Status Update and Interim Results from the Asymptomatic Carotid Surgery Trial-2 (ACST-2)

Objectives: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. Methods: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. Results: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical treatment. For 691 patients undergoing intervention with at least 1-month follow-up and Rankin scoring at 6 months for any stroke, the overall serious cardiovascular event rate of periprocedural (within 30 days) disabling stroke, fatal myocardial infarction, and death at 30 days was 1.0%. Conclusions: Early ACST-2 results suggest contemporary carotid intervention for asymptomatic stenosis has a low risk of serious morbidity and mortality, on par with other recent trials. The trial continues to recruit, to monitor periprocedural events and all types of stroke, aiming to randomize up to 5,000 patients to determine any differential outcomes between interventions. Clinical trial: ISRCTN21144362. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved

14 3 3 protein masks the nuclear localization sequence of caspase 2

Caspase‐2 is an apical protease responsible for the proteolysis of cellular substrates directly involved in mediating apoptotic signaling cascades. Caspase‐2 activation is inhibited by phosphorylation followed by binding to the scaffolding protein 14‐3‐3, which recognizes two phosphoserines located in the linker between the caspase recruitment domain and the p19 domains of the caspase‐2 zymogen. However, the structural details of this interaction and the exact role of 14‐3‐3 in the regulation of caspase‐2 activation remain unclear. Moreover, the caspase‐2 region with both 14‐3‐3‐binding motifs also contains the nuclear localization sequence (NLS), thus suggesting that 14‐3‐3 binding may regulate the subcellular localization of caspase‐2. Here, we report a structural analysis of the 14‐3‐3ζ:caspase‐2 complex using a combined approach based on small angle X‐ray scattering, NMR, chemical cross‐linking, and fluorescence spectroscopy. The structural model proposed in this study suggests that phosphorylated caspase‐2 and 14‐3‐3ζ form a compact and rigid complex in which the p19 and the p12 domains of caspase‐2 are positioned within the central channel of the 14‐3‐3 dimer and stabilized through interactions with the C‐terminal helices of both 14‐3‐3ζ protomers. In this conformation, the surface of the p12 domain, which is involved in caspase‐2 activation by dimerization, is sterically occluded by the 14‐3‐3 dimer, thereby likely preventing caspase‐2 activation. In addition, 14‐3‐3 protein binding to caspase‐2 masks its NLS. Therefore, our results suggest that 14‐3‐3 protein binding to caspase‐2 may play a key role in regulating caspase‐2 activation

14 3 3 protein directly interacts with the kinase domain of calcium calmodulin dependent protein kinase kinase CaMKK2

BackgroundCalcium/calmodulin-dependent protein kinase kinase 2 (CaMKK2) is a member of the Ca$^{2+}$/calmodulin-dependent kinase (CaMK) family involved in adiposity regulation, glucose homeostasis and cancer. This upstream activator of CaMKI, CaMKIV and AMP-activated protein kinase is inhibited by phosphorylation, which also triggers an association with the scaffolding protein 14-3-3. However, the role of 14-3-3 in the regulation of CaMKK2 remains unknown.MethodsThe interaction between phosphorylated CaMKK2 and the 14-3-3γ protein, as well as the architecture of their complex, were studied using enzyme activity measurements, small-angle x-ray scattering (SAXS), time-resolved fluorescence spectroscopy and protein crystallography.ResultsOur data suggest that the 14-3-3 protein binding does not inhibit the catalytic activity of phosphorylated CaMKK2 but rather slows down its dephosphorylation. Structural analysis indicated that the complex is flexible and that CaMKK2 is located outside the phosphopeptide-binding central channel of the 14-3-3γ dimer. Furthermore, 14-3-3γ appears to interact with and affect the structure of several regions of CaMKK2 outside the 14-3-3 binding motifs. In addition, the structural basis of interactions between 14‐3-3 and the 14-3-3 binding motifs of CaMKK2 were elucidated by determining the crystal structures of phosphopeptides containing these motifs bound to 14-3-3.Conclusions14-3-3γ protein directly interacts with the kinase domain of CaMKK2 and the region containing the inhibitory phosphorylation site Thr145 within the N-terminal extension.General significanceOur results suggested that CaMKK isoforms differ in their 14-3-3-mediated regulations and that the interaction between 14-3-3 protein and the N-terminal 14-3-3-binding motif of CaMKK2 might be stabilized by small-molecule compounds