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Novel mutations in the calcium‐sensing receptor gene associated with biochemical and functional differences in familial hypocalciuric hypercalcaemia
Author(s) -
Ward Bryan K.,
Magno Aaron L.,
Blitvich Bradley J.,
Rea Alexander J.,
Stuckey Bronwyn G. A.,
Walsh John P.,
Ratajczak Thomas
Publication year - 2006
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2006.02512.x
Subject(s) - missense mutation , mutant , mutation , calcium sensing receptor , biology , endocrinology , receptor , wild type , genetics , medicine , gene , nonsense mutation , phenotype , calcium , calcium metabolism
Summary Objective Heterozygous inactivating mutations of the calcium‐sensing receptor (CaR) gene cause familial hypocalciuric hypercalcaemia (FHH), a generally benign disorder characterized by mild to moderate PTH‐dependent hypercalcaemia. We aimed to identify the causative CaR mutations in three families with FHH and examine the correlation between type of mutation and biochemical and/or functional phenotypes. Patients, design and measurements The CaR gene from FHH family members was assessed for mutations by direct DNA sequencing and mutations were confirmed by restriction enzyme analysis. Functional studies on two missense mutations were conducted by introducing them by site‐directed mutagenesis into the CaR cloned into a mammalian expression vector, and assessing calcium responsiveness using an inositol phosphate (IP) assay in HEK293 cells. Biochemical data from patients heterozygous for each type of mutant were correlated with functionality. Results Two novel nonsense mutations (R25stop and K323stop) and one novel missense mutation (G778D) were identified. The G778D mutant receptor and another mutation identified in an earlier study (L174R) demonstrated a complete lack of Ca 2+ responsiveness using the IP assay. When cotransfected with wild‐type receptor, the mutant receptors demonstrated a dominant‐negative effect on wild‐type receptor response, with L174R having a more pronounced effect than G778D. Significantly more severe hypercalcaemia and a trend towards higher PTH levels were observed in patients heterozygous for CaR mutants with a stronger dominant‐negative effect. Conclusions Naturally occurring CaR mutations with differences in dominant‐negative effect on wild‐type receptor demonstrate differences in biochemical severity in FHH.