Abstract

Objective: Digenic causes of human disease are rarely reported. Insulin via its receptor, encoded by INSR, plays a key role in both metabolic and growth signaling pathways. Heterozygous INSR mutations are the most common cause of monogenic insulin resistance. However, growth retardation is only reported with homozygous or compound heterozygous mutations. We describe a novel translocation [t(7;19)(p15.2;p13.2)] co-segregating with insulin resistance and pre- and post-natal growth deficiency. Chromosome translocations present a unique opportunity to identify modifying loci therefore our objective was to determine the mutational mechanism resulting in this complex phenotype.

Research design and Methods: Breakpoint mapping was performed by Fluorescence in-situ hybridisation (FISH) on patient chromosomes. Sequencing and gene expression studies of disrupted and adjacent genes were performed on patient derived tissues.

Results: Affected individuals had increased insulin, c-peptide, insulin/c-peptide ratio and adiponectin levels consistent with an insulin receptoropathy. FISH mapping established that the translocation breakpoints disrupt INSR on chromosome 19p15.2 and CHN2 on chromosome 7p13.2. Sequencing demonstrated INSR haploinsufficiency accounting for elevated insulin levels and dysglycaemia. CHN2 encoding beta-2 chimerin was shown to be expressed in insulin sensitive tissues and its disruption to result in decreased gene expression in patient derived adipose tissue.

Conclusions: We present a likely digenic cause of insulin resistance and growth deficiency resulting from the combined heterozygous disruption of INSR and CHN2; implicating CHN2 for the first time as a key element of proximal insulin signaling in-vivo.