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Glover M, Ware J, Henry A, Wolley M, Walsh R, Wain L, Xu S, Van’t Hoff W, Tobin M, Hall I, Cook S, Gordon R, Stowasser M, O’Shaughnessy K. Detection of mutations in KLHL3 and CUL3 in families with FHHt (familial hyperkalaemic hypertension or Gordon's syndrome). Clin Sci (Lond) 2014; 126:721-6. [PMID: 24266877 PMCID: PMC3963521 DOI: 10.1042/cs20130326] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/11/2013] [Accepted: 11/25/2013] [Indexed: 11/29/2022]
Abstract
The study of families with rare inherited forms of hypo- and hyper-tension has been one of the most successful strategies to probe the molecular pathophysiology of blood pressure control and has revealed dysregulation of distal nephron Na+ reabsorption to be a common mechanism. FHHt (familial hyperkalaemic hypertension; also known as Gordon's syndrome) is a salt-dependent form of hypertension caused by mutations in the regulators of the thiazide-sensitive Na+-Cl- co-transporter NCC [also known as SLC12A3 (solute carrier family 12 member 3)] and is effectively treated by thiazide diuretics and/or dietary salt restriction. Variation in at least four genes can cause FHHt, including WNK1 [With No lysine (=K) 1] and WNK4, KLHL3 (kelch-like family member 3), and CUL3 (cullin 3). In the present study we have identified novel disease-causing variants in CUL3 and KLHL3 segregating in 63% of the pedigrees with previously unexplained FHHt, confirming the importance of these recently described FHHt genes. We have demonstrated conclusively, in two unrelated affected individuals, that rare intronic variants in CUL3 cause the skipping of exon 9 as has been proposed previously. KLHL3 variants all occur in kelch-repeat domains and so probably disrupt WNK complex binding. We have found no evidence of any plausible disease-causing variants within SLC4A8 (an alternative thiazide-sensitive sodium transporter) in this population. The results of the present study support the existing evidence that the CUL3 and KLHL3 gene products are physiologically important regulators of thiazide-sensitive distal nephron NaCl reabsorption, and hence potentially interesting novel anti-hypertensive drug targets. As a third of our non-WNK FHHt families do not have plausible CUL3 or KLHL3 variants, there are probably additional, as yet undiscovered, regulators of the thiazide-sensitive pathways.
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Key Words
- diuretic
- gordon's syndrome
- hypertension
- hyperkalaemia
- pseudohypoaldosteronism
- thiazide
- cul3, cullin 3
- fhht, familial hyperkalaemic hypertension
- gan, gigaxonin
- ibd, identity by descent
- klhl3, kelch-like family member 3
- ncc, na+–cl− co-transporter
- ngs, next-generation sequencing
- slc, solute carrier
- snp, single nucleotide polymorphism
- spak, ste20/sps1-related proline/alanine-rich kinase
- ste20, sterile 20
- wnk, with no lysine (=k)
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Affiliation(s)
- Mark Glover
- *Division of Therapeutics and Molecular Medicine, University of Nottingham,
Nottingham, U.K
| | - James S. Ware
- †NIHR Biomedical Research Unit in Cardiovascular Disease at Royal Brompton and
Harefield NHS Foundation Trust and Imperial College London, London, U.K
- ‡National Heart and Lung Institute, Imperial College, London, U.K
| | - Amanda Henry
- *Division of Therapeutics and Molecular Medicine, University of Nottingham,
Nottingham, U.K
| | - Martin Wolley
- §Endocrine Hypertension Research Centre, University of Queensland School of
Medicine, Brisbane, Australia
| | - Roddy Walsh
- †NIHR Biomedical Research Unit in Cardiovascular Disease at Royal Brompton and
Harefield NHS Foundation Trust and Imperial College London, London, U.K
| | - Louise V. Wain
- ¶Genetic Epidemiology Group, University of Leicester, Leicester, U.K
| | - Shengxin Xu
- §Endocrine Hypertension Research Centre, University of Queensland School of
Medicine, Brisbane, Australia
| | - William G. Van’t Hoff
- ∥Paediatric Nephrology Department, Great Ormond Street Hospital for Children,
London, U.K
| | - Martin D. Tobin
- ¶Genetic Epidemiology Group, University of Leicester, Leicester, U.K
| | - Ian P. Hall
- *Division of Therapeutics and Molecular Medicine, University of Nottingham,
Nottingham, U.K
| | - Stuart Cook
- ‡National Heart and Lung Institute, Imperial College, London, U.K
- **Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore, Singapore
- ††National Heart Centre Singapore, Singapore
| | - Richard D. Gordon
- §Endocrine Hypertension Research Centre, University of Queensland School of
Medicine, Brisbane, Australia
| | - Michael Stowasser
- §Endocrine Hypertension Research Centre, University of Queensland School of
Medicine, Brisbane, Australia
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