DOI: 10.12890/2026_006130
Novel phenotype due to KCNJ11 pathogenic variant associated with maturity-onset diabetes of the young-KCNJ-11
Authors
michiel.reunes1@gmail.com
Keywords
MODY-KCNJ11, diabetes, genetics, pathogenic variantAbstract
Introduction: Maturity-onset diabetes of the young (MODY) KCNJ11 is caused by pathogenic variants in the KATP channel of the pancreatic beta-cell leading to altered insulin secretion. Bi-allelic loss-of-function variants lead to neonatal diabetes mellitus (DM) whereas heterozygous gain-of-function variants lead to congenital hyperinsulinism. Heterozygous loss-of-function variants, however, are suggested to cause a bimodal pattern with hyperinsulinaemic hypoglycaemia in early life (with an often-mild presentation) and progressing to glucose intolerance in early adulthood.
Case description: We describe three family members with early-onset DM (or glucose intolerance) without clear features of type 1 or type 2 DM. A heterozygous likely pathogenic missense variant c.119G>A (p.(Gly40Asp)) was found in an autosomal dominant pattern. This variant was previously only linked to cases of congenital hyperinsulinism and had been described as likely pathogenic or pathogenic in patients with type 2 DM.
Conclusion: To our knowledge, this is the first report linking the c.119G>A KCNJ11 variant to a clinical context of MODY. We have no evidence in our patients of clinically significant hypoglycaemia at young age. However, we still hypothesise - congruent with the latest evidence - that there might be a bimodal pattern in individuals with this variant. This report adds to the clinical and genetic heterogenicity of MODY and illustrates the complexity of early diagnosis of MODY.
References
- Fajans SS, Bell GI. MODY: history, genetics, pathophysiology, and clinical decision making. Diabetes Care 2011;34:1878–1884. doi: 10.2337/dc11-0035
- Vedovato N, Salguero MV, Greeley SAW, Yu CH, Philipson LH, Ashcroft FM. A loss-of-function mutation in KCNJ11 causing sulfonylurea-sensitive diabetes in early adult life. Diabetologia 2024;67:940–951. doi: 10.1007/s00125-024-06103-w
- Suchi M, MacMullen CM, Thornton PS, Adzick NS, Ganguly A, Ruchelli ED, et al. Molecular and immunohistochemical analyses of the focal form of congenital hyperinsulinism. Mod Pathol 2006;19:122–129. doi: 10.1038/modpathol.3800497
- Gloyn AL, Pearson ER, Antcliff JF, Proks P, Bruining GJ, Slingerland AS, et al. Activating mutations in the gene encoding the ATP-sensitive potassium-channel subunit Kir6.2 and permanent neonatal diabetes. N Engl J Med 2004;350:1838–1849. doi: 10.1056/NEJMoa032922. Erratum in: N Engl J Med 2004;351:1470.
- Scala R, Li Y, Gao J, York NW, Unnikrishnan R, Anjana RM, et al. Paradoxical maturity-onset diabetes of the young arising from loss-of-function mutations in ATP-sensitive potassium channels. Diabetes 2025;75:180–192. doi: 10.2337/db25-0110
- Richards S, Aziz N, Bale S, Bick D, Das S, Gastier-Foster J, et al. ACMG Laboratory Quality Assurance Committee. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med 2015;17:405–424. doi: 10.1038/gim.2015.30
- Bonnefond A, Boissel M, Bolze A, Durand E, Toussaint B, Vaillant E, et al. Pathogenic variants in actionable MODY genes are associated with type 2 diabetes. Nat Metab 2020;2:1126–1134. doi: 10.1038/s42255-020-00294-3
- Chen Y, Hu X, Cui J, Zhao M, Yao H. A novel mutation KCNJ11 R136C caused KCNJ11-MODY. Diabetol Metab Syndr 2021;13:91. doi: 10.1186/s13098-021-00708-6
- Kapoor RR, Flanagan SE, James CT, McKiernan J, Thomas AM, Harmer SC, et al. Hyperinsulinaemic hypoglycaemia and diabetes mellitus due to dominant ABCC8/KCNJ11 mutations. Diabetologia 2011;54:2575–2583. doi: 10.1007/s00125-011-2207-4
- Koufakis T, Sertedaki A, Tatsi EB, Trakatelli CM, Karras SN, Manthou E, et al. First report of diabetes phenotype due to a loss-of-function ABCC8 mutation previously known to cause congenital hyperinsulinism. Case Rep Genet 2019;2019:3654618. doi: 10.1155/2019/3654618.