RASopathies are genetic syndromes that impair normal development and affect various organs and tissues. These conditions are often caused by germline gain-of-function (GoF) mutations in the key genes and players involved in RAS/MAK signaling, resulting in a hyperactivation (increased phosphorylation) of the extracellular signal-regulated kinase (ERK). ERK regulates some fundamental processes important during development-tissue growth-by translocating to the nucleus1,2. Somatic mutations in genes involved in the RAS-MAPK pathway are the most common events leading to cancer3. Thus, not surprisingly, cancer predisposition is also observed in RASopathies. Noonan syndrome (NS), characterized by developmental delay, short stature, cognitive deficits with variable severity, and cardiomyopathy, is the most common form of RASopathy2. In most cases, the disease is caused by GoF mutations in PTPN11, the first RASopathy gene to be discovered in early 20004 encoding for the protein tyrosine phosphatase SHP2, which acts as a positive regulator of the pathway.
Since then, thanks to the exponential use of exome sequencing approaches in undiagnosed patients, potentially pathogenic variants affecting factors involved in the RAS-MAPK, and likely linked to various forms of RASopathies, continue to be discovered and await functional characterization for efficient patients' stratification2. To achieve this goal, experimental protocols that guarantee fast and informative functional validation at the organismal level are required. Employing classical and standardized mammalian models to test variants with unknown significance would be costly, extremely time-consuming, and require invasive methods in non-transparent large animals. Such a strategy is clearly not compatible with the requirement for fast testing, given the societal burden represented by poor or undiagnosed RASopathy patients, currently without management or treatment. Protocols for quantitative assessment of key phenotypic traits and molecular correlates in entire organisms would also serve to accelerate the possible clinical translation of drugs possibly available to RASopathy patients by repurposing/repositioning.
Zebrafish is an ideal vertebrate model to study diseases that affect early development. As a start, zebrafish share a high level of genetic homology with humans. The high fecundity of adult fish results in a large production of embryos that are small and develop fast. Embryos are transparent at early stages, such that major developmental processes-epiboly, gastrulation, axes, and body plan formation-can be visualized effortlessly using standard microscopy. In addition, the availability of transgenic lines that can be used to track specific cellular behavior and dynamic molecular events in space and time during development, in conjunction with advanced techniques to generate genetic models, is unbeatable. Furthermore, phenotypic readouts can be assessed at multiple levels in zebrafish (from organismal to cellular defects), and dedicated assays are already established for several diseases, including RASopathies5. Moreover, relatively simple bath-immersion methods for drug administration during the early stages, at least for water-soluble compounds, permit high-throughput drug screening in vivo in a 96-well format.
From a molecular point of view, studies using standard approaches, such as immunohistochemistry and immunoblot, robustly demonstrate the correlation between ERK activation and RASopathy-associated developmental defects in fish embryos6,7. The recently developed EKAR-type FRET biosensor in zebrafish (Tg[ef1a:ERK biosensor-nes], Teen) provides a reliable in vivo tool to register ERK activation during embryogenesis in a spatiotemporally resolved manner. Hence, it could be valuable for better assessment of dynamic ERK alterations and pharmacological modulations in RASopathy fish models.
In the Teen sensor, a specific ERK substrate in the reporter is phosphorylated upon ERK activation, triggering a conformational change that brings in close vicinity the fluorescent CFP donor (D) and the fluorescent Ypet (improved YFP) acceptor (A). If the D emission spectrum overlaps considerably with the absorption spectrum of the A, FRET can occur (energy absorption from D to A). This is proportional to the distance between D and A and, therefore, in Teen, to the ERK activation status. Different imaging protocols can be set up using both standard and advanced imaging modules of standard or confocal microscopes in both live and fixed samples. Upon D excitation, the acquisition of multispectral scans along a defined spectrum of emission (λ) from CFP to YFP followed by spectral "unmixing" algorithms is among the most reliable methods to register and quantify FRET data8. It can be applied also to live zebrafish specimens to record in vivo tissue dynamics.
Following previous reports6,9 and our recent application7, here, we detail the step-by-step workflow using Teen fish to assess ERK activation in cells at the margin of the animal pole of NS models at the beginning of gastrulation and correlate it with characteristic body axes defects visible only later in development. We show how to obtain and examine quantitative FRET data from live NS gastrulae before and after treatment with an available MEKi and how to cross-validate the results via standard immunohistochemistry against phosphorylated (active) ERK or perform correlative morphometric analysis of embryo elongation defects.
The workflow could be applied to boost the functional test of emerging variants and disease genes putatively associated with RASopathies and to get insights into the correlation of ERK activation dynamics spatially and temporally during vertebrate development and the morphological defects in embryos. We show that this protocol can also be used to test the efficacy of candidate drugs acting to modulate ERK activation.