Mutations in the coactivator CREB-binding protein (CBP) are a major cause of the human skeletal dysplasia Rubinstein-Taybi syndrome (RTS); however, the mechanism by which these mutations affect skeletal mineralization and patterning is unknown. Here, we report the identification of 3-phosphoinositide-dependent kinase 1 (PDK1) as a key regulator of CBP activity and demonstrate that its functions map to both osteoprogenitor cells and mature osteoblasts. In osteoblasts, PDK1 activated the CREB/CBP complex, which in turn controlled runt-related transcription factor 2 (RUNX2) activation and expression of bone morphogenetic protein 2 (BMP2). These pathways also operated in vivo, as evidenced by recapitulation of RTS spectrum phenotypes with osteoblast-specific Pdk1 deletion in mice (Pdk1 osx mice) and by the genetic interactions observed in mice heterozygous for both osteoblast-specific Pdk1 deletion and either Runx2 or Creb deletion. Finally, treatment of Pdk1 osx and Cbp +/-embryos with BMPs in utero partially reversed their skeletal anomalies at birth. These findings illustrate the in vivo function of the PDK1-AKT-CREB/CBP pathway in bone formation and provide proof of principle for in utero growth factor supplementation as a potential therapy for skeletal dysplasias.
IntroductionRubinstein-Taybi syndrome (RTS) was first described in 1963 as a condition characterized by impaired intellectual function, broad thumbs and halluces, craniofacial dysmorphism, and frequent fractures (1, 2). Characteristic craniofacial defects include a short philtrum, micrognathia, a high arched palate, and dental defects such as talon cusps, enamel hypoplasia, and abnormalities in tooth number (3). Genetically, RTS is associated with microdeletions, inversions, and translocations involving chromosome 16p13.3 (4). Mapping of the 16p13.3 region in patients with RTS has identified heterozygous mutations in CREB-binding protein (CBP) that account for approximately 40% of RTS cases (5). Cbp +/-mice show a similar range of defects as those in RTS, including neurodevelopmental and behavioral defects; oligodactyly; extra, split, or asymmetric vertebrae; calvarial hypomineralization; and delayed ossification at several sites (6-9). However, despite these advances in understanding the genetic basis of RTS, the mechanism by which these defects arise is unclear, and we have little insight into which pathways might function upstream and downstream of CBP during development.