title: Mutants of glucokinase cause hypoglycaemia- and hyperglycaemia syndromes and their analysis illuminates fundamental quantitative concepts of glucose homeostasis.
abstract: OBJECTIVE
  Mutations of the glucokinase gene cause hyperglycaemia or hypoglycaemia. A quantitative understanding of these defects of glucose homeostasis linked to the glucokinase gene was lacking. Therefore a database of kinetic variables of wild-type and 20 missense mutants of glucokinase was developed and used in mathematical modelling to predict the thresholds for glucose-stimulated insulin release.
  
  
  METHODS
  Recombinant human glucokinase was generated in E. coli. The k(cat), glucose S(0.5), ATP K(m), and Hill number of glucokinase were determined. Inhibition by Stearoyl CoA and glucokinase regulatory protein and thermal stability were assayed for all mutants kinetically similar to wild-type glucokinase. A mathematical model predicting the threshold for glucose-stimulated insulin release was constructed. This model is based on the two substrate kinetics of glucokinase and the kinetic variables of the database. It is assumed that both glucokinase gene alleles are equally expressed in beta-cells and that induction of glucokinase occurs as a function of basal blood glucose.
  
  
  RESULTS
  Large changes, varying greatly between mutants were found in nearly all variables. Glucokinase flux at threshold for glucose-stimulated insulin release was about 25 % of total phosphorylating potential in the normal beta-cell and this was used to predict thresholds for the mutant heterozygotes. Clinical data for maturity onset diabetes of the young type linked to the glucokinase gene and familial hyperinsulinaemic hypoglycaemia linked to the glucokinase gene and the glucokinase kinetic data of this study were used to test the model. The model predicts fasting blood glucose between 3 and 7 mmol/l in these cases.
  
  
  CONCLUSIONS
  A kinetics database of wild-type and 20 mutants of glucokinase was developed. Many kinetic differences were found for the mutants. The mathematical model to calculate the threshold for glucose-stimulated insulin release predicts fasting blood glucose between 3 and 7 mmol/l in subjects with glucokinase gene mutations. [Diabetologia 42: 1175-1186]
authors.affiliation: Department of Biochemistry and Biophysics and the Diabetes Research Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Davis
authors.forename: A
authors.initials: A
authors.lastname: Cuesta-Muñoz
authors.forename: M
authors.initials: M
authors.lastname: Raoul
authors.forename: C
authors.initials: C
authors.lastname: Buettger
authors.forename: I
authors.initials: I
authors.lastname: Sweet
authors.forename: M
authors.initials: M
authors.lastname: Moates
authors.forename: M A
authors.initials: MA
authors.lastname: Magnuson
authors.forename: F M
authors.initials: FM
authors.lastname: Matschinsky
mesh_terms: D048868:Adaptor Proteins, Signal Transducing; D000255:Adenosine Triphosphate / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D002352:Carrier Proteins; D004789:Enzyme Activation / Q000187:drug effects / Q000235:genetics; D004795:Enzyme Stability; D005941:Glucokinase / Q000037:antagonists & inhibitors / Q000235:genetics* / Q000378:metabolism*; D005947:Glucose / Q000494:pharmacology / Q000502:physiology*; D005982:Glutathione Transferase / Q000235:genetics; D006706:Homeostasis; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000235:genetics*; D007003:Hypoglycemia / Q000097:blood / Q000235:genetics*; D007328:Insulin / Q000097:blood; D008954:Models, Biological; D009154:Mutation; D011506:Proteins / Q000494:pharmacology; D011993:Recombinant Fusion Proteins / Q000235:genetics / Q000302:isolation & purification / Q000378:metabolism; D013577:Syndrome
chemical_list: D048868:Adaptor Proteins, Signal Transducing; D001786:Blood Glucose; D002352:Carrier Proteins; C485100:GCKR protein, human; D007328:Insulin; D011506:Proteins; D011993:Recombinant Fusion Proteins; C080906:glucokinase regulatory protein; D000255:Adenosine Triphosphate; D005982:Glutathione Transferase; D005941:Glucokinase; D005947:Glucose