Review
Dawn of a New RAMPage

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Highlights

  • RAMPs interact with GPCRs to regulate receptor function.

  • RAMP–GPCR coevolution studies suggest that RAMPs globally interact with GPCRs.

  • Over the past year, two studies expanded the RAMP–GPCR interactome using both multiplexed suspension bead array (SBA) and bioluminescence resonances energy transfer (BRET) methodologies.

  • Human mutations in RAMP–GPCR pairings have been identified and linked to human disease, including a mutation in calcitonin receptor-like receptor (CLR), associated with hydrops fetalis, and mutations in RAMP2, associated with glaucoma.

  • For the first time, the US FDA approved a GPCR-directed antibody against RAMP1–CLR, which reduces the number of migraine days patients experience.

  • The expanded RAMP–GPCR interactome and pivotal success of the first targeted therapy of RAMP–GPCR pairs has ushered in a new RAMPage.

Receptor activity-modifying proteins (RAMPs) interact with G-protein-coupled receptors (GPCRs) to modify their functions, imparting significant implications upon their physiological and therapeutic potentials. Resurging interest in identifying RAMP–GPCR interactions has recently been fueled by coevolution studies and orthogonal technological screening platforms. These new studies reveal previously unrecognized RAMP-interacting GPCRs, many of which expand beyond Class B GPCRs. The consequences of these interactions on GPCR function and physiology lays the foundation for new molecular therapeutic targets, as evidenced by the recent success of erenumab. Here, we highlight recent papers that uncovered novel RAMP–GPCR interactions, human RAMP–GPCR disease-causing mutations, and RAMP-related human pathologies, paving the way for a new era of RAMP-targeted drug development.

Section snippets

Historical Paradigm of RAMP–GPCR Signaling

GPCRs are the most tractable and druggable class of proteins, comprising ~30% of all approved therapeutics [1., 2., 3.]. These seven-transmembrane pass receptors mediate intercellular communication through the binding of endogenous or exogenous ligands, eliciting subsequent receptor conformational changes to release bound G-proteins. Over the past decade, the field of GPCR biology has experienced a dramatic revitalization with the discovery of biased signaling, spawning a new generation of

RAMP–GPCR Coevolution: Emerging Evidence of a Global RAMP–GPCR Interactome

As of 2016, there were only 11 reported RAMP–GPCR interactions [12]. Furthermore, nine of these 11 known RAMP–GPCR pairings involved Class B GPCRs, with the remaining two RAMP–GPCR pairs involving Class A and Class C receptors [13., 14., 15.]. Given that Class B GPCRs only account for ~5% of the non-odorant GPCRs, one can speculate that the breadth of RAMP–GPCR pairings is more extensive than previously thought.

In support of this hypothesis, Barbash et al. [16,17] provided compelling evidence

Expanding the RAMP Repertoire

The early groundwork for RAMP–GPCR interactions focused on Class B GPCR receptors, which revealed that RAMPs interact with calcitonin receptor (CT) [23], CLR [4], corticotropin-releasing factor receptors (CRF) [8], glucagon receptor [7,24], parathyroid hormone receptors [24], secretin receptor [25], and pituitary adenylate cyclase-activating peptide (PACAP) receptors [8,24]. The characterization of these interactions uncovered diverse functions of RAMPs, including alteration of ligand binding,

Physiological and Pathophysiological Roles of RAMPs

The aforementioned bioinformatic and biochemical screening approaches revealed exciting new RAMP–GPCR interactions. However, despite the diverse and widespread tissue expression of RAMPs, the field has been largely unsuccessful in linking specific RAMP–GPCR pairings to physiological and pathological phenotypes [35]. This is due, in large part, to a lack of rigorous in situ detection approaches. To date, much of our current understanding of the physiological role of RAMPs has been gleaned

Therapeutic Targeting of RAMP–GPCRs

Considering the rapidly expanding cohort of GPCRs that functionally interact with RAMPs and the breadth of physiological systems affected by RAMP signaling axes, it stands to reason that the protein–protein interface of a RAMP–GPCR interaction could be exploited for therapeutic benefit. Indeed, the therapeutic tractability of targeting RAMP–GPCR pairs was recently established through the generation of monoclonal antibodies targeting CGRP or its receptor (RAMP1–CLR) for the treatment of

Concluding Remarks and Future Perspectives

The past several years have marked an exciting time for the RAMP–GPCR field, where RAMP–GPCR coevolution studies hypothesized a global RAMP–GPCR interactome. Importantly, in 2019, we witnessed the experimental validation of these bioinformatic studies with the identification of previously unrecognized RAMP–GPCR interactions using two screening platforms (BRET and SBA). These studies effectively expanded the list of RAMP-interacting GPCRs from 11 to 44 receptors that span Class A, B, C, and the

Acknowledgments

We apologize to any in the field whose work is not cited here due to space restrictions. This work was supported by National Institutes of Health (NIH) R01 grants to the National Heart Lung and Blood Institute HL1290986, National Institute of Diabetes and Digestive and Kidney Diseases DK119145, and Eunice Kennedy Shriver National Institute of Child Health and Human Development HD060860 to K.M.C. N.R.N. was supported by a National Heart Lung and Blood Institute F31 HL143836. N.R.H. was supported

Glossary

Adrenomedullin (AM)
a 52-amino acid peptide and member of the CGRP family. It is a potent vasodilator with a regulatory role in the cardiovascular and lymphatic systems through activation of CLR paired with RAMP2 or RAMP3.
Adrenomedullin 2 (AM2)
also known as intermedin; member of the CGRP family and is expressed in both the peripheral and central nervous systems.
Atypical chemokine receptor 3 (ACKR3)
also known as C-X-C chemokine receptor type 7 (CXCR7); a decoy receptor that binds the chemokines

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    • Structural perspective of class B1 GPCR signaling

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      RAMPs are a family of single transmembrane proteins represented by three subtypes (RAMP1, 2, and 3) and can modulate GPCR function in several ways [46]. The simplest way is to act as molecular chaperones for class A, B, and C GPCRs [47]. The functions of RAMPs bound to individual class B1 GPCRs have been reported, covering CLR, CTR, VIP2R, PTH1R, PTH2R, GHRHR, CRF1R, SCTR, GCGR, GIPR, GLP‐1R and GLP‐2R with all three RAMPs [32,48,49], VIP1R with RAMP2 and RAMP3 [49], and CRF2R with RAMP3 [49].

    • Molecular simulations reveal the impact of RAMP1 on ligand binding and dynamics of calcitonin gene-related peptide receptor (CGRPR) heterodimer

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      Molecular modeling and simulation methods have become a common tool for visualizing and simulating many physiological systems, as well as studying cellular events in multidimensional approaches. Till date, the role of RAMPs in class B GPCRs are broadly investigated [11,15–18], and there are various experimental studies performed for the neuropeptide-cell signaling and activation mechanisms [15,18–21], as well as the receptor stability and ligand selectivity [9,22,23]. The release of whole structural domains of the human CGRP receptor (CLR + RAMP1) with bound CGRP neuropeptide and in complex with the Gs-protein heterotrimer by Liang et al. is expected to give great momentum to the in silico studies in this area.

    • Modulating effects of RAMPs on signaling profiles of the glucagon receptor family

      2022, Acta Pharmaceutica Sinica B
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      This feature would promote the bias of oxyntomodulin towards β-arrestins or ERK1/2 phosphorylation over cAMP relative to GLP-1. Both the glucagon receptor family members and RAMPs are key players of the metabolic and endocrine systems10. They have an overlap organ distribution including the lung, pancreas, kidney, brain, heart and liver45–50.

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