Using an integrative genomics strategy that involved linkage analysis, global expression profiling and high-density copy number mapping, we previously defined a novel pheochromocytoma susceptibility locus to chromosome 2q11, which we named FP (
Familial
Pheochromocytoma)
3. Identification of other affected individuals in the original kindred established a dominant model of transmission (
Suppl. Fig. 1) and additional linked families redefined the limits of the FP locus to a region containing 205 genes (NCBI Build 35.1,
Suppl. Table 1) spanning 19.62Mb between 94,81Mbp and 114,43Mbp. Tumor DNA from one of the affected cases (index case of Family 1) was used as a template for exon-based sequencing, as described
4. Using this approach, we identified a splice-site variant (IVS3-2A>C) in the provisional transmembrane-encoding gene,
TMEM127, also known as
FLJ20507 (,
Suppl. Fig. 2A, 2B). This mutation was also present in this patient’s germline DNA as well as in each of six other affected siblings, but not in samples from two unaffected sibs.
| Table 1Clinical and genetic features of patients and families with TMEM127 gene mutations |
We next sequenced germline and/or tumor DNA from an additional 102 index pheochromocytomas, 19 of which had a clear familial history, and 83 were apparently sporadic cases. We detected six additional
TMEM127 mutations in these samples (,
Suppl. Fig. 2C). Six of the seven
TMEM127 variants identified were splice-site or nonsense mutations predicted to interrupt prematurely the protein reading frame (,
Suppl. Fig.2A and B). In all, four
TMEM127 variants (including the index case) were detected among 12 families without mutations in other pheochromocytoma susceptibility genes (
Suppl.Table 2,
Suppl.Fig.2A and B). The remaining three mutations were identified among the ‘sporadic’ samples that were also wild-type for the known pheochromocytoma-related genes. One of the patients was adopted and thus heredity status was unknown (patient 2, ), and the other two individuals reported no family history of pheochromocytoma (patients 4 and 7, ). In all cases, mutations were detected in the corresponding germline DNA and, when available, in DNA from other relatives with pheochromocytoma (). One of the identified mutations, IVS3-2A>C, was detected in two separate families (, families 1 and 5). Haplotype analysis of tumor DNA excluded a common ancestor (
Suppl. Table 3). None of the sequence changes found in the pheochromocytoma samples were identified in a control group of 1064 ethnically-matched alleles, although novel and known polymorphic variants were detected (
Suppl. Table 4).
Loss of heterozygosity (LOH) at the
TMEM127 locus was examined in 35 pheochromocytomas: all
TMEM127-mutant tumors tested (n=19, including multiple affected individuals from the same family or bilateral tumors) had LOH, in contrast with only 2 of 16 wild-type
TMEM127 samples (P=5.17e-8,
Suppl. Table 5). In each mutant
TMEM127 pheochromocytoma, the wild-type allele was lost (
Suppl.Fig.2A), in agreement with a two-hit model of tumor suppressor inactivation. The only missense mutation (V90M) in this series targeted an amino acid conserved amongst putative mammalian
TMEM127 orthologs. As only germline DNA was available from this sample, LOH status could not be determined.
We next measured
TMEM127 transcription in pheochromocytomas and found a 4-fold decrease in expression levels of
TMEM127-mutant samples (n=7) compared to 16 non-mutated pheochromocytomas of various genetic backgrounds (P=0.002,
Suppl.Fig. 2D). This degree of downregulation suggests instability of the mutant transcript, rather than low expression simply due to loss of one allele. RNA was unavailable from the two tumors that had LOH at 2q11 but no
TMEM127 mutation.
Clinically, patients with
TMEM127 mutations developed pheochromocytomas on average at 45.3 years of age, similar to the mean age at diagnosis of sporadic pheochromocytomas (43.6-43.9y
1,5) but notably older than syndromic cases (24.9-30.2y
1,5). All tumors arose from the adrenal medulla and were bilateral in approximately half of the patients (). No malignancies, defined by the presence of metastasis in nonchromaffin-derived tissues, or recurrences, were detected during follow-up of the affected cases (4 to 16 years). Four mutation carriers from Family 1 () remain without clinical disease at 43 to 58 years of age, but a clear picture of the actual penetrance and phenotypic spectrum of
TMEM127 mutations awaits larger studies. Taken together, the data above suggest that
TMEM127 gene mutations are associated with pheochromocytoma predisposition and that
TMEM127 has features of a classic tumor suppressor gene.
The
TMEM127 gene is predicted to encode a protein with three transmembrane regions (
Suppl. Fig. 2C) and no clearly recognizable functional domains. Its sequence is highly conserved throughout evolution and putative orthologs can be identified from mammals to fish (
Suppl. Fig. 3A). The human gene is broadly expressed both in normal tissue (
Suppl. Fig. 3B) and in a diverse panel of cancer cell lines
6 (
Suppl. Fig. 3C), with variable transcription levels that may reflect tissue of origin. Likewise, its putative mouse ortholog is widely expressed from an early postnatal age through adulthood (
Suppl. Fig. 3D).
To begin to probe the functional consequences of
TMEM127 mutations, we generated wild-type and mutant constructs tagged with Flag (either at the N- or C-terminus of the protein) or HA (N-terminus) epitopes. A single product of approximately 26KDa was recognized in HEK293 cells transfected with the wild-type constructs (). However, we were unable to detect a translation product from the mutant constructs in these cell lines (), despite equivalent transfection efficiencies (
Suppl. Fig.4A). These data suggest that
TMEM127-mutant proteins are not expressed, in support of a loss-of-function effect of these variants. Using confocal microscopy, we found that TMEM127 localizes to the plasma membrane and the cytoplasm, displaying both a punctate pattern and as perinuclear clusters (,
Suppl. Fig. 4B). Colocalization studies showed that TMEM127 associates with a subpopulation of vesicular organelles corresponding to early endosomal structures labeled by Rab5 (), the Golgi, labeled both with syntaxin 6 () and N-acetylgalactosaminyltransferase-2 (
Suppl. Fig.5A) and lysosomes (
Suppl. Fig. 5B). We further found that association of TMEM127 with the plasma membrane is enhanced by inhibition of endocytosis
7 (), while increasing pH in the culture media partially traps TMEM127 in endosomal structures
7 (). These findings suggest that TMEM127 associates dynamically with endosomes and may participate in protein trafficking between the plasma membrane, the Golgi and lysosomes.
We used microarray-based expression profiling to define the transcription signature of
TMEM127-mutant tumors. Profiles from eight samples carrying three distinct
TMEM127 mutations, as well as additional pheochromocytomas with mutations in other pheochromocytoma susceptibility genes (8
RET-, 4
NF1-, 8
VHL- and 15
SDHB- or
SDHD-mutant tumors) were analyzed by unsupervised and supervised methods (
Suppl. Table 6), as before
8. In this sample set we confirmed the cluster association between the
TMEM127-mutant tumors and pheochromocytomas with
NF1 and
RET mutations, suggested by our earlier study of FP-linked tumors
3. The gene set enrichment analysis (GSEA) algorithm
9, used to identify pathways associated with the
TMEM127-mutant tumor signature, revealed high statistical association with kinase receptor signals (,
Suppl. Fig. 6A), which had been previously linked to
NF1- and
RET-mutants
3,8. This pattern differed from the expression profiles of pheochromocytomas with mutations in
VHL, SDHB or
SDHD genes, which were uniquely enriched for transcripts involved in the response to hypoxia (,
Suppl. Fig.6B)
8.
| Table 2TMEM127 mutant tumors are transcriptionally enriched for kinase signaling pathway. |
To further evaluate these findings, we knocked down
TMEM127 expression by short interfering (si) or short hairpin (sh) RNA (
Suppl. Fig. 6C). In agreement with the GSEA analysis, HIF1α and its targets were not induced by
TMEM127 downregulation in HEK293 or Hela cells (
Suppl. Fig. 6D). To explore the putative functional relationship with
NF1-mutant tumors, we began by examining RAS activation, the hallmark of
NF1 loss
10.
TMEM127 depletion by two distinct shRNA sequences did not increase RAS activity (). Likewise, AKT phosphorylation, a surrogate for PI3K activity which is enhanced by both
NF111 and
RET12 mutations, was not increased after TMEM127 knockdown (,
Suppl. Fig. 7A). Deregulation of mTOR, a target of several kinase receptor pathways
13, is also a feature of
NF1 loss
14. This fact, combined with the kinase receptor signature displayed by
TMEM127-mutant tumors
3, prompted us to investigate the effects of TMEM127 on mTOR signaling.
mTOR operates as two functionally distinct complexes, mTORC1 and mTORC2
13,15. mTORC1 promotes cell growth and protein translation, and phosphorylates 4EBP1 and S6K. The cellular role of mTORC2 is less clear and its best known substrate is AKT
15. As shown above, TMEM127 knockdown did not impact on AKT activation (). Likewise, enforced expression of TMEM127 did not change AKT phosphorylation (), suggesting that mTORC2 is not involved in this signal. In contrast, TMEM127 knockdown led to increased phosphorylation of 4EBP1 in various cell lines (). These effects were observed by distinct TMEM127 shRNA target sequences () and were independent of serum in HEK293 () and A2058 cells (
Suppl. Fig. 7B). Conversely, enforced expression of TMEM127 using independent constructs led to reduced mTORC1 signaling (,
Suppl. Fig. 7C). Consistent with the observation that mTORC1 is a critical regulator of cell growth and size in many species
16, we found that TMEM127 knockdown cells were larger (,
Suppl. Fig.7D) and proliferated at increased rates compared to control cell lines (,
Suppl. Fig.7E), while cell proliferation was reduced in cells overexpressing TMEM127 (
Suppl. Fig 7F). To determine the relevance of these findings in primary tumors, we examined lysates from
TMEM127-mutant pheochromocytomas and found increased phosphorylation of S6K compared to normal adrenal medulla or tumors without a
TMEM127 mutation (). In agreement with the reported effects of NF1 towards mTOR
14, one
NF1-mutant pheochromocytoma showed elevated S6K phosphorylation, comparable to tumors with a
TMEM127 mutation. Collectively, these results suggest that TMEM127 contributes to control mTORC1 signals and support a role for TMEM127 as a tumor suppressor.
To further determine the extent to which TMEM127 influences mTOR regulation, we tested the effect of amino acids, powerful modulators of mTOR activity that supersede the actions of other regulators of this pathway
17. Two independent
TMEM127-specific shRNA sequences increased phosphorylation of the mTORC1 target S6K in 293E cells, both in amino acid-starved and rich conditions (). In agreement with these findings, overexpression of TMEM127 decreased phosphorylation of mTORC1 targets after amino-acid repletion (,
Suppl. Fig. 7G). To further characterize the interplay between mTOR and TMEM127, we co-expressed myc-mTOR and HA-TMEM127 in HEK293T cells and examined their localization by confocal microscopy. In the absence of amino acid, myc-mTOR, like endogenous mTOR, localized diffusely within the cytoplasm but upon amino acid exposure, it became clustered to the perinuclear region of the cell(), a required step for its activation by Rheb1
17. We found that TMEM127 localized to the same cellular compartment as that of amino acid-activated mTOR (). Interestingly, the extent of myc-mTOR perinuclear localization after amino acid stimulation was significantly more pronounced in cells co-expressing TMEM127 than in control cells not overexpressing this gene (93.4±12%,
vs. 64.3±12% respectively, p<0.001,
Suppl. Fig. 8). This finding suggests that the effects of TMEM127 toward mTOR may be compartment-specific and influence mTOR subcellular localization.
In summary, we identified a novel tumor suppressor gene that is associated with pheochromocytoma development. Similar to other genetic mutations reported in these tumors, all
TMEM127 gene variants were present in the germline
1. Our results suggest that TMEM127 limits mTORC1 activation and that it occupies the same intracellular domain as active mTOR. Interestingly, a component of the
transGolgi network that shuttles between the plasma membrane and the endomembrane system has recently been implicated in cancer by modulating mTOR signals
18. Taken together with other recent evidence
19-20, our data give further support to an emerging role of the endomembrane and vacuolar network in mTOR regulation and in cancer. Future studies using in vivo models should determine whether mTOR activation is sufficient to explain the tumor phenotype resulting from
TMEM127 mutation. Finally, our results support the notion that disruptions of TMEM127 could be the underlying basis for tumors with an aberrant mTOR pathway and validate the power of hereditary tumor models to shed light on cell growth-related signals.