Biology subjects

Nigam, A.

Publications and source records attributed to Nigam, A..

14 recordsLinked to original sources

bioRxiv2026

Regional distribution of white matter hyperintensity burden in coronary artery disease and links with coronary revascularization procedure

IntroductionCoronary artery disease (CAD) increases the risk of cerebrovascular events, yet early brain injury in this population remains poorly characterized. White matter hyperintensities (WMHs), a biomarker of cerebrovascular lesions, are prevalent in CAD and are linked to risk of stroke. Beyond total burden, spatial distribution of WMHs carries pathological significance and is critical for understanding CAD-related injury. While clinical outcomes including coronary revascularization procedure and myocardial infarction influence CAD prognosis, their impact on WMH burden remains unclear. MethodsThis study investigated regional WMH burden in CAD and its relationship with clinical characteristics. 82 adults over 50 years participated, including 44 individuals with CAD and 38 controls. WMHs were segmented from fluid attenuated inversion recovery and T1-weighted MRI and categorized as total, periventricular, deep, and superficial regions. History of myocardial infarction and coronary revascularization (coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)), was obtained from medical files. ResultsIndividuals with CAD exhibited higher total, periventricular, and deep WMH volumes than controls. Participants who underwent CABG had higher superficial WMH volumes than those with PCI, suggesting greater disease severity influences WMH burden. ConclusionCAD is characterized by a distinct pattern of cerebrovascular vulnerability, with revascularization procedures influencing WMH burden

neuroscience↗

bioRxiv2026

Evolutionary exploration of drug-like chemical space utilizing generative AI and virtual screening

The identification of suitable lead molecules in the vast chemical space is a critical and challenging task in drug discovery campaigns. Recently, it has been demonstrated that large-scale virtual screening provides a powerful approach to accelerate the identification of novel drug candidates by screening ever increasing virtual ligand libraries, which have reached magnitudes of > 1020 compounds. However, this desirable increase in potentially bioactive molecules poses a new challenge as enumerating and virtually screening such huge compound libraries is computationally prohibitive. Consequently, advanced approaches to navigate ultra-large chemical spaces and to identify suitable candidate molecules therein are urgently needed. Here, we present an evolutionary algorithm framework using molecular generative AI, reaction-based substructure searching, and iterative model fine-tuning for a targeted and efficient exploration of chemical fragment spaces. Combining this approach with large-scale virtual screening we are able to identify target-specific candidate molecules within the commercially available Enamine REAL Space ([~]1015). We demonstrate the applicability of the approach by successfully identifying and biochemically validating pH-specific ligands of the {micro}-opioid receptor. Our results demonstrate that integrating generative AI with evolutionary algorithms provides a promising route to explore ultra-large chemical spaces for the discovery of novel, synthetically accessible lead molecules.

bioinformatics↗

bioRxiv2026

Coronary artery disease is linked with demyelination and iron deposition in white matter watershed areas

Coronary artery disease increases risk of cognitive decline and stroke and is associated with white matter alterations. However, the biological basis of these changes remains unclear. Myelin content and iron deposition are crucial measures of white matter health and can be measured with quantitative MRI. This study investigated whether myelin and iron alterations occur in coronary artery disease, and their relationship with cognition. In this cross-sectional study, 46 individuals with coronary artery disease and 40 healthy controls aged > 50 years, with normal cognition underwent 3T MRI and cognitive assessments. Quantitative MRI metrics (susceptibility, magnetization transfer saturation, R2* and R1 relaxation rates) were calculated in the border zones between adjacent arterial territories (watershed regions) and in the areas outside these borders (non-watershed regions). Relative to controls, the coronary artery disease group showed lower myelin and higher iron content, as measured by lower magnetization transfer saturation and R1, and higher susceptibility specifically in watershed regions. Importantly, these microstructural alterations were associated with poorer cognitive performance in the coronary artery disease group with lower magnetization transfer and R1related to poorer global cognition and with higher magnetic susceptibility with poorer verbal memory. These findings suggest that coronary artery disease is associated with demyelination and iron deposition in white matter, most prominently in watershed regions, which are known for their susceptibility to stroke. The association of these microstructural alterations with cognition highlights the role of white matter as a key vulnerable region and a promising focus for future mechanistic and therapeutic studies.

neuroscience↗

bioRxiv2026

WISP1 drives a mechanically active immune modulatory and proliferative cardiac myofibroblast state

Pathological cardiac remodeling is driven by the proliferation and differentiation of resident fibroblasts into active myofibroblasts and results in excessive extracellular matrix (ECM) deposition and tissue stiffening. Expression of the matricellular protein WISP1 has previously been shown to be increased with cardiac fibrosis and promote myofibroblast activity, but the mechanisms by which this occurs remain unknown. Primary cardiac fibroblasts were isolated from adult mouse hearts and treated with recombinant WISP1 or TGF{beta}1 both alone and in combination to determine the functional role of the matricellular protein WISP1 in driving cardiac myofibroblast activity. WISP1 significantly increased alpha-smooth muscle actin and collagen type I expression, total collagen secretion, collagen gel contractility, and wound healing equally in fibroblasts from both male and female mice. However, WISP1 alone failed to induce expression of periostin, a hallmark myofibroblast marker, suggesting the resulting WISP1-dependent cell phenotype is unique and/or acting through non-canonical pathways. Indeed, inhibition of P38 MAPK completely ablated the WISP1-dependent increase in SMA and collagen expression, while having little to no impact on TGF{beta}1-dependent expression of myofibroblast marker genes. We next employed a multi-omics approach to define the functional impact of WISP1 on fibroblast cell-state within the transcriptome, cytosolic, and secreted ECM proteome. RNA-seq results show that WISP1 broadly promotes the expression of proliferative and immune modulatory genes at the transcriptomic level, while having very little impact on traditional myofibroblast and ECM modifying gene expression programs. At the proteome level, WISP1 was again a much weaker mediator of traditional myofibroblast and ECM proteins. However, in agreement with RNA-seq data, we observed a strong WISP1-dependent enrichment for proliferation-associated proteins in the cytosolic proteome and inflammation-associated proteins in the ECM proteome. Interestingly, WISP1 also showed a context-dependent response with TGF{beta}1, suggesting a more complex and yet to be elucidated signaling interaction between these independent mediators of myofibroblast activity. In conclusion, our data suggests that WISP1 promotes a unique proliferative and immune-modulatory myofibroblast phenotype. HighlightsO_LIWISP1 is sufficient to drive myofibroblast SMA and collagen expression and ECM deposition C_LIO_LIWISP1 promotes canonical myofibroblast contractility and wound healing activity C_LIO_LIWISP1 mediates myofibroblast activity via a non-canonical, P38 MAPK-dependent signaling pathway C_LIO_LIMulti-omics analysis of WISP1-dependent RNA and protein expression show that WISP promotes a proliferative and immune modulatory myofibroblast phenotype C_LI

cell biology↗

bioRxiv2025

Deciphering the intra-tissue specific Collagen PTMs site-specific heterogeneity in Human Adrenal extracellular-matrix

The human adrenal is one of the pivotal glands of the endocrine system. Recently, the extracellular matrix (ECM) of the adrenal capsule and cortex was explored by dividing them into two fractions: outer (OF) and inner (IF). A significant variation in the levels of ECM proteins, including collagens, was documented. During the biosynthesis of collagen, it undergoes a plethora of PTMs exhibiting crucial roles such as cell-matrix interaction, adhesion, crosslinking, stability, etc. However, the site-specific identification and characterization of collagen PTMs remained challenging and is unknown for the human adrenal gland. We applied our in-house developed proteomics pipeline to identify several PTMS in 25 collagen chains from human adrenal-ECM. In the entire collagenome, we identified a total of 963 4-hydroxyproline (4-HyP), 201 3-hydroxyproline (3-HyP), 105 hydroxylysine (HyK), 17 galactosyl-hydroxylysine (G-HyK), and 35 glucosyl galactosyl-hydroxylysine (GG-HyK) sites. Although the site-specificity of collagen PTMs (3-HyP, HyK, G/GG-HyK) across fractions is conserved, the occupancies were different in a site-specific manner. Classically, a fully 3-hydroxylated site (P1164) of COL1A1 associated with osteogenesis imperfecta was found to be approximately fully hydroxylated ([~]99%) across fractions. Similarly, we also looked at the microheterogeneity of lysine modifications on one lysine residue (K862) of COL1A1. We observed that the hydroxylation level was higher in OF, while glycosylation levels were higher in IF. This may suggest a change in the crosslinking of collagen I across both fractions. Further, our analysis revealed much higher site-specific O-glycosylation in basement membrane collagen-IV, potentially facilitating the secretion of steroids from the adrenal gland. For the first time, we have annotated the collagen PTMs, developed a COL1A1 PTM map, and quantitated site-specific PTMs in the human adrenal gland. Taken together, this work revealed that intra-tissue-specific site-specific PTM collagen heterogeneity and lay the foundation for understanding their role in region-specific functions.

biochemistry↗

bioRxiv2025

Greater cardiorespiratory fitness is associated with higher cerebral blood flow and lower oxygen extraction fraction in healthy older adults

Aerobic exercise training promotes cardiovascular, brain and cognitive health. Regular exercise is associated with higher cardiorespiratory fitness, commonly assessed by peak oxygen uptake (VO2peak) during maximal effort testing. Higher cardiorespiratory fitness has been linked to preserved brain health, particularly higher grey matter volume and perfusion. The brain relies heavily on oxidative metabolism, yet the relationship between cardiorespiratory fitness and brain oxidative metabolism remains underexplored. This study investigated the association between VO2peak and two key cerebral metabolic parameters: the cerebral metabolic rate of oxygen consumption (CMRO2) and oxygen extraction fraction (OEF), which represents the balance between cerebral blood flow (CBF) and CMRO2. Thirty-seven healthy adults aged [≥]50 underwent maximal cardiopulmonary exercise testing for VO2peak assessment. Neuroimaging included dual calibrated functional MRI (dc-fMRI) and quantitative susceptibility mapping (QSM). Higher VO2peak correlated positively with higher CBF across whole-brain grey matter but showed no relationship with CMRO2. Conversely, higher VO2peak negatively correlated with lower OEF from both dc-fMRI and QSM. These findings suggest that greater cardiorespiratory fitness enhances cerebral perfusion without changing resting metabolic rate in healthy older adults, resulting in a reduced oxygen extraction. These results are consistent with exercise yielding improved vascular- metabolic coupling, which would reduce the likelihood of transient hypoxic episodes.

biophysics↗

bioRxiv2025

Preservation of cerebral vascular and metabolic health with greater cardiorespiratory fitness in coronary artery disease

BackgroundCoronary artery disease (CAD) is the leading cause of cardiovascular-related death globally. Beyond its cardiac consequences, CAD significantly impacts brain health, causing grey matter atrophy, reduced cerebral blood flow (CBF), impaired cerebrovascular reactivity (CVR), and cognitive decline. Recent evidence also highlights altered cerebral metabolism in CAD, characterized by reduced cerebral metabolic rate of oxygen consumption (CMRO2) and increased oxygen extraction fraction (OEF). Notably, impaired cardiorespiratory fitness, as measured by reduced peak oxygen uptake (VO2peak), is a hallmark of CAD progression and a strong prognostic marker of cardiovascular and neurological outcomes. Although VO2peak is associated with brain structural integrity and cognitive function, its relationship to cerebral vascular and metabolic function in CAD patients remains poorly understood. MethodsThirty-seven healthy individuals (age=65.35 {+/-} 8.31) and thirty-five patients with CAD (age=66.42 {+/-} 9.29) participated in this study. The objective was to determine whether higher cardiorespiratory fitness is associated with markers of cerebral health known to be impaired in CAD, in order to assess the potential of exercise as a strategy to mitigate CAD-related brain alterations. Cerebral vascular and metabolic biomarkers, including CBF, CVR, CMRO2, and OEF, were quantified using calibrated functional magnetic resonance imaging (MRI). Participants also completed a maximal cardiopulmonary exercise test on a bicycle ergometer to determine peak oxygen uptake (VO2peak). ResultsAcross all participants, VO2peak was positively associated with CBF ({beta}=0.32, p=0.02), and CVR ({beta}=0.002, p=0.04), in grey matter, confirming a link between aerobic fitness and vascular health across the cardiovascular health spectrum. However, metabolic markers exhibited group-specific patterns. Specifically, in CAD patients, VO2peak was positively associated with CMRO2 ({beta} = 0.08, p = 0.02), suggesting that reduced CMRO2 in CAD may be partially preserved by greater cardiorespiratory fitness. In contrast, a negative association between VO2peak and OEF was observed exclusively in healthy controls ({beta} = -3.6, p = 0.02), consistent with adaptations in healthy aging being primarily driven by improved CBF without changes in CMRO2. ConclusionThis study shows that higher cardiorespiratory fitness is associated with improved cerebral vascular and metabolic function, with distinct patterns observed between healthy individuals and those with CAD. In patients with CAD, greater fitness appears to preserve cerebral oxygen metabolism, while in healthy individuals, fitness is primarily linked to enhanced perfusion. These findings support the role of aerobic exercise as a promising strategy to counteract CAD-related brain alterations, emphasizing the importance of targeting cardiorespiratory fitness in both prevention and rehabilitation settings.

biophysics↗

bioRxiv2025

The Impact of Coronary Artery Disease on Brain Vascular and Metabolic Health: Links to Cognitive Function

BackgroundCoronary artery disease (CAD) is the leading cause of mortality worldwide and is associated with an increased incidence of cognitive decline, however the pathological mechanisms linking CAD to brain and cognitive health remain unclear. Prior research has identified regional deficits in cerebral blood flow (CBF) and cerebrovascular reactivity (CVR), a measure of vascular reserve, in patients with CAD. However, the impact of these cerebrovascular deficits on cognition has not been explored, nor has the effect of CAD on cerebral metabolic health. This study aims to fill these gaps by investigating how CAD influences cerebral vascular and metabolic health, and how these alterations relate to cognitive function across multiple domains. MethodsQuantitative magnetic resonance imaging (MRI) was employed to measure a comprehensive profile of cerebral vascular and metabolic health, including CBF, CVR, cerebral metabolic rate of oxygen (CMRO2), and oxygen extraction fraction (OEF). Cognition was assessed using a validated neuropsychological battery from which composite scores were extracted, reflecting executive functions, working memory, processing speed, and verbal episodic memory. ResultsA total of 35 patients with CAD and 37 healthy controls were included in the final analysis. Patients with CAD demonstrated widespread impairments in both cerebral vascular and metabolic health, characterized by lower CBF, CVR, and CMRO2, and increased OEF, indicative of insufficient oxygen delivery. Notably, lower CVR was associated with poorer executive function, suggesting a specific role of vascular reserve for preserving executive functions. Furthermore, higher OEF was associated with poorer working memory, showing the importance of preserved oxygen consumption for maintaining cognitive function. ConclusionThis study reveals that CAD is associated with impaired cerebral vascular and metabolic health, providing a pathological basis for cognitive decline. Specifically, reduced CVR and elevated OEF emerged as sensitive biomarkers linking impaired brain health and cognition. These markers hold promise for guiding future interventions aimed at preserving cognitive health in patients with CAD. Clinical PerspectiveO_ST_ABSWhat Is New?C_ST_ABSO_LICoronary artery disease is associated with an increased incidence of cognitive decline but the biological mechanisms underlying these changes in cognition are unclear. C_LIO_LIThis is the first study to comprehensively demonstrate profound and widespread deficits in both cerebral vascular and oxidative metabolic health in patients with coronary artery disease. C_LIO_LICerebrovascular reactivity and oxygen extraction fraction may be sensitive biomarkers of early cognitive decline in coronary artery disease. C_LI What Are the Clinical Implications?O_LIThe widespread impairments in cerebral vascular and metabolic health suggest that coronary artery disease has profound consequences on the brain. C_LIO_LIPoor vascular reserve and an imbalance between oxygen delivery and usage may be crucial determinants of cognitive health. These results highlight the limitations of traditional biomarkers in understanding the brains vulnerability and the need for these novel and quantitative biomarkers of cerebral physiological health. C_LIO_LIThese findings suggest that cerebral vascular and metabolic deficits exist even in the absence of overt cognitive decline in coronary artery disease, emphasizing the need for early detection and preventative strategies. C_LI

biophysics↗

bioRxiv2025

Multivariate white matter microstructure alterations in older adults with coronary artery disease

Patients with coronary artery disease (CAD) face an increased risk of cognitive impairment, dementia, and stroke. While white matter (WM) lesions are frequently reported in patients with CAD, the effects on WM microstructure alterations remain largely unknown. We aimed to identify WM microstructural alterations in individuals with CAD compared to healthy controls (HC), and to examine their relationships with cognitive performance. Forty-three (43) patients with CAD and 36 HC aged 50 and older underwent comprehensive neuropsychological testing and multi-modal 3T MRI. A novel multivariate approach - the Mahalanobis distance (D2) - was used to quantify WM abnormalities as the amount of deviation from the HC reference group. D2 integrates multiple MRI-derived diffusion-weighted imaging, R1 relaxometry, and magnetization transfer imaging metrics, while accounting for covariance between metrics. Relationships between WM D2 and cognition (executive function and processing speed) were also assessed. Compared to HCs, patients with CAD had higher D2 values in the whole WM (p=0.009) and in the territories right anterior, bilateral middle, and right posterior cerebral artery territories (p<0.05). Myelin-sensitive metrics, particularly R1 relaxation rate and MT saturation (MTsat), were the most important contributors to D2. Processing speed was positively associated with greater R1 in both the whole WM and left middle cerebral artery territory. These findings suggest that greater WM microstructural alterations observed in patients with CAD were mainly driven by differences in myelin content, as R1 and MTsat were the most important contributors. These alterations may contribute to a heightened risk of cognitive impairment.

neuroscience↗

bioRxiv2024

Prediction and design of transcriptional repressor domains with large-scale mutational scans and deep learning

Regulatory proteins have evolved diverse repressor domains (RDs) to enable precise context-specific repression of transcription. However, our understanding of how sequence variation impacts the functional activity of RDs is limited. To address this gap, we generated a high-throughput mutational scanning dataset measuring the repressor activity of 115,000 variant sequences spanning more than 50 RDs in human cells. We identified thousands of clinical variants with loss or gain of repressor function, including TWIST1 HLH variants associated with Saethre-Chotzen syndrome and MECP2 domain variants associated with Rett syndrome. We also leveraged these data to annotate short linear interacting motifs (SLiMs) that are critical for repression in disordered RDs. Then, we designed a deep learning model called TENet (Transcriptional Effector Network) that integrates sequence, structure and biochemical representations of sequence variants to accurately predict repressor activity. We systematically tested generalization within and across domains with varying homology using the mutational scanning dataset. Finally, we employed TENet within a directed evolution sequence editing framework to tune the activity of both structured and disordered RDs and experimentally test thousands of designs. Our work highlights critical considerations for future dataset design and model training strategies to improve functional variant prioritization and precision design of synthetic regulatory proteins.

genomics↗

bioRxiv2023

Drug Discovery in Low Data Regimes: Leveraging a Computational Pipeline for the Discovery of Novel SARS-CoV-2 Nsp14-MTase Inhibitors

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to significant global morbidity and mortality. A crucial viral protein, the non-structural protein 14 (nsp14), catalyzes the methylation of viral RNA and plays a critical role in viral genome replication and transcription. Due to the low mutation rate in the nsp region among various SARS-CoV-2 variants, nsp14 has emerged as a promising therapeutic target. However, discovering potential inhibitors remains a challenge. In this work, we introduce a computational pipeline for the rapid and efficient identification of potential nsp14 inhibitors by leveraging virtual screening and the NCI open compound collection, which contains 250,000 freely available molecules for researchers worldwide. The introduced pipeline provides a cost-effective and efficient approach for early-stage drug discovery by allowing researchers to evaluate promising molecules without incurring synthesis expenses. Our pipeline successfully identified seven promising candidates after experimentally validating only 40 compounds. Notably, we discovered NSC620333, a compound that exhibits a strong binding affinity to nsp14 with a dissociation constant of 427 {+/-} 84 nM. In addition, we gained new insights into the structure and function of this protein through molecular dynamics simulations. We identified new conformational states of the protein and determined that residues Phe367, Tyr368, and Gln354 within the binding pocket serve as stabilizing residues for novel ligand interactions. We also found that metal coordination complexes are crucial for the overall function of the binding pocket. Lastly, we present the solved crystal structure of the nsp14-MTase complexed with SS148 (PDB:8BWU), a potent inhibitor of methyltransferase activity at the nanomolar level (IC50 value of 70 {+/-} 6 nM). Our computational pipeline accurately predicted the binding pose of SS148, demonstrating its effectiveness and potential in accelerating drug discovery efforts against SARS-CoV-2 and other emerging viruses.

biochemistry↗

bioRxiv2023

SLC12A9 is a lysosome-detoxifying ammonium - chloride co-transporter

Ammonia is a ubiquitous, toxic by-product of cell metabolism. Its high membrane permeability and proton affinity causes ammonia to accumulate inside acidic lysosomes in its poorly membrane-permeant form: ammonium (NH4+). Ammonium buildup compromises lysosomal function, suggesting the existence of mechanisms that protect cells from ammonium toxicity. Here, we identified SLC12A9 as a lysosomal ammonium exporter that preserves lysosomal homeostasis. SLC12A9 knockout cells showed grossly enlarged lysosomes and elevated ammonium content. These phenotypes were reversed upon removal of the metabolic source of ammonium or dissipation of the lysosomal pH gradient. Lysosomal chloride increased in SLC12A9 knockout cells and chloride binding by SLC12A9 was required for ammonium transport. Our data indicate that SLC12A9 is a chloride-driven ammonium co-transporter that is central in an unappreciated, fundamental mechanism of lysosomal physiology that may have special relevance in tissues with elevated ammonia, such as tumors.

cell biology↗

bioRxiv2023

VirtualFlow 2.0 - The Next Generation Drug Discovery Platform Enabling Adaptive Screens of 69 Billion Molecules

Identifying potent lead molecules for specific targets remains a major bottleneck in drug discovery. As structural information about proteins becomes increasingly available, ultra-large virtual screenings (ULVSs) which computationally evaluate billions of molecules offer a powerful way to accelerate early-stage drug discovery. Here, we introduce AdaptiveFlow, an open-source platform designed to make ULVSs more accessible, scalable, and efficient. AdaptiveFlow provides free access to a screening-ready version of the Enamine REAL Space (1), the largest library of ready-to-dock, drug-like molecules, containing 69 billion compounds that we prepared using the ligand preparation module of the platform. A key innovation of the platform is its use of a multi-dimensional grid of molecular properties, which helps researchers explore and prioritize chemical space more effectively and reduce the computational costs by a factor of approximately 1000. This grid forms the basis of a new method for identifying promising regions of chemical space, enabling systematic exploration and prioritization of compound libraries. An optional active learning component can further accelerate this process by adaptively steering the search toward molecules most likely to bind a given target. To support a broad range of applications, AdaptiveFlow is compatible with over 1,500 docking protocols. The platform achieves near-linear scaling on up to 5.6 million CPUs in the AWS Cloud, setting a new benchmark for large-scale cloud computing in drug discovery. Using this approach, we identified nanomolar inhibitors of two disease-relevant targets: ferroptosis suppressor protein 1 (FSP1) and poly(ADP-ribose) polymerase 1 (PARP-1) (2, 3). By leveraging newly solved crystal structures of FSP1 in complex with NAD+, FAD, and coenzyme Q1, we validated these hits experimentally and determined the co-crystal structures of FSP1 bound to small-molecule inhibitors, enabling insights into inhibitor binding mechanisms previously unknown. With its high scalability, flexibility, and open accessibility, AdaptiveFlow offers a powerful new resource for discovering and optimizing drug candidates at an unprecedented scale and speed.

bioinformatics↗

bioRxiv2021

mTOR-activating mutations in RRAGD cause kidney tubulopathy and cardiomyopathy (KICA) syndrome

BackgroundOver the last decaces, advances in genetic techniques have resulted in the identification of rare hereditary disorders of renal magnesium and salt handling. Nevertheless, {+/-}20% of all tubulopathy patients remain without genetic diagnosis. Here, we explore a large multicentric patient cohort with a novel inherited salt-losing tubulopathy, hypomagnesemia and dilated cardiomyopathy (DCM). MethodsWhole exome and genome sequencings were performed with various subsequent functional analyses of identified RRAGD variants in vitro. ResultsIn 8 children from unrelated families with a tubulopathy characterized by hypomagnesemia, hypokalemia, salt-wasting, and nephrocalcinosis, we identified heterozygous missense variants in RRAGD that mostly occurred de novo. Six of these patients additionally suffered from DCM requiring heart transplantation in 3 of them. An additional dominant variant in RRAGD was simultaneously identified in eight members of a large family with a similar renal phenotype. RRAGD encodes GTPase RagD mediating amino acid signaling to the mechanistic target of rapamycin complex 1 (mTORC1). RagD expression along the mammalian nephron include the thick ascending limb and the distal convoluted tubule. The identified RRAGD variants were shown to induce a constitutive activation of mTOR signaling in vitro, ConclusionsOur findings establish a novel disease phenotype combining kidney tubulopathy and cardiomyopathy (KICA) caused by an activation of mTOR signaling suggesting a critical role of Rag GTPase D for renal electrolyte handling and cardiac function. SIGNIFICANCE STATEMENTHere, we report on heterozygous variants in RRAGD in patients with profound hypomagnesemia, renal salt wasting, nephrocalcinosis, and dilated cardiomyopathy. The identified RagD variants induce a constitutive activation of mTOR signaling in vitro. These findings not only establish a novel monogenic disorder of the kidney tubule, but demonstrate the essential role of mTOR signaling for distal tubular electrolyte handling and cardiac function.

genetics↗