Objective: Description of the clinical, biochemical and genetic features of a Polish patient with familial glucocorticoid deficiency. Methods: Detailed clinical investigation, hormonal analysis and sequencing of the coding region of the melanocortin 2 receptor (MC2R) gene in this patient. Results: We report on a 3-month-old boy with familial glucocorticoid deficiency who presented at the age of 3 months with skin hyperpigmentation, muscle weakness, mild jaundice and constipation. Hormonal analyses revealed high ACTH and TSH serum concentrations, low serum cortisol concentration along with normal blood electrolytes. On hydrocortisone supplementation, the disease symptoms disappeared and the child recovered completely. His physical and mental development progresses normally. Genetic analysis disclosed a novel compound heterozygous MC2R mutation p.Leu46fs and p.Val49Met. Conclusion: The heterozygous p.Leu46fs mutation adds to the small number of MC2R nonsense mutations and is the first frameshift mutation within the first transmembrane domain of the receptor. According to molecular modeling the Val49Met mutation results in a structural change of the first transmembrane domain and in a potential novel interaction of the transmembrane domains I and VII. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

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Le récepteur mélanocortine de type 4 (MC4R) est un récepteur couplé aux protéines G impliqué dans la régulation de la prise alimentaire et de l’homéostasie énergétique. Quatre-vingt pour cent des mutants du MC4R reliés à l’obésité morbide précoce (OMP) sont retenus à l’intérieur de la cellule. Le système de contrôle de qualité (SCQ) est probablement responsable de cette rétention, par la reconnaissance d’une conformation inadéquate des mutants. Le rétablissement de l’expression à la surface cellulaire et de la fonctionnalité de ces mutants est donc d’intérêt thérapeutique. Dans cette optique, des composés lipophiles spécifiques pour le MC4R ont été sélectionnés sur la base de leur sélectivité. Nous avons démontré qu’ils agissent à titre de chaperone pharmacologique (CP) en rétablissant l’expression à la surface cellulaire et la fonctionnalité des récepteurs mutants S58C et R165W, et qu’ils favorisent leur N-glycosylation complexe (maturation). Le suivi par BRET du site d’action des CP du MC4R suggère une action en aval de l’interaction calnexine-MC4R. De manière générale, une CP peut avoir un effet différent selon le mutant traité en induisant des conformations distinctes du récepteur plus ou moins aptes à se dissocier du SCQ et à activer la voie de signalisation, et un mutant peut répondre différemment selon la CP utilisée par des différences d’affinité pour le ligand, la CP et les effecteurs. Une meilleure compréhension du mode d’action des CP pourrait aider au développement de nouvelles approches thérapeutiques non seulement pour l’OMP, mais aussi pour d’autres maladies conformationnelles causées par le mauvais repliement de protéines. / The MC4R is a G-protein coupled receptor involved in the central regulation of food intake and energy homeostasis. Eighty percent of childhood obesity-related MC4R mutants are retained intracellularly, probably via the quality control system acting on misfolded receptors. Thus, rescuing cell surface targeting and functionality of these mutant receptors could be of therapeutic value. Cell permeable MC4R selective ligands have been tested and were able to restore cell surface expression and signalling activity of S58C and R165W MC4R mutants. Those compounds, according to their mode of action, are described as pharmacological chaperones (PC). The MC4R-PCs also helps to rescue the glycosylation pattern (maturation) of the MC4R mutants. The site of action of MC4R-PCs of the MC4R mutants monitored by BRET suggests an action downstream of the calnexin-MC4R interaction, most likely at the level of the Golgi apparatus. Generally, a CP can have different effects according to the mutant by stabilizing distinct conformations of the receptor that are more or less able to exit the quality control system and to activate the signaling pathway, and a mutant can respond differently according to the CP used by its distinct affinity to the ligand, the CP itself and the effectors. A better understanding of PCs’ mode of action could help in the design of novel therapeutic approaches not only for early-onset morbid obesity (EOMO) but also for other conformational diseases resulting from protein misfolding.

Various molecular pathways in the brain shape our understanding of good and bad, as well as our motivation to seek and avoid such stimuli. This work evolves around how systemic inflammation causes aversion; and why general unpleasant states such as sickness, stress, pain and nausea are encoded by our brain as undesirable; and contrary to these questions, how drugs of abuse can subjugate the motivational neurocircuitry of the brain. A common feature of these various disease states is involvement of the motivational neurocircuitry - from mesolimbic to striatonigral pathways. Having an intact motivational system is what helps us evade negative outcomes and approach natural positive reinforcers, which is essential for our survival. During disease-states the motivational neurocircuitry may be overthrown by the molecular mechanisms that originally were meant to aid us. In study I, to investigate how inflammation is perceived as aversive, we used a behavioral test based on Pavlovian place conditioning with the aversive inflammatory stimulus E. coli lipopolysaccharide (LPS). Using a combination of cell-type specific gene deletions, pharmacology, and chemogenetics, we uncovered that systemic inflammation triggered aversion by MyD88-dependent activation of the brain endothelium followed by COX1-mediated cerebral prostaglandin E2 (PGE2) synthesis. Moreover, we showed that inflammation-induced PGE2 targeted EP1 receptors on striatal dopamine D1 receptor–expressing neurons and that this signaling sequence induced aversion through GABA-mediated inhibition of dopaminergic cells. Finally, inflammation-induced aversion was not an indirect consequence of fever or anorexia but constituted an independent inflammatory symptom triggered by a unique molecular mechanism. Collectively, these findings demonstrate that PGE2-mediated modulation of the dopaminergic circuitry is a key mechanism underlying inflammation-induced aversion. In study II, we investigate the role of peripheral IFN-γ in LPS induced conditioned place aversion by employing a strategy based on global and cell-type specific gene deletions, combined with measures of gene-expression. LPS induced IFN-ɣ expression in the blood, and deletion of IFN-ɣ or its receptor prevented conditioned place aversion (CPA) to LPS. LPS increased the expression of chemokine Cxcl10 in the striatum of normal mice. This induction was absent in mice lacking IFN-ɣ receptors or Myd88 in blood brain barrier endothelial cells. Furthermore, inflammation-induced aversion was blocked in mice lacking Cxcl10 or its receptor Cxcr3. Finally, mice with a selective deletion of the IFN-ɣ receptor in brain endothelial cells did not develop inflammation-induced aversion. Collectively, these findings demonstrate that circulating IFN-ɣ binding to receptors on brain endothelial cells which induces Cxcl10, is a central link in the signaling chain eliciting inflammation-induced aversion. In study III, we explored the role of melanocortin 4 receptors (MC4Rs) in aversive processing using genetically modified mice in CPA to various stimuli. In normal mice, robust aversions were induced by systemic inflammation, nausea, pain and kappa opioid receptor-induced dysphoria. In sharp contrast, mice lacking MC4Rs displayed preference towards most of the aversive stimuli, but were indifferent to pain. The unusual flip from aversion to reward in mice lacking MC4Rs was dopamine-dependent and associated with a change from decreased to increased activity of the dopamine system. The responses to aversive stimuli were normalized when MC4Rs were re-expressed on dopamine D1 receptor-expressing cells or in the striatum of mice otherwise lacking MC4Rs. Furthermore, activation of arcuate nucleus proopiomelanocortin neurons projecting to the ventral striatum increased the activity of striatal neurons in a MC4R-dependent manner and elicited aversion. Our findings demonstrate that melanocortin signaling through striatal MC4Rs is critical for assigning negative motivational valence to harmful stimuli. The neurotransmitter acetylcholine has been implied in reward learning and drug addiction. However, the role of cholinergic receptor subtypes in such processes remains elusive. In study IV we investigated the function of muscarinic M4Rs on dopamine D1R expressing neurons and acetylcholinergic neurons, using transgenic mice in various reward-enforced behaviors and in a “waiting”-impulsivity test. Mice lacking M4-receptors from D1-receptor expressing neurons exhibited an escalated reward seeking phenotype towards cocaine and natural reward, in Pavlovian conditioning and an operant self-administration task, respectively. In addition, the M4-D1RCre mice showed impaired waiting impulsivity in the 5-choice-serial-reaction-time-task. On the contrary, mice without M4Rs in acetylcholinergic neurons were unable to learn positive reinforcement to natural reward and cocaine, in an operant runway paradigm and in Pavlovian conditioning.  Immediate early gene expression mirrored the behavioral findings arising from M4R-D1R knockout, as cocaine induced cFos and FosB was significantly increased in the forebrain of M4-D1RCre mice, whereas it remained normal in the M4R-ChatCre mice. Our study illustrates that muscarinic M4Rs on specific neural populations, either cholinergic or D1R-expressing, are pivotal for learning processes related to both natural reward and drugs of abuse, with opposing functionality.

No description available.