Regulator of G protein signaling (RGS) proteins stimulate the GTPase activity of Gα subunits of heterotrimeric G proteins, thereby negatively regulating G protein signaling. In this way, RGS2 acts as a negative regulator of Gq and Gi signaling. It has also been described as a negative regulator of Gs signaling, but via a different mechanism. It inhibits the activation of adenylyl cyclase (AC), the target molecule of Gs, by interacting with it. In olfactory neurons, it was shown that RGS2 attenuates activation of AC type III (Sinnarajah et al., Nature 2001), the main AC subtype in platelets. In this study, we describe the first human genetic defect in RGS2 and provide evidence that RGS2 influences the cAMP level in platelets after Gs stimulation. The proposita is an obese 16-year-old girl with borderline IQ, hirsutism and an increased bone alkaline phosphatase. These symptoms are similar to features of Albright hereditary osteodystrophy, due to heterozygous inactivating mutations in the Gsα gene. The Gsα gene of the proposita is normal, but she carries a missense mutation in the RGS2 gene, resulting in a Gly to Asp substitution in the conserved residue 23 (G23D). This substitution could also be found in her mother and brother, but not in 200 unrelated normal controls. The family members carrying this mutation present with a relatively low number of platelets (+/−150.000/μL) and an increased mean platelet volume (+/−13 fL) and platelet distribution width (+/−17.5 %). Also, platelet function is affected by the mutation. Platelet aggregation is normal in response to all standard agonists, but when the Gs pathway is challenged in their platelets, high levels of different Gs agonists are needed to get inhibition of aggregation in comparison to controls or the father. We also measured cAMP levels in platelets and found that stimulation of the Gs coupled receptors with Gs agonists produced less cAMP in the affected family members. The functional relevance of the mutation was further studied in vitro in HEK293 and MEG-01 cells transfected with wildtype RGS2 and RGS2-G23D. cAMP levels were measured at different time points after stimulation of these cells with Gs agonists. These measurements show that cAMP levels are lower in cells transfected with RGS2-G23D, compared to wildtype RGS2. This indicates that the reduction in cAMP levels found in the platelets of the affected members, is a functional consequence of the mutation. To understand why this mutation leads to an altered function of RGS2, we studied the effect of the mutation at the protein level. Recently, it was shown that there are 4 different translation initiation sites in the RGS2 mRNA, giving rise to 4 proteins with different functional characteristics (Gu et al., Mol Pharmacol 2008). An in vitro transcriptiontranslation assay showed that the presence of the mutation results in a different protein expression profile. We excluded a difference in posttranslational modifications to be the cause of this divergent pattern. The G23D mutation is located in the proximity of 2 of the different translation initiation sites and its presence alters the use of these sites. This results in a different expression profile of the functionally different RGS2 proteins. In conclusion, we present the first platelet Gs signaling defect due to an RGS2 mutation associated with aberrant RGS2 translation.

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