The Akt signaling pathway is required for tissue maintenance and regeneration in planarians

Background Akt (PKB) is a serine threonine protein kinase downstream of the phosphoinositide 3-kinase (PI3K) pathway. In mammals, Akt is ubiquitously expressed and is associated with regulation of cellular proliferation, metabolism, cell growth and cell death. Akt has been widely studied for its central role in physiology and disease, in particular cancer where it has become an attractive pharmacological target. However, the mechanisms by which Akt signaling regulates stem cell behavior in the complexity of the whole body are poorly understood. Planarians are flatworms with large populations of stem cells capable of dividing to support adult tissue renewal and regeneration. The planarian ortholog Smed-Akt is molecularly conserved providing unique opportunities to analyze the function of Akt during cellular turnover and repair of adult tissues. Results Our findings abrogating Smed-Akt with RNA-interference in the planarian Schmidtea mediterranea led to a gradual decrease in stem cell (neoblasts) numbers. The reduced neoblast numbers largely affected the maintenance of adult tissues including the nervous and excretory systems and ciliated structures in the ventral epithelia, which impaired planarian locomotion. Downregulation of Smed-Akt function also resulted in an increase of cell death throughout the animal. However, in response to amputation, levels of cell death were decreased and failed to localize near the injury site. Interestingly, the neoblast mitotic response was increased around the amputation area but the regenerative blastema failed to form. Conclusions We demonstrate Akt signaling is essential for organismal physiology and in late stages of the Akt phenotype the reduction in neoblast numbers may impair regeneration in planarians. Functional disruption of Smed-Akt alters the balance between cell proliferation and cell death leading to systemic impairment of adult tissue renewal. Our results also reveal novel roles for Akt signaling during regeneration, specifically for the timely localization of cell death near the injury site. Thus, Akt signaling regulates neoblast biology and mediates in the distribution of injury-mediated cell death during tissue repair in planarians. Electronic supplementary material The online version of this article (doi:10.1186/s12861-016-0107-z) contains supplementary material, which is available to authorized users.

Akt regulates adult stem cell proliferation, migration and apoptosis and its deregulation has been implicated in the progression of cancer, diabetes, and aging [1][2][3][4][8][9][10]. Conditional deletions and transgenic approaches have revealed key aspects of Akt signaling in hematopoietic, epithelial, neural and other tissues [2,3,[11][12][13][14]. Nonetheless, there is limited understanding of how Akt signaling controls the response of stem cells during cellular turnover and tissue injury in the complexity of the whole organism. This paucity is likely due to the ubiquitous nature of this signaling pathway and the difficulty of analyzing stem cells in their natural environment during physiological cell turnover and regeneration in conventional animal models [15][16][17].
Thus, we sought to investigate Akt function during cellular turnover and injury using the planarian flatworm Schmidtea mediterranea. This organism is well known for its stem cell-based regenerative capability. Planarians contain an abundant and accessible population of somatic adult stem cells called neoblasts [18][19][20][21]. The neoblasts are the only dividing cells in planarians and constantly proliferate to repair tissues and support systemic cellular turnover [21]. Recently, we described that the genome of S. mediterranea contains a single Akt ortholog termed Smed-Akt, which affects cell division and impairs planarian locomotion [22]. This study defined the role of Smed-Akt in abnormal cell proliferation triggered by the abrogation of the phosphatase PTEN, an upstream component of the Akt signaling pathway, which is highly mutated in human cancers.
Here we report on an extended RNA-interference (RNAi) strategy that disrupts Smed-Akt in the whole organism, to analyze its function on the response of neoblasts during systemic cell turnover and tissue repair. Our results show, Smed-Akt abrogation leads to a gradual decline in the number of neoblasts, accompanied by massive cell death that affects cellular turnover and maintenance of adult tissues. We also found that impaired locomotion in the Smed-Akt phenotype is due to the disruption of cilia maintenance in the ventral epithelium. Intriguingly, large-scale tissue injury is capable of reducing the high levels of Smed-Akt(RNAi)-induced levels of cell death, while increasing neoblast proliferation near the wound site however, animals failed to complete the formation of the regenerative blastema. Thus, our results reveal novel roles for Akt signaling during systemic cell turnover and large-scale regeneration of adult tissues.

Smed-Akt is Required for Proper Neoblast Function
Our previous studies identified in the planarian Schmidtea mediterranea genome a single Akt ortholog (Smed-Akt) to the mammalian Akt2/PKB-ß [22]. Smed-Akt is widely expressed in neoblasts and differentiated cells and functional downregulation with RNAinterference [Smed-Akt(RNAi)] led to the reduction of neoblast numbers and loss of planarian locomotion [22]. To test whether Akt signaling plays additional roles in the regulation of cellular turnover and tissue regeneration in the adult body, we designed an RNAi protocol consisting of six dsRNA microinjections that effectively downregulated (8.4 folds) Smed-Akt expression over the span of 30 days (Fig. 1a).
Neoblast division was visualized through whole-mount immunostaining against the α-phosphorylated histone-3 (H3P) antibody, which labels cells in G2/M phase of the cell cycle (observed as yellow dots in Fig. 1b). Animals subjected to Smed-Akt(RNAi) initially displayed an important increase in neoblast division (~0.75 fold) 10 days post RNAi initiation, which was followed by a gradual decline in mitoses, reaching~five-fold decrease by day 30, when compared to control (Fig. 1b, c). Importantly, all samples were processed either before or a few days after injection to avoid the possibility of injury-induced increase in mitotic activity. To further characterize the effects of Akt downregulation on the cell cycle dynamics, we evaluated the incorporation of the bromodeoxyuridine analog (BrdU) every ten days for one month (Fig. 1d). BrdU is incorporated during the S phase of the cell cycle and remains in the cell through multiple rounds of cell division, albeit at lower concentrations in each successive cell generation. Control and Smed-Akt(RNAi) animals were exposed to a single BrdU pulse at different time points after the first dsRNA injection (i.e. 10, 20, and 30 days) and after 12 h samples were processed as previously described [23]. Consistent with the mitotic counts, BrdU positive cells increased in the first 10 days after Smed-Akt(RNAi) and gradually decrease to almost undetectable levels after one month of RNAi treatment (Fig. 1d). We also found a consistent trend in the expression of genes associated with cell cycle regulation (i.e. cyclin A, cyclin B, CDK1, CDK2, and CDK4), which showed general increase during the first 10 days and dramatically decreases in the successive days, further confirming our observations in mitotic activity and BrdU labeling upon Smed-Akt(RNAi) (Fig. 1e). The early increase in gene expression and proliferative cells upon Smed-Akt downregulation implies that the phenotype most likely starts before day 10. Our results suggest that Smed-Akt is essential to maintain the appropriate number of proliferating neoblast during tissue renewal in adult planarians.
To assess whether the effects of Smed-Akt(RNAi) are restricted to cell cycle events, we analyzed the expression of markers associated with neoblasts and the early and late division progeny (e.g. smedwi-1, Prog-1, and Agat-1, respectively). This analysis revealed a dramatic decrease in the expression of markers associated with neoblasts and their progeny (Fig. 2a). Interestingly, the pattern of expression for smedwi-1 and Agat-1 were similar to that previous observed in cell cycle genes, while the marker for the early neoblast progeny (prog-1) followed a somewhat different pattern, characterized by a strong downregulation from the beginning of Smed-Akt(RNAi). Whole mount fluorescent in situ hybridization (FISH) with markers of neoblasts and the post-mitotic progeny one month after Smed-Akt(RNAi) further confirmed the quantitative PCR (qPCR) results and showed a generalized reduction in gene expression throughout the body, after Smed-Akt(RNAi) (Additional file 1).
Proliferative neoblasts are contained within the irradiation sensitive X1 population and can be isolated via flow cytometry cell sorting (FACS) [24]. Recently, cells within the X1 population were classified into two functionally distinct subclasses, the zeta-and sigmaneoblasts [25]. FACS was used to isolate equal number of X1 cells from both control and Smed-Akt(RNAi) animals after one month of RNAi. We used a larger number of experimental animals to obtain comparable amount of FACS-isolated cells between both groups. The total RNA extracted was processed to evaluate levels of expression of markers of the sigma and zeta populations (Fig. 2b).
Markers of the sigma neoblast subpopulations tend to increase upon Smed-Akt(RNAi), while there little to no change in the zeta subclass, suggesting the effect of Smed-Akt(RNAi) is not homogeneously distributed among the neoblasts. Thus, additional experiments are required to further define the differences between gene expression in the neoblast subclasses and to understand these implications. Altogether, our results indicate that Smed-Akt is essential for the appropriate expression of neoblast and progeny markers and suggests that a gradual depletion in the number of neoblasts takes place after Smed-Akt(RNAi).

Smed-Akt is a Critical Regulator of Cell Death in Planarians
A fine balance between stem cell proliferation and programmed cell death enables physiological cellular turnover that supports maintenance and growth of adult tissues [26]. Over a 40 days starvation period, animals subjected to Smed-Akt(RNAi) exhibited a~3 fold reduction in   surface area compared to the control group (0.23 ± 0.08 vs 0.72 ± 0.07 mm 2 , respectively) (Fig. 3a). These results together with the reduction in neoblast proliferation suggests that the Smed-Akt(RNAi) phenotype may be accompanied by increased levels of cell death, contributing to an accelerated reduction in animal size over time, and death by~45 days after the first injection. Akt function has been implicated in cellular prosurvival mechanisms [14,[27][28][29]. Thus, we examined possible roles of Smed-Akt as regulator of cell death in planarians by analyzing levels of cell death after RNAi treatment. First, spatial distribution of cell death in the whole body was evaluated using the terminal deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL) assay [30]. These experiments revealed that Smed-Akt (RNAi) double the number of TUNEL positive cells, 15 days after the first dsRNA injection and it gradually increase to about threefold by day 30 of the RNAi treatment (Fig. 3b). Despite a slight increase in TUNEL positive cells by day 10 of Smed-Akt(RNAi) (data not shown), the predominant increase in cell death was observed around day 15 after the first dsRNA injection. TUNEL positive cells appeared indistinctively scattered along the planarian body at all times, suggesting this is a generalized event, most likely involving both neoblasts and differentiated cells (Fig. 3c). Next, we performed flow cytometry analysis using Annexin V and 7AAD staining [31,32]. This experiment confirmed the high levels of cell death induced by Smed-Akt(RNAi) may involve apoptosis and necrosis (Fig. 3d). The increased levels of cell death in Smed-Akt (RNAi) together with the overall animal size reduction indicates that Akt is an important regulator of cellular turnover. The mechanisms are not entirely clear however, it is possible that the impairment in tissue renewal may result from either (1) an initial reduction in neoblast numbers that fail to support homeostasis or (2) generalized cell death events that impact both neoblasts and differentiated cells alike.  animals. All values are relative to equal number (~20,000) of X1 cells sorted from control-water injected animals at 30 days. Gene expressions are all relative to the internal control, the ubiquitously expressed clone H.55.12e. Graphs represent mean ± s.e.m. of triplicated samples of two or more biological replicates with at least ten animals per experiment. P values ** < 0.001, *** < 0.0005 and **** < 0.0001, were calculated by two way ANOVA

Smed-Akt Regulates the Maintenance of Differentiated Tissues
A distinctive macroscopic feature of the Smed-Akt (RNAi) phenotype is the impairment of locomotion accompanied by the elongation of the whole body, which are initiated as early as day 15 and progress for over 35 days after the first dsRNA injection (Additional file 2). Planarian gliding is mediated by synchronized cilia movement on the ventral epithelial surface of the animal [33]. Since locomotion is impaired in Smed-Akt(RNAi) animals, we therefore evaluated the status of cilia through the expression levels of genes specifically corresponding to intraflagellar transport machinery and flagellar beating (IFT88, IC2, LC1, LRRC50 and DNAHβ-1) [34,35]. First, we observed through qPCR, a dramatic reduction in the expression of cilia markers required for the structural and mechanical integrity of cilia [34,36] ( Fig. 4a). The reduction in gene expression of cilia markers is detected as early as 10 days after Smed-Akt (RNAi) and their expression continues to reduce over time. Second, whole-mount staining with anti-α-Ac-tubulin antibody allowed us to visualize the integrity of ciliated All experiments were independently repeated three times with at least ten animals each time structures in the ventral epithelia, including parts of the excretory system (e.g. proximal tubules and flame cells in protonephridia) [22,[33][34][35][36][37]. We noted that one month after Smed-Akt(RNAi), the anti-α-Ac-tubulin antibody signal is nearly absent in the areas corresponding to ventral cilia, while control animals showed dense coverage by cilia (magenta signal in Fig. 4b). The confocal stacks, 30 days after Smed-Akt(RNAi), showed a marked reduction of ventral cilia, making the proximal tubules and flame cells of the excretory system readily evident (Fig. 4b). Together, the results obtained through gene and protein expression demonstrates that Smed-Akt is required for the structural integrity of cilia and its maintenance. Additionally, our findings suggest that the impaired locomotion in the Akt phenotype is most likely a consequence of inadequate cilia density in the ventral epithelia. We next sought to evaluate whether the Smed-Akt (RNAi) effects are specific to the ventral epithelia or if they extend to other tissues. The excretory system in planarians consists of protonephridial tubules including both ciliated and non-ciliated structures that could be labeled with anti-α-Ac-tubulin antibody and the Smed-CAVII-1 gene, respectively [36][37][38]. Additional markers to each portion of the protonephridial tubules were recently mapped [36], thus providing better opportunities to analyze effects on the excretory system. Specifically, we evaluated the expression of solute carrier transporters (slc) family of genes expressed along the proximal and distal tubules, and the collecting ducts of the protonephridia [36]. We further extended the analysis to include planarian homologs of nephrocystins known to regulate excretory functions and upon their downregulation, lead to cyst-like disease in S.

Smed-AKT(RNAi)
mediterranea [36]. The results provided evidence of a generalized reduction in gene expression throughout the protonephridial structures and the nephrocystin markers (NPHP5, 6 and 8) (Fig. 5a, b). The striking reduction in gene expression in the protonephridial structures is evident as early as 10 days after Akt disruption. However, macroscopic signs of excretory system defects such as edema and clearing of body pigmentation are evident in Smed-Akt Smed-AKT(RNAi) 10 20 30 N P H P 6 10 20 30 N P H P 8 10 3A). Formation of the edema phenotype is consistent with the markedly downregulation of nephrocystin genes, and structural alterations in the proximal structures of the protonephridia (Fig. 5c). Particularly, Smed-Akt(RNAi) lead to a generalized decrease in both (13.63 ± 0.55 vs 4.77 ± 0.37) and proximal tubules per protonephridial unit (protonephridial unit is outlined in Fig. 5c), when compared to control. This structural disruption is consistent with the manifestation of edema in planarians [36][37][38], further validating the reduced integrity of the excretory system during the advanced stages of the Smed-Akt(RNAi) phenotype.
To determine whether Smed-Akt(RNAi) also affects other organs within planarians, we set out to explore gene and protein expression of markers in terminally differentiated tissues [21,23,[39][40][41][42][43]. Specifically, mRNA levels of genes associated with the nervous and digestive system, connective and muscle tissues. The results from these experiments demonstrated that most of the genes screened (i.e. 8/10) tend to gradually deplete after Smed-Akt(RNAi), but at least two of the markers including the choline acetyltransferase ChAT (neurons) and tropomyosin (muscle) followed a different pattern characterized by an increase in expression one month after Akt downregulation (Fig. 6a). Staining with the monoclonal antibody Smed-6G10 (6G10) that labels different muscle fibers in the planarian body [44], revealed the disruption of the Akt signaling affects planarian musculature. Specifically, we observed the disorganization of circular and diagonal muscle fibers and the absence of signal in some areas, suggesting alterations in the normal tissue architecture (arrows in head and pharynx, Fig. 6b). The structural changes in musculature may also explain the incapability to ingest food after 20 days of Akt-RNAi (data not shown) but also the animal's ability to slightly maneuver through peristaltic muscle contractions [34]. ISH experiments also confirmed the widespread reduction in expression of markers of the excretory (Smed-CAVII-1), and the nervous (Smed-PC2) system, further supporting the notion that disruption of tissue integrity is not restricted to one tissue in particular but rather a more generalized event after downregulation of Akt function (Additional files 3B, and 4). Future experiments are needed to determine whether particular cell types are more susceptible to structural alterations after Akt systemic inhibition. Nonetheless, these results together demonstrate Smed-Akt is essential for the maintenance of tissues in planarians.

Smed-Akt(RNAi) Leads to Regeneration Defects
Tissue amputation triggers well-coordinated waves of apoptosis and cellular proliferation aimed at recreating missing tissues and organs within the regenerative blastema. The Smed-Akt phenotype is characterized by a reduction in neoblast numbers and increased cell death, affecting the maintenance of differentiated tissues. Thus, we assessed how an unbalance in cell death and proliferation affects large-scale injury-induced regeneration in S. mediterranea. We performed planarian head decapitations after 30 days post-RNAi initiation and followed macroscopic and microscopic responses in regenerative body trunks (Fig. 7). One week after amputation control animals formed head blastemas with photoreceptor pigmentation, whereas Smed-Akt(RNAi) animals only formed a marginal blastema with limited eye pigmentation (Fig. 7a). Further experiments with antibodies that recognize brain structures and visual neurons (i.e. anti-SYNORF1, anti-VC1), revealed Smed-Akt(RNAi) animals failed to regenerate brain and visual neuronal connections (Figs. 7b, c). Likewise, animals with tail amputation also fail to regenerate during the advanced phenotype, suggesting that the reduced number of neoblasts may affect both anterior and posterior regeneration in Smed-Akt(RNAi) animals (data not shown). These results also imply that injury-mediated cell differentiation is active despite the initial high levels of cell death and low levels of cellular proliferation.
Previous studies in S. mediterranea have shown that localized waves of cell death concentrate to the injury site and a systemic spike of neoblast division take place within the first six hours post-amputation [30,43]. We followed both cell death and the mitotic response post amputation for seven days and observed cell death is suppressed over time, whereas cell division is increased in Smed-Akt(RNAi) animals when compared to the initial time point (Figs. 7d-g). Moreover, cell death not only reduced in Smed-Akt(RNAi) animals but it also failed to localize to the injury site as is expected in the first six hours post-amputation (Fig. 7d, e and Additional file 4A, B). The system wide cell death expected was also absent even after more than 2 days of amputation (Additional file 5A-C). Instead, TUNEL positive cells were slightly accumulated to the uninjured, opposite end of the regenerating trunk (n = 10/10). Intriguingly, amputation in the Smed-Akt(RNAi) group elicited a system-wide increase in cell division that peaked at six hours post-amputation and was sustained during the first week post-amputation (Fig. 7f, g). Additionally, the experimental group was incapable of producing a timely and localized mitotic response at the injury site, as seen in the control animals 2 days post amputation. However, Smed-Akt(RNAi) animals exhibited a delayed localization of cell division (i.e. 4 days post amputation), which persisted through 7 days post amputation (Additional file 6A-C). We propose Smed-Akt functions as regulator of cell death and proliferation, during large-scale tissue regeneration in planarians.

Discussion
Maintenance of adult tissues proceeds through a fine balance between cell death and cell division. Our results implicate Smed-Akt as a critical regulator of cellular turnover, adult tissue maintenance, and regeneration. Disrupting Smed-Akt signaling affects the number of proliferative neoblasts during cellular turnover and alters integrity and function of differentiated tissues. Strikingly, tissue injury is capable of altering patterns of cell death and cell proliferation after Akt downregulation.
The Smed-Akt phenotype is characterized by an initial increase in cell division that is followed by a gradual depletion in the number of proliferative neoblasts. The nature of the signals triggering cell proliferation in the first 10 days of the phenotype are not clear, but it might involve a compensatory response to overcome deficiencies in cellular turnover due to abnormalities in ciliogenesis [45][46][47][48]. Interestingly, even at late stages of the Akt phenotype some neoblasts continue dividing probably to self-renew and/or to continue supporting tissue turnover to some extent as animals subjected to Smed-Akt(RNAi) survive for over one month. Two non-exclusive scenarios may explain the presence of dividing neoblasts after Smed-Akt(RNAi): (1) residual Akt expression after RNAi, due to incomplete abrogation. Our qPCR analyses demonstrated that Smed-Akt expression is strongly downregulated after RNAi, however, additional experiments involving specific antibody against SMED-AKT protein may be needed to rule out whether AKT protein is still present and active, and (2) intrinsic differences among neoblast populations may confer survival properties to a select group of stem cells when Akt is downregulated. This possibility is supported by the differential expression displayed by neoblast subclasses after Smed-Akt(RNAi) (Fig. 2b). Recent progress to unravel the diversity of neoblast sub-populations suggest planarian stem cells are more complex than previously anticipated [25,49]. The quantification was performed on the regenerating trunk fragment. g Representative images showing mitotic activity (red dots) after head amputation at 0 and 6 h in trunk fragments. All images are representative of two or more biological replicates consisting of five animals or more per experiment. Scale bar 200 μm. Graphs represent mean ± s.e.m. of two or more biological replicates and P values *<0.01, **<0.001, ***<0.0005 and ****<0.0001 were obtained with Wilcoxon test or two way ANOVA Therefore, we envision future experiments would evaluate individual neoblast subpopulations to identify whether some neoblast subtypes are more susceptible to Akt downregulation [3,9,10,50,51].
The increased amount of cell death in Smed-Akt (RNAi) suggests this is a rather generalized event involving both neoblasts and differentiated cells. Our findings implicate decisions of cellular survival greatly depend on Akt signaling, but future experiments are required to discern whether apoptosis and/or necrosis initially target neoblasts. This possibility may, in fact, reduce the number of neoblasts making them unable to efficiently support demands of cellular turnover, leading to generic tissue defects. We did not address the mechanism of cell death in the Smed-Akt phenotype but since the mitochondrial pathway of apoptosis is remarkably conserved in planarians; it may serve, as in vertebrates, as the favored mechanism for Akt-mediated cell death [2,13,30,31,52,53].
Studies in mammals show that not all tissues respond homogeneously in response to Akt deficiency, while some do not show measurable changes (e.g. bone marrow and pancreas), others undergo apoptosis (e.g. testes and thymus) [52]. A fine balance between stem cell proliferation and programmed cell death enables physiological cellular turnover to support adult tissue maintenance. Tissue renewal is seen to be altered in Smed-Akt(RNAi) animals, most likely due to the increased levels of cell death, which reduce the number of proliferating neoblasts. Our findings indicate that Smed-Akt(RNAi) lead to a heterogeneous gene expression response and mixed effects on the architecture of differentiated tissues. This differential sensitivity to Smed-Akt deficiency is observed early with alteration of cilia-mediated locomotion and the late onset of a cystic phenotype defined by a malfunctioning excretory system. The effects of abrogated Smed-Akt in differentiated tissues may depend on tissue-specific turnover rates but more experiments are needed to better understand the phenotype at systemic level.
The mechanisms by which cilia is strongly reduced after Smed-Akt(RNAi) is unclear but our findings indicating severe downregulation in IFT88 may suggest, as in other systems [45-47, 54, 55], that phosphorylated Akt fail to localize to the cilium at the cilliary base leading to disruption of the apical cellular projections. An intriguing finding of the Smed-Akt(RNAi) phenotype is the disruption of ciliated structures within the epithelium and excretory system (e.g. flame cells and proximal tubules), which is being recently introduced as an alternative model for cystic kidney disease [36]. Our results showed a significant reduction in gene expression correlating to ciliated structures, protonephridia and nephrocystins within the first 10 days of RNAi initiation that persisted to decrease by day 30. Interestingly, impaired locomotion in Smed-Akt(RNAi) animals became slightly evident by day 15 after RNAi treatment, which was exacerbated over time, and the delayed onset of the edema phenotype that correlated with a dysfunctional excretory system. Planarian studies have shown functional downregulation of genes correlating to ciliated structures and nephrocystins led to a rapid edema phenotype by 9-15 days post RNAi treatment [36][37][38]. These results imply that Akt activity may facilitate the assembly of ciliated structures by regulating gene and protein expression required for maintenance of these structures (e.g. IFT88, NPHPs and SCL family of genes). It is also possible that during the initial part of the Akt phenotype, functional protonephridial units balance electrolyte and carry on waste excretion to compensate the reduction in the number of flame cells and proximal tubules. However, as the phenotype progresses it become unsustainable deriving in extensive damage, leading to the collapse of the excretory system. Further experiments will be required to discriminate how Akt signaling regulates the delayed onset of cyst-like formations. Nonetheless, these results are also significant because Akt signaling and cilia are emerging as possible therapeutic target in leukemia and polycystic disease [56][57][58][59]. Altogether, these findings highlight the convenience of the planarian model for analyzing Akt signaling dysfunction in the whole adult organism.
Akt has been studied extensively in the context of cancer and as a regulator of cellular functions, but its participation in large-scale regeneration remains poorly understood. Our findings reveal that Akt plays critical roles during planarian regeneration. Specifically, disruption of Akt impairs the process of blastema formation but does not prevent the initial peaks of cell proliferation upon amputation. In response to amputation, some cells migrate and differentiate to form an incipient blastema, which is discontinued probably due to the lack of timely localization of cell death near the wounded area. The mechanisms by which cell death regulates the process of regeneration still remains poorly understood [60]. Nonetheless, the Akt phenotype presents unique opportunities to address whether a particular signaling pathway and/or cell type that plays major role in guiding injury-induced apoptosis. We propose that Akt signaling serves as mediator of localized cell death events during planarian regeneration.
The intriguing finding that injury-induced repair signals in Smed-Akt(RNAi) is capable of reducing cell death is exciting and it reveals a novel role for Akt in largescale tissue regeneration. Uninjured animals subjected to Smed-Akt(RNAi) show high levels of cell death and restricted neoblast division, but within a few hours after amputation, levels of apoptosis dramatically reduce while cellular proliferation increase in the absence of functional Akt. While future experiments will be required to investigate the mechanisms contributing to injurymediated cellular death, these results imply tissue damage and repair may alter cellular decisions imposed by a dysfunctional Akt pathway.

Conclusions
Our results demonstrate that Akt forms part of an ancient signaling pathway controlling cellular fate decisions in members of the lophotrocozoans. Thus, we introduce S. mediterranea as a valuable model system to dissect Akt function in stem cell-based cellular turnover and repair of adult tissues. The mechanisms controlling the molecular cascade guiding large-scale tissue regeneration are poorly understood however, our analysis identified that Akt is necessary for events related with cell death during regeneration. Future experiments are needed to address the injury-mediated signals capable of reverting levels of cell death and proliferation in the absence of Akt signaling.

Planarian Culture
The clonal lines of the Planarian strain, Schmidtea mediterranea CIW4 was used for all experimental procedures and were cultured as previously described [61].

RNAi Experiments
The synthesis of dsRNA was carried out as previously described in [62] and microinjection experiments were carried out following the schedule in Fig. 1a. Following this injection schedule, phenotype was accomplished by 25-30 days post first injection. All experiments were conducted 5 days after last injection.

BrdU Staining
Single staining of BrdU staining was performed as previously described [23,64].

Flow Cytometry Analysis and Cell Sorting
Planarians were dissociated as previously described [24,32]. Brielfy, 1X10 6 cells from dissociated planaria were stained with DNA marker Draq5 (eBioscience Cat # 65-0880-96) at a 1:500 dilution in CMF media for 30 min at RT in the dark. Incubation with calcein (Invitrogen Cat # C3100MP) 1:500 diluted in CMF media for 10 min at RT was sufficient to stain live cells. BD FACSDiva™ software was used for initial gating and samples were either analyzed using LSRII flow cytometer (BD Biosciences) or sorted using ARIAII flow cytometer (BD Biosciences). Apoptotic cells were identified with Annexin V (Pacific Blue) and 7-AAD (PECy5) staining according the manufacturer's instructions (eBiosence) and additional modifications found in our protocol [32]. Flow cytometry analyses were performed with FlowJo software (version 8). Further details on this protocol can be found in our previous publication [63].

TUNEL Assay
Cell death was measured, using the TUNEL assay that labels double stranded DNA breaks with fluorescent tags. Further details on this protocol can be found elsewhere [30]. Animals were mounted and fluorescent images were captured and evaluated with Nikon AZ-100 multizoom microscope and NIS Elements software.

Quantification of Cellular Events, Planarian Measurements and Imaging Processing
Nikon AZ-100 multizoom microscope and NIS Elements (Nikon) AR 3.2 software was used to record animal behavior and digital images of planarian and/or cellular events within the animal. Whole animal measurements were calculated using the number of cellular events (eg. H3P or TUNEL-positive foci) per millimeter square. Area measurement of planarian size decreases was conducted by using 6 or more independent experiment containing 20 or more animals per experiment. Both the control and Smed-AKT(RNAi) animals were photographed using the same magnification and area measurements (per mm) were calculated along the 40 day time course. All areas were averaged across experiments. Average areas taken at the site of amputation were confined to a consistent area with a width of 161.05 pixels and a height of 146.939pixels. Fold change representations were determined by dividing experimental/control conditions. Additional details can be found as previously described [63]. Nikon Eclipse Ti confocal microscope and E Z-C1 software were used to obtain Z-stack images using 20X objective. Z-stacks containing 20 sections at 2-1μm intervals were processed using Image J (1.48v). For all images, Adobe Photoshop and Adobe Illustrator were used to adjust color and brightness.

Quantitative RT-PCR
RNA extraction and quantitative real-time PCR (RT-PCR) reactions were preformed as previously described [63]. RT-PCR from sorted cells was obtained by dissociating >20 animals per condition to extract RNA and prepare cDNA as described before [63]. Equal amount of cells were sorted from both control and experimental conditions, which in some cases required extra animals in experimental groups to achieve the desired target number of cells. In all cases, gene expressions are relative to the ubiquitously expressed clone H.55.12e [24,63]. Gene expression corresponds to the mean of triplicated samples of at least two independent experiments with pooled RNA extraction of >20 animals each. Fold change represents standardized expression levels of Smed-Akt(RNAi)/Control. Each RNAi time point had its own corresponding control RNA extract.

Whole Mount In Situ Hybridization (WISH)
WISH and fluorescent in situ hybridization were performed on animals fixed in 5% N-acteyl cistein (NAC) solution. Riboprobes were synthesized using T3 and T7 polymerase and digoxigenin-labeled ribonucletide mix with specific PCR templates as previously described [24,63]. Further details about WISH protocols are found as previously described [65].

Statistical Analysis
All graphs are expressed as mean ± s.e.m. Statistical analyses were performed with GraphPad Prism software. P value less than 0.05 were considered statistically significant.

Availability of Data and Materials
The datasets supporting the conclusions of this article are included within the article and its Additional files 1, 2, 3, 4, 5 and 6.

Ethics approval and consent to participate
The study does not involve human data or vertebrate animals. For intensity images and graph, low levels of expression are seen in purple and high levels of intensity in TUNEL-positive cells are seen in yellow/red. The graphs on the right represent the distribution of these intensities from the anterior to the posterior region of the amputation site (control in orange and experimental in gray). The intensity measurement was obtained from the area covered by the semi-transparent vertical line by using Image J software. Scale bar 100μm. (C) Immunostaining of TUNEL-positive nuclei of trunk fragments for both the control and experimental group at 6 h (localized cell death response), 2 days (system-wide cell death response) and 7 days (blastema formation) post amputation. Arrows indicate cell death dynamics, proper dynamics (control) and improper dynamics (Smed-Akt(RNAi)). Yellow brackets denote the formation of the blastema and its relative size. Scale bar 200μm. All images are representative of two or more biological replicates consisting of five animals or more per experiment. Graphs represent mean ± s.e.m. of two or more biological replicates and P values * < 0.01, ** < 0.001, *** < 0.0005 and **** < 0.0001 were obtained with two way ANOVA. (PDF 391 kb) Additional file 6: Delayed mitotic response upon amputation in Smed-Akt(RNAi) animals. (A) Mitotic activity at the site of amputation at various time points during regeneration, control (black) and Smed-Akt(RNAi) in grey. (B) Heat map depicting the intensity of signal generated by H3P-positive cells 4 days post amputation at the site of head regeneration. For intensity images and graph, low levels of expression are seen in purple and high levels of intensity in H3P -positive cells are seen in red. The graphs on the right represent the distribution of these intensities from the anterior to the posterior region of the amputation site (control in orange and experimental in gray). The intensity measurement was obtained from the area covered by the semi-transparent vertical line by using Image J software. Scale bar 100μm. (C) Whole-mount immunostaining of H3P-positive cells on trunk fragments for both the control and experimental group from 0 to 6 h (system-wide mitotic response), 2 to 4 days (localized mitotic response) and 7 days (blastema formation) post amputation. Arrows indicate cell proliferation dynamics during regeneration, proper dynamics (control) and improper dynamics (Smed-Akt(RNAi). Yellow brackets denote the formation of the blastema and its size. Notice, at 4 and 7 days, mitotic activity is localized to the site of amputation. Scale bar 200μm. All images are representative of two or more biological replicates consisting of five animals or more per experiment. Graphs represent mean ± s.e.m. of two or more biological replicates and P values * < 0.01, ** < 0.001, *** < 0.0005 and **** < 0.0001 were obtained with two way ANOVA. (PDF 282 kb)