Glyburide ameliorates motor coordination and glucose homeostasis in a child with diabetes associated with the KCNJ11/S225T, del226-232 mutation.
Gain-of-function mutations of KCNJ11 can cause permanent neonatal diabetes mellitus, but only rarely after 6 months of age. Specific uncommon mutations KCNJ11give rise to a syndrome defined as developmental delay, epilepsy, and neonatal diabetes (DEND), or - more frequently - to a milder sub-type lacking epilepsy, denoted as intermediate-DEND (iDEND). Our aim was to consider a possible monogenic etiology in a 12-yr-old boy with early onset diabetes and mild neurological features. We studied a subject diagnosed with diabetes at 21 months of age, and negative to type 1 diabetes autoantibodies testing. He had learning difficulties during primary school, and a single episode of seizures at the age of 10 yr. We performed direct DNA sequencing of the KCNJ11 gene with subsequent functional study of mutated channels in COSm6 cells. The patient's clinical response to oral glyburide (Glyb) was assessed. Motor coordination was evaluated before and after 6 and 12 months of Glyb therapy. Sequencing of the KCNJ11 gene detected the novel, spontaneous mutation S225T, combined with deletion of amino acids 226-232. In vitro studies revealed that the mutation results in a K(ATP)  channel with reduced sensitivity to the inhibitory action of ATP. Glyb improved diabetes control (hemoglobin A1c on insulin: 52 mmol/mol/6.9%; on Glyb: 36 mmol/mol/5.4%) and also performance on motor coordination tests that were impaired before the switch of therapy. We conclude that KCNJ11/S225T, del226-232 mutation caused a mild iDEND form in our patient. KCNJ11 should be considered as the etiology of diabetes even beyond the neonatal period if present in combination with negative autoantibody testing and even mild neurological symptoms.
Child Neurology Unit, Department of Pediatrics, Sacro Cuore Catholic University, Rome, Italy.
Domenica
D
Battaglia
Yu-Wen
YW
Lin
Claudia
C
Brogna
Antonino
A
Crinò
Valeria
V
Grasso
Alessia F
AF
Mozzi
Lucia
L
Russo
Sabrina
S
Spera
Carlo
C
Colombo
Stefano
S
Ricci
Colin G
CG
Nichols
Eugenio
E
Mercuri
Fabrizio
F
Barbetti
D002648:Child; D048909:Diabetes Complications / Q000188:drug therapy; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000235:genetics*; D003929:Diabetic Neuropathies / Q000188:drug therapy*; D004827:Epilepsy; D005905:Glyburide / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D009048:Motor Skills / Q000187:drug effects; D024661:Potassium Channels, Inwardly Rectifying / Q000235:genetics*; D011597:Psychomotor Performance / Q000187:drug effects; D017384:Sequence Deletion / Q000235:genetics*; D000099161:Kcnj11 Channel
D005905:Glyburide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D024661:Potassium Channels, Inwardly Rectifying; D000099161:Kcnj11 Channel