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2017 ; 69
(6
): 1207-1216
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Physiological and Pathological Roles in Human Adrenal of the Glomeruli-Defining
Matrix Protein NPNT (Nephronectin)
#MMPMID28416583
Teo AE
; Garg S
; Johnson TI
; Zhao W
; Zhou J
; Gomez-Sanchez CE
; Gurnell M
; Brown MJ
Hypertension
2017[Jun]; 69
(6
): 1207-1216
PMID28416583
show ga
Primary aldosteronism is a common cause of hypertension, which becomes refractory
if undiagnosed, but potentially curable when caused by an aldosterone-producing
adenoma (APA). The discovery of somatic mutations and differences in clinical
presentations led to recognition of small but common zona glomerulosa (ZG)-like
adenomas, distinct from classical large zona fasciculata-like adenomas. The
inverse correlation between APA size and aldosterone synthase expression prompted
us to undertake a systematic study of genotype-phenotype relationships. After a
microarray comparing tumor subtypes, in which NPNT (nephronectin) was the most
highly (>12-fold) upregulated gene in ZG-like APAs, we aimed to determine its
role in physiological and pathological aldosterone production. NPNT was
identified by immunohistochemistry as a secreted matrix protein expressed
exclusively around aldosterone-producing glomeruli in normal adrenal ZG and in
aldosterone-dense ZG-like APAs; the highest expression was in ZG-like APAs with
gain-of-function CTNNB1 mutations, whose removal cured hypertension in our
patients. NPNT was absent from normal zona fasciculata, zona fasciculata-like
APAs, and ZG adjacent to an APA. NPNT production was regulated by canonical Wnt
pathway, and NPNT overexpression or silencing increased or reduced aldosterone,
respectively. NPNT was proadhesive in primary adrenal and APA cells but
antiadhesive and antiapoptotic in immortalized adrenocortical cells. The
discovery of NPNT in the adrenal helped recognition of a common subtype of APAs
and a pathway by which Wnt regulates aldosterone production. We propose that this
arises through NPNT's binding to cell-surface integrins, stimulating cell-cell
contact within glomeruli, which define ZG. Therefore, NPNT or its cognate
integrin could present a novel therapeutic target.