Type II Transmembrane Serine Proteases^*

Enteropeptidase in Digestion

The role of enteropeptidase in digestion was first recognized by Ivan Pavlov in canine models in the early 1900s and subsequently studied by Moses Kunitz with purified proteins in the 1930s (21). Enteropeptidase is expressed on the brush-border membrane of the duodenum, where it converts pancreatic trypsinogen to trypsin. This function is essential for initiating proteolytic reactions of digestive enzymes in the small intestine. Patients with congenital enteropeptidase deficiency, which is caused by mutations in the PRSS7 gene encoding enteropeptidase (21), are unable to digest food efficiently and suffer from malnutrition and growth delay.

Corin in Cardiac Function and Blood Pressure Regulation

Corin is expressed primarily in cardiomyocytes. Corin converts pro-ANP to active ANP, a cardiac hormone that regulates blood pressure and cardiac function by promoting natriuresis, dieresis, and vasodilation (22). In mice, lack of corin prevents conversion of pro-ANP to ANP (23). Corin null mice develop hypertension that is exacerbated by a high-salt diet and exhibit cardiac hypertrophy. Single nucleotide polymorphisms in the corin gene are found in African Americans with a history of high blood pressure and cardiac hypertrophy (24, 25). These single nucleotide polymorphisms alter amino acids in corin frizzled domain 2 and impair its zymogen activation and pro-ANP processing activity (26), suggesting that genetic defects in corin contribute to hypertensive disease in humans. Corin is also expressed in other tissues (supplemental Table S2) and has a role in pigmentation of mouse fur (27).

TTSPs in Hearing

Several TTSPs play a role in normal hearing (supplemental Table S3). The TMPRSS3 gene was first identified in a locus on chromosome 21 that was associated with familiar congenital deafness. An array of mutations in the TMPRSS3 gene have been found in patients with nonsyndromic recessive hearing loss (28). Mutations in the TMPRSS5 gene may also contribute to hearing loss (29). Both TMPRSS3 and TMPRSS5 are expressed in inner ear tissues. Many naturally occurring mutations prevent zymogen activation of these enzymes. Recently, hepsin was also found to be important for normal hearing (30). Hepsin null mice have abnormal cochlear structures and reduced myelin protein expression in the auditory nerve. Hepsin null mice also have low levels of thyroxine. As thyroid hormone is required for the development of the inner ear, this suggests that the impaired hearing may be secondary to a defect in thyroid hormone metabolism.

Matriptase-2 in Iron Metabolism

Matriptase-2 plays an important role in iron homeostasis. In chemically induced or gene knock-out mouse models, disruption of the Tmprss6 gene caused severe iron deficiency anemia (31, 32). Similarly, mutations in the TMPRSS6 gene have been identified in patients with microcytic anemia who respond poorly to iron therapy (33). Matriptase-2 is expressed primarily in the liver, where it appears to suppress hepcidin expression. Hepcidin binds and internalizes the iron export protein, ferroportin, on the surface of enterocytes and macrophages, thereby reducing iron supply. Recently, matriptase-2 was shown to degrade hemojuvelin, a membrane-anchored protein that acts as a cofactor for bone morphogenetic protein-mediated activation of hepcidin gene expression (34). Matriptase-2 deficiency leads to high levels of hemojuvelin and hence increased hepcidin expression, which in turn suppresses iron absorption and causes iron deficiency anemia.

TTSPs in Epithelial Homeostasis

HAT, HAT-like 2, TMPRSS2, and matriptase are widely expressed in epithelial tissues (supplemental Table S2). Other TTSPs may have a similar expression pattern, as judged by mRNA abundance in tissues (supplemental Table S2). HAT is expressed in airway epithelium, suprabasal layers of the epidermis, and multiple other organs (supplemental Table S2). HAT is proposed to execute a diverse array of functions, including fibrinogenolysis, PAR-2 activation, amphiregulin expression, and urokinase plasminogen activator receptor cleavage (4, 35). However, these candidate proteolytic targets of HAT and the roles of HAT in epithelial physiology and pathology were designated only from the study of in vitro cleavage reactions and cell-based assays. HAT-like 2, encoded by the Desc4 gene, is found in epithelial cells of the circumvallate papillae of adult rats, embryonic salivary gland ducts, nasal epithelial cells, and tear gland ducts, and the mRNA has been detected in a large number of other tissues but has not been localized to specific cell types (supplemental Table S2). Desc4 is a pseudogene in both humans and chimpanzees (3), indicating that the functions of HAT-like 2 are rodent-specific or are redundant with other proteases in higher mammalian species. TMPRSS2 was first found in basal cells of the prostate epithelium (36) and later in the epithelial component of a number of other tissues, including kidney tubules, upper airway epithelium and alveoli, colonic epithelium, bile duct, and ovaries. TMPRSS2 transcripts have also been detected in many other tissues without cellular localization (supplemental Table S2). Expression of the TMPRSS2 gene in the prostate is androgen- and androgen receptor-dependent (8, 36). The physiological function of TMPRSS2 is unclear, as Tmprss2 null mice did not present with an obvious phenotype, and no compensatory up-regulation of other TTSPs with overlapping patterns of expression was apparent (37). TMPRSS2 has been proposed to regulate epithelial sodium currents in the lung through proteolytic cleavage of the epithelial sodium channel (38) and inflammatory responses in the prostate via the proteolytic activation of PAR-2 (39). Matriptase is widely, although not uniformly, expressed in epithelial tissues. Human monocytes, B-cells, and mast cells also express matriptase (supplemental Table S2). The recent identification of individuals with homozygosity for null and hypomorphic mutations in the ST14 gene (encoding matriptase) and the study of St14 null and hypomorphic mice revealed a critical role for matriptase in terminal epidermal differentiation, epidermal barrier formation, and hair follicle development (supplemental Table S2). Matriptase-deficient individuals and mice display ichthyosis (dry, thickened, and scaly skin) and hypotrichosis (sparse and abnormal hair) (40–43). Corneal opacity, photophobia, and abnormal primary and deciduous teeth are other manifestations of matriptase deficiency. Matriptase may be part of an epidermal proteolytic cascade that involves the glycosylphosphatidylinositol-anchored serine protease prostasin as based on the identical phenotype of mice with epidermal ablation of either the St14 or Prss8 gene (encoding prostasin), the efficient activation of pro-prostasin by matriptase in vitro, and the greatly reduced levels of active prostasin in the epidermis of matriptase-deficient mice and humans (40, 44).

TTSPs and Epithelial Carcinogenesis

Hepsin, TMPRSS2, and matriptase have attracted considerable attention in the context of epithelial carcinogenesis. General interest in hepsin in cancer was kindled when analysis of high-density cDNA and tissue microarrays revealed that the HPN gene (encoding hepsin) was among the most consistently and quantitatively overexpressed genes in human prostate cancer and was the most reliable single discriminator of prostatic intraepithelial neoplasia from benign prostate hyperplasia (45, 46). The association between hepsin and prostate cancer progression was further strengthened when overexpression of Hpn in prostate epithelium was shown to induce metastasis in a non-metastatic murine model of prostate carcinoma (47). More recently, expression of hepsin, but not a catalytically inactive version of hepsin, was reported to promote the progression of two ovarian carcinoma cell lines after engraftment in mice (48). Overexpression of hepsin in basal prostate epithelial cells of mice leads to the disorganization of the basement membrane (47). Substrates linked to carcinogenesis that can be cleaved by hepsin ex vivo are coagulation factor VII, pro-hepatocyte growth factor, laminin 332, and pro-urokinase plasminogen activator (46, 49).

A breakthrough in the understanding of the molecular pathogenesis of prostate cancer was made with the discovery of somatic fusions of the TMPRSS2 gene to members of the ETS gene family of transcription factors in the majority of prostate cancers (50). Four different ETS fusion partners have been identified, ERG, ETV1, ETV4, and ETV5, of which the TMPRSS2-ERG fusion is the most common. A complex array of chromosomal rearrangements causes the fusion of TMPRSS2 to ERG and ETV genes, leading to the generation of a wide variety of C-terminally truncated TMPRSS2 proteins fused to N-terminally truncated ERG/ETV proteins or to the expression of N-terminally truncated ERG/ETV proteins. In all cases, these gene fusions result in androgen-regulated and overall increased expression of this family of cell growth-regulating proto-oncogenes (supplemental Table S3). TMPRSS2 rearrangements have been detected in high-grade prostatic intraepithelial neoplasia, indicating that they are early events in prostate carcinogenesis (51). Additionally, the presence of TMPRSS2-ERG fusion transcripts is associated with a high rate of prostate cancer recurrence, distant metastasis, and death after prostatectomy (52–54).

Elevated matriptase, high matriptase/HAI-1 ratio, or increased activation of matriptase is associated with poor prognosis in many human carcinomas (55). This is noteworthy because matriptase in many epithelia is found exclusively in terminally differentiated cells but not in cells of the basal compartment from which carcinomas originate. Indeed, matriptase becomes expressed de novo in the epidermal basal compartment during pre-malignant progression (55). Low-level forced expression of the protease in basal keratinocytes of mice suffices to induce squamous cell carcinoma and dramatically potentiates ras-mediated squamous cell carcinogenesis (56). Tumor grafting experiments suggest that matriptase may also promote late stages of tumor dissemination (57, 58). Pro-hepatocyte growth factor, pro-urokinase plasminogen activator, and PAR-2 represent possible downstream targets for matriptase in carcinogenesis (5, 59–61).