The genetic and functional basis of three inherited cutaneous and gastrointestinal diseases in humans

Abstract

This thesis describes investigations into the genetic basis and pathophysiology of three distinct inherited diseases in humans, two of which are strongly associated to the function of the ectodomain sheddase enzyme ADAM17. The first of these is a novel inherited syndrome of neonatal onset inflammatory skin and bowel disease, which is associated in a consanguineous family with homozygous loss-offunction mutations in ADAM17. This thesis describes investigations of the expression and function of ADAM17 – and downstream proteins it regulates – in an individual affected by this disease. This is accompanied by genetic investigations into other individuals suspected of suffering from the same syndrome. The second investigated disease is Tylosis with Oesophageal Cancer (TOC), an inherited cutaneous disease which represents the only known syndrome of familial oesophageal cancer susceptibility. This disease was associated to dominantly inherited mutations in the Rhomboid protein iRHOM2. This work describes investigations of immortalised keratinocyte cell lines and tissues derived from TOC-affected individuals, and illustrates that the pathogenesis of TOC is characterised by increased iRHOM2-dependent activation and activity of ADAM17, and upregulation of the shedding of ADAM17 substrates, particularly in the EGFR ligand family, accompanied by increased desmosome turnover and transglutaminase 1 activity. This pattern of upregulation results in attendant increases in growth factor signalling, proliferation and motility in TOC keratinocytes, dependent on ADAM17. The third focus of this thesis is a life-threatening inherited gastrointestinal disease (accompanied by severe extraintestinal complications) whose symptoms correspond to Cryptogenic Multifocal Ulcerative Stenosing Enteritis. This work describes the identification of mutations in cytosolic phospholipase A2-α (cPLA2α) – an enzyme responsible for arachidonic acid production, the first step in the eicosanoid synthesis pathway – as associated with this condition in a single affected family. The expression and function of cPLA2α in this disease was investigated, using platelet aggregation stimulated by a downstream product of cPLA2α (Thromboxane A2) as a model