Past studies on common mutant aldosterone-producing adenomas (APAs) had found genotype-phenotype correlations associated with histological appearance. Most of these studies did not perform CYP11B2-guided sequencing of APAs or sequencing for all the currently known aldosterone-driver genes. Hence, misinterpretation of the genotype-phenotype correlations could have occurred. Herein, we aimed to identify the genotype-phenotype correlations associated with the histopathology of the different mutant APAs utilizing CYP11B2-guided sequencing. A total of 33 APAs with confirmed aldosterone-driver mutation (17 KCNJ5 mutant APAs, 8 ATP1A1 mutant APAs, 6 CACNA1D mutant APAs, and 2 CTNNB1 mutant APAs) were immunohistochemically stained using H&E, CYP17A1, CYP11B2, KCNJ5, Ki67, β-catenin, and LHCGR antibody. Interestingly, APAs with a p.Thr41Ala CTNNB1 mutation also harbored a p.Val1373Met CACNA1D mutation. The CTNNB1 double mutant APAs had less expression of CYP17A1 and larger quantities of spironolactone bodies than a single mutant APA with a p.Ser45Phe CTNNB1 mutation. However, both CTNNB1 mutant APAs displayed diffuse active β-catenin expression with prominent nuclear staining that reflects the constitutive activation of the Wnt/β-catenin signaling pathway (p = 0.016 compared to other genotypes) but no significant increase in LHCGR. KCNJ5 mutant APAs displayed distinct existence of atypical cells (6 of the 17 KCNJ5 mutant APAs), whereas CACNA1D mutant APAs had frequent presentations of spironolactone bodies (4 of the 6 CACNA1D mutant APAs), and ATP1A1 mutant APAs had significantly higher Ki67 score than KCNJ5 mutant APAs (p = 0.020). The results of this study support the notion that CYP11B2-guided sequencing of all currently known aldosterone-driver genes can fine-tune existing genotype-phenotype correlations in histopathological profiles.

• Klíčová slova
• CYP11B2-guided sequencing, aldosterone-driver mutations, aldosterone-producing adenomas, genotype–phenotype correlations, immunohistochemistry analysis,
• Publikační typ
• časopisecké články MeSH

Aldosterone-producing adenomas (APAs) are the commonest curable cause of hypertension. Most have gain-of-function somatic mutations of ion channels or transporters. Herein we report the discovery, replication and phenotype of mutations in the neuronal cell adhesion gene CADM1. Independent whole exome sequencing of 40 and 81 APAs found intramembranous p.Val380Asp or p.Gly379Asp variants in two patients whose hypertension and periodic primary aldosteronism were cured by adrenalectomy. Replication identified two more APAs with each variant (total, n = 6). The most upregulated gene (10- to 25-fold) in human adrenocortical H295R cells transduced with the mutations (compared to wildtype) was CYP11B2 (aldosterone synthase), and biological rhythms were the most differentially expressed process. CADM1 knockdown or mutation inhibited gap junction (GJ)-permeable dye transfer. GJ blockade by Gap27 increased CYP11B2 similarly to CADM1 mutation. Human adrenal zona glomerulosa (ZG) expression of GJA1 (the main GJ protein) was patchy, and annular GJs (sequelae of GJ communication) were less prominent in CYP11B2-positive micronodules than adjacent ZG. Somatic mutations of CADM1 cause reversible hypertension and reveal a role for GJ communication in suppressing physiological aldosterone production.

• MeSH
• adenom kůry nadledvin * MeSH
• adrenokortikální nádory * MeSH
• aldosteron MeSH
• buněčná adhezní molekula 1 MeSH
• cytochrom P450 CYP11B2 MeSH
• hyperaldosteronismus * MeSH
• hypertenze * MeSH
• lidé MeSH
• mezerový spoj MeSH
• mutace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• aldosteron MeSH
• buněčná adhezní molekula 1 MeSH
• CADM1 protein, human MeSH Prohlížeč
• cytochrom P450 CYP11B2 MeSH