Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.
The Human Genetic institute, Carmel Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel.
Hum Mol Genet. 2020 Jul 21;29(11):1772-1783. doi: 10.1093/hmg/ddz108.
The RASopathies are a group of genetic syndromes caused by upregulated RAS signaling. Noonan syndrome (NS), the most common entity among the RASopathies, is characterized mainly by short stature, cardiac anomalies and distinctive facial features. Mutations in multiple RAS-MAPK pathway-related genes have been associated with NS and related phenotypes. We describe two unrelated patients presenting with hypertrophic cardiomyopathy (HCM) and dysmorphic features suggestive of NS. One of them died in the neonatal period because of cardiac failure. Targeted sequencing revealed de novo MRAS variants, c.203C > T (p.Thr68Ile) and c.67G > C (p.Gly23Arg) as causative events. MRAS has only recently been related to NS based on the observation of two unrelated affected individuals with de novo variants involving the same codons here found mutated. Gly23 and Thr68 are highly conserved residues, and the corresponding codons are known hotspots for RASopathy-associated mutations in other RAS proteins. Functional analyses documented high level of activation of MRAS mutants due to impaired GTPase activity, which was associated with constitutive plasma membrane targeting, prolonged localization in non-raft microdomains, enhanced binding to PPP1CB and SHOC2 protein, and variably increased MAPK and PI3K-AKT activation. This report provides additional evidence that a narrow spectrum of activating mutations in MRAS represents another rare cause of NS, and that MRAS has to be counted among the RASopathy genes predisposing to HCM. Moreover, our findings further emphasize the relevance of the MRAS-SHOC2-PPP1CB axis in the control of MAPK signaling, and the contribution of both MAPK and PI3K-AKT pathways in MRAS functional upregulation.
RAS 病是一组由 RAS 信号转导上调引起的遗传综合征。RAS 病中最常见的努南综合征(Noonan syndrome,NS)的主要特征是身材矮小、心脏异常和独特的面部特征。多个 RAS-MAPK 通路相关基因的突变与 NS 和相关表型有关。我们描述了两名不相关的患者,他们表现为肥厚型心肌病(hypertrophic cardiomyopathy,HCM)和提示 NS 的畸形特征。其中一名患者因心力衰竭在新生儿期死亡。靶向测序显示,新生突变 MRAS 变体 c.203C>T(p.Thr68Ile)和 c.67G>C(p.Gly23Arg)为致病事件。MRAS 最近才被认为与 NS 有关,这是基于观察到两个不相关的受影响个体存在涉及此处突变的相同密码子的新生变异。Gly23 和 Thr68 是高度保守的残基,并且在其他 RAS 蛋白中,与 RAS 病相关的突变已知是这些密码子的热点。功能分析记录了由于 GTP 酶活性受损,MRAS 突变体的高水平激活,这与质膜的组成型靶向、非筏微域中的延长定位、与 PPP1CB 和 SHOC2 蛋白的增强结合以及 MAPK 和 PI3K-AKT 激活的可变增加有关。本报告提供了额外的证据,表明 MRAS 中的窄谱激活突变代表 NS 的另一个罕见原因,并且 MRAS 必须被归类为易患 HCM 的 RAS 病基因之一。此外,我们的研究结果进一步强调了 MRAS-SHOC2-PPP1CB 轴在控制 MAPK 信号转导中的相关性,以及 MAPK 和 PI3K-AKT 通路在 MRAS 功能上调中的贡献。