title: Mutations in KCNJ11 are associated with the development of autosomal dominant, early-onset type 2 diabetes.
abstract: OBJECTIVE
  More than 90% of Chinese familial early-onset type 2 diabetes mellitus is genetically unexplained. To investigate the molecular aetiology, we identified and characterised whether mutations in the KCNJ11 gene are responsible for these families.
  
  
  METHODS
  KCNJ11 mutations were screened for 96 familial early-onset type 2 diabetic probands and their families. Functional significance of the identified mutations was confirmed by physiological analysis, molecular modelling and population survey.
  
  
  RESULTS
  Three novel KCNJ11 mutations, R27H, R192H and S116F117del, were identified in three families with early-onset type 2 diabetes mellitus. Mutated KCNJ11 with R27H or R192H markedly reduced ATP sensitivity (E23K>R27H>C42R>R192H>R201H), but no ATP-sensitive potassium channel currents were detected in the loss-of-function S116F117del channel in vitro. Molecular modelling indicated that R192H had a larger effect on the channel ATP-binding pocket than R27H, which may qualitatively explain why the ATP sensitivity of the R192H mutation is seven times less than R27H. The shape of the S116F117del channel may be compressed, which may explain why the mutated channel had no currents. Discontinuation of insulin and implementation of sulfonylureas for R27H or R192H carriers and continuation/switch to insulin therapy for S116F117del carriers resulted in good glycaemic control.
  
  
  CONCLUSIONS
  Our results suggest that genetic diagnosis for the KCNJ11 mutations in familial early-onset type 2 diabetes mellitus may help in understanding the molecular aetiology and in providing more personalised treatment for these specific forms of diabetes in Chinese and other Asian patients.
authors.affiliation: Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, 600 Yishan Road, Shanghai, 200233, China, lmliu@sjtu.edu.cn.
authors.forename: Limei
authors.initials: L
authors.lastname: Liu
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nagashima
authors.forename: Takao
authors.initials: T
authors.lastname: Yasuda
authors.forename: Yanjun
authors.initials: Y
authors.lastname: Liu
authors.forename: Hai-Rong
authors.initials: HR
authors.lastname: Hu
authors.forename: Guang
authors.initials: G
authors.lastname: He
authors.forename: Bo
authors.initials: B
authors.lastname: Feng
authors.forename: Mingming
authors.initials: M
authors.lastname: Zhao
authors.forename: Langen
authors.initials: L
authors.lastname: Zhuang
authors.forename: Taishan
authors.initials: T
authors.lastname: Zheng
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Friedman
authors.forename: Kunsan
authors.initials: K
authors.lastname: Xiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019943:Amino Acid Substitution; D044466:Asian People / Q000235:genetics*; D002648:Child; D004252:DNA Mutational Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000235:genetics*; D005260:Female; D006442:Glycated Hemoglobin / Q000235:genetics; D006801:Humans; D054086:KATP Channels / Q000097:blood / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense; D010375:Pedigree; D024661:Potassium Channels, Inwardly Rectifying / Q000235:genetics*; D000099161:Kcnj11 Channel
chemical_list: D006442:Glycated Hemoglobin; D054086:KATP Channels; D024661:Potassium Channels, Inwardly Rectifying; D000099161:Kcnj11 Channel; C517652:hemoglobin A1c protein, human
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