Role of Proinsulin Self-Association in Mutant INS Gene-Induced Diabetes

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Role of Proinsulin Self-Association in Mutant INS Gene-Induced Diabetes Page 1 of 43 Diabetes Role of Proinsulin Self-Association in Mutant INS gene-induced Diabetes of Youth Jinhong Sun1*, Yi Xiong1*, Xin Li2, Leena Haataja1, Wei Chen1,3, Saiful A. Mir4, Li Lv2, Rachel Madley1, Dennis Larkin1, Arfah Anjum1, Balamurugan Dhayalan5, Nischay Rege5, Nalinda D. Wickramasinghe5, Michael A. Weiss5, Pamela Itkin-Ansari4,8, Randal J. Kaufman6, David A. Ostrov7, Peter Arvan1¶, Ming Liu1,2¶ 1. Division of Metabolism, Endocrinology & Diabetes, the University of Michigan Medical School, Ann Arbor, MI 48105 USA 2. Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin 300052, China 3. Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China 4. Development, Aging and Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037 USA 5. Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis IN 46202 USA 6. Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037 USA 7. Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL 32610 USA 8. Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093 USA * Authors contributed equally to this work. ¶ To whom correspondence should be addressed: Ming Liu, Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, 154 Ann Anshan road, Heping district, Tianjin 300052, China. E-mail: [email protected]; Peter Arvan, Division of Metabolism, Endocrinology & Diabetes, the University of Michigan, Brehm Tower, 1000 Wall Street, Ann Arbor, MI 48105 E-mail: [email protected]; 1 Diabetes Publish Ahead of Print, published online March 5, 2020 Diabetes Page 2 of 43 Abstract Abnormal interactions between misfolded mutant and wild-type (WT) proinsulin in the endoplasmic reticulum (ER) drive the molecular pathogenesis of Mutant-INS-gene induced Diabetes of Youth (MIDY). How these abnormal interactions are initiated remains unknown. Normally, proinsulin-WT dimerizes in the ER. Here, we suggest that the normal proinsulin-proinsulin contact surface, involving the B-chain, contributes to dominant-negative effects of misfolded MIDY mutants. Specifically, we find that proinsulin Tyr-B16, which is a key residue in normal proinsulin dimerization, helps confer dominant-negative behavior of MIDY mutant proinsulin-C(A7)Y. Substitutions of Tyr-B16 with ether Ala, Asp, or Pro in proinsulin-C(A7)Y each decrease the abnormal interactions between the MIDY mutant and proinsulin-WT, rescuing proinsulin-WT export, limiting ER stress, and increasing insulin production in -cells and human islets. This study reveals the first evidence indicating that noncovalent proinsulin-proinsulin contact initiates dominant-negative behavior of misfolded proinsulin, pointing to a novel therapeutic target to enhance proinsulin-WT export and increase insulin production. 2 Page 3 of 43 Diabetes Introduction Proinsulin misfolding, endoplasmic reticulum (ER) stress, and decreased -cell mass are key features of -cell failure and diabetes in the autosomal-dominant diabetes known as Mutant-INS-gene induced Diabetes of Youth (MIDY) (1-3). All MIDY patients carry a mutation in only one of two INS alleles (3-6), and, in principle, one normal INS allele should be sufficient to maintain normoglycemia (7). The underlying mechanism of MIDY is thought to involve abnormal interactions of misfolded mutant proinsulin with bystander proinsulin-WT in the ER, impairing the ER export of proinsulin-WT and decreasing production of bioactive mature insulin (8,9). However, to date, how these interactions are initiated remains largely unknown. Interestingly, the clinical spectrum of MIDY ranges from neonatal-onset severe insulin deficient diabetes to relatively late- onset mild diabetes (1,2), suggesting that different proinsulin mutants may behave differently in their folding processes, as well as their ability to interact and obstruct bystander proinsulin-WT in the ER. In this study, we report that a proline (Pro) substitution for tyrosine residue at the 16th position of the proinsulin B chain (Tyr-B16) [i.e., proinsulin-Y(B16)P] results in dramatic proinsulin misfolding in the ER, and yet is unable to interact with bystander proinsulin-WT in the ER, and is unable to impair the ER export of proinsulin-WT or to block its ability to form mature insulin. Interestingly, Y(B16)P disrupts the main α-helix in the proinsulin B-domain. Normally, proinsulin uses this B-domain α-helix in order to homodimerize in the ER (10). Thus, we hypothesize that cross-dimerization between 3 Diabetes Page 4 of 43 MIDY mutant and proinsulin-WT may be required to initiate their abnormal interaction that impairs the intracellular transport of proinsulin-WT, resulting in insulin deficiency that leads to diabetes (11). Structural evidence strongly implicates Tyr-B16 as a key residue for normal proinsulin dimerization (12). With this in mind, we have mutagenized this residue to either aspartic acid [Y(B16D)] or alanine [Y(B16)A]; both substitutions were entirely innocuous when introduced into proinsulin-WT. Notably, however, when these substitutions were introduced into the MIDY-causing Akita proinsulin-C(A7)Y, each could function as an intra-allelic suppressor, limiting abnormal interactions with proinsulin-WT; alleviating dominant-negative behavior on proinsulin-WT intracellular trafficking; and increasing insulin production in pancreatic -cell lines and human islets. This study provides insight that protecting the proinsulin-proinsulin contact surface might be a potential druggable target to limit abnormal proinsulin interactions and prevent/delay the development and progression of MIDY. 4 Page 5 of 43 Diabetes Materials and Methods Materials Guinea pig polyclonal anti-porcine insulin, human insulin-specific RIA kit, human proinsulin-specific RIA kit, and mouse insulin ELISA kit were from Millipore (Billerica MA, USA); Guinea pig polyclonal anti-human insulin was from Novus (Centennial, CO, USA); Rabbit polyclonal anti-mouse proinsulin C-peptide (EVEDPQVAQLELGGGPGAGDLQTLALEVAQQ) was raised by Bioworld (Nanjing, China); Mouse monoclonal anti-human proinsulin C-peptide—A-chain junction (GSLQKRGIVE) was raised by Abmart (Shanghai, China) as previously described (13) ; Rabbit anti-Myc and anti-GFP were from Immunology Consultants Laboratories (Portland, OR, USA); Rabbit anti-BiP was a gift from Dr. P.S. Kim (U. Cincinnati); 35S-amino acid mixture was from PerkinElmer (Waltham, MA, USA); dithiothreitol (DTT), protein A- agarose, digitonin, N-ethylmaleimide (NEM), brefeldin A, and all other chemical reagents were from Sigma-Aldrich (St. Louis, MO, USA); 4-12% gradient SDS-PAGE employed NuPage gels, Met/Cys-deficient Dulbecco’s modified Eagle’s medium (DMEM) and all other tissue culture reagents were from Invitrogen (Thermo Fisher, Waltham, MA, USA); tris-tricine-urea-SDS-PAGE was performed as described previously (14). Synthesis and purification of single-chain insulin analogs, and NMR Single-chain TyrB16-DesDi and AspB16-DesDi insulin analogs were synthesized using a Tribute Peptide Synthesizer with preprogrammed solid-phase Fmoc protocol (15). The synthesis was carried out on a 0.1-mmol scale using H-Asn(Trt)-HMPB-ChemMatrix resin 5 Diabetes Page 6 of 43 (0.46 mmol/g loading). Side chain protection was: Asn(Trt), Arg(Pbf), Asp(OtBu) Cys(Trt), Gln(Trt), Glu(OtBu), His(Trt), Lys(Boc), Ser(tBu), Thr(tBu), Tyr(tBu). DIC/ 6- chloro-HOBt in 1:2 Dichloromethane/DMF was used for the coupling and 20% piperidine in DMF for Nα-Fmoc-deprotection. The product peptide was then cleaved from the resin and simultaneously deprotected by subjecting it to TFA/TIPS/water/DODT/anisole (90: 2.5: 2.5: 2.5: 2.5 v/v) for 2.5 h at ambient temperature; the crude product was precipitated with ice-cold ether, washed, and dried. For folding, 100 mg AspB16-DesDi crude polypeptide (corresponding to 18 µmol), cysteine hydrochloride (43mg, 2 mM) and glycine (270 mg, 20 mM) were placed in 600-mL glass beaker and distilled, deionized water added to a 0.1 mM final concentration. The pH of the solution was adjusted to 10.5, and reaction was stirred open to air at 4° C for 16 h. Desired folded product was purified both by preparative HPLC, and by analytical reverse-phase HPLC on a C8 Proto (4.6x250 mm) 300 Å, 5 μm, Higgins Analytical Inc. column, using 25-50% Solvent B (0.1% TFA in acetonitrile) in Solvent A (0.1% TFA in water) over 35 min at a flow rate of 1.0 ml/min (Waters 1525). Protein elution was monitored at 215 and 280 nm (Waters 2489 absorbance detector) and masses were confirmed by MALDI-TOF. Normal insulin helical structure was confirmed by far-UV CD spectra from 190-250 nm (16), and normal thermodynamic stability was established by guanidine hydrochloride-induced denaturation (monitored by CD at 222 nm). 1H-NMR spectra were acquired on protein solutions (0.5 mg in 300 L D2O; direct meter reading pD 7.6) at 25° C using a Bruker AVANCE 700 MHz spectrometer. Synthesis and purification of two-chain insulin analogs, and size exclusion chromatography. 6 Page 7 of 43 Diabetes The non-standard amino acid Ornithine (Orn) was employed at position B29 in place of lysine to preserve the side-chain amino group without susceptibility to tryptic cleavage (16). Two-chain insulin analogs ([TyrB16, OrnB29]-insulin and [AspB16, OrnB29]-insulin) were prepared by trypsin-catalyzed cleavage of human insulin or AspB16-DesDi single-
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