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El Khouri E, Diab F, Louvrier C, Assrawi E, Daskalopoulou A, Nguyen A, Piterboth W, Deshayes S, Desdoits A, Copin B, Dastot Le Moal F, Karabina SA, Amselem S, Aouba A, Giurgea I. A critical region of A20 unveiled by missense TNFAIP3 variations that lead to autoinflammation. eLife 2023; 12:e81280. [PMID: 37342083 DOI: 10.7554/elife.81280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/03/2023] [Indexed: 06/22/2023] Open
Abstract
A20 haploinsufficiency (HA20) is an autoinflammatory disease caused by heterozygous loss-of-function variations in TNFAIP3, the gene encoding the A20 protein. Diagnosis of HA20 is challenging due to its heterogeneous clinical presentation and the lack of pathognomonic symptoms. While the pathogenic effect of TNFAIP3 truncating variations is clearly established, that of missense variations is difficult to determine. Herein, we identified a novel TNFAIP3 variation, p.(Leu236Pro), located in the A20 ovarian tumor (OTU) domain and demonstrated its pathogenicity. In the patients' primary cells, we observed reduced A20 levels. Protein destabilization was predicted in silico for A20_Leu236Pro and enhanced proteasomal degradation was confirmed in vitro through a flow cytometry-based functional assay. By applying this approach to the study of another missense variant, A20_Leu275Pro, for which no functional characterization has been performed to date, we showed that this variant also undergoes enhanced proteasomal degradation. Moreover, we showed a disrupted ability of A20_Leu236Pro to inhibit the NF-κB pathway and to deubiquitinate its substrate TRAF6. Structural modeling revealed that two residues involved in OTU pathogenic missense variations (i.e. Glu192Lys and Cys243Tyr) establish common interactions with Leu236. Interpretation of newly identified missense variations is challenging, requiring, as illustrated here, functional demonstration of their pathogenicity. Together with functional studies, in silico structure analysis is a valuable approach that allowed us (i) to provide a mechanistic explanation for the haploinsufficiency resulting from missense variations and (ii) to unveil a region within the OTU domain critical for A20 function.
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Affiliation(s)
- Elma El Khouri
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), "Maladies génétiques d'expression pédiatrique", Paris, France
| | - Farah Diab
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), "Maladies génétiques d'expression pédiatrique", Paris, France
| | - Camille Louvrier
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), "Maladies génétiques d'expression pédiatrique", Paris, France
- Département de Génétique Médicale, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eman Assrawi
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), "Maladies génétiques d'expression pédiatrique", Paris, France
| | - Aphrodite Daskalopoulou
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), "Maladies génétiques d'expression pédiatrique", Paris, France
| | - Alexandre Nguyen
- Département de Médecine Interne et Immunologie Clinique, Normandie Univ, UNICAEN, UR4650 PSIR, CHU de Caen Normandie, Caen, France
| | - William Piterboth
- Département de Génétique Médicale, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samuel Deshayes
- Département de Médecine Interne et Immunologie Clinique, Normandie Univ, UNICAEN, UR4650 PSIR, CHU de Caen Normandie, Caen, France
| | | | - Bruno Copin
- Département de Génétique Médicale, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florence Dastot Le Moal
- Département de Génétique Médicale, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sonia Athina Karabina
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), "Maladies génétiques d'expression pédiatrique", Paris, France
| | - Serge Amselem
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), "Maladies génétiques d'expression pédiatrique", Paris, France
- Département de Génétique Médicale, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Achille Aouba
- Département de Médecine Interne et Immunologie Clinique, Normandie Univ, UNICAEN, UR4650 PSIR, CHU de Caen Normandie, Caen, France
| | - Irina Giurgea
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), "Maladies génétiques d'expression pédiatrique", Paris, France
- Département de Génétique Médicale, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
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Louvrier C, El Khouri E, Grall Lerosey M, Quartier P, Guerrot AM, Bader Meunier B, Chican J, Mohammad M, Assrawi E, Daskalopoulou A, Arenas Garcia A, Copin B, Piterboth W, Dastot Le Moal F, Karabina SA, Amselem S, Giurgea I. De Novo Gain-Of-Function Variations in LYN Associated With an Early-Onset Systemic Autoinflammatory Disorder. Arthritis Rheumatol 2023; 75:468-474. [PMID: 36122175 DOI: 10.1002/art.42354] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/12/2022] [Accepted: 09/08/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify the molecular basis of a severe systemic autoinflammatory disorder (SAID) and define its main phenotypic features, and to functionally assess the sequence variations identified in LYN, a gene encoding a nonreceptor tyrosine kinase. METHODS We used targeted next-generation sequencing and in vitro functional studies of Lyn phosphorylation state and Lyn-dependent NF-κB activity after expression of recombinant Lyn isoforms carrying different sequence variations. RESULTS We identified a de novo LYN variation (p.Tyr508His) in a patient presenting since birth with recurrent fever, chronic urticaria, atopic dermatitis, arthralgia, increased inflammatory biomarkers, and elevated plasma cytokine levels. We studied the consequences on Lyn phosphorylation state of the p.Tyr508His variation and of the 2 LYN variations reported so far (p.Tyr508Phe and p.Tyr508*), and found that all 3 variations prevent phosphorylation of residue 508 and lead to autophosphorylation of Tyr397. Additionally, these 3 LYN variations activate the NF-κB pathway. These results show a gain-of-function effect of the variations involving Tyr508 on Lyn activity. CONCLUSION This study demonstrates the pathogenicity of the first 3 LYN variations identified in SAID patients and delineates the phenotypic spectrum of a disease entity characterized by severe, early-onset, systemic inflammatory disease affecting neonates with no family history of SAID. All 3 LYN variations affect the same tyrosine residue located in the C-terminus of Lyn, thereby demonstrating the critical role of this residue in the proper regulation of Lyn activity in humans.
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Affiliation(s)
- Camille Louvrier
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, and Département de Génétique médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | - Elma El Khouri
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Martine Grall Lerosey
- Département de pédiatrie et médecine de l'adolescent, CHU-Hôpitaux de Rouen, Rouen, France
| | - Pierre Quartier
- RAISE reference centre for rare diseases, Unité d'Immunologie-Hématologie et Rhumatologie pédiatrique, and Imagine Institute, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne-Marie Guerrot
- Université de Rouen Normandie, Inserm Unit U1245, and Rouen University Hospital, Department of Genetics and Reference Center for Developmental Disorders, and Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Brigitte Bader Meunier
- RAISE reference centre for rare diseases, Unité d'Immunologie-Hématologie et Rhumatologie pédiatrique, and Imagine Institute, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julie Chican
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Malaïka Mohammad
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Eman Assrawi
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Aphrodite Daskalopoulou
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Angela Arenas Garcia
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Bruno Copin
- Département de Génétique médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | - William Piterboth
- Département de Génétique médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | - Florence Dastot Le Moal
- Département de Génétique médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | - Sonia A Karabina
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Serge Amselem
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, and Département de Génétique médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | - Irina Giurgea
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, and Département de Génétique médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
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Louvrier C, Awad F, Cosnes A, El Khouri E, Assrawi E, Daskalopoulou A, Copin B, Bocquet H, Chantot Bastaraud S, Arenas Garcia A, Dastot Le Moal F, De La Grange P, Duquesnoy P, Guerrera CI, Piterboth W, Ortonne N, Chosidow O, Karabina SA, Amselem S, Giurgea I. RNF213-associated urticarial lesions with hypercytokinemia. J Allergy Clin Immunol 2022; 150:1545-1555. [PMID: 35780935 DOI: 10.1016/j.jaci.2022.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Urticarial lesions are observed in both cutaneous and systemic disorders. Familial forms of urticarial syndromes are rare and can be encountered in systemic autoinflammatory diseases. OBJECTIVE We sought to investigate a large family with dominantly inherited chronic urticarial lesions associated with hypercytokinemia. METHODS We performed a genetic linkage analysis in 14 patients from a 5-generation family, as well as whole-exome sequencing, cytokine profiling, and transcriptomic analyses on samples from 2 patients. The identified candidate protein was studied after in vitro expression of the corresponding normal and mutated recombinant proteins. An unsupervised proteomic approach was used to unveil the associated protein network. RESULTS The disease phenotype of the most affected family members is characterized by chronic urticarial flares associated with extremely high plasma levels of proinflammatory (IL-1β, IL-6, and TNF-α) and anti-inflammatory (IL-10 and IL-1 receptor antagonist [IL-1RA]) cytokines, with no secondary organ dysfunction, no susceptibility to infections, no fever, and normal C-reactive protein levels. Monocyte transcriptomic analyses identified an immunotolerant profile in the most affected patient. The affected family members carried a loss-of-function mutation in RNF213 that encodes mysterin, a protein with a poorly known physiologic role. We identified the deubiquitinase CYLD, a major regulator of inflammation, as an RNF213 partner and showed that CYLD expression is inhibited by wild-type but not mutant RNF213. CONCLUSION We identified a new entity characterized by chronic urticarial lesions associated with a clinically blunted hypercytokinemia. This disease, which is due to loss of function of RNF213, reveals mysterin's key role in the complex molecular network of innate immunity.
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Affiliation(s)
- Camille Louvrier
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France; Département de Génétique Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | - Fawaz Awad
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Anne Cosnes
- Faculté de Santé de Créteil and Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France
| | - Elma El Khouri
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Eman Assrawi
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Aphrodite Daskalopoulou
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Bruno Copin
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France; Département de Génétique Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | - Hélène Bocquet
- Faculté de Santé de Créteil and Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France
| | - Sandra Chantot Bastaraud
- Département de Génétique Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | - Angela Arenas Garcia
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Florence Dastot Le Moal
- Département de Génétique Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | | | - Philippe Duquesnoy
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Chiara I Guerrera
- Plateforme protéomique Necker, Université de Paris, Structure Fédérative de Recherche Necker, Inserm US24/CNRS UMS3633, Paris, France
| | - William Piterboth
- Département de Génétique Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France
| | - Nicolas Ortonne
- Département d'Anatomo-Pathologie, APHP, Hôpital Henri-Mondor, Créteil, France
| | - Olivier Chosidow
- Faculté de Santé de Créteil and Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France; Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Sonia A Karabina
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France
| | - Serge Amselem
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France; Département de Génétique Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France.
| | - Irina Giurgea
- Sorbonne Université, Inserm, Childhood Genetic Disorders, Hôpital Armand-Trousseau, Paris, France; Département de Génétique Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Paris, France.
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