Deciphering genetic signatures by whole exome sequencing in a case of co-prevalence of severe renal hypouricemia and diabetes with impaired insulin secretion.

BACKGROUND: Renal hypouricemia (RHUC) is a hereditary disorder where mutations in SLC22A12 gene and SLC2A9 gene cause RHUC type 1 (RHUC1) and RHUC type 2 (RHUC2), respectively. These genes regulate renal tubular reabsorption of urates while there exist other genes counterbalancing the net excretion of urates including ABCG2 and SLC17A1. Urate metabolism is tightly interconnected with glucose metabolism, and SLC2A9 gene may be involved in insulin secretion from pancreatic ß-cells. On the other hand, a myriad of genes are responsible for the impaired insulin secretion independently of urate metabolism. CASE PRESENTATION: We describe a 67 year-old Japanese man who manifested severe hypouricemia (0.7 mg/dl (3.8-7.0 mg/dl), 41.6 µmol/l (226-416 µmol/l)) and diabetes with impaired insulin secretion. His high urinary fractional excretion of urate (65.5%) and low urinary C-peptide excretion (25.7 µg/day) were compatible with the diagnosis of RHUC and impaired insulin secretion, respectively. Considering the fact that metabolic pathways regulating urates and glucose are closely interconnected, we attempted to delineate the genetic basis of the hypouricemia and the insulin secretion defect observed in this patient using whole exome sequencing. Intriguingly, we found homozygous Trp258* mutations in SLC22A12 gene causing RHUC1 while concurrent mutations reported to be associated with hyperuricemia were also discovered including ABCG2 (Gln141Lys) and SLC17A1 (Thr269Ile). SLC2A9, that also facilitates glucose transport, has been implicated to enhance insulin secretion, however, the non-synonymous mutations found in SLC2A9 gene of this patient were not dysfunctional variants. Therefore, we embarked on a search for causal mutations for his impaired insulin secretion, resulting in identification of multiple mutations in HNF1A gene (MODY3) as well as other genes that play roles in pancreatic ß-cells. Among them, the Leu80fs in the homeobox gene NKX6.1 was an unreported mutation. CONCLUSION: We found a case of RHUC1 carrying mutations in SLC22A12 gene accompanied with compensatory mutations associated with hyperuricemia, representing the first report showing coexistence of the mutations with opposed potential to regulate urate concentrations. On the other hand, independent gene mutations may be responsible for his impaired insulin secretion, which contains novel mutations in key genes in the pancreatic ß-cell functions that deserve further scrutiny.

Effect of enamel matrix derivative on the differentiation of C2C12 cells.

BACKGROUND: Although enamel matrix derivative (EMD) can initiate de novo cementum and bone formation by stimulating and inducing differentiation of mesenchymal cells in the periodontal ligament, the molecular mechanism of this phenomenon is not fully understood. The purpose of this study was to determine the effect of EMD on the differentiation of pluripotential mesenchymal cells. METHODS: A typical pluripotential mesenchymal cell line, C2C12, was used to clarify the effect of EMD on cell differentiation. The cells were cultured in 5% serum-containing medium to induce cell differentiation, either with or without the addition of EMD. Differentiation to myoblasts was analyzed by immunostaining of desmin and type II myosin heavy chains. Osteoblast differentiation was evaluated by measuring alkaline phosphatase (ALPase) activity. Furthermore, to verify the cell lineage after culture with EMD, mRNA expression of cellular phenotype-specific markers characterizing osteoblasts (ALPase and osteocalcin), chondroblasts (type X collagen), myoblasts (desmin and MyoD), and adipocytes (lipoprotein lipase) was studied using semiquantitative reverse transcription-polymerase chain reaction. RESULTS: C2C12 cells cultured in differentiation medium without EMD altered their phenotype to myoblasts, exhibiting positive reactions to desmin and myosin heavy chains by immunological analysis. However, the cells cultured in the presence of EMD were strongly inhibited from developing into myoblasts, and showed high ALPase activity that was approximately 2 to 4 times greater than that of the vehicle. The mRNA expression of ALPase, osteocalcin, and type X collagen was increased markedly by the EMD-stimulated medium, whereas the expression of desmin, MyoD, and lipoprotein lipase was drastically decreased. CONCLUSIONS: Our study provides clear evidence that EMD converts the differentiation pathway of C2C12 cells into the osteoblast and/or chondroblast lineage.