Transforming growth factor-β (TGF-β) is implicated in numerous pathological disorders, including cancer and mediates a broad range of biological responses by signaling through the type I and II TGF-β receptors. Internalization of these receptors via the clathrin-coated pits pathway facilitates SMAD-mediated signaling, whereas internalization via the caveolae pathway is associated with receptor degradation. Thus, molecules that modulate receptor endocytosis are likely to play a critical role in regulating TGF-β action. We previously identified CD109, a GPI-anchored protein, as a TGF-β co-receptor and a negative regulator of TGF-β signaling. Here, we demonstrate that CD109 associates with caveolin-1, a major component of the caveolae. Moreover, CD109 increases binding of TGF-β to its receptors and enhances their internalization via the caveolae. In addition, CD109 promotes localization of the TGF-β receptors into the caveolar compartment in the presence of ligand and facilitates TGF-β-receptor degradation. Thus, CD109 regulates TGF-β receptor endocytosis and degradation to inhibit TGF-β signaling. This article is part of a Special Issue entitled: 11th European Symposium on Calcium.

Transforming growth factor-β (TGF-β) is a multifunctional cytokine that regulates a wide variety of cellular processes including proliferation, differentiation, and extracellular matrix deposition. Dysregulation of TGF-β signaling is associated with several diseases such as cancer and tissue fibrosis. TGF-β signals through two transmembrane proteins known as the type I (TGFBR1) and type II (TGFBR2) receptors. The levels of these receptors at the cell surface are tightly regulated by several mechanisms, including degradation following recruitment of the E3 ubiquitin ligase SMAD ubiquitination regulatory factor (Smurf) 2 by SMAD7. In addition, TGF-β co-receptors can modulate TGF-β signaling receptor activity in a cell-specific manner. We have previously identified a novel TGF-β co-receptor, CD109, a glycosyl phosphatidylinositol (GPI)-anchored protein that negatively regulates TGF-β signaling. Despite CD109's potential relevance as a regulator of TGF-β action in vivo, the mechanisms by which CD109 regulates TGF-β signaling are still incompletely understood. Previously, we have shown that CD109 downregulates TGF-β signaling by promoting TGF-β receptor localization into the lipid raft/caveolae compartment and by enhancing TGF-β receptor degradation. Here, we demonstrate that CD109 enhances SMAD7/Smurf2-mediated degradation of TGFBR1 in a ligand-dependent manner. Moreover, we show that CD109 regulates the localization and the association of SMAD7/Smurf2 with TGFBR1. Finally, we demonstrate that CD109's inhibitory effect on TGF-β signaling and responses require SMAD7 expression and Smurf2 ubiquitin ligase activity. Taken together, these results suggest that CD109 is an important regulator of SMAD7/Smurf2-mediated degradation of TGFBR1.

Objectives: Older adults living in long-term care facilities (LTCFs) are particularly at risk during transitions in care, most notably from acute care back to their LCTF. Issues surrounding miscommunication of information or medications are often mentioned as important challenges. Transitional care interventions (TCi) have emerged as solutions to improve outcomes. The objective of this review was therefore to determine the effects of TCi on several indicators of quality of care, clinical outcomes, healthcare services use and satisfaction among older patients discharged from acute care to LTCFs. Methods: Medline, CINAHL, EMBASE, Cochrane Central and Social Work Abstracts were searched. Study selection (title/abstract, full-text), data extraction and assessment of study quality were conducted by two independent reviewers. A narrative synthesis of the data was performed. Results: From the 5,506 references identified, 11 were included. Eight studies reported on quality of care: six on medication problems, and two on advance directives. Four studies reported on clinical outcomes: three on mortality, two on mobility/function and one on confusion/behavioral symptoms. Seven studies reported on healthcare services use: six on hospital readmissions/ED visits, and five on hospital days. Three studies reported on satisfaction with TCi. While satisfaction levels were high with TCi, other outcomes were inconclusive. Medications problems appeared to be the outcome most likely to benefit from TCi. Discussion: TCi targeting the acute to long-term care transition have obtained inconclusive results so far. More studies investigating the outcomes of quality of care, clinical outcomes, healthcare services use are needed.