Mutations that prevent phosphorylation of the BMP4 prodomain impair proteolytic maturation of homodimers leading to early lethality in mice

Reviewer #1 (Public review):

Summary:

The authors demonstrate that two human preproprotein human mutations in the BMP4 gene cause a defect in proprotein cleavage and BMP4 mature ligand formation, leading to hypomorphic phenotypes in mouse knock-in alleles and in Xenopus embryo assays.

Strengths:

They provide compelling biochemical and in vivo analyses supporting their conclusions, showing the reduced processing of the proprotein and concomitant reduced mature BMP4 ligand protein from impressively mouse embryonic lysates. They perform excellent analysis of the embryo and post-natal phenotypes demonstrating the hypomorphic nature of these alleles. Interesting phenotypic differences between the S91C and E93G mutants are shown with excellent hypotheses for the differences. Their results support that BMP4 heterodimers act predominantly throughout embryogenesis whereas BMP4 homodimers play essential roles at later developmental stages.

Weaknesses:

A control of BMP7 alone in the Xenopus assays seems important to exclude BMP7 homodimer activity in these assays.

The Discussion could be strengthened by more in-depth explanations of how BMP4 homodimer versus heterodimer signaling is supported by the results, so that readers do not have to think it all through themselves. Similarly, a discussion of why the S91C mutant has a stronger phenotype than E93G early in the Discussion would be helpful or least mention that it will be addressed later.

Reviewer #2 (Public review):

Summary:

Kim et al. report that two disease mutations in proBMP4, Ser91Cys and Glu93Gly, which disrupt the Ser91 FAM20C phosphorylation site, block the activation of proBMP4 homodimers. Consequently, analysis of DMZ explants from Xenopus embryos expressing the proBMP4 S91C or E93G mutants showed reduced pSmad1 and tbxt1 expression. The block in BMP4 activity caused by the mutations could be overcome by co-expression of BMP7, suggesting that the missense mutations selectively affect the activity of BMP4 homodimers but not BMP4/7 heterodimers. The expert amphibian tissue transplant studies were extended to in vivo studies in Bmp4S91C/+ and Bmp4E93G/+ mice, demonstrating the impact of these mutations on embryonic development, particularly in female mice, in line with patient studies. Finally, studies in MEFs revealed that the mutations did not affect proBMP4 glycosylation or ER-to-Golgi transport but appeared to inhibit the furin-dependent cleavage of proBMP4 to BMP4. Based on these findings and AI (AlphaFold) modeling of proBMP4, the authors speculate that pSer91 influences access of furin to its cleavage site at Arg289AlaLysArg292.

Strengths:

The Xenopus and mouse studies are valuable and elegantly describe the impact of the S91C and E93G disease mutations on BMP signaling and embryonic development.

Weaknesses:

The interpretation of how the mutations may disturb the furin-mediated cleavage of proBMP4 is underdeveloped and does not consider all of their data. Understanding how pS91 influences the furin-dependent cleavage at Arg292 seems to be the crux of this work and thus warrants more consideration. Specifically:

(1) Figure S1 may be significantly more informative than implied. The authors report that BMP4S91D activates pSmad1 only incrementally better than S91C and much less than WT BMP4. However, Fig. S1B does not support the conclusion on page 7 (numbering beginning with title page); "these findings suggest that phosphorylation of S91 is required to generate fully active BMP4 homodimers". The authors rightly note that the S91C change likely has manifold effects beyond inhibiting furin cleavage. The E93G change may also affect proBMP4 beyond disturbing FAM20C phosphorylation. Additional mutation analyses would strengthen the work.

(2) These findings in Figure S1 are potentially significant because they may inform how proBMP4 is protected from cleavage during transit through the TGN and entry into peripheral cellular compartments. Intriguing modeling studies in Figure 6 suggest that pSer91 is proximal to the furin cleavage site. Based on their presentation, pSer91 may contact Arg289, the critical P4 residue at the furin site. If so, might that suggest how pS91 may prevent furin cleavage, thus explaining why the S91D mutation inhibits processing as presented, and possibly how proBMP4 processing is delayed until transit to distal compartments (perhaps activated by a change in the endosomal microenvironment or a Ser91 phosphatase)? Have the authors considered or ruled out these possibilities? In addition to additional mutation analyses of the FAM20C site, moving the discussion of this model to an "Ideas and Speculation" subsection may be warranted.

(3) The lack of an in vitro protease assay to test the effect of the S91 mutations on furin cleavage is problematic.

Reviewer #3 (Public review):

Summary:

The authors describe important new biochemical elements in the synthesis of a class of critical developmental signaling molecules, BMP4. They also present a highly detailed description of developmental anomalies in mice bearing known human mutations at these specific elements.

Strengths:

Exceptionally detailed descriptions of pathologies occurring in mutant mice. Novel findings regarding the interaction of propeptide phosphorylation and convertase cleavage, both of which will move the field forward. Provocative hypothesis regarding furin access to cleavage sites, supported by Alphafold predictions.

Weaknesses:

Figure 6A presents two testable models for pre-release access of furin to cleavage sites since physical separation of enzyme from substrate only occurs in one model; could immunocytochemistry resolve?