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<article xml:lang="en" article-type="research-article" xmlns:xlink="http://www.w3.org/1999/xlink">
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Molecular Medicine Reports</journal-id>
<journal-title-group>
<journal-title>Molecular Medicine Reports</journal-title>
</journal-title-group>
<issn pub-type="ppub">1791-2997</issn>
<issn pub-type="epub">1791-3004</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3892/mmr.2017.6452</article-id>
<article-id pub-id-type="publisher-id">mmr-15-06-3871</article-id>
<article-categories>
<subj-group>
<subject>Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Perfluorooctanoic acid induces oxidative damage and mitochondrial dysfunction in pancreatic &#x03B2;-cells</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author"><name><surname>Suh</surname><given-names>Kwang Sik</given-names></name>
<xref rid="af1-mmr-15-06-3871" ref-type="aff">1</xref>
<xref rid="fn1-mmr-15-06-3871" ref-type="author-notes">&#x002A;</xref></contrib>
<contrib contrib-type="author"><name><surname>Choi</surname><given-names>Eun Mi</given-names></name>
<xref rid="af1-mmr-15-06-3871" ref-type="aff">1</xref>
<xref rid="fn1-mmr-15-06-3871" ref-type="author-notes">&#x002A;</xref></contrib>
<contrib contrib-type="author"><name><surname>Kim</surname><given-names>Yu Jin</given-names></name>
<xref rid="af2-mmr-15-06-3871" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Hong</surname><given-names>Soo Min</given-names></name>
<xref rid="af2-mmr-15-06-3871" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Park</surname><given-names>So Yong</given-names></name>
<xref rid="af2-mmr-15-06-3871" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Rhee</surname><given-names>Sang Youl</given-names></name>
<xref rid="af1-mmr-15-06-3871" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author"><name><surname>Oh</surname><given-names>Seungjoon</given-names></name>
<xref rid="af1-mmr-15-06-3871" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author"><name><surname>Kim</surname><given-names>Sung Woon</given-names></name>
<xref rid="af1-mmr-15-06-3871" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author"><name><surname>Pak</surname><given-names>Youngmi Kim</given-names></name>
<xref rid="af3-mmr-15-06-3871" ref-type="aff">3</xref></contrib>
<contrib contrib-type="author"><name><surname>Choe</surname><given-names>Wonchae</given-names></name>
<xref rid="af4-mmr-15-06-3871" ref-type="aff">4</xref></contrib>
<contrib contrib-type="author"><name><surname>Chon</surname><given-names>Suk</given-names></name>
<xref rid="af1-mmr-15-06-3871" ref-type="aff">1</xref>
<xref rid="c1-mmr-15-06-3871" ref-type="corresp"/></contrib>
</contrib-group>
<aff id="af1-mmr-15-06-3871"><label>1</label>Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</aff>
<aff id="af2-mmr-15-06-3871"><label>2</label>Department of Medicine, Graduate School, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</aff>
<aff id="af3-mmr-15-06-3871"><label>3</label>Department of Physiology, School of Medicine, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</aff>
<aff id="af4-mmr-15-06-3871"><label>4</label>Department of Biochemistry and Molecular Biology (BK21 Project), School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</aff>
<author-notes>
<corresp id="c1-mmr-15-06-3871"><italic>Correspondence to</italic>: Dr Suk Chon, Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 02447, Republic of Korea, E-mail: <email>imdrjs@khu.ac.kr</email>; <email>cemsuh@gmail.com</email></corresp>
<fn id="fn1-mmr-15-06-3871"><label>&#x002A;</label><p>Contributed equally</p></fn>
</author-notes>
<pub-date pub-type="ppub"><month>06</month><year>2017</year></pub-date>
<pub-date pub-type="epub"><day>11</day><month>04</month><year>2017</year></pub-date>
<volume>15</volume>
<issue>6</issue>
<fpage>3871</fpage>
<lpage>3878</lpage>
<history>
<date date-type="received"><day>21</day><month>12</month><year>2015</year></date>
<date date-type="accepted"><day>09</day><month>02</month><year>2017</year></date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2017, Spandidos Publications</copyright-statement>
<copyright-year>2017</copyright-year>
</permissions>
<abstract>
<p>Several environmental contaminants have been linked to the development of diabetes and increased diabetes-associated mortality. Perfluorooctanoic acid (PFOA) is a widely used perfluoroalkane found in surfactants and lubricants, and in processing aids used in the production of polymers. Furthermore, PFOA has been detected in humans, wildlife and the environment. The present study investigated the toxic effects of PFOA on rat pancreatic &#x03B2;-cell-derived RIN-m5F cells. Cell viability, apoptosis, reactive oxygen and nitrogen species, cytokine release and mitochondrial parameters, including membrane potential collapse, reduced adenosine triphosphate levels, cardiolipin peroxidation and cytochrome <italic>c</italic> release were assessed. PFOA significantly decreased RIN-m5F cell viability and increased apoptosis. Exposure to PFOA increased the formation of reactive oxygen species, mitochondrial superoxide, nitric oxide and proinflammatory cytokines. Furthermore, PFOA induced mitochondrial membrane potential collapse and reduced adenosine triphosphate levels, cardiolipin peroxidation and cytochrome <italic>c</italic> release. These results indicate that PFOA is associated with the induction of apoptosis in RIN-m5F cells, and induces cytotoxicity via increased oxidative stress and mitochondrial dysfunction.</p>
</abstract>
<kwd-group>
<kwd>perfluorooctanoic acid</kwd>
<kwd>pancreatic &#x03B2;-cell-derived RIN-m5F cells</kwd>
<kwd>mitochondrial function</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec sec-type="intro">
<title>Introduction</title>
<p>Diabetes is a complex metabolic disorder characterized by abnormalities in glucose homeostasis and insulin sensitivity (<xref rid="b1-mmr-15-06-3871" ref-type="bibr">1</xref>). The increasing prevalence of metabolic syndrome indications, including dyslipidemia, obesity and insulin resistance, has stimulated rising interest in the role environmental pollutants serve in such diseases (<xref rid="b2-mmr-15-06-3871" ref-type="bibr">2</xref>). Environmental exposure to persistent organic pollutants is associated with diabetes (<xref rid="b3-mmr-15-06-3871" ref-type="bibr">3</xref>). Perfluorooctanoic acid (PFOA) is one of the most common perfluoroalkyl acids (PFAAs), which has been detected in humans and wildlife due to environmental exposure. Substantial progress has been made in the toxicological research of these compounds, particularly in the areas of developmental toxicity, immunotoxicity, hepatotoxicity and the potential associated modes of action (<xref rid="b4-mmr-15-06-3871" ref-type="bibr">4</xref>); PFOA is not metabolized and has an estimated human half-life of 2.3&#x2013;3.4 years (<xref rid="b5-mmr-15-06-3871" ref-type="bibr">5</xref>). Notably, PFOA is water-soluble and migrates readily from soil to groundwater, and human exposure can occur via contaminated drinking water, with other sources of exposure including food, food packaging, treated fabrics, house dust and air (<xref rid="b4-mmr-15-06-3871" ref-type="bibr">4</xref>). Previous research has suggested that PFOA is associated with risk factors for type 2 diabetes, including glucose homeostasis and metabolic disorder (<xref rid="b6-mmr-15-06-3871" ref-type="bibr">6</xref>). Furthermore, PFOA-exposed employees at manufacturing facilities presented an increased risk of mortality from type 2 diabetes (<xref rid="b7-mmr-15-06-3871" ref-type="bibr">7</xref>), and in a longitudinal prospective cohort study of pregnant women followed from pre-conception to delivery, Zhang <italic>et al</italic> (<xref rid="b8-mmr-15-06-3871" ref-type="bibr">8</xref>) revealed a significant positive association between serum PFOA concentrations and the risk of gestational diabetes. Although several epidemiological studies identified no association between PFOA and other PFAAs and the incidence of diabetes, the evidence suggested that these compounds influenced glucose metabolism (<xref rid="b2-mmr-15-06-3871" ref-type="bibr">2</xref>,<xref rid="b9-mmr-15-06-3871" ref-type="bibr">9</xref>,<xref rid="b10-mmr-15-06-3871" ref-type="bibr">10</xref>). Notably, experimental studies have reported that PFOA is able to induce oxidative stress and apoptosis in primary cultured tilapia hepatocytes (<xref rid="b11-mmr-15-06-3871" ref-type="bibr">11</xref>), and in human hepatoma HepG2 cells (<xref rid="b12-mmr-15-06-3871" ref-type="bibr">12</xref>).</p>
<p>Oxidative stress is considered to be a key risk factor for the development and progression of various chronic degenerative diseases, including diabetes (<xref rid="b13-mmr-15-06-3871" ref-type="bibr">13</xref>). Oxidative stress in pancreatic &#x03B2;-cells reduces the mitochondrial membrane potential (MMP), which promotes the release of apoptogenic factors that activate downstream death programs (<xref rid="b14-mmr-15-06-3871" ref-type="bibr">14</xref>). Although the exact mechanism underlying pancreatic &#x03B2;-cell dysfunction is not currently known, the enhanced production of mitochondrial reactive oxygen species (ROS) that occurs under hyperglycemic and hyperlipidemic conditions is a major contributing factor to the disruption of &#x03B2;-cell function in type 2 diabetes (<xref rid="b15-mmr-15-06-3871" ref-type="bibr">15</xref>). Pancreatic &#x03B2;-cells are particularly sensitive to oxidative damage; therefore mitochondrial oxidative damage may underlie the marked loss of &#x03B2;-cell function (<xref rid="b16-mmr-15-06-3871" ref-type="bibr">16</xref>). Apoptosis is the predominant mode of pancreatic &#x03B2;-cell death in diabetes (<xref rid="b17-mmr-15-06-3871" ref-type="bibr">17</xref>) and serves a crucial role in the pathogenesis of diabetes (<xref rid="b18-mmr-15-06-3871" ref-type="bibr">18</xref>). The apoptotic process occurs via two pathways: The &#x2018;extrinsic&#x2019; or death receptor-initiated pathway, and the &#x2018;intrinsic&#x2019; or mitochondrial-initiated pathway (<xref rid="b19-mmr-15-06-3871" ref-type="bibr">19</xref>). The intrinsic apoptotic pathway involves fatal alterations to mitochondrial homeostasis, this occurs via the loss of outer mitochondrial membrane integrity and the subsequent release of cytochrome <italic>c</italic>. Mitochondrial pore-formation and the release of cytochrome <italic>c</italic> are believed to irreversibly commit a cell to apoptosis (<xref rid="b20-mmr-15-06-3871" ref-type="bibr">20</xref>).</p>
<p>Proinflammatory cytokines, including interleukin-1&#x03B2; (IL-1&#x03B2;) and tumor necrosis factor &#x03B1; (TNF-&#x03B1;), moderate the expression and activity of antioxidant enzymes, further stimulating an imbalance in the redox status of insulin-producing cells (<xref rid="b21-mmr-15-06-3871" ref-type="bibr">21</xref>). In addition, proinflammatory cytokines stimulate inducible nitric oxide synthase (iNOS) expression, which promotes nitric oxide (NO) formation (<xref rid="b21-mmr-15-06-3871" ref-type="bibr">21</xref>). NO has been widely implicated in nitrosative stress, an event that is linked to cell damage. Therefore, NO and ROS are considered crucial elements in proinflammatory cytokine-mediated pancreatic &#x03B2;-cell death (<xref rid="b22-mmr-15-06-3871" ref-type="bibr">22</xref>). During apoptosis, pancreatic &#x03B2;-cell mitochondria may be influenced by proinflammatory cytokines, and this occurs via activation of the intrinsic or extrinsic pathways (<xref rid="b23-mmr-15-06-3871" ref-type="bibr">23</xref>). Furthermore, cytokines may impair the MMP and disturb adenosine triphosphate (ATP) homeostasis, leading to the release of cytochrome <italic>c</italic> and activation of &#x03B2;-cell apoptosis. The present study therefore investigated the <italic>in vitro</italic> cytotoxic effects of PFOA on pancreatic &#x03B2;-cells and its underlying mechanisms, using the RIN-m5F rat pancreatic &#x03B2;-cell line.</p>
</sec>
<sec sec-type="materials|methods">
<title>Materials and methods</title>
<sec>
<title/>
<sec>
<title>Materials</title>
<p>PFOA (<xref rid="f1-mmr-15-06-3871" ref-type="fig">Fig. 1</xref>) was purchased from Sigma-Aldrich (Merck KGaA, Darmstadt, Germany). Fetal bovine serum (FBS) and RPMI-1,640 medium were purchased from Gibco (Thermo Fisher Scientific, Inc., Waltham, MA, USA). Other reagents were of the highest commercial grade available and were purchased from Sigma-Aldrich (Merck KGaA).</p>
</sec>
<sec>
<title>Cell culture</title>
<p>RIN-m5F cells derived from rat pancreatic &#x03B2;-cells were purchased from the American Type Culture Collection (Manassas, VA, USA) and maintained in RPMI-1,640 supplemented with 10&#x0025; FBS and 1&#x0025; penicillin/streptomycin, at 37&#x00B0;C and saturated humidity with 5&#x0025; CO<sub>2</sub>. Cells were seeded into a 24-well plate (2&#x00D7;104 cells/well) and cultured for 48 h, and subsequently treated with 0&#x2013;500 &#x00B5;M PFOA at 37&#x00B0;C for 48 h.</p>
</sec>
<sec>
<title>Cell viability</title>
<p>Cell viability was measured using an EZ-Cytox kit (Daeil Lab Service Co. Ltd., Seoul, South Korea). Cells were treated with water-soluble tetrazolium (WST) reagent and incubated at 37&#x00B0;C for 2 h. Live cells metabolized the WST reagent, resulting in an orange-colored product, the intensity of which was measured at 450 nm using a Zenyth 3100 multimode detector spectrofluorometer (Anthos Labtec Instruments GmbH, Salzburg, Austria). The data were expressed as a percentage of the control [&#x0025; control=100x (absorbance of experimental group/absorbance of control group)].</p>
</sec>
<sec>
<title>Measurement of apoptosis</title>
<p>Apoptosis was assessed using a Cell Death Detection ELISAPLUS kit (Roche Diagnostics GmbH, Mannheim, Germany), according to the manufacturer&#x0027;s protocol. The assay was based on the quantitative sandwich-enzyme-immunoassay-principle, using DNA- and histone-directed mouse monoclonal antibodies, and allowed the specific determination of mono- and oligonucleosomes in the cytoplasmic fraction of cell lysates (<xref rid="b24-mmr-15-06-3871" ref-type="bibr">24</xref>).</p>
</sec>
<sec>
<title>Measurement of intracellular ROS</title>
<p>ROS was measured using 2,7-dichlorofluorescin diacetate (DCFH-DA). Oxidation of the non-fluorescent DCFH-DA yields dichlorofluorescin (DCF), a highly fluorescent product that detects reactive oxygen intermediates in intact cells (<xref rid="b25-mmr-15-06-3871" ref-type="bibr">25</xref>). Cells were treated with 10 &#x00B5;M DCFH-DA at 37&#x00B0;C for 1 h. Following washing with Dulbecco&#x0027;s PBS, ROS levels were determined by measuring the fluorescence intensity at an excitation wavelength of 485 nm and an emission wavelength of 530 nm, using a Zenyth 3100 multimode detector spectrofluorometer.</p>
</sec>
<sec>
<title>Measurement of mitochondrial superoxide</title>
<p>Mitochondrial superoxide levels were detected using MitoSOX&#x2122; Red mitochondrial superoxide indicator (Invitrogen; Thermo Fisher Scientific Inc.), a fluorogenic dye used for the highly selective detection of mitochondrial superoxide (<xref rid="b26-mmr-15-06-3871" ref-type="bibr">26</xref>). Briefly, cells were incubated with 5 &#x00B5;M MitoSOX&#x2122; Red at 37&#x00B0;C for 20 min, according to the manufacturer&#x0027;s protocol. The cells were subsequently washed by Dulbecco&#x0027;s PBS, and then MitoSOX&#x2122; Red fluorescence was measured at an excitation wavelength of 510 nm, and an emission wavelength of 580 nm.</p>
</sec>
<sec>
<title>Measurement of intracellular NO production</title>
<p>A sensitive fluorescent indicator of NO, 2,7-difluorofluorescein (DAF-FM) diacetate, was used to detect intracellular NO production. DAF-FM diacetate is a cell-permeable derivative of DAF-FM, which is converted to the less permeable DAF-FM by cellular esterases when it enters the cell, thus preventing signal loss due to diffusion of the molecule from the cell. In the presence of oxygen, DAF-FM reacts with NO to yield the highly fluorescent triazolofluorescein. Cells were incubated with 5 &#x00B5;M DAF-FM diacetate (Invitrogen; Thermo Fisher Scientific, Inc.) for 2 h at 37&#x00B0;C (<xref rid="b27-mmr-15-06-3871" ref-type="bibr">27</xref>). Following the removal of excess probe, DAF-fluorescence intensity was measured at an excitation wavelength of 495 nm and an emission wavelength of 515 nm.</p>
</sec>
<sec>
<title>Cytokine (TNF-&#x03B1; and IL-1&#x03B2;) immunoassay</title>
<p>Cell extracts were prepared using cell lysis buffer (Cell Signaling Technology, Inc., Danvers, MA, USA) and centrifuged at 10,000 &#x00D7; g for 15 min at 4&#x00B0;C. The cytosolic concentrations of TNF-&#x03B1; (cat. no. RTA00) and IL-1&#x03B2; (cat. no. RBL00) were measured using ELISA kits (R&#x0026;D System Inc., Minneapolis, MN, USA) according to the manufacturer&#x0027;s protocol. Briefly, cytoplasmic cytokines were bound to antibodies immobilized on a pre-coated microplate. Unbound substances were removed by washing, and a cytokine-specific enzyme-linked polyclonal antibody was added to each well. Unbound antibody-enzyme reagent was removed by washing, and the provided substrate was added to each well. The enzyme reaction yielded a blue product, which was converted to a yellow product following addition of the stop solution. The absorbance was measured at 450 nm; the measured color intensity was proportional to the amount of bound cytokine.</p>
</sec>
<sec>
<title>Measurement of ATP concentration</title>
<p>Cells were homogenized in ATP assay buffer (BioVision, Inc., Milpitas, CA, USA) Intracellular ATP concentrations were determined using an ATP Colorimetric Assay kit (BioVision, Inc.), which allows rapid measurement of intracellular ATP. The assay was performed according to the manufacturer&#x0027;s protocol. ATP concentrations were normalized to protein content in the samples, protein concentrations were determined using the Bradford Protein assay kit (Bio-Rad Laboratories, Inc., Hercules, CA, USA) (<xref rid="b25-mmr-15-06-3871" ref-type="bibr">25</xref>). A standard curve using known ATP concentrations was plotted to allow the calculation of nmoles ATP/mg protein. Results are presented as a percentage of the control.</p>
</sec>
<sec>
<title>Measurement of the MMP</title>
<p>MMP was measured fluorometrically using the fluorescent probe rhodamine 123 (<xref rid="b28-mmr-15-06-3871" ref-type="bibr">28</xref>). Cells (1&#x00D7;104) were cultured in black 96-well plates and allowed to adhere overnight. Following adhesion, cells were treated for a further 48 h with PFOA, as aforementioned. The cells were then washed twice with PBS and incubated with 10 &#x00B5;M rhodamine 123 solution, at 37&#x00B0;C in the dark, for 30 min. Following a further 2 washes with PBS, the fluorescence intensity was measured using a spectrofluorometer at an excitation wavelength of 505 nm and an emission wavelength of 534 nm. The data were analyzed by GraphPad Prism software 4.0 (GraphPad Software, Inc., San Diego, CA, USA).</p>
</sec>
<sec>
<title>Cytochrome c release assay</title>
<p>Cells were cultured at 2&#x00D7;104 cells/well onto 24-well plates. Cell extracts were prepared using cell lysis buffer and centrifuged at 10,000 &#x00D7; <italic>g</italic> for 15 min at 4&#x00B0;C. The supernatants (200 &#x00B5;l) were detected using a cytochrome <italic>c</italic> ELISA kit (cat. no. ab110172; Abcam, Cambridge, MA, USA). The assay was performed according to the manufacturer&#x0027;s protocol. Cytochrome <italic>c</italic> from the conditioned medium was immunocaptured within the wells, and the concentration was determined by adding a cytochrome <italic>c</italic>-specific antibody conjugated to horseradish peroxidase. Following addition of the provided colorless substrate, the peroxidase converted the substrate to a blue end-product. This reaction occurred in a time-dependent manner, which was proportional to the amount of protein captured in the wells. The rate of blue color development was detected at 600 nm. The change in absorbance was expressed as change in milliOD/min.</p>
</sec>
<sec>
<title>Measurement of cardiolipin peroxidation</title>
<p>Cardiolipin peroxidation was assessed using 10-N-nonyl-Acridine Orange (NAO) (Molecular Probes; Thermo Fisher Scientific, Inc.), which binds to mitochondria-specific cardiolipin. NAO loses its affinity for peroxidized cardiolipin; therefore, a decrease in NAO fluorescence reflects the peroxidation of intracellular cardiolipin (<xref rid="b29-mmr-15-06-3871" ref-type="bibr">29</xref>). Cells were labeled with NAO (5 &#x00B5;M, at 37&#x00B0;C for 20 min), washed twicewithDulbecco&#x0027;s PBS, and the fluorescence was measured at an excitation wavelength of 485 nm and an emission wavelength of 530 nm.</p>
</sec>
<sec>
<title>Statistical analysis</title>
<p>The results were expressed as the mean &#x00B1; standard error of the mean, for triplicate experiments. One-way analysis of variance was followed by Dunnett&#x0027;s t-test. P&#x003C;0.05 was considered to indicate a statistically significant difference. Data was analyzed using SAS statistical software (version 9.1.3; SAS Institute, Inc., Cary, NC, USA).</p>
</sec>
</sec>
</sec>
<sec sec-type="results">
<title>Results</title>
<sec>
<title/>
<sec>
<title>Cytotoxicity of PFOA in RIN-m5F cells</title>
<p>To determine whether PFOA induced cytotoxicity and apoptosis in RIN-m5F cells, cells were treated with 0&#x2013;500 &#x00B5;M PFOA for 48 h. PFOA significantly decreased RIN-m5F cell viability in a concentration-dependent manner (&#x2265;100 &#x00B5;M, <xref rid="f2-mmr-15-06-3871" ref-type="fig">Fig. 2A</xref>), with cells treated with 100 &#x00B5;M PFOA exhibiting 76&#x0025; cell viability, compared with control. Furthermore, apoptosis was significantly increased in PFOA-treated cells (100&#x2013;500 &#x00B5;M; <xref rid="f2-mmr-15-06-3871" ref-type="fig">Fig. 2B</xref>); following treatment with 500 &#x00B5;M PFOA apoptosis was increased 2.4-fold. These results indicated that PFOA may reduce cell viability by inducing apoptosis.</p>
</sec>
<sec>
<title>PFOA induces oxidative/nitrosative stress in RIN-m5F cells</title>
<p>To investigate whether PFOA-induced apoptosis in RIN-m5F cells was associated with the accumulation of ROS, RIN-m5F cells were treated with DCFH-DA, a fluorescent probe for ROS. PFOA (&#x2265;200 &#x00B5;M) significantly increased DCF fluorescence, which was 3.2-fold greater following treatment with 500 mM PFOA (<xref rid="f3-mmr-15-06-3871" ref-type="fig">Fig. 3A</xref>).</p>
<p>Mitochondria are a major source of ROS (<xref rid="b25-mmr-15-06-3871" ref-type="bibr">25</xref>). To determine whether PFOA regulated mitochondrial ROS accumulation in RIN-m5F cells, cells were incubated with MitoSOX Red, a fluorogenic dye that specifically detects superoxide in the mitochondria of live cells (<xref rid="b30-mmr-15-06-3871" ref-type="bibr">30</xref>). Cells treated with PFOA (&#x2265;200 &#x00B5;M) demonstrated significantly higher levels of MitoSOX&#x2122; Red fluorescence, compared with control cells, which was 4-fold greater following treatment with 500 &#x00B5;M PFOA. This result indicated that high concentrations of PFOA may increase superoxide accumulation in the mitochondria of RIN-m5F cells (<xref rid="f3-mmr-15-06-3871" ref-type="fig">Fig. 3B</xref>).</p>
<p>NO overproduction induces oxidative/nitrosative stress, which results in cell apoptosis or necrosis. The NO-specific DAF-FM probe was employed to investigate PFOA-induced NO production. NO production was greater in RIN-m5F cells incubated with PFOA for 48 h (&#x2265;50 &#x00B5;M) compared with control cells, up to 6.6-fold following treatment with 400 &#x00B5;M PFOA (<xref rid="f3-mmr-15-06-3871" ref-type="fig">Fig. 3C</xref>). This result suggested that PFOA may induce oxidative/nitrosative stress in pancreatic &#x03B2;-cells, via stimulation of NO overproduction.</p>
</sec>
<sec>
<title>PFOA increases cytosolic TNF-&#x03B1; and IL-1&#x03B2; levels in RIN-m5F cells</title>
<p>Proinflammatory cytokines activate various metabolic pathways in pancreatic &#x03B2;-cells that result in cell death (<xref rid="b31-mmr-15-06-3871" ref-type="bibr">31</xref>). Therefore, the present study investigated whether PFOA modulates the production of the cytokines TNF-&#x03B1; and IL-1&#x03B2;. The production of TNF-&#x03B1; and IL-1&#x03B2; was significantly increased at PFOA concentrations &#x2265;100 and &#x2265;200 &#x00B5;M respectively; TNF-&#x03B1; was increased by 2.7-fold and IL-1&#x03B2; was increased by 4.6-fold following treatment with 500 &#x00B5;M PFOA (<xref rid="f4-mmr-15-06-3871" ref-type="fig">Fig. 4</xref>).</p>
</sec>
<sec>
<title>Effects of PFOA on MMP and ATP production in RIN-m5F cells</title>
<p>The irreversible loss of mitochondrial function is a prerequisite for apoptosis (<xref rid="b32-mmr-15-06-3871" ref-type="bibr">32</xref>). To determine whether PFOA treatment disrupts the MMP in RIN-m5F cells, MMP was evaluated using the fluorescent dye rhodamine 123, which accumulates in the mitochondrial compartment in an MMP-dependent manner. PFOA treatment (&#x2265;300 &#x00B5;M) for 48 h significantly disrupted the MMP in RIN-m5F cells, up to 1.9-fold following treatment with 500 &#x00B5;M PFOA (<xref rid="f5-mmr-15-06-3871" ref-type="fig">Fig. 5A</xref>). Living cells require a continuous supply of ATP to support the complex biological functions that are essential for survival, and ATP concentration is an important indicator of mitochondrial function. Intracellular ATP was measured in cells exposed to increasing concentrations of PFOA. ATP levels were significantly increased in response to low PFOA concentrations (10&#x2013;50 &#x00B5;M), up to 1.3-fold following treatment with 50 &#x00B5;M PFOA (<xref rid="f5-mmr-15-06-3871" ref-type="fig">Fig. 5B</xref>). However, intracellular ATP decreased following exposure to high concentrations (&#x2265;200 &#x00B5;M) of PFOA, and had decreased to 42&#x0025;, compared with the control, in cells treated with 500 &#x00B5;M PFOA.</p>
</sec>
<sec>
<title>Effects of PFOA on cytochrome c release and cardiolipin peroxidation in RIN-m5F cells</title>
<p>Mitochondrial cytochrome <italic>c</italic> release is a key event in apoptotic initiation. PFOA treatment (&#x2265;200 &#x00B5;M) stimulated a significant increase in cytochrome <italic>c</italic> release into the medium, and was increased 4-fold following treatment with 500 &#x00B5;M PFOA (<xref rid="f6-mmr-15-06-3871" ref-type="fig">Fig. 6A</xref>). Cardiolipin, which is a phospholipid found almost exclusively at the inner mitochondrial membrane, is an early target of oxygen-free radical attack due to its high content of unsaturated fatty acids. An oxidation-induced decrease in cardiolipin may facilitate the release of cytochrome <italic>c</italic> into the cytosol. The fluorescent probe NAO binds to cardiolipin, and this was used to determine whether PFOA induced cardiolipin peroxidation in RIN-m5F cells. NAO binding was reduced in cells treated with PFOA (&#x2265;200 &#x00B5;M), and was reduced to 27&#x0025;, compared with the control, in cells treated with 500 &#x00B5;M PFOA, thus indicating the occurrence of mitochondrial PFOA-induced cardiolipin peroxidation (<xref rid="f6-mmr-15-06-3871" ref-type="fig">Fig. 6B</xref>).</p>
</sec>
</sec>
</sec>
<sec sec-type="discussion">
<title>Discussion</title>
<p>The present study demonstrated that PFOA induces apoptosis and impairs the viability of the rat pancreatic &#x03B2;-cell line RIN-m5F. Furthermore, PFOA damages &#x03B2;-cells by mediating the accumulation of reactive nitrogen species (RNS) and ROS, and through mitochondrial dysfunction. To the best of our knowledge, the present study is the first to demonstrate a direct cytotoxic effect of PFOA on pancreatic &#x03B2;-cells. Treatment with PFOA independently disrupted MMP and reduced intracellular ATP levels in &#x03B2;-cells, thus suggesting that inhibition of mitochondrial metabolism may mediate this cytotoxic effect. Mitochondria are the main source of intracellular ROS; superoxide is produced at complexes I and III in the mitochondrial matrix and is converted to hydrogen peroxide (H<sub>2</sub>O<sub>2</sub>) by manganese superoxide dismutase (<xref rid="b1-mmr-15-06-3871" ref-type="bibr">1</xref>). Pancreatic &#x03B2;-cells are particularly sensitive to destruction by mitochondrial ROS because the expression of antioxidant enzymes is relatively low in these cells (<xref rid="b33-mmr-15-06-3871" ref-type="bibr">33</xref>). PFOA-induced alterations in mitochondrial membrane integrity result in the subsequent leakage of ions, which may affect the proton gradient and, subsequently, the oxidative phosphorylation required to produce ATP. Therefore, it may be hypothesized that in &#x03B2;-cells exposed to PFOA, RNS/ROS-induced oxidative stress damages the cell membrane, and the subsequent oxidative stimulus induces the cytosolic signaling pathway of the cell, disrupts mitochondrial function and initiates apoptosis.</p>
<p>The mitochondrial-mediated apoptotic pathway serves a major role in pancreatic &#x03B2;-cell death. Previous research has demonstrated that a common effector phase of mitochondrial permeability transition (MPT) may be shared by several types of apoptosis and necrosis (<xref rid="b34-mmr-15-06-3871" ref-type="bibr">34</xref>). MPT is caused by the opening of a multiprotein complex pore positioned at a connecting point between the inner and outer mitochondrial membranes leading to MMP disruption, uncoupling of the respiratory chain and termination of ATP production, hyperproduction of ROS, Ca<sup>2&#x002B;</sup> release and depletion of reduced-glutathione, some of which may provoke necrosis (<xref rid="b34-mmr-15-06-3871" ref-type="bibr">34</xref>). Furthermore, MPT is associated with the mitochondrial release of apoptosis-inducing factor and cytochrome <italic>c</italic>, which may activate caspases involved in the degradation phase of apoptosis (<xref rid="b35-mmr-15-06-3871" ref-type="bibr">35</xref>). A decrease in cardiolipin levels induces cytochrome <italic>c</italic> detachment from the inner mitochondrial membrane, and facilitates the subsequent release into the cytosol (<xref rid="b36-mmr-15-06-3871" ref-type="bibr">36</xref>). Once released into the cytoplasm, cytochrome <italic>c</italic> promotes assembly of the apoptosome in response to the cell-death stimulus, and activated caspase-9 subsequently induces the processing and activation of effector caspases, ultimately culminating in apoptosis (<xref rid="b37-mmr-15-06-3871" ref-type="bibr">37</xref>). The discovery that PFOA treatment results in the release of mitochondrial cytochrome <italic>c</italic> indicates that this mechanism may serve an important role in the promotion of oxidative damage and pancreatic &#x03B2;-cell damage.</p>
<p>Mitochondrial ROS stimulate lipid peroxidation and reactive aldehyde formation in pancreatic &#x03B2;-cells, leading to the development of type 2 diabetes (<xref rid="b38-mmr-15-06-3871" ref-type="bibr">38</xref>). The present study demonstrated that PFOA-induced apoptosis is associated with increased levels of mitochondrial ROS production and cardiolipin peroxidation. Cardiolipin is a unique dimeric phospholipid found almost exclusively in the inner mitochondrial membrane. This lipid contains a high percentage of unsaturated fatty acids and is readily oxidized by ROS, a step that is considered essential for the release of cytochrome <italic>c</italic> (<xref rid="b39-mmr-15-06-3871" ref-type="bibr">39</xref>). Following mitochondrial damage, cardiolipin is repositioned to the outer membrane of the mitochondria where it functions as a recognition signal for dysfunctional mitochondria. Cardiolipin and cytochrome <italic>c</italic> interact at two sites on cytochrome <italic>c</italic> (<xref rid="b40-mmr-15-06-3871" ref-type="bibr">40</xref>); cytochrome <italic>c</italic> can accept a hydrogen proton and it can oxidize cardiolipin with an extra oxygen molecule (<xref rid="b41-mmr-15-06-3871" ref-type="bibr">41</xref>). Korytowski <italic>et al</italic> (<xref rid="b42-mmr-15-06-3871" ref-type="bibr">42</xref>) demonstrated that oxidized cardiolipin species were significantly increased in the mitochondria, following exposure to apoptotic stress.</p>
<p>The outcomes of the present study are consistent with previous investigations into the toxicity of fluorochemicals. Panaretakis <italic>et al</italic> (<xref rid="b43-mmr-15-06-3871" ref-type="bibr">43</xref>) observed MMP dissipation in HepG2 cells following incubation with PFOA. Starkov and Wallace (<xref rid="b44-mmr-15-06-3871" ref-type="bibr">44</xref>) reported that treatment with perfluorinated derivatives induced collapse of the MMP and subsequent swelling of rat liver mitochondria. The study by Starkov and Wallace (<xref rid="b44-mmr-15-06-3871" ref-type="bibr">44</xref>) indicated that PFOA may induce peroxisome proliferation and interfere with mitochondrial metabolic pathways. Free acid PFOA has previously been reported to induce a small increase in the intrinsic proton leak of the mitochondrial inner membrane, and the resulting alteration in membrane fluidity was similar to that induced by a surfactant (<xref rid="b44-mmr-15-06-3871" ref-type="bibr">44</xref>). Peroxisome proliferators can slightly increase the steady-state level of H<sub>2</sub>O<sub>2</sub> in rodents, perhaps due to an upregulation of acyl-CoA oxidase combined with a small increase in catalase activity (<xref rid="b45-mmr-15-06-3871" ref-type="bibr">45</xref>), and it is well known that long-chain fatty acids are capable of inducing MPT <italic>in vitro</italic> (<xref rid="b46-mmr-15-06-3871" ref-type="bibr">46</xref>).</p>
<p>The present study indicated that PFOA induces the production of high levels of NO. Increased generation of NO during insulitis may contribute to pancreatic &#x03B2;-cell destruction (<xref rid="b47-mmr-15-06-3871" ref-type="bibr">47</xref>). NO can diffuse through the mitochondrial membrane and react with H<sub>2</sub>O<sub>2</sub> in an environment rich in free-iron, which promotes the formation of hydroxyl radicals. The mitochondria are therefore the predominant site of hydroxyl radical formation in pancreatic &#x03B2;-cells, and the primary site of ROS toxicity, suggesting that mitochondrial damage may be responsible for PFOA-induced cell death. Catalase enzyme activity is reduced by the induction of iNOS and the accompanying production of NO, which binds to the iron moiety in the catalase heme groups (<xref rid="b48-mmr-15-06-3871" ref-type="bibr">48</xref>). Furthermore, a reaction of NO with superoxide results in the production of peroxynitrite (<xref rid="b49-mmr-15-06-3871" ref-type="bibr">49</xref>), a highly reactive oxidant species that is associated the development of autoimmune diabetes (<xref rid="b50-mmr-15-06-3871" ref-type="bibr">50</xref>). Although the precise role of NO in the development of diabetes is not fully understood, synthesis of the NO radical contributes significantly to &#x03B2;-cell dysfunction and apoptosis. Previous research demonstrated that iNOS serves an important role in reduced mitochondrial function in &#x03B2;-cells and islets (<xref rid="b51-mmr-15-06-3871" ref-type="bibr">51</xref>). Hirst and Robson (<xref rid="b52-mmr-15-06-3871" ref-type="bibr">52</xref>) reported that NO initiated alterations in the MMP, and the subsequent release of cytochrome <italic>c</italic> induced apoptosis. Notably, cytokine-induced production of NO inhibits the mitochondrial enzyme aconitase, thus resulting in a subsequent reduction in ATP production, which may contribute to the promotion of necrotic cell death (<xref rid="b53-mmr-15-06-3871" ref-type="bibr">53</xref>). The reaction of NO with superoxide mediates physiological processes, another method through which this may occur involves NO interaction with a metal at enzymatic active sites, particularly in the Krebs cycle, which ultimately results in significantly decreased glucose metabolism and ATP production (<xref rid="b54-mmr-15-06-3871" ref-type="bibr">54</xref>). Therefore, it is possible that PFOA may exert its toxic effect through the damaging effects of NO on mitochondrial function.</p>
<p>Pancreatic &#x03B2;-cell damage-initiated diabetes is a complex process that is mediated, at least in part, by interactions among cytokines, NO and oxygen-free radicals with the target &#x03B2;-cells (<xref rid="b55-mmr-15-06-3871" ref-type="bibr">55</xref>). The present study revealed that PFOA increased the release of TNF-&#x03B1; and IL-1&#x03B2;. These inflammatory cytokines are cytotoxic to &#x03B2;-cells <italic>in vitro</italic>, and they have demonstrated an ability to induce apoptosis in primary human (<xref rid="b56-mmr-15-06-3871" ref-type="bibr">56</xref>) and mouse (<xref rid="b57-mmr-15-06-3871" ref-type="bibr">57</xref>) pancreatic &#x03B2;-cells, possibly by stimulating NO synthesis (<xref rid="b58-mmr-15-06-3871" ref-type="bibr">58</xref>). These cytokines increase mitochondrial ROS production in several cell types (<xref rid="b59-mmr-15-06-3871" ref-type="bibr">59</xref>). Therefore, mitochondrial ROS serves an important role in cytokine toxicity. The mechanism that underlies mitochondrial ROS signaling in cytokine-induced apoptosis remains unknown, however it has been suggested that the destructive effects include cardiolipin peroxidation, MPT facilitation and inhibition of mitochondrial metabolism (<xref rid="b60-mmr-15-06-3871" ref-type="bibr">60</xref>). Previous research has indicated that various inhibitors of NO generation may protect insulin-secreting cells against cytokine-mediated toxicity, however this occurs with variable efficiency depending on the chemical inhibitor involved and the cytokine combination (<xref rid="b61-mmr-15-06-3871" ref-type="bibr">61</xref>).</p>
<p>In conclusion, the present study demonstrated that PFOA induced an increase in the production of RNS, ROS and inflammatory cytokines, and reduced ATP levels. Furthermore, PFOA induced MMP collapse and the release of cytochrome <italic>c</italic> from RIN-m5F rat pancreatic &#x03B2;-cell mitochondria. Therefore, these results indicated that PFOA may exert its cytotoxic effect on RIN-m5F cells through the increased oxidative stress and mitochondrial dysfunction associated with the induction of apoptosis.</p>
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<ack>
<title>Acknowledgements</title>
<p>The present study was supported by a grant of the Korea Health Technology R&#x0026;D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health &#x0026; Welfare, Republic of Korea (grant no. HI14C-2700-020014).</p>
</ack>
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</back>
<floats-group>
<fig id="f1-mmr-15-06-3871" position="float">
<label>Figure 1.</label>
<caption><p>Chemical structure of perfluorooctanoic acid.</p></caption>
<graphic xlink:href="MMR-15-06-3871-g00.tif"/>
</fig>
<fig id="f2-mmr-15-06-3871" position="float">
<label>Figure 2.</label>
<caption><p>Effects of PFOA on cell viability and apoptosis in RIN-m5F cells. (A) Cell viability and (B) apoptosis in RIN-m5F cells treated with PFOA for 48 h. &#x002A;P&#x003C;0.05, vs. control. PFOA, perfluorooctanoic acid.</p></caption>
<graphic xlink:href="MMR-15-06-3871-g01.tif"/>
</fig>
<fig id="f3-mmr-15-06-3871" position="float">
<label>Figure 3.</label>
<caption><p>Effects of PFOA on oxidative stress in RIN-m5F cells. RIN-m5F cells were incubated with PFOA for 48 h. (A) Treatment with PFOA significantly increased ROS levels as measured by dichlorofluorescin fluorescence. (B) Mitochondrial superoxide levels were determined using MitoSOX&#x2122; Red mitochondrial superoxide indicator. (C) NO levels were measured using 2&#x2032;,7&#x2032;-difluorofluorescein diacetate. Data are expressed as relative percentages of the control fluorescence (n=6). &#x002A;P&#x003C;0.05, vs. control. PFOA, perfluorooctanoic acid; ROS, reactive oxygen species; NO, nitric oxide.</p></caption>
<graphic xlink:href="MMR-15-06-3871-g02.tif"/>
</fig>
<fig id="f4-mmr-15-06-3871" position="float">
<label>Figure 4.</label>
<caption><p>Effects of PFOA on cytosolic TNF-&#x03B1; and IL-1&#x03B2; levels in RIN-m5F cells. RIN-m5F cells were incubated with PFOA for 48 h. (A) TNF-&#x03B1; and (B) IL-1&#x03B2; control values were 1.28&#x00B1;0.071 and 2.56&#x00B1;0.29 ng/mg, respectively. Data are expressed as percentages of the control (n=6). &#x002A;P&#x003C;0.05, vs. control. PFOA, perfluorooctanoic acid; TNF-&#x03B1;, tumor necrosis factor &#x03B1;; IL-1&#x03B2;, interleukin-1&#x03B2;.</p></caption>
<graphic xlink:href="MMR-15-06-3871-g03.tif"/>
</fig>
<fig id="f5-mmr-15-06-3871" position="float">
<label>Figure 5.</label>
<caption><p>Effects of PFOA on MMP stability and ATP levels in RIN-m5F cells. RIN-m5F cells were incubated with PFOA for 48 h. (A) Rhodamine 123 was used to measure MMP collapse. Data are expressed as relative percentages of the fluorescence emitted by rhodamine 123 with respect to non-treated control cells (n=6). (B) Cellular ATP levels in control and PFOA-treated cells. The ATP control concentration was 0.326&#x00B1;0.019 nmol/mg. Data are expressed as percentages of the control (n=6). &#x002A;P&#x003C;0.05, vs. control. PFOA, perfluorooctanoic acid; MMP, mitochondrial membrane potential; ATP, adenosine triphosphate.</p></caption>
<graphic xlink:href="MMR-15-06-3871-g04.tif"/>
</fig>
<fig id="f6-mmr-15-06-3871" position="float">
<label>Figure 6.</label>
<caption><p>Effects of PFOA on cytochrome <italic>c</italic> release and cardiolipin peroxidation in RIN-m5F cells. RIN-m5F cells were incubated with PFOA for 48 h. (A) Cytochrome <italic>c</italic> release into the culture media was determined. The control value for cytochrome <italic>c</italic> was 1.31&#x00B1;0.286. (B) Cardiolipin oxidation was measured using 5 &#x00B5;M NAO. Data are expressed as relative percentages of the fluorescence emitted by bound NAO with respect to non-treated control cells; a decrease in NAO binding was related to cardiolipin peroxidation. Data are expressed as percentages of control (n=6). &#x002A;P&#x003C;0.05, vs. control. PFOA, perfluorooctanoic acid; NAO, 10-N-nonyl-Acridine Orange.</p></caption>
<graphic xlink:href="MMR-15-06-3871-g05.tif"/>
</fig>
</floats-group>
</article>