ABCC8 p.Cys717*
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[hide] Histopathology of congenital hyperinsulinism: retr... Pediatr Dev Pathol. 2003 Jul-Aug;6(4):322-33. Suchi M, MacMullen C, Thornton PS, Ganguly A, Stanley CA, Ruchelli ED
Histopathology of congenital hyperinsulinism: retrospective study with genotype correlations.
Pediatr Dev Pathol. 2003 Jul-Aug;6(4):322-33., [PMID:14692646]
Abstract [show]
The majority of the most severe cases of congenital hyperinsulinism (HI) are caused by defects in the beta-cell adenosine triphosphate (ATP)-sensitive potassium channel and usually require pancreatectomy to control blood sugar levels. In contrast to the recent advances in understanding the pathophysiology and genetic bases of HI, the histologic classification of this condition remains controversial. A recent proposal to classify the HI pancreata into diffuse and focal forms has drawn much interest because of its relative simplicity and its good correlation with the genetic abnormalities. We undertook a retrospective study to determine whether this classification scheme could be applied to 38 pancreata resected for HI at our institution. We also obtained leukocyte genomic DNA from 29 cases and screened the exons of ABCC8 and KCNJ11 genes for the presence of mutations. Nineteen cases (50.0%) were histologically classified as diffuse HI and 14 cases (36.8%) were categorized as focal form. The mutational analysis revealed that 14 of the 16 diffuse cases analyzed had either homozygous or compound heterozygous mutations of ABCC8 or KCNJ11 and 7 of 10 focal cases had only the paternally inherited mutations, consistent with the previous observations. Two patients (5.3%) had normal pancreatic histology but had persistent hypoglycemia postoperatively, leaving the possibility of residual focal lesion. Three of 38 cases (7.9%) did not fit well into either diffuse or focal category. Two cases differed from the described pattern for the diffuse form in that the nuclear enlargement was confined to a single area of the pancreas. The other case had a focal lesion but beta-cell nuclear enlargement was present in nonadjacent areas. Mutations for typical diffuse or focal HI were not identified in two of these three equivocal cases. We conclude from this study that nearly 90% of HI cases can be classified into either a diffuse or a focal form. However, a small percentage of cases represented a diagnostic challenge.
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148 Clinical features, histologic diagnoses, and genotypes of HI patients Case no. Sex Age at surgery Type of pancreatectomy Immediate outcome Histology ABCC8 and KCNJ11 mutations (paternal/ maternala ) 1 F Newborn Near total Hypoglycemia Diffuse 3992-9 g to a/delF1388 2 F 5 m, 28 d Near total Hypoglycemia Diffuse ND 3 M 1 m, 14 d Near total Hypoglycemia Diffuse 3992-9 g to a/R1215Q 4 F 1 m, 6 d Near total Hypoglycemia Diffuse delF1388/3992-9 g to a 5 F 0 m, 28 d Near total Hypoglycemia Diffuse 3992-9 g to a/3992-9 g to a 6 M 0 m, 14 d Near total Hypoglycemia Diffuse 3992-9 g to a/delF1388 7 M 0 m, 17 d Near total Diabetes mellitus Diffuse 3992-9 g to a/3992-9 g to a 8 M 1 y, 11 m Near total Hypoglycemia Diffuse -/- 9 M 1 y, 2 m Near total Hypoglycemia Diffuse 3992-9 g to a/3992-9 g to a 10 M 1 m, 17 d Near total Hypoglycemia Diffuse ND 11 M 0 m, 27 d Near total Hypoglycemia Diffuse 3992-9 g to a/3992-9 g to a 12 F 1 m, 10 d Near total Hypoglycemia Diffuse ND 13 M 1 m, 3 d Partial Hypoglycemia Diffuse delF1388/3992-9 g to a 2 m, 24 d Partial Hypoglycemia Diffuse 2 y, 6 m Near total Hypoglycemia Diffuse 14 F 1 m, 7 d Near total Hypoglycemia Diffuse delF1388/3992-9 g to a 15 M 0 m, 16 d Near total Hypoglycemia Diffuse 3992-9 g to a/3992-9 g to a 16 F 1 y, 8 m Near total Hypoglycemia Diffuse -/- 17 F 4 m, 19 d Near total Diabetes mellitus Diffuse * G134Ab /* P266Lb 18 M 1 m, 5 d Near total Diabetes mellitus Diffuse * R74W/R1215Q 19 F 3 m, 27 d Near total Hypoglycemia Diffuse * R999X/* R598X 20 F Infant Near total Cure Focal ND 21 F 1 m, 16 d Near total Cure Focal ND 22 M 0 m, 13 d Near total Cure Focal ND 23 M 1 m, 7 d Near total Hypoglycemia Focal * 2116 ϩ 1 g to t (not maternal) 24 M 1 m, 26 d Near total Cure Focal ND 25 M 0 m, 15 d Near total Cure Focal 3992-9 g to a/- 26 M 1 m, 30 d Near total Cure Focal R1494Q/- 27 F 7 m, 24 d Near total Cure Focal -/- 28 M 0 m, 27 d 95% Hypoglycemia Normal 3992-9 g to a/- 1 m, 18 d Near total Hypoglycemia Focal 29 M 1 m, 27 d Near total Hypoglycemia Focal * 3576del g/- 2 m, 0 d Near total Hypoglycemia 2 m, 18 d Total Hypoglycemia 30 M 2 m, 28 d Near total Cure Focal * R74W/- 31 M 1 m, 2 d Near total Hypoglycemia Focal * C717X/- 32 F 1 m, 22 d Near total Cure Focal * 1874del c/- 33 M 2 m, 16 d 30% Cure Focal Q954X/- 34 F 2 m, 7 d 85% Hypoglycemia Normal ND 3 m, 4 d Near total Hypoglycemia Normal (continued) the patient underwent a mere 30% pancreatectomy.
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ABCC8 p.Cys717* 14692646:148:2197
status: NEW[hide] Preoperative evaluation of infants with focal or d... J Clin Endocrinol Metab. 2004 Jan;89(1):288-96. Stanley CA, Thornton PS, Ganguly A, MacMullen C, Underwood P, Bhatia P, Steinkrauss L, Wanner L, Kaye R, Ruchelli E, Suchi M, Adzick NS
Preoperative evaluation of infants with focal or diffuse congenital hyperinsulinism by intravenous acute insulin response tests and selective pancreatic arterial calcium stimulation.
J Clin Endocrinol Metab. 2004 Jan;89(1):288-96., [PMID:14715863]
Abstract [show]
Infants with congenital hyperinsulinism often require pancreatectomy. Recessive mutations of the ATP-dependent plasma membrane potassium channel (K(ATP)) genes, SUR1 and K(ir)6.2, cause diffuse hyperinsulinism. K(ATP) channel mutations can also cause focal disease through loss of heterozygosity for maternal 11p, resulting in expression of a paternal mutation. This study evaluated whether focal vs. diffuse hyperinsulinism could be diagnosed by acute insulin response (AIR) tests and whether arterial calcium stimulation/venous sampling (ASVS) could localize focal lesions. Fifty infants with diazoxide-unresponsive hyperinsulinism were studied. Focal lesions occurred in 70% of the cases. Positive AIR calcium occurred in 17 of 30 focal and 10 of 13 diffuse cases (P < 0.04). Positive AIR tolbutamide occurred in 27 of 30 focal vs. seven of 13 diffuse cases (P < 0.02); K(ATP) channel mutations were identified in four of the latter. ASVS localized the lesion in 24 of 33 focal cases (73%) but correctly diagnosed diffuse disease in only four of 13 cases. These results indicate that preoperative AIR tests do not distinguish focal vs. diffuse disease because some K(ATP) channel mutations retain responsiveness to tolbutamide. The ASVS test can be used to localize focal lesions in infants. The combination of ASVS, careful intraoperative histologic analysis, and surgical expertise succeeded in correcting hypoglycemia in 86% of the infants with focal hyperinsulinism.
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205 of alleles SUR1 region Exon 1 F27Sa 1 Exon 2 R74W 2 Exon 4 536-9 del atgga 1 Exon 4 N188S 1 Exon 5 ins 6a.a. 1 Exon 10 R495Qa 1 Exon 10 E501Ka 1 Intron 10 g 1630ϩ1 aa,b 1 Exon 12 R598X 1 Exon 13 1874 del c 1 Exon 15 F686Sa 1 Exon 16 C717X 1 Intron 24 c 2924-9 aa 1 Exon 24 2835-8 del agaga 2 Exon 24 Q954X 1 Exon 25 R999X 2 Exon 29 3576 del g 1 Exon 29 R1215Q 2 Exon 29 R1215Wa,b 2 Intron 32 g 3992-9 a 4 Exon 33 L1350Qa 1 Exon 33 G1401Ra 1 Exon 34 S1387F 1 Exon 34 delF1388 1 Exon 36 D1472Ha 1 Exon 36 D1472Na 1 Kir6.2 region A102Na 1 G134A 1 R136La 1 P266L 1 R301Ha 1 a Novel mutations.
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ABCC8 p.Cys717* 14715863:205:239
status: NEW[hide] Molecular and immunohistochemical analyses of the ... Mod Pathol. 2006 Jan;19(1):122-9. Suchi M, MacMullen CM, Thornton PS, Adzick NS, Ganguly A, Ruchelli ED, Stanley CA
Molecular and immunohistochemical analyses of the focal form of congenital hyperinsulinism.
Mod Pathol. 2006 Jan;19(1):122-9., [PMID:16357843]
Abstract [show]
Congenital hyperinsulinism is a rare pancreatic endocrine cell disorder that has been categorized histologically into diffuse and focal forms. In focal hyperinsulinism, the pancreas contains a focus of endocrine cell adenomatous hyperplasia, and the patients have been reported to possess paternally inherited mutations of the ABCC8 and KCNJ11 genes, which encode subunits of an ATP-sensitive potassium channel (K(ATP)). In addition, the hyperplastic endocrine cells show loss of maternal 11p15, where imprinted genes such as p57(kip2) reside. In order to evaluate whether all cases of focal hyperinsulinism are caused by this mechanism, 56 pancreatectomy specimens with focal hyperinsulinism were tested for the loss of maternal allele by two methods: immunohistochemistry for p57(kip2) (n=56) and microsatellite marker analysis (n=27). Additionally, 49 patients were analyzed for K(ATP) mutations. Out of 56 focal lesions, 48 demonstrated clear loss of p57(kip2) expression by immunohistochemistry. The other eight lesions similarly showed no nuclear labeling, but the available tissue was not ideal for definitive interpretation. Five of these eight patients had paternal K(ATP) mutations, of which four demonstrated loss of maternal 11p15 within the lesion by microsatellite marker analysis. All of the other three without a paternal K(ATP) mutation showed loss of maternal 11p15. K(ATP) mutation analysis identified 32/49 cases with paternal mutations. There were seven patients with nonmaternal mutations whose paternal DNA material was not available, and one patient with a mutation that was not present in either parent's DNA. These eight patients showed either loss of p57(kip2) expression or loss of maternal 11p15 region by microsatellite marker analysis, as did the remaining nine patients with no identifiable K(ATP) coding region mutations. The combined results from the immunohistochemical and molecular methods indicate that maternal 11p15 loss together with paternal K(ATP) mutation is the predominant causative mechanism of focal hyperinsulinism.
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93 KATP mutationsa Nuclear labeling of p57kip2 Microsatellite marker analysis at 11p15 Remarks on histology Lesion Islets in normal area 1 g3992-9a/ + ND 2 R1494Q/ + ND 3 V21D/ + ND 4 g3992-9a/ + ND 5 3576 del g/ Small lesion + ND 6 R74W/ Small normal area and weak Loss of maternal allele 7 C717X/ + Loss of maternal allele 8 1874 del c/ + ND 9 Q954X/ + ND 10 g3992-9g/ + Loss of maternal allele 11 E501K/ + Loss of maternal allele 12 R136Lb / Weak Loss of maternal allele 13 c2924-9a/ + Loss of maternal allele Focal lesion occupies large area of pancreas 14 g3992-9a/ + ND 15 3084 del g/ + ND 16 R302Hb / + Loss of maternal allele 17 g3992-9a/ + ND 18 536-539 del atgg/ + ND 19 R1215W/ + Loss of maternal allele 20 R999X/ + ND 21 L1350Q/ + ND 22 G1401R/ Weak Loss of maternal allele 23 g2041-21a/ + Loss of maternal allele 24 G7R/ Weak Loss of maternal allele 25 g3992-9a/ + Loss of maternal allele Rare nonadjacent large islet cell nuclei 26 g3992-9a/ + ND 27 Q954X/ + ND 28 delF1388/ + ND 29 Q472X/ + ND 30 G40Db / + Loss of maternal allele 31 S116Pb / + ND 32 g3992-9a/ + ND 33 g2116+1t, nonmaternal + ND 34 A101Db , nonmaternal Small normal area Loss of maternal allele Focal lesion occupies large area of pancreas 35 F27S, nonmaternal Weak Loss of maternal allele 36 G1379R, nonmaternal + ND 37 1631 del t, nonmaternal + ND 38 R1215W, nonmaternal + Loss of maternal allele 39 L503P, nonmaternal + Loss of maternal allele 40 F686S, de novo + Loss of maternal allele 41 1332+4 del c, maternalc + Loss of maternal allele 42 / + Loss of maternal allele 43 / + ND 44 / Small lesion + Loss of maternal allele 45 / + Loss of maternal allele 46 / + Loss of maternal allele 47 / + ND 48 / + Loss of maternal allele 49 / + ND 50 ND + ND 51 ND + ND 52 ND + Loss of maternal allele Rare nonadjacent large islet cell nuclei 53 ND + Loss of maternal allele Focal lesion occupies large area of pancreas All 10 pancreatic specimens studied from patients with diffuse hyperinsulinism did not show loss of p57kip2 labeling of the islet cell nuclei (data not shown).
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ABCC8 p.Cys717* 16357843:93:305
status: NEW