Recurrent EZH1 mutations are a second hit in autonomous thyroid adenomas

Autonomous thyroid adenomas (ATAs) are a frequent cause of hyperthyroidism. Mutations in the genes encoding the TSH receptor (TSHR) or the Gs protein alpha subunit (GNAS) are found in approximately 70% of ATAs. The involvement of other genes and the pathogenesis of the remaining cases are presently unknown. Here, we performed whole-exome sequencing in 19 ATAs that were paired with normal DNA samples and identified a recurrent hot-spot mutation (c.1712A>G; p.Gln571Arg) in the enhancer of zeste homolog 1 (EZH1) gene, which codes for a catalytic subunit of the polycomb complex. Targeted screening in an independent cohort confirmed that this mutation occurs with high frequency (27%) in ATAs. EZH1 mutations were strongly associated with known (TSHR, GNAS) or presumed (adenylate cyclase 9 [ADCY9]) alterations in cAMP pathway genes. Furthermore, functional studies revealed that the p.Gln571Arg EZH1 mutation caused increased histone H3 trimethylation and increased proliferation of thyroid cells. In summary, this study revealed that a hot-spot mutation in EZH1 is the second most frequent genetic alteration in ATAs. The association between EZH1 and TSHR mutations suggests a 2-hit model for the pathogenesis of these tumors, whereby constitutive activation of the cAMP pathway and EZH1 mutations cooperate to induce the hyperproliferation of thyroid cells.IZKF Wurzburg [B-281]; ERA-NET E-Rare [01GM1407B]; Deutsche KrebshilfeDeutsche Krebshilfe [109994]; Wilhelm Sander Stiftung [2013.010.1]We wish to thank Eileen Bosenberg, Bianca Klupfel, and Ines Elsner for technical support and Ulrike Zabel for DNA cloning. This study was partially supported by grants from the IZKF Wurzburg (B-281, to DC and MF); the ERA-NET E-Rare (01GM1407B, to MF and DC); the Deutsche Krebshilfe (109994, to ME); and the Wilhelm Sander Stiftung (project 2013.010.1, to RP)

Differential expression of the protein kinase A subunits in normal adrenal glands and adrenocortical adenomas

Somatic mutations in protein kinase A catalytic a subunit (PRKACA) were found to be causative for 30-40% of cortisol-producing adenomas (CPA) of the adrenal gland, rendering PKA signalling constitutively active. In its resting state, PKA is a stable and inactive heterotetramer, consisting of two catalytic and two regulatory subunits with the latter inhibiting PKA activity. The human genome encodes three different PKA catalytic subunits and four different regulatory subunits that are preferentially expressed in different organs. In normal adrenal glands all regulatory subunits are expressed, while CPA exhibit reduced protein levels of the regulatory subunit II beta. In this study, we linked for the first time the loss of RII beta protein levels to the PRKACA mutation status and found the down-regulation of RII beta to arise post-transcriptionally. We further found the PKA subunit expression pattern of different tumours is also present in the zones of the normal adrenal cortex and demonstrate that the different PKA subunits have a differential expression pattern in each zone of the normal adrenal gland, indicating potential specific roles of these subunits in the regulation of different hormones secretion

PKA catalytic subunit mutations in adrenocortical Cushing's adenoma impair association with the regulatory subunit

We recently identified a high prevalence of mutations affecting the catalytic (C alpha) subunit of protein kinase A (PKA) in cortisol-secreting adrenocortical adenomas. The two identified mutations (Leu206Arg and Leu199_Cys200insTrp) are associated with increased PKA catalytic activity, but the underlying mechanisms are highly controversial. Here we utilize a combination of biochemical and optical assays, including fluorescence resonance energy transfer in living cells, to analyze the consequences of the two mutations with respect to the formation of the PKA holoenzyme and its regulation by cAMP. Our results indicate that neither mutant can form a stable PKA complex, due to the location of the mutations at the interface between the catalytic and the regulatory subunits. We conclude that the two mutations cause high basal catalytic activity and lack of regulation by cAMP through interference of complex formation between the regulatory and the catalytic subunits of PKA

Mutationen in der katalytischen Untereinheit von Proteinkinase A als Ursache des adrenalen Cushing Syndroms: Mechanismen und funktionelle Konsequenzen

Protein kinase A (PKA) is the main effector of cyclic-adenosine monophosphate (cAMP) and plays an important role in steroidogenesis and proliferation of adrenal cells. In a previous study we found two mutations (L206R, 199_200insW) in the main catalytic subunit of protein kinase A (PKA C) to be responsible for cortisol-producing adrenocortical adenomas (CPAs). These mutations interfere with the formation of a stable holoenzyme, thus causing constitutive PKA activation. More recently, we identified additional mutations affecting PKA C in CPAs associated with overt Cushing syndrome: S213R+insIILR, 200_201insV, W197R, d244 248+E249Q, E32V. This study reports a functional characterization of those PKA Cmutations linked to CPAs of Cushing’s patients. All analyzed mutations except for E32V showed a reduced interaction with at least one tested regulatory (R) subunit. Interestingly the results of the activity differed among the mutants and between the assays employed. For three mutants (L206R, 199_200insW, S213R+insIILR), the results showed enhanced translocation to the nucleus. This was also observed in CRISPR/Cas9 generated PRKACA L206R mutated HEK293T cells. The enhanced nuclear translocation of this mutants could be due to the lack of R subunit binding, but also other mechanisms could be at play. Additionally, I used an algorithm, which predicted an effect of the mutation on substrate specificity for four mutants (L206R, 199_200insW, 200_201insV, d244 248+E249Q). This was proven using phosphoproteomics for three mutants (L206R, 200_201insV, d244 248+E249Q). In PRKACA L206R mutated CPAs this change in substrate specificity also caused hyperphosphorylation of H1.4 on serine 36, which has been reported to be implicated in mitosis. Due to these observations, I hypothesized, that there are several mechanisms of action of PRKACA mutations leading to increased cortisol secretion and cell proliferation in adrenal cells: interference with the formation of a stable holoenzyme, altered subcellular localization and a change in substrate specificity. My data indicate that some PKA C mutants might act via just one, others by a combination of these mechanisms. Altogether, these findings indicate that several mechanisms contribute to the development of CPAs caused by PRKACA mutations. Moreover, these findings provide a highly illustrative example of how alterations in a protein kinase can cause a human disease.Proteinkinase A (PKA) ist der Haupteffektor von cyclischem Adenosinmonophosphat (cAMP) und spielt eine wichtige Rolle bei der Synthese von Steroiden und der Proliferation von Nebennierenzellen. In einer vorangegangenen Studie fanden wir zwei Mutationen (L206R, 199_200insW) der wichtigsten katalytischen Untereinheit von PKA (PKA C), die für Kortisol sekretierende Nebennierenrindenadenome (CPAs) verantwortlich sind. Diese Mutationen stören die Bildung eines stabilen Holoenzyms und verursachen somit eine dauerhafte PKA Aktivierung. Vor Kurzem fanden wir weitere Mutationen der PKA C in CPAs von Patienten mit Cushing Syndrom: S213R+insIILR, 200_201insV, W197R, d244 248+E249Q, E32V. In dieser Arbeit wurde eine funktionelle Charakterisierung dieser PKA C Mutanten, die im Zusammenhang mit CPAs von Cushing Patienten stehen, durchgeführt. Alle PKA Mutanten, mit Ausnahme von E32V, zeigten eine reduzierte Interaktion mit mindestens einer getesteten regulatorischen (R) Untereinheit. Interessanterweise hatten die Mutanten unterschiedliche Effekte auf die Aktivität der Kinase. Zusätzlich hatte die Analysemethode ebenfalls Einfluss auf die Aktivität der Mutanten. Für drei Mutanten (L206R, 199_200insW, S213R+insIILR) zeigten die Ergebnisse eine verstärkte Translokation der C Untereinheit in den Zellkern. Dies wurde auch in HEK293T Zellen bestätigt, in deren PRKACA Gen mittels CRISPR/Cas9 die L206R Mutation eingeführt wurde. Diese erhöhte Translokation kann durch die fehlende Bindung zur R Untereinheit erklärt werden, aber auch andere Mechanismen könnten eine Rolle spielen. Außerdem zeigten die Ergebnisse eine Veränderung der Substratspezifität, die für vier Mutanten durch einen Algorithmus vorausberechnet wurde (L206R, 199_200insW, 200_201insV, d244-248+E249Q). Für drei dieser Mutanten (L206R, 200_201insV, d244 248+E249Q) wurde dieses Ergebnis mittels Phosphoproteomics nachgewiesen. Diese Änderung der Substratspezifität verursacht in PRKACA L206R mutierten CPAs auch eine Hyperphosphorylierung von H1.4 an Serin 36, welches eine wichtige Rolle in der Zellteilung spielt. Meine Ergebnisse weisen darauf hin, dass es mehrere Wirkungsmechanismen von PRKACA Mutationen gibt, die zu einer erhöhten Sekretion von Kortisol und Zellproliferation in Nebennierenzellen führen: Störung der Bildung eines stabilen Holoenzyms, Änderung der subzellulären Lokalisation und eine Veränderung der Substratspezifität. Meine Ergebnisse weisen darauf hin, dass einige PKA C-Mutanten durch nur einen, andere durch eine Kombination dieser Mechanismen wirken. Insgesamt zeigen diese Ergebnisse, dass PRKACA Mutationen durch mehrere Mechanismen zur Entwicklung von CPAs beitragen. Darüber hinaus liefern diese Ergebnisse ein anschauliches Beispiel dafür, wie Mutationen in einer Proteinkinase eine menschliche Krankheit verursachen können

Camp signaling in cortisol-producing adrenal adenoma

The cAMP signaling pathway is one of the major players in the regulation of growth and hormonal secretion in adrenocortical cells. Although its role in the pathogenesis of adrenocortical hyperplasia associated with Cushing's syndrome has been clarified, a clear involvement of the cAMP signaling pathway and of one of its major downstream effectors, the protein kinase A (PKA), in sporadic adrenocortical adenomas remained elusive until recently. During the last year, a report by our group and three additional independent groups showed that somatic mutations of PRKACA, the gene coding for the catalytic subunit a of PKA, are a common genetic alteration in patients with Cushing's syndrome due to adrenal adenomas, occurring in 35-65% of the patients. In vitro studies revealed that those mutations are able to disrupt the association between catalytic and regulatory subunits of PKA, leading to a cAMP-independent activity of the enzyme. Despite somatic PRKACA mutations being a common finding in patients with clinically manifest Cushing's syndrome, the pathogenesis of adrenocortical adenomas associated with subclinical hypercortisolism seems to rely on a different molecular background. In this review, the role of cAMP/PKA signaling in the regulation of adrenocortical cell function and its alterations in cortisolproducing adrenocortical adenomas will be summarized, with particular focus on recent developments

PKA Cα subunit mutation triggers caspase-dependent RIIβ subunit degradation via Ser¹¹⁴phosphorylation

Mutations in the PRKACA gene are the most frequent cause of cortisol-producing adrenocortical adenomas leading to Cushing’s syndrome. PRKACA encodes for the catalytic subunit α of protein kinase A (PKA). We already showed that PRKACA mutations lead to impairment of regulatory (R) subunit binding. Furthermore, PRKACA mutations are associated with reduced RIIβ protein levels; however, the mechanisms leading to reduced RIIβ levels are presently unknown. Here, we investigate the effects of the most frequent PRKACA mutation, L206R, on regulatory subunit stability. We find that Ser$^{114}$ phosphorylation of RIIβ is required for its degradation, mediated by caspase 16. Last, we show that the resulting reduction in RIIβ protein levels leads to increased cortisol secretion in adrenocortical cells. These findings reveal the molecular mechanisms and pathophysiological relevance of the R subunit degradation caused by PRKACA mutations, adding another dimension to the deregulation of PKA signaling caused by PRKACA mutations in adrenal Cushing’s syndrome