Shwachman-Diamond syndrome (SDS) results from mutations in the SBDS gene, characterized by exocrine pancreatic insufficiency and hematologic and skeletal abnormalities. Neutropenia and neutrophil dysfunction are hallmark features of SDS; however, causes for the bone defects are unknown. Dysfunction of boneresorbing osteoclasts, formed by the fusion of monocytic progenitors derived from the same granulocytic precursors as neutrophils, could be responsible. We report that Sbds is required for in vitro and in vivo osteoclastogenesis (OCG).Sbds-null murine monocytes formed osteoclasts of reduced number and size because of impaired migration and fusion required for OCG. Phenotypically, Sbdsnull mice exhibited low-turnover osteoporosis consistent with findings in SDS patients. Western blotting of Rho GTPases that control actin dynamics and migration showed a 5-fold decrease in Rac2, whereas Rac1, Cdc42, and RhoA were unchanged or only mildly reduced. Although migration was rescued on Rac2 supplementation, OCG was not. This was attributed to impaired signaling downstream of receptor activator of nuclear factor-B (RANK) and reduced expression of the RANK-ligand-dependent fusion receptor DC-STAMP. We conclude that Sbds is required for OCG by regulating monocyte migration via Rac2 and osteoclast differentiation signaling downstream of RANK. Impaired osteoclast formation could disrupt bone homeostasis, resulting in skeletal abnormalities seen in SDS patients. (Blood. 2011;117(6): 2044-2053)
IntroductionShwachman-Diamond syndrome (SDS) is an autosomal recessive disorder with hallmark features of bone marrow failure, exocrine pancreatic insufficiency, and skeletal abnormalities. [1][2][3] Neutropenia is the most common clinical manifestation of bone marrow failure, but patients may also experience pancytopenia, anemia, and thrombocytopenia, and be at increased risk of developing aplastic anemia and acute myeloid leukemia. 4 In early crosssectional studies, metaphyseal dysostosis was observed in 40% to 80% of SDS patients, and rib and/or thoracic cage abnormalities in 30% to 50% of SDS patients. [5][6][7] More recently, in a longitudinal study, all of the SDS patients studied displayed various skeletal abnormalities, including delayed appearance of secondary ossification centers, variable widening, and irregularity of the metaphyses in early childhood followed by progressive thickening and irregularity of the growth plates, and generalized osteopenia. 8 In addition, a subset of patients showed early signs of osteoporotic vertebral deformities and disturbances in bone homeostasis manifesting in low-turnover osteoporosis. 8,9 Oral and dental diseases and conditions, including periodontitis, delayed eruption of the permanent dentition, increased caries risk in primary and permanent dentitions, and increased soft tissue pathoses, have also been reported. 10 SDS results from mutations in the ubiquitously expressed, conserved Shwachman-Bedian-Diamond syndrome gene (SBDS). 11 The exact function of the SBDS protein remains unclear; h...