title: A novel CYP11B2 gene mutation in an Asian family with aldosterone synthase deficiency.
abstract: BACKGROUND
  Three siblings of Pakistani origin presented neonatally with isolated hyperreninemic hypoaldosteronism and were well controlled on fludrocortisone therapy during childhood and adolescence.
  
  
  OBJECTIVE
  These individuals were reevaluated as adults after fludrocortisone withdrawal to investigate the biochemical and molecular basis of their disorder.
  
  
  RESULTS
  When reassessed off fludrocortisone treatment, hyperreninemic hypoaldosteronism was confirmed in all subjects but with significant hyperkalemia in only one case. Profiling of urinary steroid metabolites showed a biochemical pattern (elevated tetrahydrocorticosterone to 18-hydroxytetrahydro-11-dehydrocorticosterone ratio but normal 18-hydroxytetrahydro-11-dehydrocorticosterone to tetrahydroaldosterone ratio) consistent with partial type 1 aldosterone synthase deficiency. Sequencing of the CYP11B2 gene showed that affected subjects were homozygous for a single nucleotide substitution (T925C) in exon 5, corresponding to a serine to proline mutation (S308P) in the predicted protein, with unaffected family members being heterozygous. Consistent with structural modeling showing that the mutated residue is located within the alpha-helix I, close to the hemebinding, active site of the enzyme, functional characterization of the S308P mutant protein in vitro showed complete loss of enzyme activity. However, administration of dexamethasone further reduced levels of circulating aldosterone and its urinary metabolites in affected subjects, suggesting that some mineralocorticoid biosynthesis occurs in vivo.
  
  
  CONCLUSIONS
  We have identified the first CYP11B2 gene defect in a family of Asian origin, associated with a type 1 aldosterone synthase deficiency phenotype. Preservation of some aldosterone production suggests either residual mutant CYP11B2 enzyme activity in vivo or mineralocorticoid biosynthesis via an alternative pathway.
authors.affiliation: Department of Medicine, University of Cambridge, Cambridge CB2 1TN, United Kingdom.
authors.forename: Kristian
authors.initials: K
authors.lastname: Løvås
authors.forename: Ian
authors.initials: I
authors.lastname: McFarlane
authors.forename: Huy-Hoang
authors.initials: HH
authors.lastname: Nguyen
authors.forename: Suzanne
authors.initials: S
authors.lastname: Curran
authors.forename: John
authors.initials: J
authors.lastname: Schwabe
authors.forename: David
authors.initials: D
authors.lastname: Halsall
authors.forename: Rita
authors.initials: R
authors.lastname: Bernhardt
authors.forename: A Michael
authors.initials: AM
authors.lastname: Wallace
authors.forename: V Krishna K
authors.initials: VK
authors.lastname: Chatterjee
mesh_terms: D000328:Adult; D000450:Aldosterone / Q000097:blood; D019405:Cytochrome P-450 CYP11B2 / Q000172:deficiency* / Q000235:genetics*; D006801:Humans; D008297:Male; D009154:Mutation
chemical_list: D000450:Aldosterone; D019405:Cytochrome P-450 CYP11B2