ZNF687 Mutations in Severe Paget Disease of Bone Associated with Giant Cell Tumor  Giuseppina Divisato, Daniela Formicola, Teresa Esposito, Daniela Merlotti,

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ZNF687 Mutations in Severe Paget Disease of Bone Associated with Giant Cell Tumor  Giuseppina Divisato, Daniela Formicola, Teresa Esposito, Daniela Merlotti, Laura Pazzaglia, Andrea Del Fattore, Ethel Siris, Philippe Orcel, Jacques P. Brown, Ranuccio Nuti, Pasquale Strazzullo, Maria Serena Benassi, M. Leonor Cancela, Laetitia Michou, Domenico Rendina, Luigi Gennari, Fernando Gianfrancesco  The American Journal of Human Genetics  Volume 98, Issue 2, Pages 275-286 (February 2016) DOI: 10.1016/j.ajhg.2015.12.016 Copyright © 2016 The Authors Terms and Conditions

Figure 1 Identification of the c.2810C>G Mutation in ZNF687 (A) The pedigree of family 1, including 14 affected members, four of whom developed GCT at pagetic skeletal sites. Circles indicate female family members, and squares indicate male family members; slashes indicate that the family member is deceased. Family members with the GCT/PDB phenotype are indicated by a white dot in solid symbols, those with PDB are indicated by solid symbols, and those without any clinical symptoms are indicated by open symbols. + or – signs indicate the presence or absence of the c.2810C>G mutation. This panel also includes the pedigree for a different family (family 2) with the same c.2810C>G mutation in ZNF687. The index individual with PDB (II-1) is indicated by an arrow. (B) The DNA sequence of a segment flanking c.2810C>G in ZNF687 from an unaffected family member (left) and a heterozygous GCT/PDB-affected individual (right). A single base substitution changes the non-mutant cytosine to guanine, leading to the substitution of proline (P) for arginine (R) at the 937 codon (indicated by a solid line). (C) A portion of the amino acid sequence of ZNF687 from diverse mammal species. (D) The ancestral haplotype with rare variants in SV2A-rs149735232 (t minor-allele frequency = 1.5%), SETDB1-rs138864506 (t minor-allele frequency = 0.1%), ZNF687-rs142842127 (a minor-allele frequency = 0.2%), and HRNR (ta deletion, frequency not available), all of which are genes surrounding the c.2810C>G mutation in ZNF687. For each variant, the position on chromosome 1 is indicated by arabic numerals. The American Journal of Human Genetics 2016 98, 275-286DOI: (10.1016/j.ajhg.2015.12.016) Copyright © 2016 The Authors Terms and Conditions

Figure 2 Identification of the c.725G>T Mutation in ZNF687 (A) The pedigree of family 3. The index individual is indicated by an arrow. Individuals with PDB are indicated by black symbols, and individuals without PDB are shown as unfilled symbols. Circles represent females, squares represent males, and slashes indicate deceased subjects. (B) The DNA sequence of a segment flanking c.725G>T in ZNF687 from an unaffected family member (left) and a heterozygous PDB-affected individual (right). A single base substitution changes the non-mutant guanine to thymine, leading to the substitution of serine (S) for isoleucine (I) at the 242 codon (indicated by a solid line). (C) The evolutive conservation of the 242 serine from rodents to humans. (D) The number of the affected skeletal sites (left) and the age of disease onset (right) across PDB-affected individuals with ZNF687 mutations, PDB-affected individuals with SQSTM1 mutations, and PDB-affected individuals without mutations in either gene. Genotype-phenotype correlations were tested by ANOVA with Bonferroni correction and reported as mean ratio ± SEM (not mutated, n = 615; mutated in SQSTM1, n = 78; mutated in ZNF687, n = 20). ∗p < 0.05; ∗∗p < 0.01; ∗∗∗p < 0.001. The American Journal of Human Genetics 2016 98, 275-286DOI: (10.1016/j.ajhg.2015.12.016) Copyright © 2016 The Authors Terms and Conditions

Figure 3 Expression and Functional Characterization of ZNF687 (A and B) Expression analysis of ZNF687 during human osteoclastogenesis (A) and human osteoblastogenesis (B). The data shown are representative of three independent experiments and were analyzed by Student’s t test. (C and D) The scheme of caudal fin regeneration in zebrafish (Danio rerio) (C) and the expression of ZNF687a and ZNF687b (zebrafish orthologs) during this process (D). (E) ZNF687a and ZNF687b expression during Danio rerio development. (F) Bioinformatic prediction of the NLS in ZNF687 between amino acids 938 and 955 enhanced as a consequence of the substitution of arginine at the 937 position. (G) The expression of ZNF687 in nuclear- and cytoplasmic-extracts in lymphoblastic cell lines derived from affected individuals with the p.Pro937Arg change (PDB-affected individuals 1–4) in comparison to expression in those derived from healthy subjects (control individuals 1 and 2). ZNF687 antibody detected one band of about 135 kDa in the cytoplasm and two bands of about 100 and 135 kDa in the nucleus. Cytoplasm and nuclear extracts contained only minimal or no contamination (data not shown). (H) The quantifications of cytoplasmic and nuclear fractions. (I–K) The increased number of nuclei and the increased cellular area of osteoclasts derived from PDB subjects carrying the c.2810C>G mutation compared to the controls. ∗p < 0.05; ∗∗p < 0.01; ∗∗∗p < 0.001. The American Journal of Human Genetics 2016 98, 275-286DOI: (10.1016/j.ajhg.2015.12.016) Copyright © 2016 The Authors Terms and Conditions

Figure 4 Upregulation of ZNF687 in Peripheral Blood of PDB-Affected Subjects and in Tumor Tissues of GCT/PDB-Affected Individuals (A) The expression of ZNF687 in peripheral blood from healthy subjects, PDB-affected individuals without SQSTM1 or ZNF687 mutations, PDB-affected individuals with an SQSTM1 mutation, and PDB-affected individuals with a ZNF687 mutation. ∗ = p < 0.05; ∗∗ = p < 0.01; ∗∗∗ = p < 0.001. (B) NFkB binding sites on the ZNF687 promoter region. (C) The expression profile of ZNF687 in frozen tumor tissues from five GCT/PDB-affected individuals in comparison to the expression in tissue from healthy bone marrow. (D and E) ZNF687 expression on a tumor biopsy of a GCT/PDB-affected individual (D) in comparison to the tumor section derived from the same individual (E) without primary antibody (negative control). (F) A hypothetical model of ZNF687 involvement in the PDB molecular pathway. The American Journal of Human Genetics 2016 98, 275-286DOI: (10.1016/j.ajhg.2015.12.016) Copyright © 2016 The Authors Terms and Conditions