Ehlers-Danlos Syndrome (EDS) comprises a spectrum of heritable connective tissue disorders with varying genetic origins and clinical manifestations such as soft tissue fragility and skin hyperextensibility. There are multiple EDS subtypes, the first few of which were defined by collagen mutations. Many new EDS variants have been discovered involving mutations that do not necessarily implicate collagen biosynthesis but do involve extracellular matrix (ECM) proteins. One of these proteins, Aortic Carboxypeptidase-Like Protein (ACLP), is a large secreted protein encoded by the AEBP1 (adipocyte enhancer binding protein 1) gene. Previous research has shown that ACLP plays a vital role in binding collagen via its discoidin domain and therefore regulates connective tissue assembly. Thus far, individuals from 7 different families have been identified with different EDS-causing ACLP mutations. Some mutations are ACLP null whereas other mutations lead to expressed mutant ACLP. One of these mutations is characterized by a single-nucleotide deletion that causes the insertion of 40 amino acids in the discoidin domain of ACLP. It is therefore denoted “ACLP-Ins40”. The goal of this research was to characterize the ACLP-Ins40 protein and investigate how mutations in ACLP disrupt ECM homeostasis and cause EDS. We initially sought to determine if the ACLP-Ins40 mutation would alter ACLP’s ability to bind collagen. To achieve this goal we generated expression vectors of full length human ACLP carrying the Ins40 mutation. By western blot, it was determined that ACLP-Ins40 was not secreted from fibroblasts and was retained intracellularly. We then hypothesized that the retention of ACLP-Ins40 in the secretory pathway would induce ER stress due to misfolding. 3T3 fibroblasts were co-transfected with the ACLP-Ins40 expression vector and an XBP1u-EGFP sensor of ER stress. Immunofluorescence imaging revealed that in comparison to WT, fibroblasts expressing ACLP-Ins40 experienced ER stress with significantly increased spliced XBP1. This may then cause cell death, the improper secretion of other important ECM proteins, or defective collagen scaffolding, all which could contribute to symptoms of EDS. These studies contribute to our current understanding of how mutations in the AEBP1 gene and alterations in the ACLP protein cause EDS. This connection provides a framework for future research and for targeted interventions to treat EDS. / 2021-06-17T00:00:00Z