Mental retardation is a common debilitating condition of the human brain present in 1%–2% of the population. Major advances have been made in unraveling the molecular basis of this disease in cases in which the causes are primarily genetic. X-linked mental retardation (XLMR) is defined simply as the presence of mental retardation (defined as an IQ <70) where the causative gene is on the X chromosome. Classical linkage analysis together with positional cloning has led to the identification of a number of genes
10,11, but many remain elusive. In order to identify the remaining genes, we embarked on a systematic and comprehensive approach of resequencing of 737 genes, annotated in the Vertebrate Genome Annotation (VEGA) database, in probands from 250 families with mental retardation, which are compatible with X linkage and which did not have mutations in the currently known XLMR-linked genes
12-14.
As part of this effort, we identified mutations in the UPF3 regulator of nonsense transcripts homolog B (yeast) (UPF3B) gene. The UPF3B gene is composed of 11 exons and is located on Xq24 (at ~118.8 Mb, build 36). We identified three different protein-truncating mutations in three families. One family had a clinical diagnosis of FG syndrome (OMIM 305450; family 407/K8890). Two others had a clinical diagnosis of Lujan-Fryns syndrome (LFS; OMIM 309520). In family 1 (which had a diagnosis of FG syndrome), we identified a deletion of four nucleotides, 674_677delGAAA, in exon 7 of UPF3B, leading to a translational frameshift and subsequent protein truncation, R225fs*20 (). Family 2 (LFS) had a two-nucleotide deletion, 867_868delAG, in exon 9. This mutation causes a frameshift and UPF3B protein truncation G290fs*2 (). In family 3 (with LFS), we identified a nonsense mutation, 1288C>T, in exon 10, leading to a premature termination codon (PTC) and subsequent protein truncation, R430* (). A subsequent analysis of 118 additional probands from a cohort of new families with putative XLMR (collected by the Greenwood Genetic Center) identified a single-nucleotide substitution, 478T>G, in exon 5 in a family K9170 (family 4, ) with nonsyndromic XLMR. This nucleotide change is predicted to cause a missense amino acid change, Y160D (). The tyrosine residue at this position is invariant in UPF3B and UPF3A orthologs from animals and plants, suggesting that it is of crucial importance for UPF3B and UPF3A protein function (). The UPF3B mutation in each family was found only in affected individuals. We did not find any other sequence variants in the 250-case cohort. Moreover, complete sequencing of the coding sequences and splice site junctions of UPF3B in 730 control X chromosomes did not show these or any further variants (data not shown). We did not observe the Y160D alteration in an additional 422 normal males. Taken together, these results strongly suggest that the three protein-truncating mutations and the mutation resulting in the missense Y160D change are the disease-causing mutations in these families.
Three of the four mutations identified introduce a PTC into the
UPF3B mRNA ORF (). Such PTCs often trigger NMD of mRNA
1. Given that the UPF3B protein itself is an important component of NMD surveillance protein complexes
8,9,15, we investigated the consequence of the probable lack of UPF3B function on NMD of its own mutant
UPF3B PTC-containing mRNA. For this purpose, we used RNA isolated from the Epstein-Barr virus–transformed lymphoblastoid cell lines (LCLs) of affected individual III-1 from family 1 and individuals III-4 and III-5 from family 2. Real-time quantitative RT-PCR (qRT-PCR) analysis showed significantly reduced levels of the
UPF3B PTC-containing mRNAs from all three individuals (). This result suggested that the NMD-mediated mRNA degradation of
UPF3B PTC-containing mRNA was not substantially compromised by the lack of UPF3B protein function. Blocking protein translation in LCLs with 100 μg ml
−1 cycloheximide restored
UPF3B PTC-containing mRNA expression (). To investigate further the functionality of NMD in the cells of these individuals, we selected (based on their expression in LCLs) three known NMD targets:
SMG5, PANK2 and
GADD45B (ref.
16). Expression of
GADD45B mRNA (part of the classical NMD pathway target) was significantly higher in individuals with
UPF3B PTCs compared with controls (
P < 0.05), indicating that the classical NMD pathway is compromised in these individuals. By contrast, mRNA expression of
SMG5 and
PANK2 (alternative NMD pathway targets) did not significantly differ between individuals with
UPF3B PTCs and controls, suggesting that the alternative NMD pathway is intact (). Thus, these results demonstrate that NMD is only partially compromised in individuals with
UPF3B PTCs and that this is primarily due to dysfunction of the classical NMD pathway. Moreover, the data suggest that although
UPF3B seems to be more important in the classical NMD pathway, the
UPF3B transcript itself may be at least partially regulated by the alternative pathway.
We also investigated the effect of these mutations on UPF3B protein expression. Protein blot analysis using two peptide-based antibodies targeted to the N terminus (hUPF3B_901 and hUPF3B_913) did not detect wild-type or truncated UPF3B proteins in lysates from LCLs of four affected individuals () (a truncated protein of ~30 kDa was theoretically possible in the affected males from family 1, and a protein of ~35 kDa was possible in affected males from family 2; ). Irrespective of NMD-mediated degradation of
UPF3B PTC-containing mRNAs, which could be tissue specific
17 and thus different in the brain, the resulting UPF3B proteins of affected individuals from each of the three families would lack either the entire C-terminal Y14 protein-interacting domain (in families 1 and 2) or the major part of it (in family 3) (). This domain is essential for NMD through proper assembly of the exon junction complex
18,19. As such, the three different protein-truncating mutations are probably complete loss-of-function mutations of
UPF3B.
Previously published analyses
9 and our RT-PCR () and EST (data not shown) analyses show that
UPF3B is expressed in a variety of tissues and developmental stages. The only characterized alternative splicing involves exon 8. Inclusion of exon 8 seems to be tissue specific (). The larger ORF of 1,452 bp (including exon 8) is translated to a 483-residue protein (~58 kDa, Figs. and ).
We have shown that the
UPF3B PTC-containing mRNA from the affected individuals we studied is subject to NMD, even in the absence of the UPF3B protein itself. Thus, UPF3B is an important but probably nonessential component of the NMD protein machinery (see also ref.
15). Redundancy of the NMD pathways has recently been uncovered
15,20.
UPF3B shares high similarity and comparable tissue specificity, but not necessarily the same level of expression ( and ref.
9), with its autosomal paralog
UPF3A (partial alignment shown in ). Therefore, we tested whether
UPF3A expression was altered to compensate for the reduction of
UPF3B expression in LCLs. We did not find any significant differences in
UPF3A mRNA expression (or in
UPF2 mRNA expression) by qRT-PCR ().
Eleven of the thirteen affected individuals from the four families were available for examination. The clinical features of these affected individuals are summarized in . Almost all of the clinical features frequently observed in the affected males with truncating UPF3B mutations were absent in the three affected males with the Y160D missense change ( and ). With respect to the eight males with the truncating mutations, the features present at >50% frequency were slender build with poor musculature (87%), long, thin face (75%), high arched palate (75%), high nasal bridge (75%) and pectus (62%). Notably, we observed autistic features (4/8) and behavioral problems (3/8) as well, although these are common coincident findings in mental retardation. Overall, the clinical phenotype is variable, although many of the clinical features are suggestive of LFS and FG phenotypes. Apart from family 1 and perhaps family 3, most individuals are not overtly dysmorphic. All carrier females examined had normal intelligence and physical examinations. For family 4 with the Y160D missense change, the males had rather normal physical examinations, consistent with the designation of nonsyndromic XLMR.
| Table 1Summary of clinical features in affected males from families with UPF3B mutations |
LFS (OMIM 309520), or XLMR with marfanoid habitus syndrome, is a syndromal form of XLMR predominantly affecting males. The main features include mild to moderate mental retardation, distinct facial dysmorphism (prominent forehead, maxillary hypoplasia, small mandible, long nose with short and deep philtrum, thin upper lip and low-set normally shaped ears), hypernasal voice, marfanoid-like features (tall stature after puberty and long, thin hyper-extensible fingers and toes) and hypotonia
5,6. Behavioral problems and psychiatric disorders are frequently present
21,22. FG syndrome was first described by Opitz and Kaveggia in 1974 in a family with five affected males that presented with mental retardation, macrocephaly, imperforate anus and hypotonia
7. Facial anomalies include a high broad forehead with frontal cowlick, hypertelorism and a prominent lower lip
23. Clinical diagnosis of both conditions remains challenging. None of the physical features in either syndrome is a prerequisite, and many of the features overlap and are commonly seen in individuals with mental retardation.
Until recently the genetic basis for both FG and LFS syndromes was not known, although genetic heterogeneity was expected
22,23. Others
24 have identified a recurrent mutation, 2881C>T/R961W, in the
MED12 gene in the original Opitz-Kaveggia (FG) syndrome family
7 and five other FG families. Notably, another mutation in the same gene has been found
25 in the original family described in ref.
5, suggesting that LFS and FG syndrome are allelic. Mutations in
ZDHHC9 have also been reported in XLMR with marfanoid habitus and in one family where FG was suggested as a clinical diagnosis
14. Our findings of
UPF3B mutations in families ascertained as having LFS (two families) or FG (one family) provide further evidence for the overlap of these two clinical phenotypes.
The UPF3A and UPF3B proteins are crucial but are probably alternative components of the exon junction complex, which assembles about 20–24 bp upstream of each exon-exon junction on processed mRNA
8. A recent study
15 demonstrated that although the UPF3A and UPF3B proteins show considerable similarity, they differ functionally. They showed that the UPF3B protein is much more active in NMD and translation regulation than UPF3A
15.
UPF3B gene expression is also considerably higher than that of UPF3A in most human tissues, including adult and fetal brain ( and ref.
9). More recent work
16 suggests the existence of an alternative NMD pathway, which is very likely to be independent of UPF3B and UPF3A. Our results on naturally occurring mutations in
UPF3B strongly support the existence of such alternative NMD pathway(s). The molecular mechanism by which loss-of-function mutations of
UPF3B lead to mental retardation and associated features in the individuals we studied is not known. It is conceivable that the absence of UPF3B leads to a partial, although apparently not complete, loss of NMD, especially in tissues where
UPF3A expression levels are low. This may result in subtle deregulation of mRNA surveillance of multiple genes or their isoforms, which are otherwise physiologically controlled by NMD. There may also be an effect on the translation of certain mRNAs, nuclear export, RNA localization or a general increase in RNA noise (for example, expression of pseudogenes
26 and viral sequences
27). It is also possible, however, that the redundancy of UPF3B in NMD is complete in some tissues and that the phenotype associated with
UPF3B mutations is due to a loss of functions other than those of NMD. The identification of naturally occurring loss-of-function mutations of the human
UPF3B gene may therefore offer an opportunity to identify
bona fide targets of UPF3B-activated NMD and translation control and may provide a glimpse into the complexities of human NMD pathways.