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Codon Arg15 mutations of the AP2S1 gene: common occurrence in familial hypocalciuric hypercalcemia cases negative for calcium-sensing receptor (CASR) mutations.
[familial hypocalciuric hypercalcemia]
Familial
hypocalciuric
hypercalcemia
(
FHH
)
is
an
autosomal
dominant
disorder
with
three
known
subtypes
:
FHH
1
,
FHH
2
,
and
FHH
3
.
About
65
%
of
FHH
cases
are
FHH
1
,
caused
by
inactivating
mutations
of
the
calcium-sensing
receptor
(
CASR
)
gene
.
FHH
3
was
recently
found
to
be
caused
by
codon
Arg
15
(
p
.
R
15
)
mutations
in
the
adaptor-related
protein
complex
2
,
σ-
2
subunit
that
interacts
with
the
CaSR
and
is
encoded
by
the
AP
2
S
1
gene
.
T
he
objective
of
the
study
was
to
assess
the
prevalence
of
AP
2
S
1
mutations
,
and
describe
the
phenotype
of
FHH
3
,
in
an
independent
cohort
of
FHH
subjects
lacking
CASR
mutations
.
Thirty
-
nine
patients
presenting
with
some
combination
of
hypercalcemia
,
hypermagnesemia
,
nonsuppressed
serum
PTH
levels
,
and
reduced
urinary
calcium
excretion
were
studied
.
Exon
2
of
the
AP
2
S
1
gene
was
PCR
amplified
from
patient
genomic
DNA
and
Sanger
sequenced
.
The
presence
of
p
.
R
15
mutations
was
confirmed
by
restriction
enzyme
analysis
.
Five
of
the
39
subjects
had
AP
2
S
1
p
.
R
15
mutations
,
a
frequency
of
13
%
.
The
three
recurrent
mutations
reported
previously
were
all
found
in
our
cohort
(
p
.
R
15
C
in
two
,
p
.
R
15
L
in
two
,
and
p
.
R
15
H
in
one
subject
)
.
The
FHH
3
phenotype
did
not
differ
materially
from
that
of
FHH
1
due
to
CASR
mutations
.
T
he
results
affirm
that
a
significant
number
of
patients
suspected
of
having
FHH
but
proven
negative
for
CASR
mutation
have
AP
2
S
1
p
.
R
15
mutations
.
Screening
for
AP
2
S
1
p
.
R
15
mutations
in
such
cases
should
be
considered
,
given
the
clinical
benefits
(
avoiding
unnecessary
parathyroidectomy
)
that
have
already
been
demonstrated
for
CASR
screening
in
FHH
1
.
Diseases
Validation
Diseases presenting
"recurrent mutations"
symptom
dedifferentiated liposarcoma
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
familial hypocalciuric hypercalcemia
junctional epidermolysis bullosa
kindler syndrome
neuralgic amyotrophy
papillon-lefèvre syndrome
phenylketonuria
x-linked adrenoleukodystrophy
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