The structural integrity and mechanical properties of tissues are regulated by the extracellular matrix (ECM). Perturbations in the ECM contribute to fibrosis, cancer, and cardiovascular disease progression (
1Overview of the matrisome—an inventory of extracellular matrix constituents and functions.
,
2- Finch-Edmondson M.
- Sudol M.
Framework to function: mechanosensitive regulators of gene transcription.
,
3- Lampi M.C.
- Reinhart-King C.A.
Targeting extracellular matrix stiffness to attenuate disease: from molecular mechanisms to clinical trials.
,
4- Tschumperlin D.J.
- Ligresti G.
- Hilscher M.B.
- Shah V.H.
Mechanosensing and fibrosis.
). The reduction in ECM synthesis and dysfunctional assembly is also the underlying cause of the morbidity observed in individuals with impaired wound healing and in those with genetic connective tissue disorders, including the Ehlers–Danlos syndromes (EDS) (
5- Malfait F.
- Francomano C.
- Byers P.
- Belmont J.
- Berglund B.
- Black J.
- Bloom L.
- Bowen J.M.
- Brady A.F.
- Burrows N.P.
- Castori M.
- Cohen H.
- Colombi M.
- Demirdas S.
- De Backer J.
- et al.
The 2017 international classification of the Ehlers-Danlos syndromes.
,
6- Vanakker O.
- Callewaert B.
- Malfait F.
- Coucke P.
The Genetics of soft connective tissue disorders.
). Individuals with EDS-causing mutations in collagen or collagen regulatory proteins display a disease spectrum that includes aberrant wound healing, joint hypermobility, and vascular disruption, all related to a mechanically weak or fragile ECM (
5- Malfait F.
- Francomano C.
- Byers P.
- Belmont J.
- Berglund B.
- Black J.
- Bloom L.
- Bowen J.M.
- Brady A.F.
- Burrows N.P.
- Castori M.
- Cohen H.
- Colombi M.
- Demirdas S.
- De Backer J.
- et al.
The 2017 international classification of the Ehlers-Danlos syndromes.
). Mutations in genes encoding collagens I, III, and V lead to irregularities in collagen primary structure, processing, folding, and cross-linking (
5- Malfait F.
- Francomano C.
- Byers P.
- Belmont J.
- Berglund B.
- Black J.
- Bloom L.
- Bowen J.M.
- Brady A.F.
- Burrows N.P.
- Castori M.
- Cohen H.
- Colombi M.
- Demirdas S.
- De Backer J.
- et al.
The 2017 international classification of the Ehlers-Danlos syndromes.
,
6- Vanakker O.
- Callewaert B.
- Malfait F.
- Coucke P.
The Genetics of soft connective tissue disorders.
).
Recently, several groups have identified EDS-causative mutations in the
AEBP1 gene, which encodes the ECM protein aortic carboxypeptidase-like protein (ACLP) (
7- Alazami A.M.
- Al-Qattan S.M.
- Faqeih E.
- Alhashem A.
- Alshammari M.
- Alzahrani F.
- Al-Dosari M.S.
- Patel N.
- Alsagheir A.
- Binabbas B.
- Alzaidan H.
- Alsiddiky A.
- Alharbi N.
- Alfadhel M.
- Kentab A.
- et al.
Expanding the clinical and genetic heterogeneity of hereditary disorders of connective tissue.
,
8- Blackburn P.R.
- Xu Z.
- Tumelty K.E.
- Zhao R.W.
- Monis W.J.
- Harris K.G.
- Gass J.M.
- Cousin M.A.
- Boczek N.J.
- Mitkov M.V.
- Cappel M.A.
- Francomano C.A.
- Parisi J.E.
- Klee E.W.
- Faqeih E.
- et al.
Bi-allelic alterations in AEBP1 lead to defective collagen assembly and connective tissue structure resulting in a variant of Ehlers-Danlos syndrome.
,
9- Hebebrand M.
- Vasileiou G.
- Krumbiegel M.
- Kraus C.
- Uebe S.
- Ekici A.B.
- Thiel C.T.
- Reis A.
- Popp B.
A biallelic truncating AEBP1 variant causes connective tissue disorder in two siblings.
,
10- Ritelli M.
- Cinquina V.
- Venturini M.
- Pezzaioli L.
- Formenti A.M.
- Chiarelli N.
- Colombi M.
Expanding the clinical and mutational spectrum of recessive AEBP1-related classical-like Ehlers-Danlos syndrome.
,
11- Syx D.
- De Wandele I.
- Symoens S.
- De Rycke R.
- Hougrand O.
- Voermans N.
- De Paepe A.
- Malfait F.
Bi-allelic AEBP1 mutations in two patients with Ehlers-Danlos syndrome.
). These compound heterozygous or homozygous
AEBP1/ACLP mutations cause a distinct EDS subtype, designated EDS classic-like 2 (EDSCLL2). Individuals with
AEBP1/ACLP mutations suffer from severe connective tissue pathologies including common and variable features. ACLP mutations in humans result in delayed wound healing, abnormal scarring, joint hypermobility, hip dislocations, osteopenia, mitral valve prolapse, dilatation of the aortic root, and aortic dissection (
7- Alazami A.M.
- Al-Qattan S.M.
- Faqeih E.
- Alhashem A.
- Alshammari M.
- Alzahrani F.
- Al-Dosari M.S.
- Patel N.
- Alsagheir A.
- Binabbas B.
- Alzaidan H.
- Alsiddiky A.
- Alharbi N.
- Alfadhel M.
- Kentab A.
- et al.
Expanding the clinical and genetic heterogeneity of hereditary disorders of connective tissue.
,
8- Blackburn P.R.
- Xu Z.
- Tumelty K.E.
- Zhao R.W.
- Monis W.J.
- Harris K.G.
- Gass J.M.
- Cousin M.A.
- Boczek N.J.
- Mitkov M.V.
- Cappel M.A.
- Francomano C.A.
- Parisi J.E.
- Klee E.W.
- Faqeih E.
- et al.
Bi-allelic alterations in AEBP1 lead to defective collagen assembly and connective tissue structure resulting in a variant of Ehlers-Danlos syndrome.
,
9- Hebebrand M.
- Vasileiou G.
- Krumbiegel M.
- Kraus C.
- Uebe S.
- Ekici A.B.
- Thiel C.T.
- Reis A.
- Popp B.
A biallelic truncating AEBP1 variant causes connective tissue disorder in two siblings.
,
10- Ritelli M.
- Cinquina V.
- Venturini M.
- Pezzaioli L.
- Formenti A.M.
- Chiarelli N.
- Colombi M.
Expanding the clinical and mutational spectrum of recessive AEBP1-related classical-like Ehlers-Danlos syndrome.
,
11- Syx D.
- De Wandele I.
- Symoens S.
- De Rycke R.
- Hougrand O.
- Voermans N.
- De Paepe A.
- Malfait F.
Bi-allelic AEBP1 mutations in two patients with Ehlers-Danlos syndrome.
). These symptoms are also observed in classical, hypermobile, cardiac-valvular, vascular, musculocontractural, and kyphoscoliotic EDS (
11- Syx D.
- De Wandele I.
- Symoens S.
- De Rycke R.
- Hougrand O.
- Voermans N.
- De Paepe A.
- Malfait F.
Bi-allelic AEBP1 mutations in two patients with Ehlers-Danlos syndrome.
).
The gene name
AEBP1 (adipocyte enhancer–binding protein 1) is derived from a mouse cDNA that was proposed to be a transcriptional repressor (
12- He G.P.
- Muise A.
- Li A.W.
- Ro H.S.
A eukaryotic transcriptional repressor with carboxypeptidase activity.
). Compared with ACLP, the mouse Aebp1 cDNA is missing ∼1.5 kb of sequence (encoding more than 400 amino acids), and it does not likely encode for an authentic protein (
13- Layne M.D.
- Endege W.O.
- Jain M.K.
- Yet S.F.
- Hsieh C.M.
- Chin M.T.
- Perrella M.A.
- Blanar M.A.
- Haber E.
- Lee M.E.
Aortic carboxypeptidase-like protein, a novel protein with discoidin and carboxypeptidase-like domains, is up-regulated during vascular smooth muscle cell differentiation.
,
14Adipocyte enhancer binding protein 1 and aortic carboxypeptidase-like protein.
,
15Carboxypeptidases from A to Z: implications in embryonic development and Wnt binding.
,
16- Abderrahim-Ferkoune A.
- Bezy O.
- Astri-Roques S.
- Elabd C.
- Ailhaud G.
- Amri E.Z.
Transdifferentiation of preadipose cells into smooth muscle-like cells: role of aortic carboxypeptidase-like protein.
,
17- Teratani T.
- Tomita K.
- Suzuki T.
- Furuhashi H.
- Irie R.
- Nishikawa M.
- Yamamoto J.
- Hibi T.
- Miura S.
- Minamino T.
- Oike Y.
- Hokari R.
- Kanai T.
Aortic carboxypeptidase-like protein, a WNT ligand, exacerbates nonalcoholic steatohepatitis.
). Consistent with a role in the extracellular environment, ACLP contains a signal peptide, an N-terminal domain predicted to fold into thrombospondin type I repeats, a central collagen-binding discoidin domain, and a C-terminal catalytically inactive metallocarboxypeptidase domain (
8- Blackburn P.R.
- Xu Z.
- Tumelty K.E.
- Zhao R.W.
- Monis W.J.
- Harris K.G.
- Gass J.M.
- Cousin M.A.
- Boczek N.J.
- Mitkov M.V.
- Cappel M.A.
- Francomano C.A.
- Parisi J.E.
- Klee E.W.
- Faqeih E.
- et al.
Bi-allelic alterations in AEBP1 lead to defective collagen assembly and connective tissue structure resulting in a variant of Ehlers-Danlos syndrome.
,
13- Layne M.D.
- Endege W.O.
- Jain M.K.
- Yet S.F.
- Hsieh C.M.
- Chin M.T.
- Perrella M.A.
- Blanar M.A.
- Haber E.
- Lee M.E.
Aortic carboxypeptidase-like protein, a novel protein with discoidin and carboxypeptidase-like domains, is up-regulated during vascular smooth muscle cell differentiation.
,
14Adipocyte enhancer binding protein 1 and aortic carboxypeptidase-like protein.
,
15Carboxypeptidases from A to Z: implications in embryonic development and Wnt binding.
). Supporting the concept that ACLP functions in collagen assembly and regulatory pathways, ACLP is expressed in collagen-rich connective tissues, including the vasculature, skin, tendons, and ligaments (
18- Layne M.D.
- Yet S.F.
- Maemura K.
- Hsieh C.M.
- Bernfield M.
- Perrella M.A.
- Lee M.E.
Impaired abdominal wall development and deficient wound healing in mice lacking aortic carboxypeptidase-like protein.
,
19- Ith B.
- Wei J.
- Yet S.F.
- Perrella M.A.
- Layne M.D.
Aortic carboxypeptidase-like protein is expressed in collagen-rich tissues during mouse embryonic development.
). Our previous studies determined that loss of ACLP function in mice resulted in delayed dermal wound healing and provided protection in the lung against a profibrotic injury (
18- Layne M.D.
- Yet S.F.
- Maemura K.
- Hsieh C.M.
- Bernfield M.
- Perrella M.A.
- Lee M.E.
Impaired abdominal wall development and deficient wound healing in mice lacking aortic carboxypeptidase-like protein.
,
20- Schissel S.L.
- Dunsmore S.E.
- Liu X.
- Shine R.W.
- Perrella M.A.
- Layne M.D.
Aortic carboxypeptidase-like protein is expressed in fibrotic human lung and its absence protects against bleomycin-induced lung fibrosis.
). We showed that the central discoidin domain of ACLP bound to fibrillar collagens
in vitro (
8- Blackburn P.R.
- Xu Z.
- Tumelty K.E.
- Zhao R.W.
- Monis W.J.
- Harris K.G.
- Gass J.M.
- Cousin M.A.
- Boczek N.J.
- Mitkov M.V.
- Cappel M.A.
- Francomano C.A.
- Parisi J.E.
- Klee E.W.
- Faqeih E.
- et al.
Bi-allelic alterations in AEBP1 lead to defective collagen assembly and connective tissue structure resulting in a variant of Ehlers-Danlos syndrome.
).
Despite these functions for ACLP in multiple diseases, including fibrosis and EDS, currently very little is known about the mechanisms of ACLP processing and post-translational modifications that result in secretion of ACLP into the extracellular environment. The goal of the present study was to characterize the post-translational processing and secretion of ACLP. Based on accumulating evidence that biallelic mutations in AEBP1 cause a distinct EDS subtype (EDSCLL2), we examined the contribution of ACLP to collagen fiber mechanical properties and discovered that at least one EDS-causing mutation in ACLP generates an expressed protein that is retained within the secretory pathway.
Discussion
Here we show that ACLP secretion was tightly regulated by N-linked glycosylation and that the inhibition of glycosylation resulted in intracellular retention. We identified that modification of specific Asn residues (Asn-471 and Asn-1030) was necessary for secretion and also identified a previously unrecognized N-terminal proteolytic ACLP fragment. We studied a human EDS-causing ACLP mutation and determined that this protein was retained in the ER and induced ER stress measured with an XBP1-based ER stress reporter. To assess the contribution of ACLP to ECM mechanical properties, we generated wet-spun collagen ACLP composite fibers and by mechanical testing determined that the presence of ACLP enhanced the modulus, toughness, and tensile strength of the fibers. Thus, N-linked glycosylation of ACLP was necessary for secretion, and these findings contribute to the understanding of ACLP function in the ECM and the role of ACLP in EDS.
Accumulating evidence supports important functions for ACLP in multiple disease conditions, including lung, adipose tissue, and liver fibrosis (
17- Teratani T.
- Tomita K.
- Suzuki T.
- Furuhashi H.
- Irie R.
- Nishikawa M.
- Yamamoto J.
- Hibi T.
- Miura S.
- Minamino T.
- Oike Y.
- Hokari R.
- Kanai T.
Aortic carboxypeptidase-like protein, a WNT ligand, exacerbates nonalcoholic steatohepatitis.
,
20- Schissel S.L.
- Dunsmore S.E.
- Liu X.
- Shine R.W.
- Perrella M.A.
- Layne M.D.
Aortic carboxypeptidase-like protein is expressed in fibrotic human lung and its absence protects against bleomycin-induced lung fibrosis.
,
21- Tumelty K.E.
- Smith B.D.
- Nugent M.A.
- Layne M.D.
Aortic carboxypeptidase-like protein (ACLP) enhances lung myofibroblast differentiation through transforming growth factor β receptor-dependent and -independent pathways.
,
31- Gerhard G.S.
- Hanson A.
- Wilhelmsen D.
- Piras I.S.
- Still C.D.
- Chu X.
- Petrick A.T.
- DiStefano J.K.
AEBP1 expression increases with severity of fibrosis in NASH and is regulated by glucose, palmitate, and miR-372-3p.
), wound healing (
18- Layne M.D.
- Yet S.F.
- Maemura K.
- Hsieh C.M.
- Bernfield M.
- Perrella M.A.
- Lee M.E.
Impaired abdominal wall development and deficient wound healing in mice lacking aortic carboxypeptidase-like protein.
), cancers (
32- Xing Y.
- Zhang Z.
- Chi F.
- Zhou Y.
- Ren S.
- Zhao Z.
- Zhu Y.
- Piao D.
AEBP1, a prognostic indicator, promotes colon adenocarcinoma cell growth and metastasis through the NF-κB pathway.
,
33MicroRNA 214 inhibits adipocyte enhancer-binding protein 1 activity and increases the sensitivity of chemotherapy in colorectal cancer.
,
34- Li S.
- Juan C.X.
- Feng A.M.
- Bian H.L.
- Liu W.D.
- Zhang G.Q.
- Wang C.Z.
- Cao Q.
- Zhou G.P.
Attenuating the abnormally high expression of AEBP1 suppresses the pathogenesis of childhood acute lymphoblastic leukemia via p53-dependent signaling pathway.
,
35- Liu J.Y.
- Jiang L.
- Liu J.J.
- He T.
- Cui Y.H.
- Qian F.
- Yu P.W.
AEBP1 promotes epithelial-mesenchymal transition of gastric cancer cells by activating the NF-κB pathway and predicts poor outcome of the patients.
), and neurodegeneration (
36- Shijo M.
- Honda H.
- Suzuki S.O.
- Hamasaki H.
- Hokama M.
- Abolhassani N.
- Nakabeppu Y.
- Ninomiya T.
- Kitazono T.
- Iwaki T.
Association of adipocyte enhancer-binding protein 1 with Alzheimer’s disease pathology in human hippocampi.
,
37- Piras I.S.
- Krate J.
- Delvaux E.
- Nolz J.
- De Both M.D.
- Mastroeni D.F.
- Serrano G.E.
- Sue L.I.
- Beach T.G.
- Coleman P.D.
- Huentelman M.J.
Association of AEBP1 and NRN1 RNA expression with Alzheimer’s disease and neurofibrillary tangle density in middle temporal gyrus.
). Significantly, multiple different mutations in the
AEBP1 gene, which encodes ACLP, cause a new variant of the connective tissue disorder EDS (
7- Alazami A.M.
- Al-Qattan S.M.
- Faqeih E.
- Alhashem A.
- Alshammari M.
- Alzahrani F.
- Al-Dosari M.S.
- Patel N.
- Alsagheir A.
- Binabbas B.
- Alzaidan H.
- Alsiddiky A.
- Alharbi N.
- Alfadhel M.
- Kentab A.
- et al.
Expanding the clinical and genetic heterogeneity of hereditary disorders of connective tissue.
,
8- Blackburn P.R.
- Xu Z.
- Tumelty K.E.
- Zhao R.W.
- Monis W.J.
- Harris K.G.
- Gass J.M.
- Cousin M.A.
- Boczek N.J.
- Mitkov M.V.
- Cappel M.A.
- Francomano C.A.
- Parisi J.E.
- Klee E.W.
- Faqeih E.
- et al.
Bi-allelic alterations in AEBP1 lead to defective collagen assembly and connective tissue structure resulting in a variant of Ehlers-Danlos syndrome.
,
9- Hebebrand M.
- Vasileiou G.
- Krumbiegel M.
- Kraus C.
- Uebe S.
- Ekici A.B.
- Thiel C.T.
- Reis A.
- Popp B.
A biallelic truncating AEBP1 variant causes connective tissue disorder in two siblings.
,
10- Ritelli M.
- Cinquina V.
- Venturini M.
- Pezzaioli L.
- Formenti A.M.
- Chiarelli N.
- Colombi M.
Expanding the clinical and mutational spectrum of recessive AEBP1-related classical-like Ehlers-Danlos syndrome.
,
11- Syx D.
- De Wandele I.
- Symoens S.
- De Rycke R.
- Hougrand O.
- Voermans N.
- De Paepe A.
- Malfait F.
Bi-allelic AEBP1 mutations in two patients with Ehlers-Danlos syndrome.
). Individuals with
AEBP1 mutations display clinical characteristics similar to symptoms of classical-like EDS and hypermobile EDS (
8- Blackburn P.R.
- Xu Z.
- Tumelty K.E.
- Zhao R.W.
- Monis W.J.
- Harris K.G.
- Gass J.M.
- Cousin M.A.
- Boczek N.J.
- Mitkov M.V.
- Cappel M.A.
- Francomano C.A.
- Parisi J.E.
- Klee E.W.
- Faqeih E.
- et al.
Bi-allelic alterations in AEBP1 lead to defective collagen assembly and connective tissue structure resulting in a variant of Ehlers-Danlos syndrome.
), and this new EDS subtype is designated EDS classic-like 2 (EDSCLL2). Although there are many similarities with the classical-like subtype, EDS symptoms caused by ACLP mutations can also fall under other subtypes. Additional work is needed to fully define the nature of the mutations in
AEBP1/ACLP that result in null alleles or ablation of protein expression. Beyond the ACLP-Ins40 mutation described in this study, there is limited information characterizing the alleles that are null for protein expression or alleles that result in truncated or mutated proteins. For example, ACLP was not detected in fibroblasts isolated from an individual with the homozygous ACLP p.Arg440Serfs*3 mutation (
8- Blackburn P.R.
- Xu Z.
- Tumelty K.E.
- Zhao R.W.
- Monis W.J.
- Harris K.G.
- Gass J.M.
- Cousin M.A.
- Boczek N.J.
- Mitkov M.V.
- Cappel M.A.
- Francomano C.A.
- Parisi J.E.
- Klee E.W.
- Faqeih E.
- et al.
Bi-allelic alterations in AEBP1 lead to defective collagen assembly and connective tissue structure resulting in a variant of Ehlers-Danlos syndrome.
). This individual suffered from mitral valve prolapse and aortic root dilation, symptoms typically associated with vascular EDS (
8- Blackburn P.R.
- Xu Z.
- Tumelty K.E.
- Zhao R.W.
- Monis W.J.
- Harris K.G.
- Gass J.M.
- Cousin M.A.
- Boczek N.J.
- Mitkov M.V.
- Cappel M.A.
- Francomano C.A.
- Parisi J.E.
- Klee E.W.
- Faqeih E.
- et al.
Bi-allelic alterations in AEBP1 lead to defective collagen assembly and connective tissue structure resulting in a variant of Ehlers-Danlos syndrome.
). An additional patient presented with pectus excavatum and displayed spontaneous pneumothorax in adulthood, which is only seen in vascular EDS (
11- Syx D.
- De Wandele I.
- Symoens S.
- De Rycke R.
- Hougrand O.
- Voermans N.
- De Paepe A.
- Malfait F.
Bi-allelic AEBP1 mutations in two patients with Ehlers-Danlos syndrome.
). Other individuals are predicted to be null for ACLP protein expression and suffer from severe osteopenia, severe joint and skin laxity, and disruptions in their facial features (
7- Alazami A.M.
- Al-Qattan S.M.
- Faqeih E.
- Alhashem A.
- Alshammari M.
- Alzahrani F.
- Al-Dosari M.S.
- Patel N.
- Alsagheir A.
- Binabbas B.
- Alzaidan H.
- Alsiddiky A.
- Alharbi N.
- Alfadhel M.
- Kentab A.
- et al.
Expanding the clinical and genetic heterogeneity of hereditary disorders of connective tissue.
). In this case, it appears that the complete absence of ACLP caused many common clinical features of EDS to be experienced, whereas other truncating mutations result in kyphoscoliotic phenotypes (
9- Hebebrand M.
- Vasileiou G.
- Krumbiegel M.
- Kraus C.
- Uebe S.
- Ekici A.B.
- Thiel C.T.
- Reis A.
- Popp B.
A biallelic truncating AEBP1 variant causes connective tissue disorder in two siblings.
). An additional mutation in ACLP encodes for a proline substitution in the carboxypeptidase-like domain that may disrupt both proper folding of ACLP and its secretion. The function of the catalytically inactive carboxypeptidase domain of ACLP is currently unknown. Reznik and Fricker (
15Carboxypeptidases from A to Z: implications in embryonic development and Wnt binding.
) postulated that this domain could function as a binding domain rather than an active enzyme. Additional studies are needed to determine whether the ACLP L642P point mutation in the carboxypeptidase domain discovered by Ritelli and colleagues (
10- Ritelli M.
- Cinquina V.
- Venturini M.
- Pezzaioli L.
- Formenti A.M.
- Chiarelli N.
- Colombi M.
Expanding the clinical and mutational spectrum of recessive AEBP1-related classical-like Ehlers-Danlos syndrome.
) results in intracellular retention and ER stress similar to the ACLP-Ins40 mutation. We predict that mutations in ACLP will result in improper secretion and also hinder ACLP’s ability to contribute to collagen assembly and mechanical properties, which are the underlying cause of EDS symptoms. It is also unclear whether ACLP has intracellular roles in collagen biosynthesis or chaperone-like function within the secretory pathway. Interestingly, the collagen chaperone, heat shock protein 47 (Hsp47), relieves ER stress in cancer cells (
38- Yoneda A.
- Sakai-Sawada K.
- Minomi K.
- Tamura Y.
Heat shock protein 47 maintains cancer cell growth by inhibiting the unfolded protein response transducer IRE1α.
). It is possible that ACLP has multiple functions in collagen biosynthesis and extracellular assembly.
The symptoms of EDS vary in severity based on subtype and extent of disease progression (
39- Beighton P.
- De Paepe A.
- Steinmann B.
- Tsipouras P.
- Wenstrup R.J.
Ehlers-Danlos syndromes: revised nosology, Villefranche, 1997. Ehlers-Danlos National Foundation (U.S.A.) and Ehlers-Danlos Support Group (UK).
). A defining clinical feature is soft tissue fragility that affects almost every major organ system (
40The Ehlers-Danlos syndrome.
). EDS patients often display skin hyperextensibility and are prone to lacerations and bleeding even following minor abrasions. Vascular symptoms are the most concerning, as arterial or other spontaneous organ ruptures can result in sudden death (
41- Pepin M.
- Schwarze U.
- Superti-Furga A.
- Byers P.H.
Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type.
). Loss of ACLP results in vascular defects in some individuals, and our prior work identified roles for ACLP in vascular remodeling (
42- Layne M.D.
- Yet S.F.
- Maemura K.
- Hsieh C.M.
- Liu X.
- Ith B.
- Lee M.E.
- Perrella M.A.
Characterization of the mouse aortic carboxypeptidase-like protein promoter reveals activity in differentiated and dedifferentiated vascular smooth muscle cells.
). The mechanical testing studies of ACLP-collagen composite fibers (
Fig. 5) support the concept that ACLP plays a structural role in collagen fiber stability. Additional research is needed to define the function of ACLP in collagen fibers; however, the significant decrease in diameter could indicate a change in structural arrangement that allows the fibers to condense more. ACLP's collagen-binding discoidin domain could contribute to collagen mechanical properties by acting like a protein bridge or cross-linker, as is observed for collagen V (
43- Connizzo B.K.
- Freedman B.R.
- Fried J.H.
- Sun M.
- Birk D.E.
- Soslowsky L.J.
Regulatory role of collagen V in establishing mechanical properties of tendons and ligaments is tissue dependent.
,
44- Sun M.
- Chen S.
- Adams S.M.
- Florer J.B.
- Liu H.
- Kao W.W.
- Wenstrup R.J.
- Birk D.E.
Collagen V is a dominant regulator of collagen fibrillogenesis: dysfunctional regulation of structure and function in a corneal-stroma-specific Col5a1-null mouse model.
).
The ACLP-Ins40 protein that was discovered in an EDS patient was retained intracellularly and not secreted. Due to the location of this mutation in the collagen-binding discoidin domain, we predicted that this protein would be secreted but not properly bind to collagen. However, when this protein was expressed in fibroblasts, it accumulated intracellularly and induced ER stress (
Fig. 7). Therefore, it is likely that this mutation is a loss of function with respect to ECM assembly. The conserved glycosylation sites in the discoidin domain (mouse Asn-471 and Asn-519;
Fig. 3A) and equivalent human sites (Asn-480 and Asn-528) are intact in the ACLP-Ins40 protein. Although it is possible that the ACLP-Ins40 protein glycosylation state is somehow altered by this mutation, the amino acid insertion in the discoidin domain is predicted to disrupt the highly conserved structure, which may be responsible for retention within the secretory pathway (
Fig. 7). The amino acid insertion in the discoidin domain is predicted to disrupt the highly conserved structure, which may also be responsible for retention within the secretory pathway. The retention of ECM proteins and induction of ER stress have been observed with mutations in collagen III and VI, which like ACLP mutations cause connective tissue disease (
29- Boot-Handford R.P.
- Briggs M.D.
The unfolded protein response and its relevance to connective tissue diseases.
). In addition to ACLP discoidin mutations in EDS, there are a number of other diseases that result from mutations in discoidin domain–containing proteins, including retinoschisis (
45Functional implications of the spectrum of mutations found in 234 cases with X-linked juvenile retinoschisis. The Retinoschisis Consortium.
), and in coagulation factors V and VIII (
46- Fuentes-Prior P.
- Fujikawa K.
- Pratt K.P.
New insights into binding interfaces of coagulation factors V and VIII and their homologues lessons from high resolution crystal structures.
). Similar to the pathogenic mutations in the retinoschisin 1 gene that result in the separation of the retinal layers or restinoschisis, the mutation in the ACLP-Ins40 protein includes the addition of 3 cysteine residues (
8- Blackburn P.R.
- Xu Z.
- Tumelty K.E.
- Zhao R.W.
- Monis W.J.
- Harris K.G.
- Gass J.M.
- Cousin M.A.
- Boczek N.J.
- Mitkov M.V.
- Cappel M.A.
- Francomano C.A.
- Parisi J.E.
- Klee E.W.
- Faqeih E.
- et al.
Bi-allelic alterations in AEBP1 lead to defective collagen assembly and connective tissue structure resulting in a variant of Ehlers-Danlos syndrome.
). It is possible that these cysteine residues result in aberrant folding, disulfide bond formation, protein aggregation, or intracellular retention. Additional research will need to test these hypotheses. Future studies will examine whether other branches of the unfolded protein response pathway, including activating transcription factor 6 (ATF6) and protein kinase R–like endoplasmic reticulum kinase (PERK) (
47The unfolded protein response: from stress pathway to homeostatic regulation.
), are activated by mutations in the
AEBP1 gene that result in expressed proteins.
In addition to a role in ECM assembly, our previous work determined that ACLP signals via the TGFβ receptor complex (
21- Tumelty K.E.
- Smith B.D.
- Nugent M.A.
- Layne M.D.
Aortic carboxypeptidase-like protein (ACLP) enhances lung myofibroblast differentiation through transforming growth factor β receptor-dependent and -independent pathways.
), and Teratani
et al. (
17- Teratani T.
- Tomita K.
- Suzuki T.
- Furuhashi H.
- Irie R.
- Nishikawa M.
- Yamamoto J.
- Hibi T.
- Miura S.
- Minamino T.
- Oike Y.
- Hokari R.
- Kanai T.
Aortic carboxypeptidase-like protein, a WNT ligand, exacerbates nonalcoholic steatohepatitis.
) determined that ACLP bound to and activated the LRP6/Frz8 signaling pathway, leading to β-catenin activation. Understanding the nature of the secreted ACLP protein is important to elucidate the details of these signaling pathways, and similar to our observations that secreted ACLP is glycosylated, Teratani
et al. (
17- Teratani T.
- Tomita K.
- Suzuki T.
- Furuhashi H.
- Irie R.
- Nishikawa M.
- Yamamoto J.
- Hibi T.
- Miura S.
- Minamino T.
- Oike Y.
- Hokari R.
- Kanai T.
Aortic carboxypeptidase-like protein, a WNT ligand, exacerbates nonalcoholic steatohepatitis.
) also identified modifications in ACLP. Whether glycosylation is required for ACLP signaling activity, processing, and/or secretion remains to be determined. Furthermore, the nature of the proteolytic processing of ACLP in signaling is currently unknown, and the protease responsible for ACLP cleavage still remains to be identified. Interestingly, multiple bands of ACLP were observed in Western blotting analysis from human aortic aneurysms, which were proposed to be due to MMP9 or MMP12 activity (
48- Didangelos A.
- Yin X.
- Mandal K.
- Saje A.
- Smith A.
- Xu Q.
- Jahangiri M.
- Mayr M.
Extracellular matrix composition and remodeling in human abdominal aortic aneurysms: a proteomics approach.
). An additional predicted candidate is bone morphogenetic protein 1 (Bmp1), a secreted metalloproteinase, which provides the procollagen C-proteinase activity responsible for cleaving the C-propeptides from procollagens I-III (
49- Hopkins D.R.
- Keles S.
- Greenspan D.S.
The bone morphogenetic protein 1/Tolloid-like metalloproteinases.
,
50Diverse biological functions of extracellular collagen processing enzymes.
). Bmp1 null mouse embryos display herniation of the gut with a failure to close the ventral body wall, resulting in the embryos not being able to survive beyond birth (
51- Suzuki N.
- Labosky P.A.
- Furuta Y.
- Hargett L.
- Dunn R.
- Fogo A.B.
- Takahara K.
- Peters D.M.
- Greenspan D.S.
- Hogan B.L.
Failure of ventral body wall closure in mouse embryos lacking a procollagen C-proteinase encoded by Bmp1, a mammalian gene related to Drosophila tolloid.
). This phenotypic characteristic of the Bmp1 null mouse model has striking similarities to the ACLP-null mouse (
18- Layne M.D.
- Yet S.F.
- Maemura K.
- Hsieh C.M.
- Bernfield M.
- Perrella M.A.
- Lee M.E.
Impaired abdominal wall development and deficient wound healing in mice lacking aortic carboxypeptidase-like protein.
).
In this study, we have identified new mechanisms that regulate ACLP secretion and characterized an EDS-causing mutation. These data also have practical implications for studies generating recombinant forms of ACLP for in vitro testing in that alteration of glycosylation can cause intracellular retention. It remains to be determined whether other EDS-causing mutations in protein-coding domains of ACLP show similar intracellular retention, potentially resulting in loss of tissue integrity and collagen mechanics.
Article info
Publication history
Published online: June 01, 2020
Received in revised form:
May 28,
2020
Received:
April 15,
2020
Edited by Gerald W. Hart
Footnotes
Author contributions—N. V., W. J. M., G. A. H., J. Y. W., M. L. S., and M. D. L. conceptualization; N. V., W. J. M., G. A. H., B. R., V. D., and M. D. L. investigation; N. V., W. J. M., G. A. H., J. Y. W., M. L. S., and M. D. L. methodology; N. V., W. J. M., and M. D. L. writing-original draft; N. V., W. J. M., G. A. H., B. R., V. D., J. Y. W., M. L. S., and M. D. L. writing-review and editing; J. Y. W., M. L. S., and M. D. L. supervision; M. D. L. funding acquisition; M. D. L. project administration.
Funding and additional information—This work was supported in part by National Institutes of Health Grant HL078869 (to M. D. L.). G. A. H. was supported by National Institutes of Health Graining Grants T32 GM008764 and F31 HL151082. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflict of interest—The authors declare that they have no conflicts of interest with the contents of this article.
Present address for William J. Monis: Sanofi, Cambridge, Massachusetts, USA. Present address for Vincent DiGiacomo: DeepBiome Therapeutics, Cambridge, Massachusetts, USA.
Abbreviations—The abbreviations used are: ECM
extracellular matrix
EDSEhlers–Danlos syndrome
EDSCLL2EDS classic-like 2
ACLPaortic carboxypeptidase-like protein
TGFtransforming growth factor
SMCsmooth muscle cells
PNGase Fpeptide:N-glycosidase F
EGFPenhanced GFP
DMEMDulbecco's modified Eagle's medium
DAPI4′,6-diamidino-2-phenylindole.
Copyright
© 2020 Vishwanath et al.