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Mutations affecting G-protein subunit α11 in hypercalcemia and hypocalcemia.
[familial hypocalciuric hypercalcemia]
Familial
hypocalciuric
hypercalcemia
is
a
genetically
heterogeneous
disorder
with
three
variants
:
types
1
,
2
,
and
3
.
Type
1
is
due
to
loss
-of-function
mutations
of
the
calcium-sensing
receptor
,
a
guanine
nucleotide-binding
protein
(
G-
protein
)
-
coupled
receptor
that
signals
through
the
G-
protein
subunit
α
11
(
Gα
11
)
.
Type
3
is
associated
with
adaptor-related
protein
complex
2
,
sigma
1
subunit
(
AP
2
S
1
)
mutations
,
which
result
in
altered
calcium-sensing
receptor
endocytosis
.
We
hypothesized
that
type
2
is
due
to
mutations
effecting
Gα
11
loss
of
function
,
since
Gα
11
is
involved
in
calcium-sensing
receptor
signaling
,
and
its
gene
(
GNA
11
)
and
the
type
2
locus
are
colocalized
on
chromosome
19
p
13
.
3
.
We
also
postulated
that
mutations
effecting
Gα
11
gain
of
function
,
like
the
mutations
effecting
calcium-sensing
receptor
gain
of
function
that
cause
autosomal
dominant
hypocalcemia
type
1
,
may
lead
to
hypocalcemia
.
We
performed
GNA
11
mutational
analysis
in
a
kindred
with
familial
hypocalciuric
hypercalcemia
type
2
and
in
nine
unrelated
patients
with
familial
hypocalciuric
hypercalcemia
who
did
not
have
mutations
in
the
gene
encoding
the
calcium-sensing
receptor
(
CASR
)
or
AP
2
S
1
.
We
also
performed
this
analysis
in
eight
unrelated
patients
with
hypocalcemia
who
did
not
have
CASR
mutations
.
In
addition
,
we
studied
the
effects
of
GNA
11
mutations
on
Gα
11
protein
structure
and
calcium-sensing
receptor
signaling
in
human
embryonic
kidney
293
(
HEK
293
)
cells
.
T
he
kindred
with
familial
hypocalciuric
hypercalcemia
type
2
had
an
in
-frame
deletion
of
a
conserved
Gα
11
isoleucine
(
Ile
200
del
)
,
and
one
of
the
nine
unrelated
patients
with
familial
hypocalciuric
hypercalcemia
had
a
missense
GNA
11
mutation
(
Leu
135
Gln
)
.
Missense
GNA
11
mutations
(
Arg
181
G
ln
and
Phe
341
L
eu
)
were
detected
in
two
unrelated
patients
with
hypocalcemia
;
they
were
therefore
identified
as
having
autosomal
dominant
hypocalcemia
type
2
.
All
four
GNA
11
mutations
predicted
disrupted
protein
structures
,
and
assessment
on
the
basis
of
in
vitro
expression
showed
that
familial
hypocalciuric
hypercalcemia
type
2
-
associated
mutations
decreased
the
sensitivity
of
cells
expressing
calcium
-sensing
receptors
to
changes
in
extracellular
calcium
concentrations
,
whereas
autosomal
dominant
hypocalcemia
type
2
-
associated
mutations
increased
cell
sensitivity
.
Gα
11
mutants
with
loss
of
function
cause
familial
hypocalciuric
hypercalcemia
type
2
,
and
Gα
11
mutants
with
gain
of
function
cause
a
clinical
disorder
designated
as
autosomal
dominant
hypocalcemia
type
2
.
(
Funded
by
the
United
Kingdom
Medical
Research
Council
and
others
.
)
.
Diseases
Validation
Diseases presenting
"hypocalcemia"
symptom
22q11.2 deletion syndrome
child syndrome
cystinuria
familial hypocalciuric hypercalcemia
oligodontia
primary hyperoxaluria type 1
This symptom has already been validated