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REVIEWS AMP-activated/SNF1 protein kinases: conserved guardians of cellular energy D. Grahame Hardie Abstract | The SNF1/AMP-activated protein kinase (AMPK) family maintains the balance between ATP production and consumption in all eukaryotic cells. The kinases are heterotrimers that comprise a catalytic subunit and regulatory subunits that sense cellular energy levels. When energy status is compromised, the system activates catabolic pathways and switches off protein, carbohydrate and lipid biosynthesis, as well as cell growth and proliferation. Surprisingly, recent results indicate that the AMPK system is also important in functions that go beyond the regulation of energy homeostasis, such as the maintenance of cell polarity in epithelial cells. Non-fermentable carbon source A carbon source (for example, glycerol) that cannot be metabolized by anaerobic fermentation in yeast, and is only metabolized by oxidative, aerobic metabolism. Division of Molecular Physiology, College of Life Sciences, University of Dundee, Dow Street, Dundee, DD1 5EH, Scotland, UK. e-mail: [email protected] doi:10.1038/nrm2249 Published online 22 August 2007 In 1946, in his book What is Life?, Erwin Schrödinger wrote: “When is a piece of matter said to be alive? When it goes on moving and exchanging material with its environ ment for a much longer period than we would expect of an inanimate piece of matter. When a system that is not alive is isolated or placed in a uniform environment, all motion usually comes to a standstill very soon; differ ences of electric or chemical potential are equalized, temperature becomes uniform by heat conduction. After that the whole system fades away into a dead, inert lump of matter”1. Living cells are capable of achieving the remarkable feat described by Schrödinger because they exploit the environment, constantly taking in energy to maintain a high ratio of ATP to ADP, analogous to a fully charged electrical cell or battery. Extending this analogy, catabo lism (and photosynthesis in photosynthetic organisms) ‘charges up the battery’ by converting ADP and phosphate to ATP, whereas almost all other cellular processes require energy and tend to ‘flatten the battery’ by hydrolysing ATP to ADP and phosphate (or, in a few cases, to AMP and pyrophosphate). If the latter reactions were allowed to reach equilibrium, cells would become Schrödinger’s “dead, inert lump of matter”. It is therefore obligatory that this is not allowed to happen, and mechanisms have evolved that maintain the rates of catabolism and/or photosynthesis in balance with rates of ATP consumption. I would argue that, at least since the evolution of eukaryo tic cells, the AMP-activated protein kinase (AMPK), with its relatives in other eukaryotic kingdoms including the SNF1 complexes in yeasts and the SNF1-related kinases in plants (hereafter also referred to as SNF1 complexes), have been major players in maintaining this balance. 774 | october 2007 | volume 8 AMPK was originally defined as a mammalian pro tein kinase that was allosterically activated by AMP2 and was able to phosphorylate and inactivate enzymes of lipid synthesis3. In Saccharomyces cerevisiae, the SNF1 (sucrose non-fermenting‑1) gene was discovered by a screen for mutations that caused failure to grow on sucrose, or on non-fermentable carbon sources such as gly cerol and ethanol. Although SNF1 was shown to encode a protein kinase in 1986 (Ref. 4), it was not realized that it was the orthologue of AMPK until the catalytic subunit of the latter was sequenced in 1994 (Refs 5,6). Mammalian AMPK is sensitive to the cellular AMP: ATP ratio and is activated by metabolic stresses that inhibit ATP production (for example, hypoxia, glucose deprivation, addition of metabolic inhibitors) or those that stimulate ATP consumption (for example, activation of motor proteins, ion pumps or channels, or biosynthetic pathways) (FIG. 1). It is also modulated (FIG. 2) by cytokines that regulate whole-body energy balance7, including leptin, adiponectin, ghrelin, cannabinoids, interleukin‑6 (Ref. 8) and ciliary neurotrophic factor (CNTF)9, by drugs used to treat type 2 diabetes (including metformin10 and thiazolidinediones11), and by natural plant products such as berberine12, resveratrol13 (present in grapes and red wine) and (–)epigallocatechin‑3-gallate 14 (present in green tea), which are reported to have healthgiving properties that include the prevention of obesity and insulin resistance, and extension of lifespan. In most cases, the mechanism by which these agents activate AMPK remains unclear. Once activated by metabolic stresses, cytokines or drugs, AMPK switches on catabolic pathways that gener ate ATP such as the uptake and metabolism of glucose www.nature.com/reviews/molcellbio © 2007 Nature Publishing Group REVIEWS Metabolic stress (for example, hypoxia, glucose deprivation, metformin) Catabolism ADP Adenylate kinase AMP AMPK ATP ATP ATP consumption Increased ATP consumption (for example, cell growth and division, activation of motor proteins) Figure 1 | Regulation of energy homeostasis by the Nature Reviewsconditions | Molecular(adequate Cell Biology AMPK system. Under unstressed carbon source and oxygen, optimal environment), catabolism maintains a high ratio of ATP:ADP. This drives the adenylate kinase reaction in favour of ADP synthesis and, consequently, the cellular AMP:ATP ratio is low and AMP-activated protein kinase (AMPK) is inactive. However, if the cell is subjected to a metabolic stress that interferes with ATP synthesis (for example, hypoxia, glucose deprivation or a metabolic inhibitor such as metformin) or a stress that accelerates ATP consumption (for example, activation of motor proteins, ion pumps or channels, or biosynthetic pathways), the ADP:ATP ratio tends to increase. This is amplified by adenylate kinase into a much larger increase in the AMP:ATP ratio that then switches on AMPK. In turn, AMPK restores energy homeostasis by promoting catabolism and inhibiting ATP-consuming processes. Adenylate kinase An enzyme that catalyses the reversible interconversion of ATP, ADP and AMP via the reaction 2ADP ↔ ATP + AMP. Ser/Thr kinase domain A kinase domain is a region of ~300 amino acids that folds into a structure that catalyses the phosphorylation of proteins. Ser/Thr kinases are specific for phosphorylation of Ser and Thr side chains. Activation loop A feature that is conserved in many protein kinases. In many cases, phosphorylation of the activation loop is required for the kinase to be active. and fatty acids, while switching off ATP-consuming, anabolic pathways such as the synthesis of fatty acids, cholesterol, glycogen and proteins (FIGS 1,2). It achieves this by rapid phosphorylation of metabolic enzymes and by phosphorylation of transcription factors and co-activators that regulate gene expression. Regulation of AMPK in the hypothalamus of the brain by cytokines and other agents also controls food intake. For example, its activation by hypoglycaemia (low glucose) stimulates feeding behaviour, consistent with the idea that AMPK represents an ancient starvation response system. Here, I focus on recent insights into the regulation of the mammalian and fungal AMPK/SNF1 systems that have been provided by structural studies. I also discuss selected recent findings that concern the downstream processes regulated by mammalian AMPK, especially glucose transport, transcription, cell growth and pro liferation, and the establishment and maintenance of cell polarity. Insights gained from studies in other eukaryotes such as plants, nematode worms and insects are also considered. The role of AMPK in the metabolic responses to exercise, in the regulation of whole-body energy balance, or as a target for drugs used in the treatment of metabolic disorders such as obesity and diabetes, have been recently reviewed elsewhere7,15–17. nature reviews | molecular cell biology Regulation and structure of AMPK All AMPK/SNF1 kinases appear to exist as hetero trimeric complexes comprising catalytic α-subunits and regulatory β- and γ-subunits (FIG. 3). The mamma lian kinases are activated by AMP in two ways. First, the kinase activity that resides in the α-subunit is stimulated by the binding of AMP to the γ-subunit. Second, AMP binding to the γ-subunit also promotes phosphoryla tion of a Thr residue within the kinase domain (Thr172 in the rat α-subunits), the phosphorylation of which is essential for activity18. The combination of the two effects causes >1000-fold increase in kinase activity19. Although it was previously thought that AMP promoted phosphorylation20 and inhibited dephosphorylation21, recent work suggests that it works entirely by inhibiting the dephosphorylation of Thr172, probably catalysed by a form of protein phosphatase-2C22. Whatever the exact mechanism, the effects of AMP to activate the kinase directly and to promote phosphorylation are antago nized by high concentrations of ATP21,23. Therefore, the kinase acts as an energy sensor. Because of the adenylate kinase reaction (FIG. 1), the AMP:ATP ratio is a more sensitive indicator of cellular energy status than the ADP:ATP ratio. The finding that AMPK activation is greatly reduced during contraction of muscles from mice that are deficient in adenylate kinase24 supports the important role of that enzyme in the generation of the activating signal. One puzzling finding is that the S. cerevisiae SNF1 complex is not activated by AMP in cell-free assays, despite the fact that there are large increases in the AMP:ATP ratio in vivo under conditions where it is activated6,25. Although the yeast kinase contains a residue equivalent to Thr172 (Thr210) that must be phosphorylated for activity26, exactly how the SNF1 complex is activated in response to glucose starvation remains unclear. An important recent development was the determina tion of a crystal structure for the core of the αβγ complex from Schizosaccharomyces pombe27 (FIG. 4). This structure contains the whole γ-subunit but only the C‑terminal domains of the α- and β-subunits. Unfortunately, we know almost nothing about the properties of the enzyme from S. pombe, but this structure does define the core interactions between the three subunits, which are likely to be conserved between different eukaryotes. The α-subunits: catalytic subunits. Two α-subunit iso forms (α1/α2) are encoded by distinct genes in mammals (PRKAA1 and PRKAA2) whereas in budding yeast, only one isoform exists, encoded by the single gene SNF1. All have conventional Ser/Thr kinase domains at the N terminus, with the conserved Thr residue that must be phosphorylated for activity in the activation loop18, which is a common feature in many protein kinases (FIG. 3). The structures of the kinase domains from S. cerevisiae Snf1 (Ref. 28) (Protein Data Bank (PDB) ID 2FH9) and human α2 (PDB ID 2H6D) have recently been determined. They contain the canonical two-lobed structure of eukaryotic kinase domains, but in both structures the protein was in an inactive, dephosphorylated state and the activation loops were not fully resolved. volume 8 | october 2007 | 775 © 2007 Nature Publishing Group REVIEWS Adipocyte Thiazolidinediones PPARγ Cannabinoids Low glucose Leptin Ghrelin Resistin Leptin Adiponectin IL-6 CNTF Berberine Resveratrol EGCG Muscle, liver, other cells AMPK Hypothalamus Food intake AMPK Glucose uptake ↑ Glycolysis ↑ AS160 EF2K PFK2 ACC2 PGC1α Fatty acid oxidation ↑ Mitochondrial biogenesis ↑ ACC1 HMGR Fatty acid synthesis ↓ GS mTOR Sterol synthesis ↓ Protein synthesis ↓ Glycogen synthesis ↓ Figure 2 | Activation of AMPK by cytokines, drugs and polyphenols, and key downstream events. In the hypothalamus, Nature Reviews | Molecular Cell Biology AMP-activated protein kinase (AMPK) is inhibited by agents that inhibit food intake (leptin) and is stimulated by agents that stimulate food intake (cannabinoids, low glucose, ghrelin). In other cells such as liver and muscle, AMPK is inhibited by the adipokine resistin, activated by the adipokines leptin and adiponectin, activated by other cytokines such as interleukin‑6 (IL‑6) and ciliary neurotrophic factor (CNTF), and by plant products such as berberine, resveratrol and (–)epigallocatechin‑3gallate (EGCG). The thiazolidinediones (for example, rosiglitazone and pioglitazone) may activate AMPK in a similar manner to metformin (FIG. 1) at high concentrations, but their main effect appears to be to promote the release of adiponectin from adipocytes by activation of peroxisome proliferator-activated receptor‑γ (PPARγ). Some of the major targets downstream of AMPK, and their effects on energy metabolism, are also shown; not all of these are phosphorylated directly. Overall, AMPK switches off ATP-consuming processes (such as protein synthesis, glycogen synthesis, sterol synthesis) and upregulates processes that increase ATP (such as glycolysis, mitochondrial biogenesis and glucose uptake). ACC1, acetylCoA carboxylase‑1; ACC2, acetyl-CoA carboxylase‑2; AS160, AKT substrate of 160 kDa; EF2K, elongation factor‑2 kinase; GS, glycogen synthase; HMGR, 3-hydroxy-3-methylglutaryl coenzyme A reductase; mTOR, mammalian target of rapamycin; PGC1a, PPARγ co-activator‑1α; PFK2, 6-phosphofructo‑2-kinase. Ubiquitin-associated domain A type of protein domain. The role of some, but not all, of these domains is to cause association with ubiquitylated or polyubiquitylated proteins. α1–6-linked branch point A branch point in α1–4-linked glucans (such as starch or glycogen) that is formed by a linkage between carbon-1 (in the α‑anomeric configuration) of the glucose at one end of the side chain, and carbon-6 of a glucose unit on the main chain to which the side chain is attached. α1–4-linked glucan A polymer of glucose (for example, amylose) that is formed by linkages between carbon-1 of one glucose unit and carbon-4 of the next, with all glucose units in the α‑anomeric configuration. A region that is C‑terminal to the kinase domain appears to act as an autoinhibitory sequence (AIS) that represses kinase activity, because bacterially expressed constructs that contain the kinase domain are >10-fold less active when they also contain the AIS29,30. The AIS shows some sequence similarity with the ubiquitin-associated domains that are found in the same position in several members of the AMPK-related kinase family31. The C‑terminal region of the α-subunit is required for formation of the complex with the β- and γ-subunits29,32 and, in the crystal structure of the S. pombe core complex, forms a compact domain around which the C‑terminal region of the β-subunit (which is required for the forma tion of the mammalian complex33) is entwined (FIG. 4). The extreme C terminus of the β-subunit in the S. pombe structure forms two strands of a β-sheet with the γ-subunit providing the third strand, whereas the contacts between the α and γ subunits are more limited. The S. pombe structure is consistent with previous models that have been proposed for the mammalian enzyme, in which the β- and γ-subunits interact directly with each other34,35. An alternative model36, which predicts that the α- and γ-subunits can interact in the absence of the β-subunit, is not supported by the S. pombe structure. The β-subunits: scaffolds with glycogen-binding domains. Two β-subunit isoforms (β1 and β2) are encoded by distinct genes in mammals (PRKAB1 and PRKAB2), whereas there are three β-subunit genes (SIP1, SIP2 776 | october 2007 | volume 8 (Snf1-interacting protein‑1 and ‑2) and GAL83 (galactose metabolism‑83)) in budding yeast. Because their C‑terminal domains appear to bridge the α- and γ-subunits, they can be regarded as protein ‘scaffolds’ on which the AMPK complex assembles. The β-subunits also contain a central carbohydrate-binding domain (FIG. 3) that causes the mammalian αβγ complex to associate with glycogen in intact cells33,37. The domain is related to non-catalytic domains found in enzymes that meta bolize the α1–6-linked branch points in starch and glyco gen. The glycogen-binding domain of mammalian β1 has been crystallized in the presence of β‑cyclodextrin (a circular α1–4-linked glucan of seven glucose units), thus defining the carbohydrate-binding site38. However, cyclodextrins do not occur naturally in mammals, and it seems likely that the real physiological ligands might be the branch points in glycogen. Although the physio logical function of glycogen binding is unknown, in muscle cells it may function to localize the kinase close to glycogen synthase — a substrate of AMPK. Alternatively, AMPK may sense some aspect of glycogen structure, and therefore respond to the medium-term reserves of cellular energy in the form of glycogen, as well as to the immediately available energy in the form of AMP and ATP. Another interesting finding is that this domain appears to be responsible for an inter action between AMPK and the glycogen debranching enzyme39, although the physiological significance of this remains unclear. www.nature.com/reviews/molcellbio © 2007 Nature Publishing Group REVIEWS α-subunits: Upstream kinases β-binding P N Kinase Glycogen binding β-subunits: α-CTD AIS N C α-binding β-CTD GBD C γ-binding Bateman domains AMP/ATP binding AMP/ATP binding γ 1: N γ 2 (long): N γ 3 (long): N CBS1 CBS2 CBS3 CBS4 C γ2-NTD CBS1 CBS2 CBS3 CBS4 C γ3-NTD CBS1 CBS2 CBS3 CBS4 C CBS2 CBS3 CBS4 C β-binding Starch binding? Plant βγ subunits: N SBD CBS1 Figure 3 | Domain structure of AMPK subunits. The figure is drawn approximately to scale, and domains shown in the same colour are related in sequence. The mammalian Nature Reviews | Molecular Cell Biology α1/α2 and β1/β2 isoforms are very similar and a generalized example is shown for each. The α subunits have a C‑terminal domain (α-CTD) that is required for binding the βγ subunits and an autoinhibitory sequence (AIS) that inhibits the activity of the kinase domain. The kinase domain also contains the Thr residue that must be phosphorylated (P) for activity. The β-subunits contain central glycogen-binding domains (GBD) and C‑terminal domains (β-CTD) that are required for binding the α- and γ-subunits. The three γ-subunit isoforms have variable N‑terminal domains (NTDs), a short region that is required for binding to the β-subunit, and four conserved cystathionine β‑synthase motifs (CBS1–4). The CBS motifs act in pairs to form two Bateman domains that bind AMP or ATP. Some plants express unusual βγ subunits (bottom) that have a domain that is related to the mammalian GBD (a postulated starch-binding domain (SBD)), which appears to have fused with a γ-subunit. Plants also express β-subunits that contain just the β‑CTD, as well as more conventional β- and γ-subunits. Ventricular pre-excitation A clinical condition in which the delay between the excitation of the atria (small chambers) and ventricles (large chambers) of the heart is reduced. The γ-subunits: the AMP/ATP binding subunits. Three γ-subunit isoforms (γ1, γ2, γ3) are encoded by distinct genes in mammals (PRKAG1, PRKAG2 and PRKAG3), whereas in budding yeast, only one isoform exists, encoded by the single gene SNF4. The mammalian γ2 and γ3 isoforms contain unrelated N‑terminal exten sions (FIG. 3), which are subject to truncation by RNA splicing and whose functions are currently unknown. C‑terminal to these are short conserved regions that are involved in the interaction with the β-subunit, as shown by truncation experiments 35. Consistent with this, in the S. pombe structure this region of the γ-subunit forms the αB helix and the β1 strand, which interact with the β2-β3 loop and the β3 strand, respectively, on the β-subunit (FIG. 4). This region is followed by four tandem repeats of a sequence of ~60 residues (FIGS 3,4), which were first recognized by Bateman in the enzyme cystathionine β‑synthase (CBS) and other proteins40, and termed a CBS motif. These motifs act in pairs to form two domains now referred to as Bateman domains. nature reviews | molecular cell biology When the Bateman domains (that is, CBS1–CBS2 and CBS3–CBS4) from human γ2 were expressed separately, they each bound one molecule of AMP and, as expected from the antagonistic effects of ATP on kinase activation, they also bound ATP in a mutually exclusive manner, although with an affinity that was fivefold lower41. When the tandem Bateman domains were expressed together (CBS1–CBS2–CBS3–CBS4), they bound two molecules of AMP or ATP in a highly cooperative manner, suggesting that the second binding site only becomes available when nucleotide has bound to the first. Binding of ATP did not require Mg2+, which agrees with the finding that no divalent metals were present in the crystals of the S. pombe complex grown in the presence of ATP, even when they were included in the medium27. Because free ATP is present in cells at concentrations that are almost two orders of magnitude lower than the Mg2+–ATP complex, this helps to explain how AMP in the micromolar range can effectively com pete with ATP for binding to the γ subunit, even though the total cellular concentration of ATP is usually in the millimolar range. How does binding of AMP to the Bateman domains cause allosteric activation of the αβγ complex? Many protein kinases are inhibited by internal autoinhibitory sequences that resemble the sequences at target sites for the kinase (pseudosubstrate sequences), the effects of which are relieved by binding of the activating ligand42. Recently, myself and co-workers identified pseudo substrate sequences within CBS2 in the N‑terminal Bateman domain of all eukaryotic γ-subunits43. These sequences closely resemble the consensus recognition motif for AMPK substrates 44, except that they have non-phosphorylatable residues in place of Ser or Thr. The pseudosubstrate sequence contains basic residues that we propose are involved both in the interaction between the pseudosubstrate sequence and the kinase domain, and in the binding of AMP to the N‑terminal Bateman domain. Because these two interactions would be mutually exclusive, this suggests an elegant mechanism for allosteric activation. In the absence of AMP, the pseudosubstrate sequence would bind to the substrate-binding groove on the kinase domain, which inhibits kinase activity. AMP binding probably occurs initially at the C‑terminal Bateman domain (as in the S. pombe enzyme; FIG. 4). This then promotes binding of the nucleotide at the N‑terminal domain, which pre vents the interaction of the pseudosubstrate sequence with the kinase domain and therefore causes activa tion43. How this mechanism interfaces with the effect of the AIS on the α-subunit (see above) remains unclear at present. Mutations in the γ-subunit cause heart disease. Several point mutations in the human γ2 subunit isoform are associated with heart disease41,45–47. Most cause a heredi tary, autosomal dominant form with an adult onset. The main clinical feature of this disorder is ventricular pre-excitation (Wolff–Parkinson–White syndrome) — a premature excitation of the muscle of the large chambers (ventricles) of the heart caused by abnormal electrical volume 8 | october 2007 | 777 © 2007 Nature Publishing Group REVIEWS Glycogen-binding domain N β-CTD α-CTD C C β2-β3 loop β1 strand αB helix CBS1 CBS2 γ-NTD N CBS3 C CBS4 AMP Figure 4 | Structure of the core of the Nature Reviews | Molecular Cell Biology Schizosaccharomyces pombe αβγ complex. The structures that have been solved27 contain the C‑terminal domains (CTDs) of the α-subunit (yellow) and β-subunit (red), and the entire γ-subunit. The crystals contained dimers of heterotrimers, but only a monomer is shown. The N‑terminal end of the α‑C-terminal domain (α-CTD), to which the autoinhibitory and kinase domains would be linked, lies in the centre to the rear in this view. The N‑terminal domain of γ (γ-NTD) is shown in white and its four cystathionine β‑synthase motifs (CBS1–4) are shown in pale blue, magenta, green and orange, respectively. A single molecule of AMP lies in the cleft between CBS3 and CBS4 with the phosphate group at the top in this view (C atoms in green, N in blue, O in red, P in magenta; H atoms are omitted). The equivalent site in the cleft between CBS1 and CBS2 is unoccupied. The main interaction between the β- and γ-subunits is via the central three-stranded β‑sheet with two strands (β2/β3, red) from β and one strand (β1, white) from γ, but there are also interactions between the αB helix on γ and the β2‑β3 loop on β. Image created using the coordinates from Protein Data Bank ID 2OOX in MacPyMOL100. connections with the small chambers (atria). There are also more severe forms of the disease that are not inherited because they result in death from heart failure or respiratory distress in early infancy. The common feature of both types of disease is elevated storage of glycogen in cardiac myocytes45–48, which, in the milder forms, appears to affect the development of the electri cally insulating layer between the atria and ventricles49 and, in the severe forms, also appears to compromise contractile function. When these mutations were made in bacterially expressed Bateman domains, or in AMPK heterotrimers expressed in mammalian cells, they inter fered with AMP binding and also reduced or abolished AMP activation41,45,46,50. This provided the crucial evi dence that the Bateman domains represent the regulatory AMP-binding sites. 778 | october 2007 | volume 8 At least eight different point mutations in the γ2 sub unit have been found to be associated with heart disease, and five of them neutralize positively charged side chains on conserved Arg or His residues in similar positions in CBS motifs 1, 2 and 4. Modelling suggests that these residues bind the negatively charged α-phosphate group of AMP41,51. In agreement with this, the Arg residue in CBS4 is conserved in the S. pombe γ-subunit (R290) and in human γ1 (R299), and in recent crystal structures of these domains the side chains of these Arg residues form ionic interactions with the phosphate groups of AMP or ATP27,52. The effect of the γ2 mutations on AMPK activity are complex because, as well as reducing binding of the activ ating nucleotide AMP (a loss-of-function effect), they also reduce binding of the inhibitory nucleotide ATP (a gain-of-function effect). Therefore, although they pre vent activation by AMP, they also appear to increase the basal activity45,48, which explains why these mutations are dominant in effect. A recent study of transgenic mice expressing in cardiac muscle the N488I mutation (which had been previously identified in a family affected by pre-excitation syndrome and cardiac hypertrophy) suggested that this causes increases in basal cardiac glucose uptake, glucose‑6-phosphate content and glyco gen synthesis53. Although increased basal AMPK would be expected to inactivate glycogen synthase owing to its increased phosphorylation54, this inhibitory effect would be overridden by the high levels of glucose‑6-phosphate, an allosteric activator of glycogen synthase. Some γ2 mutations have been reported to cause elevated glycogen in skeletal muscle (where γ2 is also expressed) as well as cardiac muscle, although this does not seem to cause any clinical problems. Interestingly, a mutation in the skeletal muscle-specific γ3 isoform (R200Q, equivalent to R302Q in human γ2, a mutation that causes heart disease) is associated with elevated skeletal muscle glycogen content in pigs55. It is worth pointing out that the γ1 isoform provides the majority of AMPK activity in most cell types, including skeletal and cardiac muscle. As yet, no mutations in γ1 have been identified, possibly because they would be more deleterious than γ2 or γ3 mutations. However, musclespecific expression of an R70Q mutant γ1 transgene in mice (equivalent to R302Q in human γ2) also caused elevated muscle glycogen56. Because mutations in either Bateman domain reduce or abolish activation by AMP, it seems likely that both sites must be occupied for AMP activation to occur. It was therefore surprising that in the structure of the core complex from S. pombe, which had been crystallized in the presence of high concentrations of AMP, only one of the potential binding sites was occupied (FIG. 4) . However, whether the S. pombe kinase is activated by AMP like the human enzyme, or is insensitive to AMP like the S. cerevisiae enzyme, is a question that remains to be resolved. It seems most likely that the S. pombe enzyme will also be AMP-insensitive because basic residues that are required for AMP binding to the N‑terminal Bateman domain of human γ2 (R302 and H383), which are conserved in all γ-subunit sequences in species where www.nature.com/reviews/molcellbio © 2007 Nature Publishing Group REVIEWS AMP activation has been demonstrated (mammals, Drosophila melanogaster and Caenorhabditis elegans), are not conserved in S. pombe or S. cerevisiae. Calmodulin A small protein that binds Ca2+, causing a conformational change that causes the complex to bind to and activate many downstream target proteins. MAP kinase kinase kinase A Ser/Thr protein kinase at the head of a cascade of three protein kinases, the final one being a mitogen-activated protein kinase such as ERK1 or ERK2. GLUT4 A member of the plasmamembrane glucose transporter (GLUT) family expressed in insulin-sensitive tissues such as muscle and adipose tissue. GLUT4 translocates to the membrane in response to insulin. GTPase-activating protein A protein that activates the intrinsic GTP-hydrolysing activity of small GTP-binding proteins of the Ras/Rab family. Rab protein A member of the family of small GTP-binding proteins related to Ras, most of which are thought to be involved in the regulation of membrane traffic. Identification of upstream kinases For many years, the identities of the upstream kinase(s) responsible for phosphorylation of the critical Thr172 phosphorylation site on the α-subunit18 were elusive. The initial breakthrough came from the yeast system, where Sak1 (Snf1-activating kinase‑1, formerly known as Pak1), Elm1 (elongated morphology‑1) and Tos3 (target of Sbf3) were identified as kinases that func tion upstream of the SNF1 complex by various wholegenome screening strategies26,57,58. There is sufficient redundancy in the function of these three kinases such that all three must be knocked out to generate the same phenotype as a snf1 mutant57,58. Although there are no clear orthologues of SAK1, TOS3 or ELM1 in the human genome, the protein kinases with kinase domains closest in sequence are LKB1 and the two calmodulin-dependent protein kinase kinases, CaMKKα and CaMKKβ. Subsequent studies revealed that both LKB1 (Refs 20,59) and CaMKKs60–62, especially CaMKKβ, can act upstream of AMPK in mammalian cells. A recent screen for mammalian kinases that activate the SNF1 complex when expressed in yeast has yielded a further candidate, transforming growth factor‑β (TGFβ)-activated kinase‑1 (TAK1)63. TAK1 was originally identified as a MAP kinase kinase kinase that acts upstream of members of the stressactivated MAP kinase family; whether activation of AMPK by TAK1 is physiologically relevant remains uncertain at present. The discovery that LKB1 was an upstream kinase for AMPK was particularly interesting because LKB1 was originally discovered as a tumour suppressor that is mutated in an inherited susceptibility to human cancer, Peutz–Jeghers syndrome64. LKB1 also functions upstream of 12 other kinases (AMPK-related kinases) that fall on the same branch as AMPK by phylogenetic analysis of kinase domain sequences64,65. The roles of AMPK to inhibit cell growth and proliferation and promote cell polarity (see below) suggest that it could be responsi ble for the tumour-suppressor role of LKB1, although the involvement of the other AMPK-related kinases cannot be excluded at present. Although LKB1 must be bound to two accessory subunits (STRAD (sterile‑ 20-related adaptor) and MO25 (mouse protein‑25)) to be functional, the protein kinase activity appears to be constitutively active65,66. The trigger for increased phos phorylation of AMPK appears instead to be the binding of AMP to AMPK, which inhibits dephosphorylation of Thr172 (Refs 21,22). The capability of CaMKKβ to act as an alternate upstream kinase means that, in cells in which it is expressed, signals that increase cytosolic Ca2+ would be able to activate AMPK in the absence of an increase in AMP. Increasing cytosolic Ca2+ often triggers ATPconsuming processes, such as activation of motor pro teins or membrane traffic, and Ca2+ must also be pumped back out of the cytosol by ATP-driven membrane pumps. Activation of AMPK could therefore be viewed nature reviews | molecular cell biology as a mechanism to anticipate the large increased demand for ATP that usually accompanies Ca2+ release. Unlike LKB1, which appears to be ubiquitous, the expression of CaMKKs is more restricted. Both isoforms are expressed predominantly in neural tissue, although CaMKKβ is also found in cells of the endothelial or haematopoietic lineage. Recently, AMPK has been shown to be activated via the CaMKK pathway in response to K+-induced depolarization in rat brain slices60, thrombin activa tion of endothelial cells67, and stimulation of the T-cell receptor in T cells68: all of these are situations in which Ca2+ is released into the cytosol and in which cellular energy turnover is likely to increase rapidly following stimulation. Downstream functions of AMPK/SNF1 In general, AMPK activation stimulates ATP-producing, catabolic pathways and inhibits ATP-consuming anabolic pathways, both by rapid effects via direct phosphoryla tion of metabolic enzymes, and by longer-term effects via regulation of transcription. Some of the metabolic targets are shown in FIG. 2, and a more complete list of AMPK targets is shown in TABLE 1. A more exhaustive account of these targets and effects can be found in recent reviews elsewhere7,15–17. Regulation of glucose uptake. One key effect of AMPK is its capability to stimulate glucose uptake in muscle by increasing the translocation of the glucose transporter GLUT4 to the plasma membrane69. Insulin is thought to produce the same effect, at least in part, by phos phorylation of the AKT substrate of 160 kDa (AS160) by the insulin-activated protein kinase, AKT/PKB (protein kinase B)70. AS160 contains a GTPase-activating protein (GAP) domain for small G proteins of the Rab family, and insulin treatment appears to cause AS160 to dissociate from intracellular GLUT4 storage vesicles. A current model is that AS160 dissociation allows for activation of a Rab protein by GTP, which triggers the docking and/or fusion of GLUT4 storage vesicles with the plasma membrane (FIG. 5a). Intriguingly, activation of AMPK causes phosphorylation of AS160 at some of the same sites as insulin71,72, indicating that insulin and AMPK might trigger GLUT4 translocation by intersecting mechanisms. Regulation of transcription. A paradigm for the mecha nism by which AMPK regulates gene expression came from studies of glucose-repressed genes in S. cerevisiae, involving phosphorylation of the transcription factor Mig1 (FIG. 5b). Mig1 binds to and inhibits the promoters of glucose-repressed genes, including the SUC2 gene that encodes a secreted invertase enzyme, which is required to metabolize sucrose. The removal of glucose from the medium activates the SNF1 complex, which phospho rylates Mig1 at four sites73. Phosphorylation of Mig1 abolishes its interaction with the co-repressor complex, Cyc8–Tup1, relieving repression74. At the same time, phosphorylation triggers the interaction of Mig1 with the nuclear export factor Msn5, causing its translocation from the nucleus to the cytoplasm75 (FIG. 5b). volume 8 | october 2007 | 779 © 2007 Nature Publishing Group REVIEWS Table 1 | Protein targets for which there is good evidence for direct phosphorylation by AMPK* Protein target Effect on protein function Pathway Tissue Effect on pathway ACC1 ↓ activity Fatty acid synthesis All cells? ↓ fatty acid synthesis ACC2 Lipid metabolism ↓ activity Fatty acid oxidation Muscle, liver ↑ fatty acid oxidation HMGR ↓ activity Isoprenoid synthesis Liver ↓ cholesterol synthesis HSL ↓ activity Lipolysis Adipose tissue ↓ lipolysis AS160 ↓ Rab-GAP? GLUT4 trafficking Muscle ↑ glucose uptake Glycogen synthase Carbohydrate metabolism ↓ activity Glycogen synthesis Muscle ↓ glycogen synthesis PFK2 (cardiac isoform) ↑ activity Glycolysis Heart ↑ glycolysis PFK2 (inducible isoform) ↑ activity Glycolysis Monocytes, macrophages ↑ glycolysis Protein metabolism (translation) EF2K ↑ activity Protein synthesis All cells? ↓ translation elongation TSC2 (tuberin) ↑ Rheb-GAP Regulation of TOR All cells? ↓ translation initiation, ↓ cell growth, ↓ protein synthesis eNOS ↑ activity Nitric oxide production Endothelial cells ↑ nitric oxide, ↑ increased blood flow? IRS1 ↑ PI 3‑kinase Insulin signalling All cells? ↑ insulin signalling? p300 ↓ interaction Gene expression All cells? ↓ transcription by nuclear receptors HNF4‑α ↓ DNA binding, ↑ degradation Gene expression Liver, others ↓ transcription ChREBP ↓ DNA binding Gene expression Liver ↓ transcription of lipogenic genes TORC2 ↑ cytoplasmic translocation Gene expression, localization Liver ↓ transcription of gluconeogenic genes ↓ channel opening Ion transport, fluid secretion Airway, gut epithelium ↓ ion transport, ↓ fluid secretion Cell signalling Transcription Ion transport/ion balance CFTR ACC1, acetyl-CoA carboxylase‑1; ACC2, acetyl-CoA carboxylase‑2; AS160, AKT substrate of 160 kDa; CFTR, cystic fibrosis transmembrane conductance regulator; ChREBP, carbohydrate-response element-binding protein; EF2K, elongation factor‑2 kinase; eNOS, endothelial nitric oxide synthase; GLUT4, glucose transporter type-4; HMGR, 3-hydroxy-3-methylglutaryl coenzyme A reductase; HNF4-α, hepatocyte nuclear factor-4α; HSL, hormone-sensitive lipase; IRS1, insulin receptor substrate‑1; PFK2, 6-phosphofructo‑2-kinase; PI, phosphatidylinositol; Rab-GAP, Rab GTPase-activating protein; Rheb-GAP, Ras homologue enriched in brain GTPase-activating protein; TOR, target of rapamycin; TORC2, transducer of regulated CREB (cyclic AMP-responsive element binding) activity; TSC2, tuberous sclerosis-2. *Detailed references can be found elsewhere16. Cyclin A protein that controls progress through the cell division cycle by binding to and activating a cyclin-dependent protein kinase. G1–S boundary An event in the cell division cycle: the boundary between the first phase (Gap 1) and the second (S phase, when DNA replication occurs). Quiescent (non-dividing) cells are usually arrested just before the G1–S boundary. In mammals, AMPK activation downregulates expression of biosynthetic genes, such as those involved in gluconeogenesis and lipogenesis in the liver, and upregulates genes involved in catabolism, such as GLUT4 and mitochondrial genes in muscle. These effects are achieved by phosphorylation of numerous targets, including transcription factors and co-activators (TABLE 1). The expression of other transcriptional regula tors are upregulated (for example, the key co-activator for mitochondrial biogenesis, PPARγ (peroxisome prolifera tor-activated receptor‑γ) co-activator‑1α (PGC1α)76,77) or downregulated (for example, the lipogenic tran scription factor, sterol response element-binding protein-1c (SREBP-1c)10), although the mechanisms for these effects remain unclear. 780 | october 2007 | volume 8 Regulation of cell growth and proliferation. Because cell growth and proliferation are energy-intensive processes, it is not surprising that AMPK activation should inhibit them. Pharmacological activation of AMPK inhibits the growth of cancer cells, and causes phosphorylation of p53 on Ser15 and accumulation of p53 and the cyclindependent kinase inhibitors, p21 and p27 (Refs 78,79). Mouse embryo fibroblasts (MEFs) that are deprived of glucose arrest at the G1–S boundary, and this effect required phosphorylation of Ser18 on p53 (equivalent to human Ser15) by AMPK, suggesting that the kinase forms an ‘energy checkpoint’ that delays progress through the cell cycle if insufficient energy is available80. Recently, p27 was reported to become phosphorylated at the C‑terminal residue Thr198 in response to AMPK www.nature.com/reviews/molcellbio © 2007 Nature Publishing Group REVIEWS a b Plasma membrane GLUT4 GLUT4 storage vesicle Plasma membrane P P SNF1 Rab–GTP P P AS160 Rab–GDP Low glucose P PKB P Mig1 Cytoplasm Mig1 Cyc8 SNF1 AMPK Mig1 SUC2 promoter Insulin Metabolic stress Msn5 Cyc8 Tup1 Tup1 SUC2 coding sequence Transcription of SUC2 Nucleus Figure 5 | Models for regulation by AMPK/SNF1 of glucose uptake in muscle and gene expression in yeast. Nature storage Reviews vesicles. | Molecular Cell Biology a | In resting muscle, the glucose transporter GLUT4 is mainly located in intracellular GLUT4 Activation of AKT/protein kinase B (PKB) by the insulin signalling pathway, or activation of the AMP-activated protein kinase (AMPK) pathway by metabolic stress, causes phosphorylation of overlapping sets of sites on AKT substrate of 160 kDa (AS160). This triggers dissociation of AS160 from the GLUT4 storage vesicle, preventing AS160 from converting the Rab protein to its inactive GDP form. The activated Rab–GTP complex then promotes docking and/or fusion of the GLUT4 storage vesicle with the plasma membrane. b | Regulation of expression of the SUC2 gene (which encodes a sucrose-hydrolyzing enzyme) by the SNF1 complex in Saccharomyces cerevisiae. In high glucose conditions, the repressor protein Mig1 is bound to the promoter of the SUC2 gene, to which it recruits the co-repressor Cyc8–Tup1 complex, thus repressing transcription. Removal of glucose from the medium activates the SNF1 complex, which translocates to the nucleus and phosphorylates Mig1 at multiple sites. This disrupts the interaction of Mig1 with Cyc8–Tup1, and also causes binding of Mig1 to the nuclear export factor, Msn5. Mig1 is then exported from the nucleus and the SUC2 gene is expressed. AU-rich element A region in mRNA that is rich in the bases adenine and uracil. It is often a binding site for proteins that control mRNA degradation. Autophagy A process that occurs inside cells in which cytoplasmic components are engulfed by membrane vesicles and degraded. It is thought to be used to recycle amino acids and other components. Anterior–posterior axis The line between the head and tail of an organism. Apical–basal polarity In epithelial cells, which separate the interior of an organism from the exterior or the gut, the term apical–basal polarity refers to the unequal distribution of proteins and other materials between the apical side (facing the exterior or the gut) and the basal side (facing the interior). activation, although, similar to the phosphorylation of Ser15/18 on p53, it is not yet clear whether this is a direct phosphorylation. However, phosphorylation of p27 appears to stabilize the protein, which contributes to cell-cycle arrest81. Another mechanism by which AMPK may cause cell-cycle arrest is by preventing nuclear export of the RNA-binding protein human antigen R (HuR). This reduces the binding of HuR to AU‑rich elements, which is required to stabilize mRNAs that encode vital cell-cycle regulators such as cyclins A and B1 (Ref. 82). Both the p53 and the HuR pathways appear to be involved in the ability of AMPK to promote senescence in fibro blasts, which is associated with an elevated cellular AMP:ATP ratio80,83. As well as causing cell-cycle arrest, AMPK activation also inhibits cell growth. It can achieve this, in part, by its classical effects that inhibit lipid synthesis, but also by switching off protein synthesis by two pathways (FIG. 2). These are the activation of elongation factor‑2 kinase, which causes inhibition of the elongation step of translation84, and inhibition of the target-of-rapamycin (TOR) pathway, which stimulates the initiation step of protein synthesis by phosphorylation of multiple targets85. TOR is activated by an upstream pathway involving the TSC1–TSC2 (tuberous sclerosis complex) heterodimer and the small Ras-related G protein Rheb (Ras homologue enriched in brain). The TSC2 subunit has a GTPase-activating protein (GAP) domain that inhibits the ability of Rheb to activate TOR. AMPK phosphorylates the TSC1–TSC2 complex and appears to enhance its ability to switch off TOR86. By contrast, AKT/PKB phosphorylates TSC1–TSC2 at different nature reviews | molecular cell biology sites in response to activation of the insulin/insulin-like growth factor‑1 (IGF1) signalling pathway, and inhibits its ability to switch off Rheb87. Therefore, insulin and IGF1, which signify the availability of nutrients, and AMPK, which signifies a lack of energy or nutrients, have opposing effects on cell growth (FIG. 6). Inhibition of the TOR pathway using rapamycin (the antibiotic that led to the initial discovery of the pathway) also stimulates autophagy. Therefore, it is not surprising that autophagy is stimulated by activation of the SNF1 complex in S. cerevisiae88 and by AMPK in mamma lian cells89. Phosphorylation of p27 may be involved in this effect81. Establishment and maintenance of cell polarity. An unexpected role for AMPK that has recently emerged is in the regulation of cell polarity, especially in epithelial cells. In D. melanogaster, mutations in the gene encoding the upstream kinase LKB1 are embryonic lethal. LKB1 is required for polarization of the oocyte cytoskeleton that defines the embryonic anterior–posterior axis, as well as for apical–basal polarity in epithelial cells90. Consistent with this finding, activation of LKB1 in mammalian intestinal epithelial cell lines by inducing expression of its accessory subunit, STRAD, results in cell polari zation, with reorganization of the actin cytoskeleton and the formation of tight junctions and brush border membranes91. Because some of the other protein kinases downstream of LKB1 were known to have roles in the establishment of cell polarity (especially MARKs, the mammalian homologues of C. elegans PAR‑1), it had been assumed that the effects of LKB1 on cell polarity were probably not mediated by AMPK. However, this volume 8 | october 2007 | 781 © 2007 Nature Publishing Group REVIEWS Insulin IRS1 PtdIns(4,5)P2 Pi PI3K PTEN PtdIns(3,4,5)P3 PDK1 Rheb–GDP PKB/AKT TSC2 TSC1 ATP AMP Stress AMPK Pi TOR Protein synthesis, cell growth Rheb–GTP LKB1 Figure 6 | The opposing effects of insulin and AMPK activation on the target-of-rapamycin (TOR) pathway. Insulin Nature Reviews | Molecular Cell Biology activates phosphatidylinositol 3‑kinase (PI3K) by phosphorylation of insulin receptor substrate‑1 (IRS1) by the insulin receptor. PI3K catalyses the conversion of phosphatidylinositol‑4,5-bisphosphate (PtdIns(4,5)P2) to phosphatidylinositol‑ 3,4,5-trisphosphate (PtdIns(3,4,5)P3), an effect that is reversed by PTEN (phosphatase and tensin homologue deleted on chromosome ten). PtdIns(3,4,5)P3 triggers the phosphorylation of protein kinase B (PKB/AKT) by its upstream kinase phosphoinositide-dependent kinase‑1 (PDK1). Activated PKB then phosphorylates tuberous sclerosis‑2 (TSC2), which inhibits its Ras homologue enriched in brain (Rheb)-GTPase activating protein (GAP) activity and promotes the activation of TOR by Rheb–GTP. TOR, in turn, promotes protein synthesis and cell growth. Conversely, AMP-activated protein kinase (AMPK) is activated by metabolic stresses that increase the AMP:ATP ratio, causing binding of AMP to AMPK, promoting net phosphorylation of Thr172 by the protein kinase LKB1 (this effect involves inhibition of dephosphorylation, see main text). AMPK phosphorylates TSC2 at different sites from PKB, stimulating the Rheb-GAP activity of the TSC1–TSC2 complex and inhibiting activation of TOR. Proteins shown in blue are tumour suppressors, for which loss-of-function mutations cause TOR activation. view may have to be modified. Intriguingly, activation of AMPK appears to be required for repolarization of Madin–Darby canine kidney cells in response to changes of extracellular calcium92,93. Activation of AMPK in an intestinal epithelial cell line by depletion of ATP with deoxyglucose also induces polarization94. Because the maintenance of cell polarity requires energy, it may seem counter-intuitive that a protein kinase that is switched on during negative energy balance should promote it. However, the maintenance of the perme ability barrier provided by epithelia is clearly crucial, and this may be one case where the AMPK system is diverting what limited energy is available to a critical survival function. AMPK orthologues in other eukaryotes Although studies of mammalian cells and budding yeast have provided the most detailed insights into the AMPK/SNF1 systems, it is worth briefly considering some interesting findings that have been made in other eukaryotic systems. Dauer larval form An alternative developmental stage in worms, which is activated under stressful conditions. Dauer larvae are sterile and are adapted for long-term survival. Green plants. Genes encoding α-, β- and γ-subunit isoforms of AMPK are found in all plant genomes, although there are also intriguing gene products in which the carbohydrate-binding domains (which, pre sumably, bind starch in plants) appear to have switched from the β- to the γ-subunits95 (FIG. 3, bottom). When the two catalytic subunit genes were knocked out in a primitive green plant, the moss Physcomitrella patens, the plants survived if maintained in 24 hour light, but died if subjected to a normal alternate light/dark cycle96. Darkness is, of course, the equivalent of starvation for a photosynthetic organism, and these results indicate that the primary role of the plant kinases is the response to starvation of a carbon source, as in yeast. 782 | october 2007 | volume 8 Caenorhabditis elegans. C. elegans has two genes (AMP-activated kinases (aak)‑1 and ‑2) that encode homologues of the AMPK/SNF1 catalytic subunit, and AMPK complexes from this organism are activated by AMP97. Application of a sublethal stress during early life, such as high temperature, starvation or treatment with mitochondrial inhibitors, can extend subsequent lifespan. Intriguingly, aak‑2 mutants have a 12% shorter lifespan than the wild-type but, more dramatically, the effects of heat stress to increase lifespan are abolished, and its effects to decrease fertility are also reduced. The aak‑2 mutants also do not display the extension of lifespan that is induced by reduced function mutations in the insulin-like receptor DAF‑2, which signals the availability of nutrients97. Thus, AAK‑2 appears to be required for the sensing of starvation and other stresses in early life, which leads to subsequent extension of lifespan. More recently, the aak‑1/‑2 and the par‑4 genes (the latter encoding LKB1) have been shown to be required for the extended cell-cycle arrest of germ cells98 — char acteristic of the long-lived but sterile dauer larval form — which is induced by environmental stress. These results are compatible with the ‘disposable soma’ theory of ageing, which proposes that lifespan in multicel lular organisms is a compromise between the energy expenditure required to maintain integrity of somatic cells and the necessity to live long enough to reproduce. An extension of this is the proposal that AMPK delays ageing in response to stresses during early life, in order to allow reproduction at a later date when conditions improve. These findings raise the possibility that AMPK is involved in the extension of lifespan induced by caloric restriction in mammals and, consistent with this, the AMPK activator resveratrol increases lifespan in mice that are fed a high-fat diet13. www.nature.com/reviews/molcellbio © 2007 Nature Publishing Group REVIEWS Drosophila melanogaster. The D. melanogaster genome encodes single isoforms of the α-, β- and γ-subunits of AMPK. D. melanogaster AMPK is activated by AMP, and all three subunits are essential for activity99. In cul tured cells, the α-subunit is phosphorylated at Thr184 (equivalent to Thr172 in the mammalian α-subunit) and, consequently, is activated in response to inhibi tors of ATP synthesis99. Recently, the catalytic subunits of AMPK have been knocked out in D. melanogaster in vivo. As already discussed above, mutations in LKB1 caused defects in cell polarity in the early embryo92 and the phenotype of the AMPK null mutant was essen tially identical94. In the same study, it was reported that AMPK phosphorylates the regulatory light chain of myosin (MRLC) at Ser22, which is known to trig ger movement of the myosin motor protein on actin fibres. Intriguingly, the defects in embryonic cell polarity of LKB1 and AMPK mutations were rescued by expression of a phosphomimetic mutant (T21E/ S22E) of MRLC 94. This is remarkable given that it is likely that AMPK has tens, if not hundreds, of dif ferent targets in D. melanogaster. It seems likely that the phosphorylation of MRLC will also have a role in the polarization of mammalian epithelial cells, as already discussed above. Conclusions and remaining questions For a unicellular eukaryote such as S. cerevisiae, it can be argued that the most important factor regulating cell growth and proliferation is the availability of its favoured carbon source, glucose. 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Competing interests statement The author declares no competing financial interests. DATABASES Entrez Gene: http://www.ncbi.nlm.nih.gov/entrez/query. fcgi?db=gene PRKAA1 | PRKAA2 | PRKAB1 | PRKAB2 | PRKAG1 | PRKAG2 | PRKAG3 | SNF1 OMIM: http://www.ncbi.nlm.nih.gov/entrez/query. fcgi?db=OMIM Peutz–Jeghers syndrome | type 2 diabetes | Wolff–Parkinson–White syndrome Protein Data Bank: http://www.pdb.org/pdb/home/home.do 2FH9 | 2H6D | 2OOX UniProtKB: http://ca.expasy.org/sprot LKB1 FURTHER INFORMATION D. Grahame Hardie’s homepage: http://www.lifesci.dundee.ac.uk/people/grahame_hardie All links are active in the online pdf. volume 8 | october 2007 | 785 © 2007 Nature Publishing Group