Primary hypomagnesemia constitutes a rare heterogeneous group of disorders characterized by renal or intestinal magnesium (Mg 2+ ) wasting resulting in generally shared symptoms of Mg 2+ depletion, such as tetany and generalized convulsions, and often including associated disturbances in calcium excretion. However, most of the genes involved in the physiology of Mg 2+ handling are unknown. Through the discovery of a mutation in the EGF gene in isolated autosomal recessive renal hypomagnesemia, we have, for what we believe is the first time, identified a magnesiotropic hormone crucial for total body Mg 2+ balance. The mutation leads to impaired basolateral sorting of pro-EGF. As a consequence, the renal EGFR is inadequately stimulated, resulting in insufficient activation of the epithelial Mg 2+ channel TRPM6 (transient receptor potential cation channel, subfamily M, member 6) and thereby Mg 2+ loss. Furthermore, we show that colorectal cancer patients treated with cetuximab, an antagonist of the EGFR, develop hypomagnesemia, emphasizing the significance of EGF in maintaining Mg 2+ balance.
IntroductionMagnesium (Mg 2+ ) is established as a central electrolyte in a large number of cellular metabolic reactions, including DNA synthesis, neurotransmission, and hormone receptor binding. It is a component of GTPase and a cofactor for Na,K-ATPase, adenylate cyclase, phosphoinositide kinases, and phosphofructokinase (1). Mg 2+ is also important for the regulation of parathyroid hormone release (2, 3). Accordingly, Mg 2+ deficiency (plasma Mg 2+ concentrations below 0.70 mM) has an effect on multiple body functions. Symptoms of Mg 2+ deficiency are mostly related to muscle dysfunctioning, such as tetany, prolonged QT interval, and cardiac arrhythmias (4). Children with hypomagnesemia often present with tetany and/or convulsions. Hypomagnesemia is a problem frequently observed in more than 10% of hospitalized patients and occurrences can be as high as 65% in intensive care patients (5). A long-term complication seen in many adult patients with chronic hypomagnesemia is chondrocalcinosis, which can lead to impairment of joint function (4). Mg 2+ deficiency can be secondary to systemic diseases (for instance, diabetes mellitus and Crohn disease) or to the use of osmotic agents, diuretics, and drugs such as cyclosporin and cisplatin (6). In addition, primary Mg 2+ deficiency is observed in several monogenetic disorders. Failure of early diagnosis or noncompliance with treatment can be fatal or result in permanent neurological damage.