interactions with the PINK1/-Parkin signaling pathway (Figure 7). Based on these results, the Bcl-2 protein family is implicated as a therapeutic target in sepsis-induce ALI.   . The bronchoalveolar lavage was repeated three times with 1 ml PBS through the endotracheal tube. The BALF was collected and centrifuged at 2500 rpm for 10 min, and the protein concentration in the supernatant was measured by using the BCA method [49].

Hematoxylin and Eosin (HE) Staining and Lung Injury
Score. The lungs were fixed with 10% buffered formalin, embedded with paraffin, and cut into sections. Images were captured under a microscope (Olympus Tokyo, Japan). Lung injury scores were calculated by using the pathological ALI scoring system from the American Thoracic Association [18]. This system comprises four categories (alveolar congestion, hemorrhage, infiltration or aggregation of neutrophils in the alveolar cavity or vascular wall, and alveolar wall thickening and/or transparent membrane formation), with a score of 0 to 4 in each domain (0, no lesions or very mild lesions; 1, mild lesions; 2, moderate lesions; 3, severe lesions; and 4, extremely severe lesions) and a total score of 16. Lung injury was evaluated by independent pathologists who were blinded to the group allocation. In brief, A549 cells were digested and washed with PBS three times. After centrifugation at 800 × g for 5 min, the cells were collected. Reagents were added to 10 7 cells to obtain the mitochondrial suspension. Finally, the mitochondrial suspension and the cytoplasmic fraction were stored at -80°C, respectively.
antibodies (1 : 100) for 1 h at room temperature. The staining was visualized under the microscope. Sections were then washed and restained with hematoxylin for 3 min and differentiated with hydrochloric acid/alcohol. Sections were then rinsed, dehydrated, and visualized under the microscope.
4.14. Immunofluorescence. After washing with preheated PBS, cells were treated with 4% formaldehyde for 30 min at room temperature. Cells were permeabilized with 0.2% Triton X-100 (Beyotime, Haimen, China) for 2-5 min, washed three times, and blocked with 5% BSA for 30 min at room temperature. Cells were then incubated overnight at 4°C with the following primary antibodies: anti-Parkin, anti-Tom20, and anti-LC-3 (diluted with 1% BSA). Then, cells were incubated with the secondary antibody (1 : 50), washed with PBS, and sealed with 95% glycerin. Immunofluorescence was observed under a fluorescence microscope (Olympus Tokyo, Japan). Finally, Pearson's correlation coefficient was calculated to evaluate the colocalization of target proteins.

Statistical
Analysis. Data were represented as the mean ± standard error of the mean (SEM) and analyzed using the SPSS 20.0 (California, USA). Student's t-test or analysis of variance (ANOVA) was used as appropriate. Two-tailed P values of <0.05 were considered to indicate statistical significance.