2.4.1. IRAG1 and the gastrointestinal system
PKGI is of important relevance for the function of gastrointestinal SMCs [
23]. The fact that IRAG1 forms a complex together with the PKGIβ and is phosphorylated by this enzyme combined with the strong expression of IRAG1 in the gastrointestinal tract suggests that IRAG1 is also of vital importance there [
1,
2,
19,
21]. Therefore, the (patho-)physiological function of IRAG1 was investigated in more detail by mouse models: the
Irag1Δ12/Δ12 mouse and the global
Irag1-deficient (
Irag1-/-) mouse [
3,
4].
Irag1Δ12/Δ12 mice reveal an interruption of the interaction between IRAG1 and IP
3R-I, caused by deletion of exon 12 of
Irag1, which encodes the N-terminal part of the coiled-coil domain. The loss of the interaction between IRAG1 and IP
3R-I did not affect the carbachol induced contraction but impaired the cGMP-mediated relaxation of SMCs of the colon as well as the tonic phase of depolarization induced contraction [
3,
24]. Similar results were found in colonic SMCs of global
Irag1-deficient mice [
4]. However, in jejunum of
Irag1Δ12/Δ12 mice this was not observed [
24]. This confirmed the important function of IRAG1 in the cGMP-mediated relaxation of receptor-triggered contraction of SMCs. Furthermore, these results approved the interaction between IRAG1 and the IP
3R-I and that PKGIβ/IRAG1 signaling is of major importance for the cGMP-mediated relaxation of smooth muscles.
Studies on the physiological functions of IRAG1 in mouse models showed that IRAG1 is crucial for the functionality of the gastrointestinal tract
in toto.
Irag1Δ12/Δ12 mice developed an enlarged gastrointestinal tract, impaired gastrointestinal motility and pyloric stenosis [
3]. These pathological changes could also be observed in global
Irag1-/- mice [
4]. Further studies with these transgenic mice revealed that they had an iron deficiency anemia as a result of gastrointestinal bleedings and subsequently developed a splenomegaly [
16]. The results verified indications about splenomegaly in earlier studies of
Irag1 mouse mutants [
3,
4]. Interestingly, these findings occurred mainly in female
Irag1-deficient mice [
16]. In this context, it was shown, that IRAG1 has a function in the development of achalasia. Achalasia is a disease of the gastrointestinal tract, which leads to impaired esophageal motility and incomplete relaxation of the lower esophageal sphincter. In two achalasia patients, a homozygous nonsense mutation of
IRAG1 was detected. This mutation resulted in a loss of the known interaction of IRAG1 and PKGIβ. As a consequence, the central role of IRAG1 in regulation of Ca
2+ levels and the associated regulation of cGMP-regulated smooth muscle relaxation was lost [
25]. This case report is consistent with previously reported data showing that micro RNA (miRNA) regulate
IRAG1 in esophageal SMCs in achalasia patients [
26]. In
Irag1 mouse mutants it was further observed that mutation or deficiency of IRAG1 caused a decrease in protein expression of PKGIβ [
3,
4,
16]. The reduced protein expression of PKGIβ could not be explained by a decrease of the corresponding gene expression [
16]. In this context, it is interesting to know that
Prkg1 mouse mutants – which do not encode both isoforms of the PKGI – develop a similar phenotype to the
Irag1 mouse mutants, only in a much stronger manifestation [
27,
28,
29].
Combining the known data on IRAG1 and PKGIβ, this suggests that a disruption of PKGIβ/IRAG1 signaling pathway is significantly responsible for development of gastrointestinal disorders.
2.4.2. IRAG1 and (cardio-)vascular system
Besides the gastrointestinal SMCs IRAG1 is also highly expressed in VSMCs and the heart [
19].
In vitro experiments with VSMCs of
Irag1Δ12/Δ12 and
Irag1-/- mice gave comparable results to those in SMCs of the colon. The loss of the interaction between IRAG1 and IP
3R-I impaired cGMP-mediated relaxation of VSMCs of aorta [
3,
4]. Furthermore, in global
Irag1-deficient mice the cGMP- and atrial natriuretic peptide (ANP)-mediated relaxation of VSMCs was reduced after acetylcholine induced contraction. Thus, IRAG1 has a central role in NO/cGMP- and ANP-mediated relaxation of VSMCs [
4]. The detailed mechanism of cGMP-mediated relaxation of VSMCs has not yet been conclusively determined. A possible mechanism could be an interaction between IRAG1 and the transient receptor potential melastatin 4 channel (TRPM4). These sodium channels are activated by Ca
2+ from the SR and take part in the vasoconstriction of blood vessels. In cerebral arteries IRAG1 and TRPM4 were colocalized in the SR of those VSMCs. When targeting
Irag1 with morpholinos the NO-induced vasodilation was blunted and activity of TRPM4 was reduced. This indicates that NO/cGMP/PKG signaling decreases TRPM4 activity through an IRAG1-mediated inhibition of Ca
2+ release from the SR [
20]. Moreover, it was shown that not only cGMP promotes relaxation in VSMCs via IRAG1. The cyclic nucleotide cyclic cytidine 3’,5’-monophosphate (cCMP) also influences their relaxation. So, it was demonstrated that cCMP-mediated relaxation is also reduced in
Irag1-deficient VSMCs in analogy to cGMP-mediated relaxation. It can be assumed that the effects of cCMP occur via stimulation of PGKI which then leads to phosphorylation of IRAG1 [
30]. Physiological investigation of IRAG1 in
Irag1-deficient mice exposed that a loss of IRAG1 caused a mild pulmonary arterial remodeling and an increasing percentage of muscularized arteries if these mice were kept under normoxic conditions [
17]. A genetic analysis of a Caucasian family with moyamoya syndrome (MMS), which was associated with neurofibromatosis type 1 (NF1), revealed a polymorphism of
IRAG1 in exon 5. This polymorphism might represent
IRAG1 as a genetic susceptibility factor for MMS in NF1 [
31]. Furthermore,
IRAG1 was one of seven new identified genes in the context of lacunar stroke and was abundantly expressed on astrocytes [
32].
Based on the physiological function of IRAG1 in VSMCs, the role of IRAG1 in the heart was of interest as it is also expressed there [
6,
17,
18,
19]. A good parameter to assess this is the heart function.
Irag1 mouse mutants have a slight tendency for hypotension [
3,
4]. However, after induction of a sepsis, blood pressure remained constant in
Irag1-deficient mice in contrast to wild type mice [
4]. As already mentioned,
Irag1-/- mice did not show any difference in the blood pressure. Though, under normoxic conditions an
Irag1 deficiency caused a significant increase of the systolic pressure of the right ventricle (RV) and they develop a RV hypertrophy and dilatation. However, no evidence of heart fibrosis was recognized. Thus, an
Irag1 deficiency causes the spontaneous development of pulmonary hypertonia (PH) under normoxic condition without any trigger,
e.g. hypoxia [
17]. This finding is consistent with the data of the pulmonary vascular remodeling of
Irag1-/- mice, as pulmonary vascular remodeling is often associated with PH. The cardioprotective function of IRAG1 is also supported by other results. Burn-induced cardiomyopathy in rats causes a decrease of cGMP and various genes like
Irag1 and
Prkg. If these rats are treated with the phosphodiesterase (PDE) 5 inhibitor sildenafil, there was a normalization of cardiac function and an increase of cGMP and mRNA levels, among others of
Irag1 and
Prkg. This indicates that PDE5/cGMP/PKG are mediating the burn-induced heart dysfunction [
33]. In the process of demonstrating HCN4 as a novel interaction partner of IRAG1, it was detected in the sinoatrial node of murine hearts. Based on a model of funny current (I
f) it was predicted that IRAG1 will increase the I
f in sinoatrial myocytes [
18]. So, IRAG1, as a HCN4 modulator, is suggested to have a possible role in heart rate regulation [
34].
Furthermore, IRAG1 is expressed in lungs [
19]. Analysis of the expression of IRAG1 protein in lungs and isolated pulmonary artery of smooth muscle cells (PASMCs) of end stage idiopathic pulmonary arterial hypertension (IPAH) revealed an increased expression of IRAG1 and PKGIβ. This contrasted with hypoxic
Irag1-deficient mice. They showed a decreased PKGIβ protein expression in lung and murine PASMCs [
17].
IRAG1 is not only expressed in tissues of the cardiovascular system, but also in a huge amount in platelets [
19]. The facts that PKGI has a crucial function in platelet aggregation and that IRAG1 is a substrate of the PKGIβ and also forms a macrocomplex with PKGIβ and IP
3R-I, raised the question of the physiological function of IRAG1 in platelets [
2,
35]. This well-known macrocomplex, as well as the phosphorylation of IRAG1 by PKGIβ, which results in the inhibition of Ca
2+ release from IP
3R-I, was found in human and murine platelets. However, in human platelets two phosphorylated serine residues were identified – Ser664 and Ser677 – whereby the Ser677 in human IRAG1 corresponds to the Ser696 in bovine IRAG1 [
2,
5,
36]. The examination of platelets from
Irag1∆12/∆12 and global
Irag1-deficient mouse mutants revealed that cGMP- and NO-induced platelet aggregation was inhibited in these mouse mutants [
5,
36]. cAMP- or prostacyclin-mediated aggregation was not affected and the cGMP- or NO-mediated and thrombin-induced Ca
2+ release was not suppressed in the mutant platelets [
5]. Therefore, IRAG1 has a crucial function in impeding NO/cGMP signaling in platelet aggregation by suppression of intracellular Ca
2+ [
5]. However, not only the cGMP-mediated inhibition of platelet aggregation is affected by IRAG1. The cCMP-mediated inhibition of aggregation was also inhibited in
Irag1-deficient platelets. This suggests that, similar to VSMCs, cCMP-regulated effects are operated by the PGKI/IRAG1 pathway [
30]. In addition, IRAG1 is involved in the NO- or cGMP-induced inhibition of adenosine triphosphate and serotonin secretion from dense granules and P-selectin secretion from alpha granules in platelets [
36]. The circumstance that global
Irag1-deficent mice showed reduced bleeding time confirmed the results on the physiological function of IRAG1 determined in
in vitro experiments [
36]. Furthermore, IRAG1 is necessary for cGMP-dependent inhibition of platelet activation and prevention of arterial thrombosis as well as for inhibition of thrombin-induced adhesion of platelets to fibrinogen [
5,
36]. These experimental data on the physiological function of IRAG1 are supported by several clinical data. Meta analyses discovered single nucleotide polymorphisms (SNPs) in the human
IRAG1 gene, which cause an increased aggregability of platelets to agonists and reduce mean platelet volume [
37,
38,
39].
Taken together, IRAG1 is an important protein for the physiological function of the (cardio-)vascular system and for platelet function. These findings and the participation in the development of disorders make IRAG1 an interesting target for further studies and possible pharmacological treatments.
2.4.3. IRAG1 and cancer disease
In addition to the (patho-)physiological functions of IRAG1 described so far, it is also important in tumor diseases. This was already evident in the first description of
IRAG1 respectively
MRVI1, where it was detected in BXH2 leukemias. It was concluded that
IRAG1 can induce myeloid leukemia by altering the expression of a gene important for myeloid cell growth and/or differentiation, and it was suspected that
IRAG1 may function as a tumor suppressor gene [
6]. Involvement of IRAG1 in myeloid leukemias was also demonstrated in another study investigating the extent to which the recurrent chromosomal translocations of the tyrosine kinases BCR-ABL, TEL-PDGFRB, and TEL-JAK2 regulate distinct and overlapping gene transcription profiles. It was shown that
IRAG1 was increasingly expressed in Ba/F3 cells after transfection with either BCR-ABL or TEL-PDGFRB. Again, it was concluded that
IRAG1 plays an important role in the development of leukemia. However, this remains to be conclusively elucidated [
40]. This statement is supported by the findings that CD300A was upregulated in patients with an acute myeloid leukemia of the intermediate or adverse risk category of the WHO criteria (2018) and predicts a poor survival. CD300A upregulation stimulates the cGMP/PKG signaling pathway and
IRAG1 was positive correlated with CD300A [
41].
Besides its involvement in the development of myeloid leukemia, IRAG1 is also important in solid tumors. In particular, association of IRAG1 with tumors of the female reproductive system was described so far. The response of patients suffering from serious ovarian carcinoma stage III to cytostatic therapies varies. It was reported that
IRAG1 was upregulated in 61 % of these patients. Overexpression of
IRAG1 has a direct impact on the survival because these patients have a significantly worse prognosis in terms of survival than those in whom
IRAG1 was not upregulated. Furthermore, if the tumor was chemoresistant, the prognosis was even worse. These results implicate that
IRAG1 is involved in chemoresistance of serious ovarian carcinoma [
42]. While the involvement of IRAG1 in ovarian carcinoma is associated with a poor prognosis, this does not apply to endometrial carcinoma. MicroRNAs modulate cellular processes and there is growing evidence that they are linked to the progression of diverse cancers like the endometrial carcinoma. MicroRNA miR-940 acts as an oncogene during progression and high expression is associated with, among other things, reduced overall survival. In these tumors it was found that expression of IRAG1, which is a direct target of miR-940, was decreased. Moreover, IRAG1 expression was associated with,
e.g. survival of the patients in the context that high expression levels of IRAG1 are linked to a good prognosis. Thus, miR-940 regulates progression of endometrial carcinoma by affecting the expression of IRAG1 [
43]. Similar to endometrial carcinoma, low expression of
IRAG1 in cervical carcinoma was associated with poor overall survival. This is caused by hypermethylation in the promotor regions of
IRAG1 promoter, resulting in low gene expression of
IRAG1 [
44]. Furthermore, the gene expression of
IRAG1 was upregulated in context of pancreatic ductal adenocarcinoma (PDAC), after silencing the transcription factor basic transcription factor 3 (BTF3) in pancreatic cancer cell lines [
45]. Additionally, expression of
IRAG1 was negatively associated with high expression of the cell division cycle associated protein 2 (CDCA2) in glioma [
46].
Based on the current data, it can be concluded that it is not yet possible to make a clear statement on the function of IRAG1 in the development and/or progression of tumors. This is mainly due to the fact, that the data collected so far are established by bioinformatic analyses and investigations on corresponding cell lines. However, from these previous studies it can be assumed that IRAG1 has different functions depending on the tumor type. The exact role of IRAG1 in these tumors remains to be investigated in systematic experimental work.
2.4.4. Further (patho-)physiological functions of IRAG1
Apart from the previously mentioned (patho-)physiological functions, IRAG1 might also have more functions. For example, an increased expression of
IRAG1 in addition to two other genes was described in keratoconus, but the role of
IRAG1 in this eye disease is still unclear so far [
47]. The attachment and motility of osteoclasts is regulated by NO and PGKI, which modulates the release of Ca
2+ by the IP
3R-I. Functional studies on osteoclasts revealed that IRAG1 is expressed in these cell types and is required for the Ca
2+ release during motility. If the IRAG1 mediated Ca
2+ release from the IP
3R-I was disrupted, this might be a cause for dysfunction of osteoclasts [
48]. IRAG1 reveals not only a significant role in the development of tumors of the female reproductive system, but it is also involved in other diseases in this body region. Proteomic analysis of tissue from intrauterine adhesions (IUA) – also known as Asherman’s syndrome – revealed IRAG1 as one of seven proteins which were upregulated in IUA. However, the exact mechanisms and signaling pathways remain to be investigated before IRAG1 can act as a potential target protein for clinical treatment of IUA [
49]. Further investigations showed that IRAG1 participates in endothelial ANP/cGMP/PKGI signaling [
50].
Taken together, IRAG1 is of importance for several physiological functions due to its large tissue distribution, but needs to be further investigated.