Familial hyperkalemic hypertension : highlight of new genes and physiopathological analysis

L’Hypertension Hyperkaliémique Familiale (HHF) est une forme rare d’hypertension associée à une hyperkaliémie et une acidose métabolique hyperchlorémique, très sensible aux diurétiques thiazidiques. Les premières analyses génétiques ont permis d’identifier deux gènes responsables, WNK1 et WNK4, mais qui n’expliquaient que 8 % de notre cohorte. L’objectif de ma thèse était de rechercher de nouveaux gènes ou variants à l’origine de l’HHF. Notre stratégie initiale a été de combiner une analyse de liaison à un séquençage d’exome entier sur trois grandes familles atteintes. Nous avons ainsi identifié un nouveau gène responsable de la maladie codant pour un acteur jusque là insoupçonné, KLHL3 (Kelch-like 3), responsable de 39% des cas de notre cohorte. La majorité des mutations sont présentes à l’état hétérozygote entrainant un phénotype modéré, alors que les rares patients porteurs d’une mutation homozygote, tous issus de familles consanguines, présentent un phénotype plus marqué. Le spectre des mutations a montré l’importance des structures en boucles de cette protéine qui joue un rôle d’adaptateur de substrat dans un complexe d’ubiquitination (publié dans Nature Genetics, 2012). La découverte d’un type unique de mutations sur le gène CUL-3 par une équipe concurrente a été confirmée dans notre cohorte, entrainant un phénotype plus précoce et plus sévère. Ces mutations ont mis en lumière l’importance de ces deux protéines dans la constitution du complexe E3 ubiquitine-ligase et la dégradation des WNKs dans le néphron, par le protéasome après ubiquitination. Nous avons aussi identifié des mutations faux-sens dans le domaine acide de WNK1 très conservé chez des patients ayant un phénotype HHF mais sans hypertension artérielle. Ce motif, similaire à celui porteur de mutations sur WNK4 est responsable de la liaison à l’adaptateur de substrat KLHL3. Les sujets atteints présentent un âge plus précoce d’apparition de la maladie avec des valeurs de pression artérielle normales. La comparaison phénotypique avec les cas porteurs d’une mutation WNK4 et d’une délétion de l’intron 1 de WNK1 a montré des différences de pression artérielle significatives. La transfection d’ARNc mutés dans les œufs de Xénope, effectuées en collaboration, a permis de démontrer que ces nouvelles mutations faux-sens de WNK1 entrainent une accumulation de son isoforme rénale KS-WNK1 (soumis à J Am Soc Nephrol). L’ensemble de ces résultats ouvre une nouvelle voie de compréhension moléculaire de la régulation du transport des ions sodium, potassium et chlore au niveau du rein et par conséquence de la pression artérielle.Familial Hyperkalemia Hypertension (FHHt), also known as Gordon syndrome is a rare form of hypertension associated with hyperkalemia and hyperchloremic metabolic acidosis, very sensitive to thiazide diuretics. In 2001, the first genetic analysis identified two genes, coding for two serine/threonine kinases WNK1 and WNK4, which explained only 8% of our cohort. The aim of my thesis was to search new genes or variants responsible for FHHt. We decided to combine a linkage analysis and a whole exome sequencing in three affected families. We identified a new gene responsible for the disease coding for an unsuspected actor KLHL3 (Kelch-like 3), responsible for 39% of our cohort. The majority of the mutations are present at a heterozygous state leading to a moderate phenotype, whereas patients with homozygous mutation, all from consanguineous families, displayed a stronger phenotype. The spectrum of mutations showed the importance of the loop structures of this protein playing an adaptor role in an ubiquitination complex (published in Nature Genetics, 2012). The discovery of a particular type of mutations in CUL-3 by another team was confirmed in our cohort, leading to an earlier and more severe phenotype. These changes have highlighted the importance of these two proteins in the formation of the E3 ubiquitin-ligase-complex and in the WNKs degradation in the nephron by the proteasome after ubiquitination. We have also identified missense mutations in the acidic motif of WNK1, highly conserved in patients with FHHt without hypertension. This pattern is similar to the WNK4 mutations and is responsible for the binding of the substrate adaptor KLHL3. Affected individuals have an earlier age of onset with normal blood pressure values for most of them. Phenotypic comparison with cases carrying WNK4 mutations and deletion of the intron 1 of WNK1 showed significant differences in blood pressure values. Transfection of mutated cRNA in Xenopus laevis oocyte demonstrated that these new WNK1 missense mutations result in the accumulation of the renal isoform KS-WNK1 (submitted to J Am Soc Nephrol). Taken together, these results open a new pathway for understanding the molecular regulation of ion transport and WNK kinases in the kidney and consequently the regulation of blood pressure

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Investigating iRHOM2-Associated Transcriptional Changes in Tylosis With Esophageal Cancer

Background and Aims: Survival rates for esophageal squamous cell carcinoma (ESCC) are extremely low due to the late diagnosis of most cases. An understanding of the early molecular processes that lead to ESCC may facilitate opportunities for early diagnosis; however, these remain poorly defined. Tylosis with esophageal cancer (TOC) is a rare syndrome associated with a high lifetime risk of ESCC and germline mutations in RHBDF2, encoding iRhom2. Using TOC as a model of ESCC predisposition, this study aimed to identify early-stage transcriptional changes in ESCC development. Methods: Esophageal biopsies were obtained from control and TOC individuals, the latter undergoing surveillance endoscopy, and adjacent diagnostic biopsies were graded as having no dysplasia or malignancy. Bulk RNA-Seq was performed, and findings were compared with sporadic ESCC vs normal RNA-Seq datasets. Results: Multiple transcriptional changes were identified in TOC samples, relative to controls, and many were detected in ESCC. Accordingly, pathway analyses predicted an enrichment of cancer-associated processes linked to cellular proliferation and metastasis, and several transcription factors were predicted to be associated with TOC and ESCC, including negative enrichment of GRHL2. Subsequently, a filtering strategy revealed 22 genes that were significantly dysregulated in both TOC and ESCC. Moreover, Keratin 17, which was upregulated in TOC and ESCC, was also found to be overexpressed at the protein level in ‘normal’ TOC esophagus tissue. Conclusion: Transcriptional changes occur in TOC esophagus prior to the onset of dysplasia, many of which are associated with ESCC. These findings support the utility of TOC to help reveal the early molecular processes that lead to sporadic ESCC

Distinct Effects of Allelic NFIX Mutations on Nonsense-Mediated mRNA Decay Engender Either a Sotos-like or a Marshall-Smith Syndrome

By using a combination of array comparative genomic hybridization and a candidate gene approach, we identified nuclear factor I/X (NFIX) deletions or nonsense mutation in three sporadic cases of a Sotos-like overgrowth syndrome with advanced bone age, macrocephaly, developmental delay, scoliosis, and unusual facies. Unlike the aforementioned human syndrome, Nfix-deficient mice are unable to gain weight and die in the first 3 postnatal weeks, while they also present with a spinal deformation and decreased bone mineralization. These features prompted us to consider NFIX as a candidate gene for Marshall-Smith syndrome (MSS), a severe malformation syndrome characterized by failure to thrive, respiratory insufficiency, accelerated osseous maturation, kyphoscoliosis, osteopenia, and unusual facies. Distinct frameshift and splice NFIX mutations that escaped nonsense-mediated mRNA decay (NMD) were identified in nine MSS subjects. NFIX belongs to the Nuclear factor one (NFI) family of transcription factors, but its specific function is presently unknown. We demonstrate that NFIX is normally expressed prenatally during human brain development and skeletogenesis. These findings demonstrate that allelic NFIX mutations trigger distinct phenotypes, depending specifically on their impact on NMD

ARTICLE Distinct Effects of Allelic NFIX Mutations on Nonsense-Mediated mRNA Decay Engender Either a Sotos-like or a Marshall-Smith Syndrome

By using a combination of array comparative genomic hybridization and a candidate gene approach, we identified nuclear factor I/X (NFIX) deletions or nonsense mutation in three sporadic cases of a Sotos-like overgrowth syndrome with advanced bone age, macrocephaly, developmental delay, scoliosis, and unusual facies. Unlike the aforementioned human syndrome, Nfix-deficient mice are unable to gain weight and die in the first 3 postnatal weeks, while they also present with a spinal deformation and decreased bone mineralization. These features prompted us to consider NFIX as a candidate gene for Marshall-Smith syndrome (MSS), a severe malformation syndrome characterized by failure to thrive, respiratory insufficiency, accelerated osseous maturation, kyphoscoliosis, osteopenia, and unusual facies. Distinct frameshift and splice NFIX mutations that escaped nonsense-mediated mRNA decay (NMD) were identified in nine MSS subjects. NFIX belongs to the Nuclear factor one (NFI) family of transcription factors, but its specific function is presently unknown. We demonstrate that NFIX is normally expressed prenatally during human brain development and skeletogenesis. These findings demonstrate that allelic NFIX mutations trigger distinct phenotypes, depending specifically on their impact on NMD

Mutation affecting the conserved acidic WNK1 motif causes inherited hyperkalemic hyperchloremic acidosis.

Gain-of-function mutations in with no lysine (K) 1 (WNK1) and WNK4 genes are responsible for familial hyperkalemic hypertension (FHHt), a rare, inherited disorder characterized by arterial hypertension and hyperkalemia with metabolic acidosis. More recently, FHHt-causing mutations in the Kelch-like 3-Cullin 3 (KLHL3-CUL3) E3 ubiquitin ligase complex have shed light on the importance of WNK's cellular degradation on renal ion transport. Using full exome sequencing for a 4-generation family and then targeted sequencing in other suspected cases, we have identified new missense variants in the WNK1 gene clustering in the short conserved acidic motif known to interact with the KLHL3-CUL3 ubiquitin complex. Affected subjects had an early onset of a hyperkalemic hyperchloremic phenotype, but normal blood pressure values"Functional experiments in Xenopus laevis oocytes and HEK293T cells demonstrated that these mutations strongly decrease the ubiquitination of the kidney-specific isoform KS-WNK1 by the KLHL3-CUL3 complex rather than the long ubiquitous catalytically active L-WNK1 isoform. A corresponding CRISPR/Cas9 engineered mouse model recapitulated both the clinical and biological phenotypes. Renal investigations showed increased activation of the Ste20 proline alanine-rich kinase-Na+-Cl- cotransporter (SPAK-NCC) phosphorylation cascade, associated with impaired ROMK apical expression in the distal part of the renal tubule. Together, these new WNK1 genetic variants highlight the importance of the KS-WNK1 isoform abundance on potassium homeostasis