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Louis-Dit-Picard H, Kouranti I, Rafael C, Loisel-Ferreira I, Chavez-Canales M, Abdel-Khalek W, Argaiz ER, Baron S, Vacle S, Migeon T, Coleman R, Do Cruzeiro M, Hureaux M, Thurairajasingam N, Decramer S, Girerd X, O'Shaugnessy K, Mulatero P, Roussey G, Tack I, Unwin R, Vargas-Poussou R, Staub O, Grimm R, Welling PA, Gamba G, Clauser E, Hadchouel J, Jeunemaitre X. Mutation affecting the conserved acidic WNK1 motif causes inherited hyperkalemic hyperchloremic acidosis. J Clin Invest 2021; 130:6379-6394. [PMID: 32790646 DOI: 10.1172/jci94171] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/11/2020] [Indexed: 01/01/2023] Open
Abstract
Gain-of-function mutations in with no lysine (K) 1 (WNK1) and WNK4 genes are responsible for familial hyperkalemic hypertension (FHHt), a rare, inherited disorder characterized by arterial hypertension and hyperkalemia with metabolic acidosis. More recently, FHHt-causing mutations in the Kelch-like 3-Cullin 3 (KLHL3-CUL3) E3 ubiquitin ligase complex have shed light on the importance of WNK's cellular degradation on renal ion transport. Using full exome sequencing for a 4-generation family and then targeted sequencing in other suspected cases, we have identified new missense variants in the WNK1 gene clustering in the short conserved acidic motif known to interact with the KLHL3-CUL3 ubiquitin complex. Affected subjects had an early onset of a hyperkalemic hyperchloremic phenotype, but normal blood pressure values"Functional experiments in Xenopus laevis oocytes and HEK293T cells demonstrated that these mutations strongly decrease the ubiquitination of the kidney-specific isoform KS-WNK1 by the KLHL3-CUL3 complex rather than the long ubiquitous catalytically active L-WNK1 isoform. A corresponding CRISPR/Cas9 engineered mouse model recapitulated both the clinical and biological phenotypes. Renal investigations showed increased activation of the Ste20 proline alanine-rich kinase-Na+-Cl- cotransporter (SPAK-NCC) phosphorylation cascade, associated with impaired ROMK apical expression in the distal part of the renal tubule. Together, these new WNK1 genetic variants highlight the importance of the KS-WNK1 isoform abundance on potassium homeostasis.
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Affiliation(s)
| | | | - Chloé Rafael
- Université de Paris, INSERM, PARCC, F-75006, Paris, France.,INSERM UMR_S1155, Tenon Hospital, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Maria Chavez-Canales
- Université de Paris, INSERM, PARCC, F-75006, Paris, France.,Translational Medicine Unit, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México and Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
| | | | - Eduardo R Argaiz
- Molecular Physiology Unit, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Stéphanie Baron
- Université de Paris, INSERM, PARCC, F-75006, Paris, France.,Service d'Explorations Fonctionnelles, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015, Paris, France
| | - Sarah Vacle
- Department of Pharmacology and Toxicology, University of Lausanne, Lausanne, Switzerland
| | | | - Richard Coleman
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Marguerite Hureaux
- Université de Paris, INSERM, PARCC, F-75006, Paris, France.,AP-HP, Département de Génétique, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Stéphane Decramer
- Service de Néphrologie Pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Xavier Girerd
- AP-HP, Institute of Cardiometabolism and Nutrition (ICAN), Unité de Prévention Cardiovasculaire, Hôpital de La Pitié-Salpêtrière, Paris, France
| | - Kevin O'Shaugnessy
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Gwenaëlle Roussey
- Néphrologie Pédiatrique-Clinique Médicale Pédiatrique, Hôpital Mère Enfant, CHU de Nantes, Nantes, France
| | - Ivan Tack
- Service des Explorations Fonctionnelles Physiologiques, CHU de Toulouse et INSERM U1048-I2MC, Toulouse, France
| | - Robert Unwin
- UCL Department of Renal Medicine, University College London, Royal Free Campus and Hospital, London, United Kingdom
| | - Rosa Vargas-Poussou
- AP-HP, Département de Génétique, Hôpital Européen Georges Pompidou, Paris, France
| | - Olivier Staub
- Department of Pharmacology and Toxicology, University of Lausanne, Lausanne, Switzerland
| | - Richard Grimm
- Departments of Medicine, Nephrology, and Physiology, Johns Hopkins University Medical School, Baltimore, Maryland, USA
| | - Paul A Welling
- Departments of Medicine, Nephrology, and Physiology, Johns Hopkins University Medical School, Baltimore, Maryland, USA
| | - Gerardo Gamba
- Molecular Physiology Unit, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Eric Clauser
- Université de Paris, INSERM, PARCC, F-75006, Paris, France
| | - Juliette Hadchouel
- Université de Paris, INSERM, PARCC, F-75006, Paris, France.,INSERM UMR_S1155, Tenon Hospital, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Xavier Jeunemaitre
- Université de Paris, INSERM, PARCC, F-75006, Paris, France.,AP-HP, Département de Génétique, Hôpital Européen Georges Pompidou, Paris, France
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