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J. Biol. Chem., Vol. 275, Issue 27, 20782-20786, July 7, 2000
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From the Division of Medical Genetics, Department of Pediatrics,
Emory University, Atlanta, Georgia 30322
Received for publication, January 11, 2000, and in revised form, April 14, 2000
Primary carnitine deficiency is an autosomal
recessive disorder of fatty acid oxidation characterized by hypoketotic
hypoglycemia and skeletal and cardiac myopathy. It is caused by
mutations in the sodium-dependent carnitine cotransporter
OCTN2. The majority of natural mutations identified in this and other
Na+/solute symporters introduce premature termination
codons or impair insertion of the mutant transporter on the plasma
membrane. Here we report that a missense mutation (E452K) identified in
one patient with primary carnitine deficiency did not affect membrane
targeting, as assessed with confocal microscopy of transporters tagged
with the green fluorescent protein, but reduced carnitine transport by
impairing sodium stimulation of carnitine transport. The natural mutation increased the concentration of sodium required to
half-maximally stimulate carnitine transport
(KNa) from the physiological value of 11.6 to
187 mM. Substitution of Glu452 with glutamine
(E452Q), aspartate (E452D), or alanine (E452A) caused intermediate
increases in the KNa. Carnitine transport decreased exponentially with increased KNa. The
E452K mutation is the first natural mutation in a mammalian
cotransporter affecting sodium-coupled solute transfer and identifies a
novel domain of the OCTN2 cotransporter involved in transmembrane
sodium/solute transfer.
Primary carnitine deficiency (On-line Mendelian Inheritance in Man
(OMIM) no. 212140) is a recessively inherited disorder of fatty acid
oxidation due to defective carnitine transport (1, 2). Carnitine is
essential for the transfer of long-chain fatty acids from the cytosol
to mitochondria for subsequent The gene for primary carnitine deficiency encodes a functional
carnitine transporter named OCTN2 (3, 4) that maps to chromosome
5q31.1-32 (3, 5). OCTN2 is a novel organic cation transporter and
operates a sodium-dependent transport of carnitine. It
belongs to a family of transporters believed important in drug absorption and detoxification, although the physiological substrate has
been identified only for OCTN2.
Human fibroblasts express the carnitine transporter defective in
primary carnitine deficiency (6). This transporter is not inhibited by
amino acids, but is competitively inhibited by acetylcarnitine,
palmitoylcarnitine, butyrobetaine, and betaine. Noncompetitive
inhibition is observed with verapamil and quinidine (6). The carnitine
transporter is energized by the sodium electrochemical potential
gradient; and in the absence of sodium, only minimal amounts of
carnitine enter the cell through a nonsaturable process (6).
Mutations in the OCTN2 gene have been reported in patients with primary
carnitine deficiency (7-11), most of whom presented early in life with
a severe metabolic decompensation. Identified mutations result in
premature termination codons or in nonfunctional transporters when
missense mutations have been expressed in mammalian cells (9). We have
recently identified a missense mutation (E452K) associated with
residual carnitine transport activity in a patient who presented at 7 years of age with severe cardiomyopathy and carnitine deficiency (10).
Preliminary experiments indicated that this mutation reduced carnitine
transport without affecting the Km for carnitine
recognition (12). Since the majority of mutations reported in the
sodium/glucose cotransporter SGLT1 impair membrane trafficking (13), it
was proposed that the E452K substitution could impair insertion of
OCTN2 carnitine transporters to the plasma membrane, with the
transporters reaching the plasma membrane having normal affinity for
carnitine (12).
Here we report that the E452K mutation does not affect membrane
insertion of carnitine transporters, but impairs activation of
carnitine transport by the cotransported sodium. This is the first
natural mutation in a sodium cotransporter affecting energization of
substrate transport and identifies a novel domain involved in sodium
recognition or transfer.
Cell Culture and Carnitine Transport--
Chinese hamster ovary
(CHO)1 cells were grown in
Ham's F-12 medium supplemented with 6% fetal bovine serum. Carnitine
transport was measured at 37 °C with the cluster-tray method as
described previously (6, 8, 12). Cells were grown to confluence in
24-well plates (Costar Corp.) and depleted of intracellular amino acids
by incubation for 90 min in Earle's balanced salt solution containing
5.5 mM D-glucose and supplemented with 0.1% bovine serum albumin. Carnitine (0.5 µM, 0.5 µCi/ml)
was then added to the cells for 10 min. Nonsaturable carnitine
transport was measured in the presence of 2 mM unlabeled
carnitine. The transport reaction was stopped by rapidly washing the
cells four times with ice-cold 0.1 M MgCl2.
Intracellular carnitine was then corrected for intracellular water
content and expressed as nmol/ml of cell water (6). Saturable carnitine
transport was calculated by subtracting sodium-independent carnitine
transport from total transport, and values are reported as means ± S.E. of three to six independent determinations. Carnitine transport
in the absence of sodium was measured substituting methylglucamine for
sodium so that the sum of methylglucamine and sodium remained constant at 150 mM (6). Initial experiments on transfected cells
indicated that carnitine accumulation at 0.5 µM was
linear for up to 30 min in cells expressing the normal OCTN2
transporter and for up to 4 h in cells expressing mutant
transporters, with a roughly inverse correlation between transport
activity and time during which transport remained linear (data not shown).
Kinetic constants for carnitine transport were determined by nonlinear
regression analysis according to a Michaelis-Menten equation (6).
Na+-independent carnitine transport was determined in
parallel trays and subtracted from total transport to obtain
Na+-dependent carnitine transport. Nonlinear
parameters are expressed as means ± 95% confidence intervals.
The Km for sodium (KNa) was
calculated from the intersection ( Construction of Green Fluorescent Protein (GFP)-tagged OCTN2
Expression Vectors--
The OCTN2 cDNA (3) cloned in pcDNA3
(8) was amplified by polymerase chain reaction using
high-fidelity Pfu polymerase and the primers
5'-GCGAATTCCCAGACCCCAGGCCGCGCT-3' and
5'-GCGGATCCAGAAGGCTGTGCTTTTAAGG-3', corresponding to the 5'- and
3'-primers of the OCTN2 cDNA with attached EcoRI and
BamHI linkers, respectively. The 3'-primer removed the
physiological stop codon of OCTN2 (TAA). The polymerase chain reaction
product was digested with EcoRI and BamHI and
ligated in the corresponding restriction sites of pEGFP-N2
(CLONTECH). The resulting plasmid had the OCTN2
cDNA fused in frame with the green fluorescent protein under
control of the cytomegalovirus promoter. The final vector was
sequenced, confirming the absence of polymerase chain reaction
artifacts and the correct fusion with the green fluorescent protein.
This plasmid was transfected into CHO cells by LipofectAMINE (Life
Technologies, Inc.) according to the manufacturer's instructions.
Cells were selected with 0.8 mg/ml G418 (Life Technologies, Inc.) for 2 weeks, and several independent clones of transfected cells were isolated.
Site-directed Mutagenesis--
The E452K, E452A, E452Q, and
E452D mutations were introduced by site-directed mutagenesis using the
QuickChange system (Stratagene) following the manufacturer's
instructions. The final plasmids were sequenced to confirm the presence
of the mutations and the absence of polymerase chain reaction
artifacts. The plasmids obtained were then transfected into CHO cells
as described above.
Northern Blot Analysis--
Cellular RNA was extracted with
guanidinium thiocyanate, separated by formaldehyde-agarose gel
electrophoresis, blotted onto nylon, and hybridized under
high-stringency conditions with the OCTN2 and actin cDNAs. cpm in
each band were determined using a micro-array radioactivity detector
(Instant Imager, Packard Instrument Co.). Lane-specific background was
subtracted from each lane. OCTN2 cpm were normalized for actin cpm to
correct for variations in RNA loading. Linearity of the assay was
determined using increasing amounts of control RNA (12). The gel was
then exposed to film.
Confocal Microscopy--
Subcellular distribution of normal and
mutant OCTN2 carnitine transporters conjugated with the green
fluorescent protein was analyzed by confocal microscopy (Zeiss LSM 410 laser scanning confocal microscope). Cells were seeded on glass slides
and covered with medium and a coverslip whose borders were chemically
sealed. Images of the cells were obtained at 1-µm sections. Multiple
cells were scanned, and the ones shown are representative of the fields observed.
The initial kinetic experiments indicated that the E452K mutation
decreased the Vmax for carnitine transport,
without affecting the Km (12). This was consistent
with the fact that the mutation could impair maturation of the
transporter to the plasma membrane, as described for mutations in the
sodium/glucose cotransporter SGLT1 (13). To test this possibility, the
OCTN2 transporter was tagged with the green fluorescent protein to
assess its subcellular distribution. Conjugation with the green
fluorescent protein did not affect carnitine transport activity, which
remained similar in CHO cells expressing the native OCTN2 cDNA and
the normal cDNA with a C-terminal addition of the green fluorescent protein (Fig. 1A). The
Km for sodium-dependent carnitine transport was 2.9 ± 1.3 µM in CHO cells transfected
with GFP-tagged OCTN2, a value similar to that seen in CHO cells
expressing the native OCTN2 cDNA (12) and in human fibroblasts (6).
Similarly, the Vmax for
sodium-dependent carnitine transport was in the range measured in cells expressing the native OCTN2 cDNA (12) (Table I). Two different clones of CHO cells
expressing the E452K mutant carnitine transporter (E452K2 and E452K)
also retained normal Km values for carnitine
(3.3 ± 1.6 and 6.2 ± 1.8 µM) (Fig. 1,
B and C), although their
Vmax values for sodium-dependent carnitine transport were still markedly reduced compared with that of
normal OCTN2 (Table I). These results indicate that modification of the
C terminus of the carnitine transporter does not significantly affect
carnitine recognition and transfer.
Analysis of the cells with a confocal microscope indicated that CHO
cells transfected with the pEGFP vector alone had a diffuse cytoplasmic
distribution of green fluorescence (Fig.
2A). By contrast, the
fluorescence was concentrated at the periphery of the cell on the
plasma membrane in cells in which GFP was conjugated with normal OCTN2
(Fig. 2B). To our surprise, cells expressing the E452K
mutant OCTN2 transporter had a distribution of fluorescence identical
to that of cells expressing normal OCTN2 (Fig. 2C), indicating that this mutation does not impair insertion of the transporter to the plasma membrane.
Abnormal Sodium Stimulation of Carnitine Transport in Primary
Carnitine Deficiency*
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ABSTRACT
TOP
ABSTRACT
INTRODUCTION
EXPERIMENTAL PROCEDURES
RESULTS AND DISCUSSION
REFERENCES
![]()
INTRODUCTION
TOP
ABSTRACT
INTRODUCTION
EXPERIMENTAL PROCEDURES
RESULTS AND DISCUSSION
REFERENCES
-oxidation, and the lack of carnitine
impairs the ability to use fat as fuel during periods of fasting or
stress. This can result in hypoketotic hypoglycemia, Reye's syndrome,
and sudden infant death in younger children or in skeletal or heart
myopathy with insidious onset later in life.
![]()
EXPERIMENTAL PROCEDURES
TOP
ABSTRACT
INTRODUCTION
EXPERIMENTAL PROCEDURES
RESULTS AND DISCUSSION
REFERENCES
1/KNa) of
linear regressions of 1/v versus 1/[sodium] at
three different carnitine concentrations (14).
![]()
RESULTS AND DISCUSSION
TOP
ABSTRACT
INTRODUCTION
EXPERIMENTAL PROCEDURES
RESULTS AND DISCUSSION
REFERENCES

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Fig. 1.
Kinetics of
Na+-dependent carnitine transport in CHO cells
transfected with normal and mutant OCTN2 cDNAs. Carnitine
(0.5-100 µM) transport was measured for 10 min at
37 °C in the presence of 150 mM sodium.
Na+-independent carnitine transport, measured substituting
methylglucamine for sodium, was subtracted from each point. Data are
means ± S.E. of triplicates. Lines represent the best
fit of the data to a Michaelis-Menten equation. Parameters for
carnitine transport are expressed as means ± 95% confidence
intervals. Note the different scale among panels. E452K and E452K2 are
two independent clones of CHO cells expressing different amounts of the
E452K mutant carnitine transporter.
Kinetic constants for Na+-dependent carnitine
transport in CHO cells expressing normal and mutant carnitine
transporters

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[in a new window]
Fig. 2.
Subcellular distribution of normal and mutant
carnitine transporters tagged with the green fluorescent protein.
CHO cells stably transfected with pEGFP-N2 (A), OCTN2-GFP
(B), or E452K-GFP (C) were seeded on glass slides
and covered with a drop of saline and a coverslip. Confocal images were
obtained at 1-µm sections using an emission wavelength of 488 nm. The
images shown are representative of the other cells observed. Light
microscopy indicated that the images seen in the case of OCTN2 and
E452K OCTN2 corresponded to the borders of the cell.
The carnitine transporter defective in primary carnitine deficiency is
energized by the sodium electrochemical potential (6). We determined
the kinetic constants of normal and mutant OCTN2 for sodium to test
whether the E452K mutation affected energization of the carnitine
transporter by the sodium electrochemical gradient. Sodium was
substituted by methylglucamine in the uptake medium (Fig.
3). The dependence of carnitine transport
on the extracellular sodium concentration was measured at different
carnitine concentrations to estimate the KNa
from the intersection of the reciprocal plots (14).
Na+-independent transport was subtracted from all transport
data prior to analysis. CHO cells expressing the normal human OCTN2 cDNA had a KNa of 11.6 mM (Fig.
3A). This value approaches that measured in cultured
fibroblasts (14.9 mM) using the same mathematical procedure
(from Fig. 2 of Ref. 6). Cells expressing the E452K mutant transporter
had a KNa of 187 mM, which was 16 times higher than that of cells expressing the normal OCTN2 transporter
(Fig. 3B). Similar KNa values were
obtained in CHO cells transfected with the E452K mutant OCTN2 cDNA
not conjugated to the green fluorescent protein (data not shown),
indicating that the abnormal KNa is not an
artifact due to the interaction of the mutant protein with the green
fluorescent protein. These results suggest that the E452K mutation
impairs sodium stimulation of carnitine transport by the OCTN2
transporter.
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In a random bireactant system, binding of one substrate may affect the
affinity of the transporter for the other substrate (14). Since the
E452K mutation significantly increased the KNa, we evaluated the apparent Km for carnitine at
different extracellular sodium concentrations (2-150 mM).
If the E452K mutation were located close to the carnitine-binding site,
at low concentrations of sodium, the recognition of carnitine could
have been affected, and the Km could have been
significantly increased. As shown in Fig.
4A, the
Vmax for carnitine transport remained relatively constant at all extracellular sodium concentrations in two independent clones of CHO cells expressing the normal OCTN2 transporter
(inverted triangles) and in E452K2 cells
(circles). By contrast, the apparent Km
for carnitine decreased as the sodium concentration increased in cells
expressing both the normal and E452K mutant carnitine transporters.
However, most of the decrease occurred at relatively low concentrations
of sodium and was complete at 50 mM sodium (Fig.
4B). This indicates that only minimal amounts of sodium are
required to improve recognition of carnitine by this transporter.
Importantly, the decrease in the apparent Km for
carnitine was identical in cells expressing the normal and E452K mutant
transporters, indicating that the E452K mutation does not affect
initial binding of sodium to the transporter and carnitine
recognition.
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The structure of the carnitine transporter is unknown. Hydropathy analysis of the amino acid sequence of OCTN2 by the method of Kyte and Doolittle (26) as described by Wu et al. (3) or with TopPred2 (4) predicts 12 transmembrane domains. When OCTN2 is modeled according to other similar membrane transporters, both the amino and carboxyl termini face the cytoplasm (3, 15). This model places on the correct side of the membrane potential glycosylation and protein kinase C phosphorylation sites as well as the sugar transporter protein signature sequence motif and the ATP/GTP-binding motif (3, 4, 15). According to this model, the E452K mutation affects an intracellular loop located between predicted transmembrane domains 10 and 11. In view of the marked increased KNa of the E452K mutant transporter (Fig. 3) and the normal decrease in the Km for carnitine with increased sodium concentration (Fig. 4), we formulated the hypothesis that Glu452 was needed for the correct transfer of the carnitine-sodium complex inside the cell. To test whether the negative charge of Glu452 was required for this function, alanine (E452A), glutamine (E452Q), or aspartate (E452D) was inserted in position 452 by site-directed mutagenesis, and the resulting plasmids were expressed in CHO cells.
Fig. 1 shows that all mutant transporters conserved a normal
Km for carnitine, but the
Vmax for sodium-dependent carnitine
transport decreased progressively as follows: wild-type OCTN2 > E452D and E452Q > E452A > E452K (Table I). The lack of changes in the Km for carnitine confirmed that
Glu452 is probably not involved in carnitine recognition.
By contrast, the KNa decreased progressively as
follows: E452K (187 mM; Fig. 3B) > E452A
(80 mM; Fig.
5A) > E452D (40.8 mM; Fig. 5B) > E452Q (38.9 mM;
Fig. 5C) > normal Glu452 (11.6 mM; Fig. 3A). The KNa
values of normal and mutant carnitine transporters were then plotted
against the Vmax for carnitine transport
normalized for OCTN2 mRNA levels (Fig.
6). There was a significant
(p < 0.01) exponential decrease in the
Vmax for carnitine transport with the increase
in KNa (r2 = 0.98). The
inverse correlation between carnitine transport and the
KNa supports the hypothesis that decreased
carnitine transport by the E452K mutation is due to altered sodium
stimulation of carnitine transfer by OCTN2. It also indicates that
glutamate in this position is more effective than aspartate for sodium
handling and that the length of the side chain is more important than
the net charge of this residue since glutamine was similar to aspartate in approaching normal function.
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Most of our knowledge of sodium/solute cotransporters derives from the study of bacterial proteins and the Na+/glucose cotransporter SGLT1 (13). In this latter protein, the N terminus seems devoted to sodium recognition and transfer, whereas the C terminus forms a pore for glucose (13). Most natural mutations of SGLT1 identified in patients with glucose/galactose malabsorption impair membrane insertion of the carrier protein (16-18). In SGLT1 and other sodium cotransporters, tyrosyl residues on the extracellular side of the transporter have been involved in sodium binding based on studies with tyrosyl group-modifying agents (19, 20). However, site-directed substitution of tyrosyl residues in the OCTN2 transporter failed to affect sodium affinity (15).
Conserved acidic and polar residues in transmembrane domains have been proposed to participate in sodium binding and progression across the plasma membrane (21, 22). Only selected transmembrane acidic residues are essential for this process (21). There is no information on the role of acidic residues putatively facing the cytoplasmic side of mammalian sodium cotransporters.
Bacterial sodium/solute cotransporters usually have a higher affinity for cotransported cations than their mammalian counterparts, with KNa values in the µM rather than the mM range (23). Acidic residues in the N terminus of these transporters are responsible for sodium binding, whereas polar residues in the transmembrane domain of the bacterial Na+/proline cotransporters are important for sodium transfer as in their mammalian counterparts (23, 24). An acidic residue (Asp187) located in the cytoplasmic side of the Na+/proline cotransporter of Escherichia coli is essential for sodium and solute transfer and may play a role in the release of Na+ to the cytoplasmic side of the membrane (24). As with substitution of Glu452 in the OCTN2 carnitine transporter, substitution of Asp187 in the bacterial Na+/proline cotransporter with Glu, Asn, or Cys resulted in a progressive decrease in the Vmax for proline uptake, without major changes in the Km for proline (24). However, this decrease in Vmax was not correlated with altered affinity for sodium, which was only minimally affected by the substitutions (24), mitigating the analogy with the E452K mutation. However, a role of Glu452 in the release of sodium to the cytoplasm remains a possibility.
An additional possibility is that Glu452 participates in
the conformational change of the transporter during the transport
process. In facilitative glucose transporters such as GLUT1 and GLUT4, the interaction of the negative and positive side chains of glutamic acid and arginine in the cytoplasmic side of transmembrane domains seems to play a key role in alternating the transporter between an
outward- and inward-facing conformation (25). Substitution of some of
these amino acids can lock the facilitative transporter in an outward-
or inward-facing configuration, as assessed by the binding of ligands
specific for the two conformations of the transporter (25). The OCTN2
carnitine transporter has a GLUT signature motif between transmembrane
domains 2 and 3 (3, 4), and the domain affected by the E452K mutation
could interact with a neighboring positive residue (Arg459)
to modify the conformation of the carnitine transporter. In summary,
the E452K mutation represents the first natural mutation affecting
sodium-stimulated substrate uptake in a mammalian cotransporter and
identifies a novel functional domain of mammalian cotransporters, possibly related to the release of sodium in the cytoplasm or to the
dynamic alteration of transporter conformation necessary for
transmembrane solute/co-substrate transfer.
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ACKNOWLEDGEMENTS |
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We thank Drs. Ron Joyner and Maria Wagner for assistance in the use of the confocal microscope.
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FOOTNOTES |
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* This work was supported in part by a grant from the Emory Children's Research Center.The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Supported by Grant DK 53824 from the National Institutes of
Health. To whom correspondence should be addressed: Div. of Medical Genetics, Dept. of Pediatrics, Emory University, 2040 Ridgewood Dr.,
Atlanta, GA 30322. Tel.: 404-727-0494; Fax: 404-727-9398; E-mail:
nl@rw.ped.emory.edu.
Published, JBC Papers in Press, April 26, 2000, DOI 10.1074/jbc.M000194200
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ABBREVIATIONS |
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The abbreviations used are: CHO, Chinese hamster ovary; GFP, green fluorescent protein.
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REFERENCES |
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