Glucokinase gene mutations: Structural and genotype-phenotype analyses in MODY children from South Italy

Background: Maturity onset diabetes of the young type 2 (or GCK MODY) is a genetic form of diabetes mellitus provided by mutations in the glucokinase gene (GCK). Methodology/Principal Findings: We screened the GCK gene by direct sequencing in 30 patients from South Italy with suspected MODY. The mutation-induced structural alterations in the protein were analyzed by molecular modelling. The patients' biochemical, clinical and anamnestic data were obtained. Mutations were detected in 16/30 patients (53%); 9 of the 12 mutations identified were novel (p.Glu70Asp, p.Phe123Leu, p.Asp132Asn, p.His137Asp, p.Gly162Asp, p.Thr168Ala, p.Arg392Ser, p.Glu290X, p.Gln106_Met107delinsLeu) and are in regions involved in structural rearrangements required for catalysis. The prevalence of mutation sites was higher in the small domain (7/12: -59%) than in the large (4/12: 33%) domain or in the connection (1/12:8%) region of the protein. Mild diabetic phenotypes were detected in almost all patients [mean (SD) OGTT=7.8 mMol/L (1.8)] and mean triglyceride levels were lower in mutated than in unmutated GCK patients [p=0.04]. Conclusions: The prevalence of GCK MODY is high in southern Italy, and the GCK small domain is a hot spot for MODY mutations. Both the severity of the GCK mutation and the genetic background seem to play a relevant role in the GCK MODY phenotyope. Indeed, a partial genotype-phenotype correlation was identified in related patients (3 pairs of siblings) but nut in two unrelated children bearing the same mutations. Thus, the molecular approach allows the physician to confirm the diagnosis and to predict severity of the mutation. © 2008 Tinto et al.