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Cisd2 deficiency drives premature aging and causes

mitochondria-mediated defects in mice
Yi-Fan Chen, Cheng-Heng Kao, Ya-Ting Chen, et al.

Genes Dev. 2009 23: 1183-1194

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Cisd2 deficiency drives premature aging

and causes mitochondria-mediated defects
in mice
Yi-Fan Chen,1 Cheng-Heng Kao,2 Ya-Ting Chen,1,3 Chih-Hao Wang,4 Chia-Yu Wu,1 Ching-Yen Tsai,1
Fu-Chin Liu,5 Chu-Wen Yang,6 Yau-Huei Wei,4 Ming-Ta Hsu,4 Shih-Feng Tsai,1,3 and Ting-Fen Tsai1,3,7
1
Department of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei 112, Taiwan; 2Center of
General Education, Chang Gung University, Taoyuan 333, Taiwan; 3Division of Molecular and Genomic Medicine, National
Health Research Institutes, Zhunan, Miaoli County 350, Taiwan; 4Institute of Biochemistry and Molecular Biology, National
Yang-Ming University, Taipei 112, Taiwan; 5Institute of Neuroscience, National Yang-Ming University, Taipei 112, Taiwan;
6
Department of Microbiology, Soochow University, Taipei 111, Taiwan;

CISD2, the causative gene for Wolfram syndrome 2 (WFS2), is a previously uncharacterized novel gene.
Significantly, the CISD2 gene is located on human chromosome 4q, where a genetic component for longevity
maps. Here we show for the first time that CISD2 is involved in mammalian life-span control. Cisd2 deficiency in
mice causes mitochondrial breakdown and dysfunction accompanied by autophagic cell death, and these events
precede the two earliest manifestations of nerve and muscle degeneration; together, they lead to a panel of
phenotypic features suggestive of premature aging. Our study also reveals that Cisd2 is primarily localized in the
mitochondria and that mitochondrial degeneration appears to have a direct phenotypic consequence that triggers
the accelerated aging process in Cisd2 knockout mice; furthermore, mitochondrial degeneration exacerbates with
age, and the autophagy increases in parallel to the development of the premature aging phenotype. Additionally,
our Cisd2 knockout mouse work provides strong evidence supporting an earlier clinical hypothesis that WFS is in
part a mitochondria-mediated disorder; specifically, we propose that mutation of CISD2 causes the mitochondria-
mediated disorder WFS2 in humans. Thus, this mutant mouse provides an animal model for mechanistic
investigation of Cisd2 protein function and help with a pathophysiological understanding of WFS2.
[Keywords: Cisd2; Wolfram syndrome 2; autophagy; knockout mice; mitochondria; premature aging]
Supplemental material is available at http://www.genesdev.org.
Received January 8, 2009; revised version accepted March 31, 2009.

CISD2 is the second member of the gene family contain- markers for early neuronal differentiation in a cell culture
ing the CDGSH iron sulfur domain. There are currently study (Boucquey et al. 2006).
three members in this gene family: CISD1 (synonyms Recently, the CISD2 gene has been identified as the
ZCD1, mitoNEET), CISD2 (synonyms ZCD2, Noxp70, second causative gene (Amr et al. 2007) associated with
and Miner1) and CISD3 (synonym Miner2). CISD1 is an Wolfram syndrome (WFS; MIM 222300), which is an
outer mitochondrial membrane protein that was origi- autosomal recessive neurodegenerative disorder. WFS is
nally identified as a target protein of the insulin sensitizer highly variable in its clinical manifestations, which in-
drug pioglitazone used to treat type 2 diabetes (Colca clude diabetes insipidus, diabetes mellitus, optic atrophy,
et al. 2004). CISD1 protein contains a transmembrane and deafness; thus, it is also known as the ‘‘DIDMOAD
domain, a CDGSH domain, and a conserved amino acid syndrome’’ (Barrett and Bundey 1997). Positional cloning
sequence for iron binding; biochemical experiments sug- and mutation studies have revealed that WFS is a genet-
gest that CISD1 is involved in the control of respiratory ically heterogeneous disease with a complex molecular
rates and regulates oxidative capacity (Wiley et al. 2007). basis involving more than one causative gene in humans
However, CISD2 and CISD3 are novel genes with pre- (Domenech et al. 2006). A portion of WFS patients
viously uncharacterized functions. The only molecular belonging to the WFS1 group (MIM 606201) carried loss-
documentation for CISD2 is that CISD2 was one of the of-function mutations in the WFS1 (wolframin) gene,
which encodes a transmembrane protein primarily local-
ized in the endoplasmic reticulum (ER) (Inoue et al. 1998;
7
Strom et al.1998; Takeda et al. 2001). In addition to this,
Corresponding author.
E-MAIL [email protected]; FAX 886-2-2828-0872. a homozygous mutation of the CISD2 gene has been
Article is online at http://www.genesdev.org/cgi/doi/10.1101/gad.1779509. identified in three consanguineous families with WFS

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Chen et al.

(Amr et al. 2007), and these patients have been classified protruding ears (Fig. 1C). Ocular abnormalities were ob-
as WFS2 (MIM 604928). However, the function of the served as the Cisd2 / mice developed opaque eyes and
CISD2 protein in these patients and in all other organ- blindness, which was accompanied by cornea damage at
isms remains unknown, and its physiological role has not 20 wk old (Fig. 1D). Histopathological examination re-
been explored. vealed that the opacity of the cornea was due to debris
Significantly, the CISD2 gene is located within the deposition in the scar tissue outside the cornea (Fig. 1E).
region on human chromosome 4q where a genetic com- In addition, corneal neovascularization was observed in
ponent for human longevity has been mapped. Previ- the Cisd2 / mice; this can impair vision and is usually
ously, Puca et al. (2001) studied 137 sets of extremely old associated with pathogenesis due to eye trauma or the
siblings (308 individuals in all) and conducted a genome- presence of a degenerative disorder (Supplemental Fig. 5).
wide scan search for predisposing loci that might confer There was also early depigmentation in the fur at ~48 wk
longevity; this linkage study revealed a single region on old (Fig. 1F; Supplemental Fig. 6); furthermore, hair fol-
chromosome 4q and suggests that there may be at least licle atrophy and a decreased hair density could be de-
one master gene contributing to life-span control; how- tected in Cisd2 / mice (Fig. 1G,H). A decrease in the hair
ever, the responsible gene has not been identified. regrowth rate was also observed in the Cisd2 / mice
In this study, we apply a mouse genetics approach (Supplemental Fig. 7A,B). Additionally, the skin of 48-
and demonstrate that Cisd2 is involved in mammalian wk-old Cisd2 / mice exhibits a phenotype with a no-
life-span control and plays an essential role in mitochon- ticeably thickened dermis, an expanded surface, and
drial integrity. Cisd2 deficiency causes mitochondria- a significant decrease in subcutaneous adipose tissue
mediated phenotypic defects in mice. Furthermore, cell and muscle (Fig. 1I–K).
culture and biochemical investigations revealed that Microcomputer tomography (micro-CT) imaging
Cisd2 is a mitochondrial protein. Additionally, Cisd2 showed that the trabeculae of the femur are noticeably
knockout mice exhibit many clinical manifestations of thinner in Cisd2 / mice (Fig. 2A). Dual energy X-ray
WFS patients including early-onset degeneration of cen- absorpitometer (DEXA) detected a decrease in femur
tral (e.g., optic) and peripheral (e.g., sciatic) nerves and pre- density after 8 wk old; interestingly, the decrease of
mature death, as well as impaired glucose tolerance. This femur density also started to emerge in heterozygous
study therefore provides an animal model for mechanistic Cisd2+/ mice, but at 24 wk old, while a progressively
understanding of WFS, specifically WFS2, pathogenesis. more severe phenotype was observed at the same age
with Cisd2 / mice (Fig. 2B). This shows, in addition to
Results what was observed in terms of life-span evaluation, that
there is also an apparent Cisd2 haploinsufficiency with
/
Shortened life span in Cisd2 mice respect to femur density. The results from the gross
anatomy viewpoint, from the X-ray radiography, and
CISD2 is an evolutionarily conserved gene localized on
using micro-CT reveal a significant lordokyphosis phe-
human chromosome 4q24 (Supplemental Table 1; Sup-
notype after 12 wk old (Fig. 2C,D; Supplemental Fig.
plemental Figs. 1, 2); the mouse syntenic region is on
7C,D); consequently, this seems to lead to a decrease in
chromosome 3G3. Northern blot analysis showed that
mean thoracic volume (Fig. 2E) and thence pulmonary
Cisd2 is a widely expressed gene in mice. Interestingly,
function abnormalities. Indeed, we observed decreases in
quantitative real-time RT–PCR revealed that expression
various respiratory parameters as measured by plethys-
levels of Cisd2 decrease in an age-dependent manner in
mography after 20 wk old in the Cisd2 / mice (Supple-
naturally aged mice (Supplemental Fig. 3). To study the
mental Fig. 8). Muscle degeneration was detectable at 3
role of Cisd2 involvement in development and patho-
wk old in the Cisd2 / mice. There was a progres-
physiology, we generated Cisd2 knockout mice. Southern
sive degeneration of muscle fibers and the magnitude of
and Northern blot analyses demonstrated that the Cisd2
the degeneration exacerbated with age (Fig. 2F–J); mus-
gene was disrupted and that there was undetectable mRNA
cle degeneration was further confirmed by transmis-
expression in the homozygous knockout (Cisd2 / ) mice
sion electron microscopy (TEM) (Supplemental Fig. 9).
(Supplemental Fig. 4). Growth retardation and a smaller
In addition, angular fibers, which are an indicator of
somatotype are clearly evident; it appears that there is
muscle atrophy caused by neuron degeneration, could
almost no growth after 5 wk old in the Cisd2 / mice (Fig.
be observed in the Cisd2 / mice (Fig. 2H).
1A). Early senescence is accompanied by a shortened life
One possible mechanism for the accelerated aging
span when survival of the various genotypes is examined
phenotypes is a defect in cellular proliferation in the
and there appears to be signs of haploinsufficiency for
Cisd2 / mice. To test this possibility, we created several
Cisd2 in view of the slightly lower survival rate for the
primary mouse embryonic fibroblast (MEF) cell lines
heterozygous (Cisd2+/–) mice (Fig. 1B).
from individual embryos with different genotypes. Our
results revealed no significant difference in the doubling
Premature aging phenotype
time and MEF cell growth (Supplemental Fig. 10), sug-
Starting at 8 wk old, Cisd2 / mice begin to acquire a set gesting that accelerated aging in the Cisd2 / mice is not
of aged appearance phenomena remarkably similar to due to an intrinsic defect in cellular proliferation.
those of premature aging syndrome (Hasty et al. 2003; A summary of the aging-related phenotypes in Cisd2 /
Kipling et al. 2004). These include prominent eyes and mice is provided in Supplemental Table 2. These mutant

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Cisd2 deficiency drives premature aging

Figure 1. The decreased body weight, the shortened life

span, and the ocular and cutaneous symptoms of aging in
Cisd2 / mice. (A) Growth curves of the different
genotypes. (B) Decreased survival rate of the Cisd2 /
mice. (C) The prominent eyes and protruding ears of the
Cisd2 / mice. (D) The Cisd2 / mice go blind at ~6 mo
old. (E) The opacity of cornea was analyzed by histolog-
ical examination. Masson’s trichrome staining indicated
debris deposition in the scar tissue outside the cornea. (F)
Early depigmentation and gray hair are present on top of
the head and on the shoulders. The representative photo
was taken from a 12-mo-old Cisd2 / female. (G) Hair
follicle atrophy in the Cisd2 / mice was demonstrated
by Masson’s trichrome staining. (H) A decreased density
of hair follicles containing hair in the Cisd2 / mice was
detected compared with wild-type skin. (I,J) Histological
analyses of the skin from 12-mo-old wild-type and
Cisd2 / mice, respectively. The Cisd2 / skin exhibits
a phenotype involving a hyperplastic epidermis, hair
follicle atrophy, a decrease in subcutaneous fat and
muscle, and an increased thickness of the dermis layer.
(K) Quantification of the subcutaneous muscle tissue,
adipose tissue, and dermis for the histological sections of
the wild-type and Cisd2 / skins. (*) P < 0.05 was
considered statistically significant.

mice exhibit a premature aging phenotype with 100% lesions, are already present to a certain extent in 2-wk-old
penetrance for both sexes using either a C57BL/6 (B6) or Cisd2 / mice (Fig. 3J–L; Supplemental Fig. 11), a stage
a 129Sv/B6 mixed background. prior to the first premature aging phenotype of muscle
and nerve degeneration in these mice. Interestingly,
the damaged mitochondria appear to induce autophagy
Mitochondrial degeneration and autophagy
to eliminate the dysfunctional organelles (Kim et al.
The observation of premature aging phenotypes involving 2007) because we identified morphologically distinct
muscle degeneration prompted a detailed examination of autophagic vacuoles (Eskelinen 2008) in muscle, sciatic
the tissue ultrastructure of the homozygous knockout nerve, optic nerve, and brain tissue (Fig. 3J–L; Supple-
mice. A TEM study revealed that mitochondrial degen- mental Fig. 12). The general term autophagic vacuole
eration occurs in the axons of sciatic nerves, brain cells refers to an autophagosome, amphisome, or autolyso-
(Fig. 3A–C), cardiac muscle cells, and skeletal muscle some. Morphologically, autophagic vacuoles can be clas-
cells (Fig. 3D–F) in the Cisd2 / mice. Notably, the sified into two categories: (1) early or initial autophagic
mitochondrial outer membrane (OM) appeared to have vacuoles (AVis)—i.e., autophagosomes, which are double-
broken down prior to the destruction of the inner cristae membraned structures containing undigested cytoplasmic
(Fig. 3B,E). In wild-type mice, the myelinated axons are material or organelles; (2) late or degradative autophagic
enveloped with a myelin sheath formed by the fusion of vacuoles (AVds), including amphisomes and autolyso-
many layers of plasma membrane from Schwann cells somes, which contain partially degraded cytoplasmic
(Fig. 3G). However, considerable disintegration of the material (Eskelinen 2008; Fader and Colombo 2009).
myelin sheath and degeneration of axon was detected in Remarkably, mitochondrial degeneration exacerbates
the Cisd2 / sciatic nerves (Fig. 3H,I). Importantly, these with age, and the magnitude of the autophagy increases
mitochondrial abnormalities, involving destruction of in parallel to the development of premature aging pheno-
mitochondria, myelin sheath disintegration, and axonal type (Fig. 3M,N). We measured the thickness of myelin

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Chen et al.

sheaths and counted the numbers of myelinated axons in

sciatic nerve; our results revealed no significant differ-
ences between different genotypes (Supplemental Fig. 13),
indicating that these two factors are not involved in the
nerve degeneration of Cisd2 / mice. We also examined
the autophagosome marker LC3-II (Kabeya et al. 2000) in
skeletal and cardiac muscles, which are the most sensi-
tive tissues to in vivo autophagic degradation (Mizushima
et al. 2004); indeed, the ratio of LC3-II/LC3-I was signif-
icantly higher in Cisd2 / mice than in their wild-type
littermates. This biochemical evidence confirms the
TEM results and provides a quantitative basis for the
autophagy induction (Fig. 3O,P).
Autophagy can lead to cell death by directly activating
autophagic (type II programmed) cell death that produces
self-degradation of the dying cells (Shimizu et al. 2004;
Mizushima et al. 2008); alternatively, autophagy might
cause cell death through activation of apoptosis (Scott
et al. 2007). To determine whether there is an increased
level of apoptosis in the Cisd2 / mice, we performed
TUNEL assays on various mouse tissues to detect apo-
ptotic cells in situ and found no evidence of increased
apoptosis in Cisd2 / mice (Supplemental Fig. 14). In
addition, it has been reported that starvation can induce
muscle autophagy (Mizushima et al. 2004). To test this
possibility, we measured the metabolic indices including
intake of food and water and generation of urine and stool.
Our results revealed no significant difference in these
metabolic indices between Cisd2 / and wild-type mice
at 6 wk old (Supplemental Fig. 15A); this is 4 wk after the
detection of autophagic activation at 2 wk old. This
excludes starvation/malnutrition as the cause of auto-
phagic induction in Cisd2 / mice. A decrease in the
metabolic index becomes evident after 12 wk old (Sup-
plemental Fig. 15B), and this is likely to be a consequence
of the aging phenotype.

Cisd2 is probably a mitochondrial OM protein

Figure 2. Abnormalities of skeleton and muscle and decrease of The annotated characteristics of Cisd2 protein are very
thoracic volume in the Cisd2 / mice. (A) Micro-CT imaging of similar to Cisd1, which is an outer mitochondrial mem-
the femur trabecula at 12 wk old. Thinner trabecular thickness was brane protein (Supplemental Fig. 16A; Wiley et al. 2007).
observed in the Cisd2 / mouse. (B) Osteopenia was analyzed by To address the subcellular localization, we expressed the
DEXA. A decrease in femur density was detected with the 8-wk-old
EGFP-tagged Cisd2 protein in NIH3T3 cells. Our result
Cisd2 / mice. At 24 wk old, a decrease in femur density also was
indicated that Cisd2 was colocalized with the mitochon-
detected with the Cisd2+/ mice and, at 24 wk old, the phenotype
had become more severe in the Cisd2 / mice. (C) Radiographs of a drial marker (Supplemental Fig. 16B). However, deletion
wild-type mouse and a Cisd2 / mouse at 16 wk old. The Cisd2 / of the N-terminal 58 amino acids completely abolished
mouse displays a lordokyphosis (curvature of the spinal column) the mitochondrial localization; furthermore, when the
phenotype. (D) Micro-CT scanning allowed three-dimensional N-terminal 58 amino acids were fused to EGFP, this
reconstruction of the thoracic and spinal column. (E) Lordokypho- construct was able to redirect EGFP from a nuclear and
sis was evident and had led to a decrease in thoracic volume in the cytoplasmic localization to the mitochondria (Fig. 4A),
Cisd2 / mice compared with their wild-type littermates. (F,G) suggesting that Cisd2 is a nucleus-encoded mitochondrial
H&E staining of transverse sections of skeletal muscle of 4-wk-old protein and its N-terminal 58 amino acids are both
and 28-mo-old wild-type mice. (H,I) Muscle degeneration of 4-wk-
necessary and sufficient to direct mitochondrial localiza-
old and 8-wk-old Cisd2 / mice was examined by H&E staining of
tion. To confirm the subcellular localization of the Cisd2
transverse sections of the skeletal muscle. Black arrows indicate
degenerated transverse fibers that are present in the Cisd2 / and protein, the cytosolic and mitochondrial fractions were
also in spontaneously aged mice. The blue arrow indicates an prepared from skeletal muscle of wild-type mice. Anti-
angular fiber, which is an indicator of muscle atrophy caused by bodies against Cisd1 and Cisd2 were generated. Western
neuron degeneration. (J) Quantification of the degenerating fibers blot analysis revealed that Cisd2 protein, like the mito-
in the skeletal muscles. (*) P < 0.05; (**) P < 0.005. chondrial proteins Cisd1 and Hsp60 (Samali et al. 1999;

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Cisd2 deficiency drives premature aging

Figure 3. Mitochondrial degeneration and autophagy

induction in the muscles and neurons of the Cisd2 /
mice. (A) Wild-type mitochondria in the brain (hippo-
campus). (B) A Cisd2 / mitochondrion in the brain
(hippocampus). Note that the outer mitochondrial mem-
brane has broken down (arrowhead), while the inner
cristae appear to be intact. (C) Cisd2 / mitochondria
in sciatic nerve. One mitochondrion (arrowhead) has
a destroyed OM, but with cristae still visible; the other
mitochondrion (arrow) has destroyed OMs and IMs. (D)
Wild-type mitochondria in cardiac muscle. (E) Cisd2 /
mitochondria in cardiac muscle. This micrograph shows
one mitochondrion (arrowhead) with a destroyed OM
and two degenerated mitochondria consisting of debris
(arrows). (F) A cluster of autophagic vacuoles and abnor-
mal mitochondria was observed between the myofibrils
of Cisd2 / skeletal muscle (white arrows). (G) A wild-
type myelinated axon of the sciatic nerve. (N) Nucleus of
Schwann cell; (MS) myelin sheath. (H) A myelinated
axon of sciatic nerve from a Cisd2 / mouse. An ovoid
with a disintegrating myelin sheath and a degenerating
axonal component are shown. (I) Debris from an axon
undergoing degeneration in the Cisd2 / sciatic nerve.
(J–L) Early or AVis enclosing mitochondria (arrows) and
late or AVds were detected in the axonal component and
cytoplasm of a Schwann cell from a 2-wk-old Cisd2 /
sciatic nerve. (M,N) Percentage of myelinated axons
present in the sciatic nerves showing disintegration of
their myelin sheaths and autophagic vacuoles, including
AVi and AVd, in their axonal component. There were
three mice for each group. (O) Western blotting to
detected the presence of the proteins LC3-I and LC3-II.
(P) Ratios of the LC3-II to LC3-I. There were three mice
for each group. (*) P < 0.05; (**) P < 0.005. Mouse age in
A–I is 4 wk old.

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Figure 4. Cisd2 is primarily localized in the

outer mitochondrial membrane, and Cisd2 de-
ficiency leads to mitochondrial dysfunction. (A)
EGFP-tagged Cisd2 protein is directed to the
mitochondria by an N-terminal signal sequence.
The EGFP-Cisd2 proteins were expressed in
NIH3T3 cells. EGFP-tagged full-length Cisd2 pro-
tein was colocalized with MitoTracker Red,
whereas deletion of the N-terminal 58 amino
acids completely abolished mitochondria locali-
zation. When the N-terminal 58-amino-acid se-
quence was fused to EGFP, this construct was
able to redirect EGFP from a nuclear and cyto-
plasmic localization to the mitochondria. (B) Sub-
cellular localization of the Cisd2 and Cisd1
proteins analyzed by Western blotting using pro-
tein extracts of the mitochondrial (Mito) and
cytosolic (Cyto) fractions prepared from skeletal
muscles of 12-wk-old mice. Polyclonal antibody
(Ab) against Cisd2 protein (15 kDa) was gener-
ated; this antibody cross-reacts with Cisd1 pro-
tein (12 kDa). Antibodies against mitochondrial
proteins Cisd1 and Hsp60 were used as controls.
(C) Ten micrograms of each submitochondrial
fraction prepared from the livers of 4-wk-old mice
were analyzed by Western blot using antibodies
against Cisd2 and known mitochondrial marker
proteins. OM marker: (VDAC-1) voltage-depen-
dent anion channel-1; IM marker: (ATP5B) com-
plex V b subunit; matrix marker: (PDH) pyruvate
dehydrogenase. (MP) Microplast (IM and matrix);
(IMS) intermembrane space. (D) Impaired mito-
chondrial respiration in the skeletal muscle of
4-wk-old Cisd2 / mice. Representative oxy-
graphs of the mitochondria after adding first
glutamate-malate and then ADP into the closed
chamber of the oxygen meter. (E) Respiratory
activity was expressed as oxygen consumption
rate (nanomoles of O2 per minute per milligram
of mitochondria) in the resting state, for gluta-
mate-malate supported respiration, and for ADP
activated respiration. A significant decrease in ox-
ygen consumption was detected in the Cisd2 /
mitochondrial samples (n = 4) compared with wild-type samples (n = 3). (F) The RCR (O2 consumption rate after ADP addition/O2
consumption rate after glutamate-malate addition) was significantly lower in the Cisd2 / mitochondria. (G) Comparison of electron
transport activities of the respiratory enzyme complexes of mitochondria prepared from the skeletal muscles of 4-wk-old Cisd2 / (n =
4) and wild-type mice (n = 4). (NCCR activity) Measurement of NCCR activity, which represents complexes I–III; (SCCR activity)
measurement of SCCR activity, which represents complexes II and III; (CCO activity) cCCO activity, which represents complex IV.
(*) P < 0.05; (**) P < 0.005.

Colca et al. 2004; Wiley et al. 2007), is primarily localized calnexin in the transfected mouse P19 and human
in the mitochondrial fraction (Fig. 4B). To further define HEK293 cells. We sought to determine if there is a small
the submitochondrial localization of Cisd2, we separated portion of the Cisd2 protein sorted into the ER/sarcoplas-
mouse liver mitochondria into the following fractions: mic reticulum (SR) using subcellular fractions prepared
OM, mitoplasts (MP, inner membrane [IM] and matrix), from skeletal muscles of wild-type mice. Our data indeed
and intermembrane space (IMS, soluble material between revealed a weak signal indicating the presence of Cisd2
the IM and OM). Immunoblotting each fraction with protein in the post-mitochondrial supernatant, and this
antibodies against Cisd2 and known markers revealed colocalized with the ER markers in the microsomal
that Cisd2 was highly enriched in the OM fraction, as was fractions. The ratio of the Cisd2 protein present in the
the OM marker VDAC-1; this result strongly suggests mitochondria versus ER was estimated to be about 5.8:1
that Cisd2 is a mitochondrial OM protein (Fig. 4C). (Supplemental Fig. 17).
Previously, Amr et al. (2007) reported that the Flag- Mitochondria are the cellular energy factories that gen-
tagged CISD2 protein colocalized with the ER marker erate ATP via oxidative phosphorylation. To investigate

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Cisd2 deficiency drives premature aging

whether the mitochondrial degeneration detected in this

study has a direct functional consequence leading to
a respiratory dysfunction, we assessed mitochondrial
aerobic respiration using isolated mitochondria prepared
from skeletal muscle. This was done by measuring the
oxygen consumption after stimulating the mitochondria
with glutamate-malate and ADP to activate the respira-
tory chain reactions. Our results revealed a significant
decrease in the oxygen consumption and the respiratory
control ratio (RCR) in the Cisd2 / mitochondria (Fig.
4D–F). To further expand this investigation, we explored
the iron-sulfur proteins, which are essential electron
carriers in the mitochondrial respiratory chain; there
are up to 12 different iron-sulfur clusters that shuttle
electrons through complex I–III (Rouault and Tong 2008).
We measured the activities of the various iron-sulfur
proteins of complex I–III (NADH cytochrome c reduc-
tase, NCCR) and complex II–III (succinate cytochrome c
reductase, SCCR). In addition, we also measured the
activity of complex IV (cytochrome c oxidase, CCO),
which contains hemes and copper centers for electron
transport (Rouault and Tong 2008). Our results showed
that there was an average 30% decrease in the electron
transport activities of complex I–III, complex II–III, and
complex IV in the Cisd2 / mitochondria compared with
wild-type mitochondria (Fig. 4G). Together with the
oxygen consumption experiment, these results reveal
a respiratory dysfunction in the Cisd2 / mitochondria.
To test whether an increased level of reactive oxygen
species (ROS), which is a by-product of mitochondrial
oxidative phosphorylation, may contribute to the pheno-
types of Cisd2 / mice, we monitored the intracellular
ROS, mainly H2O2, in MEF cells and primary cells Figure 5. Optic nerve degeneration and impaired glucose
obtained from the brains and livers of different genotypes tolerance in Cisd2 / mice. (A) A representative TEM micro-
of mice. There was no significant difference in the ROS graph showing a late or AVd detected in the axonal component
levels in these primary cells between the different geno- of a myelinated axon of the optic nerve in 24-wk-old Cisd2 /
types (Supplemental Fig. 18A). In addition, the mRNA mice. The white arrow indicates a disintegrating myelinated
axon. (B) Percentage of myelinated axons of the optic nerves
levels of the enzymes that scavenge ROS were unaffected
containing autophagic vacuoles, including AVi and AVd, in the
in brain, heart, liver, and skeletal muscle, suggesting that
axonal component. There were three mice for each group; (wk)
there was no ROS-induced stress response present in the week. (C,D) Blood glucose levels and plasma insulin levels,
Cisd2 / mice (Supplemental Fig. 18B). respectively, before (0 min) and after the glucose load at the
indicated time points. Oral glucose (1.5 g/kg body weight)
/ tolerance tests were performed on 12-wk-old Cisd2 / and
WFS and Cisd2 mice wild-type mice, all of which had a C57BL/6 genetic background.
In order to evaluate the usefulness of Cisd2 / mice as an Blood samples were collected to determine the mice’s blood
animal model for WFS2 and gain insight into the mech- glucose levels and plasma insulin levels. (E) Insulin (0.75 U/kg
anistic basis of WFS pathogenesis, we compared the body weight) tolerance tests were performed on 12-wk-old
Cisd2 / and wild-type mice. There were three mice in each
clinical manifestations of this disease and the phenotype
group, and three independent measurements were carried out on
of Cisd2 / mice. WFS is a clinically heterogeneous
each mouse. (*) P < 0.05; (**) P < 0.005. (F) IHC staining of
disease; only juvenile-onset diabetes mellitus and optic insulin in the b cells of pancreatic islets using tissue sections
atrophy are necessary criteria for WFS diagnosis. Impor- prepared from 12-wk-old Cisd2 / and wild-type mice.
tantly, Cisd2 / mice exhibit a progressive neurodegen-
erative phenotype that includes optic nerve defects (Fig.
5A,B; Supplemental Fig. 12). Regarding glucose homeo- what more sensitive to insulin (Fig. 5E). Furthermore,
stasis, we found that Cisd2 / mice display a milder immunohistochemistry (IHC) staining of the pancreatic
phenotype, namely, impaired glucose tolerance and de- islets revealed no obvious difference in insulin expression
creased insulin secretion, which was revealed by the oral within the b cells between Cisd2 / and wild-type mice
glucose tolerance test (Fig. 5C,D). In addition, insulin (Fig. 5F). Taken together, these results indicate impaired
tolerance tests did not show insulin resistance in the glucose homeostasis in the Cisd2 / mice, which seems
Cisd2 / mice; in fact, these mutant mice were some- to have an insulin secretory defect rather than insulin

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resistance. The importance of mitochondrial dysfunction in the regulation of ER stress and calcium homeostasis
in b-cell insulin secretion defects has been previously (Takeda et al. 2001; Fonseca et al. 2005; Zatyka et al.
confirmed in other mouse models, which demonstrated 2008). In animal studies, a pancreatic phenotype related
that mitochondrial ATP production is a critical part of to glucose intolerance and impaired insulin secretion, but
the b-cell signaling system and allows insulin release not the neurodegenerative phenotype, has been reported
(Wallace 2001; Torraco et al. 2009). However, there was in wolframin knockout mice. Wolframin deficiency in
no overt diabetes observed in the Cisd2 / mice with the mice leads to progressive loss of b cells and impaired
C57BL/6 congenic background. This is consistent with glucose homeostasis (Ishihara et al. 2004), which appears
a previous observation that C57BL/6 background confers to be caused by increased ER stress and apoptosis in
a more diabetes-resistant phenotype (Coleman 1992); a the pancreatic b cells (Riggs et al. 2005; Yamada et al.
similar finding of a genetic background effect also had 2006). Obviously, the pathogenesis of WFS1 patients with
been reported for WFS1 (wolframin) knockout mice wolframin mutations is mechanistically related to an ER
(Ishihara et al. 2004). In addition to optic atrophy and rather than a mitochondrial defect. This provides an ex-
glucose intolerance, the phenotypic features of Cisd2 / planation for the discrepancy as to why there were con-
mice reflect other aspects of the clinical manifestations of tradictory observations in some WFS (specifically WFS1)
WFS patients including early (juvenile) onset and pre- patients who do not have any detectable abnormality in
mature death (Supplemental Table 3). Thus, this mutant their mitochondria.
mouse may also provide an animal model for mechanistic
investigation of Cisd2 protein function and help with the
WFS2 is a mitochondria-mediated disorder
pathophysiological understanding of WFS2.
Recently, Amr et al. (2007) identified CISD2 homozygous
mutations in WFS patients and suggested that CISD2 is
Discussion the causative gene responsible for WFS2. Our Cisd2 gene
For more than a decade, physicians and researchers have knockout mouse work provides strong evidence support-
fiercely debated as to whether WFS is associated with ing the hypothesis that WFS is a mitochondria-mediated
mitochondria and a defect in ATP supply. Most WFS disorder; thus, specifically, WFS2, which is caused by
patients die prematurely with severe neurological dis- a CISD2 mutation, is a mitochondria-mediated disorder.
abilities involving the central nervous system and pe- Previous clinical studies in WFS patients suggested that
ripheral nerves (Barrett and Bundey 1997; Domenech optic atrophy probably represents a degeneration of the
et al. 2006). In 1993, Bu and Rotter proposed a dual optic nerve (Mtanda et al. 1986; Barrett et al. 1997).
genome defect model and hypothesized that mitochon- Indeed, our mouse work has revealed that progressive
drial DNA mutation and nuclear genetic defects that degeneration of the optic nerve is one of the earliest
interfere with the normal function of mitochondria can phenotypic features detected at 2–3 wk of age, which is
independently lead to WFS (Bu and Rotter 1993). This before weaning; this phenotype exacerbates with age in
hypothesis was based on the clinical observations the Cisd2 / offspring (Fig. 5; Supplemental Fig. 12).
that the affected tissues and organs in WFS patients Regarding glucose homeostasis, although the phenotype
have a high metabolic demand and most of the clinical is relatively milder and only glucose intolerance was
manifestations of WFS are consistent with an ATP supply observed in the diabetes-resistant C57BL/6 background,
defect, which is often seen in mitochondria-mediated in the future, it will be of great interest to introduce the
disorders. There were several studies supporting this Cisd2 mutant allele into C57BLKS/J (Mao et al. 2006),
hypothesis (Rötig et al. 1993; Vora and Lilleyman 1993; 129/Sv (Terauchi et al. 2003), or other diabetes-prone
Barrientos et al. 1996). Notably, Bundey et al. (1992) strains of mice, which may contain genetic modifier(s)
described a WFS patient having morphologically and that increase susceptibility to diabetes. This will allow
biochemical abnormal mitochondria in the muscle bi- the effect of the genetic background on the severity of
opsy; this finding indicated that a mitochondrial defect diabetes to be examined.
may be involved in the pathogenesis of WFS. However, Our present study reveals that Cisd2 is primarily
other clinical studies revealed no evidence supporting the localized in the mitochondria. Cisd2 deficiency causes
hypothesis of mitochondrial deficiency (Hofmann et al. mitochondrial dysfunction accompanied by autophagic
1997; Barrett et al. 2000). This controversy seems to have cell death, and these events precede neuron and muscle
been resolved by the identification of different causative degeneration; together, they lead to a panel of phenotypic
genes for WFS, and this hypothesis is supported by the features suggestive of premature aging. Since muscles and
mouse works carried out in this study. nerves have the highest energy needs and are therefore
the most dependent on mitochondrial function, this ex-
plains why neuronal lesions and muscle abnormalities
WFS1 is associated with an ER defect
are the two earliest manifestations and why they precede
Previous studies in patients had identified WFS1 (wolf- the gross premature aging phenotype. Accordingly, mito-
ramin) as the causative gene for WFS1 (Inoue et al. 1998; chondrial degeneration appears to have a direct phenotypic
Strom et al. 1998). Biochemical and cell culture inves- consequence that triggers the accelerated aging process in
tigations revealed that wolframin is a transmembrane Cisd2 / mice (Fig. 6). Our results thus provide strong
protein primarily localized in the ER and may be involved evidence for the causal involvement of mitochondrial

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Cisd2 deficiency drives premature aging

National Research Council’s Guide for the Care and Use of

Laboratory Animals. Heterozygous males were backcrossed with
B6 females for nine successive generations to introduce the
Cisd2 targeted allele onto the B6 congenic background.

Histopathology
Various mouse tissues were collected, fixed with 10% formalin
buffered with phosphate, and embedded in paraffin. Tissue
sections (3–4 mm) were subjected to hematoxylin-eosin (H&E)
and Masson’s trichome staining by standard procedures (Young
and Heath 2003).

Skeleton and bone density analyses

The bone specimens were fixed in 10% formalin buffered with
phosphate and stored in 70% ethanol. The bone density per
Figure 6. Summary of the aging-related phenotypes as a func- square centimeter was quantified from two-dimensional images
tion of age in the Cisd2 / mice. The timing of the onset of each of the bones using a DEXA apparatus (Northern Radiology). For
phenotype approximates the average age of onset for that phe- micro-CT scanning, knockout and wild-type specimens were
notype; (wk) week. The onset age for each mouse for each fixed in 10% formalin buffered with phosphate, stored in 70%
phenotype shows variation around the average onset age to ethanol, and then examined by eXplore Locus SP Preclinical
a limited degree. Specimen Micro-CT (GE Healthcare). Whole-body and femur
scans were performed in the axial plane with the specimens
mounted in a cylindrical sample holder. Three-dimensional
dysfunction in driving mammalian aging as suggested images of the skeletons were reconstructed from the micro-CT
previously by other studies in mitochondrial DNA muta- scanning slices and used for analyses of the skeletal structure and
tor mice (Trifunovic et al. 2004; Kujoth et al. 2005; morphology. Quantitative data were calculated by eXplore
Vermulst et al. 2008). There are many genetic factors MicroView version 2.0 Software Guide (GE Healthcare).
that have the potential to shorten life span (Kuro-o
et al. 1997; Hasty et al. 2003; Mounkes et al. 2003; Cutaneous and skin analyses
Niedernhofer et al. 2006). However, the human genetic
Tissue sections of the dorsal skin were stained with H&E and
factor that has been specifically identified as present on Masson’s trichome staining. The thicknesses of the dermal,
human chromosome 4q is present in the same region as adipose, and muscle layers were quantified by random measure-
Cisd2, and this is highly suggestive. Nonetheless, experi- ments of the length of individual skin samples using SPOT
ments that shorten life span might be less informative Imaging Software Advance (Diagnostic Instruments, Inc.).
than those that prolong a healthy life span (Kurosu et al.
2005; Schriner et al. 2005; Pinton et al. 2007). Accord- TEM
ingly, it will be of great interest to evaluate the life history
of transgenic mice expressing elevated levels of Cisd2 Various mouse tissues were fixed in a mixture of glutaraldehyde
protein to see whether Cisd2 is the genetic determinant (1.5%) and paraformaldehyde (1.5%) in phosphate buffer (pH 7.3).
They were post-fixed in 1% OsO4 and 1.5% potassium hexano-
on human chromosome 4 that may regulate mammalian
ferrate, then rinsed in cacodylate and 0.2 M sodium maleate
longevity and allow an unusually long life span to be buffers (pH 6.0), and block-stained with 1% uranyl acetate.
achieved. Following dehydration, the various tissues were embedded in
Epon and sectioned for TEM as described previously (Kao et al.
Materials and methods 1995).

Generation of the Cisd2 knockout mouse Western blotting and IHC staining
Mouse Cisd2 genomic DNA was obtained by screening a BAC Tissue samples were homogenized in lysis buffer (20 mM Tris at
library (Research Genetics, Inc.) derived from the C57BL/6 (B6) pH 7.4, 150 mM NaCl, 10 mM EDTA, 1% Triton X-100 with
mouse strain. A SpeI–BamHI 6.4-kb DNA fragment, which Complete protease inhibitor cocktail [(Roche]) and denatured by
contains part of intron 1, exon 2, and part of exon 3 of the Cisd2 boiling for 5 min. The extracted proteins were separated on
gene, was used as the homologous recombination arms for a 13% SDS–polyacrylamide gel (Bio-Rad) and electro-transferred
construction of an insertion-type targeting vector (Supplemental to an Amersham Hybond N+ membrane (GE Healthcare). The
Fig. 4). The Cisd2 targeting vector, containing the puromycin membranes were blocked with 5% (w/v) nonfat dry milk, in-
selection cassette, was linearized with ApaI and transfected into cubated with primary antibody, washed, and then detected using
AB2.2 ES cells using electroporation. Targeted ES cell clones a Visualizer Kit (Upstate Biotechnologies, 64-201BP). The fol-
were screened by Southern blot analysis using a 39-flanking lowing antibodies were used for Western blotting: LC3B (1:1000;
probe, specifically a 1.7-kb BamHI–EcoRI fragment from exon Cell Signaling, 2755); Gapdh (1:5000; Abcam, ab9482); Hsp60
3. Targeted ES cells were injected into B6 blastcysts. Chimeric (1:2000; Chemicon, AB3497); Hsp70 (1:2000; BD Transduction
male mice were bred with B6 females. Germline transmission Laboratories, 610608); VDAC-1 (1:1000; Calbiochem, 529532);
was obtained from their agouti progeny. The mice were bred in ATP5B (1:2000; Molecular Probe, A21351); PDH (1:1000; Santa
a specific pathogen-free facility and treated according to the Cruz Biotechnologies, sc65242). IHC staining of insulin protein

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Chen et al.

was performed using paraffin-embedded pancreas sections (3 oxygen meter at 37°C to measure the steady-state oxygen
mm). Pancreas sections were soaked in antigen retrieval buffer consumption rate of the mitochondria (Chen et al. 2008). In
containing 10 mM sodium citrate (pH 6.0) and heated in a order to further estimate the respiratory function of mitochon-
microwave oven twice for 10 min (Sunpentown, SM-1220, dria, we measured the glutamate-malate-supported respiration
650W). The sections were then incubated with primary antibody and RCR of mitochondria. First, we used a Hamilton syringe
against insulin (1:100; Abcam, ab7842 guinea pig polyclonal (Strathkelvin) to add 10 mM glutamate and 10 mM malate
antibodies) for 18–24 h at 4°C, detected by biotinylated second- (Sigma-Aldrich) into the chamber as the electron donor and
ary antibodies (1:500; Abcam, ab6907), and visualized by the recorded the glutamate–malate-supported oxygen consumption
LSAB Kit (DakoCytomation, K0690). rate. After 5 min, we injected 3 mL of 100 mM ADP to attain
a final ADP concentration of 1 mM in the assay medium. The
rate of activated respiration was recorded to measure the RCR of
Rabbit anti-mouse Cisd1 and Cisd2 polyclonal antibodies
the mitochondria.
Mouse cDNA fragments of Cisd1 (corresponding to amino acids
27–108) and Cisd2 (corresponding to amino acids 52–135) were
Respiratory enzyme complex activity
amplified by PCR and cloned into the pQE-31 (Qiagen) vector,
which contains a His tag sequence. The expression plasmids for The following activity assays were performed according to the
His-Cisd1 and His-Cisd2 were transformed into M15 bacteria, method described by Wei et al. (1998). The activities of NCCR
induced by 2 mM IPTG (isopropylthio-b-D-galactoside), and puri- (which represents complex I–III activity) and SCCR (which
fied using Nickel-resin (Novagen). These proteins were injected represents complex II–III activity) were measured by following
into rabbits to generate antisera containing polyclonal antibodies the reduction of exogenous oxidized cytochrome c. An aliquot
against the mouse Cisd1 and Cisd2, respectively. of 20~50 mg of submitochondrial particles (SMP) was preincu-
bated with the assay buffer (1.5 mM KCN, 50 mM K2HPO4 at
pH 7.4) containing b-NADH or succinate for 15 min at 37°C.
Subcellular localization
After addition of cytochrome c to the mixture, the change in the
The EGFP-tagged Cisd2 expression plasmids were transfected absorbance at 550 nm was recorded on a UV/visible spectropho-
into NIH/3T3 cells using lipofectamin 2000 (Invitrogen, 11668- tometer. CCO (which represents complex IV) activity was de-
019). Cells transiently expressing EGFP-Cisd2 fusion proteins termined by following the oxidation of exogenous reduced
were plated on gelatin-coated glass coverslips, stained with cytochrome c. An aliquot of 20~50 mg SMP was preincubated
various organelle probes including mitochondria (MitoTracker in the assay buffer (5 mM K2HPO4 at pH 7.4) for 10 min at 30°C.
Red CMXRos; Invitrogen Life Technologies), ER (anti-calnexin; After addition of ferrocytochrome c to the assay mixture, the
Sigma, C7617), and Golgi apparatus (anti-Golgi 97; Molecular change in absorbance at 550 nm was recorded on a UV/visible
Probe). The coverslips were then fixed and visualized by confocal spectrophotometer.
microscopy (Olympus FluoView FV300). Nuclei were counter-
stained with DAPI (49-6-diamidino-2-phenylindole; Sigma).
Oral glucose tolerance test and insulin tolerance test
Mice after a 10-h fast (10 p.m. to 8 a.m.) were orally adminis-
Isolation of mitochondria from skeletal muscle
trated with glucose solution (1.5 g/kg body weight) using
Fresh skeletal muscles were washed twice with PBS and homog- a feeding needle (Juan et al. 2004). Blood samples were collected
enized immediately in ice-cold SEH buffer (0.25 M sucrose, 1 from tail tips before (0 min) and after glucose load at the indicated
mM EGTA, 3 mM HEPES, protease inhibitor cocktail at pH 7.2). time points. The blood glucose levels were measured using
The mitochondrial pellet was obtained by low-speed centrifuga- glucose test strips (LifeScan; Johnson & Johnson) and SureStep
tion (800g) of the homogenate, followed by high-speed centrifu- Brand Meter. Serum insulin levels were determined by an ELISA
gation (10,000g) of the supernatant. Finally, the mitochondrial kit (Mercodia). The insulin tolerance test was performed after
pellet was resuspended in an appropriate volume of SEH buffer. a 2-h fast (9 a.m. to 11 a.m.) and involved an intraperitoneal
The isolated mitochondria were used immediately for evaluation injection of insulin (0.75 U/kg body weight; Novolin human
of mitochondrial respiration and oxidative phosphorylation. regular insulin; Novo Nordisk) (Tran et al. 2008). There were
three mice for each group and three independent measurements
for each mouse.
Mitochondrial subfractionation
Mitochondrial subfractionation was performed according to the
Statistics
method described by Pagliarini et al. (2005) with some modifi-
cations. Briefly, 0.5 mL of mitochondrial suspension (10 mg/mL) Results are presented as means 6 SD. Differences among mul-
was incubated with 10 mg of purified digitonin on ice for 30 min, tiple groups were analyzed by a one-way ANOVA (SPSS 14.0
and the mixture was gently inverted every 10 min. After high- statistical software). Comparisons between two groups were
speed centrifugation (12,000g), the mitoplast (containing the IM done using a Student’s t-test. Mouse survival rates were calcu-
and matrix) was pelleted, and the supernatant was subjected to lated by the Kaplan-Meier method, and differences in the
ultracentrifugation (150,000g) to separate the OM and IMS of the survival of different groups of mice were determined by the
mitochondria. log-rank (Mental-Cox) test. When analyzing statistical differ-
ences between the knockout and wild-type mice, P < 0.05 was
considered significant.
Measurement of oxygen consumption
The oxygen consumption rate was measured using a 782 Oxygen Acknowledgments
Meter (Strathkelvin Instruments). An aliquot of 300 mL of assay
buffer (125 mM sucrose, 65 mM KCl, 2 mM MgCl2, 20 mM We thank Dr. Lian-Fu Deng (Affiliated Ruijin Hospital of
Na+,K+-phosphate buffer at pH 7.2) containing ~0.2~0.5 mg of Shanghai Second Medical University, Shanghai Institute of
mitochondria was delivered into the closed chamber of the Traumatology and Orthopeadics); Dr. An-Guor Wang (Taipei

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Cisd2 deficiency drives premature aging

Veterans General Hospital); Dr. Ming-Ling Kuo (Chang Gung Fonseca SG, Fukuma M, Lipson KL, Nguyen LX, Allen JR, Oka
University); Dr. Chih-Cheng Chen (Academia Sinica); and Dr. Y, Urano F. 2005. WFS1 is a novel component of the unfolded
Alan M. Lin, Dr. Hen-Li Chen, Dr. Chun-Ming Chen, Dr. Chi- protein response and maintains homeostasis of the endoplas-
Chang Juan, Yi-Shin Lai, Ching-Wen Cheng, and Hui-Wen mic reticulum in pancreatic b-cells. J Biol Chem 280: 39609–
Zhuang (National Yang-Ming University) for their insight and 39615.
technical assistance. We thank the Microarray and Gene Expres- Hasty P, Campisi J, Hoeijmakers J, van Steeg H, Vijg J. 2003.
sion Analysis Core Facility of the National Yang-Ming University Aging and genome maintenance: Lessons from the mouse?
Genome Research Center. The Core Facility is supported by the Science 299: 1355–1359.
National Research Program for Genomic Medicine (NRPGM), Hofmann S, Bezold R, Jaksch M, Obermaier-Kusser B, Mertens
National Science Council. We acknowledge support from the Na- S, Kaufhold P, Rabl W, Hecker W, Gerbitz KD. 1997. Wolfram
tional Science Council (NRPGM 95HC007, NSC96-2752-B-010- (DIDMOAD) syndrome and Leber hereditary optic neuropa-
004-PAE, and NSC97-2320-B-010-015-MY3) and a grant from the thy (LHON) are associated with distinct mitochondrial DNA
Ministry of Education, Aim for the Top University Plan. haplotypes. Genomics 39: 8–18.
Inoue H, Tanizawa Y, Wasson J, Behn P, Kalidas K, Bernal-
Mizrachi E, Mueckler M, Marshall H, Donis-Keller H, Crock
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