Bi-allelic variants in CELSR3 are implicated in central nervous system and urinary tract anomalies

CELSR3 codes for a planar cell polarity protein. We describe twelve affected individuals from eleven independent families with bi-allelic variants in CELSR3. Affected individuals presented with an overlapping phenotypic spectrum comprising central nervous system (CNS) anomalies (7/12), combined CNS anomalies and congenital anomalies of the kidneys and urinary tract (CAKUT) (3/12) and CAKUT only (2/12). Computational simulation of the 3D protein structure suggests the position of the identified variants to be implicated in penetrance and phenotype expression. CELSR3 immunolocalization in human embryonic urinary tract and transient suppression and rescue experiments of Celsr3 in fluorescent zebrafish reporter lines further support an embryonic role of CELSR3 in CNS and urinary tract formation.</p

Bi-allelic variants in CELSR3 are implicated in central nervous system and urinary tract anomalies

CELSR3 codes for a planar cell polarity protein. We describe twelve affected individuals from eleven independent families with bi-allelic variants in CELSR3. Affected individuals presented with an overlapping phenotypic spectrum comprising central nervous system (CNS) anomalies (7/12), combined CNS anomalies and congenital anomalies of the kidneys and urinary tract (CAKUT) (3/12) and CAKUT only (2/12). Computational simulation of the 3D protein structure suggests the position of the identified variants to be implicated in penetrance and phenotype expression. CELSR3 immunolocalization in human embryonic urinary tract and transient suppression and rescue experiments of Celsr3 in fluorescent zebrafish reporter lines further support an embryonic role of CELSR3 in CNS and urinary tract formation.</p

Passive transfer of rabbit anti-mLAMC1-cterm IgG into neonatal mice does not reproduce the human disease.

<p>Rabbit IgG against the murine laminin γ1 C-terminus (mLAMC1-cterm) was not pathogenic when passively transferred into neonatal C57BL/6 mice. Injection of rabbit anti-mLAMC1-cterm IgG at a concentration of 10 mg/g body weight every second day for 10 days did not <u>induce</u> histopathological lesions on day 12 (<u>a</u>). Linear deposition of rabbit IgG at the DEJ was only observed in 2 of 8 mice (b), while staining of murine C3 was always negative (c). At day 12, in sera of all mice, rabbit IgG stained the basal keratinocytes at the DEJ of normal mouse skin (d), reacted with recombinant mLAMC1-cterm by ELISA (e) and immunoblotting (f, lanes 2–6) and with the 200 kDa p200 protein in extract of murine dermis (g, lanes 2–6). Polyclonal rabbit antibody H-190 against mLAMC1 (f, g, lane 1) and normal mouse serum (f, g, lane 7) was used as controls.</p

Passive transfer of rabbit anti-mLAMC1-cterm IgG into adult mice is not pathogenic.

<p>Rabbit IgG against the murine laminin γ1 C-terminus (mLAMC1-cterm) was not pathogenic when passively transferred into adult C57BL/6 and BALB/c mice. Injection of 15 mg rabbit anti-mLAMC1-cterm IgG every second day for 10 days did not result in clinical or histopathological (a, e) lesions on day 12. Linear deposition of rabbit IgG at the dermal-epidermal junction (DEJ) was only observed in 2 of 5 C57BL/6 (b) and one of 5 BALB/c mice (f), while staining of murine C3 was negative in all mice (c, g). At day 12, in sera of all 10 mice, rabbit IgG labeled the basal keratinocytes at the DEJ of normal mouse skin (d, h) and reacted with recombinant mLAMC1-cterm by ELISA (i) and immunoblotting (j, C57BL/6, lanes 1; BALB/c, lane 2) and the 200 kDa p200 protein in extract of murine dermis (k, C57BL/6 lane 1; BALB/c, lane 2). Normal mouse sera (j and k, C57BL/6, lane 3; BALB/c, lane 4) were used as controls.</p

Human IgG specific to laminin γ1 is not pathogenic ex vivo.

<p>Using recombinant forms of the C-terminus of laminin γ1 (hLAMC1-cterm) and full length laminin γ1 (LAMC1-FL) IgG specific for hLAMC1-cterm (a, c; lane 3) and LAMC1-FL (b, lane 3; c lane 5 ) was generated from anti-p200 pemphigoid serum (a, b, c; lane 2), as well as serum depleted from anti-hLAMC1-cterm (a, c, lane 4) and LAMC1-FL reactivity (b, lane 4; c lane 6) reactivity, respectively, as shown by immunoblotting with recombinant hLAMC1-cterm (a), LAMC1-FL (b), and extract of human dermis<u>-</u>(c). Interestingly, serum depleted from anti-hLAMC1-cterm and LAMC1-FL reactivity, respectively, (a, b; lane 4) still labeled the p200 protein in dermal extract (c, lane 4, lane 6). Monoclonal antibody against LAMC1 (a, b, c; lane 1) and serum from a healthy volunteer (a, b; lane 5; c lane 7) were used as controls. Arrows indicate the positions of the proteins and bars the molecular weight markers (a, 34 kD and 26 kD; b, 200 kD; c, 200 kD). hLAMC1-cterm-specific (h, i) and LAMC1-FL-specific patients IgG (l, m) and the monoclonal anti-LAMC1 antibody (d, e) labeled the dermal-epidermal junction (DEJ) by indirect immunofluorescence (IF) microscopy but did not induce dermal-epidermal separation (DES). In contrast, serum depleted from reactivity against hLAMC1-cterm (j, k), and LAMC1-FL (n, o), respectively, as well as patient serum (f, g) resulted in DES (black triangles mark base of the split). While untouched patient serum (f) as well as serum depleted from anti-hLAMC1-cterm (j) and LAMC1-FL reactivity (n), respectively, stained the DEJ of human skin in a linear pattern, the monoclonal anti-hLAMC1-antibody (d), hLAMC1-cterm-specific patient<u>-</u>IgG (h), and hLAMC1-FL-specific patient IgG showed an additional staining of basal keratinocytes. Serum from a healthy volunteer was used as control (p, q). Magnification: x200.</p

Anti-p200 pemphigoid patients’ sera induce dermal-epidermal separation ex vivo.

<p>Sera from anti-p200 pemphigoid patients recruit neutrophils to the dermal-epidermal junction (DEJ) and induce dermal-epidermal separation (DES) in cryosections of human skin. Anti-p200 pemphigoid sera (anti-p200 pemphigoid; b, e), but not from sera of healthy volunteers (HV; c, f), recruited leukocytes to the DEJ after 1 h of incubation (b, c) and induced DES after 3 h (e, f). As positive control for DES, IgG from a patient with bullous pemphigoid was used (BP a, d). Recruited neutrophils are marked by arrows, base of the split is marked by black triangles. All sections were stained with hematoxylin and eosin. Magnification, x200.</p

Primer sequences for PCR amplification of cDNA fragments of human.

<p>F, forward primer; R, reverse primer.</p

Serum autoantibody reactivity in anti-p200 pemphigoid patients with overlapping fragments of laminin γ1 covering the whole molecule.

<p>Serum autoantibody reactivity in anti-p200 pemphigoid patients with overlapping fragments of laminin γ1 covering the whole molecule.</p

Schematic diagram of the 6 recombinant fragments of human laminin γ1 (hLAMC1) used in this study.

<p>The recombinant C-terminus (hLAMC1-cterm) was previously used as antigenic target in an ELISA for the diagnosis of anti-p200 pemphigoid <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0041769#pone.0041769-Groth1" target="_blank">[8]</a>. Each recombinant fragment is fused with an N-terminal His-tag. Amino acid numbers are shown next to the fragments.</p