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Familial early-onset obesity in Turkish children: variants and polymorphisms in the melanocortin-4 receptor (MC4R) gene

  • Heves Kırmızıbekmez ORCID logo EMAIL logo , Yasemin Kendir Demirkol ORCID logo , Özlem Akgün Doğan ORCID logo , Gülcan Seymen , Elif İnan Balcı ORCID logo , Pınar Atla ORCID logo and Fatma Dursun ORCID logo
Published/Copyright: March 30, 2022

Abstract

Objectives

Genetic factors have a key role in childhood obesity with higher rates in children than adults. Among the monogenic types of non-syndromic obesity, melanocortin-4 receptor (MC4R) deficiency is the most frequent cause. Beside pathogenic variants, single-nucleotide polymorphisms in MC4R gene are also associated with lower energy expenditure. The aim of this study was to estimate the frequency of MC4R variants and polymorphisms in a cohort of Turkish children and adolescents with severe early-onset obesity, and to understand the clinical features of patients.

Methods

Patients, 1–17 years of age, with the onset of obesity before 10 years of age and a body mass index (BMI) standard deviation score (SDS) of >2.3, and who had a family history of early-onset obesity in at least one of their first-degree relatives were included in the study. Beside routine blood tests genetic analyses for MC4R gene were performed.

Results

Analyses of MC4R revealed previously known variations in three (3.5%) patients, and pathogenic polymorphisms related with obesity in four (4.7%) patients. BMI SDS values were between 2.8 and 5.5 SDS in the pathogenic variant carrier group, and 2.8–4.9 SDS in the polymorphism group. Mean BMI SDS in variant-negative group was 3.4 ± 0.82.

Conclusions

Investigation of the MC4R in individuals with early-onset obesity and presence of obesity first-degree relatives is important. Hypertension is a rare comorbidity compared to other causes. Contrary to studies reporting that insulin resistance was absent or very rare, we found it as a frequent finding in both pathogenic variants and polymorphisms of MC4R.


Corresponding author: Heves Kırmızıbekmez, Department of Pediatric Endocrinology, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Turkey, Phone: +90 216 6507676, Fax: +90 216 6327121, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.

References

1. Schonfeld-Warden, N, Warden, CH. Pediatric obesity. An overview of etiology and treatment. Pediatr Clin North Am 1997;44:339–61. https://doi.org/10.1016/s0031-3955(05)70480-6.Search in Google Scholar

2. Mǎrginean, CO, Mǎrginean, C, Meliţ, LE. New insights regarding genetic aspects of childhood obesity: a minireview. Front Pediatr 2018;6:271. https://doi.org/10.3389/fped.2018.00271.Search in Google Scholar PubMed PubMed Central

3. Tunç, S, Demir, K, Tükün, FA, Topal, C, Hazan, F, Sağlam, B, et al.. Melanocortin-4 receptor gene mutations in a group of Turkish obese children and adolescents. J Clin Res Pediatr Endocrinol 2017;9:216–21. https://doi.org/10.4274/jcrpe.4225.Search in Google Scholar PubMed PubMed Central

4. Aykut, A, Özen, S, Gökşen, D, Ata, A, Onay, H, Atik, T, et al.. Melanocortin 4 receptor (MC4R) gene variants in children and adolescents having familial early-onset obesity: genetic and clinical characteristics. Eur J Pediatr 2020;179:1445–52. https://doi.org/10.1007/s00431-020-03630-7.Search in Google Scholar PubMed PubMed Central

5. Fernandes, AE, de Melo, ME, Fujiwara, CT, Pioltine, MB, Matioli, SR, Santos, A, et al.. Associations between a common variant near the MC4R gene and serum triglyceride levels in an obese pediatric cohort. Endocrine 2015;49:653–8. https://doi.org/10.1007/s12020-015-0616-8.Search in Google Scholar PubMed

6. Vaisse, C, Clement, K, Guy-Grand, B, Froguel, P. A frameshift mutation in human MC4R is associated with a dominant form of obesity. Nat Genet 1998;20:113–4.https://doi.org/10.1038/2407.Search in Google Scholar PubMed

7. Weiss, RE, Refetoff, S. Genetic diagnosis of endocrine disorders, 2nd ed. Amsterdam: Academic Press; 2015:444 p.Search in Google Scholar

8. Gao, L, Wang, L, Yang, H, Pan, H, Gong, F, Zhu, H. MC4R single nucleotide polymorphisms were associated with metabolically healthy and unhealthy obesity in Chinese northern Han populations. Int J Endocrinol 2019. https://doi.org/10.1155/2019/4328909.Search in Google Scholar PubMed PubMed Central

9. Demiralp, DO, Berberoğlu, M, Akar, N. Melanocortin-4 receptor polymorphisms in Turkish pediatric obese patients. Clin Appl Thromb Hemost 2011;17:70–4. https://doi.org/10.1177/1076029609354330.Search in Google Scholar PubMed

10. Kelly, AS, Barlow, SE, Rao, G, Inge, TH, Hayman, LL, Steinberger, J, et al.. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches. A scientific statement from the American Heart Association. Circulation 2013;128:1689–712. https://doi.org/10.1161/cir.0b013e3182a5cfb3.Search in Google Scholar

11. Neyzi, O, Bundak, R, Gökçay, G, Günöz, H, Furman, A, Darendeliler, F, et al.. Reference values for weight, height, head circumference and body mass index in Turkish children. J Clin Res Pediatr Endocrinol 2015;7:280–93. https://doi.org/10.4274/jcrpe.2183.Search in Google Scholar PubMed PubMed Central

12. Demir, K, Özen, S, Konakçı, E, Aydın, M, Darendeliler, F. A comprehensive online calculator for pediatric endocrinologists: ÇEDD Çözüm/TPEDS metrics. J Clin Res Pediatr Endocrinol 2017;9:182–4. https://doi.org/10.4274/jcrpe.4526.Search in Google Scholar PubMed PubMed Central

13. Matthews, DR, Hosker, JP, Rudenski, AS, Naylor, BA, Treacher, DF. Homeostasis model assessment: insulin resistance and ß cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–9. https://doi.org/10.1007/bf00280883.Search in Google Scholar

14. Kurtoğlu, S, Hatipoğlu, N, Mazıcıoğlu, M, Kendirci, M, Keskin, M, Kondolot, M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol 2010;2:100–6.10.4274/jcrpe.v2i3.100Search in Google Scholar PubMed PubMed Central

15. Flynn, JT, Kaelber, DC, Baker-Smith, CM, Blowey, D, Carroll, AE, Daniels, SR, et al.. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140:e20171904. https://doi.org/10.1542/peds.2017-1904.Search in Google Scholar PubMed

16. Richards, S, Aziz, N, Bale, S, Bick, D, Das, S, Gastier-Foster, J, et al.. 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;17:405–23. https://doi.org/10.1038/gim.2015.30.Search in Google Scholar PubMed PubMed Central

17. De Rosa, MC, Chesi, A, McCormack, S, Zhou, J, Weaver, B, McDonald, M, et al.. Characterization of rare variants in MC4R in African American and Latino children with severe early-onset obesity. J Clin Endocrinol Metab 2019;104:2961–70. https://doi.org/10.1210/jc.2018-02657.Search in Google Scholar PubMed PubMed Central

18. Molou, E, Schulpis, KH, Birbilis, C, Thodi, G, Georgiou, V, Dotsikas, Y, et al.. Early screening of FTO and MC4R variants in newborns of Greek origin. J Pediatr Endocrinol Metab 2015;28:619–22. https://doi.org/10.1515/jpem-2014-0320.Search in Google Scholar PubMed

19. Polak, E, Vitariusova, E, Celec, P, Pribilincova, Z, Kostalova, L, Hlavata, A, et al.. The prevalence of melanocortin-4 receptor gene mutations in Slovak obese children and adolescents. J Pediatr Endocrinol Metab 2016;29:55–61. https://doi.org/10.1515/jpem-2015-0015.Search in Google Scholar PubMed

20. Farooqi, IS, Yeo, GS, Keogh, JM, Aminian, S, Jebb, SA, Butler, G, et al.. Dominant and recessive inheritance of morbid obesity associated with melanocortin 4 receptor deficiency. J Clin Invest 2000;106:185–7. https://doi.org/10.1172/JCI9397.Search in Google Scholar PubMed PubMed Central

21. Baldini, G, Phelan, KD. The melanocortin pathway and control of appetite-progress and therapeutic implications. J Endocrinol 2019;241:R1–33. https://doi.org/10.1530/joe-18-0596.Search in Google Scholar PubMed PubMed Central

22. Kuhnen, P, Krude, H, Biebermann, H. Melanocortin-4 receptor signalling: importance for weight regulation and obesity treatment. Trends Mol Med 2019;25:136–48. https://doi.org/10.1016/j.molmed.2018.12.002.Search in Google Scholar PubMed

23. Silva, AA, Carmo, JM, Wang, Z, Hall, JE. Melanocortin-4 receptors and sympathetic nervous system activation in hypertension. Curr Hypertens Rep 2020;21. https://doi.org/10.1007/s11906-019-0951-x.Search in Google Scholar PubMed PubMed Central

24. Tallam, LS, Stec, DE, Willis, MA, da Silva, AA, Hall, JE. Melanocortin-4 receptor-deficient mice are not hypertensive or salt-sensitive despite obesity hyperinsulinemia, and hyperleptinemia, hyperinsulinemia, and hyperleptinemia. Hypertension 2005;46:326–32. https://doi.org/10.1161/01.hyp.0000175474.99326.bf.Search in Google Scholar

25. Cooiman, MI, Kleinendorst, L, Aarts, EO, Janssen, IMC, van Amstel, HKP, Blakemore, AI, et al.. Genetic obesity and bariatric surgery outcome in 1014 patients with morbid obesity. Obes Surg 2020;30:470–7. https://doi.org/10.1007/s11695-019-04184-w.Search in Google Scholar PubMed

26. Censani, M, Conroy, R, Deng, L, Oberfield, SE, McMahon, DJ, Zitsman, JL, et al.. Weight loss after bariatric surgery in morbidly obese adolescents with MC4R mutations. Obesity (Silver Spring, Md) 2014;22:225–31. https://doi.org/10.1002/oby.20511.Search in Google Scholar PubMed PubMed Central

27. Collet, TH, Dubern, B, Mokrosinski, J, Connors, H, Keogh, JM, Mendes de Oliveira, E, et al.. Evaluation of a melanocortin-4 receptor (MC4R) agonist (Setmelanotide) in MC4R deficiency. Mol Metabol 2017;6:1321–9. https://doi.org/10.1016/j.molmet.2017.06.015.Search in Google Scholar PubMed PubMed Central

28. Fani, L, Bak, S, Delhanty, P, van Rossum, EFC, van den Akker, ELT. The melanocortin-4 receptor as target for obesity treatment: a systematic review of emerging pharmacological therapeutic options. Int J Obesity 2014;38:163–9. https://doi.org/10.1038/ijo.2013.80.Search in Google Scholar PubMed

29. Greenfield, JR, Miller, JW, Keogh, JM, Henning, E, Satterwhite, JH, Cameron, G, et al.. Modulation of blood pressure by central melanocortinergic pathways. N Engl J Med 2009;360:44–52.https://doi.org/10.1056/nejmoa0803085.Search in Google Scholar

Received: 2021-12-15
Accepted: 2022-03-11
Published Online: 2022-03-30
Published in Print: 2022-05-25

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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