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