Insulin-like growth factors (IGFs: IGF1 and IGF2) are members of the insulin superfamily of hormones, which have pleiotropic roles in embryonic and postnatal growth and differentiation through activating IGF receptors (IGFRs: IGF1R and IGF2R) and the insulin receptor signaling cascade 1. Our results provide mechanistic insight into IGF/IGFBP3/ALS ternary complex assembly and its disassembly upon proteolysis for IGF bioavailability, suggesting a structural basis for human diseases associated with IGF1 and IGFALS gene mutations such as complete ALS deficiency (ACLSD) and IGF1 deficiency. In vitro biochemical studies show that proteolysis at the central linker domain of IGFBP3 induces release of its C-terminal domain rather than IGF1 release from the ternary complex, yielding an intermediate complex that enhances IGF1 bioavailability. Here, we report cryo-EM structure of the human IGF1/IGFBP3/ALS ternary complex, revealing the detailed architecture of a parachute-like ternary complex and crucial determinants for their sequential and specific assembly. Most serum IGFs are bound in a ternary complex with IGF-binding protein 3 (IGFBP3) and acid-labile subunit (ALS), extending the serum half-life of IGFs and regulating their availability. Insulin-like growth factors (IGFs) have pleiotropic roles in embryonic and postnatal growth and differentiation.
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