Transient receptor potential vanilloid 4 (TRPV4) is a mechanosensitive ion channel highly expressed in chondrocytes that supports cartilage development and homeostasis. Mutations in the channel can cause skeletal dysplasias, including the gain-of-function mutations V620I and T89I, which lead to brachyolmia and metatropic dysplasia, respectively. These mutations suppress hypertrophic differentiation, but the mechanisms by which they alter chondrocyte response to mechanical load remain to be elucidated. To determine the effect of these mutations on chondrocyte mechanotransduction, tissue-engineered cartilage was derived from differentiated clustered regularly interspaced short palindromic repeats (CRISPR)-edited human-induced pluripotent stem cells (hiPSCs) harboring the moderate V620I or severe T89I TRPV4 mutations. Wild-type and mutant tissue-engineered hiPSC-derived cartilage contructs were subjected to compressive mechanical loading at physiological levels, and transcriptomic signatures were assessed by RNA-sequencing. Our results demonstrate that the V620I and T89I mutations diminish the mechanoresponsiveness of chondrocytes, as evidenced by reduced gene expression downstream of TRPV4 activation, including those involved in endochondral ossification. Changes in the expression of genes involved in extracellular matrix production and organization were found to contribute toward the phenotype in V620I mutant chondrocytes, whereas dysregulated retinoic acid signaling was linked to T89I, and disrupted proliferation was common to both. Our findings suggest that dysfunctional mechanotransduction due to V620I and T89I mutations in TRPV4 contribute to the developmental phenotypes, supporting TRPV4 modulation as a potential pharmacologic target.NEW & NOTEWORTHY Gain-of-function mutations in TRPV4, a mechano- and osmosensitive ion channel, are linked to skeletal dysplasias, but their effects on chondrocyte mechanotransduction remain unknown. Using human iPSCs harboring skeletal dysplasia-causing mutations, we developed and mechanically loaded tissue-engineered cartilage. Our findings show that V620I and T89I mutations reduce chondrocyte mechanoresponsiveness, evidenced by decreased gene expression downstream of TRPV4 activation, providing insight into TRPV4-related skeletal disorders and potential pharmacological targets.

Brachyolmia type 4 (BCYM4, OMIM 612847) is a rare skeletal dysplasia characterized by mild epiphyseal and metaphyseal abnormalities. We report a Chinese boy with brachyolmia caused by a novel compound heterozygous mutation in the PAPSS2 gene. Prenatal ultrasound revealed shortened long bones, and his birth length was markedly reduced (45 cm, -3.11 SD). Clinical and radiographic findings were consistent with brachyolmia, and genetic analysis confirmed the diagnosis of BCYM4 at 2 years and 9 months old. During follow-up, the patient exhibited progressive growth retardation. Under pediatric orthopedics supervision, growth hormone (GH) therapy was initiated to ameliorate his short stature since 5 years and 6 months old. Over a 2-year and 3-month treatment period, GH therapy significantly improved his growth velocity, with his height increasing from -5.02 SD to -3.87 SD. Notably, severe growth restriction was evident as early as 25 weeks' gestation, and spinal radiographs demonstrated persistent skeletal abnormalities. This case expands the phenotypic spectrum of BCYM4 and provides evidence supporting the efficacy of GH therapy in improving growth outcomes in patients with skeletal dysplasia-associated short stature.

Heterozygous TRPV4 mutations cause a group of skeletal dysplasias characterized by short stature, short trunk, and skeletal deformities. The aim of this study is to compare the natural history of clinical and radiologic features of patients with different TRPV4-related skeletal dysplasias. Thirteen patients with a mutation in TRPV4 were included in the study, and 11 were followed for a median of 6.5 years. The clinical phenotype of five patients was compatible with spondylometaphyseal dysplasia Kozlowski type, three each with metatropic dysplasia and brachyolmia type 3, and one each with spondyloepiphyseal dysplasia Maroteaux type and congenital distal spinal muscular atrophy. Short stature and bone pain when running, walking, and climbing stairs occurred in patients with spondylometaphyseal dysplasia Kozlowski type and metatropic dysplasia from the age of 5 years and worsened with increasing age. Kyphosis was more pronounced with increasing age in these two groups of patients, while severe scoliosis occurred in brachyolmia type 3. In the radiographs of patients with spondylometaphyseal dysplasia Kozlowski type and metatropic dysplasia, severe platyspondyly persisted into adulthood or puberty. The patients with spondylometaphyseal dysplasia Kozlowski type exhibited irregular proximal femora leading to destruction of the femoral head towards the end of puberty, whereas metatropic dysplasia showed marked irregularity and widening of the femoral neck. We also observed that metaphyseal dysplasia in long bones other than the proximal femur was so inconspicuous that it could be ignored in patients with spondylometaphyseal dysplasia Kozlowski type. Comparison of radiologic features that change with age in five different TRPV4-related skeletal dysplasias will be of great benefit in the management of this patient group.

Brachyolmia is a rare form of skeletal dysplasia characterized by a wide genetic and clinical heterogeneity. This condition is usually diagnosed postnatally, and very few cases of prenatal diagnosis have been described so far. Here, we report a case of a pregnant woman at 20 weeks' gestation referred to our center because of fetal short long bones. On targeted ultrasound, mild bowing of the femurs and fibulae and mild micrognathia were also observed. Exome sequencing analysis showed the presence in compound heterozygosity of two pathogenic variants-both truncating variants-in the 3-prime-phosphoadenosine 5-prime-phosphosulfate synthase 2 (PAPSS2) gene, known to cause brachyolmia type 4 (OMIM #612847). Of note, all of the few cases reported prenatally have indeed truncating variants. Hence, we speculate this kind of variant is likely responsible for a complete loss of function of the protein leading to an earlier and more severe phenotype.

Brachyolmia is a heterogeneous group of developmental disorders characterized by a short trunk, short stature, scoliosis, and generalized platyspondyly without significant deformities in the long bones. DASS (Dental Abnormalities and Short Stature), caused by alterations in the LTBP3 gene, was previously considered as a subtype of brachyolmia. The present study investigated three unrelated consanguineous families (A, B, C) with Brachyolmia and DASS from Egypt and Pakistan. In our Egyptian patients, we also observed hearing impairment. Exome sequencing was performed to determine the genetic causes of the diverse clinical conditions in the patients. Exome sequencing identified a novel homozygous splice acceptor site variant (LTBP3:c.3629-1G > T; p. ?) responsible for DASS phenotypes and a known homozygous missense variant (CABP2: c.590T > C; p.Ile197Thr) causing hearing impairment in the Egyptian patients. In addition, two previously reported homozygous frameshift variants (LTBP3:c.132delG; p.Pro45Argfs*25) and (LTBP3:c.2216delG; p.Gly739Alafs*7) were identified in Pakistani patients. This study emphasizes the vital role of LTBP3 in the axial skeleton and tooth morphogenesis and expands the mutational spectrum of LTBP3. We are reporting LTBP3 variants in seven patients of three families, majorly causing brachyolmia with dental and cardiac anomalies. Skeletal assessment documented short webbed neck, broad chest, evidences of mild long bones involvement, short distal phalanges, pes planus and osteopenic bone texture as additional associated findings expanding the clinical phenotype of DASS. The current study reveals that the hearing impairment phenotype in Egyptian patients of family A has a separate transmission mechanism independent of LTBP3.