Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

Abstract

Vascular Ehlers Danlos Syndrome (vEDS) is a connective tissue disorder caused by COL3A1 mutations for which there are no treatments due to a limited understanding of underlying mechanisms. We aimed to identify the molecular insults of mutations, focusing on collagen folding, to establish if targeting protein folding represents a potential therapeutic approach. Analysis of two novel COL3A1 glycine mutations, G189S and G906R, in primary patient fibroblast cultures revealed secretion of misfolded collagen III and intracellular collagen retention leading to lower extracellular collagen levels. This was associated with matrix defects, endoplasmic reticulum (ER) stress, reduced cell proliferation and apoptosis. The ER stress was mediated by activation of IRE1 and PERK signalling arms with evidence of allelic heterogeneity. To establish if promoting ER protein folding capacity or protein degradation represents novel therapeutic avenues, we investigated the efficacy of FDA-approved small molecules. The chemical chaperone 4-phenylbutyric acid (PBA) rescued the ER stress and thermostability of secreted collagen leading to reduced apoptosis and matrix defects, and its efficacy was influenced by duration, dosage and allelic heterogeneity. Targeting protein degradation with carbamazepine (CBZ), or PBA-CBZ in combination did not increase treatment efficacy. These data establish that ER stress is a molecular mechanism in vEDS that can be influenced by the position of COL3A1 mutation. It combines with matrix defects due to reduced collagen III levels and/or mutant protein secretion to vEDS pathogenesis. Targeting protein folding using FDA-approved chemical chaperones represents a putative mechanism-based therapeutic approach for vEDS that can rescue intra- and extracellular defects.

People

Omar, Ramla

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

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Lee, Michelle A.W.

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

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Gonzalez-Trueba, Laura

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

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Thomson, Cameron R.

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

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Hansen, Uwe

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

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Lianos, Spyridonas

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

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Hazarika, Snoopy

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

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El Abdallah, Omar

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

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Ammar, Malak A.

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

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Cassels, Jennifer

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

Donnelly, Hannah and Ross, Ewan and Xiao, Yinbo and Hermantara, Rio and Taqi, Aqeel and Doherty-Boyd, W. Sebastian and Cassels, Jennifer and Tsimbouri, Penelope M. and Dunne, Karen M. and Hay, Jodie and Cheng, Annie and Meek, R.M. Dominic and Jain, Nikhil and West, Christopher and Wheadon, Helen and Michie, Alison M. and Peault, Bruno and West, Adam G. and Salmeron-Sanchez, Manuel and Dalby, Matthew J. (2024) Bioengineered niches that recreate physiological extracellular matrix organisation to support long-term haematopoietic stem cells. Nature Communications, 15: 5791. ISSN 2041-1723

Malik, Natasha and Hay, Jodie and Almuhanna, Hassan N.B. and Dunn, Karen M. and Lees, Jamie and Cassels, Jennifer and Li, Jiatian and Nakagawa, Rinako and Sansom, Owen J. and Michie, Alison M. (2023) mTORC1-selective activation of translation elongation promotes disease progression in chronic lymphocytic leukemia. Leukemia, 37. pp. 2414-2425. ISSN 0887-6924

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Michie, Alison M.

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

Patterson, Shaun D. and Massett, Matthew E. and Huang, Xu and Jørgensen, Heather G. and Michie, Alison M. (2024) The MYC–NFATC2 axis maintains the cell cycle and mitochondrial function in acute myeloid leukaemia cells. Molecular Oncology, 18 (9). pp. 2234-2254. ISSN 1574-7891

Donnelly, Hannah and Ross, Ewan and Xiao, Yinbo and Hermantara, Rio and Taqi, Aqeel and Doherty-Boyd, W. Sebastian and Cassels, Jennifer and Tsimbouri, Penelope M. and Dunne, Karen M. and Hay, Jodie and Cheng, Annie and Meek, R.M. Dominic and Jain, Nikhil and West, Christopher and Wheadon, Helen and Michie, Alison M. and Peault, Bruno and West, Adam G. and Salmeron-Sanchez, Manuel and Dalby, Matthew J. (2024) Bioengineered niches that recreate physiological extracellular matrix organisation to support long-term haematopoietic stem cells. Nature Communications, 15: 5791. ISSN 2041-1723

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Bulleid, Neil J.

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

See full publications list

Malfait, Fransiska

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

See full publications list

Van Agtmael, Tom

Author

Omar, Ramla and Lee, Michelle A.W. and Gonzalez-Trueba, Laura and Thomson, Cameron R. and Hansen, Uwe and Lianos, Spyridonas and Hazarika, Snoopy and El Abdallah, Omar and Ammar, Malak A. and Cassels, Jennifer and Michie, Alison M. and Bulleid, Neil J. and Malfait, Fransiska and Van Agtmael, Tom (2025) The chemical chaperone 4-phenylbutyric acid rescues molecular cell defects of COL3A1 mutations that cause vascular Ehlers Danlos Syndrome. Cell Death Discovery, 11 (1): 200. ISSN 2058-7716

See full publications list
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