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Mutations in the mitochondrial thioredoxin reductase gene TXNRD2 ...

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<strong>TXNRD2</strong> and dilated cardiomyopathy 1131<br />

Figure 5 Ultrastructural analysis of Txnrd2 +/+ and Txnrd2 2/2 cells express<strong>in</strong>g wt Txnrd2 and <strong>the</strong> different Txnrd2 mutants. (A) Empty virustransduced<br />

(mock), wt Txnrd2-, and A59T- and G375R-transduced Txnrd2 +/+ mouse embryonic fibroblasts did not reveal major differences <strong>in</strong><br />

<strong>mitochondrial</strong> structures. (B) Although <strong>the</strong> sub<strong>mitochondrial</strong> structures (cristae) were less dist<strong>in</strong>ct <strong>in</strong> Txnrd2 2/2 mouse embryonic fibroblasts<br />

compared with wild-type cells, <strong>the</strong> add-back of <strong>the</strong> different Txnrd2 variants did not grossly change <strong>the</strong> overall <strong>mitochondrial</strong> structure. The<br />

scale bar represents 500 nm.<br />

Functional analysis of <strong>the</strong> two identified mutants reconstructed <strong>in</strong><br />

mur<strong>in</strong>e fibroblasts revealed that both forms do not rescue<br />

Txnrd2 2/2 cells from cell death <strong>in</strong>duced by GSH depletion and<br />

that <strong>the</strong>y exerted a dom<strong>in</strong>ant-negative effect when expressed <strong>in</strong><br />

Txnrd2 +/+ cells.<br />

Regard<strong>in</strong>g a possible causative role of <strong>the</strong> mutations for DCM,<br />

two questions had to be answered: first, are <strong>the</strong> mutations rare<br />

polymorphisms that are functionally silent or do <strong>the</strong>y abolish or<br />

impair <strong>the</strong> function of Txnrd2? And second, as <strong>the</strong> mutations<br />

were heterozygous <strong>in</strong> all three patients, do <strong>the</strong>y exert a dom<strong>in</strong>ant-<br />

negative function on <strong>the</strong> wt enzyme? Both questions raise fundamental<br />

issues regard<strong>in</strong>g <strong>the</strong> enzymatic function of Txnrd2 that is<br />

shared among different cell types and tissues and should <strong>the</strong>refore<br />

be <strong>in</strong>dependent of <strong>the</strong> cellular model system. Apparently, <strong>the</strong> first<br />

question could only be addressed <strong>in</strong> Txnrd2 2/2 cells, thus preclud<strong>in</strong>g<br />

<strong>the</strong> use of cardiomyocytes. We reasoned that if <strong>the</strong> mutant<br />

alleles could rescue <strong>the</strong> Txnrd2 2/2 phenotype <strong>in</strong> a manner<br />

similar to <strong>the</strong> wt allele, <strong>the</strong> mutations would be functionally<br />

silent. Conversely, a functional significance of <strong>the</strong> mutations<br />

could be disclosed if <strong>the</strong> mutant alleles were not able to rescue<br />

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