Multiple beta cell-independent mechanisms drive hypoglycemia in Timothy syndrome.

TitleMultiple beta cell-independent mechanisms drive hypoglycemia in Timothy syndrome.
Publication TypeJournal Article
Year of Publication2024
AuthorsMatsui M, Lynch LE, DiStefano I, Galante A, Gade AR, Wang H-G, Gómez-Banoy N, Towers P, Sinden DS, Wei EQ, Barnett AS, Johnson K, Lima R, Rubio-Navarro A, Li AK, Marx SO, McGraw TE, Thornton PS, Timothy KW, Lo JC, Pitt GS
JournalNat Commun
Volume15
Issue1
Pagination8980
Date Published2024 Oct 17
ISSN2041-1723
KeywordsAnimals, Autistic Disorder, Blood Glucose, Calcium, Calcium Channels, L-Type, Disease Models, Animal, Female, Gene Knock-In Techniques, Glucagon, Glucose, Homeostasis, Humans, Hyperinsulinism, Hypoglycemia, Hypothalamus, Insulin, Insulin-Secreting Cells, Long QT Syndrome, Male, Mice, Mutation, Syndactyly
Abstract

The canonical G406R mutation that increases Ca2+ influx through the CACNA1C-encoded CaV1.2 Ca2+ channel underlies the multisystem disorder Timothy syndrome (TS), characterized by life-threatening arrhythmias. Severe episodic hypoglycemia is among the poorly characterized non-cardiac TS pathologies. While hypothesized from increased Ca2+ influx in pancreatic beta cells and consequent hyperinsulinism, this hypoglycemia mechanism is undemonstrated because of limited clinical data and lack of animal models. We generated a CaV1.2 G406R knockin mouse model that recapitulates key TS features, including hypoglycemia. Unexpectedly, these mice do not show hyperactive beta cells or hyperinsulinism in the setting of normal intrinsic beta cell function, suggesting dysregulated glucose homeostasis. Patient data confirm the absence of hyperinsulinism. We discover multiple alternative contributors, including perturbed counterregulatory hormone responses with defects in glucagon secretion and abnormal hypothalamic control of glucose homeostasis. These data provide new insights into contributions of CaV1.2 channels and reveal integrated consequences of the mutant channels driving life-threatening events in TS.

DOI10.1038/s41467-024-52885-3
Alternate JournalNat Commun
PubMed ID39420001
PubMed Central IDPMC11487186
Grant ListR01 HD090132 / HD / NICHD NIH HHS / United States
R01 DK121140 / DK / NIDDK NIH HHS / United States
R01 HL151190 / HL / NHLBI NIH HHS / United States
T32 DA039080 / DA / NIDA NIH HHS / United States
R01 DK121844 / DK / NIDDK NIH HHS / United States