Species differences in Cl- affinity and in electrogenicity of SLC26A6-mediated oxalate/Cl- exchange correlate with the distinct human and mouse susceptibilities to nephrolithiasis

Ion transport in the intestine

PURPOSE OF REVIEW

In recent years, the field of intestinal physiology has witnessed significant progress in our understanding of the expression and function of ion transport proteins and their genes under physiological and pathophysiological conditions. This review will present some of these most recent advances in the small intestinal ion transport mechanisms.

RECENT FINDINGS

One of the new and exciting aspects of this field has been the integration of function and structure of several intestinal transport processes. This is well exemplified by the discussed intricacies of intestinal bicarbonate secretion as well as the role of scaffolding PDZ proteins interacting with several transporters. We also discuss some of the most recent data pointing to the role of ion transporters in the pathogenesis of inflammation-associated diarrhea and their potential role in the maintenance of epithelial integrity.

SUMMARY

Mouse models deficient in some of the key genes encoding ion transporters and their adapter proteins continue to provide important clues into intestinal transport processes. Several of the new in-vivo findings revise or complement past paradigms, many of which were derived from in-vitro approaches. New data on the interdependent functions of multiple transporters, as exemplified here by intestinal bicarbonate secretion, increase the complexity of the intestinal ion transport mechanisms and continue to contribute to a more integrated view of the transport phenomena in the gut. Data from patients and mouse models of intestinal inflammation also increase our understanding of the pathophysiology of inflammation-associated diarrhea.

Phenotypic and functional analysis of human SLC26A6 variants in patients with familial hyperoxaluria and calcium oxalate nephrolithiasis

BACKGROUND

Urinary oxalate is a major risk factor for calcium oxalate stones. Marked hyperoxaluria arises from mutations in 2 separate loci, AGXT and GRHPR, the causes of primary hyperoxaluria (PH) types 1 (PH1) and 2 (PH2), respectively. Studies of null Slc26a6(-/-) mice have shown a phenotype of hyperoxaluria, hyperoxalemia, and calcium oxalate urolithiasis, leading to the hypothesis that SLC26A6 mutations may cause or modify hyperoxaluria in humans.

STUDY DESIGN

Cross-sectional case-control.

SETTING & PARTICIPANTS

Cases were recruited from the International Primary Hyperoxaluria Registry. Control DNA samples were from a pool of adult subjects who identified themselves as being in good health.

PREDICTOR

PH1, PH2, and non-PH1/PH2 genotypes in cases.

OUTCOMES & MEASURES

Homozygosity or compound heterozygosity for SLC26A6 variants. Functional expression of oxalate transport in Xenopus laevis oocytes.

RESULTS

80 PH1, 6 PH2, 8 non-PH1/PH2, and 96 control samples were available for SLC26A6 screening. A rare variant, c.487C-->T (p.Pro163Ser), was detected solely in 1 non-PH1/PH2 pedigree, but this variant failed to segregate with hyperoxaluria, and functional studies of oxalate transport in Xenopus oocytes showed no transport defect. No other rare variant was identified specifically in non-PH1/PH2. Six additional missense variants were detected in controls and cases. Of these, c.616G-->A (p.Val206Met) was most common (11%) and showed a 30% reduction in oxalate transport. To test p.Val206Met as a potential modifier of hyperoxaluria, we extended screening to PH1 and PH2. Heterozygosity for this variant did not affect plasma or urine oxalate levels in this population.

LIMITATIONS

We did not have a sufficient number of cases to determine whether homozygosity for p.Val206Met might significantly affect urine oxalate.

CONCLUSIONS

SLC26A6 was effectively ruled out as the disease gene in this non-PH1/PH2 cohort. Taken together, our studies are the first to identify and characterize SLC26A6 variants in patients with hyperoxaluria. Phenotypic and functional analysis excluded a significant effect of identified variants on oxalate excretion.