We have identified 10 genes with diverse and unrelated functions, the deletion of which resulted in major skeletal abnormalities. By adopting a multi-parameter phenotyping approach, we identified a new functional classification of bone structure based on its mineral content, strength and ductility that clarifies understanding of skeletal physiology and pathology, and which maps directly to human disease. As a result of evolutionary pressure, bone structure represents an optimal compromise between strength and flexibility that requires contributions from many diverse genes. Continuous bone remodeling enables the skeleton to adjust this compromise in response to changing physiological and environmental pressures
[29],
[30]. The current studies demonstrate that loss of function of individual genes can disrupt this optimal compromise resulting in skeletal phenotypes that cluster into three functionally distinct categories.
Postmenopausal osteoporosis is characterized by weak but flexible bone with low mineral content
[31] and three of the identified knockout strains (
Bbx,
Cadm1,
Fam73B) had phenotypes in this category.
Bbx encodes a conserved transcription factor that contains a SOX-TCF HMG-box
[32]–
[36]. Family members include SRY-related
Sox genes that are implicated in skeletal dysplasias
[37],
[38] and the TCF/LEF transcription factors that mediate Wnt/β-catenin signaling
[39], a key pathway implicated in osteoporosis and osteoarthritis
[40]–
[43].
Cadm1 encodes a trans-membrane glycoprotein adhesion molecule of the immunoglobulin superfamily
[44] for which a number of disparate functions have been reported including; tumor suppression
[45], synapse development
[46], behavioral regulation
[47], T cell adhesion
[48], mast cell interactions
[49], and spermatogenesis
[50]. However, no function in the skeleton has been reported.
Fam73B encodes a conserved membrane protein of unknown function. These findings indicate that deletion of genes encoding proteins with diverse and unrelated functions can result in similar defects of bone strength and mineralization.
Disorders of bone matrix as typified by osteogenesis imperfecta
[51] are characterized by bone that is weak and brittle with low BMC, and three of the strains (
Prpsap2,
Slc38a10,
Sparc) displayed this phenotype.
Prpsap2 encodes the non-catalytic inhibitory subunit of phosphoribosylpyrophosphate synthetase
[52], and is required for synthesis of purine and pyrimidine nucleotides, the amino acids histidine and tryptophan, and the coenzyme nicotinamide adenine dinucleotide
[53]. Its function in the skeleton is unknown, although a recent study proposed
PRPSAP2 as a candidate oncogene in osteosarcoma tumorigenesis
[54].
Slc38a10 encodes a proposed sodium-coupled neutral amino acid membrane transporter
[55] that may act as a cell volume regulator in mesenchyme
[56]. The severe growth defect in
Slc38a10 knockout mice suggests a critical function in chondrocytes, which mediate linear growth by cell volume expansion during hypertrophic differentiation
[57]. Furthermore, related transporters have already been implicated in human skeletal disease.
SLC35D1 is critical for chondroitin sulphate synthesis and mutations cause Schneckenbecken skeletal dysplasia
[58]. Mutations in
SLC26A2, cause four distinct chondrodysplasia syndromes
[59] and emphasize the key role of these transporters in endochondral ossification.
Sparc encodes the well-described extracellular matrix glycoprotein osteonectin and its deletion resulted in the characteristic and expected phenotype
[22],
[23] of weak and brittle bone with low BMC. These findings highlight the importance of enzymes, transporters and structural proteins to the functional integrity of bone matrix.
Diseases of high bone mass are rare and include sclerosteosis due to deletion of
SOST
[60] and autosomal dominant high bone mass due to gain-of-function mutations in
LRP5
[61]. They are characterized by bone that is strong but brittle with high BMC, and four of the knockout strains (
Asxl1,
Setdb1,
Spns2,
Trim45) displayed such a phenotype.
Asxl1 encodes a polycomb protein that interacts with heterochromatin protein-1
[62] and is required for regulation of
Hox genes during axial patterning
[63], suggesting a role in skeletal development
[64],
[65]. Indeed,
ASXL1 heterozygous nonsense mutations were recently described to cause Bohring-Opitz syndrome
[66], a developmental disorder characterized by mental retardation, impaired intrauterine growth, trigonocephaly and wrist and metacarpophalangeal joint abnormalities. Although the disease mechanism is unknown, craniofacial defects identified in homozygous
Asxl1 knockout mice suggest that mutations in Bohring-Opitz syndrome result in a mutant protein with dominant-negative activity.
Setdb1 encodes a histone H3 methyltransferase that regulates gene silencing
[67],
[68]. Although found to be expressed in cartilage but not bone in the primary phenotype screen, other studies demonstrated
Setdb1 expression in osteoblasts and suggested a role in lineage commitment and differentiation
[69],
[70].
Spns2 encodes a sphingosine 1-phosphate (S1P) transporter
[71] that is essential for S1P secretion. S1P binds to the G-protein coupled receptors, S1PR1 and S1PR2, and regulates osteoclast
[72],
[73] and osteoblast
[74] precursor cell recruitment and migration. Thus, control of S1P secretion by
Spns2 represents a novel mechanism that couples bone resorption and formation
[75].
Trim45 is a member of the tripartite protein family, many of which act as ubiquitin or SUMO E3 ligases
[76]–
[78]. Although restricted to brain and testis in the primary phenotype screen, human studies demonstrate that
Trim45 is more widely expressed
[79]. Little is known about its function, although one study indicates
Trim45 interacts with AP-1 and inhibits activity of the MAP kinase pathway
[79]. The physiological significance of these findings and the role of
Trim45 in the skeleton are unknown, although AP-1 proteins are key regulators of osteoblast and osteoclast differentiation and function
[80],
[81]. These findings emphasize the importance of lineage commitment, control of cell differentiation and coupling of both osteoblasts and osteoclasts in high bone mass disorders.
In the context of osteoporosis, our identification of many new genes that determine bone strength, and which otherwise could not be predicted, is consistent with studies indicating that diverse genetic polymorphisms result in small effects on phenotype
[11],
[12],
[82],
[83]. Accordingly, and in line with current understanding that only 3% of the heritability of BMD is accounted for by known genetic variation
[12], none of the genes identified in this study have been recognized in osteoporosis genome-wide association studies
[84]. We hypothesize, therefore, that unbiased multi-parameter and functional phenotyping of knockout mice has the power to identify many of the major genes that determine bone strength. Ultimately, this approach is likely to identify several genes from a single signaling pathway with an important role in the control of bone mass and strength. This has the advantage of independently confirming critical pathways and the potential to identify several alternative therapeutic targets. Importantly, however, the approach has limitations. The study of knockout mice can only identify phenotypes that result from gene deletion but cannot identify genes that only cause abnormalities when they harbor gain-of-function or dominant-negative mutations. Furthermore, the strategy does not include challenges such as ageing that may reveal additional phenotypes. However, if such provocative challenges were to be incorporated into screening approaches they would inevitably increase costs and limit throughput.
Our findings resulted from development and refinement of a rapid-throughput phenotyping algorithm to identify knockout mice with major abnormalities of bone structure and strength (
Figure S3). The methods require bones from only two knockout mice, which first undergo digital point projection x-ray microradiography and micro-CT determination of six parameters of bone structure. Mahalanobis distance calculations and principal component analysis is performed and strains with at least one structural parameter >2.0 SD from the reference mean plus those with outlier Mahalanobis distances (95% confidence limit) are selected for biomechanical studies. Bones from selected strains undergo destruction 3-point bend testing to determine six measures of bone strength. Application of this unbiased approach to 100 consecutive knockout strains from the MGP pipeline identified 10% with major phenotypes affecting bone strength. Subsequent consideration of the results of primary phenotype screening and biological plausibility (
Figure S3) allowed selection of mice to be refined.
Inherent in this approach is the capability to alter the statistical stringency threshold of analyses such that the number of strains for subsequent functional studies can be adjusted according to phenotype severity. For example, if the threshold for structural parameters is increased from 2.0 to 3.0 SD, then 9 outlier strains (rather than 19) are identified. Furthermore, if the confidence limit for Mahalanobis distance is increased from 95 to 99.7% then 21 multivariate outliers (rather than 40) would be identified. Of note, Trim45, which was recognized as an outlier only by Mahalanobis analysis, would still be identified if the confidence limit were to be increased to 99.7%, thus emphasizing the importance of a robust statistical method to ensure that all functional outliers are captured. Biomechanical analysis following application of these more stringent thresholds would detect 8 outlier strains including Trim45 and Sparc, resulting in the identification of 7 novel determinants of bone mass and strength rather than 9. The intrinsic flexibility of such a bespoke approach facilitates its application to other biological systems or polygenic diseases.