NDI is a rare disease and AVPR2 mutations are responsible for the 90% of the congenital cases [17]. AVPR2 is a GPCR, which has seven transmembrane domains, locates on the plasma membrane of the kidney [18]. Recent studies showed that GPCR mutations can cause misfolding and intracellular retention because they cannot pass through the ER quality control system of the cell [5, 6, 8, 16, 19]. Since they are trapped in the ER, their presence on the plasma membrane are reduced and consequently their agonist sensitivity were reduced. Some of the intracellularly trapped mutants can be rescued using with PCs and it is shown that AVPR2 mutants could be rescued by this strategy [14, 20–22]. With the help of PCs, which are cell-permeable small molecules, mutant receptors can fold properly and pass the ER quality control system. PC specifically binds to the mutant receptor and act as a chaperone in the folding process. By this way, rescued mutant receptors can reach to the cell membrane and can be functional because some mutations affect only the folding state of the receptor not the function of it.
PCs used in this study are OPC-41061 (tolvaptan), OPC-31260 (mozavaptan) and OPC-21268. OPC-41061 and OPC-31260 are non-peptide AVPR2 antagonists, OPC-21268 is a non-peptide AVPR1 antagonist [23]. OPC-41061 is an orally active molecule and used for the treatment of severe hyponatremia, autosomal dominant polycystic kidney disease (ADPKD) and syndrome of inappropriate antidiuretic hormone, etc [24–26]. Both OPC-41061 and OPC-31260 were found to be useful even at low concentrations to increase cell surface expression of mutant receptors [8, 11, 27, 28]. OPC-21268 is an orally effective [29, 30] and also can be used to rescue misfolded AVPR2s [12]. As it mentioned before OPC-41061 is approved for the ADPKD, but it was reported that the use of tolvaptan in patients should be carefully decided by evaluating benefits and risks due to its reversible acute liver injury effects [31, 32].
Because of the therapuetical potentials of PCs on treatment of NDI associated with misfolded AVPR2 mutants, we aimed to analyze the rescue potantials of OPC-41061, OPC-31260 and OPC-21268 on R68W, ΔR67-G69/G107W, V162A and T273M mutants. For the ΔR67-G69/G107W mutant, we also analyzed both mutations (ΔR67-G69 and G107W) separately. Our point is to identify the responses of different types of mutants to selected chaperones an by this help the selection of new potential therapeutic chaperones.
According to our previous study, all mutants showed reduced cell surface expressions except V162A but their total expression in the cell were found to be not affected by mutations [16]. The change of amino acid residue of the codon 162 is from valine to alanine do not change the nonpolarity of the codon because both of them are nonpolar amino acids and this codon is not conserved among the mammalian orthologs [16]. Therefore, we can say that there is no functional change in terms of cell surface expression and cAMP accumulation in the cell for the V162A mutant [16, 33]. On the other hand, R68W and T273M mutants showed the most decreased cell surface expression levels among others (Fig. 1 and Table 1). At the codon 68, change from basic amino acid arginine to a hydrophobic amino acid tryptophan could cause misfolding since the mutant receptor had a bulky residue at the intracellular loop 1 of the receptor (ICL1) [16]. Codon 273 is a highly conserved residue in the transmembrane domain 6 (TMD6) and it is close to the cytoplasm which can be important for the function of the receptor. The residue substitution from threonine to methionine changes the polarity of the codon which could be the cause of decreased cell surface expression level.
In this study, cell surface expression levels of mutants, except V162A and ΔR67-G69/G107W, were increased when OPC-41061 was used as a PC (Fig. 1 and Table 1) and these increases were statistically significant for ΔR67-G69, R68W and T273M mutants (Table 3). For the ΔR67-G69/G107W mutant, cell surface expressions of double mutant and separate mutants were decreased compared to the wild type receptor (Table 1) and usage of PCs could increase these levels. However, Emax and EC50 values for this double mutant could not be measured because of the unsaturated concentration-response curve. Therefore, we only functionally analyzed the ΔR67-G69 mutant, which was one of the mutation that double mutant had, according to the results of ELISA experiments. ΔR67-G69 was the only mutant that its cell surface expression level was significantly increased after the treatment with all 3 PCs (Table 3). Starting from this point of view, we decided to functionally analyse R68W and ΔR67-G69 after the treatment with OPC-41061, OPC-31260 and OPC-21268, and also T273M after the treatment with only OPC-41061. By this way, we tried to understand whether they could be functional when they were rescued by these PCs. We can say that the treatment with OPC-41061 and OPC-31260 were succesful to make R68W and ΔR67-G69 mutants be functional again (Fig. 2a, 2b and Table 2). Their mutations seemed to affect only the folding processes not the functions of receptors since their Emax values were incerased compared to the untreated samples. However, except ΔR67-G69 mutant-treated with OPC-31260, other mutants showed very highly right-shifted concentration response curves which mean they need much more ligand concentrations to be half-stimulated compared to the wild type receptor (Fig. 2a, 2b and Table 2). The rescue potantial of OPC-21268 was not good for both R68W and ΔR67-G69 mutants because even if OPC-21268 increased cell surface expressions of these mutants, it was not enough to make them reach to the cell membrane which could be seen from the results of Emax values (Table 2). T273M mutant was only rescued by OPC-41061 to the cell membrane (Fig. 1 and Table 1) but according to the cAMP accumulation assay, its maximum response to ligand stimulation was very low compared to the untreated sample (Fig. 2 and Table 2). Even if T273M mutant was rescued by OPC-41061, it could not function properly because of the polarity change at the highly conserved residue and important location (TMD6). Therefore, OPC-41061 might not succesful since the mutation could effect the functionality of T273M even if cell surface expression of it was increased.
As a result, we can say that OPC-41061 was the most succesful PC among others which were used in this study (Fig. 1, 2A and 3). OPC-21268 was not succesful to rescue mutant AVPR2s even they did not show any functional loss. In addition, OPC-41061 and OPC-31260 showed their actions specifically to the mutation types because maximum responses of R68W and ΔR67-G69 were different from each other when they were treated with different PCs. For example, maximum response of the ΔR67-G69 mutant was higher when it was treated with OPC-41061 than OPC-31260. The situation was totally opposite for the R68W mutant (Table 2). The promising potentials of OPC-41061 and OPC-31260 in this study were coherent with other studies [27, 34].
Our results showed that R68W and ΔR67-G69 mutant AVPR2s could be pharmacologically rescued and translocated to the cell membrane after the treatment with OPC-41061 and OPC-31260. Also, they could be functional via initiating cAMP signaling when they were stimulated with the ligand. This study demonstrated that non-peptide AVPR2 antagonists such as OPC-41061 and OPC-31260 could act as PCs to functionally rescue misfolded R68W and ΔR67-G69 mutant AVPR2s. Using such PCs and showing their rescuing effects on several type of mutants has an importance on development of the new therapeutic strategies for NDI.