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Deletions in the CCM1, CCM2, and CCM3 genes are a common cause of familial cerebral cavernous malformations (CCMs). In current molecular genetic laboratories, targeted next-generation sequencing or multiplex ligation-dependent probe amplification are mostly used to identify copy number variants (CNVs). However, both techniques are limited in their ability to specify the breakpoints of CNVs and identify complex structural variants (SVs). To overcome these constraints, we established a targeted Cas9-mediated nanopore sequencing approach for CNV detection with single nucleotide resolution. Using a MinION device, we achieved complete coverage for the CCM genes and determined the exact size of CNVs in positive controls. Long-read sequencing for a CCM1 and CCM2 CNV revealed that the adjacent ANKIB1 and NACAD genes were also partially or completely deleted. In addition, an interchromosomal insertion and an inversion in CCM2 were reliably re-identified by long-read sequencing. The refinement of CNV breakpoints by long-read sequencing enabled fast and inexpensive PCR-based variant confirmation, which is highly desirable to reduce costs in subsequent family analyses. In conclusion, Cas9-mediated nanopore sequencing is a cost-effective and flexible tool for molecular genetic diagnostics which can be easily adapted to various target regions.
Cerebral cavernous malformations are slow-flow thrombi-containing vessels induced by two-step inactivation of the CCM1, CCM2 or CCM3 gene within endothelial cells. They predispose to intracerebral bleedings and focal neurological deficits. Our understanding of the cellular and molecular mechanisms that trigger endothelial dysfunction in cavernous malformations is still incomplete. To model both, hereditary and sporadic CCM disease, blood outgrowth endothelial cells (BOECs) with a heterozygous CCM1 germline mutation and immortalized wild-type human umbilical vein endothelial cells were subjected to CRISPR/Cas9-mediated CCM1 gene disruption. CCM1
−/− BOECs demonstrated alterations in cell morphology, actin cytoskeleton dynamics, tube formation, and expression of the transcription factors KLF2 and KLF4. Furthermore, high VWF immunoreactivity was observed in CCM1
−/−
BOECs, in immortalized umbilical vein endothelial cells upon CRISPR/Cas9-induced inactivation of either CCM1, CCM2 or CCM3 as well as in CCM tissue samples of familial cases. Observer-independent high-content imaging revealed a striking reduction of perinuclear Weibel-Palade bodies in unstimulated CCM1
−/−
BOECs which was observed in CCM1
+/− BOECs only after stimulation with PMA or histamine. Our results demonstrate that CRISPR/Cas9 genome editing is a powerful tool to model different aspects of CCM disease in vitro and that CCM1 inactivation induces high-level expression of VWF and redistribution of Weibel-Palade bodies within endothelial cells.
Abstract
Background
The CRISPR/Cas9 system has opened new perspectives to study the molecular basis of cerebral cavernous malformations (CCMs) in personalized disease models. However, precise genome editing in endothelial and other hard‐to‐transfect cells remains challenging.
Methods
In a proof‐of‐principle study, we first isolated blood outgrowth endothelial cells (BOECs) from a CCM1 mutation carrier with multiple CCMs. In a CRISPR/Cas9 gene correction approach, a high‐fidelity Cas9 variant was then transfected into patient‐derived BOECs using a ribonucleoprotein complex and a single‐strand DNA oligonucleotide. In addition, patient‐specific CCM1 knockout clones were expanded after CRISPR/Cas9 gene inactivation.
Results
Deep sequencing demonstrated correction of the mutant allele in nearly 33% of all cells whereas no CRISPR/Cas9‐induced mutations in predicted off‐target loci were identified. Corrected BOECs could be cultured in cell mixtures but demonstrated impaired clonal survival. In contrast, CCM1‐deficient BOECs displayed increased resistance to stress‐induced apoptotic cell death and could be clonally expanded to high passages. When cultured together, CCM1‐deficient BOECs largely replaced corrected as well as heterozygous BOECs.
Conclusion
We here demonstrate that a non‐viral CRISPR/Cas9 approach can not only be used for gene knockout but also for precise gene correction in hard‐to‐transfect endothelial cells (ECs). Comparing patient‐derived isogenic CCM1+/+, CCM1+/−, and CCM1−/− ECs, we show that the inactivation of the second allele results in clonal evolution of ECs lacking CCM1 which likely reflects the initiation phase of CCM genesis.
To enable control of African swine fever (ASF) in Eastern and Southern Africa, prototype live vaccine candidates were generated by targeted gene deletions from a Kenyan genotype IX ASF virus (ASFV). It was attempted to delete known nonessential genes involved in virulence (encoding TK, dUTPase, CD2v, 9GL), possibly essential genes (p12, pA104R, ribonucleotide reductase), and genes with widely unknown functions (pK145R). Isolation of the desired virus recombinants by plaque assays or limiting dilutions on a wild boar lung cell line (WSL-HP) was facilitated by substitutive reporter gene insertions encoding fluorescent proteins (GFP, DsRed), or the human membrane protein CD4. The latter protein permitted enrichment of recombinant virus particles by magnetic activated cell sorting (MACS). The isolated ASFV recombinants were characterized by PCR and sequencing of the mutated genome parts, and replication kinetics and virus spread in cell culture were investigated. Deletion of TK, CD2v, or pK145R had no detectable effect on in vitro growth of ASFV Kenya. Interestingly, virus mutants lacking the DNA binding protein pA104R which has been considered to be essential for DNA replication, also exhibited almost wild type-like growth properties.
In contrast, ASFV mutants lacking ribonucleotide reductase or p12 could not be purified to homogeneity on WSL-HP cells, indicating these proteins are essential for virus replication in cell culture. Therefore, trans-complementing cells lines stably expressing ASFV p12 have been prepared which can now be used for mutant virus purification. If this approach is successful the resulting defective mutant ASFV Kenya-p12 might be suitable as a safe “disabled in second cycle” (DISC) live vaccine in swine.
In a novel approach to improve reverse genetics of ASFV the CRISPR/Cas9 cell line WSL-gRp30 (Hübner et al., 2018a) was co-transfected with genomic DNA of ASFV-KenyaCD2vDsRed, sgRNA plasmids targeting K145R or 9GL, and GFP-expressing recombination plasmids for homology-directed repair. For booting up of the noninfectious virus genome the cells were infected with phylogenetically distant helper virus (genotype II ASFV Armenia, 84% identity) which was selectively inhibited on the used cell line. The desired double-fluorescent double-deletion mutants could be isolated after few plaque purification steps on selective WSL-gRp30 cells. Next generation sequence (NGS) analyses of reconstituted ASFV Kenya genomes showed that no unwanted recombination with the helper virus occurred, indicating that the method might be also suitable for booting of synthetic ASFV genomes cloned and mutagenized in E. coli or yeast.
The modified CRISPR/Cas9 system of S. pyogenes might be also usable for generation of ASFV resistant pigs. To evaluate this alternative control measure WSL cell clones stably expressing Cas9 nuclease and single or multiple sgRNAs against essential ASFV proteins were prepared and tested for their susceptibility to infection. Strain specific sgRNAs targeting the p30 gene of ASFV Kenya or Armenia selectively inhibited the respective viruses, and a p12 gene-specific sgRNA abrogated replication of both genotypes almost completely. Interestingly, coexpression of four ASFV-specific sgRNAs did not enhance virus inhibition, but might help to reduce the frequency of escape mutants which were occasionally isolated from the single sgRNA-expressing cells, and exhibited silent base substitutions or in-frame deletions within the target genes. First attempts to express the in vitro tested CRISPR/Cas9 constructs in transgenic pigs are in progress.
CRISPR/Cas9 supported rescue of a defective BAC clone of pseudorabies virus (PrV) vaccine strain Bartha (Hübner et al., 2018b) was used to develop putative vectored vaccines against ASFV. In the present study expression cassettes for the codon-optimized p12 and p54 genes of ASFV were successfully inserted into the PrV genome. The insertions did not significantly affect PrV recombination in cell culture, and the transgenes were expressed at similar levels as in ASFV-infected cells. It has to be tested whether coinfection with vector constructs for these and other immunogenic ASFV proteins is able to protect pigs against a lethal challenge.
For characterization of the generated ASFV mutants and PrV vector constructs, monospecific antisera against several ASFV gene products (p11.5, p12, p54, pK145R, p285L) were prepared by immunization of rabbits with bacterial GST fusion proteins. The anti-p12 serum showed only weak and strain-specific reactions with the ASFV Kenya protein, but was nevertheless useful for identification of p12-expressing PrV recombinants and WSL cell lines. All other sera showed satisfying reactions in Western blot and mostly immunofluorescence analyses, and allowed i.a. precise localization of the pK145R and p285L proteins in ASFV-infected cells and virions (Hübner et al., 2019).
Cerebral cavernous malformations are clusters of aberrant vessels that can lead to severe neurological complications. Pathogenic loss-of-function variants in the CCM1, CCM2, or CCM3 gene are associated with the autosomal dominant form of the disease. While interpretation of variants in protein-coding regions of the genes is relatively straightforward, functional analyses are often required to evaluate the impact of non-coding variants. Because of multiple alternatively spliced transcripts and different transcription start points, interpretation of variants in the 5′ untranslated and upstream regions of CCM1 is particularly challenging. Here, we identified a novel deletion of the non-coding exon 1 of CCM1 in a proband with multiple CCMs which was initially classified as a variant of unknown clinical significance. Using CRISPR/Cas9 genome editing in human iPSCs, we show that the deletion leads to loss of CCM1 protein and deregulation of KLF2, THBS1, NOS3, and HEY2 expression in iPSC-derived endothelial cells. Based on these results, the variant could be reclassified as likely pathogenic. Taken together, variants in regulatory regions need to be considered in genetic CCM analyses. Our study also demonstrates that modeling variants of unknown clinical significance in an iPSC-based system can help to come to a final diagnosis.
Zerebrale kavernöse Malformationen (CCMs) sind Gefäßfehlbildungen im Gehirn oder Rückenmark und können sich klinisch aufgrund einer erhöhten Blutungsbereitschaft mit Kopfschmerzen, Gefühls- und Sprachstörungen bis hin zu Krampfanfällen äußern. Sie treten sporadisch oder im Rahmen einer autosomal-dominant erblichen Form auf. Kausale Sequenzveränderungen sind dabei in den drei Genen CCM1, CCM2 und CCM3 bekannt. Die Detektionsrate für pathogene Varianten ist mit bis zu 60 % für sporadische Fälle und mit weit über 90 % für familiäre Fälle sehr hoch. Während Genpanel-Analysen sehr verlässlich Einzelnukleotidveränderungen, kleine Insertions- und Deletionsvarianten sowie Kopienzahlveränderungen detektieren können, werden komplexe Strukturvarianten oder Veränderungen in nicht-kodierenden Regionen kaum erfasst. Diese rücken jedoch für die bisher genetisch unaufgeklärten Fälle immer mehr in den Fokus des Interesses. Diese Arbeit adressiert daher zum einen die Identifizierung neuer Strukturvarianten und deren funktionale Interpretation im Kontext der CCM-Erkrankung.
Im Rahmen der vorliegenden Arbeit ist der erstmalige Nachweis einer interchromosomalen Insertion bei einem CCM-Patienten gelungen. Die unbalancierte Insertion genomischen Materials von Chromosom 1 in die kodierende Region des CCM2-Gens konnte durch die Verbindung von bioinformatischen Auswertestrategien der Next Generation Sequencing-Genpanel-Daten, molekularzytogenetischen Analysen und einer molekularen Bruchpunktkartierung genau charakterisiert werden. Die Identifikation einer weiteren Strukturvariante, einer Deletion des Transkriptionsstarts von CCM1, verdeutlichte die Herausforderungen bei der Bewertung von Veränderungen in nicht-kodierenden Genbereichen. Für eine eindeutige Klassifikation der Variante wurden daher funktionale Analysen durchgeführt, die auf einer CRISPR/Cas9-vermittelten Nachbildung der Deletion in iPSCs und der anschließenden Differenzierung in Endothelzellen beruhte. Damit konnte gezeigt werden, dass die Deletion zu einem Verlust der CCM1 mRNA- und Proteinexpression führt. Zudem wurde in den differenzierten Endothelzellen eine für die CCM-Pathogenese charakteristische Deregulation von KLF2, THBS1, NOS3 und HEY2 beobachtet. Schließlich war es auf Basis dieser in vitro-Analysen möglich, die Variante entsprechend den ACMG-Richtlinien als wahrscheinlich pathogen zu bewerten und somit die molekulare CCM-Diagnose zu sichern.
Die Verbindung des CRISPR/Cas9-Systems mit iPSCs ist nicht nur für die Variantenbewertung von großem Nutzen, sondern bietet auch das Potential zum besseren Verständnis von Krankheitsmechanismen. Ein weiterer Fokus der vorliegenden Arbeit lag daher auf der Etablierung und Verwendung iPSC-basierter Zellkulturmodelle für die CCM-Modellierung. Zunächst ist es gelungen, mehrere iPSC-Linien mit einer kompletten CRISPR/Cas9-vermittelten CCM1-, CCM2- oder CCM3-Inaktivierung zu generieren. Diese wurden anschließend für die Differenzierung in hBMEC-ähnliche Zellen und innovative dreidimensionale vaskuläre Organoide verwendet. In diesen Systemen konnte beispielsweise eindrücklich eine tumorähnliche Proliferation CCM3-defizienter Endothelzellen nachvollzogen werden, die nur in Kontakt mit Wildtyp-Zellen auftrat. RNA-Sequenzierungen in einem CCM1-basierten Knockout-Modell konnten darüber hinaus die Rolle von CCM1 als Endothel-spezifisches Suppressorgen stärken. Die im Rahmen der Arbeit etablierten Systeme werden zukünftig für weitere Fragestellungen der CCM-Pathogenese wie der endothelialen Barrierestörung eingesetzt und stellen darüber hinaus sehr gut geeignete Plattformen für die effektive Entwicklung dringend benötigter therapeutischer Ansätze dar.