Human AGR2 Deficiency Causes Mucus Barrier Dysfunction and Infantile Inflammatory Bowel Disease

<h3>Background & Aims</h3><p dir="ltr">The gastrointestinal epithelium plays a crucial role in maintaining homeostasis with the gut microbiome. Mucins are essential for intestinal barrier function and serve as a scaffold for antimicrobial factors. Mucin 2 (MUC2) is th...

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محفوظ في:
التفاصيل البيبلوغرافية
المؤلف الرئيسي: Ahmad A. Al-Shaibi (18552234) (author)
مؤلفون آخرون: Ussama M. Abdel-Motal (138406) (author), Satanay Z. Hubrack (18552236) (author), Alex N. Bullock (18552237) (author), Amna A. Al-Marri (18552239) (author), Nourhen Agrebi (14151222) (author), Abdulrahman A. Al-Subaiey (18552242) (author), Nazira A. Ibrahim (18552247) (author), Adrian K. Charles (112557) (author), Mamoun Elawad (438979) (author), Holm H. Uhlig (564856) (author), Bernice Lo (3441317) (author)
منشور في: 2021
الموضوعات:
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الوصف
الملخص:<h3>Background & Aims</h3><p dir="ltr">The gastrointestinal epithelium plays a crucial role in maintaining homeostasis with the gut microbiome. Mucins are essential for intestinal barrier function and serve as a scaffold for antimicrobial factors. Mucin 2 (MUC2) is the major intestinal gel-forming mucin produced predominantly by goblet cells. Goblet cells express anterior gradient 2 (AGR2), a protein disulfide isomerase that is crucial for proper processing of gel-forming mucins. Here, we investigated 2 siblings who presented with severe infantile-onset inflammatory bowel disease.</p><h3>Methods</h3><p dir="ltr">We performed whole-genome sequencing to identify candidate variants. We quantified goblet cell numbers using H&E histology and investigated the expression of gel-forming mucins, stress markers, and goblet cell markers using immunohistochemistry. AGR2-MUC2 binding was evaluated using co-immunoprecipitation. Endoplasmic reticulum (ER) stress regulatory function of mutant AGR2 was examined by expression studies in Human Embryonic Kidney 293T (HEK293T) using tunicamycin to induce ER stress.</p><h3>Results</h3><p dir="ltr">Both affected siblings were homozygous for a missense variant in <i>AGR2</i> . Patient biopsy specimens showed reduced goblet cells; depletion of MUC2, MUC5AC, and MUC6; up-regulation of AGR2; and increased ER stress. The mutant AGR2 showed reduced capacity to bind MUC2 and alleviate tunicamycin-induced ER stress.</p><h3>Conclusions</h3><p dir="ltr">Phenotype–genotype segregation, functional experiments, and the striking similarity of the human phenotype to <i>AGR2</i> <sup><em>-/-</em></sup><sup><em> </em></sup>mouse models suggest that the AGR2 missense variant is pathogenic. The Mendelian deficiency of AGR2, termed “Enteropathy caused by AGR2 deficiency, Goblet cell Loss, and ER Stress” (EAGLES), results in a mucus barrier defect, the inability to mitigate ER stress, and causes infantile-onset inflammatory bowel disease.</p><h2>Other Information</h2><p dir="ltr">Published in: Circulation: Cellular and Molecular Gastroenterology and Hepatology<br>License: <a href="https://creativecommons.org/licenses/by/4.0/" target="_blank">https://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://doi.org/10.1016/j.jcmgh.2021.07.001" target="_blank">https://doi.org/10.1016/j.jcmgh.2021.07.001</a></p>