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家族性醛固酮增多症 II 型中 CLCN2 氯离子通道突变。

CLCN2 chloride channel mutations in familial hyperaldosteronism type II.

机构信息

Department of Nephrology, Medical School, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany.

出版信息

Nat Genet. 2018 Mar;50(3):349-354. doi: 10.1038/s41588-018-0048-5. Epub 2018 Feb 5.

Abstract

Primary aldosteronism, a common cause of severe hypertension , features constitutive production of the adrenal steroid aldosterone. We analyzed a multiplex family with familial hyperaldosteronism type II (FH-II) and 80 additional probands with unsolved early-onset primary aldosteronism. Eight probands had novel heterozygous variants in CLCN2, including two de novo mutations and four independent occurrences of a mutation encoding an identical p.Arg172Gln substitution; all relatives with early-onset primary aldosteronism carried the CLCN2 variant found in the proband. CLCN2 encodes a voltage-gated chloride channel expressed in adrenal glomerulosa that opens at hyperpolarized membrane potentials. Channel opening depolarizes glomerulosa cells and induces expression of aldosterone synthase, the rate-limiting enzyme for aldosterone biosynthesis. Mutant channels show gain of function, with higher open probabilities at the glomerulosa resting potential. These findings for the first time demonstrate a role of anion channels in glomerulosa membrane potential determination, aldosterone production and hypertension. They establish the cause of a substantial fraction of early-onset primary aldosteronism.

摘要

原醛症,一种常见的重度高血压病因,其特征是肾上腺类固醇醛固酮的组成性产生。我们分析了一个家族性 II 型原醛症(FH-II)的多重家族,以及另外 80 名早期发病的未解决原醛症的个体。8 名个体存在 CLCN2 的新型杂合变体,包括两个新生突变和四个相同 p.Arg172Gln 取代的独立发生;所有伴有早期发病的原醛症的亲属均携带在个体中发现的 CLCN2 变体。CLCN2 编码一种电压门控氯离子通道,在肾上腺球状带中表达,在超极化膜电位下开放。通道打开使球状带细胞去极化,并诱导醛固酮合酶的表达,这是醛固酮生物合成的限速酶。突变通道表现出功能获得,在球状带的静息电位下具有更高的开放概率。这些发现首次证明了阴离子通道在球状带膜电位确定、醛固酮产生和高血压中的作用。它们确定了早期发病的原醛症的一个相当大的比例的病因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2eac/5862758/b5ff0a0055dd/nihms929906f1.jpg

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