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Functional validation of EIF2AK4 (GCN2) missense variants associated with pulmonary arterial hypertension.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Emanuelli, Giulia 
Zhu, JiaYi 
Morrell, Nicholas W 
Marciniak, Stefan J  ORCID logo  https://orcid.org/0000-0001-8472-7183

Abstract

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.

Description

Keywords

EIF2AK4, GCN2, PVOD, missense variants, pulmonary hypertension, Humans, Protein Serine-Threonine Kinases, Mutation, Missense, Pulmonary Arterial Hypertension, Genetic Predisposition to Disease, Hypertension, Pulmonary, Computational Biology

Journal Title

Hum Mol Genet

Conference Name

Journal ISSN

0964-6906
1460-2083

Volume Title

Publisher

Oxford University Press (OUP)
Sponsorship
MRC (MR/V028669/1)
Evelyn Trust (Project Ref: 22/03)
Medical Research Council (MR/R009120/1)
British Heart Foundation (RE/18/1/34212)
National Institute for Health and Care Research (IS-BRC-1215-20014)
MRC (MCMB MR/V028669/1 and MR/R009120/1), EPSRC (EP/R03558X/1), Cambridge Biomedical Research Centre (BRC-1215-20014); British Lung Foundation (BLF), Asthma+Lung UK (ALUK), Royal Papworth Hospital, Victor Philip Dahdaleh Foundation philanthropic funding from Rick Medlock EPSRC (EP/R03558X/1), BHF (RE/18/1/34212), Evelyn Trust (Grant 22/03), Cambridge-Tsinghua collaborative programme on sustainability and emerging technologies Cambridge Trust).