Rare mutations in SLC12A1 and SLC12A3 protect against hypertension by reducing the activity of renal salt cotransporters

Objectives Screening for variants in SLC12A1 and SLC12A3 genes, encoding the renal Na+:Cl- (NCC) and Na+:K+:2Cl(-) (NKCC2) cotransporters, respectively, in 3125 members of the Framingham Heart Study (FHS) revealed that carrying a rare mutation in one of these genes was associated with a significant reduction in blood pressure, in the risk of arterial hypertension, and of death due to cardiovascular disease. Because near 60% of the rare mutations identified have not been related to Bartter's or Gitelman's disease, the consequence of such mutations on cotransporter activity is unknown. Methods We used the heterologous expression system of Xenopus laevis oocytes, microinjected with wild-type or mutant NCC or NKCC2 cRNAs, to examine the effect of these inferred NCC and NKCC2 mutations on the cotransporters' functional properties. Cotransporter activity was defined as the diuretic-sensitive radioactive tracer uptake and response to known modulators was assessed. Results Basal NCC activity was significantly reduced in all NCC mutants and, excluding NCC-S186F, response to WNK3, WNK4, or intracellular chloride depletion was conserved. Similarly, basal activity was reduced in six out of nine NKCC2 mutants and response to WNK3 was maintained. No effect on protein expression was seen, except for NCC-S186F, which was significantly reduced. Conclusions The rare NCC or NKCC2 mutations found in the FHS significantly reduced the basal activity of the cotransporters. This observation supports that even a small, but chronic reduction of NCC or NKCC2 function results in a lower blood pressure and decreased risk of hypertension in otherwise healthy individuals in the general population. J Hypertens 29:475483 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.