JHEP Rep. 2021 Aug;3(4): 100297
Esra Karatas,
Anne-Aurélie Raymond,
Céline Leon,
Jean-William Dupuy,
Sylvaine Di-Tommaso,
Nathalie Senant,
Sophie Collardeau-Frachon,
Mathias Ruiz,
Alain Lachaux,
Frédéric Saltel,
Marion Bouchecareilh.
Background & Aims: A single point mutation in the Z-variant of alpha 1-antitrypsin (Z-AAT) alone can lead to both a protein folding and trafficking defect, preventing its exit from the endoplasmic reticulum (ER), and the formation of aggregates that are retained as inclusions within the ER of hepatocytes. These defects result in a systemic AAT deficiency (AATD) that causes lung disease, whereas the ER-retained aggregates can induce severe liver injury in patients with ZZ-AATD. Unfortunately, therapeutic approaches are still limited and liver transplantation represents the only curative treatment option. To overcome this limitation, a better understanding of the molecular basis of ER aggregate formation could provide new strategies for therapeutic intervention.
Methods: Our functional and omics approaches here based on human hepatocytes from patients with ZZ-AATD have enabled the identification and characterisation of the role of the protein disulfide isomerase (PDI) A4/ERP72 in features of AATD-mediated liver disease.
Results: We report that 4 members of the PDI family (PDIA4, PDIA3, P4HB, and TXNDC5) are specifically upregulated in ZZ-AATD liver samples from adult patients. Furthermore, we show that only PDIA4 knockdown or alteration of its activity by cysteamine treatment can promote Z-AAT secretion and lead to a marked decrease in Z aggregates. Finally, detailed analysis of the Z-AAT interactome shows that PDIA4 silencing provides a more conducive environment for folding of the Z mutant, accompanied by reduction of Z-AAT-mediated oxidative stress, a feature of AATD-mediated liver disease.
Conclusions: PDIA4 is involved in AATD-mediated liver disease and thus represents a therapeutic target for inhibition by drugs such as cysteamine. PDI inhibition therefore represents a potential therapeutic approach for treatment of AATD.
Lay summary: Protein disulfide isomerase (PDI) family members, and particularly PDIA4, are upregulated and involved in alpha 1-antitrypsin deficiency (AATD)-mediated liver disease in adults. PDI inhibition upon cysteamine treatment leads to improvements in features of AATD and hence represents a therapeutic approach for treatment of AATD-mediated liver disease.
Keywords: AAT, alpha 1-antitrypsin; AATD, alpha 1-antitrypsin deficiency; Alpha 1-antitrypsin deficiency; CF, cystic fibrosis; CFTR, cystic fibrosis transmembrane conductance regulator; Cysteamine; ER, endoplasmic reticulum; FFPE, formalin-fixed paraffin-embedded; FKBP10, FK506-binding protein (FKBP) isoform 10; HCC, hepatocellular carcinoma; IHC, immunohistochemistry; IP, immunoprecipitation; Liver damage; NHK, null Hong Kong variant of AAT; P4HB, prolyl 4-hydroxylase subunit beta/PDIA1; PDI, protein disulfide isomerase; PDIA3, protein disulfide isomerase family A member 3/ERP57; PDIA4; PDIA4, protein disulfide isomerase family A member 4/ERP70/ERP72; PDIi, PDI inhibitors; Protein disulfide isomerase; ROS, reactive oxygen species; SURF4, proteins Surfeit 4; Scr, scramble; TRX, thioredoxin; TXNDC5, thioredoxin domain containing 5/PDIA15; Treatment; WT, wild-type; Z-AAT, alpha 1-antitrypsin Z variant; ZZ, homozygosis for the Z mutant allele; siRNA, small RNA interference; ΔF508-CFTR, most common mutation of CFTR, which deletes phenylalanine508