CMTM4 as a new partner for IL-17 receptor: adding a piece in the puzzle
of IL17-driven diseases
Abstract
IL-17 has emerged as an important cytokine in protecting the host from
mucosal infections, but also as a pathogenic determinant and therapeutic
target in numerous autoimmune and inflammatory diseases (e.g. psoriasis,
psoriatic arthritis and ankylosing spondylitis, inflammatory bowel
disease and multiple sclerosis) [(1)](#ref-0001). The IL-17 family
includes six members (IL-17A to IL-17F) that act through the IL-17
receptors [(1)](#ref-0001). The most studied IL-17A, as well as
IL-17F, binds to IL-17RA and IL-17RC resulting in heterodimerization.
Currently IL-17A, IL-17F, IL-17RA or IL-23, a cytokine produced by
innate immune cells that promotes expansion of Th17 cell populations,
are targetable by monoclonal antibodies (mAbs). These mAbs have been
approved for the treatment of different autoimmune diseases, most
notably psoriasis, where their efficacy has outperformed conventional
non-steroidal anti-inflammatory and tumor necrosis factor (TNF) blocking
drugs. However, clinical trials and real-life experience have shown an
increase in fungal and bacterial upper respiratory tract infections in
patients treated with mAbs that block IL-23/IL-17 signaling.
Accordingly, single nucleotide polymorphisms in genes encoding IL-17A,
IL-17RA, IL-17RC, IL-23, or NF-κB activator 1 (ACT1, an adapter protein
downstream of the IL-17R) which abrogate cellular responsiveness to
IL-17A, were associated with susceptibility to chronic mucocutaneous
candidiasis (CMC), a persistent infection of the skin, nails, and/or
mucous membranes with commensal Candida species
[(2)](#ref-0002). So new effective targeted approaches in IL-17
signaling are desirable. Knizkova and colleagues identified a new
adaptor molecule involved in the IL-17/IL-17R cascade
[(3)](#ref-0003). Through murine and human cell models, the authors
found that CMTM4 (CKLF Like MARVEL Transmembrane Domain Containing 4)
constitutively bound to the subunit IL-17RC becoming integral part of
the IL-17R signaling complex (IL-17RSC) upon IL-17A stimulation. CMTM4
promoted the surface expression of IL-17RC by regulating
posttranslational modifications, especially IL-17RC glycosylation and
trafficking to trans-Golgi up to plasma membrane. CMTM4 was required for
the recruitment of adapter ACT1, for the activation of p38, JNK and
transcription of genes encoding proinflammatory cytokines upon IL-17A
stimulation (Figure 1A). Keratinocytes from the tail of Cmtm4−/−
mice specifically express lower levels of IL-17RC respect to
Cmtm4+/+ mice (Figure 1B). In vivo, when
imiquimod (IMQ) was applied on the ears or shaven backs of
Cmtm4−/− mice, they developed less severe
psoriatic lesions and lower local expression of IL-17A target genes
compared to Cmtm4+/+ mice (Figure 1C).