Murine models of HRAS-mediated cutaneous skeletal hypophosphatemia syndrome suggest bone as the FGF23 excess source

New Phenotypic Features in FGFR1-Related Osteoglophonic Dysplasia

Osteoglophonic dysplasia (OGD) is a rare skeletal disorder caused by certain variants in FGFR1. The FGFR1 gene encodes a receptor vital for osteogenesis in the axial and craniofacial skeleton. Key OGD features include craniosynostosis, craniofacial dysmorphism, impacted teeth, rhizomelic shortening, and nonossifying fibromas. Patients may have hypophosphatemia due to high FGF23 levels. We report two OGD patients with the c.1141T > C FGFR1 variant [p.(Cys381Arg)], initially diagnosed with Pfeiffer syndrome. Both showed classic symptoms as well as signs not previously reported, including elevated frontal temperature and overlapping toes. This report emphasizes distinguishing OGD from similar disorders and expanding the clinical phenotype.

Neurofibromatosis type I (NF1) and bone involvement in a pediatric setting: insights from FGF23 levels

BACKGROUND

Neurofibromatosis type I (NF1) is an autosomal dominant disorder characterized by extremely different phenotypes, sometimes including reduced bone mass. The underlying cause of bone impairment in these patients remains poorly understood, especially in children. Previous studies in mice and single reports in NF1 patients with osteomalacia have shown elevated serum FGF23 levels. The aim of this study was to explore for the first time these results in NF1 pediatric patients to eventually provide biological insight into bone involvement in NF1.

METHODS

This is an observational, cross-sectional, single-centre study evaluating FGF23/αKlotho levels, as well as other markers of bone metabolism and densitometric parameters in 31 children affected by NF1 and comparing them to 21 age- and sex-matched controls.

RESULTS

We enrolled 31 patients with NF1(M/F 13/18; 11.7 ± 2.9 years). After correction for bone age, BMAD Z-score was < -2SDS in 5/31 patients (16.1%). No difference was found between FGF23 and αKlotho between NF1 patients and controls. No association was found between auxological, biochemical, genetic and radiological parameters and FGF23 values.

CONCLUSION

In conclusion, this represents the first study assessing FGF23 levels in NF1 children and its possible relationship with decreased bone mineral density. Contrarily to previous observations, no significant differences were found between NF1 patients and controls regarding FGF23 and αKlotho levels. Additionally, there was no clear association between FGF23 and bone involvement, thus suggesting that this phenomenon is not FGF23-driven or FGF23 derangements might occur later in life. Further research is needed to understand the multifactorial mechanisms and determine optimal intervention strategies.

Impaired MC3T3-E1 osteoblast differentiation triggered by oncogenic HRAS is rescued by the farnesyltransferase inhibitor Tipifarnib

HRAS is a ubiquitously expressed protein and functions as a central regulator of cellular homeostasis. In somatic cells, mutations in this gene cause cancer, while germline mutations trigger a developmental disorder known as Costello syndrome (CS). Among numerous pathologies, adult CS patients develop osteoporosis. Previous studies revealed that HRAS is implicated in bone homeostasis by controlling osteoblast differentiation, adaptation to mechanical strain and repression of RANKL expression in mature osteoblasts, and by regulating osteoclast differentiation. However, the impact of HRAS on osteoblast differentiation is still debatable. In this study, we created stable doxycycline inducible cell lines overexpressing HRAS G12 mutants in MC3T3-E1 preosteoblast cell line and analyzed their impact on osteoblast differentiation. We demonstrated an inhibitory role of HRAS G12S and HRAS G12V mutants on osteogenic differentiation and identified an increased expression of Opn in an HRAS-dependent manner, which directly correlated with impaired osteogenesis, and was rescued by the farnesyl transferase inhibitor Tipifarnib. At the molecular level, Tipifarnib was not able to block HRAS activation, but impaired HRAS localization to the plasma membrane, and inhibited MAPK activation and Opn expression. Thus, HRAS abundance/activation and its potential crosstalk with OPN may be more critical for osteogenic differentiation than previously assumed.

[Etiology of hypophosphatemia in adults]

Long-term hypophosphatemia, defined by serum phosphorus (P) levels <2.5mg/dL, impairs the development and quality of mineralized tissue of the skeletal, dental, and auditory systems. P homeostasis depends mainly on intestinal absorption and renal excretion. Hypophosphatemia may be due to the redistribution of P to the intracellular space, increased renal losses, or decreased intestinal absorption. Hypophosphatemia can be categorized as acute or chronic, depending on the time course. Most cases, either acute or chronic, are due to acquired causes. However, some chronic cases may have a genetic origin. Accurate and early diagnosis, followed by adequate treatment, is essential to limit its negative effects on the body.

Burosumab for the treatment of cutaneous-skeletal hypophosphatemia syndrome

Cutaneous-skeletal hypophosphatemia syndrome (CSHS) is a rare bone disorder featuring fibroblast growth factor-23 (FGF23)-mediated hypophosphatemic rickets. We report a 2-year, 10-month-old girl with CSHS treated with burosumab, a novel human monoclonal antibody targeting FGF23. This approach was associated with rickets healing, improvement in growth and lower limb deformity, and clinically significant benefit to her functional mobility and motor development. This case report provides evidence for the effective use of FGF23-neutralizing antibody therapy beyond the classic FGF23-mediated disorders of X-linked hypophosphatemia and tumor-induced osteomalacia.

Oncogenic Ras and ΔNp63α cooperate to recruit immunosuppressive polymorphonuclear myeloid-derived suppressor cells in a mouse model of squamous cancer pathogenesis

Introduction

Amplification of human chromosome 3q26-29, which encodes oncoprotein ΔNp63 among other isoforms of the p63 family, is a feature common to squamous cell carcinomas (SCCs) of multiple tissue origins. Along with overexpression of ΔNp63, activation of the protooncogene, RAS, whether by overexpression or oncogenic mutation, is frequently observed in many cancers. In this study, analysis of transcriptome data from The Cancer Genome Atlas (TCGA) demonstrated that expression of TP63 mRNA, particularly ΔNp63 isoforms, and HRAS are significantly elevated in advanced squamous cell carcinomas of the head and neck (HNSCCs), suggesting pathological significance. However, how co-overexpressed ΔNp63 and HRAS affect the immunosuppressive tumor microenvironment (TME) is incompletely understood.

Methods

Here, we established and characterized an immune competent mouse model using primary keratinocytes with retroviral-mediated overexpression of ΔNp63α and constitutively activated HRAS (v-rasHa G12R) to evaluate the role of these oncogenes in the immune TME.

Results

In this model, orthotopic grafting of wildtype syngeneic keratinocytes expressing both v-rasHa and elevated levels of ΔNp63α consistently yield carcinomas in syngeneic hosts, while cells expressing v-rasHa alone yield predominantly papillomas. We found that polymorphonuclear (PMN) myeloid cells, experimentally validated to be immunosuppressive and thus representing myeloid-derived suppressor cells (PMN-MDSCs), were significantly recruited into the TME of carcinomas arising early following orthotopic grafting of ΔNp63α/v-rasHa-expressing keratinocytes. ΔNp63α/v-rasHa-driven carcinomas expressed higher levels of chemokines implicated in recruitment of MDSCs compared to v-rasHa-initiated tumors, providing a heretofore undescribed link between ΔNp63α/HRAS-driven carcinomas and the development of an immunosuppressive TME.

Conclusion

These results support the utilization of a genetic carcinogenesis model harboring specific genomic drivers of malignancy to study mechanisms underlying the development of local immunosuppression.