Phenotypic and pharmacogenetic evaluation of patients with thiazide-induced hyponatremia

Ware, James S. and Wain, Louise V. and Channavajjhala, Sarath K. and Jackson, Victoria E. and Edwards, Elizabeth and Lu, Run and Siew, Keith and Jia, Wenjing and Shrine, Nick and Kinnear, Sue and Jalland, Mahli and Henry, Amanda P. and Clayton, Jenny and O’Shaughnessy, Kevin M. and Tobin, Martin D. and Schuster, Victor and Cook, Stuart and Hall, Ian P. and Glover, Mark (2017) Phenotypic and pharmacogenetic evaluation of patients with thiazide-induced hyponatremia. Journal of Clinical Investigation . ISSN 1558-8238

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Abstract

Thiazide diuretics are among the most widely used treatments for hypertension, but thiazide-induced hyponatremia (TIH), a clinically significant adverse effect, is poorly understood. Here, we have studied the phenotypic and genetic characteristics of patients hospitalized with TIH. In a cohort of 109 TIH patients, those with severe TIH displayed an extended phenotype of intravascular volume expansion, increased free water reabsorption, urinary prostaglandin E2 excretion, and reduced excretion of serum chloride, magnesium, zinc, and antidiuretic hormone. GWAS in a separate cohort of 48 TIH patients and 2,922 controls from the 1958 British birth cohort identified an additional 14 regions associated with TIH. We identified a suggestive association with a variant in SLCO2A1, which encodes a prostaglandin transporter in the distal nephron. Resequencing of SLCO2A1 revealed a nonsynonymous variant, rs34550074 (p.A396T), and association with this SNP was replicated in a second cohort of TIH cases. TIH patients with the p.A396T variant demonstrated increased urinary excretion of prostaglandin E2 and metabolites. Moreover, the SLCO2A1 phospho-mimic p.A396E showed loss of transporter function in vitro. These findings indicate that the phenotype of TIH involves a more extensive metabolic derangement than previously recognized. We propose one mechanism underlying TIH development in a subgroup of patients in which SLCO2A1 regulation is altered.

Item Type: Article
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine
Identification Number: 10.1172/JCI89812
Depositing User: Eprints, Support
Date Deposited: 08 Aug 2017 07:39
Last Modified: 08 Aug 2017 08:07
URI: http://eprints.nottingham.ac.uk/id/eprint/44729

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