Introduction
Alternative splicing is an important process employed to modulate the function of eukaryotic proteins and is an important contributor to proteomic diversity. During alternative splicing, the exons of precursor mRNAs (pre-mRNAs) are spliced together in different arrangements to produce distinct mature mRNAs, which ultimately results in structurally and functionally distinct protein variants [
1]. Approximately 95% of human multi-exon genes undergo alternative splicing [
2]. This process is particularly common for genes that are expressed in the nervous system [
3]. Alternative splicing affects neuronal development in many aspects, including cell fate determination, axon guidance, and synaptogenesis [
4,
5]. Alternative splicing errors contribute to neurological and neuromuscular diseases, such as spinal muscular atrophy and frontotemporal dementia [
6,
7].
The inner ear is an important part of the peripheral nervous system and is responsible for reception and transduction of sound and balancing information. Many inner-ear-expressed genes undergo alternative splicing, and errors in this process result in syndromic or non-syndromic hearing loss. For example, a mutation in the gene encoding for splicing factor Ser/Arg repetitive matrix 4 (SRRM4) causes alternative splicing aberrance and hearing loss in mice [
8]. Another example comes from the finding that a missense mutation in
MYO7A gene causes reinforcement of a minor alternative splicing event and results in a mild form of retinopathy and deafness [
9]. Meanwhile, several deafness-causing mutations are localized to alternative exons in hearing-related genes, such as
MARVELD2,
MYO15A, and
USH1C [
10–
13]. The existence of multiple alternative splice variants in certain hearing-related genes may help to explain why different mutations in these genes result in substantial variation in clinical phenotypes.
In this review, we will focus on the role of alternative splicing in the inner ear. We will start with a discussion of inner-ear-specific gene splicing. We will also discuss the role of alternative splicing in frequency tuning. Then, we will focus on the splicing factors that have been shown to play important roles in the inner ear. We will see that although substantive advances have been achieved, the regulation of alternative splicing in the inner ear remains largely unknown. Further investigation is also needed to clarify the mechanism of hearing loss caused by alternative splicing deficits.
Inner-ear-specific gene splicing
Tissue-specific gene splicing is critical to establish tissue identity and maintain tissue function. For example, MEF2D is a ubiquitously expressed transcriptional factor, and during myogenesis,
Mef2D mRNA alternatively uses mutually exclusive exons to produce a muscle-specific isoform, which shows altered transcriptional activity by changing its susceptibility to phosphorylation by protein kinase A (PKA) [
14,
15]. Microarrays and deep sequencing have revealed more tissue-specific splicing patterns on a genome-wide scale [
16,
17].
The most well-known inner-ear-specific gene splicing occurs in
Cadherin 23 (
Cdh23) gene, which encodes for the tip-link protein Cadherin 23 (CDH23) [
18,
19] (Table 1).
CDH23 mutations cause tip-link interruption and stereocilia disorganization, resulting in syndromic and non-syndromic hearing loss in humans and mice [
20–
22]. Mouse
Cdh23 gene contains 69 exons, and when exon 68 is subject to alternative splicing, two
Cdh23 splicing variants,
Cdh23(+68) and
Cdh23(−68), are produced [
23]. Notably, although
Cdh23(−68) is ubiquitously expressed in many tissue types,
Cdh23(+68) is only detected in the inner ear [
18,
24,
25] (Fig. 1). Exon 68 is 105 base pairs long, encoding 35 amino acids in the cytoplasmic domain with no homology to other proteins. The inclusion of exon 68 has been suggested to affect the conformation as well as protein–protein interaction of CDH23 [
24,
26,
27].
Until now, not much is known on how tissue-specific splicing patterns are established. Several splicing factors have been identified that are preferentially expressed in particular tissue types, such as NOVA (encoded by
Nova) in the brain and ESRP1/2 in epithelial cells. These splicing factors are involved in tissue-specific splicing in these tissue types [
28–
31]. Tissue-specific splicing can also be achieved by tissue-specifically expressed splicing regulators other than splicing factors, such as the alternative splicing repressors PTBP1 and PTBP2. PTBP1 is broadly expressed in nonneuronal cells, whereas PTBP2 is abundantly expressed in mature neurons. This tissue-specific distribution of PTBP1/PTBP2 plays a major role in tissue-specific alternative splicing [
32,
33]. At present, such splicing factors or regulators have not been identified in the inner ear. In a microarray screening, approximately 50 splicing factors were identified to be expressed in chicken inner ear, none of which had yet been shown to be inner-ear-specific [
34]. The identification of inner-ear-specific splicing factors or regulators is essential to understanding the mechanism of inner-ear-specific splicing.
Alternative splicing and frequency tonotopy
An amazing characteristic of the auditory system is its remarkable frequency selectivity and sensitivity over a large frequency range. For humans, the frequency ranges from 20 Hz to 20 kHz. Along the cochlear sensory epithelia, hair cells at each position are most sensitive to particular sound frequencies, resulting in the so-called frequency tonotopy. Many morphological and physiological properties contribute to this frequency tonotopy, including the physical properties of the basilar membrane and tectorial membrane, and hair cell stereocilia length, etc. [
35]. Alternative splicing also plays an important role in this process, particularly in lower vertebrates, such as birds and reptiles.
In birds and reptiles, frequency tuning is achieved mainly through tonotopic differences in ion conductance within the hair cell membrane, which is mediated by the L-type voltage-gated Ca
2+ channel (CaV
1.3 channel) and the Ca
2+-activated K
+ channel (BK channel) [
36–
38]. The subunit composition and numbers of these channels determine the characteristic frequency of each hair cell. Approximately two decades ago, differential splicing of
Kcnma1, which encodes for the a subunit of BK channel, was shown to affect the channel gating properties and is important for frequency tuning (Table 1). Chicken
Kcnma1 is alternatively spliced along the tonotopic axis of the basilar papilla (Fig. 2), and its 11 alternative exons at 7 splice sites could generate up to 576 splicing variants [
39,
40]. Different splicing variants generate kinetically distinct BK channels that contribute to frequency tuning [
40,
41]. Similarly, turtle
kcnma1gene is also alternatively spliced tonotopically along the basilar papilla, and different splicing variants generate kinetically different BK channels [
42,
43].
In the mammalian cochlea, frequency tuning mainly depends on the mechanical properties of the basilar membrane, whereas alternative gene splicing appears to play a less significant role in frequency tuning. Nevertheless, tonotopic alternative splicing was present in certain genes, including
Kcnma1. A total of 27
Kcnma1 splicing variants involving 7 alternative splicing sites were identified in mouse cochlea, and several of these splicing variants show different expression patterns along the tonotopic axis [
44].
Kcnma1 knockout mice showed degenerated outer hair cells (OHCs) and developed progressive hearing loss [
45]. Tonotopic splicing also occurs in
Kcnq4, the gene encoding for a voltage-gated K
+ channel whose mutations cause progressive hearing loss in humans and mice [
46–
48] (Table 1). Beisel and colleagues showed that four
Kcnq4 splicing variants are differently expressed along the tonotopic axis of the mouse cochlea [
49]. The tonotopic splicing of these genes in the mammalian cochlea might play important roles in cochlear function.
At present, little is known about how tonotopic alternative splicing is regulated in the inner ear. In an effort to identify differentially expressed splicing activator(s) or repressor(s) responsible for tonotoic splicing along the chicken basilar papilla, a large-scale analysis of gene expression using a chicken genome array was performed. Although several genes showed different expression levels between the apex and base, no significant difference was observed in the expression of the splicing factors or repressors between these two regions [
34]. Further investigation is needed to address this question.
Splicing factors in the inner ear
In spite of the failure in identifying inner-ear-specific splicing factors and tonotopically expressed splicing factors, researchers have identified several splicing factors that play important roles in hearing. Microarray analyses revealed approximately 50 splicing factors expressed in the chicken basilar papilla, many of which are involved in alternative splicing [
34]. Noticeably, several splicing factors identified in this experiment belong to the SR protein family, including PNISR, SRRM1, SRSF3, SRSF5, SRSF6, SRSF10, TRA2A, and TRA2B. The precise expression patterns of these splicing factors in the inner ear are unknown. However, transcriptome analysis showed that these splicing factors are expressed in cochlear and vestibular hair cells as well as other cells in the inner ear (SHIELD; https://shield.hms.harvard.edu) [
50,
51]. SR proteins share a serine/arginine-rich domain and play important roles in constitutive as well as alternative pre-mRNA splicing [
52]. More splicing factors were believed to fall below the detection threshold of this analysis because of their low expression levels [
34].
Until now, two splicing factors have been clearly shown to play important roles in hearing, both of which belong to the SR protein family. The first splicing factor is SRRM4, which contains three serine/arginine-rich domains (Fig. 3). Mutation of the
Srrm4 gene causes alternative splicing defects and is responsible for profound hearing loss in Bronx Waltzer (bv) mice [
8]. bv mice were originally identified in the late 1970s and are characterized by degenerated auditory and vestibular hair cells [
53]. Notably, bv mice show inner hair cell (IHC) degeneration without OHC loss in the cochlea, and the OHCs of bv mice are functionally active [
53–
57]. Further examination showed that IHCs are formed in the E17 bv mice but fail to form synapses with spiral ganglion neurons, resulting in degeneration by P3–P5 [
58,
59]. A similar situation also occurs in vestibular hair cells [
60].
The bv deafness gene was mapped to mouse chromosome 5 [
61], and recently a 2710 bp deletion in the
Srrm4 gene was identified to be responsible for the bv mouse phenotype [
8] (Table 1). SRRM4, originally known as nSR100 (neural-specific SR-related protein of 100 kDa), regulates brain-specific alternative splicing of genes that function in neural cell differentiation [
62]. The deletion of the
Srrm4 gene in bv mouse removes a portion of the last intron and the entire coding region of the last exon, resulting in the disruption of SRRM4 protein expression. The alternative splicing of several genes are affected in the inner ear of bv mice, including
Ap1s2,
Cacnb2,
Dtna,
Dync1i2,
Kif1b,
Mef2d,
Nrcam, and
Phf21a [
8].
In situ hybridization showed that, in the cochlea,
Srrm4 is expressed specifically in IHCs, OHCs, and spiral ganglion neurons. In vestibular organs,
Srrm4 is specifically expressed in hair cells. The specific expression of
Srrm4 in cochlear and vestibular hair cells is supported by RNA sequencing results of fluorescence activated cell sorting (FACS)-sorted cells (SHIELD; https://shield.hms.harvard.edu) [
50,
51]. Notably, although
Srrm4 is abundantly expressed in other neuronal tissue types, such as cerebellum and neocortex, bv mice are subject to alternative splicing defects only in the inner ear, consistent with the fact that no phenotype exists in these tissue types in bv mice [
8]. Further investigations are needed to discover why these tissue types and OHCs are unaffected by
Srrm4 deficiency.
The second splicing factor that has been shown to play important roles in hearing is SFSWAP [
63] (Table 1). SFSWAP, also known as SFRS8, contains a DRY_EERY domain and two SWAP domains as well as a serine/arginine-rich domain (Fig. 3). First identified in
Drosophila, SFSWAP has been shown to regulate alternative splicing of several
Drosophila genes, including
Sfswap itself [
64–
66]. In mammals,
in vitro experiments indicated that SFSWAP regulates alternative splicing of
Fibronectin and
Ptprc [
67–
69]. Recently, in a random lentiviral insertional mutagenesis study,
Sfswap mutant mice were identified because of their significant circling behavior. The insertion of the lentiviral vector in intron 4 of
Sfswap gene caused a significantly reduced expression level of
Sfswap mRNA [
63]. ABR measurement revealed that a moderate hearing threshold shift (20 dB to 25 dB) exists in
Sfswap mutant mice.
In situ hybridization revealed that
Sfswap is broadly expressed in the inner ear and brain since E10.5 [
63]. In the cochlea,
Sfswap expression is high in hair cells, supporting cells, and spiral ganglion cells but low in the surrounding tissue. In
Sfswap mutant cochlea, regions that miss the third row of OHCs exist as well as regions that have ectopic IHCs. Meantime, given that mutant mice have a one third reduction in the length of the cochlea, the total numbers of IHCS and OHCs are significantly reduced [
63]. Furthermore, loss of supporting cells was also observed in
Sfswap mutant cochlea. Similar phenotypes have been observed previously in
Jagged 1 (
Jag1) heterozygous mice [
70,
71], and consistently,
Sfswap−/−;
Jag1+/− mice show more severe phenotypes than expected from simple additive effects, indicating a genetic interaction between these two genes [
63]. Jag1 is a well-known Notch ligand, and the inactivation of
Jag1 in the developing inner ear leads to a severely disrupted organ of Corti [
72,
73]. RT-PCR revealed that splicing of the Notch pathway genes is unaffected in the inner ear of
Sfswap mutant mice. Thus, further investigation is needed to address the role of SFSWAP-regulated splicing in the inner ear.
Perspectives
We have discussed that alternative splicing is important for the development and physiological function of the inner ear and that alternative splicing deficits could cause hearing loss. In spite of the substantive advances in this field, the regulation of alternative splicing in the inner ear remains elusive. At the same time, further investigation is needed to understand the precise role of alternative splicing in hearing loss.
Furthermore, several other aspects of inner ear alternative gene splicing are worth noting, such as the regulation of alternative splicing by microRNAs (miRNAs). miRNAs are 21 to 25 nucleotide-long noncoding RNAs that regulate the expression of target genes at the posttranscriptional level. Alternative splicing factors/regulators have been shown to be targets of miRNA regulation. For example,
Srsf1(SF2/ASF) mRNA is a target of miR-7, miR-10a, miR-10b, miR-28, and miR-505 [
74–
76]. Another example involves PTBP1 and PTBP2, two repressors of alternative splicing that are expressed in nonneuronal cells and neurons, respectively, which have been mentioned previously [
32,
33]. In neurons, miR-124 directly targets
Ptbp1 mRNA and downregulates
Ptbp1 expression [
77]. In nonneuronal cells, such as myoblasts, miR-133 targets
Ptbp2 mRNA and inhibits its translation [
78]. In the inner ear, miRNAs might play similar regulatory roles toward splicing factors. In line with this, many miRNAs, including several ones mentioned previously, have been shown to be expressed in the inner ear and play important roles in hearing and balance [
79–
82].
Ubiquitination has also been shown to regulate the expression of alternative splicing factors. Splicing factor SRSF1 is subject to ubiquitination and degradation by the proteasome in T cells [
83]. Splicing factor KHDRBS3, also known as SLM2 or T-STAR, was shown to be targeted by E3 ubiquitin ligase SIAH1 for degradation [
84]. Splicing factor RBM15 could be targeted by E3 ubiquitin ligase CNOT4 for degradation [
85]. In the inner ear, several ubiquitination regulatory proteins, such as FBXO2 (OCP1), SKP1 (OCP2), SMURF1/2, and NEDD4, are present and important for the development and function of the inner ear [
86–
89]. Whether these proteins regulate the degradation of alternative splicing factors in the inner ear awaits further investigation.
In conclusion, alternative splicing is important for inner ear development and function. More work is needed in the future to fully understand the mechanism how this process is regulated as well as to clarify why deficits of this process result in functional abnormality in the inner ear, such as hearing loss.
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