Familial glucocorticoid deficiency (FGD), or hereditary unresponsiveness to adrenocorticotropin (ACTH; OMIM 202200), is an autosomal recessive disorder resulting from resistance to the action of ACTH on the adrenal cortex, which stimulates glucocorticoid production. Affected individuals are deficient in cortisol and, if untreated, are likely to succumb to hypoglycemia or overwhelming infection in infancy or childhood. Mutations of the ACTH receptor (melanocortin 2 receptor, MC2R) account for approximately 25% of cases of FGD. FGD without mutations of MC2R is called FGD type 2. Using SNP array genotyping, we mapped a locus involved in FGD type 2 to chromosome 21q22.1. We identified mutations in a gene encoding a 19-kDa single-transmembrane domain protein, now known as melanocortin 2 receptor accessory protein (MRAP). We show that MRAP interacts with MC2R and may have a role in the trafficking of MC2R from the endoplasmic reticulum to the cell surface.

Our functional evaluation of AIP mutations is consistent with a tumor-suppressor role for AIP and its involvement in familial acromegaly. The abnormal expression and subcellular localization of AIP in sporadic pituitary adenomas indicate deranged regulation of this protein during tumorigenesis.

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GPCR accessory proteins ͉ receptor signalling ͉ receptor trafficking T he melanocortin receptor (MCR) family is involved in a diverse range of physiologic and disease processes (1). MC1R is important in pigmentation, MC2R in steroidogenesis, and MC5R has an exocrine function especially in sebaceous gland secretion. MC3R and MC4R are both highly expressed in the brain and play key roles in energy homeostasis. Mutations in MC4R are the most common cause of monogenic obesity. More recently, fat mass, weight, risk of obesity, and insulin resistance were associated with common variants near the MC4R locus (2, 3). Both MC4R knockout mice and humans with MC4R mutations display early-onset obesity associated with hyperphagia (4, 5). MC3R knockout mice, however, develop a milder phenotype with later-onset obesity (6, 7).We previously identified MRAP (melanocortin-2-receptor accessory protein), a small transmembrane protein, as an MC2R accessory protein, enabling the functional expression of MC2R in transfected cells. The identification of MRAP provides a molecular explanation for the difficulties encountered in the expression of the MC2R in nonadrenal cell lines (8). Furthermore, mutations in MRAP result in the autosomal recessive disorder familial glucocorticoid deficiency type 2 (9).Here we report the identification and characterization of a unique MRAP homologue encoded by C6orf117 on human chromosome 6q14.3, which we have named MRAP2. We show that both MRAP and MRAP2 can modulate the signaling of all 5 MCRs. MRAP2 is primarily expressed in human brain and adrenal gland. In the brain, MRAP2 expression is seen in the hypothalamus (10), a site that also expresses a high level of MC3R and MC4R (6,11). MRAP expression in the hypothalamus has also been demonstrated by in situ hybridization (12). These findings suggest that MRAP and MRAP2 may regulate MC3R and MC4R function in the central nervous system. Results MRAP2:A Unique Homologue of MRAP. The human MRAP2 gene consists of 4 exons, and its protein product comprises 205 aa residues, with a predicted molecular mass of 23.5 kDa (Fig. 1A). MRAP2 is homologous to MRAP, with 39% amino acid identity to MRAP in the N-terminal and transmembrane domains (Fig. 1B). The protein is highly conserved through vertebrates (supporting information Fig. S1) and like MRAP has no predicted signal sequence.

Using targeted exome sequencing we identified mutations in NNT, an antioxidant defence gene, in patients with familial glucocorticoid deficiency. In mice with Nnt loss, higher levels of adrenocortical cell apoptosis and impaired glucocorticoid production were observed. NNT knockdown in a human adrenocortical cell line resulted in impaired redox potential and increased ROS levels. Our results suggest that NNT may have a role in ROS detoxification in human adrenal glands.