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Expanded Clinical Spectrum in Hepatocyte Nuclear Factor 1B-Maturity-Onset Diabetes of the Young

Department of Pediatric Endocrinology and Diabetes (K.R., T.W., A.G., D.D., A.G.), and Institute of Medical Genetics (E.K., D.H.), Charité Campus Virchow, 13353 Berlin, Germany; Pediatric Diabetology (M.H.), Olgahospital, 70031 Stuttgart, Germany; Departments of Pediatric Nephrology (D.M.) and Pediatric Radiology (T.R.), Charité Campus Virchow, 13353 Berlin, Germany; Human Genetics, Private Practice (M.M.), 53115 Bonn, Germany; IntegraGen GmbH (J.W.), 53115 Bonn, Germany; and Max Planck Institute for Molecular Genetics (R.U.), 14195 Berlin, Germany

Address all correspondence and requests for reprints to: Klemens Raile, M.D., Department of Pediatric Endocrinology and Diabetes, Charité Children’s Hospital, Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. E-mail: klemens.raile{at}charite.de.

Aims: HNF1B-maturity-onset diabetes of the young is caused by abnormalities in the HNF1B gene encoding the transcription factor HNF-1β. We aimed to investigate detailed clinical features and the type of HNF1B gene anomaly in five pediatric cases with HNF1B-MODY.

Methods: From a cohort of 995 children and adolescents with diabetes, we analyzed the most frequent maturity-onset diabetes of the young genes (GCK, HNF1A, HNF4A) including HNF1B sequencing and deletion analysis by quantitative Multiplex-PCR of Short Fluorescent Fragments (QMPSF) if patients were islet autoantibody-negative and had one parent with diabetes or associated extrapancreatic features or detectable C-peptide outside honeymoon phase. Presence and size of disease-causing chromosomal rearrangements detected by QMPSF were further analyzed by array comparative genomic hybridization.

Results: Overall, five patients had a heterozygous HNF1B deletion, presenting renal disease, elevated liver enzymes, and diabetes. Diabetes was characterized by insulin resistance and adolescent onset of hyperglycemia. Additionally, clinical features in some patients were pancreas dysplasia and exocrine insufficiency (two of five patients), genital defects (three of five), mental retardation (two of five), and eye abnormalities (coloboma, cataract in two of five). One case also had severe growth deficit combined with congenital cholestasis, and another case had common variable immune deficiency. All patients reported here had monoallelic loss of the entire HNF1B gene. Whole genome array comparative genomic hybridization confirmed a precurrent genomic deletion of approximately 1.3–1.7 Mb in size.

Conclusion: The clinical data of our cases enlarge the wide spectrum of patients with HNF1B anomaly. The underlying molecular defect in all cases was a 1.3- to 1.7-Mb deletion, and paired, segmental duplications along with breakpoints were most likely involved in this recurrent chromosomal microdeletion.