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but they all lacked a molecular handle to


P O S T- T R A N S L AT I O N A L M O D I F I C AT I O N S — T I M E L I N E
prove that this process had a regulatory role.
In 1964, soon after Phillips demonstrated
50 years of protein acetylation: the presence of acetyl groups in histones iso-
lated from calf thymus2, Allfrey showed that
from gene regulation to epigenetics, radio­labelled acetate (acetate‑2‑C14) was rap-
idly taken up and incorporated into histones
metabolism and beyond in isolated nuclei7 (FIG. 3). Surprisingly, this
incorporation was insensitive to the transla-
tion inhibitor puromycin, suggesting that it
Eric Verdin and Melanie Ott occurred after protein synthesis. The same
was observed using C14-methyl groups and
Abstract | In 1964, Vincent Allfrey and colleagues reported the identification of histone methylation7. Histones had recently
histone acetylation and with deep insight proposed a regulatory role for this protein been shown to inhibit RNA synthesis
modification in transcription regulation. Subsequently, histone acetyltransferases in nuclei and, in a remarkably prescient
(HATs), histone deacetylases (HDACs) and acetyl-Lys-binding proteins were experiment, Allfrey further showed that
acetylation of histones lowered their ability
identified as transcription regulators, thereby providing compelling evidence for
to inhibit RNA synthesis and carefully pro-
his daring hypothesis. During the past 15 years, reversible protein acetylation and posed a “dynamic and reversible mechanism
its modifying enzymes have been implicated in many cellular functions beyond for activation as well as repression of RNA
transcription regulation. Here, we review the progress accomplished during the synthesis” by reversible post-translational
past 50 years and discuss the future of protein acetylation. histone acetylation7. It would take another
30 years for this daring hypothesis to be
validated.
Post-translational modification (PTM) proteins; the link of histone acetylation
of proteins is emerging as a major regula- to epigenetics; and the connection found Laying the foundations
tory mechanism in all life forms. PTMs between acetylation and cellular metabo- After their initial discovery, Allfrey and
confer novel properties to the modified lism. We then discuss the effects that novel colleagues continued to work actively on
proteins, including changes in enzymatic proteomic approaches have had on the acetylation, further showing that histones
activity, subcellular localization, inter­action global identification of Lys acetylation sites, are acetylated on the ε‑amino group of Lys
partners, protein stability and DNA bind- and the advances made in developing drugs residues, identifying acetylation in other
ing. Although protein phosphorylation that target them. We end with an overview proteins — the high mobility group (HMG)
was discovered in 1959 (REF. 1) and protein of some future research directions and the chromatin proteins — and identifying
acetyl­ation in 1963 (REF. 2), the history of the challenges facing the field. histon­e deacetylase activities in nuclei.
two PTMs diverged dramatically over the In the mid‑1970s, Riggs and colleagues
following decades. Protein phosphorylation A daring hypothesis showed that induction of differentiatio­n
is the most studied PTM and occupies a The field of protein acetylation rests on of Friend erythroleukaemic cells into
central role in regulating signal transduc- work by Lipmann, Bloch and Lynen, all haemoglobi­n-synthesizing normoblast-like
tion pathways, metabolism and other cellu­ Nobel Prize winners for their discoveries of cells by the short fatty acid n‑butyrate was
lar processes. By contrast, acetylation was co­enzyme A (CoA) and acetyl-CoA. Not accompanied by strong histone hyperacetyl­
relatively ignored for the 30 years following only did they solve the structure of CoA and ation8. Following on this observation, the
its discovery (FIG. 1). A remarkable series of identify its coupling to acetate but they also groups of Allfrey and Davie reported that
congruent observations in the past 20 years highlighted the role of acetyl-CoA (which n‑butyrate was an inhibitor of HDACs9,10.
has brought protein acetylation and the used to be called ‘activated acetate’) as a key These papers showed for the first time that
enzymes that control it back to the forefront precursor to acetylation reactions3–6. small molecules targeting epigenetic regula-
of c­ellular regulatory mechanisms. In the early 1960s, at a time corre- tors can modify cellular function, including
This Timeline article marks the 50th sponding to the end of the golden age of the induction of cancer cell differentiation9,10.
anniversary of the discovery of protein metabolism discoveries, Vincent Allfrey Independently from this work,
acetylation. We describe the first steps made (FIG. 2), working with Alfred Mirsky, became tubuli­n was unexpectedly also found
in the field and highlight several key dis- interested in the possible role of chromatin to be acetylated. Noticing a form of
coveries, including: the discovery of histone in the regulation of gene expression. Some tubulin that migrated differently dur-
acetyltransferases (HATs), histone dea- laboratories had previously suspected that ing two-dimensional gel electrophoresis,
cetylases (HDACs) and acetyl-Lys-binding histones might be repressing RNA synthesis, L’Hernault and Rosenbaum showed that

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PERSPECTIVES

16,000 1,600 encoding this protein revealed that it was the


Phosphorylation orthologue of Gcn5, a yeast transcription reg-
14,000 Acetylation 1,400
ulator 24. Second, in a chemical biology tour
(PubMed citations per year)

(PubMed citations per year)


12,000 1,200 de force, Schreiber and colleagues used an
affinity matrix based on the HDAC inhibitor
Phosphorylation

10,000 1,000

Acetylation
trapoxin to purify a 46-kDa bovine thymus
8,000 800 protein25. Trapoxin had previously been iden-
tified by Yoshida and colleagues in screens
6,000 600
for small molecules that induce the differen-
4,000 400 tiation of tumour cells (a common function
of HDAC inhibitors)26,27. Microsequencing of
2,000 200
the trapoxin-bound protein revealed a
0 0 bovine orthologue of the yeast transcription
1964 1974 1984 1994 2004 2014
Year regulator Rpd3 (REF. 25). Rpd3 had previ-
ously been identified in several independent
Figure 1 | Publications on protein acetylation. The graphsNature show the growth in the number of papers
Reviews | Molecular Cell Biology
published on the topic of protein acetylation during the past 50 years, in comparison to the growth in mutant suppressor screens for transcription
the number of papers published on protein phosphorylation (searched in PubMed). Note that the scale repressors28. In perfect but opposing sym-
of the y axis for protein phosphorylation (on the left) is tenfold larger than for protein acetylation (on metry to the identification of Gcn5 as a HAT,
the right). A clear inflexion point in the rate of publication is visible in the field of protein acetylation histone deacetylase 1 (HDAC1) was cloned
following the two papers by Allis24 and by Schreiber25 in 1996. as the human orthologue of Rpd3 and shown
to exhibit HDAC activity in vitro.
These discoveries were followed by the
tubulin incorporated radiolabelled acetate11. cloned the first histone acetyltransferase, identification of additional HATs associ-
Piperno et al. developed a monoclonal HAT1, by screening a collection of yeast ated with transcription regulation, such as
antibody specific for acetylated α‑tubulin12 temperature-sensitive mutants with an CREB-binding protein (CBP), E1a‑binding
and mapped its binding to a unique residue, enzymatic assay for histone H4 acetylation22. protein p300 (EP300; also known as p300),
Lys40 (REFS 13,14). These important experi- Disappointingly, hat1 mutants had no obvi- the TAF(II)250 subunit of transcription
ments demonstrated the power of using ous growth defects or phenotypes other than factor IID (TFIID) and several members of
modification-specific antibodies, which lack of enzymatic activity. the MYST family of proteins (named for its
would prove to be key tools in the study of founding members MOZ, YBF2/SAS3, SAS2
protein acetylation. Paradoxically, although The epigenetic control of gene expression. and TIP60)29–37 (see also REF. 38 for a review).
α‑tubulin acetylation has been studied for Two independent discoveries electrified the In parallel to this work, detailed biochemical
the past 30 years and is a highly conserved field in 1996 and finally established a clear work led to the identification and the first
modification, it remains poorly understood. causal link between histone acetylation and characterization of the large multiprotein
In the late 1980s, pioneering studies by transcription regulation. First, using an complexes in which many of these proteins
several groups established a link between elegant in gel assay to purify a type A HAT function: the SAGA complex 39, the Sin3
acetylated core histones and transcription- (thought to be transcription-associated), complex 40–43 and the NURD complex 44,45.
ally active genes15, and identified the key Allis and colleagues identified a catalytically Rapidly thereafter, the first EP300
part played by specific Lys residues on active, 55-kDa protein from macronuclei inhibitor, Lys-CoA, was created by
histone tails in the silencing of transcrip- of the protozoan Tetrahymena thermoph- Cole and colleague­s by covalently linkin­g
tion at telomeres and in the control of the ila23. Purification and cloning of the gene CoA and a Lys residue, producing a
mating locus in yeast 16–19. In parallel, Turner
and colleagues used site-specific antibodies
for different histone acetylation marks and Figure 2 | Vincent Allfrey (1921–2002): acety-
indirect immunofluorescence on polytene lation pioneer. Vincent Allfrey, a native New
Yorker, started his career as a young laboratory
chromosomes to show that distinct acetyla-
helper in the illustrious company of Oswald
tion modifications were localized on differ- Avery’s laboratory at the Rockefeller Institute,
ent chromosomal domains. These findings New York, USA. There, he purified pneumococcal
further supported the hypothesis that his- DNA using an experimental system that would be
tones acetylated at particular sites mediated later used by Avery and colleagues to prove that
unique and specific effects on gene expres- genetic information is linked to DNA. After
sion by modifying the degree of chromatin obtaining his Ph.D. from Columbia University,
condensation20,21 (FIG. 4). New York, USA, Allfrey joined the laboratory of
Alfred Mirsky, who was the first to isolate chroma-
Acetylation modifiers and readers tin. He rapidly became interested in the link
between chromatin and gene regulation, and is
The stage was now set for the flurry of dis-
credited with first proposing the model that his-
coveries, made between 1995 and 2000, of tone modifications, including histone acetylation
acetylation-modifying enzymes, their role and methylation, control gene expression by
in transcription regulation, their structures, regulating access to the DNA. Image (dated
multiprotein complexes and novel targets. 1992) is by Robert Reichert, courtesy of The
Sternglanz and colleagues identified and Rockefeller University Public Affairs, USA.

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PERSPECTIVES

pseudo­substrate mimicking an enzymatic Soon after the publication of the land- as an acetyl reader, with some selectivity for
intermediate of the acetylation reaction46. mark paper by Zhou and colleagues68, acetylated Lys9 from histone H3 (H3K9Ac).
A similar rapid flow of discoveries of Owens et al. crystallized an acetylated histone This suggested that additional acetyl readers
HDACs occurred, first with the identifica- H4 peptide in complex with the yeast Gcn5 might be identified in the future71.
tion of other Rpd3‑related proteins, HDAC2 bromo­domain, and identified a canonical
and HDAC3 (REFS 47–50), which, together Asn residue that is present in most bromo­ Sensing the metabolic state of the cell. In the
with HDAC1 and HDAC8, comprise the domains and is the critical interacting residue span of a few years, the field of acetylation
class I family of HDACs. A separate family of in the acetyl-Lys binding pocket69. This core had gone from having no known acetylation-
HDACs was identified based on their close structure is conserved across all eight bro- modifying enzymes, to the elucidation of the
homology to yeast Hda1, a protein related modomain families identified so far, despite structure and mechanism of action of more
to, but distinct from, Rpd3. The members of little sequence homology. In a remarkable, than 20 HATs and HDACs. Furthermore, a
this family (HDAC4–HDAC7 and HDAC9) more recent effort, several groups crystalized surprise was in store: the Sir proteins, known
are called class II HDACs51–54. HDAC10 29 of the 61 bromodomains encoded in the as transcription repressors at telomeres and
and HDAC11 were discovered later and human genome and annotated the shared and ribosomal DNA, were long suspected to be
completed the class II and IV families, unique structural characteristics, as well as regulators of protein acetylation because
respectively 55–57. the ligand preferences, of individual bromo- yeast Sir mutants exhibited increased histone
Following these discoveries, the first domains within different families70. Recently, acetylation72. Frye identified five human
protein crystal structures were solved for the YEATS domain (named after the five cDNAs with homology to the yeast SIR2 gene
an HDAC (a homologue of Rpd3 from founding domain-containing proteins, Yaf9, (he called them sirtuins) and showed that
the hyperthermophilic bacterium Aquifex ENL, AF9, Taf14 and Sas5) was also identified they metabolized NAD+ (REF. 74).
aeolicu­s)58, for type A HATs (the acetyl-
transferase domains of PCAF (also known
as KAT2B) and Gcn5 (REFS 59–61)) and for Allfrey and colleagues propose
a class III HDAC (discussed below) — a 1964 that histone acetylation
Sir2 (silent information regulator subunit 2) n-butyrate is identified as regulates gene expression7
1978
orthologue from Archaeoglobus fulgidus, in an inhibitor of HDACs9,10
complex with NAD+ (REF. 62). During the 1983 Discovery of tubulin
acetylation11
same period, a growing number of non-
histone proteins, mostly involved in tran- O O
Mutation of Lys residues in
scription regulation, were rapidly revealed to histone tails highlight their role 1990 OH
N
undergo acetylation, thereby progressively in gene regulation in yeast16–19 H
H3C
expanding the scope of cellular protein N
Yoshida and colleagues
acetylation. The first such proteins were the Allis and colleagues
CH3 identify the natural
1993
tumour suppressor p53 (REF. 63), the HIV identify Gcn5 as a HAT24 products trapoxin and
transcriptional activator Tat 64,65, the tran- trichostatin A as HDAC
HDAC1 is identified as an orthologue inhibitors26,27
scription factor nuclear factor-κB (NF-κB)66 1996
of Rpd3 by Schreiber and colleagues25
and others (reviewed in REF. 67).
TSA First structures of Zhou and colleagues identify
Reading protein acetylation. Analogous to HATs and HDACs 1999 the bromodomain as an
what had been observed for protein phos- determined58–61 acetyl-Lys-binding domain68
phorylation, whereby SRC-homology 2
(SH2) domains specifically recognize Zn
peptides containing phosphorylated Tyr Guarente and colleagues
2000
demonstrate that Sir2 is an
residues, Zhou and colleagues reported that NAD+-dependent deacetylase75
the bromodomain specifically recognizes C
acetylated Lys residues68. This introduced the Cole and colleagues synthesize
concept of ‘reader’ proteins to the acetylation Lys–CoA as a pseudosubstrate
Sinclair and colleagues show HAT inhibitor46
2003
field in addition to the previously identi- that resveratrol is a SIRT1
OH
activator88,89
fied ‘writers’ (HATs) and ‘erasers’ (HDACs)
(FIG. 4). Bromodomains were found to be HO

present in diverse types of nuclear proteins, 2006 Zhao and colleagues perform
including HATs, ATP-dependent chromatin- the first proteomic screen for
acetylation sites81
remodelling proteins, helicases, methyltrans- OH

ferases, transcription co-activators, nuclear Vorinostat receives FDA approval


scaffolding proteins, and in the bromo­ JQ1 and I-BET are identified as the for the treatment of advanced
2010
first bromodomain inhibitors91,92 primary cutaneous T cell lymphoma
domain and extraterminal (BET) protein
family (reviewed in REF. 38). The potential
recruitment of these transcription mediators
to an acetylated binding partner explained Figure 3 | Milestones in protein acetylation. Timeline of the history of protein acetylation research.
in part how acetylation could be linked to a Nature Reviews
FDA, Food and Drug Administration; HATs, histone acetyltransferases; | Molecular
HDACs, Cell Biology
histone deacetylases;
plethora of functional outcomes. Sir2, silent information regulator 2; SIRT1, sirtuin 1.

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PERSPECTIVES

were mitochondrial proteins, and the pre-


Reader
diction was made that mitochondria might
Ac
Ac Ac Ac represent a unique environment where acety-
lation is abundant. In the same year, the first
Acetylated chromatin
Open and transcriptionally active
Gene On mitochondrial acetylated protein targeted
by SIRT3 was identified — acetyl-CoA syn-
thetase81,82 — demonstrating the regulatory
role of protein acetylation in mitochondrial
Chromatin metabolism.
Writer remodelling Eraser
Three years later, Mann and colleagues
used high-resolution mass spectrometry
to look deeper into the cellular acetylome.
Deacetylated chromatin
Compact and transcriptionally repressed They identified 3,600 Lys acetylation sites in
Gene Off
1,750 proteins83, and observed that acetyla-
Figure 4 | Histone acetylation, chromatin condensation and gene expression. Acetylation targets tion was particularly prominent in large
Lys residues in the amino-terminal tails of core histone proteins. A string of nucleosomes is shown with macromolecular complexes involved in a
Nature Reviews | Molecular Cell Biology range of cellular activities, such as chromatin
the tails protruding when acetylated. Acetylation of the tail domains inhibits the folding of nucleo-
some arrays into secondary and tertiary chromatin structures, with acetylation of histones H2B and H4 remodelling, the cell cycle, splicing, nuclear
having the greatest effect on tertiary structure formation103–105. Thus, histone tail acetylation results in transport and actin nucleation. With such a
chromatin decondensation, thereby allowing access to transcription factors and other transcription large number of acetylated proteins involved
co‑activators. in numerous cellular processes, protein
acetyl­ation was finally established as a
globall­y important PTM.
Soon after, Guarente and colleagues example, SIRT3 (REFS 78,79)), suggested that
elegantly demonstrated that yeast Sir2 and acetylation might be more broadly distributed Targeting acetylation with drugs
mouse SIRT2 proteins are HDACs, the than had been anticipated. This prediction The discovery of protein acetylation and of
activity of which is uniquely dependent became partly validated in 2006 by the first the proteins that write, erase or read acetyl
on NAD+ (REF. 74). During deacetylation, reported proteomic survey of protein acetyla- groups within proteins has led to the identifi-
NAD+ is cleaved, releasing nicotinamide tion. Using a new enrichment approach based cation of many novel epigenetic drug targets.
and the ADP–ribose covalently linked to the on acetylatio­n-specific antibodies, Zhao and The first FDA-approved acetylation-modify-
removed acetyl group (acetyl–ADP–ribose) colleagues identified 388 acetylation sites in ing agent was the HDAC inhibitor vorinostat
(BOX 1). Based on previous work showing 195 proteins80. Thus, in one single experi- (also known as suberanilohydroxamic acid
that a gain‑of‑functio­n mutation of Sir2 was ment, more acetylated proteins had been (SAHA)), initially identified as an agent
associated with an increased lifespan in yeast, identified than in the preceding 40 years. inducing the differentiation of tumour
Guarente further proposed that the depend- Remarkably and unexpectedly, many of these cells in vitro and subsequently as an HDAC
ency of Sir2 on NAD+ for its enzymatic activ-
ity enabled it to sense the energy status of
the cell. Indeed, NAD+ levels increase when Box 1 | The interface between protein acetylation and metabolism
cellu­lar nutrient levels are restrictively low,
Metabolism can influence protein acetylation by changes in the cellular concentration of NAD+ and
and this activates Sir2 and other sirtuins,
acetyl-coenzyme A (acetyl-CoA). For example, during fasting the relative concentration of NAD+
thereby transducing a metabolic signal to
increases, leading to an increase in the enzymatic activity of sirtuins and the deacetylation of their
various proteins, including histones, by dea- targets (see the figure). In contrast to kinases, the enzymatic activity of which is largely
cetylating them (BOX 1). At the time of its pro- independent of fluctuations in ATP concentrations, the activity of acetyltransferases varies as a
posal, this model that chromatin-modifying function of acetyl-CoA concentrations. When nutrient abundance increases, the cellular
proteins sense changes in the environment concentration of acetyl-CoA increases, leading to an increase in acetyltransferase activity and
through their effect on intermediary metabo- target protein acetylation.
lites was a bold idea, one which is currently
gaining much experimental support for ↓ Nutrients
acetyl­ation and other chromati­n PTMs
(reviewed in REF. 75).
↑ NAD+ Ac CoA
Lys
Acetylation goes global
With the exception of tubulin, most acetylated Protein
proteins appeared to be nuclear and associ- Sirtuin Acetyltransferase
ated with transcription regulation. In 2000,
Kouzarides wondered in a review whether
“acetylation was a regulatory modification to
rival phosphorylation” (REF. 76). Soon after, Nicotinamide Lys ↑ Acetyl-CoA
+ acetyl–ADP–ribose
however, the observations that several sirtuins Protein
were localized in the cytoplasm (for exam- ↑ Nutrients
ple, SIRT2 (REF. 77)) or in mitochondria (for
Nature Reviews | Molecular Cell Biology

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PERSPECTIVES

inhibitor 84 (as was the case for another HDAC The development of HAT inhibitors has Finally, our understanding of the nexus
inhibitor, n-butyrate). Vorinostat, which proved more difficult, but recent successes between intermediary metabolites and
is approved for the treatment of cutaneous by Cole and colleagues93 in developing protein acetylation is still rudimentary and
T cell lymphoma, and two other subsequently highly selective EP300 inhibitors indicate mostly based on NAD+ and acetyl-CoA con-
approved HDAC inhibitors — romidepsin that the development of epigenetic drugs centrations. Recent results indicate that the
(Istodax, FK228, FR901228; Celgene)85 and against HATs is likely to become fruitful ketone body β-hydroxybutyrate, an impor-
panabinostat — are currently being tested as well. tant metabolite during fasting, functions as a
in a large number of cancer clinical trials. class I HDAC inhibitor and induces histone
Interestingly, the three drugs are also being The future of protein acetylation hyperacetylation during fasting102.
tested in HIV-infected individuals to reac- A key direction for future research will be Expanding on these observations and
tivate latent HIV that persists in patients the identification of all proteins the acety- carrying out further molecular studies of the
treated with antiretroviral therapy (ART). It is lation of which is regulated by different role of acetylation in regulating cellular pro-
anticipated that treatment with these HDAC acetyltransferases and deacetylases. As a cesses represent the main challenges for the
inhibitors will allow the patients’ immune first step in this direction, three recently future. In addition, exploiting the identified
system, in combination with ART, to destroy published studies described the identifica- regulators of acetylation as potential thera-
the latently infected cells86 and could lead to tion of the target sites of the mitochondrial peutic targets will fulfil the full potential of
curing HIV infections. SIRT3 in mouse tissues94,95 and in cell lines94. the field of protein acetylation.
With regard to sirtuins, the focus of It is important to note that although
drug development has instead been on many acetylation sites have been identified, Conclusion
identifying enzymatic activators, with the there is little information on the stoichiom- Allfrey’s daring hypothesis laid the founda-
hope that they would increase lifespan by etry of individual sites (that is, the percent- tion for the field of histone PTMs and epi-
mimicking the gain-of-function mutation age of each site that is acetylated in cells). genetic regulation. During the past 50 years,
in Sir2. Sinclair and colleagues reported the In fact, two recent studies addressing this protein acetylation has emerged not only
identification of the polyphenol resvera- important question found that different as an important epigenetic regulator but
trol (which is abundant in red wine) as the acetylation sites have markedly different also as a PTM, uniquely coupled to cellular
first Sir2 and SIRT1 activator, and further stoichiometries96,97. Many sites in mito- metabolism (BOX 1). Although acetylation
showed that it increased lifespan in yeast and chondrial and cytoplasmic proteins showed still has a lot of catching up to do on protein
meta­zoans87,88. Whereas subsequent observa- low stoichiometry and a strong correlation phosphoryl­ation (FIG. 1), a solid foundation
tions by other groups have questioned these between stoichiometry and acetyl-CoA has been established and much exciting
results and the selectivity of resveratrol, a level­s, consistent with protein acetyla- work remains to be done.
recent comprehensive study, also carried tion also being a non-enzymatic process. Eric Verdin and Melanie Ott are at the
out by Sinclair and colleagues, has brought By contrast, high abundance of acetylation Gladstone Institutes, University of California,
renewed support to a mechanistic model in was found mostly in nuclear proteins such San Francisco, 1650 Owens Street, San Francisco,
which sirtuin-activating compounds allos- as histones, HDAC and HAT complexes California 94158, USA.

terically activate SIRT1 (REF. 89). Thus, such and transcription factors, but also in a sub- Correspondence to E.V.
compounds could be therapeutically relevant set of mitochondrial proteins that either e‑mail: everdin@gladstone.ucsf.edu
for many age-related diseases. use or generate acetyl-CoA. Non-enzymatic doi:10.1038/nrm3931
The discovery of small-molecule inhibi- acetylation was first observed in the 1970s Published online 30 December 2014
tors that disrupt the interaction between the on histones98 and might be particularly
1. Fischer, E. H., Graves, D. J., Crittenden, E. R. &
bromodomain and acetyl-Lys was recently relevant in mitochondria, where the local Krebs, E. G. Structure of the site phosphorylated in
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1698–1704 (1959).
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tinct, harbour a triazole ring that forms the slow kinetics of non-enzymatic protein histones. Biochem. J. 87, 258–263 (1963).
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inhibitor I‑BET functions as an immuno- some sirtuins seem to target these newly Butyrate suppression of histone deacetylation leads to
suppressant, suggesting possible clinical described modifications, as SIRT5 was accumulation of multiacetylated forms of histones H3
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