Despite penetrance being an old concept in genetics, little is known about its molecular causes, especially in inherited human diseases. Notable positive examples include dominant erythropoietic protoporphyria, caused by mutations in the
FECH gene, and dominant elliptocytosis, due to mutations in
SPTA1. In these disorders, an imbalance of expression between the wild-type and the mutated alleles causes the manifestation of the symptoms
[25]–
[27].
Similar mechanisms determine penetrance of
PRPF31 mutations, since asymptomatic carriers are individuals who display increased levels of wild-type mRNA alleles, which in turn compensate for the deficiency caused by the mutation
[16]–
[18]. However, unlike erythropoietic protoporphyria and elliptocytosis, in
PRPF31-linked adRP the molecular causes of such beneficial hyper-expression have remained, up to now, unexplained. Previous mapping studies have shown that the penetrance and expression of
PRPF31 is influenced by at least two loci: one, likely having a major effect, lies within the same chromosomal region as
PRPF31 (proximal modifier), the other is on chromosome 14 (distant modifier)
[16],
[19]. Our previous work has also demonstrated that both modifiers would act through diffusible elements (e.g. transcription factors) since their effects on
PRPF31 mRNA expression concerns equally both copies of the gene
[16]. This observation probably explains the failure of previous attempts to identify the proximal modifier as a polymorphic variant of the
PRPF31 sequence itself, according to the
FECH or
SPTA1 models.
Based on this previous knowledge, we reasoned that the expression of the proximal modifier of
PRPF31 mutations should correlate with that of
PRPF31. Therefore we started assessing mRNA levels of genes that reside within the mapped 19q13.4 interval, by using the same cellular model successfully used in previous studies of PRPF molecular genetics, and in particular of
PRPF31 penetrance
[10],
[15]–
[18],
[28],
[29]. Specifically, we studied cells derived from members of one of the largest pedigrees known to segregate a PRPF31 mutation, family RP856/AD5
[6],
[20], for which incomplete penetrance could also be, at least in part, determined by the proximal modifier
[19]. Following a filtering process based on both
in silico analyses and on mRNA expression, we were left with only 10 candidates. Of these, only one,
CNOT3, showed a pattern of expression that significantly correlated to that of
PRPF31. Interestingly, its trend of expression was inverse to that of
PRPF31, raising the possibility that CNOT3 may be a negative regulator of
PRPF31 expression.
CNOT3 encodes a protein that is part of the Ccr4-Not multi-subunit complex, an evolutionary conserved multimeric structure involved in modulation of gene expression
[21],
[30]–
[34]. Evidences that CNOT3 could be a negative regulator of transcription have been provided in yeast
[31], and then confirmed in human cell lines, by the identification of a conserved motif at its C-terminus, called the Not-Box. This motif was originally identified in another subunit of the complex, CNOT2, where it was shown to repress reporter gene activity upon promoter targeting
[35]. We confirmed the role of CNOT3 as a negative regulator of
PRPF31 expression by siRNA-mediated silencing experiments in ARPE-19 cells. Specifically, we observed that 70% depletion of
CNOT3 induced approximately a 2-fold increase in
PRPF31 expression, but had no effects on
TFPT, a gene that is contiguous to
PRPF31 and shares with it part of the promoter
[36].
CNOT3 can modulate transcription of its targets by the direct binding to their promoters
[23] or by promoting the recruitment of deadenylases at the 3′ end of their transcripts
[22]. Our data provide evidence showing that regulation of
PRPF31 expression should be mainly at the transcriptional level. First, we observed that decay of
PRPF31 mRNA was roughly the same in cells from individuals expressing different levels of
CNOT3, disfavoring gene modulation through post-transcriptional mechanisms. Second, we showed by ChIP that CNOT3 could bind directly to the
bona fide PRPF31 promoter.
In their work, McGee
et al. identified the chromosomal interval containing the proximal modifier through linkage analysis, a technique that searches for relationships between phenotypes and physical elements on the DNA sequence
[19]. This implies that variable expression of
CNOT3 must be determined by a DNA variant that is present in this same region, possibly within
CNOT3 itself. Given their supposedly high frequency within the general population, these isoalleles would very likely be polymorphic elements. Our search for
CNOT3 DNA changes that would be present in asymptomatic but not in affected carriers of mutations (or vice versa) resulted in the identification of particular alleles of rs4806718.
Are these the isoalleles originally mapped by McGee
et al.? Although statistically significant, the association between rs4806718's C allele and disease (and the T allele with an unaffected status) was not perfect. This phenomenon can be explained by the presence of additional factors capable of determining
PRPF31 penetrance, such as the one mapped on chromosome 14
[16]. These modifiers could interfere with or even mask the effects of rs4806718 alleles, ultimately allowing the “wrong” rs4806718 variant to be associated with either phenotype. Such a hypothesis is in perfect agreement with the original data on
PRPF31 isoalleles, as a few discordant phenotype-genotype associations concerning the mapped locus for the proximal modifier were also clearly recognized. Amongst other examples, 2 siblings from the last generation of RP856/AD5 had discordant phenotypes but concordant haplotypes
[19],
[37]. These same individuals, genotyped by us at the rs4806718 locus, were found indeed to share the same parental allele. Furthermore, if the modifier allele is truly inherited from the parent who does not transmit the mutation, then the chance that this does not forcibly correspond to an rs4806718 allele is relatively high in RP856/AD5, given the number of spouses external to the family who are present in this pedigree.
Another important element to consider is whether rs4806718 alleles have a direct effect on CNOT3 expression, or whether the two factors are simply in linkage disequilibrium with other elements (e.g. transcription enhancers) lying somewhere else in the region. According to in silico prediction tools, the rs4806718 C variant, which has a frequency of 0.38 in the European population, could affect CNOT3 splicing by decreasing the binding energy for one acceptor splice site. Therefore, at least potentially, rs4806718 alleles could represent the true PRPF31 isoalleles.
Taken together, all our observations suggest that CNOT3 is the modifier gene on chromosome 19q13.4 that is responsible for penetrance of PRPF31 mutations. Through direct repression of PRPF31 transcription and in virtue of its own variable expression, CNOT3 would differentially reduce the amount of available PRPF31 mRNA, thus determining incomplete penetrance. Although further studies on the physiological role of CNOT3 in human cells and tissues are definitely needed, our data open the way for a possible treatment of PRPF31-linked RP through the inhibition of this transcriptional regulator.