BiallelicNPR1loss of function variants are responsible for neonatal systemic hypertension

Abstract

BackgroundEarly-onset isolated systemic hypertension is a rare condition of unknown genetic origin. Renovascular, renal parenchymal diseases or aortic coarctation are the most common causes of secondary systemic hypertension in younger children and neonates. We investigated the genetic bases of early-onset isolated systemic hypertension.MethodsWhole-exome sequencing (WES) was followed by variant filtering and Sanger sequencing for validation and familial segregation of selected variants in a large consanguineous family. mRNA expression was performed to evaluate the impact of the predicted pathogenic variant on gene expression. WES or Sanger sequencing was performed in additional unrelated affected individuals.ResultsIn one consanguineous family with four children presenting with isolated neonatal-onset systemic hypertension, we identified homozygous stop–gain variant in theNPR1gene (NM_000906.4:c.1159C>T (p.Arg387Ter)) in the affected individuals. This variant leads to a dramatic reduction of NPR1 RNA levels.NPR1gene analysis of additional families allowed the identification of another family with two affected children carrying homozygous frameshift variant inNPR1(NM_000906.4:c.175del (p.Val59TrpfsTer8)).ConclusionWe show for the first time that biallelic loss of function ofNPR1is responsible for isolated neonatal-onset systemic hypertension in humans, which represents a new autosomal recessive genetic cause of infantile systemic hypertension or cardiogenic shock. This is consistent with studies reporting early-onset systemic hypertension and sudden death in Npr1-deficient mice.NPR1gene analysis should be therefore investigated in infants with early-onset systemic hypertension with or without cardiogenic shock of unknown origin.