SUMO protein is implicated in the etiology of many biomedical disease states not limited to: cancer, atherosclerosis, cardiovascular disease, neurodegenerative disease, diabetes, liver disease, intestinal disorders, and even infectious disease. In the case of the well-studied cancer tumor suppressor known as p53, there is a regulatory ubiquitin ligase protein in humans called Mouse Double Minute 2 protein, or MDM2, which acts to remove p53 from the cell. MDM2 regulates itself through self-ubiquitination by way of a
RING finger domain, targeting itself for proteasomal destruction. When it is SUMOylated at the RING finger domain, MDM2 no longer limits its own function in the cell. When protected from itself, it likewise ubiquitinates p53, marking the protective p53 for destruction instead, whose absence is understood to promote cancer. Here again, the base case is SUMOylation, which is actively being undone by newly discovered SUMO protease SUSP4 and also by the SUMO protease interaction of SMT3IP1/SENP3 which is understood to deSUMOylate both MDM2 and p53. One of the ways p53 functions is as a DNA-binding tetramer; interestingly, SUMOylation of p53 delocalizes it from the nucleus, which prevents such activity. The critical nature of p53 cannot be overstated: in fact, if a human carries only one non-functioning copy of p53, it results in a deadly cancer prognosis known as
Li-Fraumeni syndrome. Beyond p53, in
cancer, many oncogenes and tumor suppressors have been discovered to be SUMOylated in order for the cancer to progress or not, with each SUMOylation event having one of a variety of effects. When IκB is SUMOylated, the SUMO
post-translational modification outcompetes ubiquitination, protecting it from degradation, and by extension, the transcription factor NF-κB is bound in a complex with IκB, preventing the expression of genes that may otherwise cause cells with DNA damage to
apoptose. In hypoxic conditions as arise in some cancers,
HIF-1α, which is usually SUMOylated followed by subsequent ubiquitination and degradation through the
von Hippel-Lindau tumor suppressor's ubiquitin ligase activity, is instead deSUMOylated thereby promoting survival of the tumorigenic cells. The fallout from deSUMOylation of HIF-1α includes promotion of
MMPs which are understood to contribute to the progression of EMT, a hallmark of cancer. In atherosclerosis, both p53 and ERK5 are SUMOylated by the stimulus of disturbed blood flow. The stimulus is transduced by the activation of a serine/threonine kinsase called p90RSK, which phosphorylates the human SUMO protease SENP2 at the throenine amino acid residue 368. That phosphorylation is sufficient for the delocalization of the SENP2 from the nucleus. The effects of this phosphorylation-dependent SENP2 inhibition by nuclear export include the SUMOylation of p53 which leads to endothelial cell
apoptosis, and SUMOylation of ERK5 which leads to inflammation. Nuclear export of SENP2 additionally downregulates
endothelial nitric oxide synthase, eNOS while it upregulates inflammatory adhesion molecules. As eNOS is required for healthy vascular physiology, pathological
oxidative stress ensues in vascular endothelial cells. With the oxidative stress comes subsequent accumulation of cellular lipids; this results in the inflammatory foamy cell state that is typified by
atherosclerosis as well as the similarly inflammatory myelin-laden macrophages known to produce chronic inflammation in
SCI. In cardiovascular disease, many proteins are subject to SUMOylation. To say SUMOylation itself is bad or good regarding this or any other class of disease is to overlook the role of the multiple proteins in question. One common denominator among many conditions is fibrosis; in myocardial fibrosis,
PPARγ1 is understood to have a role in regulating expression of some key genes, and its transcriptional activity is generally inhibited by SUMOylation. Therefore, one possible therapeutic intervention in the case of cardiac hypertrophy may be countering the SUMOylation of PPARγ1. In neurodegenerative disease, we often observe pathological accumulation of proteins. Inclusion bodies form when for example, the
Huntington's disease protein, aptly named Huntingtin, accumulates and folds into a form which is impervious to the proteasome. In Huntington's disease, sufficient SUMOylation of the anomalous
Huntingtin protein prior to such refolding could perhaps delay the progression of the disease state by enabling timely destruction of the protein while the polypeptide chains are still accessible to the protease subunits within the proteasome. Other accumulating proteins which threaten neurodegenerative disorders include α-synuclein (associated with Parkinson's) and Amyloid β (associated with Alzheimer's), and if acted upon early enough, disease could perhaps be better mitigated. == Human SUMO proteins ==