General Overview:
  The ubiquitous transcription factor NFAT (nuclear factor of activated T-cells) 
  associates with other proteins to bind DNA and induce genes responsible for 
  cell-cell interactions (Crabtree et al., 2002). NFAT is expressed in a variety 
  of lymphocytes: T cells, B cells, natural killer (NK) cells, monocytes and non-immune 
  related cells: muscle, cardiac, and neuronal (Scott et al., 2001, Janeway et 
  al., 2001). In the literature there are 4 reported NFAT isoforms, which are 
  designated as NFAT1, NFAT2, NFAT3, NFAT4 (Masuda et al., 1998). The presence 
  and redundancy of these homologs suggests the critical nature of NFAT expression 
  in immune and non-immune related cells. NFAT transcriptional activity is modulated 
  by cytoplasmic Ca2+ concentration through various Ca2+ associated signaling 
  pathways (Masuda et al., 1998, Crabtree et al., 2002). Increases in cytoplasmic 
  Ca2+ concentration induce NFAT dephosphorylation and NFAT translocation to the 
  nucleus where it binds to cis regulatory elements of target genes as a monomer 
  (Masuda E.S. et al., 1998). Figure 1 outlines a general signaling mechanism 
  for NFAT activation.

Figure 1: General signaling pathway for NFAT. ATP hydrolysis is not included in the cartoon (Crabtree et al., 2002) Permission Pending for image use.
NFAT Structure: 
  NFAT secondary structure consists of b sheets and random coils forming three 
  functional domains: a Rel-similarity domain (RSD) for DNA binding and association 
  with AP-1 transcription factors, a NFAT homolog region (NHR) domain, containing 
  intracellular localization signaling sequences, and transcriptional activation 
  domains (TAD), which recruit coactivators of NFAT transcription CBP, p300 and 
  JAB1 after NFAT:AP-1 protein complex formation (Crabtree et al., 2002). Phosphorylating 
  and dephosphorylating the NHR domain determines intracellular localization. 
  NHR phosphorylation results in nuclear export and cytoplasmic localization and 
  NHR dephosphorylation results in nuclear import and nuclear localization. NFAT 
  also contains two sequence motifs: a nuclear location signal sequence (NLS) 
  and a nuclear export signal sequence (NES) that permit the import and export 
  of NFAT from the nucleus, respectively (Janeway C. A. et al., 2001). NFAT contains 
  two NLS motifs, one in the NHR domain and one in the RSD domain, the latter, 
  however, is less efficient at translocating NFAT to the nucleus. Also mutations 
  in the basic NLS domain reduce NFAT translocation. (Masuda et al., 1998) 
  The tertiary structure of NFAT has two domains that resemble immunoglobulin 
  (Ig) folds. One domain, in the RSD, specifically binds to DNA and is a beta 
  barrel comprised of three beta sheets. Within the beta barrel there are two 
  prominent loop structures, the first loop (designated as the DNA binding loop) 
  is more constrained and binds to the DNA major grove at the 5’ recognition 
  sequence GGAAAA. The second more mobile loop (designated as the Rel-insert region) 
  binds to the minor grove at the 3’ recognition sequence GGAAAA. (Masuda 
  et al., 1998) The anatomical structure, topology and protein interactions of 
  NFAT are depicted in figures 2 and 3.
Figure 2: A 2.7 Angstrom resolved crystal structure of NFAT, Ap-1 heterodimer (Fos:Jun), and a distal portion of the IL-2 gene promoter (Chen et al., 1998). Image from PDB.
Figure 3: Cartoon of NFAT crystallized with AP-1 proteins and DNA. The DNA promoter bound to the NFAT, AP-1 protein complex is ARRE2, part of the IL-2 promoter (Chen et al., 1998). The protein-protein interactions for this complex are largely polar and hydrogen bonding and salt bridges cooperatively link the protein-protein-DNA complex. (Szilak et al., 1999) These extensive interactions permit the bending of Fos and DNA to form an extended grove which interacts with 15 DNA base pairs (Chen et al., 1998). Note the Rel-homology region (RHR) N domain of NFAT extensively interacts with the Fos-Jun heterodimer. As Jun moves away from NFAT, Fos’s luecine zipper moiety interacts with the NFAT RHR-N domain (Szilak et al., 1999). Premission pending for image use.
A mechanism for NFAT regulation: Ca2+ signalling via 
  the TCR leads to NFAT activation:
  Two enzymes, calcineurin, a cytoplasmic serine/threonine phosphotase and nuclear 
  glycogen synthase kinase 3 (GSK3) are responsible for the regulation of NFAT 
  transcriptional activity. Calineurin upregulates NFAT by dephosphorylating serines 
  in the SP-repeats and in the serine rich N terminus region of NFAT (Crabtree 
  et al., 2002). This induces a conformational change exposing the NLS (Scott 
  et al., 2001), allowing NFAT to translocate to the nucleus. Calcineurin activity 
  is regulated by cytoplasmic Ca2+ concentration. In T cells, TCR stimulation 
  spurs a biphasic increase in intracellular Ca2+ concentration. The initial wave 
  of Ca2+ concentration from Ca2+ sequestered ions in the ER, the second results 
  from an influx of extra-cellular calcium ions from Ca2+ release activated Ca2+ 
  channels (CRAC) (Crabtree G. R. et al., 2002). CRAC activation is required for 
  upregulation of NFAT controlled genes since transient increases in Ca2+ concentration 
  from the ER is not sufficient to promote NFAT activation (Crabtree et al., 2002). 
  This indirectly suggests that translocated NFAT must overwhelm GSK3 in the nucleus 
  in order for NFAT to bind to target genes. 
  GSK3, on the other hand, downregulates NFAT by phosphorylating NFAT and inducing 
  a conformation change exposing the NES (Masuda et al., 1998). 
NFAT regulates….
  NFAT activation regulates a variety of immune processes: apoptosis, anergy, 
  T-cell development, and ageing of immune system. In particular, NFAT isoforms 
  are responsible for regulating interluekin (IL) 2, IL-3, IL-4, IL-5, granulocyte 
  macrophage colony-stimulation factor (GM-CSF), interferon (IFN)-y, tumor necrosis 
  factor (TNF) alpha and the cell surface receptors CD40L, CTLA-4 and FasL expression 
  (Masuda et al., 1998). Macian et al. further characterized NFAT regulatory roles, 
  hypothesizing that transcriptional activity mediates two distinct gene expression 
  patterns which are independent and dependent upon NFAT:AP1 interactions. NFAT1 
  mutagenesis studies demonstrated that NFAT:Ap-1 complexes are required for inducing 
  IL-2, GM-CSF, IL-3, IL-4, MIP1 alpha, and FasL. Conversely, the expression of 
  TNF alpha and IL13 promoter activity does not require NFAT:Ap-1 interactions 
  (Macian et al. 2002). The NFAT:Ap-1 complex is also required to induce NFAT 
  activated cell death. (Macian et al. 2000) Additional regulatory roles have 
  been observed for NFAT. For example, Gomez et al. reported that NFAT translocation 
  regulates expression of the anti-apoptotic protein Bcl-2. Inhibition of calcineurin 
  downregulates Bcl-2 expression in IL-2 cells. Conversely, constitutive calcineurin 
  expression upregulates Bcl-2 expression, indirectly implicating the function 
  of NFAT in Bcl-2 expression (Gomez J. et al., 1998). Sheng Xiao et al. observed 
  that FasL transcription could be induced by two different promoters which are 
  mediated by NFAT binding. Only one promoter, however, required Sp1 and NFAT 
  binding. Thus, the aforementioned studies suggest that NFAT has a variety of 
  regulatory roles in cells that are dependent upon promoter and NFAT:protein 
  complexes. 
Receptors inducing NFAT activity:
  The most prominent and studied NFAT activation pathway is through the TCR. TCR 
  stimulation by MHC molecules, in conjunction with CD28:B7 costimulatory signal 
  induces a biphasic intracellular Ca2+ influx that induces NFAT dephosphorylation 
  and translocation to the nucleus (Janeway et al., 2001). In B cells, BCR stimulation 
  or CD40 and IL-4R stimulation induces NFAT activation. Stimulation of FceR1 
  in mast and basophil, and FcgRIII in NK cells also induces NFAT dephosphorylation 
  and translocation, respectively. (Masuda et al., 1998)
Inhibitors of NFAT:
  NFAT inhibitors can be divided into two class, protein inhibitors and small 
  molecule inhibitors. Most of these inhibitors bind calcineurin and suppress 
  dephosphorylating activity. To date, there are four protein inhibitors which 
  prevent NFAT nuclear translocation: AKAP79, a scaffold protein that prevents 
  calcineurin substrate interactions, CABIN protein, which blocks calcineurin 
  activity, a calcineurin B homolog, CHP, and MCIP1,2,3 proteins which have the 
  ability to prevent NFAT2 phosphorylation and nuclear import (Crabtree et al., 
  2002).
  The two most prominent NFAT small molecule inhibitors are cyclosporin A and 
  FK506. Mechanistically, cyclosporin A and FK506 indirectly repress NFAT by inhibiting 
  calcineurin activity. These drugs target NFAT specific pathways and act as immunosuppressants 
  by inhibiting alloreactive T-cells. Clinically, these drugs are administered 
  to patients to prevent graft reject (Janeway C. A. et al., 2001) and have reduced 
  joint erosion and disease progression, yet there are also side effects: nephrotoxicity, 
  neurotoxicity, diabetogenicity, and gastrointestinal toxicity (Trevillyan et 
  al., 2001). Several new drug candidates, 3,5-bistriflouromethyl pyrazole (BTP) 
  derivatives inhibit Th1 and Th2 cytokine gene expression thereby indirectly 
  inhibiting the nuclear localization of NFAT. These BTP derivates, however, do 
  not dephosphorylate calcineurin and a mechanistic model for inhibition of NFAT 
  pathways has not been elucidated (Trevillyan J. M. et al. 2001). 
NFAT knockout mice:
  Several studies have been conducted using knockout NFAT mice to determine NFAT’s 
  functional role in the immune and non-immune related cells. Masuda et al. reports 
  that NFAT1 (-/-) mice have deregulated transcription of certain genes accompanied 
  by the hyperproliferation of splenic B and T cells. This hyperproliferation 
  is due to a lack of FasL expression which would normally induce cell death in 
  surviving cells (Crabtree et al., 2002) In T-cells stimulated with anti-CD3 
  there was noticeably reduced IL-4 transcription. Hence, Masuda et al, posits 
  that NFAT1 is a positive and negative regulator of cytokine expression. NFAT4 
  is also highly expressed in CD4+CD8+ thymocytes and NFAT4(-/-) mice have reduced 
  CD4+CD8+ cell counts (Amaskaki et al., 2002). Crabtree et al. suggests that 
  the loss of double positive thymocytes results from Bcl-2 suppression during 
  thymic development. Mice with mutant NFAT1/4 undergo spontaneous differentiation 
  in to T helper 2 cells with excess IgE production resulting in strong allergic 
  responses. These mice also have spontaneous T-cell hyperproliferation, which 
  does not depend on CD28 stimulation for activation (Crabtree et al. 2002). 
  Subsequent studies with knockout mice have revealed the additional importance 
  of NFAT activity in cell differentiation and development. NFAT1 (-/-) mice also 
  have small-multinucleated muscle cells, while older mice have excess cartilage 
  resulting in decreased joint mobility. Horsley et al. observed that NFAT2 (-/-) 
  mice have “defective heart valve development and abnormalities in the 
  cardiac septum”. In NFAT3/4 double knockout mice, embryo fatality result 
  from disrupted blood vessel organization and instability in the vessel walls. 
  NFAT4 knockout mice have defective embryonic myofibers (Horsley V. et al, 2002)
NFAT and T-cell’s:
  NFAT expression and trancscriptional activity are critical for the proliferation 
  and differentiation of armed effector T-cells (Janaway et al. 2001). NFAT has 
  also been implicated not only in inducing genes for an immune response but also 
  a set of anergy associated genes. Weak TCR and BCR stimulation can induce NFAT 
  activation by low sustained intracellular Ca2+ concentrations. Macian et al 
  observed that null T cells for NFAT1 do not undergo anergy and show lower expression 
  levels of anergy-genes. For T cells with “a constitutively active NFAT1” 
  where AP-1 is not induced, or NFAT:AP-1 interactions do not occur had increased 
  expression of anergy related genes indicative of an anergy associated phenotype 
  with lower TCR responsiveness (Macian et al. 2002).
NFAT and Disease:
  The ubiquitous nature of NFAT expression and its regulatory role in cell differentiation 
  and development makes it a critical enzyme in adaptive immune responses. In 
  patients with defective T-cell proliferation and IL-2 synthesis, researchers 
  noticed detectable Ca2+ release from the ER where as Ca2+ release from the plasma 
  membrane was not detected. This data supports the hypothesis that a sustained 
  intracellular calcium concentration is required for NFAT translocation via the 
  calcineurin GSK3 signaling pathway (Masuda et al, 1998).
  Various viral infections also positively and negatively interfere with NFAT 
  signaling pathways. Scott et al. observed that GFP-NFAT nuclear translocation 
  was blocked in the early stages of herpes simplex virus (HSV) infection. HIV 
  hepatitis C and African swine fever are also believed to interfere and repress 
  NFAT transcriptional activity. In particular, the protein A238L of African swine 
  fever virus binds to calcineurin, thereby blocking NFAT translocation (Crabtree 
  et al., 2002). Kaposi sarcoma associated herpes virus and rhesus monkey rhadinoviruss, 
  which, infect B cells, however, stimulate NFAT transcriptional pathways and 
  may be responsible for lymphoproliferative disorders (Scott et al. 2001). 
 References:
  Janeway C. A., Travers P., Walport M., Shlomchik M. J. 2001. Immunobiology. 
  New York, NY: Garland Publishing. p. 204-205
Masuda E. S., Imamura R., Amasaki Y, Arai K, Arai N. 1998. Signalling into the T-Cell Nucleus: NFAT regulation. Cell Signal. 10 (9): 599-611.
Xiao S, Matsui K., Fine A., Zhu B., Marshak-Rothstein A., Widom R. L., Ju S-T. 1999. FasL promoter activation by IL-2 through SP1 and NFAT but not Egr-2 and Egr-3. Eur. J. Immunol. 29:3456-3465.
Szilak L., Moll J. R., Vinson C. 1999. Structure of the DNA-Binding Domains from NFAT, FOS and JUN Bound Specifically to DNA. Chemtracts. 12: 768-773
Trevillyan J. M., Chiou X. G., Chen Y. W., Ballarom S. J., Sheets M. P., Smith M. L., Wiedeman P. E., Warrior U., Wilkins J., Gubbins E. J., Gagne G. D., Fagerland J., Carter G. W., Jay R. L., Mollison K. W., Djuric S. W. 2001 December 21. Potent Inhibition of NFAT activation and T Cell Cytokine Production by Novel Low Molecular Weight Pyrazole Compounds. Journal of Biological Chemistry 276(51): 48118-48126.
Scott E. S., Malcomber S., O’Hare P. 2001 October. Nuclear Translocation and Activation of the Transcription factor NFAT Is Blocked by Herpres Simplex Virus Infection. Journal of Virology 75(20) 9955-9965.
Amasaki Y., Adachi S., Ishida Y., Iwata M., Arai N., Arai K., 
  Miyatake S. 2002 July 12. A Constitutively Nuclear Form of NFATx Shows Efficient 
  Transactivation Activity and Induces Differentiation of CD4+CD8+ T cells. The 
  Journal of Biological Chemistry 227:28 25640-25648.
  
Horsley V., Pavlath G. K. 2002 March 5. NFAT: ubiquitous regulator of cell differentiation and adaptation. The Journal of Cell Biology: 156(5) 771-774.
Chen L, Mark Glover J. N., Hogan P. G., Rao A., Harrison S. C. 1998 March 5. Structure of the DNA-binding domains from NFAT, Fos and Jun bound specifically to DNA. Nature 392: 42-48
Macian F., Carmen G-R., Rao A. 2000. Gene expression elicited by NFAT in the presence or absence f cooperative recruitment of Fos and Jun. The EMBO Journal 19(17): 4783-4795.
Gomez J., Martinez-A C., Gonzalez A., Garcia A., Rebollo A. 1998. The Bcl-2 gene is idfferentiall regulated by IL-2 and IL-4: role of the transcription factor NFAT. Oncogene 17:1235-1243.
Macian F., Garcia-Cozar F., Im S-H., Horton H. F., Byrne M. C., Rao A. 2002 June 14. Transcriptional Mechanisms Underlying Lymphocyte Tolerance. Cell 109: 719-731.
 Crabtree G. R., Olson E. N. 2002. NFAT Signaling: Choreographing 
  the Social Lives of Cells. Cell 109: S67-S79. 
  
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