SUMMARY
Cytokines are classically thought to stimulate downstream signaling
pathways through monotonic activation of receptors. We describe a severe anemia
resulting from a homozygous mutation in the cytokine erythropoietin (EPO,
R150Q). Surprisingly, the EPO R150Q mutant shows only a mild reduction in
affinity for its receptor, but has altered binding kinetics. The EPO mutant is
less effective at stimulating erythroid cell proliferation and differentiation,
even at maximally potent concentrations. While the EPO mutant can stimulate
effectors such as STAT5 to a similar extent as the wild type ligand, there is
reduced JAK2-mediated phosphorylation of select downstream targets. This
impairment in downstream signaling mechanistically arises from altered receptor
dimerization dynamics due to extracellular binding changes. These results
demonstrate how variation in a single cytokine can lead to biased downstream
signaling and can thereby cause human disease. Moreover, we have defined a
distinct treatable form of anemia through mutation identification and functional
studies.