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Seidowsky A, Villain C, Vilaine E, Baudoin R, Tabarin A, Kottler ML, Cavalier É, Souberbielle JC, Massy ZA. [Hypercalcemia and inactive mutation of CYP24A1. Case-study and literature review]. Nephrol Ther 2017; 13:146-153. [PMID: 28456639 DOI: 10.1016/j.nephro.2017.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 02/07/2023]
Abstract
We present the case of a family whose members have high levels of serum calcium (hypercalcaemia) by loss of function of the enzyme vitamin D 24-hydroxylase due to bi-allelic mutations in the CYP24A1 gene: c.443 T>C (p.Leu148Pro) and c.1187 G>A (p.Arg396Gln). 24-VITD hydroxylase is a key player in regulating the circulating calcitriol, its tissue concentration and its biological effects. Transmission is recessive. The estimated prevalence of stones in the affected subjects is estimated between 10 and 15%. The loss of peripheral catabolism of vitamin D metabolites in patients with an inactivating mutation of CYP24A1 is responsible for persistent high levels of 1,25-dihydroxyvitamin D especially after sun exposure and a charge of native vitamin D. Although there are currently no recommendations (French review) on this subject, this disease should be suspected in association with recurrent calcium stones with nephrocalcinosis, and a calcitriol-dependent hypercalcaemia with adapted low parathyroid hormone levels. Resistance to corticosteroid therapy distinguishes it from other calcitriol-dependent hypercalcemia. A ratio of 25-hydroxyvitamin D/24.25 hydroxyvitamin D>50, is in favor of hypercalcemia with vitamin D deficiency 24-hydroxylase. Genetic analysis of CYP24A1 should be performed at the second step. The current therapeutic management includes the restriction native vitamin D supplementation and the limitation of sun exposure. Biological monitoring will be based on serum calcium control and modulation of parathyroid hormone concentrations.
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Affiliation(s)
- Alexandre Seidowsky
- Service de néphrologie, hôpital Ambroise Paré, université Versailles-Saint-Quentin en Yvelines, AP-HP, 9 avenue Charles-de-Gaulle, 92140 Boulogne-Billancourt, France; Service de néphrologie-hémodialyse, hôpital Américain de Paris, 63, boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France.
| | - Cédric Villain
- Service de néphrologie, hôpital Ambroise Paré, université Versailles-Saint-Quentin en Yvelines, AP-HP, 9 avenue Charles-de-Gaulle, 92140 Boulogne-Billancourt, France; Université Versailles-Saint-Quentin, inserm U-1018, CESP équipe 5, EpRec, 55, avenue de Paris, 78000 Versailles, France
| | - Eve Vilaine
- Service de néphrologie, hôpital Ambroise Paré, université Versailles-Saint-Quentin en Yvelines, AP-HP, 9 avenue Charles-de-Gaulle, 92140 Boulogne-Billancourt, France; Université Versailles-Saint-Quentin, inserm U-1018, CESP équipe 5, EpRec, 55, avenue de Paris, 78000 Versailles, France
| | - Roselyne Baudoin
- Service endocrinologie diabète et nutrition, CHU de Bordeaux USN, avenue Magellan-Haut-Lévèque, 33604 Pessac, France
| | - Antoine Tabarin
- Service endocrinologie diabète et nutrition, CHU de Bordeaux USN, avenue Magellan-Haut-Lévèque, 33604 Pessac, France
| | - Marie-Laure Kottler
- Service de génétique, CHU de Caen, hôpital Clémenceau, avenue George Clémenceau, 14033 Caen, France
| | - Étienne Cavalier
- Department of clinical chemistry, University of Liège, CHU Sart-Tilman, 4000 Liège, Belgique
| | - Jean-Claude Souberbielle
- Laboratoire d'explorations fonctionnelles, hôpital Necker-Enfants-Malades, 149 rue de Sèvres, 75014 Paris, France
| | - Ziad A Massy
- Service de néphrologie, hôpital Ambroise Paré, université Versailles-Saint-Quentin en Yvelines, AP-HP, 9 avenue Charles-de-Gaulle, 92140 Boulogne-Billancourt, France; Université Versailles-Saint-Quentin, inserm U-1018, CESP équipe 5, EpRec, 55, avenue de Paris, 78000 Versailles, France
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Zalewski A, Ma NS, Legeza B, Renthal N, Flück CE, Pandey AV. Vitamin D-Dependent Rickets Type 1 Caused by Mutations in CYP27B1 Affecting Protein Interactions With Adrenodoxin. J Clin Endocrinol Metab 2016; 101:3409-18. [PMID: 27399352 DOI: 10.1210/jc.2016-2124] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT CYP27B1 converts 25-hydroxyvitamin D3 to active 1,25-dihydroxyvitamin D3, playing a vital role in calcium homeostasis and bone growth. Vitamin D-dependent rickets type 1 (VDDR-1) is a rare autosomal recessive disorder caused by mutations in CYP27B1. OBJECTIVE The objective of the study was an enzymatic and structural analysis of mutations in a patient with calcipenic rickets. Design, Setting, Patient, and Intervention: Two siblings presented with calcipenic rickets and normal 1,25-dihydroxyvitamin D3 levels. CYP27B1 gene analysis showed compound heterozygous mutations confirming VDDR-1. We studied wild-type CYP27B1 and mutations H441Y and R459L by computational homology modeling, molecular dynamics simulations, and functional studies using a luciferase assay. The patients were successfully treated with calcitriol. MAIN OUTCOME The main outcomes of the study were novel mutations leading to a severe loss of CYP27B1 activities for metabolism of 25-hydroxyvitamin D3. RESULTS Mitochondrial cytochrome P450s require adrenodoxin (FDX1) and adrenodoxin reductase. We created models of CYP27B1-FDX1 complex, which revealed negative effects of mutations H441Y and R459L. Upon structural analysis, near-identical folds, protein contact areas, and orientations of heme/iron-sulfur cluster suggested that both mutations may destabilize the CYP27B1-FDX1 complex by negating directional interactions with adrenodoxin. This system is highly sensitive to small local changes modulating the binding/dissociation of adrenodoxin, and electron-transporting efficiency might change with mutations at the surface. Functional assays confirmed this hypothesis and showed severe loss of activity of CYP27B1 by both mutations. CONCLUSIONS This is the first report of mutations in CYP27B1 causing VDDR-1 by affecting protein-protein interactions with FDX1 that results in reduced CYP27B1 activities. Detailed characterization of mutations in CYP27B1 is required for understanding the novel molecular mechanisms causing VDDR-1.
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Affiliation(s)
- Adam Zalewski
- Division of Pediatric Endocrinology, Diabetology, and Metabolism (A.Z., B.L., C.E.F., A.V.P.), Department of Pediatrics, University Children's Hospital, Inselspital, Bern, and Department of Clinical Research, University of Bern, CH-3010 Bern, Switzerland; and Division of Endocrinology (N.S.M., N.R.), Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02114
| | - Nina S Ma
- Division of Pediatric Endocrinology, Diabetology, and Metabolism (A.Z., B.L., C.E.F., A.V.P.), Department of Pediatrics, University Children's Hospital, Inselspital, Bern, and Department of Clinical Research, University of Bern, CH-3010 Bern, Switzerland; and Division of Endocrinology (N.S.M., N.R.), Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02114
| | - Balazs Legeza
- Division of Pediatric Endocrinology, Diabetology, and Metabolism (A.Z., B.L., C.E.F., A.V.P.), Department of Pediatrics, University Children's Hospital, Inselspital, Bern, and Department of Clinical Research, University of Bern, CH-3010 Bern, Switzerland; and Division of Endocrinology (N.S.M., N.R.), Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02114
| | - Nora Renthal
- Division of Pediatric Endocrinology, Diabetology, and Metabolism (A.Z., B.L., C.E.F., A.V.P.), Department of Pediatrics, University Children's Hospital, Inselspital, Bern, and Department of Clinical Research, University of Bern, CH-3010 Bern, Switzerland; and Division of Endocrinology (N.S.M., N.R.), Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02114
| | - Christa E Flück
- Division of Pediatric Endocrinology, Diabetology, and Metabolism (A.Z., B.L., C.E.F., A.V.P.), Department of Pediatrics, University Children's Hospital, Inselspital, Bern, and Department of Clinical Research, University of Bern, CH-3010 Bern, Switzerland; and Division of Endocrinology (N.S.M., N.R.), Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02114
| | - Amit V Pandey
- Division of Pediatric Endocrinology, Diabetology, and Metabolism (A.Z., B.L., C.E.F., A.V.P.), Department of Pediatrics, University Children's Hospital, Inselspital, Bern, and Department of Clinical Research, University of Bern, CH-3010 Bern, Switzerland; and Division of Endocrinology (N.S.M., N.R.), Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02114
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Shah AD, Hsiao EC, O'Donnell B, Salmeen K, Nussbaum R, Krebs M, Baumgartner-Parzer S, Kaufmann M, Jones G, Bikle DD, Wang Y, Mathew AS, Shoback D, Block-Kurbisch I. Maternal Hypercalcemia Due to Failure of 1,25-Dihydroxyvitamin-D3 Catabolism in a Patient With CYP24A1 Mutations. J Clin Endocrinol Metab 2015; 100:2832-6. [PMID: 26097993 PMCID: PMC4524985 DOI: 10.1210/jc.2015-1973] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Calcium metabolism changes in pregnancy and lactation to meet fetal needs, with increases in 1,25-dihydroxyvitamin D [1,25-(OH)2D] during pregnancy playing an important role. However, these changes rarely cause maternal hypercalcemia. When maternal hypercalcemia occurs, further investigation is essential, and disorders of 1,25-(OH)2D catabolism should be carefully considered in the differential diagnosis. CASE A patient with a childhood history of recurrent renal stone disease and hypercalciuria presented with recurrent hypercalcemia and elevated 1,25-(OH)2D levels during pregnancy. Laboratory tests in the fourth pregnancy showed suppressed PTH, elevated 1,25-(OH)2D, and high-normal 25-hydroxyvitamin D levels, suggesting disordered vitamin D metabolism. Analysis revealed low 24,25-dihydroxyvitamin D3 and high 25-hydroxyvitamin D3 levels, suggesting loss of function of CYP24A1 (25-hydroxyvitamin-D3-24-hydroxylase). Gene sequencing confirmed that she was a compound heterozygote with the E143del and R396W mutations in CYP24A1. CONCLUSIONS This case broadens presentations of CYP24A1 mutations and hypercalcemia in pregnancy. Furthermore, it illustrates that patients with CYP24A1 mutations can maintain normal calcium levels during the steady state but can develop hypercalcemia when challenged, such as in pregnancy when 1,25-(OH)2D levels are physiologically elevated.
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Affiliation(s)
- Arti D Shah
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Edward C Hsiao
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Betsy O'Donnell
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Kirsten Salmeen
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Robert Nussbaum
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Michael Krebs
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Sabina Baumgartner-Parzer
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Martin Kaufmann
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Glenville Jones
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Daniel D Bikle
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - YongMei Wang
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Allen S Mathew
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Dolores Shoback
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
| | - Ingrid Block-Kurbisch
- Division of Endocrinology, Department of Medicine (A.D.S., E.C.H., D.S., I.B.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences (B.O., K.S.), and Division of Medical Genetics, Department of Medicine (R.N.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology and Metabolism (M.Kr., S.B.-P.), Medical University of Vienna, A-1090 Vienna, Austria; Department of Biomedical and Molecular Sciences (M.Ka., G.J.), Queen's University, Kingston, Ontario, Canada K7L 3N6; Endocrine Research Unit (D.D.B., Y.M., D.S.), San Francisco Department of Veterans Affairs Medical Center; San Francisco, California 94121; and Redwood Renal Associates (A.S.M.), Eureka, California 95501
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