Pharmacologic Activation of Integrated Stress Response Kinases Inhibits Pathologic Mitochondrial Fragmentation

Reviewer #1 (Public review):

Summary:

This manuscript (Baron, Oviedo et al., 2024) builds on a previous study from the Wiseman lab (Perea, Baron et al., 2023) and describes the identification of novel nucleoside mimetics that activate the HRI branch of the ISR and drive mitochondrial elongation. The authors develop an image processing and analysis pipeline to quantify the effects of these compounds on mitochondrial networks and show that these HRI activators mitigate ionomycin-driven mitochondrial fragmentation. They then show that these compounds rescue mitochondrial morphology defects in patient-derived MFN2 mutant cell lines.

Strengths:

The identification of new ISR modulators opens new avenues for biological discovery surrounding the interplay between mitochondrial form/function and the ISR, a topic that is of broad interest. It also reinforces the possibility that such compounds might represent new potential therapeutics for certain mitochondrial disorders. The development of a quantitative image analysis pipeline is valuable and has the potential to extract the subtle effects of various treatments on mitochondrial morphology.

Weaknesses:

I have three main concerns.

First, support for the selectivity of compounds 0357 and 3610 acting downstream of HRI comes from using knockdown ISR kinase cell lines and measuring the fluorescence of ATF4-mApple (Figure 1G and 1H). However, the selectivity of these compounds acting through HRI is not shown for mitochondrial morphology. Is mitochondrial elongation blocked in HRI knockdown cells treated with the compounds? While the ISRIB treatment does block mitochondrial elongation, ISRIB acts downstream of all ISR kinases and doesn't necessarily define selectivity for the HRI branch of the ISR. Additionally, are the effects of these compounds on ATF4 production and mitochondrial elongation blocked in a non-phosphorylatable eIF2alpha mutant? This point of selectivity/specificity of the compounds gets at a semantic stumbling block I encountered in the text where it was often stated "stress-independent activation" of ISR kinases. Nucleoside mimetics are likely a very biologically active class of molecules and are likely driving some level of cell stress independent of a classical ISR, UPR, heat-shock response, or oxidative stress response.

Second, it is difficult for me to interpret the data for the quantification of mitochondrial morphology. In the legend for Figure 2, it is stated that "The number of individual measurements for each condition are shown above." Are the individual measurements the number of total cells quantified? If not, how many total cells were analyzed? If the individual measurements are distinct mitochondrial structures that could be quantified why are the n's for each parameter (bounding box, ellipsoid principal axis, and sphericity) so different? Does this mean that for some mitochondria certain parameters were not included in the analysis? For me, it seems more intuitive that each mitochondrial unit should have all three parameters associated with it, but if this isn't the case it needs to be more carefully described why.

Third, the impact of these compounds on the physiological function of mitochondria in the MFN2.D414V mutants needs to be measured. Sharma et al., 2021 showed a clear deficit in mitochondrial OCR in MFN2.D414V cells which, if rescued by these compounds, would strengthen the argument that pharmacological ISR kinase activation is a strategy for targeting the functional consequences of the dysregulation of mitochondrial form.

Reviewer #2 (Public review):

Summary.

Mitochondrial dysfunction is associated with a wide spectrum of genetic and age-related diseases. Healthy mitochondria form a dynamic reticular network and constantly fuse, divide, and move. In contrast, dysfunctional mitochondria have altered dynamic properties resulting in fragmentation of the network and more static mitochondria. It has recently been reported that different types of mitochondrial stress or dysfunction activate kinases that control the integrated stress response, including HRI, PERK, and GCN2. Kinase activity results in decreased global translation and increased transcription of stress response genes via ATF4, including genes that encode mitochondrial protein chaperones and proteases (HSP70 and LON). In addition, the ISR kinases regulate other mitochondrial functions including mitochondrial morphology, phospholipid composition, inner membrane organization, and respiratory chain activity. Increased mitochondrial connectivity may be a protective mechanism that could be initiated by pharmacological activation of ISR kinases, as was recently demonstrated for GCN2.

A small molecule screening platform was used to identify nucleoside mimetic compounds that activate HRI. These compounds promote mitochondrial elongation and protect against acute mitochondrial fragmentation induced by a calcium ionophore. Mitochondrial connectivity is also increased in patient cells with a dominant mutation in MFN2 by treatment with the compounds.

Strengths:

(1) The screen leverages a well-characterized reporter of the ISR: translation of ATF4-FLuc is activated in response to ER stress or mitochondrial stress. Nucleoside mimetic compounds were screened for activation of the reporter, which resulted in the identification of nine hits. The two most efficacious dose-response tests were chosen for further analysis (0357 and 3610). The authors clearly state that the compounds have low potency. These compounds were specific to the ISR and did not activate the unfolded protein response or the heat shock response. Kinases activated in the ISR were systematically depleted by CRISPRi revealing that the compounds activate HRI.

(2) The status of the mitochondrial network was assessed with an Imaris analysis pipeline and attributes such as length, sphericity, and ellipsoid principal axis length were quantified. The characteristics of the mitochondrial network in cells treated with the compounds were consistent with increased connectivity. Rigorous controls were included. These changes were attenuated with pharmacological inhibition of the ISR.

(3) Treatment of cells with the calcium ionophore results in rapid mitochondrial fragmentation. This was diminished by pre-treatment with 0357 or 3610 and control treatment with thapsigargin and halofuginone

(4) Pathogenic mutations in MFN2 result in the neurodegenerative disease Charcot-Marie-Tooth Syndrome Type 2A (CMT2A). Patient cells that express Mfn2-D414V possess fragmented mitochondrial networks and treatment with 0357 or 3610 increased mitochondrial connectivity in these cells.

Weaknesses:

The weakness is the limited analysis of cellular changes following treatment with the compounds.

(1) Unclear how 0357 or 3610 alter other aspects of cellular physiology. While this would be satisfying to know, it may be that the authors determined that broad, unbiased experiments such as RNAseq or proteomic analysis are not justified due to the limited translational potential of these specific compounds.

(2) There are many changes in Mfn2-D414V patient cells including reduced respiratory capacity, reduced mtDNA copy number, and fewer mitochondrial-ER contact sites. These experiments are relatively narrow in scope and quantifying more than mitochondrial structure would reveal if the compounds improve mitochondrial function, as is predicted by their model.

Reviewer #3 (Public review):

Summary:

Mitochondrial injury activates eiF2α kinases - PERK, GCN2, HRI, and PKR - which collectively regulate the Integrated Stress Response (ISR) to preserve mitochondrial function and integrity. Previous work has demonstrated that stress-induced and pharmacologic stress-independent ISR activation promotes adaptive mitochondrial elongation via the PERK and GCN2 kinases, respectively. Here, the authors demonstrate that pharmacologic ISR inducers of HRI and GCN2 enhance mitochondrial elongation and suppress mitochondrial fragmentation in two disease models, illustrating the therapeutic potential of pharmacologic ISR activators. Specifically, the authors first used an innovative ISR translational reporter to screen for nucleoside mimetic compounds that induce ISR signaling and identified two compounds, 0357 and 3610, that preferentially activate HRI. Using a mitochondrial-targeted GFP MEF cell line, the authors next determined that these compounds (as well as the GCN2 activator, halofuginone) enhance mitochondrial elongation in an ISR-dependent manner. Moreover, pretreatment of MEFs with these ISR kinase activators suppressed pathological mitochondrial fragmentation caused by a calcium ionophore. Finally, pharmacologic HRI and GCN2 activation were found to preserve mitochondrial morphology in human fibroblasts expressing a pathologic variant in MFN2, a defect that leads to mitochondrial fragmentation and is a cause of Charcot Marie Tooth Type 2A disease.

Strengths:

This well-written manuscript has several notable strengths, including the demonstration of the potential therapeutic benefit of ISR modulation. New chemical entities with which to further interrogate this stress response pathway are also reported. In addition, the authors used an elegant screen to isolate compounds that selectively activate the ISR and identify which of the four kinases was responsible for activation. Special attention was also paid to a thorough evaluation of the effect of their compounds on other stress response pathways (i.e. the UPR, and heat and oxidative stress responses), thereby minimizing the potential for off-target effects. The implementation of automated image analysis rather than manual scoring to quantify mitochondrial elongation is not only practical but also adds to the scientific rigor, as does the complementary use of both the calcium ionophore and MFN2 models to enhance confidence and the broad therapeutic potential for pharmacology ISR manipulation.

Weaknesses:

The only minor concerns are with regard to effects on cell health and the timing of pharmacological administration.