PROJECT SUMMARY:
Craniofacial fibrous dysplasia (CFD) is a disabling skeletal disease with no curative medical therapies. It is
characterized by fibrotic, expansile bone lesions that compress surrounding craniofacial structures and cause
significant morbidity, including vision loss, hearing impairment, dysmorphic facies, fractures, pain, and dental
and jaw abnormalities. Fibrous dysplasia (FD) can affect one or more bones throughout the skeleton, but the
femur, ribs and craniofacial skeleton are the most commonly affected sites. FD is caused by a somatic, mosaic
activating mutation in GNAS, the gene encoding the alpha subunit of the stimulatory guanine nucleotide binding
protein, Gsa, leading to constitutive activation of Gsa and elevated intracellular cAMP levels in affected tissues.
CFD can occur in isolation or in association with McCune-Albright Syndrome (MAS), which is characterized by
polyostotic FD (FD affecting more than one bone), café-au-lait-skin hyperpigmentation and precocious puberty.
There are no approved medical treatment options for FD, and there is a critical need to understand the
pathways that are activated downstream of Gsa to identify potential therapeutic targets for this disabling
disease. Our single cell RNA sequencing (scRNAseq) data on cells collected from human craniofacial and non-
craniofacial FD bone lesions has identified critical signaling pathways that are up-regulated in FD, including
TGFβ signaling. TGFb signaling is critical for healthy skeletal development and repair, but when inappropriately
activated, it is a significant driver of tissue fibrosis, including pulmonary, renal and systemic fibrosis. Despite its
established role in driving fibrosis of non-skeletal tissues, the contributory role of TGFb signaling in FD bone
lesions remains unknown. The goal of this proposal is to elucidate the role of TGFβ signaling in driving
the fibrotic bone phenotype seen in FD/MAS. Our central hypothesis is that TGFβ signaling is activated in
response to Gs-GPCR signaling and contributes to the fibrosis and aberrant osteogenesis seen in FD lesions.
To test our hypothesis, we will pursue 2 aims. The first aim will elucidate the mechanisms driving TGFβ signaling
in response to Gs-GPCR overactivation at a cellular level. We will use our iPSC model of FD/MAS to generate
neural crest-derived mesenchymal osteogenic lineage cells and test the effect of TGFb stimulation and inhibition
on the fibrotic profile of these cells at different developmental stages. The second aim will use an in vivo murine
model of FD in which GNASR201H is expressed in early osteoblastic lineages to test the effect of TGFβ signaling
inhibition on the development of fibrosis and impaired osteogenesis using a pan-TGFβ antibody. Upon
successful completion of this project, we aim to shed light on the interplay between Gs-GPCR and TGFβ signaling
in the skeleton and apply this knowledge to the treatment of CFD as well as more common diseases of impaired
osteogenesis such as osteoporosis, heterotopic ossification, and fracture repair. The data generated in this
proposal will be used in future grant applications to explore the role of metabolic and growth factor signaling
pathways that are dysregulated in response to constitutive Gs-signaling.