Hyperinsulinemic Hypoglycemia Associated with a Ca<sub>V</sub>1.2 Variant with Mixed Gain- and Loss-of-Function Effects

oleh: Sebastian Kummer, Susanne Rinné, Gunnar Seemann, Nadine Bachmann, Katherine Timothy, Paul S. Thornton, Frank Pillekamp, Ertan Mayatepek, Carsten Bergmann, Thomas Meissner, Niels Decher

Format: Article
Diterbitkan: MDPI AG 2022-07-01

Deskripsi

The voltage-dependent L-type calcium channel isoform Ca<sub>V</sub>1.2 is critically involved in many physiological processes, e.g., in cardiac action potential formation, electromechanical coupling and regulation of insulin secretion by beta cells. Gain-of-function mutations in the calcium voltage-gated channel subunit alpha 1 C (<i>CACNA1C</i>) gene, encoding the Ca<sub>V</sub>1.2 α<sub>1</sub>-subunit, cause Timothy syndrome (TS), a multisystemic disorder that includes autism spectrum disorders and long QT (LQT) syndrome. Strikingly, TS patients frequently suffer from hypoglycemia of yet unproven origin. Using next-generation sequencing, we identified a novel heterozygous <i>CACNA1C</i> mutation in a patient with congenital hyperinsulinism (CHI) and associated hypoglycemic episodes. We characterized the electrophysiological phenotype of the mutated channel using voltage-clamp recordings and in silico action potential modeling experiments. The identified Ca<sub>V</sub>1.2<sup>L566P</sup> mutation causes a mixed electrophysiological phenotype of gain- and loss-of-function effects. In silico action potential modeling supports that this mixed electrophysiological phenotype leads to a tissue-specific impact on beta cells compared to cardiomyocytes. Thus, <i>CACNA1C</i> variants may be associated with non-syndromic hyperinsulinemic hypoglycemia without long-QT syndrome, explained by very specific electrophysiological properties of the mutated channel. We discuss different biochemical characteristics and clinical impacts of hypoglycemia in the context of <i>CACNA1C</i> variants and show that these may be associated with significant morbidity for Timothy Syndrome patients. Our findings underline that the potential of hypoglycemia warrants careful attention in patients with <i>CACNA1C</i> variants, and such variants should be included in the differential diagnosis of non-syndromic congenital hyperinsulinism.