Loss of the Repressor REST in Uterine Fibroids Promotes Aberrant G

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Loss of the Repressor REST in Uterine Fibroids Promotes Aberrant G Loss of the repressor REST in uterine fibroids promotes aberrant G protein-coupled receptor 10 expression and activates mammalian target of rapamycin pathway Binny V. Varghesea, Faezeh Koohestania, Michelle McWilliamsa, Arlene Colvina, Sumedha Gunewardenaa, William H. Kinseyb, Romana A. Nowakc, Warren B. Nothnicka, and Vargheese M. Chennathukuzhia,1 Departments of aMolecular and Integrative Physiology and bAnatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS 66160; and cDepartment of Animal Sciences, University of Illinois, Urbana–Champaign, IL 61801 Edited by R. Michael Roberts, University of Missouri, Columbia, MO, and approved November 28, 2012 (received for review September 12, 2012) Uterine fibroids (leiomyomas) are the most common tumors of the differentially activate this pathway in fibroids compared with female reproductive tract, occurring in up to 77% of reproductive- normal myometrium. aged women, yet molecular pathogenesis remains poorly under- In a focused effort aimed at finding putative signaling molecules stood. A role for atypically activated mammalian target of rapamycin upstream of mTOR that may regulate cell growth and tumori- (mTOR) pathway in the pathogenesis of uterine fibroids has been genesis in leiomyomas, we identified GPR10 as the most highly up- suggested in several studies. We identified that G protein-coupled regulated G protein coupled-receptor (GPCR) in human fibroid receptor 10 [GPR10, a putative signaling protein upstream of the samples. GPR10, also known as the prolactin releasing hormone phosphoinositide 3-kinase–protein kinase B/AKT–mammalian target receptor (PRLHR), is the receptor for prolactin releasing peptide fi of rapamycin (PI3K/AKT–mTOR) pathway] is aberrantly expressed in (PrRP), although evidence for its speci c role in pituitary PRL uterine fibroids. The activation of GPR10 by its cognate ligand, pro- production is tenuous (16, 17). Normal expression and function of lactin releasing peptide, promotes PI3K–AKT–mTOR pathways and GPR10 have been shown to be limited to several regions of the cell proliferation specifically in cultured primary leiomyoma cells. hypothalamus (18, 19). The mechanism of hypothalamic GPR10 Additionally, we report that RE1 suppressing transcription factor/ action that evokes stress hormone release (19) from the pituitary is BIOLOGY neuron-restrictive silencing factor (REST/NRSF), a known tumor sup- not well understood and its function in the periphery, either in DEVELOPMENTAL pressor, transcriptionally represses GPR10 in the normal myometrium, normal tissues or in disease, has not been reported. The near- ubiquitous overexpression of GPR10, a normally neuronal specific and that the loss of REST in fibroids permits GPR10 expression. Impor- G protein coupled receptor (GPCR), in human leiomyomas is tantly, mice overexpressing human GPR10 in the myometrium develop unparalleled among genes shown to be dysregulated in fibroids. myometrial hyperplasia with excessive extracellular matrix deposi- fi fi This increased expression of GPR10 in uterine broids is partic- tion, a hallmark of uterine broids. We demonstrate previously un- ularly relevant because its activation by PrRP has been shown to recognized roles for GPR10 and its upstream regulator REST in the promote the proliferation of cultured cells (20). pathogenesis of uterine fibroids. Importantly, we report a unique ge- fi The RE1 silencing transcription factor/neuron-restrictive silenc- netically modi ed mouse model for a gene that is misexpressed in ing factor (REST/NRSF) has been shown to transcriptionally re- fi uterine broids. press GPR10 in cell lines (21). Particularly relevant to the role that PI3K/AKT appears to play in the pathogenesis of leiomyomas, the terine fibroids (leiomyomas) are benign smooth muscle cell activation of GPR10 as well as the loss of REST/NRSF, is shown to U(SMC) tumors of the myometrium. Leiomyomas represent trigger PI3K/AKT signaling and proliferation in tumor cell lines (20, the most frequent clinical indication for hysterectomy that pre- 22–24). REST is an important transcriptional repressor that silences maturely ends a woman’s reproductive capability (1). However, a multitude of genes in the periphery through epigenetic mecha- despite this, there are currently no approved drugs that can nisms (25). The loss of this tumor suppressor through proteasomal provide effective, long-term treatment for these tumors. In the degradation has been shown to result in oncogenic transformation year 2010, the estimated annual cost of uterine fibroid tumors in of human mammary epithelial cells (24). Mutations or alternative the United States was $5.9–34.4 billion (2). Although uterine splicing that result in dominant negative forms of REST have also fibroids are the most common tumors of the female reproductive been associated with lung and colon cancers (24, 26, 27). A tumor tract and a major quality of life issue for a significant percentage suppressor role for REST in the uterus has not been described of women, the mechanisms that initiate leiomyoma growth and previously. We demonstrate that the loss of REST permits over- pathogenesis are still not well understood. expression of GPR10 in leiomyomas and this misexpression func- Several genetic and environmental risk factors have been sug- tionally promotes tumor cell proliferation contributing to the gested to influence the etiology of leiomyomas (1, 3–5). Although, pathogenesis of uterine fibroids. Our study describes unique roles rare germ-line mutations that give rise to heritable leiomyomas are for GPR10 and for the loss of REST in the development of fibroids. known, such mutations being rare do not account for the vast majority of uterine fibroids. The occurrence of high-frequency somatic missense mutations in the second coding exon of the Author contributions: V.M.C. designed research; B.V.V., F.K., M.M., A.C., S.G., W.H.K., R.A.N., mediator gene MED12 was reported in fibroid tumors in a recent W.B.N., and V.M.C. performed research; R.A.N. contributed new reagents/analytic tools; study (6). The functional significance of missense mutations to this B.V.V., F.K., M.M., A.C., S.G., W.H.K., W.B.N., and V.M.C. analyzed data; and B.V.V., F.K., mediator complex protein and its developmental origins are not M.M., S.G., W.H.K., R.A.N., W.B.N., and V.M.C. wrote the paper. currently known. Alternative mechanisms including epigenetic The authors declare no conflict of interest. variations, microRNA-mediated posttranscriptional gene regula- This article is a PNAS Direct Submission. tion, and altered cell signaling have recently gained traction as Freely available online through the PNAS open access option. – putative disease initiating events (7 12). Several recent studies Data deposition: The Affymetrix gene expression data from the siRNA knockdown experi- have demonstrated a central role for a dysregulated phosphoino- ments reported in this paper have been deposited in the Gene Expression Omnibus (GEO) sitide 3-kinase–protein kinase B/AKT (PI3K/AKT) pathway database, www.ncbi.nlm.nih.gov/geo (accession no. GSE41386). leading to the activation of mammalian target of rapamycin 1To whom correspondence should be addressed. E-mail: [email protected]. – (mTOR) in the pathogenesis of leiomyomas (13 15). There is This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10. a need to identify signaling molecules upstream of mTOR that 1073/pnas.1215759110/-/DCSupplemental. www.pnas.org/cgi/doi/10.1073/pnas.1215759110 PNAS Early Edition | 1of6 Downloaded by guest on September 27, 2021 Results Aberrant Expression of GPR10 in Uterine Fibroids. In an effort to identify drug targetable, signaling molecules upstream of the mTOR pathway that might be aberrantly regulated in uterine fibroids, we analyzed gene expression profiling data available from the GEO database. Analysis of human leiomyoma and normal myometrial samples from dataset GSE13319 revealed that GPR10, a GPCR with known functions in PI3K/AKT pathway activation, was the most highly dysregulated GPCR in fibroids (Fig. 1A). TaqMan RT-PCR was used to confirm the expression of GPR10 mRNA in fibroids (Fig. 1B). Expression of GPR10 was signifi- cantly up-regulated in 13 out of 14 patient samples. The aberrant expression of GPR10 was further confirmed by Western blotting (Fig. 1C). Expression of the receptor protein was evident in all of the fibroid tissue samples tested, whereas expression was either absent or negligible in matched normal myometrial tissues (Fig. 1C). Because fibroid tumor growth is known to be associated with activation of the PI3K/AKT pathway leading to the acti- vation of mTOR, we compared the expression of GPR10 to the status of AKT phosphorylation. The AKT phosphorylation lev- els in individual patient samples reflected the level of expression of GPR10 in those samples (Fig. 1D), indicating that the aber- rant expression of GPR10 and PI3K/AKT pathway activation Fig. 2. Cultured primary leiomyoma cells express functional GPR10. (A) may be related. GPR10 expression in primary myometrial (MC1–3) and autologous leiomyoma SMCs (LC1–3). β-Actin was used as loading control. (B) Anti–phospho-AKT μ Activation of GPR10 Leads to PI3K/AKT–mTOR Pathway Activation and (s473) Western blot showing that the activation of GPR10 using PrRP (1 M) leads to the phosphorylation of AKT in leiomyoma SMCs. Total AKT was used Leiomyoma Cell Proliferation. Next we tested whether the activa- – tion of GPR10 leads to regulation of the PI3K/AKT–mTOR as loading control. (C and D) Representative anti p-AKT (s473) Western blot and densitometric analysis of Western blots from three independent pathways in primary myometrial and leiomyoma SMCs cultured experiments, respectively, showing that siRNA knockdown of GPR10 leads to in vitro. Abundant expression of GPR10 was maintained in – a loss of PrRP response on AKT phosphorylation. (E) PrRP treatment of cultured leiomyoma cells (Fig. 2A, LC1 LC3), whereas in nor- leiomyoma SMCs leads to mTOR pathway activation. β-Actin was used as mal myometrial SMCs GPR10 expression was negligible (Fig.
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