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Activating mutations in the gene encoding the ATP-sensitive potassium-channel subunit Kir6.2 and permanent neonatal diabetes

Activating mutations in the gene encoding the ATP-sensitive potassium-channel subunit Kir6.2 and permanent neonatal diabetes
Activating mutations in the gene encoding the ATP-sensitive potassium-channel subunit Kir6.2 and permanent neonatal diabetes
Background Patients with permanent neonatal diabetes usually present within the first three months of life and require insulin treatment. In most, the cause is unknown. Because ATP-sensitive potassium (KATP) channels mediate glucose-stimulated insulin secretion from the pancreatic beta cells, we hypothesized that activating mutations in the gene encoding the Kir6.2 subunit of this channel (KCNJ11) cause neonatal diabetes.
Methods We sequenced the KCNJ11 gene in 29 patients with permanent neonatal diabetes. The insulin secretory response to intravenous glucagon, glucose, and the sulfonylurea tolbutamide was assessed in patients who had mutations in the gene.
Results Six novel, heterozygous missense mutations were identified in 10 of the 29 patients. In two patients the diabetes was familial, and in eight it arose from a spontaneous mutation. Their neonatal diabetes was characterized by ketoacidosis or marked hyperglycemia and was treated with insulin. Patients did not secrete insulin in response to glucose or glucagon but did secrete insulin in response to tolbutamide. Four of the patients also had severe developmental delay and muscle weakness; three of them also had epilepsy and mild dysmorphic features. When the most common mutation in Kir6.2 was coexpressed with sulfonylurea receptor 1 in Xenopus laevis oocytes, the ability of ATP to block mutant KATP channels was greatly reduced.
Conclusions Heterozygous activating mutations in the gene encoding Kir6.2 cause permanent neonatal diabetes and may also be associated with developmental delay, muscle weakness, and epilepsy. Identification of the genetic cause of permanent neonatal diabetes may facilitate the treatment of this disease with sulfonylureas.
1838-1849
Gloyn, Anna L.
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Pearson, Ewan R.
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Antcliff, Jennifer F.
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Proks, Peter
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Bruining, Jan
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Slingerland, Annabelle S.
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Howard, Neville
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Srinivasan, Shubha
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Silva, José M.C.L.
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Molnes, Janne
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Edghill, Emma L.
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Frayling, Timothy M.
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Temple, I. Karen
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Mackay, Deborah
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Shield, Julain P.H.
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Sumnik, Zdenek
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Van Rhijn, Adrian
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Wales, J.erry K.H.
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Clark, Penelope
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Gorman, Shaun
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Aisenberg, Javier
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Ellard, Sian
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Njolstad, Pal R.
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Ashcroft, Frances M.
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Hattersley, Andrew T.
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Gloyn, Anna L.
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Pearson, Ewan R.
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Antcliff, Jennifer F.
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Proks, Peter
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Bruining, Jan
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Slingerland, Annabelle S.
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Howard, Neville
a285e3a3-abc5-4a2e-b0fa-0302239676a4
Srinivasan, Shubha
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Silva, José M.C.L.
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Molnes, Janne
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Edghill, Emma L.
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Frayling, Timothy M.
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Temple, I. Karen
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Mackay, Deborah
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Shield, Julain P.H.
e453c056-ee74-4800-bfdc-72068b3e9cd6
Sumnik, Zdenek
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Van Rhijn, Adrian
f737726a-01d9-45ff-8132-4b4e6cbe44d0
Wales, J.erry K.H.
b43917c8-8b81-4a26-a44d-ff8decf70adc
Clark, Penelope
48f2b1de-4941-4b81-8f0f-c8190ee53e77
Gorman, Shaun
e62bb721-bd84-45d6-92e1-bf104e05e72b
Aisenberg, Javier
23489b78-5eb3-4758-9991-e3ec0a98ac98
Ellard, Sian
6c9b0ede-8980-4602-b063-444b165baa09
Njolstad, Pal R.
d6ce42de-4987-4504-9631-244d966e2046
Ashcroft, Frances M.
f0452ff8-645e-4b32-8359-9567771fc88c
Hattersley, Andrew T.
429254b8-e75b-46bd-a6f6-274130336b0d

Gloyn, Anna L., Pearson, Ewan R., Antcliff, Jennifer F., Proks, Peter, Bruining, Jan, Slingerland, Annabelle S., Howard, Neville, Srinivasan, Shubha, Silva, José M.C.L., Molnes, Janne, Edghill, Emma L., Frayling, Timothy M., Temple, I. Karen, Mackay, Deborah, Shield, Julain P.H., Sumnik, Zdenek, Van Rhijn, Adrian, Wales, J.erry K.H., Clark, Penelope, Gorman, Shaun, Aisenberg, Javier, Ellard, Sian, Njolstad, Pal R., Ashcroft, Frances M. and Hattersley, Andrew T. (2004) Activating mutations in the gene encoding the ATP-sensitive potassium-channel subunit Kir6.2 and permanent neonatal diabetes. New England Journal of Medicine, 350 (18), 1838-1849. (doi:10.1056/NEJMoa032922).

Record type: Article

Abstract

Background Patients with permanent neonatal diabetes usually present within the first three months of life and require insulin treatment. In most, the cause is unknown. Because ATP-sensitive potassium (KATP) channels mediate glucose-stimulated insulin secretion from the pancreatic beta cells, we hypothesized that activating mutations in the gene encoding the Kir6.2 subunit of this channel (KCNJ11) cause neonatal diabetes.
Methods We sequenced the KCNJ11 gene in 29 patients with permanent neonatal diabetes. The insulin secretory response to intravenous glucagon, glucose, and the sulfonylurea tolbutamide was assessed in patients who had mutations in the gene.
Results Six novel, heterozygous missense mutations were identified in 10 of the 29 patients. In two patients the diabetes was familial, and in eight it arose from a spontaneous mutation. Their neonatal diabetes was characterized by ketoacidosis or marked hyperglycemia and was treated with insulin. Patients did not secrete insulin in response to glucose or glucagon but did secrete insulin in response to tolbutamide. Four of the patients also had severe developmental delay and muscle weakness; three of them also had epilepsy and mild dysmorphic features. When the most common mutation in Kir6.2 was coexpressed with sulfonylurea receptor 1 in Xenopus laevis oocytes, the ability of ATP to block mutant KATP channels was greatly reduced.
Conclusions Heterozygous activating mutations in the gene encoding Kir6.2 cause permanent neonatal diabetes and may also be associated with developmental delay, muscle weakness, and epilepsy. Identification of the genetic cause of permanent neonatal diabetes may facilitate the treatment of this disease with sulfonylureas.

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Published date: 29 April 2004

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Local EPrints ID: 24713
URI: http://eprints.soton.ac.uk/id/eprint/24713
PURE UUID: bde37013-bb09-4bd4-ab42-4970e1ef5103
ORCID for I. Karen Temple: ORCID iD orcid.org/0000-0002-6045-1781
ORCID for Deborah Mackay: ORCID iD orcid.org/0000-0003-3088-4401

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Date deposited: 03 Apr 2006
Last modified: 17 Dec 2019 01:54

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Contributors

Author: Anna L. Gloyn
Author: Ewan R. Pearson
Author: Jennifer F. Antcliff
Author: Peter Proks
Author: Jan Bruining
Author: Annabelle S. Slingerland
Author: Neville Howard
Author: Shubha Srinivasan
Author: José M.C.L. Silva
Author: Janne Molnes
Author: Emma L. Edghill
Author: Timothy M. Frayling
Author: I. Karen Temple ORCID iD
Author: Deborah Mackay ORCID iD
Author: Julain P.H. Shield
Author: Zdenek Sumnik
Author: Adrian Van Rhijn
Author: J.erry K.H. Wales
Author: Penelope Clark
Author: Shaun Gorman
Author: Javier Aisenberg
Author: Sian Ellard
Author: Pal R. Njolstad
Author: Frances M. Ashcroft
Author: Andrew T. Hattersley

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