Impaired angiogenesis and extracellular matrix metabolism in autosomal-dominant hyper-IgE syndrome

• Published in: The Journal of clinical investigation Vol. 130; no. 8; pp. 4167 - 4181
• Main Authors: Dmitrieva, Natalia I., Walts, Avram D., Nguyen, Dai Phuong, Grubb, Alex, Zhang, Xue, Wang, Xujing, Ping, Xianfeng, Jin, Hui, Yu, Zhen, Yu, Zu-Xi, Yang, Dan, Schwartzbeck, Robin, Dalgard, Clifton L., Kozel, Beth A., Levin, Mark D., Knutsen, Russell H., Liu, Delong, Milner, Joshua D., López, Diego B., O’Connell, Michael P., Lee, Chyi-Chia Richard, Myles, Ian A., Hsu, Amy P., Freeman, Alexandra F., Holland, Steven M., Chen, Guibin, Boehm, Manfred
• Format: Journal Article
• Language: English
• Published: United States American Society for Clinical Investigation 01.08.2020
• Subjects: Advertising executives; Analysis; Angiogenesis; Animal models; Animals; Biomedical research; Biopsy; Cell culture; Collagen; Connective tissue; Connective tissues; Coronary artery; Cytokines; Disease; Drug development; Extracellular matrix; Extracellular Matrix - genetics; Extracellular Matrix - metabolism; Extracellular Matrix - pathology; Female; Fibroblasts; Gene expression; Genes; Genetic aspects; Humans; Hypoxia; Hypoxia-Inducible Factor 1, alpha Subunit - genetics; Hypoxia-Inducible Factor 1, alpha Subunit - metabolism; Hypoxia-inducible factor 1a; Immunodeficiency; Immunoglobulin E; Infections; Job Syndrome - genetics; Job Syndrome - metabolism; Job Syndrome - pathology; Job's syndrome; Male; Mice; Mortality; Mutation; Neovascularization, Physiologic; Pathophysiology; Patients; Physiological aspects; Proteins; Rare diseases; Skin; Skin - blood supply; Skin - metabolism; Skin - pathology; Stat3 protein; STAT3 Transcription Factor - genetics; STAT3 Transcription Factor - metabolism; Transcription; Vascularization; Wound care; Wound Healing; Wounds and Injuries - genetics; Wounds and Injuries - metabolism; Wounds and Injuries - pathology; Maryland; Cardiovascular disease; Extracellular matrix; Monogenic diseases; Vascular Biology; Therapeutics
• ISSN: 0021-9738; 1558-8238; 1558-8238
• DOI: 10.1172/JCI135490

There are more than 7000 described rare diseases, most lacking specific treatment. Autosomal-dominant hyper-IgE syndrome (AD-HIES, also known as Job's syndrome) is caused by mutations in STAT3. These patients present with immunodeficiency accompanied by severe nonimmunological features, including skeletal, connective tissue, and vascular abnormalities, poor postinfection lung healing, and subsequent pulmonary failure. No specific therapies are available for these abnormalities. Here, we investigated underlying mechanisms in order to identify therapeutic targets. Histological analysis of skin wounds demonstrated delayed granulation tissue formation and vascularization during skin-wound healing in AD-HIES patients. Global gene expression analysis in AD-HIES patient skin fibroblasts identified deficiencies in a STAT3-controlled transcriptional network regulating extracellular matrix (ECM) remodeling and angiogenesis, with hypoxia-inducible factor 1α (HIF-1α) being a major contributor. Consistent with this, histological analysis of skin wounds and coronary arteries from AD-HIES patients showed decreased HIF-1α expression and revealed abnormal organization of the ECM and altered formation of the coronary vasa vasorum. Disease modeling using cell culture and mouse models of angiogenesis and wound healing confirmed these predicted deficiencies and demonstrated therapeutic benefit of HIF-1α-stabilizing drugs. The study provides mechanistic insights into AD-HIES pathophysiology and suggests potential treatment options for this rare disease.