The MODY-associated TALK-1 L114P mutation causes islet α-cell overactivity and β-cell inactivity resulting in transient neonatal diabetes and glucose dyshomeostasis in adults

Reviewer #1 (Public Review):

This paper focuses on the effects of a L114P mutation in the TALK-1 channel on islet function and diabetes. This mutation is clinically relevant and a cause of MODY diabetes. This work employs a mouse model with heterozygous and homozygous mutants. The homozygous mice are homozygous lethal from severe hyperglycemia. The work shows that the mutation increases K+ currents and inhibits insulin secretion. This is a very nice paper with mechanistic insight and clear clinical importance. It is generally well-written and the data is well-presented.

Reviewer #2 (Public Review):

Summary:
This work follows previous work from the group where they have demonstrated the role of TASK1 in the regulation of glucose-stimulated insulin secretion. Moreover, a recent study links a mutation in KCNK16, the gene encoding TALK-1 channels to MODY. Here the authors have constructed a mouse model with the specific mutation (TALK-1 L114P mutation) and investigated the phenotype. They have to perform a couple of breeding tricks to find a model that is lethal in adult which might complicate the conclusions, however, the phenotype of the heterozygote model used has a MODY-like phenotype. The study is convincing and solid.

Strengths:

1. The work is a natural follow-up from previous studies from the groups.

2. The authors present convincing and solid data that in the long perspective will help patients with these mutations.

3. Both in vivo and in vitro data are presented to give the full picture of the phenotype.

4. Data from both female and male mice are presented.

Weaknesses:

1. The authors perform an RNA-sequencing showing that the cAMP amplifying pathway is upregulated. A weakness is that this is not further followed up. The remaining questions include; Is this also true in humans with this mutation? Would treatment with incretins improve glucose-stimulated insulin secretion and and lower blood glucose?
2. The authors avoid further investigating what it means that the glucagon area and secretion are increased in the model.
3. The performance of measurements in both male and female mice is praiseworthy. However, despite differences in the response, the authors do not investigate the potential reason for this. Are hormonal differences of importance?

Reviewer #3 (Public Review):

Summary:
The L114P gain of function mutation in the K2P channel TALK-1 encoded by KCNJ16 has been associated with MODY. In this study, Nakhe et al. generated mice carrying L114P TALK-1 and evaluated the impact of the mutation on glucose homeostasis. The authors report that the mutation increases neonatal lethality, owing to hyperglycemia caused by a lack of glucose-stimulated Ca2+ influx and insulin secretion. Adult mutant mice showed glucose intolerance and fasting hyperglycemia, which is attributed to blunted glucose-stimulated insulin secretion as well as increased glucagon secretion. Interestingly, male mice were more affected than female mice. Islets from adult mutant mice were found to have reduced Ca2+ entry upon glucose stimulation but also enhanced IP3-induced ER Ca2+ release, consistent with previous studies from the group showing a role of TALK-1 in ER Ca2+ homeostasis. Finally, a comparison of bulk RNA sequencing results from WT and mutant islets revealed altered expression of genes involved in β-cell identification, function, and signalling, which also contributes to the observed islet dysfunction.

The study is in general well designed and executed, and the conclusions are largely supported by the experimental evidence. The results confirm the pathogenic effect of L114P TALK-1 in human MODY. The findings that the mutation causes neonatal diabetes and affects male mice more than female mice have potential clinical implications with regard to genetic screening and diagnosis.

Strengths:
A major strength of the study is the detailed characterization of the mutant mice in two different genetic backgrounds. The overall results provide compelling evidence that L114P TALK-1 disrupts glucose-stimulated insulin secretion and causes hyperglycemia. The neonatal diabetes phenotype and the gender difference in adults uncovered by the study are significant and should be considered in human patients. Results showing that the mutation not only attenuates membrane depolarization and Ca2+ entry upon glucose stimulation but also enhances IP3-induced ER Ca2+ release is consistent with the channel's dual role in membrane hyperpolarization and in providing counter currents to support ER Ca2+ release. The observed altered islet cell composition and the RNA seq data also add to the story and suggest the mutation has secondary effects that could explain the phenotypes observed.

Weaknesses:
Some conclusions lack definitive evidence. For example, the authors conclude that L114P TALK-1 causes transient neonatal diabetes but there is no longitudinal glucose monitoring data to show remission of the diabetes. The contribution to defective insulin response from defects in plasma membrane depolarization relative to that from ER Ca2+ mishandling is not addressed. It is unclear whether the altered Ca2+ release in response to Ach is a direct result of GOF TALK-1 in the ER membrane or is due to the many transcriptional changes observed in the mutant islets.