Cambridge Institute for Medical Research (CIMR), University of Cambridge, Keith Peters Building, Biomedical Campus, Hills Rd, Cambridge CB2 0XY, United Kingdom.
Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Papworth Road, Trumpington, Cambridge CB2 0BB, United Kingdom.
Hum Mol Genet. 2024 Aug 18;33(17):1495-1505. doi: 10.1093/hmg/ddae082.
Pulmonary arterial hypertension (PAH) is a disorder with a large genetic component. Biallelic mutations of EIF2AK4, which encodes the kinase GCN2, are causal in two ultra-rare subtypes of PAH, pulmonary veno-occlusive disease and pulmonary capillary haemangiomatosis. EIF2AK4 variants of unknown significance have also been identified in patients with classical PAH, though their relationship to disease remains unclear. To provide patients with diagnostic information and enable family testing, the functional consequences of such rare variants must be determined, but existing computational methods are imperfect. We applied a suite of bioinformatic and experimental approaches to sixteen EIF2AK4 variants that had been identified in patients. By experimentally testing the functional integrity of the integrated stress response (ISR) downstream of GCN2, we determined that existing computational tools have insufficient sensitivity to reliably predict impaired kinase function. We determined experimentally that several EIF2AK4 variants identified in patients with classical PAH had preserved function and are therefore likely to be non-pathogenic. The dysfunctional variants of GCN2 that we identified could be subclassified into three groups: misfolded, kinase-dead, and hypomorphic. Intriguingly, members of the hypomorphic group were amenable to paradoxical activation by a type-1½ GCN2 kinase inhibitor. This experiment approach may aid in the clinical stratification of EIF2AK4 variants and potentially identify hypomorophic alleles receptive to pharmacological activation.
肺动脉高压(PAH)是一种具有较大遗传成分的疾病。EIF2AK4 基因的双等位基因突变,该基因编码激酶 GCN2,是两种超罕见 PAH 亚型——肺静脉闭塞病和肺毛细血管血管瘤病的致病原因。在经典 PAH 患者中也发现了 EIF2AK4 意义不明的变异体,但其与疾病的关系仍不清楚。为了向患者提供诊断信息并进行家族测试,必须确定此类罕见变异体的功能后果,但现有的计算方法并不完善。我们应用了一套生物信息学和实验方法来研究在患者中发现的 16 种 EIF2AK4 变异体。通过实验测试 GCN2 下游整合应激反应(ISR)的功能完整性,我们确定现有的计算工具灵敏度不足,无法可靠地预测激酶功能受损。我们通过实验确定,在经典 PAH 患者中发现的几种 EIF2AK4 变异体具有保留的功能,因此很可能是非致病性的。我们鉴定的 GCN2 功能失调变异体可分为三组:错误折叠、激酶失活和功能降低。有趣的是,功能降低组的成员可以通过 1.5 型 GCN2 激酶抑制剂的反常激活。这种实验方法可能有助于 EIF2AK4 变异体的临床分层,并可能鉴定出对药物激活有反应的功能降低等位基因。
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