Alternatively spliced MEFV transcript lacking exon 2 and its protein isoform pyrin-2d implies an epigenetic regulation of the gene in inflammatory cell culture models

Abstract The function of gene body DNA methylation in alternative splicing, and its relation to disease pathogenesis is not fully elucidated. The gene for familial Mediterranean fever (MEFV) encodes the pyrin protein and contains a 998 bp CpG island, covering the second exon, which is differentially methylated in FMF patients compared to healthy controls. Our further observation of increased exon 2-spliced MEFV transcript in leukocytes of FMF patients provoked us to test the role of exon methylation in alternative splicing using inflammatory cell culture models. First, in vitro exon methylation triggered an increased level of exon 2 exclusion using a splicing cassette in a promyelocytic leukemia cell line (HL-60). HL-60 cells subjected to methylating and demethylating agents, as well as cells differentiated to neutrophil-like cells, exhibited different levels of spliced/unspliced transcripts. We observed increased levels of spliced transcripts in neutrophil-like (p = 0.0005), activated (p = 0.0034) and methylated cells (p < 0.0001), whereas decreased levels in demethylated cells (p = 0.0126) compared to control untreated HL-60 cells. We also showed that the protein isoform of pyrin lacking the exon 2 has an adverse subcellular localization in neutrophil-like cells. Therefore, it remains in the cytoplasm rather than the nucleus. This may point to an epigenetic involvement in an important inflammatory gene.


Introduction
DNA methylation reduces gene expression by either blocking transcription start sites or interacting with nucleosomes that leads to heterochromatinization.Studies also show that promoter silencing precedes DNA methylation, which acts as a "lock" rather than a "silencer" (Lock et al., 1987;Ohm et al., 2007;Schlesinger et al., 2007;Widschwendter et al., 2007;Gal-Yam et al., 2008).DNA methylation can also enhance gene expression through alternative promoters or by blocking insulators (reviewed in Jones, 2012).More recently, multiple sources of evidence positively correlate exon methylation with active gene transcription, which is also conserved across species (Jones, 1999;Nguyen et al., 2001;Hellman and Chess, 2007;Cokus et al., 2008;Hodges et al., 2009;Feng et al., 2010;Gonzalez et al., 2016).
Two possible mechanisms were proposed for the explanation of the effect of exonic DNA methylation on alternative splicing: a) methylation interferes with RNA Pol II elongation (Shukla et al., 2011;Maunakea et al., 2013), and b) recruitment of splicing factors to methylated sites (Saint-André et al., 2011;Yearim et al., 2015).Argonaute proteins (1 and 2), generally known for their role in transcriptional silencing, combine these two mechanisms by recruiting splice factors as well as slowing down the RNA Pol II elongation rate in a study which used CD44 gene as a model (Ameyar-Zazoua et al., 2012).
However, a more specific indication of methylation in alternative splicing and chromatin dynamics, and its relation to disease pathogenesis is limited.MEFV contains a 998 bp CpG island (NC_000016.10 from 3254057 to 3255054) encompassing its whole exon 2. We have previously observed a negative correlation between methylation and expression levels of MEVF gene transcripts in familial Mediterranean fever (FMF) patients and control groups, in which patients were showing slightly higher exon 2 methylation levels (p = 0.049) (Kirectepe et al., 2011a).Interestingly, exon 2 spliced transcript (MEFV-d2) levels were significantly higher in leukocytes of FMF patients compared to healthy controls (p = 0.026) (Kirectepe et al., 2011b).This finding is compatible with the general notion that gene body methylation is positively correlated with expression (Yang et al., 2014).
MEFV (MEditerranean FeVer) is the gene responsible for FMF, which is an autoinflammatory disease characterized by acute episodes of inflammation, with a high incidence in Mediterranean populations.It is suggested that pathogenic variants on MEFV gene result in defective pyrin production, which in turn affects FMF pathology (The International FMF Consortium, 1997).However, there are certain percentages of FMF patients (5-15%), depending on the ethnic background, who do not carry MEFV pathogenic variants but still present a full FMF phenotype (Lidar and Livneh, 2007).MEFV protein product pyrin is known to have a regulatory role in inflammation as part of the inflammasome complex.MEFV is mainly expressed in neutrophils, eosinophils, monocytes, dendritic cells and synovial fibroblasts (Centola et al., 2000) and its expression is increased by proinflammatory agents such as interferon g (IFN-g), tumor necrosis factor a (TNF-a), lipopolysaccharide (LPS) and interleukin 1b (IL-1b) (Matzner et al., 2000).
Here, we aimed to analyze the possible relationship between splicing of MEFV exon 2 and its methylation using in vitro cell culture model systems to further investigate our in vivo results from FMF patients (Kirectepe et al., 2011a,b).HL-60 promyelotic cells were first transfected with methylated and non-methylated splicing constructs using a splicing cassette, as a preliminary in vitro study to assess the possible role of methylation on the alternative splicing of MEFV second exon.Later, expression levels of the exon 2 lacking transcripts were analyzed in cell culture models, using methanol as methylating and 5-aza-2'deoxycytidine as demethylating agents, DMSO for differentiation to neutrophil-like cells, and LPS as an activating agent.Methylation status analysis of cell culture systems was also performed using real-time quantitative PCR analysis, which allowed us to explore the methylation level of MEFV CpG island.We have shown that in vitro methylation of the splicing cassette containing the second exon of MEFV leads to its splicing.We also observed that MEFV-d2 transcript levels were increased when cells were subjected to methylation, differentiated to neutrophil-like cells or activated, and decreased when the cells were demethylated.
Because abnormal localization of proteins participates in the pathogenesis of many human diseases (Hung and Link, 2011;Agostinho et al., 2015;Liu and Hu, 2016), we also studied localization differences of pyrin-fl and pyrin-d2 exploring the localization of recombinant constructs via confocal microscopy.Our results also confirmed that pyrin full-length form was localized in cytoplasm and exon 2 spliced form in nucleus of HL-60 cell-line.On the other hand, unlike previous findings, both forms were found to be localized in the cytoplasm of neutrophil-like cells.Our results showed for the first time that methylation causes splicing of the second exon, which leads to the inability of pyrin-d2 form to localize into nucleus in neutrophil-like cells.These findings strengthen our hypothesis of MEFV-d2 transcripts having a role in inflammatory conditions through epigenetic modifications.

Splicing reporter assay using pSpliceExpress cassette
The insert sequence comprised in the CpG island (800 bp), starting from NC_000016.103254236 until 3255036, which covers the whole of exon 2 and 85 nucleo-Erdem et al.
tides from intron 1 and 83 nucleotides from intron 2 was amplified from peripheral blood genomic DNAs of healthy control samples without any pathogenic or benign MEFV variations via PCR, using the primers given in Supplementary Table S1.
A second PCR reaction was performed to add the appropriate recombination sites (attb 1 and 2) with primers given in supplementary Table S2.Amplicons were cloned to pSpliceExpress (Kishore et al., 2008) vector using amplicon Gateway® BP Clonase® II Enzyme (Invitrogen, Waltham, Massachusetts, USA), and the recombination product was transformed to E. coli Top 10 cells via heatshock.After overnight incubation, plasmid isolation was performed from colonies using High Pure Plasmid Isolation Kit (Roche Diagnostics, Mannheim, Germany), followed by measurement of the plasmid concentrations using a Nanodrop (Thermo Fisher Scientific Inc., Waltham, MA USA) spectrophotometer.Later, half of the amount was methylated with CpG Methylase (M.SssI) (Zymo Research, Irvine, CA, USA) overnight at 30 °C, and the other half was left unmethylated.The methylation of the insert was confirmed with digestion using SmaI enzyme, which cuts at non-methylated CCC/GGG sites.
HL-60 cells were cultured in RPMI 1640 medium containing 10% FBS and 300 mL penicillin/streptomycin. Then the cells (2 x 10 6 ) were transfected with methylated and unmethylated pSpliceExpress cassettes containing the CpG island DNA element (2 mg), together with the empty pSpliceExpress vector as a negative control, by nucleofection using Amaxa® Cell Line Nucleofector® Kit V (Amaxa, Cologne, Germany).Transfected cells were incubated for 24 h at 37 °C in a humidified atmosphere containing 5% CO 2 , and RNA isolation was performed using High Pure RNA Isolation Kit (Roche Diagnostics, Mannheim, Germany).cDNA synthesis was done using High Capacity cDNA Reverse Transcription Kit (Applied Biosystems, Inc. Foster City, California).PCR reaction was setup with rat insulin primers (given in supplementary Table S3), which are specific to the rat insulin exons present within the pSpliceExpress vector, known to be concurrently spliced.

Cell culture models
HL-60 promyelotic cells were cultured in liquid suspension in RPMI 1640 medium supplemented with 10% fetal bovine serum, 2 mM L-glutamine, 100 U/mL penicillin and 100 pg/mL streptomycin (each from Lonza, Amaxa, Cologne, Germany).The cells were cultured at 37 °C in a humidified atmosphere containing 5% CO 2 .Different cell culture models were generated to mimic different in vivo conditions as explained below.

a) Neutrophil-like cells
Cells were induced to differentiate into neutrophils with 1.75% (vol/vol) DMSO for 6 days.2 x 10 5 cells/mL, 1.5 x 10 5 cells/mL, 1 x 10 5 cells/mL and 0.5 x 10 5 cells/mL were used as initial cell numbers.Cell cultures were diluted with a fresh medium every 48 h, and DMSO concentrations were adjusted accordingly.Differentiation into neutrophil-like cells was assessed via confocal imaging subsequent to 4',6-diamidino-2-phenylindole (DAPI) staining as well as by flow cytometry assay using PE-CD44 antibody (Moll et al., 1998;Spring et al., 1988).Granularity was also assessed via side-scattered light (SSC).

Quantitative real-time PCR for exon 2 transcription analysis
Total RNA isolation from the established cell cultures (5 x 10 6 cells approximately) was done by High Pure RNA Isolation Kit (Roche Diagnostics, Mannheim, Germany).High Capacity Reverse Transcription Kit (Applied Biosystems, Inc. Foster City, California) was used for cDNA synthesis.
Expression analyses were done using Power SYBR® Green Master Mix (Thermo Fisher Scientific Inc., Waltham, MA USA) and performed at StepOnePlus Real-Time PCR System (Applied Biosystems®).Primers listed in supplementary Table S4 were used for detecting different levels of MEFV transcripts of the cell culture models: The 1-3 primer, encompassing the junction of exons 1 and 3, amplifies MEFV transcripts without exon 2. The 2-3 primer, binding to the junction of exons 2 and 3, amplifies all other forms containing exon 2. Through these amplifications, we could acquire all possible MEFV transcripts with these two primers.GAPDH was used as a house-keeping gene.
The relative expression level was calculated using the DCT method.All reactions were done in duplicates (technical replicates) and were repeated three times (biological replicates).To compare the MEFV-d2 transcript ratio in cell culture models, and considering that the relative expression of both transcripts varies greatly in these cells, we normalized our data as follows: where DCt is the average Ct value from the Test reaction minus the average Ct value from the Reference reaction.

Pyrin localization analysis
Plasmid constructs containing CMV promoter and GFP tagged full-length cDNA sequence (pCMV6-AC-GFP-MEFV-fl) (Figure S1) and the cDNA sequence without the second exon of MEFV (pCMV6-AC-GFP-MEFV-d2) (Figure S2) were manufactured by Origene Technologies, Inc. (Rockville, Maryland, ABD).These constructs (2 mg) were transfected to 2 x 10 6 HL-60 cells, neutrophil-like cells and LPS+PMA induced cells using Lonza Nucleofection Kit V (Amaxa, Cologne, Germany) with appropriate Nucleofector Program X-001 (X-01) for Nucleo-fector® I Device.For fluorescent staining and imaging, 24 hours after transfection, cells were fixed with methanol, and DAPI was used for cell nucleus imaging.Cells were visualized using laser confocal microscopy (Leica TCS SP2 SE, Wetzlar, Germany).Localization studies were performed with at least three transfections and the images were obtained with a 63 oil objective.

Statistical analysis
Expression variations of MEFV transcripts, as well as methylation ratios were analyzed by using two-tailed unpaired t-test in Graphpad Prism (v.6.0) software (GraphPad Software Inc, La Jolla, CA USA) and were reported as means and two-sided 95% confidence intervals.

Analysis of splicing reporter assay of methylated MEFV-exon2
We first tested whether methylation affects splicing by transfecting HL-60 cells with methylated and unmethylated constructs containing the 633 bp MEFV exon 2 plus the intron sequences, 800 bp in total, cloned in pSpliceExpress splicing vector.This vector allows tracing splicing events by means of its rat insulin exons splicing concurrently.We have shown that MEFV exon 2 is spliced when methylated (Figure 1), resulting in a smaller amplicon that lacks the second exon of MEFV.

Splicing analysis of the cells' MEFV transcripts
Different cell culture inflammation models were established to analyze the effect of methylation on the exon 2 splicing of the cells' endogenous MEFV transcripts.To this end, HL-60 promyelotic cells were used as control groups and were induced with different agents: DMSO for Erdem et al.
691 Methylation of the MEFV second exon leads to its splicing, which can be observed as a broader band at 157 bp, similar to the empty vector amplified with rat insulin exon primers.B) Agarose gel of the restriction enzyme analysis for confirmation of the methylation.The methylated construct is not cut, whereas non-methylated construct is cut by SmaI enzyme, which is sensitive to methylation.
neutrophil-like transformation, PMA and LPS for activation, methanol for methylation and deazacytidine for demethylation.Differentiation of HL-60 cells into neutrophil-like cells was achieved as shown in DAPI staining (Figure S3), flow cytometry analysis using PE-CD44 antibody (Figure S4) as well as SSC results (Figure S5), given in supplementary data.CD44 is a cell surface glycoprotein involved in cell-cell interactions, cell adhesion and migration, and is expressed in different cell types including hematopoietic cells.DMSO-induced differentiation towards neutrophils causes downregulation of CD44 from the surface of cells compatible with a similar reduction in CD44 expression during normal granulopoiesis process (Moll et al., 1998;Spring et al., 1988).
Methanol is known as a toxic and mutagenic substance, generally used as a fixing agent in cell imaging.It has also been shown to increase genomic methylation by incorporating methyl residues into DNA (Huang et al., 2001).In our methylation cell model, we also used 5% (vol/vol) methanol to increase global methylation levels in HL-60 cells.
Expression studies were performed via two sets of primers amplifying cells endogenous MEFV exon 2-lacking and exon 2-containing transcripts and the data was normalized by dividing individual CTs to the total transcripts'.We observed that neutrophil-like cells (p = 0.0005, 2-fold increase), activated cells (p = 0.0034; 2.5-fold increase) and methylated cells (p < 0.0001; 2.5-fold increase) exhibit an increased MEFV-d2 transcript expression whereas demethylated cells (p = 0.0126; 1.7-fold decrease) exhibit a decreased level, compared to untreated HL-60 cells (Figure 2).
Analysis of induced and repressed global methylation studies in cell culture models confirmed that DMSO, PMA & LPS and methanol treatments increase, while deazacytidine decreases MEFV second exon methylation (Figure 3).The differences in methylation level were not statistically significant, with a positive trend in HL-60 cells treated with DMSO (p = 0.4) and HL-60 cells treated with PMA & LPS (p = 0.053).

Cellular localization of pyrin and its isoform pyrin-d2
The localization of full-length pyrin and exon 2lacking pyrin isoform (pyrin-d2) were investigated in HL-60 cells along with neutrophil-like cells via confocal microscopy, since our findings imply that MEFV-d2 transcript is increased in these cells.
In untreated HL-60 controls, the MEFV-fl-GFP protein was localized in the cytoplasm and MEFV-d2-GFP was localized in the nucleus (Figure 4).In contrast, in neutrophil-like cells, both MEFV-fl-GFP and MEFV-d2-GFP products were localized in the cytoplasm (Figure 5).

Discussion
Alternative splicing causes the production of protein isoforms with differential subcellular localization, which may lead to altered functions (Stamm et al., 2005;Hughes, 2006).More than 90% of human genes are subjected to alternative splicing, which is an evolutionarily conserved mechanism, ensuring proteomic diversity (Ast, 2004;Pan et al., 2008).Co-transcriptional splicing enables the formation of alternative transcripts through epigenetic regulation of the chromatin (Iannone and Valcárcel, 2013).Epigenomic studies have illustrated that CG dinucleotides were more abundant on exonic sites than intronic sites, and 3' and 5' splice sites were mostly methylated (nearly 100%) compared to surrounding CG rich regions (Gelfman et al., 2013).

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Methylation and alternative splicing    Previously, we showed that MEFV exon 2 methylation levels of patients were slightly but significantly higher than the levels of controls (p = 0.049) (Kirectepe et al., 2011b).Furthermore, we observed a negative correlation between methylation and expression in all groups (r=-0.29,p = 0.041), which was more accentuated in the patient group (r=-0.36,p = 0.035).Here, we proposed a model where the methylation of MEFV exon 2 is related to its alternative splicing and expression.To test that hypothesis, MEFV exon 2 including approximately 80 nucleotides of its flanking introns was cloned into a splicing reporter vector, which proved that transfected MEFV exon 2 is spliced when methylated.Then, different cell culture models were constructed to confirm this finding with endogenous MEFV expression: HL-60 cells were used as controls and DMSO induced cells, activated cells trough PMA and LPS, methylated cells with methanol, demethylated cells via deazacytidine constituted the induced group where the expression level of MEFV exon 2-containing and lacking-transcripts were analyzed.The results indicated that methylation increased the expression of MEFV-d2 transcript, along with neutrophil transformation and activation with PMA & LPS, contrary to demethylated cells in which it was decreased.These findings suggest that methylation might play a role in the splicing of the second exon.The methylation levels of the CpG island of these cell culture models were further analyzed (Figure 3).Although the differences were not statistically significant, they exhibited similar increased methylation patterns, implying that methylation increases in inflammatory-like conditions.
An increasing number of studies are pointing to the involvement of DNA methylation in the regulation of alternative splicing.A genome wide study performed in mouse retina and brain showed that differently methylated regions regulate alternative splicing in a tissue-specific manner (Wan et al., 2013).Another genome-wide study on honey bees, in which the authors inhibited the expression of Dnmt3 (DNA (cytosine-5)-methyltransferase 3), changed the alternative splicing pattern due to the decrease in methylation levels (Li-Byarlay et al., 2013).A recent study proposed that alternative splicing of sarcomeric gene Myh7 may be linked to the cardiac epigenome, which may lead to disease formation (Vujic et al., 2015).Absence of the MEFV exon 2-deleted form in mice and rats, which do not contain a CpG island on the MEFV gene (Papin et al., 2000), also points towards the possible role of DNA methylation in alternative splicing, and also strengthens our hypothesis.
Several mechanisms have been proposed in attempting to explain the role of epigenetic modifications in alternative splicing.Some studies have shown that methylation leads to the inclusion of alternative exons.For example, MeCP2 (methyl-CpG binding protein 2) and HP1 (heterochromatin protein 1) are proteins found to participate in exon retention in the presence of DNA methylation (Yea-rim et al., 2015).Adversely, another protein, CTCF, was found to play a role in the recognition of a weak exon signal in the CD45 gene in the absence of DNA methylation (Shukla et al., 2011).Although our research on the CTCFBSDB database, a database for CTCF binding sites, has shown the absence of CTCF in the MEFV gene in HL-60 cells, the CTCF prediction tool on the same site predicts a binding site 35 bp from the exon recognition consensus sequence.As alternative splicing is regulated via splice site strength, and, thus, stronger sites increase the inclusion of alternative exons (Schwartz et al., 2009), recognition of weak splice sites via reducing RNA PolII elongation rate is crucial for the retention of subjected exons.Methylation may also simply block cis-acting sequences where RNAbinding proteins bind to enhance the inclusion level.We found many putative exonic splicing enhancer sites containing a CG dinucleotide, which could be blocked by methylation (Human Splicing Finder).Therefore, differential methylation of specific sites within a CpG island may be responsible for exon inclusion levels, rather than methylation of a specific region.It would be very informative to perform an analysis of a potential protein, like CTCF, slowing down the elongation rate of the RNA PolII and thus enabling the recognition of the MEFV exon 2 signal, leading to its inclusion.This would also suggest methylation of its specific binding site, which will be further analyzed.
Point mutations/variations are also known to cause alternative splicing.Rittore et al. (2014) showed three variations [rs4149570(c.-610G> T), rs767455(c.36A> G,pPro12Pro), rs1800692(c.473-33C> T)] in the promoter, exon 1 and intron 2, respectively, of TNFRSF1A gene enhance the splicing of exon 2 in vitro.These variations appeared to have a role in the pathogenesis of TRAPS disease (Rittore et al., 2014).Furthermore, in another study, Tone et al. (2011) suggested that c.910G > A variant (rs75977701) leads to the skipping of MEFV exon 2. This rare variant, which has a Minor Allele Frequency (MAF) of T = 0.0074/37 in the Thousands Genomes Project, was absent in our FMF cohort.In Japan, where this variant is more frequently encountered, its frequency in FMF patients is 0.9% (Kishida et al., 2014).This is in contradiction with our finding of higher MEFV-d2 transcript levels in FMF patients compared to healthy controls (Kirectepe et al., 2011a), suggesting a different mechanism for the splicing of exon 2, at least for the Turkish population.
Since many diseases are shown to be caused by abnormal localization of proteins, the localization differences of GFP tagged full-length pyrin (pyrin-fl) and exon 2 spliced forms (pyrin-d2) were also analyzed in inflammation related cell culture models.Both MEFV-fl-GFP and MEFV-d2-GFP proteins were found to be localized in the cytoplasm of DMSO-treated neutrophil-like cells (Figure 4).On the other hand, in non-treated HL-60 cells, the product of MEFV-fl-GFP construct was cytoplasmic, in contrast with the MEFV-d2-GFP product present in the nucleus (Figure 5).This type of experiment requires a western blot confirmation in cytoplasmic vs. nuclear fractions.However, only a maximum of 40% of HL-60 cells differentiated into neutrophil-like cells, and the transfection efficiency was not constant among the experiments.Thus western blot studies had inconsistencies in these in vitro models.Therefore, we increased the repeats of our confocal experiments to obtain reliable results.The 14.3.3proteins, potent antiapoptotic factors that control intracellular signaling, cell cycle and apoptosis, interact with pyrin-fl but not pyrin-d2 through three serine residues located in exon 2. Jéru et al. (2005) showed that this interaction caused full-length pyrin to be retained in the cytoplasm.Furthermore, the lack of interaction with pyrin-d2 isoform resulted in protein translocation to the nucleus.Thus, cell-specific post-translational processing and/or protein-protein interactions, may ultimately determine subcellular localization relating to pathological functions in different cell types.Although alternative splicing of exon 2 creates a nuclear localization signal, it does not correspond to known NLS motifs.Exon 1-3 junction encodes a domain, which is necessary but not sufficient to target the spliced form to nucleus.Thus, this domain may be required for the activity of another NLS-like motif located elsewhere in the spliced form.We and other authors previously suggested that pyrin-d2 may have a role as a transcription factor, and its function may be impaired during inflammation (Kirectepe et al., 2011a).Thus, understanding the proteins that interact with the exon 2-deleted but not the full-length pyrin protein and their functions may lead to identification of a mechanism involved in nuclear import and inflammatory diseases.
Several other studies analyzed similar features: Tidow et al. (2000) studied the localization of full-length pyrin in COS-1 and found it to be cytoplasmic.They also found that DMSO induction increases the full-length expression in HL-60 cells but they did not investigate the expression of exon 2 spliced transcript.Diaz et al. (2004) induced the expression of exon 2 spliced form by LPS in synovial fibroblasts and monocyte-enriched PBLs from patients; however, they found it to be still two times less abundant than the full-length form.We had opposite results with HL-60 promyelotic cells, which are known to be neutrophilic precursors, suggesting that the expression of spliced transcript may change with harmful stimuli, since neutrophils are the first responders in cases of inflammation.Cazeneuve et al. (2003) reported pyrin-d2 to be in the nucleus of HeLa cells; nevertheless, they also found that it interacts with ASC in the cytoplasm.In a recent study, pyrin was shown to co-localize with actin in HL-60 cells (Akkaya-Ulum et al., 2015).Knowing that the overexpression of recombinant products transfected to cells in a transient manner could disrupt physiological pathways for protein transport (Kremmidiotis et al., 1999), it could be of interest to generate an antibody specific to exon 2 spliced form to detect the localization of native protein in different cells via confocal microscopy and western blot analyses.
Despite the fact that FMF is reported to be a recessively inherited disease, 15 to 25% of patients from locations where FMF is less prevalent present no pathogenic variations in the MEFV gene.A modifier gene has been suggested as a primary alternative, and studies were conducted to identify another gene or locus having an epistatic interaction with MEFV.Touitou et al. (2001) proposed MICA as a modifier gene in FMF; however, they could not find a significant result for affected patients from different ethnic origins.Hence, any disruption leading to truncated pyrin formation may have a role in the pathology of FMF.Our findings clearly show the differences between undifferentiated and differentiated cells.Research should be conducted with patients in active inflammation and relapse periods and healthy controls to further understand the exact mechanism.However, methylation leading to the splicing of MEFV second exon, and consequently to a protein that has an aberrant localization, may explain the pathogenesis of FMF without the MEFV pathogenic variants.
methylation analysis of the cell culture models DNA was isolated from the established cell cultures (5 x 10 6 cells approximately) using DNA Isolation Kit for Cells and Tissues (Roche Diagnostics, Mannheim, Germany).Methylation analyses were performed with One-Step qMethyl Kit (Zymo Research, Irvine, CA, USA) using primers amplifying the MEFV CpG island, analyzed via qRT-PCR.Two reactions were setup as Test and Reference reactions: The Test reaction includes Methylation Sensitive Restriction Enzymes (MSREs) to cut at the methylated nucleotides, whereas the Reference reaction does not contain these enzymes.Therefore, the Test reaction samples are cut if methylated, creating smaller fragments, which result in lower Ct values.The data was analyzed with qMethyl Calculator, which calculates the methylation ratio as follows: Percent methylation = 100 x 2 -DCt .

Figure 1 -
Figure 1 -Agarose gel results of the splicing reporter experiments A)Agarose gel of PCR performed with primers specific to rat insulin exons.Methylation of the MEFV second exon leads to its splicing, which can be observed as a broader band at 157 bp, similar to the empty vector amplified with rat insulin exon primers.B) Agarose gel of the restriction enzyme analysis for confirmation of the methylation.The methylated construct is not cut, whereas non-methylated construct is cut by SmaI enzyme, which is sensitive to methylation.

Figure 4 -
Figure 4 -Localization of recombinant MEFV proteins in untreated HL-60 cells.MEFV-fl-GFP and MEFV-d2-GFP constructs were transfected via Nucleofection and the localization of their products was analyzed using confocal microscopy.The transfection efficiency was 67% for MEFV-fl and 58% for MEFV-2d.A) DAPI staining of HL-60 cells transfected with MEFV-fl-GFP; B) GFP visualization of MEFV-fl-GFP; C) Merged image of A and B; D) DAPI staining of HL-60 cell transfected with MEFV-d2-GFP; E) GFP visualization of MEFV-d2-GFP; F) Merged image of D and E.

Figure 5 -
Figure 5 -Localization of recombinant MEFV proteins into neutrophil-like cells.5 x 10 4 cells/mL were incubated with DMSO for 6 days.MEFV-fl-GFP and MEFV-d2-GFP constructs were transfected via Nucleofection and the localization of their products was analyzed using confocal microscopy.The transfection efficiency was 50% for MEFV-fl and 72% for MEFV-2d.A) DAPI staining of DMSO induced HL-60 cell transfected with MEFV-fl-GFP; B) GFP visualization of MEFV-fl-GFP; C) Merged image of A and B; D) DAPI staining of DMSO induced HL-60 cell transfected with MEFV-d2-GFP; E) GFP visualization of MEFV-d2-GFP; F) Merged image of D and E.