Mutations in the TGFβ Binding-Protein-Like Domain 5 of FBN1 Are Responsible for Acromicric and Geleophysic Dysplasias Carine Le Goff, Clémentine Mahaut,

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Mutations in the TGFβ Binding-Protein-Like Domain 5 of FBN1 Are Responsible for Acromicric and Geleophysic Dysplasias Carine Le Goff, Clémentine Mahaut, Lauren W. Wang, Slimane Allali, Avinash Abhyankar, Sacha Jensen, Louise Zylberberg, Gwenaelle Collod-Beroud, Damien Bonnet, Yasemin Alanay, Angela F. Brady, Marie-Pierre Cordier, Koen Devriendt, David Genevieve, Pelin Özlem Simsek Kiper, Hiroshi Kitoh, Deborah Krakow, Sally Ann Lynch, Martine Le Merrer, André Mégarbane, Geert Mortier, Sylvie Odent, Michel Polak, Marianne Rohrbach, David Sillence, Irene Stolte-Dijkstra, Andrea Superti-Furga, David L. Rimoin, Vicken Topouchian, Sheila Unger, Bernhard Zabel, Christine Bole-Feysot, Patrick Nitschke, Penny Handford, Jean-Laurent Casanova, Catherine Boileau, Suneel S. Apte, Arnold Munnich, Valérie Cormier-Daire The American Journal of Human Genetics Volume 89, Issue 1, Pages 7-14 (July 2011) DOI: 10.1016/j.ajhg.2011.05.012 Copyright © 2011 The American Society of Human Genetics Terms and Conditions

Figure 1 Clinical and Radiological Features in GD and AD (B, D, F, and G) GD patient 1 at 5 years and (A, C, and E) 15 years; note the “happy” face with full cheeks, a shortened nose, and a long and flat philtrum with a thin upper lip. (D and E) Note the delayed bone age and cone-shaped epiphyses, (F) shortened long tubular bones, epiphyseal dysplasia, and (G) ovoid vertebral bodies. (H and I) AD patient 21 at 3 years and 62 years. Note the round face, bulbous nose, pseudomuscular build, (J, K, L, and M) very short hands and feet with a delayed bone age, and (N) the internal notch of the femoral head. The American Journal of Human Genetics 2011 89, 7-14DOI: (10.1016/j.ajhg.2011.05.012) Copyright © 2011 The American Society of Human Genetics Terms and Conditions

Figure 2 Location of FBN1 Mutations Identified in GD and AD Patients (A) Functional domains of FBN1. The location of the amino change found in each family is shown (GD are families listed in roman font; AD families are in italics, and mutations shared by AD and GD are in bold). (B) 3D modeling of the fibrillin-1 cbEGF24-TB5-cbEGF25 region showing residues affected by GD and AD mutations. GD substitutions (I) are shown in magenta and AD substitution sites (II) are shown in cyan. Note the clustering of disease-causing substitutions in the region of the TB domain previously associated with protein-protein interactions. cbEGF domains are shown in green, and the TB domain is in blue. Red spheres represent calcium ions bound to domains cbEGF24 and cbEGF25. Homology modeling created with Modeler software7 and the coordinates of the fibrillin-1 cbEGF22-TB4-cbEGF23 structure (PDB 1UZJ). The figure was generated with Pymol. GD substitutions are shown in roman font, whereas those found in AD or in both diseases are shown in italics and bold, respectively. The American Journal of Human Genetics 2011 89, 7-14DOI: (10.1016/j.ajhg.2011.05.012) Copyright © 2011 The American Society of Human Genetics Terms and Conditions

Figure 3 Microfibril and TGFβ-Signaling Analysis in GD and AD Skin Fibroblasts (A) Microfibril analysis in skin fibroblasts from (a) control, (b) a GD patient, and (c) an AD patient. The microfibrillar network formation was detected by indirect immunofluorescence with fibrillin-1 antibody. (MAB019). The staining revealed abundant long microfibrils in the control fibroblasts (a). Conversely, the GD and AD patient fibroblasts showed a reduced number of microfibrils and a disorganization of the MF network (b and c). The scale bar represents 50 μm. (B) Enhanced phosphorylation of SMAD2 (pSMAD2) in skin fibroblasts from one GD patient (family 8), one AD patient (family 22), and control. pSMAD2 was normalized to actin for comparison of pSMAD2 levels in affected and unaffected fibroblasts as shown in the right panel. (C) Quantification of total (gray bars) and active (black bars) TGFβ in the conditioned medium of fibroblasts from individuals with GD (family 8) or AD (family 22) and controls. The conditioned medium from families 8 and 22 showed an amount of total TGFβ (∗p < 0,003) greater than the conditioned medium from the controls. The American Journal of Human Genetics 2011 89, 7-14DOI: (10.1016/j.ajhg.2011.05.012) Copyright © 2011 The American Society of Human Genetics Terms and Conditions

Figure 4 ADAMTSL2 Interacts Directly with Fibrillin-1 (A) The domain structure of the fibrillin peptide hFib1-49 is shown relative to the full-length fibrillin-1. The key to the fibrillin-1 modules is shown. (B) Colloidal Coomassie-blue-stained-reducing polyacrylamide gel showing purification of hFib1-49 (arrow). The molecular weight markers (in kDa) are indicated on the left. (C) SPR analysis of ADAMTSL2 (analyte) binding to hFib1-49 (ligand). The sensorgrams shown were obtained after injection of increasing concentrations of ADAMTSL2 as indicated. The y axis indicates the response difference obtained between the flow cell with bound hFib1-49 and the control flow cell without hFib1-49 when ADAMTSL2 was used as the analyte. The x axis shows time (s). The American Journal of Human Genetics 2011 89, 7-14DOI: (10.1016/j.ajhg.2011.05.012) Copyright © 2011 The American Society of Human Genetics Terms and Conditions