451
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Contrôle de l’axe gonadotrope : nouveaux aspects physiologiques et thérapeutiques. ANNALES D'ENDOCRINOLOGIE 2017; 78 Suppl 1:S31-S40. [DOI: 10.1016/s0003-4266(17)30923-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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452
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Nie M, Xu H, Chen R, Mao J, Wang X, Xiong S, Zheng J, Yu B, Cui M, Ma W, Huang Q, Zhang H, Wu X. Analysis of genetic and clinical characteristics of a Chinese Kallmann syndrome cohort with ANOS1 mutations. Eur J Endocrinol 2017; 177:389-398. [PMID: 28780519 DOI: 10.1530/eje-17-0335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/20/2017] [Accepted: 07/31/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To analyze ANOS1 gene mutations in a large Chinese Kallmann syndrome (KS) cohort and to characterize the clinical presentation of the disease in patients with ANOS1 mutations. PATIENTS AND METHODS Chinese patients with KS, including 187 sporadic and 23 pedigree cases were recruited. Patients' ANOS1 gene sequences were analyzed by direct sequencing of PCR-amplified products. In silico analysis was used to assess functional relevance of newly identified missense mutations. Patients' clinical characteristics were analyzed retrospectively. RESULTS Fifteen nonsynonymous rare ANOS1 variants were found in 13 out of 187 sporadic and 8 out of 23 familial IHH probands. Seven novel (C86F, C90Y, C151W, Y379X, c.1062 + 1G > A, Y579L fs 591X, R597X) and eight recurrent ANOS1 mutations (S38X, R257X, R262X, R423X, R424X, V560I, c.1843-1G > A, p.R631X) were identified. All the novel mutations were predicted to be pathogenic. The prevalence of cryptorchidism was high (38.1%) and occurred in patients with different kind of ANOS1 mutations, while the patients with the same mutation did not present with cryptorchidism uniformly. CONCLUSIONS The prevalence of ANOS1 gene mutations is low in sporadic KS patients, but is much higher in familial KS patients. In the present study, we identify seven novel ANOS1 mutations, including two mutations in the CR domain, which are probably pathogenic. These mutations expand the ANOS1 mutation spectrum and provide a foundation for prenatal diagnosis and genetic counseling.
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Affiliation(s)
- Min Nie
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
| | - Hongli Xu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
| | - Rongrong Chen
- Department of Physiology, State Key Laboratory of Medical Molecular Biology, School of Basic Medicine, Graduate School of Peking Union Medical College, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiangfeng Mao
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
| | - Xi Wang
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
| | - Shuyu Xiong
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
| | - Junjie Zheng
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
| | - Bingqing Yu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
| | - Mingxuan Cui
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
| | - Wanlu Ma
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
| | - Qibin Huang
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
| | - Hongbing Zhang
- Department of Physiology, State Key Laboratory of Medical Molecular Biology, School of Basic Medicine, Graduate School of Peking Union Medical College, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Xueyan Wu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key laboratory of Endocrine, Ministry of Health, Beijing, China
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453
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Berges-Raso I, Giménez-Palop O, Gabau E, Capel I, Caixàs A, Rigla M. Kallmann syndrome and ichthyosis: a case of contiguous gene deletion syndrome. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170083. [PMID: 30352392 DOI: 10.1530/edm-17-0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/07/2017] [Indexed: 02/28/2024] Open
Abstract
Kallmann syndrome is a genetically heterogeneous form of hypogonadotropic hypogonadism caused by gonadotropin-releasing hormone deficiency and characterized by anosmia or hyposmia due to hypoplasia of the olfactory bulbs; osteoporosis and metabolic syndrome can develop due to longstanding untreated hypogonadism. Kallmann syndrome affects 1 in 10 000 men and 1 in 50 000 women. Defects in 17 genes, including KAL1, have been implicated. Kallmann syndrome can be associated with X-linked ichthyosis, a skin disorder characterized by early onset dark, dry, irregular scales affecting the limb and trunk, caused by a defect of the steroid sulfatase gene (STS). Both KAL1 and STS are located in the Xp22.3 region; therefore, deletions in this region cause a contiguous gene syndrome. We report the case of a 32-year-old man with ichthyosis referred for evaluation of excessive height (2.07 m) and weight (BMI: 29.6 kg/m2), microgenitalia and absence of secondary sex characteristics. We diagnosed Kallmann syndrome with ichthyosis due to a deletion in Xp22.3, a rare phenomenon. Learning points: Kallmann syndrome is a genetically heterogeneous disease characterized by hypogonadotropic hypogonadism with anosmia or hyposmia associated with defects in the production or action of gonadotropin-releasing hormone (GnRH) and hypoplasia of the olfactory bulbs. Several genes have been implicated in Kallmann syndrome, including KAL1, located in the Xp22.3 region, which is responsible for X-linked Kallmann syndrome. KAL1 encodes the protein anosmin-1. X-linked ichthyosis is caused by deficiency of the steroid sulfatase enzyme, encoded by STS, which is also located in the Xp22.3 region. Deletions involving this region can affect both genes and result in contiguous gene syndromes. Phenotype can guide clinicians toward suspicion of a specific genetic mutation. KAL1 mutations are mostly related to microgenitalia, unilateral renal agenesis and synkinesia, although patients need not present all these abnormalities. Longstanding untreated hypogonadism is associated with poor sexual health, osteoporosis and metabolic syndrome with the concomitant risk of developing type 2 diabetes mellitus and obesity. Treatment aims to promote the development of secondary sex characteristics, build and sustain normal bone and muscle mass and restore fertility. Treatment can also help minimize some psychological consequences. Treatments available for patients with congenital GnRH deficiency such as Kallmann syndrome include gonadal steroid hormones, human gonadotropins and GnRH. The choice of therapy depends on the goal or goals.
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Affiliation(s)
- Irene Berges-Raso
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
| | - Olga Giménez-Palop
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
| | - Elisabeth Gabau
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
| | - Ismael Capel
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
| | - Assumpta Caixàs
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
| | - Mercedes Rigla
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
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454
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Schiffer L, Kempegowda P, Arlt W, O’Reilly MW. MECHANISMS IN ENDOCRINOLOGY: The sexually dimorphic role of androgens in human metabolic disease. Eur J Endocrinol 2017; 177:R125-R143. [PMID: 28566439 PMCID: PMC5510573 DOI: 10.1530/eje-17-0124] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/12/2017] [Accepted: 05/03/2017] [Indexed: 12/22/2022]
Abstract
Female androgen excess and male androgen deficiency manifest with an overlapping adverse metabolic phenotype, including abdominal obesity, insulin resistance, type 2 diabetes mellitus, non-alcoholic fatty liver disease and an increased risk of cardiovascular disease. Here, we review the impact of androgens on metabolic target tissues in an attempt to unravel the complex mechanistic links with metabolic dysfunction; we also evaluate clinical studies examining the associations between metabolic disease and disorders of androgen metabolism in men and women. We conceptualise that an equilibrium between androgen effects on adipose tissue and skeletal muscle underpins the metabolic phenotype observed in female androgen excess and male androgen deficiency. Androgens induce adipose tissue dysfunction, with effects on lipid metabolism, insulin resistance and fat mass expansion, while anabolic effects on skeletal muscle may confer metabolic benefits. We hypothesise that serum androgen concentrations observed in female androgen excess and male hypogonadism are metabolically disadvantageous, promoting adipose and liver lipid accumulation, central fat mass expansion and insulin resistance.
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Affiliation(s)
- Lina Schiffer
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
| | - Punith Kempegowda
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Michael W O’Reilly
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Edgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
- Correspondence should be addressed to M W O’Reilly;
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455
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Chachlaki K, Garthwaite J, Prevot V. The gentle art of saying NO: how nitric oxide gets things done in the hypothalamus. Nat Rev Endocrinol 2017. [PMID: 28621341 DOI: 10.1038/nrendo.2017.69] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The chemical signalling molecule nitric oxide (NO), which freely diffuses through aqueous and lipid environments, subserves an array of functions in the mammalian central nervous system, such as the regulation of synaptic plasticity, blood flow and neurohormone secretion. In this Review, we consider the cellular and molecular mechanisms by which NO evokes short-term and long-term changes in neuronal activity. We also highlight recent studies showing that discrete populations of neurons that synthesize NO in the hypothalamus constitute integrative systems that support life by relaying metabolic and gonadal signals to the neuroendocrine brain, and thus gate the onset of puberty and adult fertility. The putative involvement and therapeutic potential of NO in the pathophysiology of brain diseases, for which hormonal imbalances during postnatal development could be risk factors, is also discussed.
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Affiliation(s)
- Konstantina Chachlaki
- Inserm, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Jean-Pierre Aubert Research Centre, UMR-S 1172, 1 place de Verdun, F-59000 Lille, France
- University of Lille, University Hospital Federations (FHU) 1,000 days for Health, School of Medicine, 1 place de Verdun, F-59000 Lille, France
| | - John Garthwaite
- The Wolfson Institute for Biomedical Research, University College London, Gower Street, London WC1E 6BT, UK
| | - Vincent Prevot
- Inserm, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Jean-Pierre Aubert Research Centre, UMR-S 1172, 1 place de Verdun, F-59000 Lille, France
- University of Lille, University Hospital Federations (FHU) 1,000 days for Health, School of Medicine, 1 place de Verdun, F-59000 Lille, France
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456
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Mumusoglu S, Ata B, Turan V, Demir B, Kahyaoglu I, Aslan K, Seyhan Ata A, Yilmaz B, Yakin K, Avci B, Uncu G, Bozdag G. Does pituitary suppression affect live birth rate in women with congenital hypogonadotrophic hypogonadism undergoing intra-cytoplasmic sperm injection? A multicenter cohort study. Gynecol Endocrinol 2017; 33:728-732. [PMID: 28447505 DOI: 10.1080/09513590.2017.1318278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
In this retrospective multicenter cohort study, women with congenital hypogonadotrophic hypogonadism (CHH) (n = 57) who underwent intra-cytoplasmic sperm injection in-between 2010-2014 were compared to age-matched controls with tubal factor infertility (n = 114) to assess ovarian stimulation cycle and pregnancy outcomes. Live birth rates (LBRs) per started cycle were 31.6 and 24.6% in CHH and controls groups, respectively (p = 0.36). Comparable success rates were also confirmed with the logistic regression analysis (OR: 1.44, 95% CI: 0.78-2.67, p = 0.24). Of the 57 women with CHH, 19 were stimulated with the gonadotropin-releasing hormone (GnRH) antagonist protocol, 13 with the long-GnRH-agonist protocol. Pituitary suppression (PS) was not employed in the remaining 25 cases. Compared to women with PS, women without PS had significantly higher embryo implantation rates (21.6 versus 52.6%, p = 0.03). Although there was a trend favoring no PS, LBRs (25.0 versus 40.0%, p = 0.26) per cycle were short of statistical significance. LBRs per cycle (57.1 versus 31.2%, p = 0.11) and miscarriage rates (11.1 versus 16.7%, p = 0.75) were similar between CHH women who were given estrogen + progesterone and progesterone alone to support the luteal phase. In conclusion, the optimal stimulation protocol appears to be exogenous gonadotropin stimulation alone, without PS, and progesterone-only luteal phase support in CHH patients.
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Affiliation(s)
- Sezcan Mumusoglu
- a Department of Obstetrics and Gynecology , Hacettepe University School of Medicine , Ankara , Turkey
| | - Baris Ata
- b Department of Obstetrics and Gynecology , Koc University School of Medicine , Istanbul , Turkey
| | - Volkan Turan
- c Department of Obstetrics and Gynecology , Yeni Yuzyil University School of Medicine, GOP Hospital , Istanbul , Turkey
| | - Berfu Demir
- d Department of Obstetrics and Gynecology , Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Inci Kahyaoglu
- d Department of Obstetrics and Gynecology , Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Kiper Aslan
- e Department of Obstetrics and Gynecology , Uludag University School of Medicine , Bursa , Turkey
| | - Ayse Seyhan Ata
- f Women's Health and Assisted Reproduction Center of American Hospital , Istanbul , Turkey
| | - Bulent Yilmaz
- g Department of Obstetrics and Gynecology , Katip Celebi University School of Medicine , Izmir , Turkey
- h Department of Obstetrics and Gynecology , Tepecik Education and Research Hospital , Izmir , Turkey , and
| | - Kayhan Yakin
- b Department of Obstetrics and Gynecology , Koc University School of Medicine , Istanbul , Turkey
| | - Berrin Avci
- i Department of Histology Embryology , Uludag University School of Medicine , Bursa , Turkey
| | - Gurkan Uncu
- e Department of Obstetrics and Gynecology , Uludag University School of Medicine , Bursa , Turkey
| | - Gurkan Bozdag
- a Department of Obstetrics and Gynecology , Hacettepe University School of Medicine , Ankara , Turkey
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457
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Dzemaili S, Tiemensma J, Quinton R, Pitteloud N, Morin D, Dwyer AA. Beyond hormone replacement: quality of life in women with congenital hypogonadotropic hypogonadism. Endocr Connect 2017; 6:404-412. [PMID: 28698240 PMCID: PMC5551425 DOI: 10.1530/ec-17-0095] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Little is known about how women with isolated GnRH deficiency cope with their condition. This study aimed to examine the health and informational needs of women with congenital hypogonadotropic hypogonadism (CHH) and evaluate if their experiences differ from women with more common forms of infertility. DESIGN Cross-sectional, multiple methods study using web-based data collection to reach dispersed rare disease patients. METHODS A community-based participatory research framework was employed to develop an online survey and collect quantitative and qualitative data. Adult women diagnosed with CHH who had received at least one year of hormonal treatment completed the Morisky Medication Adherence Scale, Revised Illness Perception Questionnaire and Zung Self-Rating Depression Scale. Information on health care experiences, treatment outcomes and patient-reported challenges were also collected. RESULTS Women (n = 55) were often diagnosed late (20.7 ± 7.4, range: 10-48 years) and 16/20 patients receiving fertility treatment conceived. Poor adherence was frequently observed (34/55) while more than half (27/49) reported a gap in treatment exceeding a year. Low adherence correlated with depressive symptoms (r = 0.3, P > 0.05). Negative illness perceptions were pervasive and 30/55 exhibited some depressive symptoms - significantly greater than women with common female factor infertility (P < 0.01). Symptoms were underappreciated by providers as only 15 of 55 patients had discussions about psychological services. Women identified isolation, need for information and finding expert care as challenges to living with CHH. CONCLUSIONS Despite being a treatable form of female infertility, the presumable availability of treatment does not necessarily ensure adequate quality of life for women with isolated GnRH deficiency.
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Affiliation(s)
- Shota Dzemaili
- University of LausanneInstitute of Higher Education and Research in Healthcare, Lausanne, Switzerland
| | - Jitske Tiemensma
- University of California MercedPsychological Science, Merced, CA, USA
| | - Richard Quinton
- Department of EndocrinologyInstitute for Human Genetics, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, United Kingdom
| | - Nelly Pitteloud
- EndocrinologyDiabetes & Metabolism Service of the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Diane Morin
- University of LausanneInstitute of Higher Education and Research in Healthcare, Lausanne, Switzerland
- Faculty of Nursing ScienceLaval University, Québec City, Canada
| | - Andrew A Dwyer
- University of LausanneInstitute of Higher Education and Research in Healthcare, Lausanne, Switzerland
- EndocrinologyDiabetes & Metabolism Service of the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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458
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Gonçalves CI, Aragüés JM, Bastos M, Barros L, Vicente N, Carvalho D, Lemos MC. GNRHR biallelic and digenic mutations in patients with normosmic congenital hypogonadotropic hypogonadism. Endocr Connect 2017; 6:360-366. [PMID: 28611058 PMCID: PMC5527354 DOI: 10.1530/ec-17-0104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/13/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Normosmic congenital hypogonadotropic hypogonadism (nCHH) is a rare disorder characterised by lack of pubertal development and infertility, due to deficient production, secretion or action of gonadotropin-releasing hormone (GnRH) and, unlike Kallmann syndrome, is associated with a normal sense of smell. Mutations in the GNRHR gene cause autosomal recessive nCHH. The aim of this study was to determine the prevalence of GNRHR mutations in a group of 40 patients with nCHH. DESIGN Cross-sectional study of 40 unrelated patients with nCHH. METHODS Patients were screened for mutations in the GNRHR gene by DNA sequencing. RESULTS GNRHR mutations were identified in five of 40 patients studied. Four patients had biallelic mutations (including a novel frameshift deletion p.Phe313Metfs*3, in two families) in agreement with autosomal recessive inheritance. One patient had a heterozygous GNRHR mutation associated with a heterozygous PROKR2 mutation, thus suggesting a possible role of synergistic heterozygosity in the pathogenesis of the disorder. CONCLUSIONS This study further expands the spectrum of known genetic defects associated with nCHH. Although GNRHR mutations are usually biallelic and inherited in an autosomal recessive manner, the presence of a monoallelic mutation in a patient should raise the possibility of a digenic/oligogenic cause of nCHH.
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Affiliation(s)
- Catarina I Gonçalves
- CICS-UBIHealth Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - José M Aragüés
- Serviço de EndocrinologiaDiabetes e Metabolismo, Hospital de Santa Maria, Lisboa, Portugal
| | - Margarida Bastos
- Serviço de EndocrinologiaDiabetes e Metabolismo, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Luísa Barros
- Serviço de EndocrinologiaDiabetes e Metabolismo, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Nuno Vicente
- Serviço de EndocrinologiaDiabetes e Metabolismo, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Davide Carvalho
- Serviço de EndocrinologiaDiabetes e Metabolismo, Hospital de São João e Faculdade de Medicina do Porto, Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Manuel C Lemos
- CICS-UBIHealth Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
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459
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Tournaye H, Krausz C, Oates RD. Novel concepts in the aetiology of male reproductive impairment. Lancet Diabetes Endocrinol 2017; 5:544-553. [PMID: 27395771 DOI: 10.1016/s2213-8587(16)30040-7] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/09/2016] [Accepted: 04/04/2016] [Indexed: 12/11/2022]
Abstract
Infertility is a widespread problem and a male contribution is involved in 20-70% of affected couples. As a man's fertility relies on the quantity and quality of his sperm, semen analysis is generally used as the proxy to estimate fertility or gain insight into the underlying reasons for infertility. Male reproductive impairment might result from factors that affect sperm production, quality, function, or transport. Although in most men the origin of infertility remains unexplained, genetic causes are increasingly being discovered. In this first of two papers in The Lancet Diabetes and Endocrinology Series on male reproductive impairment, we propose a novel, clinically based aetiological construct with a genetic focus, and consider how this might serve as a helpful way to conceptualise a diagnostic algorithm.
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Affiliation(s)
- Herman Tournaye
- Centre for Reproductive Medicine, University Hospital of the Free University Brussels, Brussels, Belgium.
| | - Csilla Krausz
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Robert D Oates
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
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460
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Tournaye H, Krausz C, Oates RD. Concepts in diagnosis and therapy for male reproductive impairment. Lancet Diabetes Endocrinol 2017; 5:554-564. [PMID: 27395770 DOI: 10.1016/s2213-8587(16)30043-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
An accurate medical history and directed physical examination are essential in diagnosis of male infertility. We review the hormonal assessments and specific genetic analyses that are useful additional tests, and detail other evidence-based examinations that are available to help guide therapeutic strategies. By contrast with female infertility treatments-especially hormonal manipulations to stimulate or enhance oocyte production-spermatogenesis and sperm quality abnormalities are much more difficult to affect positively. In general, a healthy lifestyle can improve sperm quality. A few men have conditions in which evidence-based therapies can increase their chances for natural conception. In this second of two papers in The Lancet Diabetes and Endocrinology Series on male reproductive impairment, we examine the agreements and controversies that surround several of these conditions. When we are not able to cure, correct, or mitigate the cause of conditions such as severe oligozoospermia, non-remedial ductal obstruction, and absence of sperm fertilising ability, assisted reproductive technologies, such as in-vitro fertilisation (IVF) with intracytoplasmic sperm injection (ICSI), can be used as an adjunctive measure to allow for biological paternity. Not considered possible just two decades ago, azoospermia due to testicular failure, including 47,XXY (Klinefelter syndrome), is now treatable in approximately 50% of cases when combining surgical harvesting of testicular sperm and ICSI. Although genetic fatherhood is now possible for many men previously considered sterile, it is crucial to discover and abrogate causes as best possible, provide reliable and evidenced-based therapy, consider seriously the health and wellness of any offspring conceived, and always view infertility as a possible symptom of a more general or constitutional disease.
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Affiliation(s)
- Herman Tournaye
- Centre for Reproductive Medicine, University Hospital of the Free University Brussels, Brussels, Belgium.
| | - Csilla Krausz
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Robert D Oates
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
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461
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Luo H, Zheng R, Zhao Y, Wu J, Li J, Jiang F, Chen DN, Zhou XT, Li JD. A dominant negative FGFR1 mutation identified in a Kallmann syndrome patient. Gene 2017; 621:1-4. [DOI: 10.1016/j.gene.2017.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/24/2017] [Accepted: 04/10/2017] [Indexed: 02/07/2023]
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462
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Messina A, Langlet F, Prevot V. [MicroRNAs: new players in the hypothalamic control of fertility]. Med Sci (Paris) 2017; 33:506-511. [PMID: 28612726 DOI: 10.1051/medsci/20173305014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
MicroRNAs are small non-coding RNAs that modulate gene expression post-transcriptionally. Discovered more than 15 years ago, their functions start to be unraveled. Increasing evidence points to an important functional role of microRNAs in brain development. In particular, miRNAs have recently been established to play a vital role in the mechanisms underlying the infantile rise in gonadotropin-releasing hormone (GnRH) production by neurons in the hypothalamus, a phenomenon necessary for the onset of puberty in mammals.
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Affiliation(s)
- Andrea Messina
- Service d'Endocrinologie, Diabétologie et Métabolisme, Hôpital universitaire de Lausanne, Lausanne, Suisse
| | - Fanny Langlet
- Columbia University Medical Center and Berrie Diabetes Center, New York, États-Unis
| | - Vincent Prevot
- Laboratoire de Développement et de Plasticité du Cerveau Neuroendocrine, FHU 1000 days for health, Inserm U1172, Université de Lille, Lille, France
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463
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Stoupa A, Samara-Boustani D, Flechtner I, Pinto G, Jourdon I, González-Briceño L, Bidet M, Laborde K, Chevenne D, Millischer AE, Lottmann H, Blanc T, Aigrain Y, Polak M, Beltrand J. Efficacy and Safety of Continuous Subcutaneous Infusion of Recombinant Human Gonadotropins for Congenital Micropenis during Early Infancy
. Horm Res Paediatr 2017; 87:103-110. [PMID: 28081535 DOI: 10.1159/000454861] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early postnatal administration of gonadotropins to infants with congenital hypogonadotropic hypogonadism (CHH) can mimic minipuberty, thereby increasing penile growth. We assessed the effects of gonadotropin infusion on stretched penile length (SPL) and hormone levels in infants with congenital micropenis. METHODS Single-center study including 6 males with micropenis in case of isolated CHH (n = 4), panhypopituitarism (n = 1), and partial androgen insensitivity syndrome (PAIS; n = 1). Patients were evaluated at baseline, monthly and at the end of the study through a clinical examination (SPL, testicular position and size), serum hormone assays (testosterone, luteinizing hormone, follicle-stimulating hormone, inhibin B, anti-Müllerian hormone [AMH]), and ultrasound of penis/testes. RESULTS In CHH, significant increases occurred in serum testosterone (from undetectable level to 3.5 ± 4.06 ng/mL [12.15 ± 14.09 nmol/L]), SPL (from 13.8 ± 4.5 to 42.6 ± 5 mm; p < 0.0001), inhibin B (from 94.8 ± 74.9 to 469.4 ± 282.5 pg/mL, p = 0.04), and AMH (from 49.6 ± 30.6 to 142 ± 76.5 ng/mL, p = 0.03). Micropenis was corrected in all patients, except one. On treatment, in the patient with PAIS, SPL was increased from 13 to 38 mm. CONCLUSIONS Early gonadotropin infusion is a safe, well-tolerated and effective treatment. The effect in PAIS has not been reported previously. Long-term follow-up is needed to assess the impact, if any, on future fertility and reproduction.
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464
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Lima Amato LG, Latronico AC, Gontijo Silveira LF. Molecular and Genetic Aspects of Congenital Isolated Hypogonadotropic Hypogonadism. Endocrinol Metab Clin North Am 2017; 46:283-303. [PMID: 28476224 DOI: 10.1016/j.ecl.2017.01.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Congenital isolated hypogonadotropic hypogonadism (IHH) is a clinically and genetically heterogenous disorder characterized by abnormal synthesis, secretion, or action of gonadotropin-releasing hormone, a key hypothalamic decapeptide that orchestrates the reproductive axis. Several modes of inheritance have been identified. A growing list of causative genes has been implicated in the molecular pathogenesis of syndromic and nonsyndromic IHH, largely contributing for better understanding the complex neuroendocrine control of reproduction. This article summarizes the great advances of molecular genetics of IHH and pointed up the heterogeneity and complexity of the genetic basis of this condition.
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Affiliation(s)
- Lorena Guimaraes Lima Amato
- Division of Endocrinology, Development Endocrinology Unit, Laboratory of Hormones and Molecular Genetics/LIM42, Clinical Hospital, Sao Paulo Medical School, Sao Paulo University, Av. Dr. Eneas de Carvalho Aguiar 255, 7 andar, sala 7037, Sao Paulo, SP 05403-000, Brazil
| | - Ana Claudia Latronico
- Division of Endocrinology, Development Endocrinology Unit, Laboratory of Hormones and Molecular Genetics/LIM42, Clinical Hospital, Sao Paulo Medical School, Sao Paulo University, Av. Dr. Eneas de Carvalho Aguiar 255, 7 andar, sala 7037, Sao Paulo, SP 05403-000, Brazil.
| | - Leticia Ferreira Gontijo Silveira
- Division of Endocrinology, Development Endocrinology Unit, Laboratory of Hormones and Molecular Genetics/LIM42, Clinical Hospital, Sao Paulo Medical School, Sao Paulo University, Av. Dr. Eneas de Carvalho Aguiar 255, 7 andar, sala 7037, Sao Paulo, SP 05403-000, Brazil.
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465
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Abstract
PURPOSE OF REVIEW To describe pubertal testicular growth in humans, changes in testicular cell populations that result in testicular growth, and the role of testosterone and gonadotrophins follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in testicular growth. When human data were not available, studies in nonhuman primates and/or rodents were used as surrogates. RECENT FINDINGS Testicular growth in puberty follows a sigmoidal growth curve, with a large variation in timing of testicular growth and adult testicular volume. Testicular growth early in puberty is due to increase in Sertoli cell number and length of seminiferous tubules, whereas the largest and fastest growth results from the increase in the diameter of the seminiferous tubules first due to spermatogonial proliferation and then due to the expansion of meiotic and haploid germ cells. FSH stimulates Sertoli cell and spermatogonial proliferation, whereas LH/testosterone is mandatory to complete spermatogenesis. However, FSH and LH/testosterone work in synergy and are both needed for normal spermatogenesis. SUMMARY Testicular growth during puberty is rapid, and mostly due to germ cell expansion and growth in seminiferous tubule diameter triggered by androgens. Pre-treatment with FSH before the induction of puberty may improve the treatment of hypogonadotropic hypogonadism, but remains to be proven.
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Affiliation(s)
- Jaakko J Koskenniemi
- Institute of Biomedicine, Department of Physiology, University of Turku, and Department of Paediatrics, Turku University Hospital, Turku, Finland
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466
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Albuquerque EVA, Scalco RC, Jorge AAL. MANAGEMENT OF ENDOCRINE DISEASE: Diagnostic and therapeutic approach of tall stature. Eur J Endocrinol 2017; 176:R339-R353. [PMID: 28274950 DOI: 10.1530/eje-16-1054] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/23/2017] [Accepted: 03/08/2017] [Indexed: 12/17/2022]
Abstract
Tall stature is defined as a height of more than 2 standard deviations (s.d.) above average for same sex and age. Tall individuals are usually referred to endocrinologists so that hormonal disorders leading to abnormal growth are excluded. However, the majority of these patients have familial tall stature or constitutional advance of growth (generally associated with obesity), both of which are diagnoses of exclusion. It is necessary to have familiarity with a large number of rarer overgrowth syndromes, especially because some of them may have severe complications such as aortic aneurysm, thromboembolism and tumor predisposition and demand-specific follow-up approaches. Additionally, endocrine disorders associated with tall stature have specific treatments and for this reason their recognition is mandatory. With this review, we intend to provide an up-to-date summary of the genetic conditions associated with overgrowth to emphasize a practical diagnostic approach of patients with tall stature and to discuss the limitations of current growth interruption treatment options.
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Affiliation(s)
- Edoarda V A Albuquerque
- Unidade de Endocrinologia GenéticaLaboratório de Endocrinologia Celular e Molecular (LIM/25), Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Renata C Scalco
- Unidade de Endocrinologia do DesenvolvimentoLaboratório de Hormônios e Genética Molecular (LIM/42) do Hospital das Clinicas, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Disciplina de Endocrinologia da Faculdade de Ciências Médicas da Santa Casa de São PauloSão Paulo, Brazil
| | - Alexander A L Jorge
- Unidade de Endocrinologia GenéticaLaboratório de Endocrinologia Celular e Molecular (LIM/25), Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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467
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Turan I, Hutchins BI, Hacihamdioglu B, Kotan LD, Gurbuz F, Ulubay A, Mengen E, Yuksel B, Wray S, Topaloglu AK. CCDC141 Mutations in Idiopathic Hypogonadotropic Hypogonadism. J Clin Endocrinol Metab 2017; 102:1816-1825. [PMID: 28324054 PMCID: PMC5470764 DOI: 10.1210/jc.2016-3391] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/18/2017] [Indexed: 12/24/2022]
Abstract
CONTEXT Gonadotropin-releasing hormone neurons originate outside the central nervous system in the olfactory placode and migrate into the central nervous system, becoming integral components of the hypothalamic-pituitary-gonadal axis. Failure of this migration can lead to idiopathic hypogonadotropic hypogonadism (IHH)/Kallmann syndrome (KS). We have previously shown that CCDC141 knockdown leads to impaired migration of GnRH neurons but not of olfactory receptor neurons. OBJECTIVE The aim of this study was to further describe the phenotype and prevalence of CCDC141 mutations in IHH/KS. DESIGN Using autozygosity mapping, candidate gene screening, whole-exome sequencing, and Sanger sequencing, those individuals carrying deleterious CDCD141 variants and their phenotypes were determined in a cohort of 120 IHH/KS families. PATIENTS AND INTERVENTIONS No interventions were made. RESULTS Our studies revealed nine affected individuals from four independent families in which IHH/KS is associated with inactivating CCDC141 variants, revealing a prevalence of 3.3%. Affected individuals (with the exception of those from family 1 who concomitantly have FEZF1 mutations) have normal olfactory function and anatomically normal olfactory bulbs. Four affected individuals show evidence of clinical reversibility. In three of the families, there was at least one more potentially deleterious variant in other known puberty genes with evidence of allelic heterogeneity within respective pedigrees. CONCLUSIONS These studies confirm that inactivating CCDC141 variants cause normosmic IHH but not KS. This is consistent with our previous in vitro experiments showing exclusively impaired embryonic migration of GnRH neurons upon CCDC141 knockdown. These studies expand the clinical and genetic spectrum of IHH and also attest to the complexity of phenotype and genotype in IHH.
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Affiliation(s)
- Ihsan Turan
- Division of Pediatric Endocrinology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - B. Ian Hutchins
- Cellular and Developmental Neurobiology Section, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892
| | - Bulent Hacihamdioglu
- Department of Pediatrics, Gulhane Military Medical Academy Haydarpasa Training Hospital, 34668 Istanbul, Turkey
| | - L. Damla Kotan
- Division of Pediatric Endocrinology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Fatih Gurbuz
- Division of Pediatric Endocrinology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Ayca Ulubay
- Department of Forensic Medicine, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Eda Mengen
- Division of Pediatric Endocrinology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Bilgin Yuksel
- Division of Pediatric Endocrinology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Susan Wray
- Cellular and Developmental Neurobiology Section, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892
| | - A. Kemal Topaloglu
- Division of Pediatric Endocrinology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
- Department of Neurobiology and Anatomical Sciences, Division of Pediatric Endocrinology, Batson Children’s Hospital, University of Mississippi Medical Center, Jackson, Mississippi 39216
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468
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Poliandri A, Miller D, Howard S, Nobles M, Ruiz-Babot G, Harmer S, Tinker A, McKay T, Guasti L, Dunkel L. Generation of kisspeptin-responsive GnRH neurons from human pluripotent stem cells. Mol Cell Endocrinol 2017; 447:12-22. [PMID: 28232089 DOI: 10.1016/j.mce.2017.02.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/17/2017] [Accepted: 02/19/2017] [Indexed: 12/27/2022]
Abstract
GnRH neurons are fundamental for reproduction in all vertebrates, integrating all reproductive inputs. The inaccessibility of human GnRH-neurons has been a major impediment to studying the central control of reproduction and its disorders. Here, we report the efficient generation of kisspeptin responsive GnRH-secreting neurons by directed differentiation of human Embryonic Stem Cells and induced-Pluripotent Stem Cells derived from a Kallman Syndrome patient and a healthy family member. The protocol involves the generation of intermediate Neural Progenitor Cells (NPCs) through long-term Bone morphogenetic protein 4 inhibition, followed by terminal specification of these NPCs in media containing Fibroblast Growth Factor 8 and a NOTCH inhibitor. The resulting GnRH-expressing and -secreting neurons display a neuroendocrine gene expression pattern and present spontaneous calcium transients that can be stimulated by kisspeptin. These in vitro generated GnRH expressing cells provide a new resource for studying the molecular mechanisms underlying the development and function of GnRH neurons.
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Affiliation(s)
- Ariel Poliandri
- Centre for Endocrinology, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Duncan Miller
- Centre for Endocrinology, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Sasha Howard
- Centre for Endocrinology, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Muriel Nobles
- The Heart Centre, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Gerard Ruiz-Babot
- Centre for Endocrinology, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Stephen Harmer
- The Heart Centre, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Andrew Tinker
- The Heart Centre, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Tristan McKay
- School of Healthcare Science, The Manchester Metropolitan University, Manchester, M1 5GD, UK
| | - Leonardo Guasti
- Centre for Endocrinology, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Leo Dunkel
- Centre for Endocrinology, Queen Mary University of London, London, EC1M 6BQ, UK.
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469
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Le Tissier P, Campos P, Lafont C, Romanò N, Hodson DJ, Mollard P. An updated view of hypothalamic-vascular-pituitary unit function and plasticity. Nat Rev Endocrinol 2017; 13:257-267. [PMID: 27934864 DOI: 10.1038/nrendo.2016.193] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The discoveries of novel functional adaptations of the hypothalamus and anterior pituitary gland for physiological regulation have transformed our understanding of their interaction. The activity of a small proportion of hypothalamic neurons can control complex hormonal signalling, which is disconnected from a simple stimulus and the subsequent hormone secretion relationship and is dependent on physiological status. The interrelationship of the terminals of hypothalamic neurons and pituitary cells with the vasculature has an important role in determining the pattern of neurohormone exposure. Cells in the pituitary gland form networks with distinct organizational motifs that are related to the duration and pattern of output, and modifications of these networks occur in different physiological states, can persist after cessation of demand and result in enhanced function. Consequently, the hypothalamus and pituitary can no longer be considered as having a simple stratified relationship: with the vasculature they form a tripartite system, which must function in concert for appropriate hypothalamic regulation of physiological processes, such as reproduction. An improved understanding of the mechanisms underlying these regulatory features has implications for current and future therapies that correct defects in hypothalamic-pituitary axes. In addition, recapitulating proper network organization will be an important challenge for regenerative stem cell treatment.
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Affiliation(s)
- Paul Le Tissier
- Centre for Integrative Physiology, University of Edinburgh, George Square, Edinburgh, EH8 9XD, UK
| | - Pauline Campos
- Centre National de la Recherche Scientifique (CNRS), UMR-5203, Institut de Génomique Fonctionnelle, rue de la Cardonille, F-34000 Montpellier, France
- INSERM, U661, rue de la Cardonille, F-34000 Montpellier, France
- Université de Montpellier, rue de la Cardonille, UMR-5203, F-34000 Montpellier, France
| | - Chrystel Lafont
- Centre National de la Recherche Scientifique (CNRS), UMR-5203, Institut de Génomique Fonctionnelle, rue de la Cardonille, F-34000 Montpellier, France
- INSERM, U661, rue de la Cardonille, F-34000 Montpellier, France
- Université de Montpellier, rue de la Cardonille, UMR-5203, F-34000 Montpellier, France
| | - Nicola Romanò
- Centre for Integrative Physiology, University of Edinburgh, George Square, Edinburgh, EH8 9XD, UK
| | - David J Hodson
- Institute of Metabolism and Systems Research and Centre of Membrane Proteins and Receptors (COMPARE), University of Birmingham, Edgbaston, B15 2TT, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK
| | - Patrice Mollard
- Centre National de la Recherche Scientifique (CNRS), UMR-5203, Institut de Génomique Fonctionnelle, rue de la Cardonille, F-34000 Montpellier, France
- INSERM, U661, rue de la Cardonille, F-34000 Montpellier, France
- Université de Montpellier, rue de la Cardonille, UMR-5203, F-34000 Montpellier, France
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470
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Chemaitilly W, Cohen LE. DIAGNOSIS OF ENDOCRINE DISEASE: Endocrine late-effects of childhood cancer and its treatments. Eur J Endocrinol 2017; 176:R183-R203. [PMID: 28153840 DOI: 10.1530/eje-17-0054] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/01/2017] [Indexed: 12/12/2022]
Abstract
Endocrine complications are frequently observed in childhood cancer survivors (CCS). One of two CCS will experience at least one endocrine complication during the course of his/her lifespan, most commonly as a late-effect of cancer treatments, especially radiotherapy and alkylating agent chemotherapy. Endocrine late-effects include impairments of the hypothalamus/pituitary, thyroid and gonads, as well as decreased bone mineral density and metabolic derangements leading to obesity and/or diabetes mellitus. A systematic approach where CCS are screened for endocrine late-effects based on their cancer history and treatment exposures may improve health outcomes by allowing the early diagnosis and treatment of these complications.
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Affiliation(s)
- Wassim Chemaitilly
- Departments of Pediatric Medicine-Division of Endocrinology
- Departments of Epidemiology and Cancer ControlSt Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Laurie E Cohen
- Departments of Epidemiology and Cancer ControlSt Jude Children's Research Hospital, Memphis, Tennessee, USA
- Division of EndocrinologyBoston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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471
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Xu C, Lang-Muritano M, Phan-Hug F, Dwyer AA, Sykiotis GP, Cassatella D, Acierno J, Mohammadi M, Pitteloud N. Genetic testing facilitates prepubertal diagnosis of congenital hypogonadotropic hypogonadism. Clin Genet 2017; 92:213-216. [PMID: 28195315 DOI: 10.1111/cge.12996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 11/28/2022]
Abstract
Neonatal micropenis and cryptorchidism raise the suspicion of congenital hypogonadotropic hypogonadism (CHH), a rare genetic disorder caused by gonadotropin-releasing hormone deficiency. Low plasma testosterone levels and low gonadotropins during minipuberty provide a clinical diagnostic clue, yet these tests are seldomly performed in general practice. We report a male neonate with no family history of reproductive disorders who was born with micropenis and cryptorchidism. Hormonal testing at age 2.5 months showed low testosterone (0.3 nmol/L) and undetectable gonadotropins (luteinizing hormone and follicle-stimulating hormone both <0.5 U/L), suggestive of CHH. Genetic testing identified a de novo, heterozygous mutation in fibroblast growth factor receptor 1 (FGFR1 p.L630P). L630 resides on the ATP binding cleft of the FGFR1 tyrosine kinase domain, and L630P is predicted to cause a complete loss of receptor function. Cell-based assays confirmed that L630P abolishes FGF8 signaling activity. Identification of a loss-of-function de novo FGFR1 mutation in this patient confirms the diagnosis of CHH, allowing for a timely hormonal treatment to induce pubertal development. Therefore, genetic testing can complement clinical and hormonal assessment for a timely diagnosis of CHH in childhood.
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Affiliation(s)
- C Xu
- Endocrinology, Diabetology & Metabolism Service, Lausanne University Hospital, Lausanne, Switzerland
| | - M Lang-Muritano
- Endocrinology and Diabetology Department, University Children's Hospital, Zurich, Switzerland
| | - F Phan-Hug
- Endocrinology-Diabetology Unit, Department of Paediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - A A Dwyer
- Endocrinology, Diabetology & Metabolism Service, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - G P Sykiotis
- Endocrinology, Diabetology & Metabolism Service, Lausanne University Hospital, Lausanne, Switzerland
| | - D Cassatella
- Endocrinology, Diabetology & Metabolism Service, Lausanne University Hospital, Lausanne, Switzerland
| | - J Acierno
- Endocrinology, Diabetology & Metabolism Service, Lausanne University Hospital, Lausanne, Switzerland
| | - M Mohammadi
- Department of Biochemistry & Molecular Pharmacology, New York University School of Medicine, New York, New York, USA
| | - N Pitteloud
- Endocrinology, Diabetology & Metabolism Service, Lausanne University Hospital, Lausanne, Switzerland.,Endocrinology-Diabetology Unit, Department of Paediatrics, Lausanne University Hospital, Lausanne, Switzerland
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472
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Badiu C, Bonomi M, Borshchevsky I, Cools M, Craen M, Ghervan C, Hauschild M, Hershkovitz E, Hrabovszky E, Juul A, Kim SH, Kumanov P, Lecumberri B, Lemos MC, Neocleous V, Niedziela M, Djurdjevic SP, Persani L, Phan-Hug F, Pignatelli D, Pitteloud N, Popovic V, Quinton R, Skordis N, Smith N, Stefanija MA, Xu C, Young J, Dwyer AA. Developing and evaluating rare disease educational materials co-created by expert clinicians and patients: the paradigm of congenital hypogonadotropic hypogonadism. Orphanet J Rare Dis 2017; 12:57. [PMID: 28320476 PMCID: PMC5359990 DOI: 10.1186/s13023-017-0608-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/06/2017] [Indexed: 11/22/2022] Open
Abstract
Background Patients with rare diseases face health disparities and are often challenged to find accurate information about their condition. We aimed to use the best available evidence and community partnerships to produce patient education materials for congenital hypogonadotropic hypogonadism (CHH) and the olfacto-genital (Kallmann) syndrome (i.e., CHH and defective sense of smell), and to evaluate end-user acceptability. Expert clinicians, researchers and patients co-created the materials in a multi-step process. Six validated algorithms were used to assess reading level of the final product. Comprehensibility and actionability were measured using the Patient Education Materials Assessment Tool via web-based data collection. Descriptive statistics were employed to summarize data and thematic analysis for analyzing open-ended responses. Subsequently, translation and cultural adaption were conducted by clinicians and patients who are native speakers. Results Co-created patient education materials reached the target 6th grade reading level according to 2/6 (33%) algorithms (range: grade 5.9–9.7). The online survey received 164 hits in 2 months and 63/159 (40%) of eligible patients completed the evaluation. Patients ranged in age from 18 to 66 years (median 36, mean 39 ± 11) and 52/63 (83%), had adequate health literacy. Patients scored understandability at 94.2% and actionability at 90.5%. The patient education materials were culturally adapted and translated into 20 languages (available in Additional file 1). Conclusions Partnering with patients enabled us to create patient education materials that met patient- identified needs as evidenced by high end-user acceptability, understandability and actionability. The web-based evaluation was effective for reaching dispersed rare disease patients. Combining dissemination via traditional healthcare professional platforms as well as patient-centric sites can facilitate broad uptake of culturally adapted translations. This process may serve as a roadmap for creating patient education materials for other rare diseases. Electronic supplementary material The online version of this article (doi:10.1186/s13023-017-0608-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Corin Badiu
- Department of Endocrinology, National Institute of Endocrinology, C. Davila University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Marco Bonomi
- Deptartment of Clinical Sciences & Community Health and the Division of Endocrine and Metabolic Diseases & Laboratory of Endocrine and Metabolic Research, University of Milan, Milan, Italy.,Ospedale San Luca, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - Ivan Borshchevsky
- Patient Advocacy Working Group and the International Medical Interpreters Association, Pyatigorsk, Russia
| | - Martine Cools
- University Hospital Ghent Department of Pediatric Endocrinology, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Margarita Craen
- University Hospital Ghent Department of Pediatric Endocrinology, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Cristina Ghervan
- University of Medicine and Pharmacy "Iuliu Hatieganu", 8, V Babes str., 400012, Cluj-Napoca, Romania
| | - Michael Hauschild
- Endocrinology, Diabetes & Obesity Service of the Department of Pediatric Medicine and Surgery, Children's Hospital of Lausanne, Chemin de Montétan 16, 1004, Lausanne, Switzerland
| | - Eli Hershkovitz
- Pediatric Endocrinology and Metabolism Unit, Faculty of Health Sciences, Soroka Medical Center, Ben-Gurion University of the Negev, PO Box 151, IL-84101, Beer-Sheva, Israel
| | - Erik Hrabovszky
- Laboratory of Endocrine Neurobiology of the Institute of Experimental Medicine of the Hungarian Academy of Sciences, 43 Szigony St., 1083, Budapest, Hungary
| | - Anders Juul
- Department of Growth and Reproduction GR, Rigshospitalet section 5064, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Soo-Hyun Kim
- St. George's Medical School of the University of London, Molecular & Clinical Sciences Research Institute, Cell Biology & Genetics Research Centre, Cranmer Terrace, London, SW17 0RE, UK
| | - Phillip Kumanov
- Clinical Center of Endocrinology, Medical University, 2 Zdrawe St, 1431, Sofia, Bulgaria
| | - Beatriz Lecumberri
- Autónoma University of Madrid, Hospital La Paz Institute of Health Research (IdiPAZ), Endocrinology and Nutrition Service of La Paz University Hospital, Castellana 261, 28046, Madrid, Spain
| | - Manuel C Lemos
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilha, 6200-506, Portugal
| | - Vassos Neocleous
- Department of Molecular Genetics of the Cyprus Institute of Neurology and Genetics, P.O. Box 23462, Nicosia, Cyprus
| | - Marek Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572, Poznan, Poland
| | - Sandra Pekic Djurdjevic
- School of Medicine, University of Belgrade & Clinic of Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center Belgrade, dr Subotic 13, 11000, Belgrade, Serbia
| | - Luca Persani
- Ospedale San Luca, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy.,Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy.,Division of Endocrine and Metabolic Diseases & Laboratory of Endocrine and Metabolic Research, Milan, Italy
| | - Franziska Phan-Hug
- Endocrinology, Diabetes & Obesity Service of the Department of Pediatric Medicine and Surgery, Children's Hospital of Lausanne, Chemin de Montétan 16, 1004, Lausanne, Switzerland
| | - Duarte Pignatelli
- Department of Endocrinology, Hospital S João, Alameda Hernani Monteiro, 4200, Porto, Portugal
| | - Nelly Pitteloud
- University of Lausanne and the Endocrinology, Diabetes & Metabolism Service, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, 1011, Switzerland
| | - Vera Popovic
- School of Medicine, University of Belgrade, dr Subotic 8, 11000, Belgrade, Serbia
| | - Richard Quinton
- University of Newcastle-upon-Tyne, Institute of Genetic Medicine and the Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 3BZ, UK
| | - Nicos Skordis
- Division of Pediatric Endocrinology, Paedi Center for specialized Pediatrics, Nicosia, Cyprus.,St George's University of London Medical School at the University of Nicosia, Nicosia, Cyprus
| | - Neil Smith
- Patient Advocacy Working Group, London, UK
| | - Magdalena Avbelj Stefanija
- University Medical Centre Ljubljana, University Children's Hospital, Dept. of pediatric endocrinology, diabetes and metabolism, Bohoriceva ul. 20, 1000, Ljubljana, Slovenia
| | - Cheng Xu
- University of Lausanne and the Endocrinology, Diabetes & Metabolism Service, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, 1011, Switzerland
| | - Jacques Young
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, Le Kremlin-Bicêtre, 94275, France
| | - Andrew A Dwyer
- University of Lausanne, Institute of Higher Education & Research in Healthcare and the Endocrinology, Diabetes & Metabolism Service of the Lausanne University Hospital, Route de la Corniche 10, Lausanne, 1010, Switzerland.
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473
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Marcos S, Monnier C, Rovira X, Fouveaut C, Pitteloud N, Ango F, Dodé C, Hardelin JP. Defective signaling through plexin-A1 compromises the development of the peripheral olfactory system and neuroendocrine reproductive axis in mice. Hum Mol Genet 2017; 26:2006-2017. [DOI: 10.1093/hmg/ddx080] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/27/2017] [Indexed: 11/13/2022] Open
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474
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Dwyer AA, Tiemensma J, Quinton R, Pitteloud N, Morin D. Adherence to treatment in men with hypogonadotrophic hypogonadism. Clin Endocrinol (Oxf) 2017; 86:377-383. [PMID: 27647266 DOI: 10.1111/cen.13236] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/29/2016] [Accepted: 09/15/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Men with congenital hypogonadotrophic hypogonadism (CHH) typically require lifelong hormonal therapy, and discontinuing treatment can have negative health consequences. Little is known about adherence to treatment or the psychosocial impact of CHH. DESIGN A sequential, multiple methods approach was used. A quantitative online survey assessed adherence to treatment, depressive symptoms and illness perceptions. Subsequently, qualitative focus groups explored patient-reported factors for adherence. PATIENTS Adult men with CHH on at least 1 year of treatment were recruited internationally. MEASUREMENTS Adherence (Morisky medication adherence scale), depressive symptoms (Zung self-rating depression scale) and patient perception of CHH (revised illness perception questionnaire) were assessed in an online survey, and comparisons were made to reference groups. Patient focus group discussions were conducted and thematic analysis was employed to identify patient-reported factors for adherence. RESULTS In total, 101 men on long-term treatment were included (mean age 37 ± 11 years). Forty three percent (43/101) exhibited low medication adherence and a significantly elevated prevalence of mild, moderate or severe depressive symptoms (27%, 17%, 20%, respectively, all P < 0·001 vs reference population). Patients reported negative illness perceptions and significant psychosocial consequences. Focus group discussions (n = 3, 26 total patients) identified patient-, health professional- and healthcare system-related barriers as targets for improving adherence. CONCLUSIONS Congenital hypogonadotrophic hypogonadism men are challenged to adhere to long-term treatment. Poor adherence may contribute to adverse effects on bone, sexual and psychological health. The psychosocial morbidity of CHH is significant and appears to be underappreciated by healthcare providers.
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Affiliation(s)
- Andrew A Dwyer
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Endocrinology, Diabetes & Metabolism Service of the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jitske Tiemensma
- Department of Psychology, University of California Merced, Merced, CA, USA
| | - Richard Quinton
- Department of Endocrinology, Institute for Human Genetics, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
| | - Nelly Pitteloud
- Endocrinology, Diabetes & Metabolism Service of the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Department of Physiology, Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland
| | - Diane Morin
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Faculty of Nursing Science, Laval University, Québec City, QC, Canada
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475
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Ahmed K, LaPierre MP, Gasser E, Denzler R, Yang Y, Rülicke T, Kero J, Latreille M, Stoffel M. Loss of microRNA-7a2 induces hypogonadotropic hypogonadism and infertility. J Clin Invest 2017; 127:1061-1074. [PMID: 28218624 DOI: 10.1172/jci90031] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/15/2016] [Indexed: 12/21/2022] Open
Abstract
MicroRNAs (miRNAs) are negative modulators of gene expression that fine-tune numerous biological processes. miRNA loss-of-function rarely results in highly penetrant phenotypes, but rather, influences cellular responses to physiologic and pathophysiologic stresses. Here, we have reported that a single member of the evolutionarily conserved miR-7 family, miR-7a2, is essential for normal pituitary development and hypothalamic-pituitary-gonadal (HPG) function in adulthood. Genetic deletion of mir-7a2 causes infertility, with low levels of gonadotropic and sex steroid hormones, small testes or ovaries, impaired spermatogenesis, and lack of ovulation in male and female mice, respectively. We found that miR-7a2 is highly expressed in the pituitary, where it suppresses golgi glycoprotein 1 (GLG1) expression and downstream bone morphogenetic protein 4 (BMP4) signaling and also reduces expression of the prostaglandin F2a receptor negative regulator (PTGFRN), an inhibitor of prostaglandin signaling and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion. Our results reveal that miR-7a2 critically regulates sexual maturation and reproductive function by interconnecting miR-7 genomic circuits that regulate FSH and LH synthesis and secretion through their effects on pituitary prostaglandin and BMP4 signaling.
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476
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Rabconnectin-3α is required for the morphological maturation of GnRH neurons and kisspeptin responsiveness. Sci Rep 2017; 7:42463. [PMID: 28209974 PMCID: PMC5314327 DOI: 10.1038/srep42463] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 01/11/2017] [Indexed: 12/18/2022] Open
Abstract
A few hundred hypothalamic neurons form a complex network that controls reproduction in mammals by secreting gonadotropin-releasing hormone (GnRH). Timely postnatal changes in GnRH secretion are essential for pubertal onset. During the juvenile period, GnRH neurons undergo morphological remodeling, concomitantly achieving an increased responsiveness to kisspeptin, the main secretagogue of GnRH. However, the link between GnRH neuron activity and their morphology remains unknown. Here, we show that brain expression levels of Dmxl2, which encodes the vesicular protein rabconnectin-3α, determine the capacity of GnRH neurons to be activated by kisspeptin and estradiol. We also demonstrate that Dmxl2 expression levels control the pruning of GnRH dendrites, highlighting an unexpected role for a vesicular protein in the maturation of GnRH neuronal network. This effect is mediated by rabconnectin-3α in neurons or glial cells afferent to GnRH neurons. The widespread expression of Dmxl2 in several brain areas raises the intriguing hypothesis that rabconnectin-3α could be involved in the maturation of other neuronal populations.
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477
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Ayers KL, Bouty A, Robevska G, van den Bergen JA, Juniarto AZ, Listyasari NA, Sinclair AH, Faradz SMH. Variants in congenital hypogonadotrophic hypogonadism genes identified in an Indonesian cohort of 46,XY under-virilised boys. Hum Genomics 2017; 11:1. [PMID: 28209183 PMCID: PMC5314676 DOI: 10.1186/s40246-017-0098-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/11/2017] [Indexed: 11/16/2022] Open
Abstract
Background Congenital hypogonadotrophic hypogonadism (CHH) and Kallmann syndrome (KS) are caused by disruption to the hypothalamic-pituitary-gonadal (H-P-G) axis. In particular, reduced production, secretion or action of gonadotrophin-releasing hormone (GnRH) is often responsible. Various genes, many of which play a role in the development and function of the GnRH neurons, have been implicated in these disorders. Clinically, CHH and KS are heterogeneous; however, in 46,XY patients, they can be characterised by under-virilisation phenotypes such as cryptorchidism and micropenis or delayed puberty. In rare cases, hypospadias may also be present. Results Here, we describe genetic mutational analysis of CHH genes in Indonesian 46,XY disorder of sex development patients with under-virilisation. We present 11 male patients with varying degrees of under-virilisation who have rare variants in known CHH genes. Interestingly, many of these patients had hypospadias. Conclusions We postulate that variants in CHH genes, in particular PROKR2, PROK2, WDR11 and FGFR1 with CHD7, may contribute to under-virilisation phenotypes including hypospadias in Indonesia.
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Affiliation(s)
- Katie L Ayers
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Aurore Bouty
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gorjana Robevska
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | - Achmad Zulfa Juniarto
- Division of Human Genetics, Centre for Biomedical Research, Faculty of Medicine, Diponegoro University (FMDU), JL. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia
| | - Nurin Aisyiyah Listyasari
- Division of Human Genetics, Centre for Biomedical Research, Faculty of Medicine, Diponegoro University (FMDU), JL. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia
| | - Andrew H Sinclair
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sultana M H Faradz
- Division of Human Genetics, Centre for Biomedical Research, Faculty of Medicine, Diponegoro University (FMDU), JL. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia.
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478
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Ohtaka K, Fujisawa Y, Takada F, Hasegawa Y, Miyoshi T, Hasegawa T, Miyoshi H, Kameda H, Kurokawa-Seo M, Fukami M, Ogata T. FGFR1
Analyses in Four Patients with Hypogonadotropic Hypogonadism with Split-Hand/Foot Malformation: Implications for the Promoter Region. Hum Mutat 2017; 38:503-506. [DOI: 10.1002/humu.23178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/11/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Kohnosuke Ohtaka
- Department of Pediatrics; Hamamatsu University School of Medicine; Hamamatsu 431-3192 Japan
| | - Yasuko Fujisawa
- Department of Pediatrics; Hamamatsu University School of Medicine; Hamamatsu 431-3192 Japan
| | - Fumio Takada
- Department of Medical Genetics and Genomics; Kitasato University Graduate School of Medical Sciences; Sagamihara 252-0375 Japan
| | - Yukihiro Hasegawa
- Division of Endocrinology and Metabolism; Tokyo Metropolitan Children's Medical Center; Tokyo 183-8561 Japan
| | - Tatsuya Miyoshi
- Division of Endocrinology and Metabolism; Tokyo Metropolitan Children's Medical Center; Tokyo 183-8561 Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics; Keio University School of Medicine; Tokyo 160-8582 Japan
| | - Hideaki Miyoshi
- Division of Rheumatology, Endocrinology and Nephrology; Hokkaido University Graduate School of Medicine; Sapporo 060-8638 Japan
| | - Hiraku Kameda
- Division of Rheumatology, Endocrinology and Nephrology; Hokkaido University Graduate School of Medicine; Sapporo 060-8638 Japan
| | - Misuzu Kurokawa-Seo
- Division of Life Sciences, Graduate School of Life Sciences; Kyoto Sangyo University; Kyoto 603-8555 Japan
| | - Maki Fukami
- Department of Molecular Endocrinology; National Research Institute for Child Health and Development; Tokyo 157-8535 Japan
| | - Tsutomu Ogata
- Department of Pediatrics; Hamamatsu University School of Medicine; Hamamatsu 431-3192 Japan
- Department of Molecular Endocrinology; National Research Institute for Child Health and Development; Tokyo 157-8535 Japan
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479
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Hess M, Zumsteg U. [Not Available]. PRAXIS 2017; 106:127-133. [PMID: 28169596 DOI: 10.1024/1661-8157/a002594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Zur Beurteilung einer relevanten Pubertätsstörung ist es essenziell, die Physiologie der Pubertät zu kennen. Bei Mädchen ist die prämature Thelarche ein häufiger Konsultationsgrund. Meist benötigt diese keine weitere Therapie, muss aber gegen eine Pubertas praecox abgegrenzt werden. Diese braucht in jedem Fall weitere Diagnostik und möglicherweise auch eine pubertätshemmende Therapie. Bei Knaben ist hingegen die Pubertätsgynäkomastie und die Pubertas tarda ein häufigerer Vorstellungsgrund. Beides geht oft mit einem erheblichen Leidensdruck einher. Die physiologische Pubertätsgynäkomastie ist in den meisten Fällen nach 6–18 Monaten spontan rückläufig und bedarf nur selten einer weiteren Abklärung oder Therapie. Die Pubertas tarda tritt häufig im Rahmen einer konstitutionellen Entwicklungsverzögerung auf, differenzialdiagnostisch muss aber ein permanenter Hypogonadismus ausgeschlossen werden.
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Affiliation(s)
- Melanie Hess
- 1 Pädiatrische Endokrinologie/Diabetologie, Universitätskinderspital beider Basel UKBB, Basel
| | - Urs Zumsteg
- 1 Pädiatrische Endokrinologie/Diabetologie, Universitätskinderspital beider Basel UKBB, Basel
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480
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Langdahl JH, Frederiksen AL, Nguyen N, Brusgaard K, Juhl CB. Boucher Neuhäuser Syndrome – A rare cause of inherited hypogonadotropic hypogonadism. A case of two adult siblings with two novel mutations in PNPLA6. Eur J Med Genet 2017; 60:105-109. [DOI: 10.1016/j.ejmg.2016.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/14/2016] [Accepted: 11/13/2016] [Indexed: 10/20/2022]
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481
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Quinton R, Mamoojee Y, Jayasena CN, Young J, Howard S, Dunkel L, Cheetham T, Smith N, Dwyer AA. Society for Endocrinology UK guidance on the evaluation of suspected disorders of sexual development: emphasizing the opportunity to predict adolescent pubertal failure through a neonatal diagnosis of absent minipuberty. Clin Endocrinol (Oxf) 2017; 86:305-306. [PMID: 27749014 DOI: 10.1111/cen.13257] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Richard Quinton
- Endocrine Research Group, Institute of Genetic Medicine, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
- Department of Endocrinology, Newcastle-upon-Tyne Hospitals, Newcastle-upon-Tyne, UK
| | - Yaasir Mamoojee
- Department of Endocrinology, Newcastle-upon-Tyne Hospitals, Newcastle-upon-Tyne, UK
| | - Channa N Jayasena
- Section of Investigative Medicine, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Jacques Young
- Université Paris Sud - IDEX Univ PARIS SACLAY, Assistance Publique-Hôpitaux de Paris, INSERM U1185 Service d'Endocrinologie Adultes, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Paris, France
| | - Sasha Howard
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, Uk
| | - Leo Dunkel
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, Uk
| | - Tim Cheetham
- Endocrine Research Group, Institute of Genetic Medicine, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
- Department of Paediatric Endocrinology, Newcastle-upon-Tyne Hospitals, Newcastle-upon-Tyne, UK
| | - Neil Smith
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Andrew A Dwyer
- Institute of Higher Education & Research in Healthcare, University of Lausanne, Switzerland
- Endocrinology, Diabetes & Metabolism Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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482
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Affiliation(s)
- Andrea Messina
- Service d'Endocrinologie, diabétologie et métabolisme, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Vincent Prevot
- Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, University of Lille, School of Medicine, Lille, France
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483
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Abstract
Subfertility is defined as the condition of being less than normally fertile though still capable of effecting fertilization. When these subfertile couples seek assistance for conception, a thorough evaluation of male endocrine function is often overlooked. Spermatogenesis is a complex process where even subtle alterations in this process can lead to subfertility or infertility. Male endocrine abnormalities may suggest a specific diagnosis contributing to subfertility; however, in many patients, the underlying etiology is still unknown. Optimizing underlying endocrine abnormalities may improve spermatogenesis and fertility. This manuscript reviews reproductive endocrine abnormalities and hormone-based treatments.
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484
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Maione L, Brailly-Tabard S, Nevoux J, Bouligand J, Young J. Reversal of congenital hypogonadotropic hypogonadism in a man with Kallmann syndrome due to SOX10 mutation. Clin Endocrinol (Oxf) 2016; 85:988-989. [PMID: 27616149 DOI: 10.1111/cen.13231] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Luigi Maione
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin Bicêtre, France
- Department of Molecular Genetics and Hormonology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin Bicêtre, France
- University of Paris-Sud, Le Kremlin Bicêtre, France
| | - Sylvie Brailly-Tabard
- Department of Molecular Genetics and Hormonology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin Bicêtre, France
- University of Paris-Sud, Le Kremlin Bicêtre, France
- INSERM UMR-1185, Le Kremlin Bicêtre, France
| | - Jérôme Nevoux
- INSERM UMR-1185, Le Kremlin Bicêtre, France
- Otorhinolaryngology Department, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Jérôme Bouligand
- Department of Molecular Genetics and Hormonology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin Bicêtre, France
- University of Paris-Sud, Le Kremlin Bicêtre, France
- INSERM UMR-1185, Le Kremlin Bicêtre, France
| | - Jacques Young
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin Bicêtre, France
- University of Paris-Sud, Le Kremlin Bicêtre, France
- INSERM UMR-1185, Le Kremlin Bicêtre, France
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485
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Bouilly J, Beau I, Barraud S, Bernard V, Azibi K, Fagart J, Fèvre A, Todeschini AL, Veitia RA, Beldjord C, Delemer B, Dodé C, Young J, Binart N. Identification of Multiple Gene Mutations Accounts for a new Genetic Architecture of Primary Ovarian Insufficiency. J Clin Endocrinol Metab 2016; 101:4541-4550. [PMID: 27603904 DOI: 10.1210/jc.2016-2152] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Idiopathic primary ovarian insufficiency (POI) is a major cause of amenorrhea and infertility. POI affects 1% of women before age 40 years, and several genetic causes have been reported. To date, POI has been considered a monogenic disorder. OBJECTIVE The aim of this study was to identify novel gene variations and to investigate if individuals with POI harbor mutation in multiple loci. PATIENTS AND METHODS One hundred well-phenotyped POI patients were systematically screened for variants in 19 known POI loci (and potential candidate genes) using next-generation sequencing. RESULTS At least one rare protein-altering gene variant was identified in 19 patients, including missense mutations in new candidate genes, namely SMC1β and REC8 (involved in the cohesin complex) and LHX8, a gene encoding a transcription factor. Novel or recurrent deleterious mutations were also detected in the known POI candidate genes NOBOX, FOXL2, SOHLH1, FIGLA, GDF9, BMP15, and GALT. Seven patients harbor mutations in two loci, and this digenicity seems to influence the age of symptom onset. CONCLUSIONS Genetic anomalies in women with POI are more frequent than previously believed. Digenic findings in several cases suggest that POI is not a purely monogenic disorder and points to a role of digenicity. The genotype-phenotype correlations in some kindreds suggest that a synergistic effect of several mutations may underlie the POI phenotype.
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Affiliation(s)
- Justine Bouilly
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Isabelle Beau
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Sara Barraud
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Valérie Bernard
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Kemal Azibi
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Jérôme Fagart
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Anne Fèvre
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Anne Laure Todeschini
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Reiner A Veitia
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Chérif Beldjord
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Brigitte Delemer
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Catherine Dodé
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Jacques Young
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Nadine Binart
- Inserm 1185 (J.B., I.B., S.B., J.F., J.Y., N.B.), Le Kremlin-Bicêtre, Université Paris-Saclay, Faculté de Médecine Paris Sud, 94270 Le Kremlin-Bicêtre, France; Service de Biochimie et Génétique Moléculaire (K.A., C.B., C.D.), Hôpital Cochin, AP-HP, Université Paris-Descartes, 75004 Paris, France; Service d'Endocrinologie-Diabète-Nutrition (A.F., B.D.), CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France; Institut Jacques Monod (A.L.T., R.A.V.), Université Paris Diderot-PARIS 7/CNRS UMR7592, 75013 Paris, France; and Service d'Endocrinologie et des Maladies de la Reproduction (J.Y.), APHP, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
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486
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Abstract
Turner syndrome and idiopathic congenital hypogonadism including Kallmann syndrome are conditions associated to a large number of widely known comorbidities that need a medical support forever. One of the characteristics shared by both conditions is the lack of sexual development that influencing the sexuality functioning and quality of life of the affected women. Few studies have been conducted to assess these topics, but they need to be considered in the treatment to all women with hypogonadism. This review on the major medical issues and psychological aspects, also focus in the present knowledge about sexual function and quality of life of women with Turner syndrome and idiopathic congenital hypogonadism, which aims to help in the comprehensive management of these patients.
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Affiliation(s)
- María Fernanda Garrido Oyarzún
- a Department of Obstetrics & Gynecology and Reproductive Biology, Faculty of Medicine , Universidad de los Andes , Santiago , Chile and
| | - Camil Castelo-Branco
- b Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic-Institut, d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona , Barcelona , Spain
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487
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Adjunct Management of Male Hypogonadism. CURRENT SEXUAL HEALTH REPORTS 2016. [DOI: 10.1007/s11930-016-0089-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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488
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Eggers S, Sadedin S, van den Bergen JA, Robevska G, Ohnesorg T, Hewitt J, Lambeth L, Bouty A, Knarston IM, Tan TY, Cameron F, Werther G, Hutson J, O'Connell M, Grover SR, Heloury Y, Zacharin M, Bergman P, Kimber C, Brown J, Webb N, Hunter MF, Srinivasan S, Titmuss A, Verge CF, Mowat D, Smith G, Smith J, Ewans L, Shalhoub C, Crock P, Cowell C, Leong GM, Ono M, Lafferty AR, Huynh T, Visser U, Choong CS, McKenzie F, Pachter N, Thompson EM, Couper J, Baxendale A, Gecz J, Wheeler BJ, Jefferies C, MacKenzie K, Hofman P, Carter P, King RI, Krausz C, van Ravenswaaij-Arts CMA, Looijenga L, Drop S, Riedl S, Cools M, Dawson A, Juniarto AZ, Khadilkar V, Khadilkar A, Bhatia V, Dũng VC, Atta I, Raza J, Thi Diem Chi N, Hao TK, Harley V, Koopman P, Warne G, Faradz S, Oshlack A, Ayers KL, Sinclair AH. Disorders of sex development: insights from targeted gene sequencing of a large international patient cohort. Genome Biol 2016; 17:243. [PMID: 27899157 PMCID: PMC5126855 DOI: 10.1186/s13059-016-1105-y] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/10/2016] [Indexed: 01/20/2023] Open
Abstract
Background Disorders of sex development (DSD) are congenital conditions in which chromosomal, gonadal, or phenotypic sex is atypical. Clinical management of DSD is often difficult and currently only 13% of patients receive an accurate clinical genetic diagnosis. To address this we have developed a massively parallel sequencing targeted DSD gene panel which allows us to sequence all 64 known diagnostic DSD genes and candidate genes simultaneously. Results We analyzed DNA from the largest reported international cohort of patients with DSD (278 patients with 46,XY DSD and 48 with 46,XX DSD). Our targeted gene panel compares favorably with other sequencing platforms. We found a total of 28 diagnostic genes that are implicated in DSD, highlighting the genetic spectrum of this disorder. Sequencing revealed 93 previously unreported DSD gene variants. Overall, we identified a likely genetic diagnosis in 43% of patients with 46,XY DSD. In patients with 46,XY disorders of androgen synthesis and action the genetic diagnosis rate reached 60%. Surprisingly, little difference in diagnostic rate was observed between singletons and trios. In many cases our findings are informative as to the likely cause of the DSD, which will facilitate clinical management. Conclusions Our massively parallel sequencing targeted DSD gene panel represents an economical means of improving the genetic diagnostic capability for patients affected by DSD. Implementation of this panel in a large cohort of patients has expanded our understanding of the underlying genetic etiology of DSD. The inclusion of research candidate genes also provides an invaluable resource for future identification of novel genes. Electronic supplementary material The online version of this article (doi:10.1186/s13059-016-1105-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefanie Eggers
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Victorian Clinical Genetic Services, Melbourne, VIC, Australia
| | - Simon Sadedin
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Thomas Ohnesorg
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Jacqueline Hewitt
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,University of Melbourne, School of Bioscience, Melbourne, VIC, Australia.,Department Of Paediatric Urology, Monash Children's Hospital, Clayton, VIC, Australia
| | - Luke Lambeth
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Aurore Bouty
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Ingrid M Knarston
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Tiong Yang Tan
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Victorian Clinical Genetic Services, Melbourne, VIC, Australia
| | - Fergus Cameron
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - George Werther
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - John Hutson
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Michele O'Connell
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Sonia R Grover
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Yves Heloury
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Margaret Zacharin
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Philip Bergman
- Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Clayton, VIC, Australia.,Monash Medical Centre, Clayton, VIC, Australia
| | - Chris Kimber
- Monash Children's Hospital, Clayton, VIC, Australia
| | - Justin Brown
- Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Nathalie Webb
- Department Of Paediatric Urology, Monash Children's Hospital, Clayton, VIC, Australia
| | - Matthew F Hunter
- Department of Paediatrics, Monash University, Clayton, VIC, Australia.,Monash Genetics, Monash Health, Clayton, VIC, Australia
| | - Shubha Srinivasan
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW, Australia
| | - Angela Titmuss
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW, Australia
| | - Charles F Verge
- Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, UNSW, Sydney, NSW, Australia
| | - David Mowat
- Department of Medical Genetics, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Grahame Smith
- Urology and Clinical Programs, The Children's Hospital at Westmead, Westmead, NSW, Australia.,The University of Sydney, Westmead, NSW, Australia
| | - Janine Smith
- Department of Clinical Genetics, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Lisa Ewans
- Department of Medical Genomics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Carolyn Shalhoub
- Department of Medical Genetics, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Patricia Crock
- John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
| | - Chris Cowell
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW, Australia
| | - Gary M Leong
- Department of Paediatric Endocrinology and Diabetes, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Makato Ono
- Department of Paediatrics, Tokyo Bay Medical Centre, Tokyo, Chiba, Japan
| | - Antony R Lafferty
- Centenary Hospital for Women and Children, Canberra, ACT, Australia.,ANU Medical School, Canberra, ACT, Australia
| | - Tony Huynh
- Department of Paediatric Endocrinology and Diabetes, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Uma Visser
- Sydney Children's Hospital, Randwick, NSW, Australia
| | - Catherine S Choong
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Subiaco, WA, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Crawley, WA, Australia
| | - Fiona McKenzie
- School of Paediatrics and Child Health, The University of Western Australia, Crawley, WA, Australia.,Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Nicholas Pachter
- School of Paediatrics and Child Health, The University of Western Australia, Crawley, WA, Australia.,Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Elizabeth M Thompson
- SA Clinical Genetics Service, SA Pathology at the Women's and Children's Hospital, North Adelaide, SA, Australia.,School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Jennifer Couper
- Women's and Children's Hospital and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Anne Baxendale
- SA Clinical Genetics Service, SA Pathology at the Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Jozef Gecz
- School of Medicine and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Craig Jefferies
- Diabetes and Endocrinology, Auckland District Health Board, Auckland, New Zealand
| | | | - Paul Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Philippa Carter
- Starship Paediatric Diabetes and Endocrinology, Auckland, New Zealand
| | - Richard I King
- Canterbury Health Laboratories, Christchurch, Canterbury, New Zealand
| | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Leendert Looijenga
- Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Sten Drop
- Department of Paediatrics, Division of Endocrinology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Stefan Riedl
- St Anna Children's Hospital, Vienna, Austria.,Paediatric Department, Medical University of Vienna, Vienna, Austria
| | - Martine Cools
- Department of Paediatric Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Angelika Dawson
- Genomic Laboratory, Diagnostic Services of Manitoba and Genetics & Metabolism Program, WRHA, Winnipeg, MB, Canada.,Department Biochemistry & Medical Genetics and Paediatrics & Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Achmad Zulfa Juniarto
- Division of Human Genetics, Centre for Biomedical Research Faculty of Medicine Diponegoro University (FMDU), Semarang, Indonesia
| | - Vaman Khadilkar
- Growth and Pediatric Endocrine Clinic, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India.,Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Anuradha Khadilkar
- Growth and Pediatric Endocrine Clinic, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India.,Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | | | - Vũ Chí Dũng
- Department of Endocrinology, Metabolism and Genetics National Children's Hospital, Hanoi, Vietnam
| | - Irum Atta
- National Institute of Child Health, Karachi, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | | | - Tran Kiem Hao
- Paediatric Centre, Hue Central Hospital, Hue city, Vietnam
| | - Vincent Harley
- Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Peter Koopman
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Garry Warne
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Sultana Faradz
- Division of Human Genetics, Centre for Biomedical Research Faculty of Medicine Diponegoro University (FMDU), Semarang, Indonesia
| | - Alicia Oshlack
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,University of Melbourne, School of Bioscience, Melbourne, VIC, Australia
| | - Katie L Ayers
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew H Sinclair
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
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489
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Germain N, Fauconnier A, Klein JP, Wargny A, Khalfallah Y, Papastathi-Boureau C, Estour B, Galusca B. Pulsatile gonadotropin-releasing hormone therapy in persistent amenorrheic weight-recovered anorexia nervosa patients. Fertil Steril 2016; 107:502-509. [PMID: 27887708 DOI: 10.1016/j.fertnstert.2016.10.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/01/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare hormonal and clinical responses to GnRH pulsatile treatment in weight-recovered anorexia nervosa patients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA) vs. in patients with secondary and primary HA. DESIGN Retrospective, observational, ambulatory study. SETTING University hospital. PATIENT(S) Forty-one women: 19 Rec-AN (body mass index >18.5 kg/m2 without menses recovery), 15 secondary HA without any eating disorders patients (SHA), and 7 primary HA patients (PHA). INTERVENTION(S) Gonadotropin-releasing hormone pulsatile therapy. MAIN OUTCOME MEASURE(S) Baseline E2, LH, and P plasma levels and their changes during induction cycles; ovulation, follicular recruitment, and pregnancies. RESULTS The Rec-AN group displayed higher basal E2 and LH plasma levels after GnRH injection compared with SHA and PHA. Higher E2 and LH levels were observed during induction cycles in Rec-AN compared with SHA and PHA. Follicular recruitment was higher in Rec-AN. The ovulation rate was higher in Rec-AN compared with PHA but similar to SHA. CONCLUSION(S) This study showed increased gonadal status and higher E2 response to pulsatile GnRH therapy in persistent amenorrheic weight-recovered AN compared with HA from other causes. It suggests that their individual set-point of body weight allowing a fully functional gonadal axis is not reached yet. Specific factors of gonadal inertia in Rec-AN still remain unclear.
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Affiliation(s)
- Natacha Germain
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet University, Saint-Etienne, France.
| | - Anaïs Fauconnier
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Philippe Klein
- Department of Histology and Embryology, University Hospital of Saint-Etienne, Saint-Etienne, France; Unité de Mixte de Recherche Institut National de la Santé et de la Recherche Médicale 1059, Jean Monnet University, Saint Etienne, France
| | - Amélie Wargny
- Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet University, Saint-Etienne, France
| | - Yadh Khalfallah
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France
| | - Chrysoula Papastathi-Boureau
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France
| | - Bruno Estour
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet University, Saint-Etienne, France
| | - Bogdan Galusca
- Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet University, Saint-Etienne, France
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490
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Casoni F, Malone SA, Belle M, Luzzati F, Collier F, Allet C, Hrabovszky E, Rasika S, Prevot V, Chédotal A, Giacobini P. Development of the neurons controlling fertility in humans: new insights from 3D imaging and transparent fetal brains. Development 2016; 143:3969-3981. [DOI: 10.1242/dev.139444] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/05/2016] [Indexed: 12/12/2022]
Abstract
Fertility in mammals is controlled by hypothalamic neurons that secrete gonadotropin-releasing hormone (GnRH). These neurons differentiate in the olfactory placodes during embryogenesis and migrate from the nose to the hypothalamus before birth. Information regarding this process in humans is sparse. Here, we adapted new tissue-clearing and whole-mount immunohistochemical techniques to entire human embryos/fetuses to meticulously study this system during the first trimester of gestation in the largest series of human fetuses examined to date. Combining these cutting-edge techniques with conventional immunohistochemistry, we provide the first chronological and quantitative analysis of GnRH neuron origins, differentiation and migration, as well as a 3D atlas of their distribution in the fetal brain. We reveal not only that the number of GnRH-immunoreactive neurons in humans is significantly higher than previously thought, but that GnRH cells migrate into several extrahypothalamic brain regions in addition to the hypothalamus. Their presence in these areas raises the possibility that GnRH has non-reproductive roles, creating new avenues for research on GnRH functions in cognitive, behavioral and physiological processes.
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Affiliation(s)
- Filippo Casoni
- University of Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille 59000, France
- Inserm, UMR-S 1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille 59000, France
| | - Samuel A. Malone
- University of Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille 59000, France
- Inserm, UMR-S 1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille 59000, France
| | - Morgane Belle
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, Paris 75012, France
| | - Federico Luzzati
- Department of Life Sciences and Systems Biology (DBIOS), University of Turin, Turin 10123, Italy
- Neuroscience Institute Cavalieri Ottolenghi (NICO), Orbassano 10043, Italy
| | - Francis Collier
- FHU 1,000 Days for Health, University of Lille, School of Medicine, Lille 5900, France
- CHU Lille, Gynaecology Service - Hospital Jeanne de Flandre, Lille 59000, France
| | - Cecile Allet
- University of Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille 59000, France
- Inserm, UMR-S 1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille 59000, France
| | - Erik Hrabovszky
- Institute of Experimental Medicine, Laboratory of Endocrine Neurobiology, Budapest 1083, Hungary
| | | | - Vincent Prevot
- University of Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille 59000, France
- Inserm, UMR-S 1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille 59000, France
- FHU 1,000 Days for Health, University of Lille, School of Medicine, Lille 5900, France
| | - Alain Chédotal
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, Paris 75012, France
| | - Paolo Giacobini
- University of Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille 59000, France
- Inserm, UMR-S 1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille 59000, France
- FHU 1,000 Days for Health, University of Lille, School of Medicine, Lille 5900, France
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491
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Neuroendokrine Regulation der Pubertät und ihre Störungen. GYNAKOLOGISCHE ENDOKRINOLOGIE 2016. [DOI: 10.1007/s10304-016-0091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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492
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Ulloa-Aguirre A, Lira-Albarrán S. Clinical Applications of Gonadotropins in the Male. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2016; 143:121-174. [PMID: 27697201 DOI: 10.1016/bs.pmbts.2016.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The pituitary gonadotropins, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) play a pivotal role in reproduction. The synthesis and secretion of gonadotropins are regulated by complex interactions among several endocrine, paracrine, and autocrine factors of diverse chemical structure. In men, LH regulates the synthesis of androgens by the Leydig cells, whereas FSH promotes Sertoli cell function and thereby influences spermatogenesis. Gonadotropins are complex molecules composed of two subunits, the α- and β-subunit, that are noncovalently associated. Gonadotropins are decorated with glycans that regulate several functions of the protein including folding, heterodimerization, stability, transport, conformational maturation, efficiency of heterodimer secretion, metabolic fate, interaction with their cognate receptor, and selective activation of signaling pathways. A number of congenital and acquired abnormalities lead to gonadotropin deficiency and hypogonadotropic hypogonadism, a condition amenable to treatment with exogenous gonadotropins. Several natural and recombinant preparations of gonadotropins are currently available for therapeutic purposes. The difference between natural and the currently available recombinant preparations (which are massively produced in Chinese hamster ovary cells for commercial purposes) mainly lies in the abundance of some of the carbohydrates that conform the complex glycans attached to the protein core. Whereas administration of exogenous gonadotropins in patients with isolated congenital hypogonadotropic hypogonadism is a well recognized therapeutic approach, their role in treating men with normogonadotropic idiopathic infertility is still controversial. This chapter concentrates on the main structural and functional features of the gonadotropin hormones and how basic concepts have been translated into the clinical arena to guide therapy for gonadotropin deficit in males.
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Affiliation(s)
- A Ulloa-Aguirre
- Research Support Network, Universidad Nacional Autónoma de México (UNAM)-National Institutes of Health, Mexico City, Mexico.
| | - S Lira-Albarrán
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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493
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Massimi L, Izzo A, Paternoster G, Frassanito P, Di Rocco C. Arachnoid cyst: a further anomaly associated with Kallmann syndrome? Childs Nerv Syst 2016; 32:1607-14. [PMID: 27379494 DOI: 10.1007/s00381-016-3154-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kallmann syndrome (KS) is defined by the association of hypogonadotropic hypogonadism and anosmia. It is characterized by a significant clinical and genetic heterogeneity; actually, it may present several non-reproductive non-olfactory anomalies, and all the ways of genetic transmission can be involved in the inheritance of the disease. Although six pathogenesis-related genes have been identified so far, KS remains sporadic in 70 % of the cases, and the genetic diagnosis is not available for all of them. The purpose of this paper is to present a further disease that can enrich the wide spectrum of KS variability, that is cerebral arachnoid cyst. CASE DESCRIPTION This 11-year-old boy presented with the typical characteristics of KS together with those related to a sylvian arachnoid cyst. He was admitted because of worsening headache. At the admission, the physical examination revealed eunuchoid aspect, micropenis, previous cryptorchidism, and anosmia. MRI pointed out a large, left sylvian arachnoid cyst, agenesia of the olfactory bulbs/tracts complex, and hypoplasia of the left olfactory sulcus. The child was operated on by endoscopic fenestration of the cyst, followed by transient external drainage for subdural hygroma and microscopic fenestration for recurrence of the cyst. His statural growth is normal but the sexual development still delayed in spite of hormone replacement therapy. CONCLUSION According to the present and the other four cases in the literature, arachnoid cyst should be included among the anomalies possibly accompanying KS date although this association seems to be occasional as far as embryogenesis and physiopathology are concerned.
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Affiliation(s)
- Luca Massimi
- Pediatric Neurosurgery, A. Gemelli Hospital, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Alessandro Izzo
- Pediatric Neurosurgery, A. Gemelli Hospital, Largo A. Gemelli, 8, 00168, Rome, Italy
| | | | - Paolo Frassanito
- Pediatric Neurosurgery, A. Gemelli Hospital, Largo A. Gemelli, 8, 00168, Rome, Italy
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494
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Abstract
Groups of neurons in the hypothalamus synchronize their activity to trigger the production of hormones that sustain fertility.
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Affiliation(s)
- Sonal Shruti
- Laboratory of Development and Plasticity of the Neuroendocrine Brain and the NEUROBESE International Associated Laboratory, Institut National de la Santé et de la Recherche Médicale, Université de Lille, Unité Mixte de Recherche 1172, Lille, France
| | - Vincent Prevot
- Laboratory of Development and Plasticity of the Neuroendocrine Brain and the NEUROBESE International Associated Laboratory, Institut National de la Santé et de la Recherche Médicale, Université de Lille, Unité Mixte de Recherche 1172, Lille, France
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495
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Zernov N, Skoblov M, Baranova A, Boyarsky K. Mutations in gonadotropin-releasing hormone signaling pathway in two nIHH patients with successful pregnancy outcomes. Reprod Biol Endocrinol 2016; 14:48. [PMID: 27544332 PMCID: PMC4992333 DOI: 10.1186/s12958-016-0183-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anomalous levels of gonadotropin-releasing hormone (GnRH) secretion result in a variety of reproductive phenotypes associated with infertility or subfertility. The normosmic isolated hypogonadotropic hypogonadism (nIHH) is due to a failure of either GnRH pulsatile secretion in hypothalamus or its reception in pituitary. The spectrum of nIHH-associated alterations continues to expand, especially when additional ethnic populations are investigated. The aim of this study was to uncover genetic causes for nIHH in patients of Russian origin. METHODS For two nIHH patients referred to infertility clinic, both exons and promoter sequences of 6 GnRH signaling genes were sequenced. RESULTS Patient 1 was a compound heterozygote for mutations in GnRH and its receptor encoding genes, while in Patient 2 GnRHR mutations were found in homozygous state. In both patients, the coding frame of GnRHR gene harbored missense-mutation Arg139His previously described as founder mutation in Polish and Brazilan patients. IVF/ET treatments were successful, with phenotypically healthy offsprings delivered. CONCLUSION Polish founder mutation Arg139His in GnRHR was found in two nIHH patients originating from Western region of Russia. Common variant of GnRH-encoding gene, Trp16Ser, could possibly contribute to reproductive phenotypes in patients with heterozygous mutations of other GnRH signaling pathway genes.
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Affiliation(s)
- Nikolay Zernov
- Federal State Budgetary Institution “Research Centre for Medical Genetics”, Moskvorechie 1, Moscow, Russia
| | - Mikhail Skoblov
- Federal State Budgetary Institution “Research Centre for Medical Genetics”, Moskvorechie 1, Moscow, Russia
- The Moscow Institute of Physics and Technology, Dolgoprudny, 141700 Moscow Region, Russia
- The Russian National Research Medical University named after N.I.Pirogov (RNRMU), Ostrovityanova 1, Moscow, 117997 Russia
| | - Ancha Baranova
- Federal State Budgetary Institution “Research Centre for Medical Genetics”, Moskvorechie 1, Moscow, Russia
- The Moscow Institute of Physics and Technology, Dolgoprudny, 141700 Moscow Region, Russia
- Center for the Study of Chronic Metabolic and Rare Diseases, School of Systems Biology, College of Science, George Mason University, 4400 University Dr David King Hall MSN3 E1, Fairfax, VA USA
- Atlas Biomed Group, 31 Malaya Nikitskaya Str, Bldg. 1, Moscow, 123317 Russia
| | - Konstantin Boyarsky
- Center of Human Reproduction “Genesis”, St. Petersburg, Russia
- Department of Obstetrics and Gynecology, State Pediatric Medical University, St. Petersburg, Russia
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496
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497
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Abstract
The gonadotropin-releasing hormone (GnRH) neuronal network generates pulse and surge modes of gonadotropin secretion critical for puberty and fertility. The arcuate nucleus kisspeptin neurons that innervate the projections of GnRH neurons in and around their neurosecretory zone are key components of the pulse generator in all mammals. By contrast, kisspeptin neurons located in the preoptic area project to GnRH neuron cell bodies and proximal dendrites and are involved in surge generation in female rodents (and possibly other species). The hypothalamic-pituitary-gonadal axis develops embryonically but, apart from short periods of activation immediately after birth, remains suppressed through a combination of gonadal and non-gonadal mechanisms. At puberty onset, the pulse generator reactivates, probably owing to progressive stimulatory influences on GnRH neurons from glial and neurotransmitter signalling, and the re-emergence of stimulatory arcuate kisspeptin input. In females, the development of pulsatile gonadotropin secretion enables final maturation of the surge generator that ultimately triggers the first ovulation. Representation of the GnRH neuronal network as a series of interlocking functional modules could help conceptualization of its functioning in different species. Insights into pulse and surge generation are expected to aid development of therapeutic strategies ameliorating pubertal disorders and infertility in the clinic.
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Affiliation(s)
- Allan E Herbison
- Centre for Neuroendocrinology and Department of Physiology, University of Otago School of Medical Sciences, Dunedin 9054, New Zealand
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498
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Abitbol L, Zborovski S, Palmert MR. Evaluation of delayed puberty: what diagnostic tests should be performed in the seemingly otherwise well adolescent? Arch Dis Child 2016; 101:767-71. [PMID: 27190100 DOI: 10.1136/archdischild-2015-310375] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
Abstract
Delayed puberty (DP) is defined as the lack of pubertal development by an age that is 2-2.5 SDs beyond the population mean. Although it generally represents a normal variant in pubertal timing, concern that DP could be the initial presentation of a serious underlying disorder has led to a diagnostic approach that is variable and may include tests that are unnecessary and costly. In this review, we examine available literature regarding the recommended diagnostic tests and aetiologies identified during the evaluation of youth with DP. We view this literature through the prism of the seemingly otherwise well adolescent. To provide further clinical context, we also evaluate the clinical and laboratory data from patients seen with DP in our centre over a 2-year period. The literature and our data reveal wide variability in the number of tests performed and raise the question of whether tests, other than gonadotropins, obtained in the absence of signs or symptoms of an underlying disorder are routinely warranted. Together this information provides a pragmatic rationale for revisiting recommendations calling for broad testing during the initial diagnostic evaluation of an otherwise healthy adolescent with DP. We highlight the need for further research comparing the utility of broader screening with a more streamlined approach, such as limiting initial testing to gonadotropins and a bone age, which, while not diagnostic, is often useful for height prediction, followed by close clinical monitoring. If future research supports a more streamlined approach to DP, then much unnecessary testing could be eliminated.
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Affiliation(s)
- Leah Abitbol
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Zborovski
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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499
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Pubertal development in healthy children is mirrored by DNA methylation patterns in peripheral blood. Sci Rep 2016; 6:28657. [PMID: 27349168 PMCID: PMC4923870 DOI: 10.1038/srep28657] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/07/2016] [Indexed: 12/21/2022] Open
Abstract
Puberty marks numerous physiological processes which are initiated by central activation of the hypothalamic–pituitary–gonadal axis, followed by development of secondary sexual characteristics. To a large extent, pubertal timing is heritable, but current knowledge of genetic polymorphisms only explains few months in the large inter-individual variation in the timing of puberty. We have analysed longitudinal genome-wide changes in DNA methylation in peripheral blood samples (n = 102) obtained from 51 healthy children before and after pubertal onset. We show that changes in single methylation sites are tightly associated with physiological pubertal transition and altered reproductive hormone levels. These methylation sites cluster in and around genes enriched for biological functions related to pubertal development. Importantly, we identified that methylation of the genomic region containing the promoter of TRIP6 was co-ordinately regulated as a function of pubertal development. In accordance, immunohistochemistry identified TRIP6 in adult, but not pre-pubertal, testicular Leydig cells and circulating TRIP6 levels doubled during puberty. Using elastic net prediction models, methylation patterns predicted pubertal development more accurately than chronological age. We demonstrate for the first time that pubertal attainment of secondary sexual characteristics is mirrored by changes in DNA methylation patterns in peripheral blood. Thus, modulations of the epigenome seem involved in regulation of the individual pubertal timing.
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500
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Varimo T, Dunkel L, Vaaralahti K, Miettinen PJ, Hero M, Raivio T. Circulating makorin ring finger protein 3 levels decline in boys before the clinical onset of puberty. Eur J Endocrinol 2016; 174:785-90. [PMID: 27025240 DOI: 10.1530/eje-15-1193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/29/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Makorin ring finger protein 3 (MKRN3) gene restrains the hypothalamic-pituitary-gonadal axis. In girls, peripheral levels of MKRN3 decline prior to the onset of puberty. We described longitudinal changes in serum MKRN3 levels in boys before and during puberty and assessed the effect of inhibition of estrogen biosynthesis on MKRN3 levels. DESIGN Longitudinal serum samples from a double-blind, randomized controlled study in 30 boys (age range: 9.1-14.2years) with idiopathic short stature who received placebo (Pl; n=14) or aromatase inhibitor letrozole (Lz; 2.5mg/day; n=16) for 2years. METHODS We analyzed the relationships between serum MKRN3 and clinical and biochemical markers of puberty by using summary measures. RESULTS Serum MKRN3 declined by 669±713 pg/mL per year (P<0.001). This change was biphasic, as the levels decreased during Tanner genital stage G1 (-2931±2750 pg/mL per year) and plateaued thereafter (-560±1510 pg/mL per year) (P<0.05). During G1, MKRN3 levels in Lz-treated subjects decreased slower than in Pl-treated boys (-782±3190 vs -2030±821 pg/mL per year, P<0.05). The decrease in serum MKRN3 levels in G1 was associated with increases in LH (r=-0.5, P<0.01), testosterone (r=-0.6, P<0.01), and inhibin B (r=-0.44, P<0.05) (n=26). CONCLUSION Peripheral MKRN3 levels in boys appear to serve as a readout of the diminishing central inhibition that controls the onset of puberty.
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Affiliation(s)
- Tero Varimo
- Children's HospitalUniversity of Helsinki and Helsinki UniversityFinland
| | - Leo Dunkel
- William Harvey Research InstituteBarts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kirsi Vaaralahti
- Faculty of Medicine/ PhysiologyUniversity of Helsinki, Helsinki, Finland
| | - Päivi J Miettinen
- Children's HospitalUniversity of Helsinki and Helsinki UniversityFinland Research Programs UnitMolecular Neurology, and Biomedicum Stem Cell Center, University of Helsinki, Finland
| | - Matti Hero
- Children's HospitalUniversity of Helsinki and Helsinki UniversityFinland
| | - Taneli Raivio
- Children's HospitalUniversity of Helsinki and Helsinki UniversityFinland Faculty of Medicine/ PhysiologyUniversity of Helsinki, Helsinki, Finland
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