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Calcium signaling regulates trafficking of familial hypocalciuric hypercalcemia (FHH) mutants of the calcium sensing receptor.
[familial hypocalciuric hypercalcemia]
Calcium
-sensing
receptors
(
CaSRs
)
regulate
systemic
Ca
(
2
+
)
homeostasis
.
Loss
-of-function
mutations
cause
familial
benign
hypocalciuric
hypercalcemia
(
FHH
)
or
neonatal
severe
hyperparathyroidism
(
NSHPT
)
.
FHH
/
NSHPT
mutations
can
reduce
trafficking
of
CaSRs
to
the
plasma
membrane
.
CaSR
signaling
is
potentiated
by
agonist-driven
anterograde
CaSR
trafficking
,
leading
to
a
new
steady
state
level
of
plasma
membrane
CaSR
,
which
is
maintained
,
with
minimal
functional
desensitization
,
as
long
as
extracellular
Ca
(
2
+
)
is
elevated
.
This
requirement
for
CaSR
signaling
to
drive
CaSR
trafficking
to
the
plasma
membrane
led
us
to
reconsider
the
mechanism
(
s
)
contributing
to
dysregulated
trafficking
of
FHH
/
NSHPT
mutants
.
We
simultaneously
monitored
dynamic
changes
in
plasma
membrane
levels
of
CaSR
and
intracellular
Ca
(
2
+
)
,
using
a
chimeric
CaSR
construct
,
which
allowed
explicit
tracking
of
plasma
membrane
levels
of
mutant
or
wild-
type
CaSRs
in
the
presence
of
nonchimeric
partners
.
Expression
of
mutants
alone
revealed
severe
defects
in
plasma
membrane
targeting
and
Ca
(
2
+
)
signaling
,
which
were
substantially
rescued
by
coexpression
with
wild-
type
CaSR
.
Biasing
toward
heterodimerization
of
wild-
type
and
FHH
/
NSHPT
mutants
revealed
that
intracellular
Ca
(
2
+
)
oscillations
were
insufficient
to
rescue
plasma
membrane
targeting
.
Coexpression
of
the
nonfunctional
mutant
E
297
K
with
the
truncation
CaSRΔ
868
robustly
rescued
trafficking
and
Ca
(
2
+
)
signaling
,
whereas
coexpression
of
distinct
FHH
/
NSHPT
mutants
rescued
neither
trafficking
nor
signaling
.
Our
study
suggests
that
rescue
of
FHH
/
NSHPT
mutants
requires
a
steady
state
intracellular
Ca
(
2
+
)
response
when
extracellular
Ca
(
2
+
)
is
elevated
and
argues
that
Ca
(
2
+
)
signaling
by
wild-
type
CaSRs
rescues
FHH
mutant
trafficking
to
the
plasma
membrane
.
Diseases
Validation
Diseases presenting
"a new steady state level of plasma membrane casr"
symptom
familial hypocalciuric hypercalcemia
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