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Introduction

Schmid-type metaphyseal chondrodysplasia (SMCD), a relatively common form of metaphyseal chondrodysplasia, is an autosomal inherited chondrodysplasia; affected patients are of short stature and exhibit coxa vara, genu varum and a waddling gait due to skeletal deformities, resulting from growth plate cartilage abnormalities (1,2). Although chondrodysplasias are considered rare [the incidence of chondrodysplasias is 1/4,000 births (3)], they severely affect the quality of life of affected individuals. Chondrodysplasias have diverse etiologies and there is ample evidence to indicate that SMCD is caused by heterozygous mutations in the gene of collagen, type X, alpha 1 (Col10a1) (4). The gene encodes a chain of type X collagen molecule whose expression is largely restricted to zones of calcifying or degrading growth plate cartilage, and thus the mutations of Col10a1 may interfere with endochondral ossification (5).

It has been demonstrated that many mutations in genes that encode cartilage extracellular matrix (ECM) molecules are involved in the etiology of chondrodysplasias (6). Chondrodysplasias caused by mutations associated with ECM are due to inappropriate processing, folding, or export of the abnormal ECM molecules, resulting in the accumulation of these molecules within the endoplasmic reticulum (ER) of chondrocytes (3,7). Subsequent to the cellular retention of mutant ECM proteins, chondrocyte ER stress and the unfolded protein response (UPR) are activated, in an attempt by the cells to deal with the inappropriate retention of mutant proteins (8). Rajpar et al used the mouse models phenocopying SMCD, a condition involving dwarfism and hypertrophic zone expansion of the growth plate caused by autosomal dominant mutations in Col10a1, and demonstrated the central importance of ER stress in the pathology of SMCD (9). By contrast, the UPR can be activated via ER membrane-spanning sensors, such as inositol-requiring enzyme-1 (IRE1) and activated IRE1 can splice the coding sequence of the X-box binding protein 1 (XBP1), a transcription factor (TF) responsible for multiple UPR target gene expression (10). Recently, Cameron et al demonstrated that the IRE1/XBP1 pathway was redundant to cartilage pathology and they proposed that the XBP1-independent UPR-driven dysregulation of CCAAT/enhancer binding protein β (C/EBP-β), a TF important for the transition from chondrocyte proliferation to hypertrophy, was significant for the pathophysiology of SMCD (11). However, the limited studies have not yet revealed the details of the molecule circuitry in SMCD.

In this study, we downloaded the microarray data from GSE72261, the same gene expression profiling used in the study by Cameron et al, from a publicly available database (11). Mice with a SMCD collagen X p.Asn617Lys knock-in mutation (ColXN617K) were crossed with mice in which XBP1 activity was ablated specifically in cartilage (Xbp1CartΔEx2), generating the compound mutant, C/X (11). In the study by Cameron et al (11), they mainly focused on the analysis of role of the IRE1/XBP1 pathway in the pathophysiology of SMCD, and thus they represented the XBP1-dependent gene expression changes using differentially expressed probes between ColXN617K and wild-type (WT), but not between Xbp1CartΔEx2 and WT or C/X and WT; the XBP1-independent gene expression changes using differentially expressed probes between ColXN617K and WT, and between C/X and WT, but not Xbp1CartΔEx2 and WT. However, they did not analyze the gene part between ColXN617K and WT, C/X and WT, and Xbp1CartΔEx2 and WT, as well as the gene part between ColXN617K and WT, Xbp1CartΔEx2 and WT, but not C/X and WT.

In the present study, differentially expressed genes (DEGs) were screened in ColXN617K, Xbp1CartΔEx2 and C/X hypertrophic zone samples compared with WT hypertrophic zone specimens, respectively. Subsequently, comprehensive bioinformatics was used to analyze the significant pathways of the DEGs, identification of TFs of the overlapping DEGs both in the three comparison groups and construction of the corresponding regulation networks. Furthermore, to further analyze the more potential genes associated with SMCD, gene co-expression modules, as well as protein-protein interaction (PPI) networks were constructed based on the sum of DEGs. We focused on the overlap of the results between regulatory networks and co-expression analysis. The aim of this study was to gain a better understanding of the molecular circuitry of SMCD, and to identify more potential genes associated with the pathogenesis of SMCD.

Materials and methods

Microarray data and data preprocessing

The microarray data of GSE72261, deposited by Cameron et al (11), were downloaded from the National Center for Biotechnology Information (NCBI) Gene Expression Omnibus (GEO) database (http://www.nibi.nih.gov/geo/). As described in the original study (11), hypertrophic zones were microdissected from one proximal tibial growth plate from three 2-week old WT mice, three 2-week old mice carrying a Col10a1 p.N617K mutation (ColXN617K), three 2-week old mice lacking XBP1 activity in chondrocytes (Xbp1CartΔEx2), and three 2-week old mice resulting from a cross between ColXN617K and Xbp1CartΔEx2 (C/X). Thus, the GSE72261 dataset consisted of 3 WT samples, 3 Xbp1CartΔEx2 specimens (named Xbp1), 3 ColXN617K specimens (named Col) and 3 C/X specimens (named C/X). The corresponding platform was GPL6887 Illumina MouseWG-6 v2.0 expression beadchip. In this study, all these 12 samples were selected to carry out the follow-up analysis.

The non-normalized data were downloaded and preprocessed using preprocessCore package (12) which is a part of Bioconductor project (http://www.bioconductor.org/). Besides, with the use of org.Mm.eg.db (13) and illuminaMousev2.db (14) packages of bioconductor, the probe symbols were transformed into corresponding gene symbols. The expression value was averaged for each gene when multiple probes were mapped to the same gene. After data preprocessing, 20,106 gene expression matrix were received.

Screening of DEGs

The DEGs in Xbp1 vs. WT, Col vs. WT, and CX vs. WT were analyzed using the limma package (15) in R/Bioconductor. |log2fold change (FC)| and p-values from an unpaired t-test implemented in the limma package (15) were used to select the DEGs. Values of p<0.01 and |log2FC|≥0.58 (showing >1.5-fold differential expression) were set as the cut-off criteria. Additionally, the DEGs identified in Xbp1 vs. WT, Col vs. WT and CX vs. WT, respectively were clustered using the gplots package (16) in R, evaluating whether the DEGs identified were sample-specific. The results were displayed as heatmaps.

By contrast, in the original study by Cameron et al (11), DEGs were screened in Xbp1 vs. WT, Col vs. WT and CX vs. WT, respectively with >2-fold differential expression and with an adjusted p-value of 0.01. Moreover, Cameron et al focused on the DEGs in Col vs. WT, but not Xbp1 vs. WT or CX vs. WT, and the DEGs in Col vs. WT and CX vs. WT, but not Xbp1 vs. WT, in the subsequent analysis.

Pathway enrichment analysis

The database for annotation, visualization and integrated discovery (DAVID) online software can provide a comprehensive set of functional annotation tools (17). In order to analyze the identified DEGs on the functional level, the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was performed for all DEGs using DAVID software (17). Subsequently, p-values were calculated using the hypergeometric test (18). Gene count ≥2 and p-values <0.05 were set as the cut-off criterion for pathway enrichment analysis.

Identification of TFs and construction of the regulatory network

iRegulon (19), available as a Cytoscape (20) plugin, implements a genome-wide ranking-and-recovery approach to detect enriched TF motifs and their optimal sets of direct target genes (19). Besides, iRegulon allows the integration of predicted regulatory binding sites directly into a biological network (19). In the original study by Cameron et al (11), DEGs in Col vs. WT and CX vs. WT and Xbp1 vs. WT, as well as the DEGs between in Col vs. WT and Xbp1 vs. WT, but not CX vs. WT, were analyzed. In this study, we screened out the overlapping DEGs with consistent expression changes (both upregulated or both downregulated) in the 3 groups (Xbp1 vs. WT, Col vs. WT and CX vs. WT). The lists of overlapping DEGs with consistent expression change were subjected to iRegulon (19) and used to predict their transcriptional regulators using the following parameters: minimum identity between orthologous genes, 0.05; and maximum false discovery rate on motif similarity, 0.001. The predicted TF-DEG pairs with normalized enrichment scores (NES) (19) >4.5 were selected for further analysis and the regulatory networks were constructed.

Analysis of gene co-expression modules

To further analyze the more potential genes associated with SMCD, we intended to perform gene co-expression analysis of DEGs. For reducing the deviation, we used all the DEGs as the scope of gene co-expression analysis.

Weighted correlation network analysis (WGCNA) can be used for finding modules (clusters) of genes with high correlations, or relating modules to external sample traits (21). A robust correlation coefficient emphasizes high correlations of genes and results in a weighted network (21). In this study, WGCNA R software package (21), which can cluster the most highly co-expressed genes in defined modules, was applied to detect modules of co-expressed genes of all the DEGs identified in Xbp1 vs. WT, Col vs. WT, and CX vs. WT. If the absolute value of the correlation coefficient was high, the co-expressed genes clustered in modules would have high gene co-expression trend consistency and the modules would be significantly related to external sample traits.

Functional enrichment analysis of genes in the co-expression modules

In order to analyze gene co-expression modules on the functional level, Gene Ontology (GO) enrichment analysis was carried out using DAVID online tool (17) to obtain the enriched biological process (BP) terms. A hypergeometric test (18) was applied to examine the significance of this enrichment analysis. The count number ≥2 and p-value <0.05 were used as the cut-off criterion.

Construction of PPI network based on genes in the co-expression modules

The Search Tool for the Retrieval of Interacting Genes (STRING) database can be used as it provides easy access to known and predicted protein interactions (22). The interaction probabilities of proteins in STRING are provided with a confidence score (22). A protein with a confidence score >0.4 is deemed to have medium confidence of interaction with other proteins (23). In the present study, the STRING database was used to select the PPIs among the DEGs identified in the co-expression modules with default parameters (species: mus musculus). Interaction pairs of DEGs with the confidence score ≥0.4 were selected for the PPI network construction and the network was visualized using Cytoscape software (24), where nodes indicated proteins and edges indicated physical interactions. In addition, node degrees of the DEGs were calculated. The nodes with higher degree in the network were considered as hub proteins.

Furthermore, we integrated the results of regulatory networks and PPI networks. The DEGs identified both in the regulatory network and PPI network may be more potential key genes associated with SMCD.

Results

Screening of DEGs

According to the gene expression profile, with p-values <0.01 and |log2FC|≥0.58, there were 481 DEGs identified in Xbp1 vs. WT, comprising 308 upregulated genes and 173 downregulated genes. The corresponding heatmap of the DEGs is shown in Fig. 1A. Furthermore, 1,530 DEGs (831 up- and 699 downregulated genes) and 1,214 DEGs (640 up- and 574 downregulated genes) were screened out in Col vs. WT and CX vs. WT, respectively. The respective heatmaps are shown in Fig. 1B and C. From the heatmaps, we found that the identified DEGs could distinguish the experimental samples from the WT samples, suggesting the DEGs were eligible for the subsequent analysis.

Figure 1 Heatmaps. (A) Heatmaps of differentially expressed genes (DEGs) identified in Xbp1 vs. WT. (B) Heat maps of DEGs identified in Col vs. WT. (C) Heat maps of DEGs identified in CX vs. WT. (D) Heat maps of overlapping DEGs in all the samples. Red color and green color represent a high expression level and low expression level of specific genes, respectively.

KEGG pathway enrichment analysis of the DEGs identified

The KEGG pathways of the significantly upregulated and downregulated DEGs are summarized in Table I. In total, 6 pathways were enriched based on the DEGs identified in Xbp1 vs. WT, such as ECM-receptor interaction and focal adhesion. Moreover, a number of pathways were enriched by the upregulated and downregulated genes in Col vs. WT and CX vs. WT. Table I only displays the top 10 and 5 pathways enriched by these DEGs in Col vs. WT and CX vs. WT, respectively. For instance, the upregulated genes in Col vs. WT were significantly associated with aminoacyl-tRNA biosynthesis and associated with ER stress (11), such as RNA degradation and glutathione metabolism. The downregulated genes in Col vs. WT were associated with focal adhesion. On the other hand, the upregulated genes identified in CX vs. WT were significantly associated with glycolysis/gluconeogenesis, as well as with the fructose and mannose metabolism pathways. The downregulated genes in CX vs. WT were found to be linked with leukocyte transendothelial migration.

Table I The pathways enriched in the Xbp1 group, and the top 10 pathways and top 5 pathways enriched in the Col group and CX group, respectively.

Table I

The pathways enriched in the Xbp1 group, and the top 10 pathways and top 5 pathways enriched in the Col group and CX group, respectively.

Gene change	KEGG term	Count	p-value
In Xbp1 group
Upregulated	mmu04512:ECM-receptor interaction	8	5.23E-04
	mmu04510:Focal adhesion	11	0.0020
	mmu04142:Lysosome	8	0.0043
	mmu00561:Glycerolipid metabolism	4	0.0468
Downregulated	mmu03010:Ribosome	8	2.69E-05
	mmu00860:Porphyrin and chlorophyll metabolism	3	0.0364
In Col group
Upregulated	mmu00970:Aminoacyl-tRNA biosynthesis	8	0.0011
	mmu00051:Fructose and mannose metabolism	7	0.0030
	mmu00600:Sphingolipid metabolism	7	0.0057
	mmu00250:Alanine, aspartate and glutamate metabolism	6	0.00594
	mmu04142:Lysosome	12	0.0071
	mmu00290:Valine, leucine and isoleucine biosynthesis	4	0.00796
	mmu00510:N-Glycan biosynthesis	7	0.00893
	mmu03018:RNA degradation	8	0.00895
	mmu00480:Glutathione metabolism	7	0.0160
	mmu00010:Glycolysis/gluconeogenesis	8	0.0172
Downregulated	mmu04510:Focal adhesion	24	1.18E-05
	mmu04070:Phosphatidylinositol signaling system	14	1.55E-05
	mmu04142:Lysosome	15	5.58E-04
	mmu04270:Vascular smooth muscle contraction	15	6.08E-04
	mmu04512:ECM-receptor interaction	12	8.03E-04
	mmu04912:GnRH signaling pathway	13	8.79E-04
	mmu05210:Colorectal cancer	12	0.00108
	mmu04540:Gap junction	12	0.00108
	mmu05213:Endometrial cancer	9	0.00157
	mmu04670:Leukocyte transendothelial migration	14	0.00175
In CX group
Upregulated	mmu00010:Glycolysis/gluconeogenesis	9	0.0012
	mmu00051:Fructose and mannose metabolism	6	0.0055
	mmu00030:Pentose phosphate pathway	5	0.0082
	mmu00520:Amino sugar and nucleotide sugar metabolism	6	0.0116
	mmu00750:Vitamin B6 metabolism	3	0.0135
Downregulated	mmu04670:Leukocyte transendothelial migration	16	1.83E-05
	mmu04510:Focal adhesion	20	7.17E-05
	mmu05210:Colorectal cancer	12	2.15E-04
	mmu04664:Fc epsilon RI signaling pathway	11	6.15E-04
	mmu04270:Vascular smooth muscle contraction	13	0.0011

[i] KEGG, Kyoto Encyclopedia of Genes and Genomes; ECM, extracellular matrix.

Analysis of the regulatory network

Among all the DEGs identified in Xbp1 vs. WT, Col vs. WT and CX vs. WT, a total of 24 common upregulated genes and 43 common downregulated genes were identified. The expression changes of these common DEGs in all the samples are shown in the heatmap (Fig. 1D). With NES >4.5, total 7 TFs were found to regulate 19 common upregulated genes (Fig. 2A). These 7 TFs were DEAF1 transcription factor (Deaf1, NES=5.608), sterol regulatory element binding transcription factor 1 (Srebf1, NES=5.579), GATA binding protein 1 (Gata1, NES=5.315), Hes Family BHLH transcription factor 5 (Hes5, NES=5.135), RAR-related orphan receptor C (Rorc, NES=4.74), hedgehog acyltransferase (Hhat, NES=4.593) and CAMP responsive element binding protein 3-like 1 (Cereb3l1, NES=4.535). By contrast, a total of 4 TFs were identified to regulate 21 common downregulated genes (Fig. 2B). These 4 TFs were zinc finger and BTB domain containing 14 (Zbtb14, NES=5.722), SMAD family member 4 (Smad4, NES=5.313), TATA box binding protein (Tbp, NES=5.137), JAZF zinc finger 1 (Jazf1, NES=4.627). However, all the TFs that could regulate upregulated genes or downregulate genes were not DEGs.

Figure 2 Regulatory networks and results of weighted correlation network analysis (WGCNA) analysis. (A) The regulatory network based on 7 transcriptional factors (TFs) and 19 common upregulated genes identified. The pink nodes indicate the common upregulated genes. The yellow nodes represent the TFs. (B) The regulatory network based on 4 TFs and 21 common downregulated genes identified. The green nodes indicate the common downregulated genes. The yellow nodes represent the TFs. (C) Gene dendrogram obtained by WGCNA. Each colored row underneath the dendrogram represents a color-coded module that contains a group of highly connected genes.

Gene co-expression modules and functional enrichment analysis of genes in these modules

As already indicated, all the identified DEGs in the 3 groups (Xbp1 vs. WT, Col vs. WT and CX vs. WT) were used to construct the co-expression network. Thus, 2,258 genes were included (967 common genes were removed, including overlapping DEGs in the 3 groups or only 2 groups). WGCNA analysis identified a total of 11 modules with highly co-expressed genes (Fig. 2C). Besides, this analysis led to the identification of dark green-colored (correlation coefficient, 0.94) and green-colored (correlation coefficient, −0.89) modules with highest significance value (Table II). The results of several significant GO BP terms (ranked by p-value) of DEGs in these 2 colored modules are shown in Table III. The results demonstrated that genes enriched in the dark green-colored module were significantly associated with the biological processes, such as ribonucleoprotein complex biogenesis and ribosome biogenesis. Additionally, genes enriched in the green-colored module were significantly correlated with cell adhesion and biological adhesion. Moreover, both the dark green- and green-colored modules were significantly enriched for biosynthetic processes, such as water-soluble vitamin biosynthetic process and cholesterol biosynthetic process.

Table II Results of gene co-expression module analysis.

Table II

Results of gene co-expression module analysis.

Module	Correlation	Gene count	p-value
Turquoise	−0.6	503	0.03850043
Dark orange	0.17	40	0.590624
Dark red	0.37	28	0.2373936
Dark olive green	0.024	24	0.9413225
Dark green	0.94	378	4.28E-06
Pale turquoise	0.69	31	0.01377187
Black	0.62	896	0.03280841
Dark magenta	−0.78	10	0.002588195
Green	−0.89	267	8.83E-05
Royal blue	−0.73	66	0.006466701
Saddle brown	−0.35	15	0.2660367

Table III The most significant GO terms of DEGs identified in darkgreen and green modules.

Table III

The most significant GO terms of DEGs identified in darkgreen and green modules.

Module	Term	p-value	Gene
Darkgreen	GO:0022613 - ribonucleoprotein complex biogenesis	10	8.91E-04
	GO:0042254 - ribosome biogenesis	9	9.96E-04
	GO:0007050 - cell cycle arrest	6	0.0037
	GO:0042364 - water-soluble vitamin biosynthetic process	4	0.0071
	GO:0034470 - ncRNA processing	9	0.0083
	GO:0000041 - transition metal ion transport	6	0.0088
	GO:0055114 - oxidation reduction	22	0.0109
	GO:0034660 - ncRNA metabolic process	10	0.0116
	GO:0016053 - organic acid biosynthetic process	8	0.0146
	GO:0046394 - carboxylic acid biosynthetic process	8	0.0146
Green	GO:0007155 - cell adhesion	14	0.0126
	GO:0022610 - biological adhesion	14	0.0128
	GO:0006928 - cell motion	10	0.0258
	GO:0006695 - cholesterol biosynthetic process	3	0.0283
	GO:0055114 - oxidation reduction	14	0.0456
	GO:0016126 - sterol biosynthetic process	3	0.0462
	GO:0006865 - amino acid transport	4	0.0482
	GO:0006694 - steroid biosynthetic process	4	0.0482

[i] GO, Gene Ontology; DEGs, differentially expressed genes.

PPI network analysis

The PPI networks upon the DEGs in the dark green- and green-colored modules are shown in Figs. 3 and 4, respectively. The PPI network of genes in the dark green-colored module consisted of 228 nodes and 444 interactions (edges) (Fig. 3). There were 13 DEGs with a node degree >12 in the network, namely, MRNA turnover 4 homolog (S. cerevisiae) (Mrto4) (degree = 27), ribosomal protein S27a (Rps27A) (degree = 25), WD repeat domain 74 (Wdr74) (degree = 21), FBJ murine osteosarcoma viral oncogene homolog (Fos) (degree = 20), vascular endothelial growth factor A (Vegfa) (degree = 19), IMP3, U3 small nucleolar ribonucleoprotein (Imp3) (degree = 17), Jun D proto-oncogene (Jund) (degree = 15), PWP2 periodic tryptophan protein homolog (yeast; Pwp2) (degree = 15), pescadillo ribosomal biogenesis factor 1 (Pes1) (degree = 15), ribosomal RNA processing 9, small subunit (Ssu) processome component, homolog (yeast; Rrp9) (degree = 13), NOP2/Sun RNA methyltransferase family, member 2 (Nsun2) (degree = 13), TRNA methyltransferase 1 homolog (S. cerevisiae) (Trmt1) (degree = 13), cyclin D2 (Ccnd2) (degree = 13). In addition, the 13 DEGs had no overlap in the regulatory networks.

Figure 3 Protein-protein interaction (PPI) network of genes in the dark green-colored module. Nodes indicate genes.

Figure 4 Protein-protein interaction (PPI) network of genes in the green-colored module. Nodes indicate genes.

On the other hand, the PPI network of genes in the green-colored module included 135 nodes and 166 interactions (edges) (Fig. 4). Besides, there were 11 DEGs with a node degree >5 in this network, namely, Kirsten rat sarcoma viral oncogene homolog (Kras) (degree = 14), collagen, type V, alpha 1 (Col5a1) (degree = 11), actin gamma 1 (Actg1) (degree = 10), protein kinase, CAMP-dependent, catalytic, alpha (Prkaca) (degree = 9), Furin (paired basic amino acid cleaving enzyme) (Furin) (degree = 9), heparan sulfate proteoglycan 2 (Hspg2) (degree = 8), phosphodiesterase 11A (Pde11A) (degree = 8), collagen, type XXVII, alpha 1 (Col27a1) (degree = 7), wingless-type M MTV integration site fam ily, member 5B (Wnt5b) (degree = 6), myosin, heavy chain 9, non-muscle (Myh9) (degree = 6), TIMP metallopeptidase inhibitor 1 (Timp1) (degree = 6). Fortunately, we found that 3 of these 11 DEGs, Kras (downregulated), Col5a1 (upregulated), and Furin (upregulated) were also included in the regulatory networks.

Discussion

In the current study, 481, 1,530 and 1,214 DEGs were screened out in Xbp1 vs. WT, Col vs. WT and CX vs. WT, respectively. Pathway enrichment analysis revealed that these DEGs were enriched in different pathways, such as ECM-receptor interaction, focal adhesion and pathways associated with metabolism. In total, 7 TFs were found to regulate 19 common upregulated genes that were with consistent gene change in the 3 groups, while 4 TFs were identified to regulate 21 common downregulated genes. WGCNA demonstrated that 2 significantly enriched gene co-expression modules (dark green- and green-colored modules) and DEGs in the 2 modules were mainly enriched different biological processes, such as ribosome biogenesis. Moreover, Kras (downregulated), Col5a1 (upregulated), and Furin (upregulated) were both in the regulatory networks and PPI network.

With greater than 2-fold differential expression and with an adjusted p-value of 0.01, Cameron et al (11) identified 1,337, 215 and 1,633 differentially expressed probes in CX vs. WT, Xbp1 vs. WT and Col vs. WT, respectively. The amount of DEGs identified in this study was slightly different from the original study of Cameron et al (11), which may result from different analysis methods or analytical errors. In the present study, we first paid more attention to the DEGs which had not been analyzed in the original study by Cameron et al (11), including DEGs in Col vs. WT and CX vs. WT and Xbp1 vs. WT, as well as the DEGs between in Col vs. WT and Xbp1 vs. WT, but not CX vs. WT. Finally, our focus was the DEGs both identified in the regulatory networks and PPI networks.

Kras was one of the DEGs that were identified in the regulatory networks and PPI network. Kras, a Kirsten ras oncogene homolog from the mammalian ras gene family, encodes a protein that is a member of the small GTPase super-family (25). Evidence has indicated that Kras can orchestrate multiple metabolic changes, including differential channeling of glucose intermediates, stimulation of glucose uptake, and reprogrammed glutamine metabolism (26). Moreover, Chan et al demonstrated that intracellular mutant collagen X could lead to deregulated cellular metabolism (27). Taken together, we suggested that Kras may play a critical role in the development of SMCD via the regulation of cell metabolism.

It is well known that SMCD can be caused by heterozygous mutations in the Col10a1 gene (4). In the present study, Col5a1 was found to be another significant DEG identified both in the regulatory networks and PPI network. Col5a1 encodes an alpha chain for one of the low abundance fibrillar collagens (28). It has been demonstrated that Col5a1 is regulated by transforming growth factor-β (TGF-β) in osteoblasts (29), and Col5a1 is involved in the collagen biosynthesis, which is associated with chondrocyte differentiation (11). In agreement with previous studies, we infer that Col5a1 may play a critical role in the pathogenesis of SMCD by participating in chondrocyte differentiation, although further verifications are required to confirm this result.

Furthermore, Furin was another focus in this study, which was identified both in the regulatory networks and PPI network. Furin is likely to represent the ubiquitous endoprotease activity within constitutive secretory pathways (30). Evidence has indicated that Furin is an authentic TGF-β1-converting enzyme (30). Besides, pericellular and diffuse interterritorial distribution of TGF-β2 has been observed in patients with SMCD and there may be a functional interaction of TGF-β2 and type X collagen (31). Thus, Furin may be essential in the mechanisms of SMCD, which warrants further investigation.

However, this study has several limitations. First, a larger sample size in the further investigations is warranted in order to verify our findings. Second, the lack of cross-check and experimental verification were also limitations. Validation using other datasets in similar topic may be used to cross-check our results. In the future, we aim to carry out experimental verifications using different analytical approaches, such as reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry.

In conclusion, the data of the present study revealed several potential key genes (Kras, Col5a1 and Furin) which may play a role in the molecular mechanisms responsible for SMCD. KRAS may play a critical role in the development of SMCD via the regulation of cell metabolism. Besides, Col5a1 may play a critical role in the pathogenesis of SMCD by participating in chondrocyte differentiation. Furin may be essential to the mechanisms of SMCD through an interaction with type X collagen. Further characterization of the genes identified in this study may provide deeper insight into the pathology of SMCD.

References