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The Journal of Clinical Endocrinology & Metabolism Vol. 84, No. 8 2933-2941
Copyright © 1999 by The Endocrine Society


Original Studies

Clinical and Molecular Evidence of Abnormal Processing and Trafficking of the Vasopressin Preprohormone in a Large Kindred with Familial Neurohypophyseal Diabetes Insipidus due to A Signal Peptide Mutation1

Charlotte Siggaard, Søren Rittig, Thomas J. Corydon, Per Hove Andreasen, Thomas G. Jensen, Brage S. Andresen, Gary L. Robertson, Niels Gregersen, Lars Bolund and Erling B. Pedersen

Research Laboratory of Nephrology and Hypertension (C.S., E.B.P.), the Department of Pediatrics, Skejby Sygehus (S.R.), and Research Unit for Molecular Medicine (P.H.A., B.S.A., N.G.), Aarhus University Hospital, and the Institute of Human Genetics, Aarhus University (T.J.C., T.G.J., L.B.), Aarhus, Denmark; and the Department of Medicine, Northwestern University Medical School (G.L.R.), Chicago, Illinois 60611

Address all correspondence and requests for reprints to: Charlotte Siggaard, M.D., Department of Pediatrics, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark. E-mail: rittig{at}iekf.au.dk


    Abstract
 Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
 References
 
The autosomal dominant form of familial neurohypophyseal diabetes insipidus (adFNDI) is a rare disease characterized by postnatal onset of polyuria and a deficient neurosecretion of the antidiuretic hormone, arginine vasopressin (AVP). Since 1991, adFNDI has been linked to 31 different mutations of the gene that codes for the vasopressin-neurophysin II (AVP-NPII) precursor.

The aims of the present study were to relate the clinical phenotype to the specific genotype and to the molecular genetic effects of the most frequently reported adFNDI mutation located at the cleavage site of the signal peptide of AVP-NPII [Ala(-1)Thr]. Genetic analysis and clinical studies of AVP secretion, urinary AVP, and urine output were performed in 16 affected and 16 unaffected family members and 11 spouses of a Danish adFNDI kindred carrying the Ala(-1)Thr mutation. Mutant complementary DNA carrying the same mutation was expressed in a neurogenic cell line (Neuro2A), and the cellular effects were studied by Western blotting, immunocytochemistry, and AVP measurements.

The clinical studies showed a severe progressive deficiency of plasma and urinary AVP that manifested during childhood. The expression studies demonstrated that the Ala(-1)Thr mutant cells produced 8-fold less AVP than wild-type cells and accumulated excessive amounts of 23-kDa NPII protein corresponding to uncleaved prepro-AVP-NPII. Furthermore, a substantial portion of the intracellular AVP-NPII precursor appeared to be colocalized with an endoplasmic reticulum antigen (Grp78).

These results provide independent confirmation that this Ala(-1)Thr mutation produces adFNDI by directing the production of a mutant preprohormone that accumulates in the endoplasmic reticulum, because it cannot be cleaved from the signal peptide and transported to neurosecretory vesicles for further processing and secretion.


    Introduction
 Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
 References
 
THE AUTOSOMAL dominant form of familial neurohypophyseal diabetes insipidus (adFNDI) is a rare disease characterized by persistent thirst, polydipsia, polyuria, and a deficient neurosecretion of the antidiuretic hormone, arginine vasopressin (AVP) (1, 2, 3, 4, 5). The deficiency of AVP secretion develops early in childhood (6) and appears to be caused by degeneration of magnocellular neurons in the supraoptic and paraventricular nuclei (7, 8, 9, 10).

Since 1991, adFNDI has been linked to 31 different mutations in 1 allele of the gene that codes for the AVP-neurophysin II precursor protein, AVP-NPII (6, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30). This gene is located in chromosome 20 and consists of 3 exons that encode, respectively, 1) the 19-amino acid signal peptide (SP), vasopressin (AVP), and the amino-terminal region of the transport protein NPII; 2) the highly conserved central part of NPII; and 3) the carboxyl-terminal region of NPII and a glycoprotein, copeptin (31). Of the 31 different mutations identified in adFNDI, 4 are predicted to alter the signal peptide (6, 13, 17, 20, 21, 22, 24, 25), 1 is predicted to alter the AVP moiety (26), and the other 26 are predicted to alter the NP moiety (11, 12, 14, 15, 16, 17, 18, 19, 20, 23, 24, 25, 27, 28, 29, 30). Of the 4 SP mutations, 3 are located near the cleavage site. One that substitutes threonine for alanine at position -1 is the most common mutation described in adFNDI, as it has now been found in 7 apparently unrelated families in America, Japan, Denmark, and Spain.

Based on the location and type of mutations identified in adFNDI and the lack of any major differences in the clinical phenotypes, we and others have postulated that all of the mutations act by replacing or deleting one or more amino acids important for proper folding and processing of the preprohormone (17). As a result of this defect, the mutant precursor cannot be folded and dimerized and is retained in the endoplasmic reticulum, where it accumulates and eventually kills the cell by interfering with the orderly processing of other essential proteins. This hypothesis is supported by recent in vitro expression studies that demonstrate accumulation of mutant AVP-NPII precursor within the endoplasmic reticulum (ER) (32, 33). In the resent study, we have investigated both the clinical phenotype and the cellular and biochemical effects of the AVP-NPII gene mutation most often identified in adFNDI.


    Subjects and Methods
 Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
 References
 
Subjects

Studies were performed on 32 living members (16 men and 16 women; mean age, 34 yr; range, 2–69 yr) from 3 generations of a Danish kindred previously shown to have FNDI (4) in association with a missense mutation predicted to alter the C-terminal residue of the signal peptide (17) (Fig. 1Go). Also studied were 11 spouses of the affected kindred members (aged 47.1 ± 11 yr). The local ethical committee approved the study, and appropriate informed consent was obtained from all human subjects.



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Figure 1. Pedigree of a Danish kindred with diagnosed adFNDI. Clinically affected subjects are marked with blackened symbols. Presence of the Ala(-1)Thr mutation by either sequencing or restriction enzyme digestion is marked with a plus. As shown, all clinically affected subjects (n = 16) and none of the unaffected (n = 27) had the mutation.

 
Clinical tests

Members of the family were questioned about the signs and symptoms of diabetes insipidus. All but two of those with a history of polyuria and polydipsia had one or more tests to confirm the diagnosis of diabetes insipidus. The tests included 1) measurements of the 24-h urine volume, urine osmolality, plasma osmolality, and plasma AVP when the subjects were untreated and on ad libitum fluid intake; 2) measurements of plasma osmolality, plasma vasopressin, and urine osmolality during a fluid deprivation test or infusion of hypertonic (3%) saline (34); and 3) measurement of spot urinary osmolality during treatment with therapeutic doses of 1-des-amino-D-arginine-8 AVP (DDAVP). In some affected and unaffected family members, vasopressin was also measured in spot urines collected randomly under conditions of ad libitum fluid intake.

Laboratory

Plasma AVP was measured by RIA, which was a modification of the method described previously (35). Before the assay procedure, C18 Sep-Pak extraction was performed, a rabbit anti-AVP was used (ICM Immunochemicals, Tumba, Sweden). The minimum level of detectability was 0.5 pg/mL. The coefficients of variation were 13% (interassay) and 9% (intraassay). Urinary AVP was determined after lyophilization and reconstitution to isotonicity with distilled water, and the values are expressed per mg creatinine as previously described (6). Plasma and urine samples were measured for osmolality by freezing point depression (Advanced Cryometric Osmometer, 3C2, Advanced Instruments, Needham, MA). Plasma creatinine was measured by routine methods.

Amplification and sequencing of genomic DNA

Genomic DNA was extracted from the buffy coat of peripheral leukocytes as described previously (6). All exons of the VPNPII gene were amplified separately by PCR using 30-bp primers flanking each exon. The primer sequences and locations as well as the PCR cycling conditions have been described previously (17). For restriction enzyme digestion analysis, the PCR product was digested with the endonuclease BstUI following the manufacturer’s instructions.

Construction of expression vectors

A pc-DNA 1 plasmid (Invitrogen, San Diego, CA) containing a 700-bp human wild-type complementary DNA (cDNA) fragment encoding the entire human AVP-NPII precursor protein, pcDNA-HV2 (36), was provided by Prof. D. Richter, Eppendorf University (Hamburg, Germany). Sequencing of the plasmid revealed a deviation from the normal genomic sequence, namely a G to T substitution at position 2120 in the genomic sequence (position 579 in the cDNA sequence (36), predicting an amino acid change in the NPII moiety (Gly88Val). This discrepancy was corrected by replacing the distal part of the cDNA with a PCR-generated fragment from the genomic DNA of a control subject.

The signal peptide mutation Ala(-1)Thr was introduced by site-directed mutagenesis according to the PCR-based method described by Kuipers et al. (37). In the first PCR, a DNA fragment was amplified with a flanking primer in the central portion of exon 2 and a mutagenesis primer containing a G to A substitution at position 279 in the genomic sequence. The purified PCR product from the first PCR was then used as a megaprimer together with the T7 primer in a second PCR with the wild-type plasmid as a template. After digestion with HindIII and SmaI, the purified product from the second PCR was ligated back into the wild-type plasmid. To confirm that no PCR-derived errors were present, the constructed plasmid and the wild-type plasmid were checked by sequencing.

Cell culture and transfection

Mouse Neuro2A cells were obtained from the American Type Culture Collection (Manassas, VA) and were grown in DMEM (Life Technologies, Inc., Gaithersburg, MD) supplemented with 10% FCS. The cells were maintained in a 5% CO2 atmosphere at 37 C. One day before transfection, the cells were recultivated in culture flasks at 50% confluence. Transfection of the cells with recombinant plasmids or pcDNA 1 vector as a control was performed using a calcium phosphate coprecipitation method (38, 39).

Northern blotting and measurement of secreted immunoreactive AVP

Sixteen hours after transfection, the cells were plated in either six-well plates for measurement of AVP immunoreactivity in the cell medium or in culture bottles for Northern blot analysis. The following day the cells from the six-well plates were washed in PBS and supplied with 2 mL fresh culture medium. After 24 h, the culture medium was harvested. The cells were lysed, and the protein concentration of the lysates was determined by Bradford protein assay (Bio-Rad Laboratories, Inc., Hercules, CA). For Northern blotting, the cells were grown for 48 h in culture medium. Total ribonucleic acid (RNA) was isolated from the transfected cells using a RNA extraction kit (RNAzol, WAK Chemical Co., Bad-Sodem, Germany). Total RNA (5 µg) was subjected to agarose gel electrophoresis and transferred to a Zeta Probe membrane (Bio-Rad Laboratories, Inc.) by capillary blotting. A 600-bp human AVP-NPII cDNA was radiolabeled (Prime It, Stratagene, La Jolla, CA) with 32P and used as a probe. Hybridization and autoradiography were performed using standard methods.

Western blot analysis

Forty-eight hours after transfection, cells for Western blotting were lysed with Ndet buffer (1% Nonidet P-40, 0.4% desoxycholate, 66 mmol/L ethylenediamine tetraacetate, and 10 mmol/L Tris-HCl, pH 7.4) supplemented with protease inhibitors (Trasylol, 200 U/mL; leupeptin, 10 µg/mL; bacitracin, 200 µg/mL; phenylmethylsulfonylfluoride, 250 µmol/L; Sigma Chemical Co., St. Louis, MO) (33). When differentiated cells were studied, cells were grown in serum-free medium for 24 h before cell lysis. Cell extracts were subjected to 16.5% Tris-tricine gel electrophoresis, and separated proteins were electrotransferred to a polyvinylidene difluoride membrane using a transfer buffer containing 50 mmol/L boric acid (pH 9.0) and 20% methanol. For the detection of NPII proteins, the membranes were blocked and incubated with anti-NPII antibody (DAKO Corp., Glostrup, Denmark), and the proteins were detected with a chemiluminescence detection system (Western-Light Plus Kit, Tropix, Bedford, MA).

Immunostaining and confocal laser scanning microscopy

Immediately after transfection, cells were grown in chamber slides (Nunc, Copenhagen, Denmark) for 24 h in culture medium containing 10% serum followed by 24 h in serum-free medium to induce differentiation to neuronal cells. The cells were then fixed with 4% paraformaldehyde and immunostained essentially as described by Jensen et al. (40). The primary antibodies were directed specifically against NPII (anti-NPII, rabbit anti human-NPII, ICN Biochemicals, Inc. Costa Mesa, CA). The secondary antibody was fluorescein isothiocyanate-conjugated porcine rabbit antibody (Dakopatts, Copenhagen, Denmark). For confocal laser scanning microscopy (Leica Corp., Heidelberg, Germany), we used a two-layer immunostaining procedure separated by a washing period in PBS. The cells were incubated for 60 min at room temperature with the NPII antibody diluted (1:1000) in blocking reagent (Boehringer Mannheim, Mannheim, Germany) followed by incubation with the secondary antibody (1:200) for another 60 min.

To look for colocalization of NPII and endoplasmatic reticulum or Golgi apparatus, cells were also incubated with either a mouse antibody directed against an ER antigen (Grp78; Stress Gen, Biotechnologies, Victoria, BC, Canada; diluted 1:50) (33) or a mouse antibody directed against a Golgi antigen (microtubule-binding Golgi membrane protein 58K, Sigma; 1:50), followed by incubation with rhodamine-conjugated goat antimouse antibody (Sigma; diluted 1:200). After washing, coverslips were mounted with one droplet of anti-fade solution (41).

The Grp78 antibody is monoclonal and identifies glucose-regulated protein 78 (Grp78) also known as Ig heavy chain binding protein and additional proteins containing the KDEL retention signal sequence. The KDEL retention signal is a carboxyl-terminal sequence (Lys-Asp-Glu-Leu) shared by luminal ER proteins and is shown to be attached to proteins retained in the ER (42). The FITC-conjugated antibody and rhodamine-conjugated antibodies are visualized by confocal laser scanning microscopy as red and green fluorescent colors, respectively. Colocalization of the NPII protein and Grp78 protein results in a merge between these two colors that is visualized as an orange/yellow fluorescent color.


    Results
 Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
 References
 
Clinical studies

Sixteen members (7 women and 9 men) from 3 generations of the kindred had a history of polyuria and polydipsia since childhood. The clinical results are listed in Table 1Go. In summary, the age of onset in this kindred was rather high and averaged 3.2 yr (range, 2.5–9 yr). All but one patient (FIII-11) showed complete diabetes insipidus with an inability to concentrate urine and a severely deficient secretion of AVP during osmotic stimulation. There was no significant gender difference in the severity of polyuria even when values were corrected for body weight (data not shown). All 15 patients responded well to treatment with DDAVP and, except for 1 who chose not to continue treatment, currently maintain normal urine volumes and osmolalities on intranasal doses ranging from 10–40 µg (mean, 22 µg/day). As in other adFNDI kindreds, 1 diseased affected family member (FI-1) had experienced a gradual decline in urine volume after the age of 50 yr to a level at which treatment was no longer necessary.


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Table 1. Clinical and hormonal data on 16 affected patients from a Danish kindred with familial neurogenic diabetes insipidus

 
As shown in Fig. 2Go, mean urinary vasopressin measured in a random sample and expressed as a function of the concurrent urinary creatinine was significantly lower in 14 affected subjects than in 11 unaffected family members and 11 spouses (15 ± 8, 39 ± 15, and 35 ± 13 pg/mg creatinine, respectively). Although the individual values in the 3 groups overlapped slightly, at a cut-off level of 25 pg/mg creatinine the positive predictive value for detecting adFNDI by this method was 81.3%, and the negative predictive value was 95.2%. As shown in the lower panel of Fig. 2Go, urinary vasopressin excretion correlated negatively with age in both affected and unaffected family members (r = -0.78; P < 0.001 and r = -0.71; P < 0.05, respectively).



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Figure 2. The urinary excretion of vasopressin (U-AVP), as determined in spot urine and related to creatinine content, showed significantly lower values in affected individuals compared with unaffected individuals or spouses. As shown in the lower panel, an age-dependent loss of vasopressin secretory capacity was indicated by a highly significant negative correlation between U-AVP levels and age in both affected and unaffected family members. •, Affected members; {circ}, unaffected members; {triangleup}, spouses.

 
Genotyping

Sequencing the coding region of AVP-NPII gene in 12 of the 16 affected family members revealed that all of them have a single base substitution (G->A) at position 279 in exon 1 of 1 allele. This mutation predicts the exchange of Ala with Thr at the -1 position of the signal peptide moiety (Fig. 3Go). No abnormalities were found in the rest of the coding region of the gene. As the mutation eliminates a restriction site for the endonuclease BstUI, digestion of exon 1 with this enzyme resulted in an abnormal 269-bp fragment in affected subjects (Fig. 4Go). This abnormal product was found in all 16 affected family members, but in none of the 16 who were unaffected or any of the 11 spouses (Figs. 1Go and 4Go). Two children (FV-7 and FV-10) who had no symptoms but were too young to assign a phenotype both showed a normal digestion pattern.



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Figure 3. A, Schematic diagram of the coding region of the AVP-NPII gene. The arrow indicates the signal peptide mutation. B, Section of the sequencing chromatogram obtained by bidirectional dye terminator sequencing of PCR-amplified exon 1 of the AVP-NPII gene from one of the affected members of the family (a, sense; b, antisense) and from an unaffected member (c, antisense). The arrow indicates the heterozygous mutation seen in both the sense and the antisense chromatogram from the affected family member. SP, Signal peptide; VP, vasopressin; NP, neurophysin; CP, copeptin.

 


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Figure 4. BstUI digestion of PCR product from genomic DNA from five affected and nine unaffected family members of the FNDI kindred. Agarose gel electrophoresis of the digestion products showed a heterozygous pattern with an abnormal band (269 bp) in all affected and in no unaffected family members.

 
Expression studies

As shown in Fig. 5Go, Neuro2A cells transiently transfected with the wild-type cDNA secreted significantly more immunoreactive AVP into the medium (41.2 ± 5.6 pg/µg cell protein·24 h) than the cells transfected with Ala(-1)Thr mutant cDNA (5.8 ± 0.9) or the unmodified vector (0.1 ± 0.01). Northern blotting showed similar levels of messenger RNA expression (data not shown).



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Figure 5. RIA measurements of AVP immunoreactivity (irAVP) secreted into the cell medium for 24 h. The immunoreactivity is expressed as picograms of irAVP per µg cell protein/24 h. The data represent the mean ± SD from six wells and demonstrate that cells transfected with the wild-type cDNA secreted irAVP at an 8-fold higher level than cells transfected with mutant cDNA.

 
As shown in Fig. 6Go, Western blotting of lysates from cells transiently transfected with wild-type cDNA revealed one band of protein that reacted with the NPII antibody. It corresponded in size to the 21-kDa glycosylated pro-AVP precursor. In contrast, cells transfected with the mutant cDNA produced a slightly larger band of protein that had a molecular size of approximately 23 kDa, which is similar to uncleaved, glycosylated prepro-AVP.



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Figure 6. Western blotting of NPII protein in the cell lysates transiently transfected with vector alone (Ve) or wild-type (WT) or mutant (M) cDNA. In both the undifferentiated and differentiated Neuro2A cells, the mutant NPII protein was larger than the wild-type signal, indicating impaired cleavage of the signal peptide. The cells were differentiated to neuronal cells by growth for 24 h in serum-free medium.

 
As shown in Fig. 7Go, cells transfected with wild-type cDNA contained small aggregates of NPII immunoreactivity (green color) that was distributed throughout the cytoplasma, especially in the tips of the cellular processes where the secretory vesicles normally are located (Fig. 7AGo). However, in cells expressing the mutant cDNA, the immunofluorescence was localized to the perinuclear network and was observed to a much lesser extent in the tips of the cells (Fig. 7BGo). Labeling with the Grp78 antibody (red color) showed a uniform perinuclear staining in both cells expressing the wild-type (Fig. 7CGo) and those expressing the mutant cDNA (Fig. 7DGo). When the cells were double labeled with the NPII antibody (green) and the Grp78 antibody (red), the wild-type cells showed no colocalization (Fig. 7EGo). However, double labeling of the cells expressing the mutant cDNA showed that a substantial portion of the NPII protein appeared to be colocalized with the ER antigen Grp78 (orange/yellow color, Fig. 7FGo). Double labeling of the cells with the NPII antibody and the Golgi antibody revealed no colocalization in either wild-type or mutant cultures (not shown).



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Figure 7. Confocal laser scanning microscopy analysis of immunostained neuro-2A cells transiently transfected with either wild-type (A, C, and E) or mutant (B, D, and F) cDNA. The cells were double labeled with NPII antibody and an ER protein (Grp78) antibody. These antibodies were visualized by two different fluorescence-conjugated secondary antibodies, seen as green (NPII, A and B) and red (Grp78, C and D), respectively. The cells expressing the normal precursor were stained throughout the cytoplasma with small aggregates of NPII immunoreactivity, especially in the tips of the cellular processes where the secretory vesicles are normally located (A). However, cells expressing the mutant precursor localized to the perinuclear network and was observed to a much lesser extent in the tips of the cells (B). Colocalization of the two antibodies is visualized as a merge of the two colors to orange, which was seen in the mutant cells (F), but not in the wild-type cells (E).

 

    Discussion
 Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
 References
 
These studies provide further clinical and molecular genetic evidence that a missense mutation affecting the -1 signal peptide residue of the AVP-NPII preprohormone causes adFNDI by directing the production of a mutant AVP-NPII precursor that cannot be processed and routed normally. As in previous reports of kindreds with this mutation (6, 13, 17, 20, 24), it cosegregated perfectly with clinical signs of the disease, affected equal numbers of males (9) and females (7), and was transmitted to approximately 50% of those at risk. Like a previous report (6), we also found that the clinically affected members always had a greater than 50% deficiency in AVP secretion even though only one allele of the gene was mutated. These findings are fully consistent with a completely penetrant autosomal dominant trait.

The present study also supports a previous report (6) that the AVP deficiency produced by this Ala(-1)Thr mutation is not present at birth, but develops early in childhood and worsens progressively with time. Thus, we found that the DI in our kindred reportedly began at ages ranging from 2–9 yr, and the urinary AVP excretion in these patients correlated negatively with age. However, as in other adFNDI families, the debut of symptoms (2–9 yr) as well as the severity of polyuria (6.6–28.8 L/24 h) and the AVP deficiency (assessed by both plasma and urine content) varied considerably within the family. Because of this variability and the limited number of patients usually available for careful evaluation, it is difficult to determine with certainty whether there are significant differences in the severity of the disease produced by the various AVP-NPII gene mutations. However, there is some evidence suggesting that the age of onset is lower in several kindreds with mutations in the NPII moiety (Leu50Pro, Gly57Arg, and Arg66Pro) than in those with the Ala(-1)Thr mutation in the SP (27, 29). This difference is consistent with theoretical expectations, because mutations affecting the SP cleavage site would be expected to allow the formation of some normal prohormone from the mutant alleles, whereas the NP mutations would not (17, 27).

The wide variability in the age of onset and severity of the AVP deficiency among patients with the same Ala(-1)Thr mutation is unexplained but is probably due to individual differences in other genetic or environmental influences on the neurohypophysis. For example, the rate of production of the mutant precursor could vary due to individual differences in the control of gene expression and/or the intensity of neurohypophyseal stimulation. Susceptibility to the postulated toxic effect of the mutant precursor could also vary due to individual differences in the capacity to degrade or otherwise dispose of the mutant precursor. Finally, the secretory reserve of the neurohypophysis could also vary due to individual differences in the development of the gland.

Our finding that the basal urinary AVP/creatinine ratio declines with age in unaffected as well as affected family members was unexpected because the plasma AVP response to osmotic stimulation increases with age in healthy adults (43). This discrepancy may be due to age-related differences in urinary AVP clearance or other variables, such as the rate of basal water intake and insensible loss. Either way, it is a reminder that even when adjusted to the rate of creatinine excretion, urinary AVP excretion is not always a reliable index of AVP secretion (44) or AVP secretory capacity. Thus, it raises questions about the significance of the age-related decline in urinary AVP that we and others (6) have observed in patients with adFNDI. Nevertheless, the measurement of the AVP/creatinine ratio in spot urine samples appears to be a relatively good predictor of AVP deficiency, at least in severely affected patients. As such, it seems worthy of further investigation as an alternative to measurement of plasma AVP during osmotic stimulation.

Expression of the Ala(-1)Thr mutation in a neurogenic cell line with a secretory apparatus capable of processing the wild-type AVP-NPII gene through the regulated pathway (45, 46) provides further evidence that the mutation impairs the production of AVP by interfering with cleavage of the signal peptide from the preprohormone and its trafficking from the ER to the secretory vesicles. Thus, compared to Neuro2A cells transiently transfected with the wild-type AVP-NPII cDNA, cells transfected with the Ala(-1)Thr mutant cDNA produced about 8-fold less immunoreactive AVP, accumulated a NPII-containing protein that had electrophoretic properties indistinguishable from those of uncleaved prepro-AVP-NPII, and remained associated with the endoplasmic reticulum.

In the only strictly comparable study published to date, Ito et al. (32) also found that the Ala(-1)Thr mutation impaired AVP secretion by Neuro2A cells. The degree of impairment was about the same as that with two other mutations (Gly57Ser and Cys67stop), but appeared to be less than that with another ({delta}Glu47) that was also associated with adFNDI. Robertson et al. also reported that Neuro2A cells transiently or stably transfected with the Ala(-1)Thr mutant produced 10- to 100-fold less immunoreactive AVP and died sooner after differentiation to postmitotic neurons than cells similarly transfected with cDNA lacking this mutation (47, 48). Although the human AVP-NPII cDNA used in these studies was found later to deviate from the standard sequence at a locus in exon 3 (see Materials and Methods), the relative deficiencies in AVP production and viability associated with the Ala(-1)Thr mutation are also relevant here because the deviation in exon 3 was also present in the wild-type cDNA, was located in an unconserved coding region of the gene, and has not been reported to affect AVP production in any system.

There are several possible mechanisms by which the Ala(-1)Thr mutation could cause the observed abnormalities in vasopressin production, precursor processing, and cellular trafficking. Theoretically, the Ala(-1)Thr mutation could either impair cleavage of the signal peptide or misdirect cleavage to an alternate site one or more residues upstream (17, 49, 50). Misdirected cleavage of the signal peptide was not observed in this or another study (32) that used pulse-chase techniques, and Western blotting in the present study also revealed only one abnormal band of approximately 23 kDa, consistent with uncleaved glycosylated prepro-AVP-NPII. Whether the lack of the 21-kDa band should be taken as evidence for a complete inhibition of SP cleavage in the mutant is not clear, as it can be argued that any correctly cleaved fraction of the prohormone would be further processed into the regulated pathway and thus would not show up on a Western blot of cell lysate. In any case, failure to remove all of the signal peptide from the N-terminus of the AVP moiety is likely to hinder its insertion in the AVP-binding pocket in neurophysin, a process that is necessary for normal folding and dimerization of the prohormone (51).

The present study also confirms that, in contrast to the wild-type prepro-AVP-NPII, a substantial portion of the mutant precursor appears to be colocalized with the ER. Immunostaining using confocal laser scanning microscopy clearly demonstrates that antibodies against the mutant protein colocalize with those against the Grp78 protein that resides in the ER. In contrast, no colocalization was found using an antibody against a Golgi protein (data not shown). In contrast, antibodies against the wild-type protein did not colocalize to either the ER or Golgi, but were concentrated elsewhere in the cell body, especially in the cell processes. This finding agrees with the results of other studies (32, 33), which showed that this and other mutations associated with adFNDI seem to result in retention of the mutant precursor in the ER. In the study by Ito et al. (32), however, NPII and ER protein were stained separately, and colocalization was judged by the localization of fluorescent material in the cell.

Although the results of this in vitro study help to clarify some of the cellular effects of this mutation, they do not demonstrate the mechanism of its dominant negative effect in vivo. Autopsy studies in a few patients with adFNDI have consistently shown atrophy of the posterior pituitary, gliosis, and a paucity of magnocellular neurons in the supraoptic nucleus (7, 8, 9, 10). These observations as well as the delayed onset of the AVP deficiency (6) suggest that the disease is due to postnatal degeneration of vasopressin-producing neurons in the neurohypophysis. This degeneration might occur because the mutant precursor forms misfolded aggregates that accumulate in the ER and interfere with processing of other proteins essential for cell survival. Preliminary evidence for such a toxic effect has been obtained from other in vitro expression studies (32, 48). However, it is also possible that degeneration of neurosecretory neurons is an inconstant, late, or incidental event and that AVP production by the normal allele is impaired primarily because normal and mutant precursors interact to form heterodimers that also cannot be folded or processed properly and are, therefore, rapidly degraded. Moreover, neither mechanism for the dominant negative effect is completely sufficient to explain why the capacity to produce AVP appears to be normal for the first few years of life (6). Further investigation of these patients as well as of in vitro cell systems in which both normal and mutant cDNA are stably coexpressed may help to clarify these issues.


    Acknowledgments
 
The authors thank Dorte Rønde, Jane Hagelskjær Knudsen, and Kirsten Tønder for skilled laboratory assistance.


    Footnotes
 
1 This work was supported by grants from the Danish Medical Research Council, the Novo Nordic Foundation, the Lundbeck Foundation, the Karen Elise Jensen Fund, and the University of Aarhus, Denmark. Back

Received August 31, 1998.

Revised April 12, 1999.

Accepted April 19, 1999.


    References
 Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
 References
 

  1. Baylis PH, Robertson GL. 1981 Vasopressin function in familial cranial diabetes insipidus. Postgrad Med J. 57:36–40.[Abstract/Free Full Text]
  2. Kaplowitz PB, D’Ercole AJ, Robertson GL. 1982 Radioimmunoassay of vasopressin in familial cental diabetes insipidus. J Pediatr. 100:76–81.[CrossRef][Medline]
  3. Blackett PR, Seif SM, Altmiller DH, Robinson AG. 1983 Familial central diabetes insipidus: vasopressin and nicotine stimulated neurophysin deficiency with subnormal oxytocin and estrogen stimulated neurophysin. Am J Med Sci. 286:42–46.[Medline]
  4. Pedersen EB, Lamm LU, Albertsen K, et al. 1985 Familial cranial diabetes insipidus: A report of five families. Genetic, diagnostic and therapeutic aspects. Q J Med. 57:883–896.[Abstract/Free Full Text]
  5. Os I, Aakesson I, Enger E. 1985 Plasma vasopressin in hereditary cranial diabetes insipidus. Acta Med Scand. 217:429–434.[Medline]
  6. McLeod JF, Kovacs L, Gaskill MB, Rittig S, Bradley GS, Robertson GL. 1993 Familial neurohypophyseal diabetes insipidus associated with a signal peptide mutation. J Clin. Endocrinol Metab. 77:599A–599G.[CrossRef]
  7. Forssman H. 1945 On hereditary diabetes insipidus with special regard to a sex-linked form. Acta Med Scand. 159:1–196.
  8. Braverman LE, Mancini JP, McGoldrick DM. 1965 Hereditary diabetes insipidus: a case report with autopsy findings. Ann Intern Med. 63:503–508.
  9. Green J, Buchan G, Alvord JE, Swanson A. 1997 Hereditary and ideopathic types of diabetes insipidus. Brain. 90:707–714.[CrossRef]
  10. Bergeron C, Kovacs K, Ezrin C, Mizzen C. 1991 Hereditary diabetes insipidus: an immunohistochemical study of the hypothalamus and pituitary gland. Acta Neuropathol Berl. 81:345–348.[CrossRef][Medline]
  11. Ito M, Mori Y, Oiso Y, Saito H. 1991 A single base substitution in the coding region for neurophysin II associated with familial central diabetes insipidus. J Clin Invest. 87:725–728.
  12. Bahnsen U, Oosting P, Swaab DF, Nahke P, Richter D, Schmale H. 1992 A missense mutation in the vasopressin-neurophysin precursor gene cosegregates with human autosomal dominant neurohypophyseal diabetes insipidus. EMBO J. 11:19–23.[Medline]
  13. Ito M, Oiso Y, Murase T, et al. 1993 Possible involvement of inefficient cleavage of preprovasopressin by signal peptidase as a cause for familial central diabetes insipidus. J Clin Invest. 91:2565–2571.
  14. Yuasa H, Ito M, Nagasaki H, et al. 1993 Glu-47, which forms a salt bridge between neurophysin-II and arginine vasopressin, is deleted in patients with familial central diabetes insipidus. J Clin Endocrinol Metab. 77:600–604.[Abstract]
  15. Repaske DR, Browning JE. 1994 A de novo mutation in the coding sequence for neurophysin-II (Pro24->Leu) is associated with onset and transmission of autosomal dominant neurohypophyseal diabetes insipidus. J Clin Endocrinol Metab. 79:421–427.[Abstract]
  16. Nagasaki H, Ito M, Yuasa H, et al. 1995 Two novel mutations in the coding region for neurophysin-II associated with familial central diabetes insipidus. J Clin Endocrinol Metab. 80:1352–1356.[Abstract]
  17. Rittig S, Robertson GL, Siggaard C, et al. 1996 Identification of 13 new mutations in the vasopressin-neurophysin II gene in 17 kindreds with familial autosomal dominant neurohypophyseal diabetes insipidus. Am J Hum Genet. 58:107–117.[Medline]
  18. Rauch F, Lenzner C, Nurnberg P, Frommel C, Vetter U. 1996 A novel mutation in the coding region for neurophysin-II is associated with autosomal dominant neurohypophyseal diabetes insipidus. Clin Endocrinol (Oxf). 44:45–51.[CrossRef][Medline]
  19. Ueta Y, Taniguchi S, Yoshida A, et al. 1996 A new type of familial central diabetes insipidus caused by a single base substitution in the neurophysin II coding region of the vasopressin gene. J Clin Endocrinol Metab. 81:1787–1790.[Abstract]
  20. Repaske DR, Summar ML, Krishnamani MR, et al. 1996 Recurrent mutations in the vasopressin-neurophysin II gene cause autosomal dominant neurohypophyseal diabetes insipidus. J Clin Endocrinol Metab. 81:2328–2334.[Abstract]
  21. Rutishauser J, Boni SM, Boni J, et al. 1996 A novel point mutation in the translation initiation codon of the pre-pro-vasopressin-neurophysin II gene: cosegregation with morphological abnormalities and clinical symptoms in autosomal dominant neurohypophyseal diabetes insipidus. J Clin Endocrinol Metab. 81:192–198.[Abstract]
  22. Repaske DR, Medlej R, Gultekin EK, et al. 1997 Heterogeneity in clinical manifestation of autosomal dominant neurohypophyseal diabetes insipidus caused by a mutation encoding Ala-1->Val in the signal peptide of the arginine vasopressin/neurophysin II/copeptin precursor. J Clin Endocrinol Metab. 82:51–56.[Abstract/Free Full Text]
  23. Gagliardi PC, Bernasconi S, Repaske DR. 1997 Autosomal dominant neurohypophyseal diabetes insipidus associated with a missense mutation encoding Gly23->Val in neurophysin II. J Clin Endocrinol Metab. 82:3643–3646.[Abstract/Free Full Text]
  24. Calvo B, Bilbao JR, Urrutia I, Eizaguirre J, Gaztambide S, Castano L. 1998 Identification of a novel nonsense mutation and a missense substitution in the vasopressin-neurophysin II gene in two Spanish kindreds with familial neurohypophyseal diabetes insipidus. J Clin Endocrinol Metab. 83:995–997.[Abstract/Free Full Text]
  25. Heppner C, Kotzka J, Bullmann C, Krone W, Muller WD. 1998 Identification of mutations of the arginine vasopressin-neurophysin II gene in two kindreds with familial central diabetes insipidus. J Clin Endocrinol Metab. 83:693–696.[Abstract/Free Full Text]
  26. Rittig S, Siggaard C, Ozata M, et al. 1997 Substitution of Tyr-2 of the antidiuretic hormone is associated with familial neurohypophyseal diabetes insipidus [Abstract]. J Invest Med. 44:387A.
  27. Hansen L, Rittig S, Robertson GL. 1997 Genetic basis of familial neurohypophyseal diabetes insipidus. Trends Endocrinol Metab. 8:363–372.[CrossRef][Medline]
  28. Goking NQ, Chertow B, Robertson GL, Rittig S, Siggaard C, Pedersen EB. 1997 Familial neurohypophyseal diabetes insipidus: a novel mutation presentingwith enuresis [Abstract]. J Invest Med. 45:29A.
  29. Mundshenk J, Rittig S, Hensen J, Lehnert H. 1998 A novel mutation in a coding region of the arginine vasopressin-neurophysin II (AVP-NPII) gene in a family with autosomal dominant neurohypophyseal diabetes insipidus [Abstract]. Exp Clin Endocrinol Diabetes. 106(Suppl):81.
  30. Grant FD, Ahmadi A, Hosley CM, Majzoub JA. 1998 Two novel mutations of the vasopressin gene associated with familial diabetes insipidus and identification of an asymptomatic carrier infant. J Clin Endocrinol Metab. 83:3958–3964.[Abstract/Free Full Text]
  31. Sausville E, Carney D, Battey J. 1985 The human vasopressin gene is linked to the oxytocin gene and is selectively expressed in a cultured lung cancer cell line. J Biol Chem. 260:10236–10241.[Abstract/Free Full Text]
  32. Ito M, Jameson JL. 1997 Molecular basis of autosomal dominant neurohypophyseal diabetes insipidus. Cellular toxicity caused by the accumulation of mutant vasopressin precursors within the endoplasmic reticulum. J Clin Invest. 99:1897–1905.[Medline]
  33. Olias G, Richter D, Schmale H. 1996 Heterologous expression of human vasopressin-neurophysin precursors in a pituitary cell line: defective transport of a mutant protein from patients with familial diabetes insipidus. DNA Cell Biol. 15:929–935.[Medline]
  34. Zerbe RL, Robertson GL. 1981 A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria. N Engl J Med. 305:1539–1546.[Abstract]
  35. Pedersen EB, Danielsen H, Spencer ES. 1984 Effect of indapramide on renal plasma flow, glomerular filtration rate, and arginine vasopressin in plasma in essential hypertension. Eur J Clin Pharmacol. 26:543–547.[CrossRef][Medline]
  36. Mohr E, Hillers M, Ivell R, Haulica I, Richter D. 1985 Expression of the vasopressin and oxytocin genes in human hypothalami. FEBS Lett. 193:12–16.[CrossRef][Medline]
  37. Kuipers OP, Boot HJ, Vos WM. 1991 Improved site-directed mutagenesis method using PCR. Nucleic Acids Res. 19:4558.[Free Full Text]
  38. Graham FM, Eb AJ. 1973 A new technique for the assay of infectivity of human adenovirus 5 DNA. Virology. 52:456–467.[CrossRef][Medline]
  39. Jensen TG, Andresen BS, Bross P, et al. 1992 Expression of wild-type and mutant medium-chain acyl-CoA dehydrogenase (MCAD) cDNA in eucaryotic cells. Biochim Biophys Acta. 1180:65–72.[Medline]
  40. Jensen TG, Andresen BS, Jensen HK, et al. 1996 Rapid characterization of desease-causing mutations in the low density lipoprotein receptor (LDL-R) gene by overexpression in COS cells. Ger J Gastroenterol. 34:1311–1325.
  41. Harlow E., Lane D. 1988 Antibodies: a laboratory manual. Cold Spring Harbor: Cold Spring Harbor Laboratory; 418.
  42. Munro S, Pelham HR. 1987 A C-terminal signal prevents secretion of luminal ER proteins. Cell. 48:899–907.[CrossRef][Medline]
  43. Ledingham JG, Crowe MJ, Forsling ML, Phillips PA, Rolls BJ. 1987 Effects of aging on vasopressin secretion, water excretion, and thirst in man. Kidney Int. 21(Suppl):S90–S92.
  44. Robertson GL. 1976 The regulation of vasopressin function in health and disease. Recent Prog Horm Res. 33:333–385.
  45. de Bree FM, Burbach JP. 1994 Heterologous biosynthesis and processing of preprovasopressin in Neuro2A neuroblastoma cells. Biochimie. 76:315–319.[Medline]
  46. de Bree FM, van der Kleij AAM, Burbach JPH. 1995 Functional role of hormone-neurophysin association in hormone biosynthesis. In: Saito T, Kurokawa K, Yoshida S, eds. Neurohypophysis: recent progress of vasopressin and oxytocin research. Amsterdam: Elsevier; 143–148.
  47. Robertson GL, Rittig S, Gu W, et al. 1995 Pathogenesis and pathophysiology of familial neurohypophyseal diabetes insipidus. In: Saito T, Kurokawa K, Yoshida S, eds. Neurohypophysis: recent progress of vasopressin and oxytocin research. Amsterdam: Elsevier; 593–603.
  48. Robertson GL, Gu W, Gaskill MB, et al. 1996 A vasopressin-neurophysin gene (VPNP) mutation linked to familialneurhypophyseal diabetes insipidus (FNDI) impairs the maturation andvasopressin (VP) production of stably transfected neuroblastoma 2A (N2A) cells [Abstract]. J Invest Med. 44:266A.
  49. Fikes JD, Barkocy-Gallagher GA, Klapper DG, Bassford Jr PJ. 1997 Maturation of Escherichia coli maltose-binding protein by signal peptidase I in vivo. J Biol Chem. 265:3417–3423.[Abstract/Free Full Text]
  50. Laforet GA, Kendall DA. 1991 Functional limits of conformation, hydrophobicity, and steric constraints in prokaryotic signal peptide cleavage regions. J Biol Chem. 266:1326–1334.[Abstract/Free Full Text]
  51. Breslow E. 1993 The conformation and functional domains of neurophysins. In: Gross P, Ricther D, Robertson GL, eds. Vasopressin. Paris: Libbey Eurotext; 143–157.



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