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Identification and functional characterization of loss-of-function mutations of the calcium-sensing receptor in four Italian kindreds with familial hypocalciuric hypercalcemia.
[familial hypocalciuric hypercalcemia]
Identification
and
characterization
of
calcium-sensing
receptor
(
CASR
)
mutations
in
four
unrelated
Italian
kindreds
with
familial
hypocalciuric
hypercalcemia
.
Clinical
evaluation
and
genetic
analysis
of
CASR
gene
.
Functional
characterization
of
mutated
CASRs
.
Direct
sequencing
of
CASR
gene
in
genomic
DNA
.
Studies
of
CASR
-mediated
increases
in
cytosolic
calcium
concentration
[
Ca
(
2
)
(
+
)
]
(
i
)
in
CASR
-transfected
COS
-
7
cells
in
vitro
.
Four
unreported
heterozygous
CASR
mutations
were
identified
,
including
three
missense
(
H
595
Y
,
P
748
H
,
and
C
7
65
W
)
and
one
splice
site
(
IVS
2
+
1
G
>
C
)
mutation
.
The
H
595
Y
,
P
748
H
,
and
C
7
65
W
mutant
receptors
,
although
expressed
at
normal
levels
on
the
cell
surface
,
showed
a
reduced
response
in
[
Ca
(
2
)
(
+
)
]
(
i
)
relative
to
the
wildtype
(
WT
)
CASR
to
increasing
extracellular
calcium
concentrations
.
Cotransfection
experiments
showed
that
the
H
595
Y
and
P
748
H
mutants
did
not
affect
the
apparent
affinity
of
the
WT
CASR
for
calcium
,
suggesting
that
they
do
not
exert
a
dominant-negative
effect
.
On
the
other
hand
,
the
co
-transfected
C
7
65
W
mutant
decreased
the
maximum
response
of
the
WT
CASR
to
calcium
,
suggesting
that
it
may
reduce
the
effective
concentration
of
the
normal
CASR
on
the
cell
surface
or
impair
its
maximal
signaling
capacity
.
Four
CASR
mutations
were
identified
.
The
reduced
functional
responses
to
extracellular
calcium
and
normal
expression
of
the
mutant
receptors
suggest
that
conformational
changes
account
for
altered
CASR
activity
.
Moreover
,
a
reduced
complement
of
normal
CASRs
in
these
heterozygous
patients
,
perhaps
combined
with
a
mutant
receptor-induced
decrease
in
maximal
activity
of
the
WT
receptor
,
may
contribute
to
defective
calcium
-sensing
in
vivo
.
Diseases
Validation
Diseases presenting
"reduced response in [ca"
symptom
familial hypocalciuric hypercalcemia
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