4. Regulation of Cytoskeletal Organization and Cell Phenotype
In migrating cells, CD44 shows a preferential distribution in actin polymerization regions such as the lamellipodia, filopodia, and apical microvilli, suggesting a role of CD44 in the regulation of actin cytoskeleton reorganization. This regulation is not direct, since CD44 ICD does not contain any binding sites for actin filaments but instead structural motifs such as the FERM (4.1 protein, Ezrin, Radixin, Moesin)-binding domain and the ankyrin-binding domain, which allow CD44 to connect and interact with the cytoskeleton. Specific clusters of basic residues (
292RRRCGQ
KKK300) in the cytoplasmic tail of CD44 constitute the FERM-binding domain that interacts with ERM proteins and merlin/NF2 followed by a structural motif containing Ser
316 (
304NSGNGAVEDRKP
SGL
318) that binds the ankyrin cytoskeletal protein
[4] (
Figure 1).
The ERM proteins and merlin are binding partners for a number of transmembrane receptors (like ICAM, syndecans, L-selectin, and integrins) acting as cross-linkers between the plasma membrane and the cortical actin filaments
[32][33][34][35][45,46,47,48]. The neurofibromatosis type 2 (NF2) gene encodes the merlin protein, which has tumor-suppressing functions through regulating Hippo signaling, as well as receptor tyrosine kinases and downstream signal transduction pathways
[36][37][38][49,50,51]. ERM proteins and merlin show a similar domain organization, with the highest homology in the conserved three-lobe N-terminal FERM domain (head).
Phosphorylation of ERM proteins promotes their transition from the closed “inactive” conformation (head-to-tail self-association) to the open “active” conformation (dissociation of the three-lobed structure from the C-terminal domain) and their recruitment to the plasma membrane, where they bind membrane phospholipids such as phosphatidylinositol 4,5-biphosphate (PIP
2). These interactions stabilize ERM proteins close to membrane-associated molecules such as CD44, which adopts a more open conformation at its ICD upon Ser
325 phosphorylation
[39][52]. Activated ERM binds to the FERM-binding domain of CD44 ICD phosphorylated at Ser
325 (a constitutive phosphorylation site operated by CaMKII), forming a dynamic CD44-cytoskeleton association. This association can be disrupted upon PKC activation, which triggers the complete dephosphorylation of Ser
325 followed by the phosphorylation of other Ser residues such as Ser
291 and Ser
316, leading to dissociation of the ERM proteins from CD44 and its disengagement from the actin cytoskeleton
[4][40][41][4,30,53].
Therefore, the phosphorylation status of CD44 at specific Ser residues within the ICD is crucial for the dynamic association of the receptor with the cytoskeletal network and CD44-mediated chemotaxis, motility, and cell phenotypic changes. These events are not random but instead fine-tuned by the coordinated action of kinases and phosphatases. These enzymes could bind directly or indirectly to CD44. For example, ezrin interacts with PKC, thereby acting as a scaffolding protein for other signaling molecules to regulate phosphorylation of CD44 and associated proteins/receptors
[42][60]. On the other hand, the existence of a PDZ-binding motif in CD44 ICD raises the possibility of a direct interaction of CD44 with PDZ domain-containing phosphatases or indirectly through PDZ domain adaptor proteins, which in turn bind protein phosphatases, thereby regulating the phosphorylation level of CD44 itself as well as other adjacent signaling molecules/receptors. For example, binding of syntenin, a syndecan-binding PDZ protein
[43][61], to the C-terminus of protein tyrosine phosphatase (PTP) eta could result in the recruitment of this transmembrane PTP into syndecan-containing complexes
[44][45][62,63].
The interaction of CD44 with the actin cytoskeleton through binding to ERM proteins and ankyrin is further stabilized by the partitioning of CD44 into detergent-insoluble, cholesterol-rich nano-domains (lipid rafts) of the plasma membrane
[4][46][47][4,69,70] (
Figure 1). The highly conserved intramembrane domain of CD44 can be reversibly palmitoylated at Cys
286 and Cys
295, which enhances localization of the receptor in cellular membranes as well as its interactions with cell surface and cytoplasmic proteins, such as several RTKs, innate receptors (TLRs), ABC transporters, EMMPRIN, PI3K, Src kinases, ezrin, and hyaluronidase 2, which preferentially localize into lipid rafts
[48][49][50][51][71,72,73,74]. Interestingly, the amount of CD44 in lipid rafts can vary in different cell types and can be displaced from these membrane domains upon E-cadherin expression, which negatively regulates HA–CD44 interactions and CD44-dependent tumor invasion and branching morphogenesis
[52][75]. In immune cells, CD44 is directed into lipid rafts via palmitoylation, which impairs the CD3-mediated signaling
[53][76]. The strong association between CD44 and the actin filament network causes CD44 to act like a transmembrane picket that connects the cytoskeleton to pericellular milieu, forming barriers against diffusion of molecules through the plasma membrane
[54][77].
Of particular interest is the cross-linking of CD44 receptors, which has been associated with the metastatic potential of several human cancers. Receptor aggregation can be drastically induced by both extracellular (pericellular HMW HA) and intracellular (phosphorylated moesin/ezrin) cues
[55][79]. The association of CD44 with ezrin and actin promotes HA binding to cells
[56][57][80,81].
5. Regulation of Cell–Cell Contact Inhibition and Cell Growth
CD44-mediated contact inhibition of cell growth is modulated by counteracting CD44 ICD interacting proteins; e.g., the tumor suppressor protein merlin and ERM proteins. Their reversible dynamic association with CD44 ICD regulates the effects of the receptor on cell growth and motility since it provides an ON (CD44–ERM)/OFF (CD44–merlin) mechanism in the CD44–actin cytoskeleton association and signal transduction pathways (
Figure 1). The importance of these interactions in cell physiology is evidenced by the finding that long-lived naked mole rats, which synthesize HA of exceptionally high molecular size, show a remarkable resistance to cancer through regulation of cell–cell contact inhibition via the HA–CD44–merlin signaling axis
[58][59][60][85,86,87]. Mechanistically, ERM proteins and merlin are both hypophosphorylated in high-cell-density conditions
[61][88]. Under these conditions, ERM proteins are inactive, while merlin adopts the active unphosphorylated closed conformation and interacts with HA-bound CD44 and E-cadherin, thus stabilizing the homophilic E-cadherin interactions and cell–cell adhesion complexes and rendering the cells stationary. Activated merlin prevents proteolytic processing of the CD44 extracellular domain, which in turn preserves cell density signaling and inhibits cell proliferation and migration
[62][89].
In addition to merlin, PAR1b (partitioning defective 1b) also links CD44 and the Hippo pathway
[63][98]. Ooki and colleagues found that HMW–HA-mediated CD44 clustering induces the interaction of CD44 ICD with the PAR1b/microtubule affinity-regulating kinase 2 (MARK2) complex, which normally inactivates MST1 and MST2 Ser/Thr kinases through binding and subsequent inhibitory phosphorylation, thus triggering Hippo signaling activation and contributing to contact inhibition of cell growth.
6. Cleavage and Intracellular Release of CD44 ICD: A Master Regulator of the Transcriptome
The proteolytic cleavage of the extracellular domain or shedding of membrane-associated proteins is an irreversible post-translational modification that regulates cell–cell communication, intercellular signaling, and biological functions by releasing growth factors, enzymes, and soluble receptors
[64][105]. In some instances, the remaining protein in the membrane is further cleaved, generating additional products that include a cytoplasmic fragment that can function in intracellular signaling, revealing an additional level of regulation of cellular functions. In line with this, CD44 can undergo successive proteolytic processing by a number of proteases, resulting in the generation of both extra- and intracellular bioactive fragments. These proteases are recruited and act at the cleavage site under specific prerequisites. The formation of CD44 dimers has been suggested to be critical
[65][106].
The sequential cleavage of CD44 begins with the ectodomain shedding by transmembrane MMPs (i.e., MT1-MMP and MT3-MMP) as well as other CD44 sheddases (i.e., disintegrin or ADAM 10, ADAM 17, and meprin β), resulting in the generation of a membrane-associated fragment of CD44 while its extracellular N-terminal region is released to the ECM
[5][66][5,111]. ERM proteins are involved in CD44 shedding, since they mediate the colocalization of MT1-MMP and CD44. In particular, the radixin FERM domain simultaneously binds the cytoplasmic tails of MT1-MMP and CD44, forming a complex that is stabilized through anchoring to filamentous actin. This ternary complex facilitates the recognition of the CD44 stem region by the PEX domain of the MT1-MMP ectodomain, resulting in CD44 shedding
[67][68][108,109] (
Figure 2).
Figure 2. Schematic illustration of the roles of CD44 ICD in the regulation of transcriptome and cell metabolism. CD44 (via its ICD) dictates the metabolic shift from mitochondrial oxidative phosphorylation to aerobic glycolysis (the Warburg effect) through regulation of important metabolic enzymes such as PKM2, PFKFB4, and LDH. Enhanced pentose phosphate flux results in NADPH production that promotes GSH synthesis, which in turn suppresses ROS accumulation. Increased lactate production due to enhanced aerobic glycolysis results in the generation of an acidified pericellular microenvironment, which favors MMP activation. MMPs can be also activated by the TGFβ/TβR/TRAF6/RAC1 axis, thus triggering CD44 cleavage and the translocation of CD44 ICD to the nucleus, where it regulates the transcription of target genes, including CD44 itself (for details, see text).
7. Regulation of Cell Metabolism
One of the proteins that were identified by the proteomic approach to interact with the C-terminus of CD44 was the M2 splice isoform of pyruvate kinase (PKM2), a glycolytic enzyme that catalyzes the generation of pyruvate and ATP from phosphoenolpyruvate and ADP
[30][40]. While this finding was considered to possibly be non-specific since PKM2 is an abundant protein that is often detected in biotin-based pull-down experiments, two years later, Tamada and colleagues confirmed the interaction of CD44 with PKM2
[69][121]. This finding suggested a role of CD44 in cancer cell metabolism, since PKM2 is a key enzyme that regulates aerobic glycolysis or the Warburg effect, a metabolic pathway utilized by tumor cells regardless of the local availability of molecular oxygen to produce energy (ATP) and promote tumor growth
[70][122]. The low or high enzymatic activity of the PKM2 isoform dictates the conversion of pyruvate to lactate, which leads to the Warburg effect or to acetyl-CoA for mitochondrial oxidative phosphorylation, respectively
[70][71][72][73][122,123,124,125]. Interestingly, the interaction of CD44 with PKM2 reduces the enzymatic activity of PKM2 via tyrosine phosphorylation by RTKs, which triggers glycolysis and the flux to the pentose phosphate pathway, a major source of NADPH (
Figure 2). This mainly occurs in hypoxic or p53-mutated glycolytic cancer cells, since p53 is known to positively regulating mitochondrial oxidative phosphorylation through cytochrome c oxidase 2 induction
[69][74][121,126]. Knock-down of CD44 enhanced oxidative phosphorylation, which led to GLUT1 suppression and a subsequent reduction in glucose uptake and pentose phosphate pathway flux. These changes resulted in reduced NADPH production, down-regulation of reduced glutathione (GSH) synthesis, and increased accumulation of ROS
[69][121].
Further, CD44 ICD enhanced aerobic glycolysis through induction of 6-phosphofructo-2-kinase/fructose-2, 6-biphosphate 4 (PFKFB4), a key enzyme that catalyzes 6-phosphofructose (F6P) to fructose-2,6-biphosphate (F-2,6-BP) via bidirectional conversion during glycolysis
[75][76][116,132].
Additional important CD44 ICD-induced genes encoding enzymes involved in aerobic glycolysis include
ALDOC (which encodes aldolase c, fructose biphosphate), and
PDK1 (which encodes pyruvate dehydrogenase kinase-1)
[75][116], highlighting CD44 as a gatekeeper of the Warburg effect (
Figure 2).
8. Conclusions
In conclusion, the association of CD44 ICD with cytoskeletal effectors (ERM, merlin, IQGAP1, and ankyrin) drives cytoskeleton rearrangements and affects the distribution of organelles and transport of molecules. In addition, through specific interactions of its cytoplasmic tail, CD44 regulates the cell-trafficking machinery, the transcriptome, and major cell metabolic pathways, with substantial impact on cell functional properties like survival, proliferation, adhesion, differentiation, therapeutic resistance, stemness properties, and EMT .