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López-Hernández B, Méndez JP, Coral-Vázquez RM, Benítez-Granados J, Zenteno JC, Villegas-Ruiz V, Calzada-León R, Soderlund D, Canto P. Duplication of SOX9 associated with 46,XX ovotesticular disorder of sex development. Reprod Biomed Online 2018; 37:107-112. [PMID: 29673731 DOI: 10.1016/j.rbmo.2018.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION The purpose of the present study was to investigate whether ten unrelated SRY-negative individuals with this sex differentiation disorder presented a double dose of SOX9 as the cause of their disease. DESIGN Ten unrelated SRY-negative 46,XX ovotesticular disorder of sexual development (DSD) subjects were molecularly studied. Multiplex-ligation dependent probe amplification (MLPA) and quantitative real-time PCR analysis (qRT-PCR) for SOX9 were performed. RESULTS The MLPA analysis demonstrated that one patient presented a heterozygous duplication of the entire SOX9 coding region (above 1.3 value of peak ratio), as well as at least a ~ 483 kb upstream duplication. Moreover, no duplication of other SOX9 probes was observed corresponding to the region between -1007 and -1500 kb upstream. A qRT-PCR analysis showed a duplication of at least -581 kb upstream and ~1.63 kb of the coding region that encompasses exon 3. The limits of the duplication were mapped approximately from ~71539762 to 72122741 of Chr17. No molecular abnormalities were found in the remaining nine patients. CONCLUSION This study is thought to be the first report regarding a duplication of SOX9 that is associated with the presence of 46,XX ovotesticular DSD, encompassing at least -581 kb upstream, and the almost entire coding region of the gene.
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Affiliation(s)
- Berenice López-Hernández
- División de Investigación Biomédica, Subdirección de Enseñanza e Investigación, Centro Médico Nacional '20 de Noviembre', Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, México DF, México
| | - Juan Pablo Méndez
- Unidad de Investigación en Obesidad, Facultad de Medicina, Universidad Nacional Autónoma de México and Clínica de Obesidad, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México
| | - Ramón Mauricio Coral-Vázquez
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, México DF, México; Subdirección de Enseñanza e Investigación, Centro Médico Nacional '20 de Noviembre', Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, México DF, México
| | - Jesús Benítez-Granados
- Unidad de Investigación en Obesidad, Facultad de Medicina, Universidad Nacional Autónoma de México and Clínica de Obesidad, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México
| | - Juan Carlos Zenteno
- Departamento de Bioquímica Facultad de Medicina, Universidad Nacional Autónoma de México and Departamento de Genética-Unidad de Investigación, Instituto de Oftalmología 'Conde de Valenciana', México DF, México
| | - Vanessa Villegas-Ruiz
- Departamento de Bioquímica Facultad de Medicina, Universidad Nacional Autónoma de México and Departamento de Genética-Unidad de Investigación, Instituto de Oftalmología 'Conde de Valenciana', México DF, México
| | - Raúl Calzada-León
- Servicio de Endocrinología, Instituto Nacional de Pediatría, México DF, México
| | | | - Patricia Canto
- Unidad de Investigación en Obesidad, Facultad de Medicina, Universidad Nacional Autónoma de México and Clínica de Obesidad, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México.
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 7. Ovotesticular DSD (True Hermaphroditism). Pediatr Dev Pathol 2015; 18:345-52. [PMID: 25105460 DOI: 10.2350/14-04-1466-pb.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Manuel Nistal
- 1 Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo #2, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo #2, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Dutta D, Shivaprasad KS, Das RN, Ghosh S, Chatterjee U, Chowdhury S, Dasgupta R. Ovotesticular disorder of sexual development due to 47,XYY/46,XY/45,X mixed gonadal dysgenesis in a phenotypic male presenting as cyclical haematuria: clinical presentation and assessment of long-term outcomes. Andrologia 2012; 46:191-3. [PMID: 23163819 DOI: 10.1111/and.12048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 11/25/2022] Open
Abstract
Ovotesticular disorder of sexual differentiation (OTDSD) is a rare cause of disorder of sexual differentiation predominantly having 46,XX karyotype, female phenotype and ambiguous genitalia. We report a 15-year-old having male body habitus, axillary and pubic hair, well-developed penis and right-descended testis with history of penoscrotal hypospadias correction, presenting with three episodes of cyclical haematuria, who biochemically had normal serum testosterone (338 ng dl(-1) ) which increased following hCG stimulation (614 ng dl(-1) ), elevated estradiol (17.35 pg ml(-1) ) along with elevated luteinising hormone (11.3 mIU l(-1) ) and follicle-stimulating hormone (31 mIU l(-1) ). Ultrasonography followed by micturating cystourethrogram and cystoscopy confirmed the presence of prostate, uterus, cervix and vagina draining into the urogenital sinus continuing till the penile urethra and left intra-abdominal gonad. Patient underwent hysterectomy and left gonadectomy. Histopathologic study of resected gonad confirmed presence of ovotestis. Low estradiol (1.2 pg ml(-1) ) following gonadectomy confirmed the ovotestis origin of estradiol. Chromosomal analysis revealed complex karyotype predominant being 47,XYY (50%) followed by 46,XY (26%) and 45,X (24%). This is perhaps the first report of 47,XYY/46,XY/45,X causing OTDSD in a phenotypic male.
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Affiliation(s)
- D Dutta
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, Kolkata, India
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4
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Ledig S, Hiort O, Wünsch L, Wieacker P. Partial deletion of DMRT1 causes 46,XY ovotesticular disorder of sexual development. Eur J Endocrinol 2012; 167:119-24. [PMID: 22573722 DOI: 10.1530/eje-12-0136] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Ovotesticular disorder of sexual development (DSD) is an unusual form of DSD, characterized by the coexistence of testicular and ovarian tissue in the same individual. In a subset of patients, ovotesticular DSD is caused by 46,XX/46,XY chimerism or mosaicism. To date, only a few monogenetic causes are known to be associated with XX and XY ovotesticular DSD. DESIGN AND METHODS Clinical, hormonal, and histopathological data, and results of high-resolution array-comparative genomic hybridization (CGH) were obtained from a female patient with 46,XY ovotesticular DSD with testicular tissue on one side and an ovary harboring germ cells on the other. Results obtained by array-CGH were confirmed by RT-quantitative PCR. RESULTS We detected a deletion of ∼35 kb affecting exons 3 and 4 of the DMRT1 gene in a female patient with 46,XY ovotesticular DSD. To the best of our knowledge, this is the smallest deletion affecting DMRT1 presented to this point in time. CONCLUSIONS We suggest that haploinsufficiency of DMRT1 is sufficient for both XY gonadal dysgenesis and XY ovotesticular DSD. Furthermore, array-CGH is a very useful tool in the molecular diagnosis of DSD.
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Affiliation(s)
- Susanne Ledig
- Institute of Human Genetics, Westfälische Wilhelms Universität Münster, Vesaliusweg 12-14, D-48149 Münster, Germany
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5
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Inguinal uterus, fallopian tube, and ovary associated with adult Mayer-Rokitansky-Küster-Hauser syndrome. Fertil Steril 2011; 95:1119.e1-4. [DOI: 10.1016/j.fertnstert.2010.09.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/16/2010] [Accepted: 09/28/2010] [Indexed: 11/17/2022]
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6
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Parada-Bustamante A, Ríos R, Ebensperger M, Lardone MC, Piottante A, Castro A. 46,XX/SRY-negative true hermaphrodite. Fertil Steril 2010; 94:2330.e13-6. [DOI: 10.1016/j.fertnstert.2010.03.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/15/2010] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
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7
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Kim JW, Bak CW, Chin MU, Cha DH, Yoon TK, Shim SH. SRY-negative 46,XX infertile male with Leydig cell hyperplasia: clinical, cytogenetic, and molecular analysis and review of the literature. Fertil Steril 2010; 94:753.e5-9. [DOI: 10.1016/j.fertnstert.2010.01.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 01/16/2010] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
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Abstract
Disorders of sexual differentiation (DSDs) presenting during adolescence are discussed, and molecular explanations are given for some. DSD conditions are often discovered during early adolescence, an age well known to predispose to high risk for adjustment problems. Presentation may be with lack of or minimal pubertal development, lack of menarche, vaginal, uterine, or breast agenesis and inappropriate sexual development such as virilization in females or feminization (gynecomastia) in males. Most such disorders require life-long therapy, with many of the medical, surgical and psychological aspects of management being accentuated during adolescence. Regardless of the age at presentation, all require skillful management to promote normal health and well-being. This care ideally involves specialists in endocrinology and medical therapy, psychology and, if required, surgery. A brief discussion of the needs of the adolescent with DSDs is presented.
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Affiliation(s)
- Peter A Lee
- Department of Pediatrics, MC-H085, Penn State College of Medicine, The Milton S. Hershey Medical Center, P.O. Box 850, 500 University Drive, Hershey, PA 17033-0850, USA.
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Maciel-Guerra AT, de Mello MP, Coeli FB, Ribeiro ML, Miranda ML, Marques-de-Faria AP, Baptista MTM, Moraes SG, Guerra-Júnior G. XX Maleness and XX true hermaphroditism in SRY-negative monozygotic twins: additional evidence for a common origin. J Clin Endocrinol Metab 2008; 93:339-43. [PMID: 18056774 DOI: 10.1210/jc.2007-1115] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Differentiation of testicular tissue in 46,XX individuals is seen either in XX males, the majority of them with SRY gene, or in individuals, usually SRY(-), with ovotesticular disorder of sex development (OT-DSD). Although they are sporadic cases, there are some reports on familial recurrence, including coexistence of XX maleness and OT-DSD in the same family. OBJECTIVE We report on a case of SRY(-) 46,XX monozygotic twins with genital ambiguity. METHODS Hormonal evaluation included testosterone, FSH, and LH measurements. SRY gene was investigated by PCR and two-step PCR in peripheral leukocytes and gonadal tissues, respectively. Direct DNA sequencing of the DAX-1 coding sequence was performed. Real-time PCR for SOX9 region on chromosome 17 was obtained. RESULTS Both twins had a 46,XX karyotype. Twin A had a 1-cm phallus with chordee, penoscrotal hypospadias, and palpable gonads. Serum levels of FSH (2.34 mIU/ml), LH (8.8 mIU/ml), and testosterone (1.6 ng/ml) were normal, and biopsies revealed bilateral testes. Twin B had a 0.5-cm phallus, perineal hypospadias, no palpable gonad on the right, and a left inguinal hernia. Hormonal evaluation revealed high FSH (8.2 mIU/ml) and LH (15 mIU/ml) and low testosterone (0.12 ng/ml). Upon herniotomy, a right testis (crossed ectopia) and a small left ovotestis were found. SRY gene was absent in both peripheral leukocytes and gonadal tissue samples. Neither DAX-1 mutations nor SOX9 duplication was identified. CONCLUSIONS This case provides evidence that both XX maleness and XX OT-DSD are different manifestations of the same disorder of gonadal development.
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Affiliation(s)
- Andréa Trevas Maciel-Guerra
- Grupo Interdisciplinar de Estudos da Determinação e Diferenciação do Sexo, Faculdade de Ciências Médicas, UNICAMP, 13083-970 Campinas, São Paulo, Brasil.
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11
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Abstract
Continuing new insights into the biology of sexual development and advances in chromosome analysis have led to early identification and prompt treatment of the intersexual patient, the results of which facilitate a more normal life for affected individuals. Based on these advances, a classification of abnormal sexual development has been developed and refined that correlates the gonadal and genital anatomy with the chromosomal findings and specific genetic or metabolic defects. In a shift from a classification anchored on whether the intersex revolves about a specific gene or whole chromosomal abnormality, the current classification is organised by broader categories into which the intersexual disorders are divided into 'abnormalities of genital differentiation', due largely to the abnormal production or sensitivity of a single hormone, or 'abnormalities in sex determination', due to abnormal gonadal differentiation, usually testicular, with or without chromosomal aberration. The current classification is an integrated approach to this complex group of disorders and is organised according to the manner by which patients present as well as on the pathophysiological basis of the defect. The classification also groups patients who are at high risk for development of gonadal neoplasia.
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Affiliation(s)
- Stanley J Robboy
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
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12
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Nieto K, Peña R, Palma I, Dorantes LM, Eraña L, Alvarez R, García-Cavazos R, Kofman-Alfaro S, Queipo G. 45,X/47,XXX/47,XX, del(Y)(p?)/46,XX mosaicism causing true hermaphroditism. Am J Med Genet A 2005; 130A:311-4. [PMID: 15378545 DOI: 10.1002/ajmg.a.30258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Sex differentiation in humans depends on the presence of the Y-linked gene SRY, which is activated in the pre-Sertoli cells of the developing gonadal primordium to trigger testicular differentiation. Occasionally testicular formation can take place in subjects lacking a Y chromosome resulting in a 46,XX sex reversal condition. True hermaphroditism (TH) is a rare form of intersexuality characterized by the presence of testicular and ovarian tissue in the same individual. Genetic heterogeneity has been proposed as a cause of dual gonadal development in some cases and recently, hidden mosaicism was reported to cause TH in some 46,XX SRY negative patients. Here we report a TH case in which hidden mosaicism for the Y and X chromosome was detected by PCR and FISH in peripheral blood and gonadal tissue, supporting the fact that mosaicism may cause TH and that molecular analysis of gonadal tissue should be performed in all 46,XX cases.
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Affiliation(s)
- Karem Nieto
- Department of Genetics, Hospital General de Mexico-Facultad de Medicina, UNAM, Mexico City, Mexico
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13
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Skewed X-chromosome inactivation pattern in SRY positive XX maleness: a case report and review of literature. ANNALES DE GENETIQUE 2003; 46:11-8. [PMID: 12818524 DOI: 10.1016/s0003-3995(03)00011-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
XX maleness is the most common condition in which testes develop in the absence of a cytogenetically detectable Y chromosome. Using fluorescence in situ hybridization (FISH) or PCR, it was possible to detect the transfer of Yp fragments including SRY gene to the terminal part of X chromosome in the majority of XX males. We report a 32-year-old-male in whom a seminal analysis showed azoospermia, an X chromatin analysis showed 44% of Barr body positive nuclei and a chromosomal analysis revealed a 46,XX karyotype. Physical examination showed a normal sexual development and bilateral small testes. Hormonal studies revealed hypergonadotropic hypogonadism. Testis histological examination showed a profile of Sertoli Only Cell Syndrome. FISH study ruled out the presence of a Y-bearing cell line, and confirmed translocation of SRY to Xp terminal part. In order to confirm that the complete masculinized phenotype was related to a preferential inactivation of the no rearranged X chromosome, X-chromosome inactivation patterns (XCIP) were studied by analysis of methylation status of the androgen receptor gene. Highly skewed XCIP was observed by greater than 90% preferential inactivation involving one of the two X chromosomes, suggesting that the SRY-bearing X chromosome was the preferentially active X allowing for sufficient SRY expression for complete masculinization.
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14
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Abstract
In humans, sexual differentiation is directed by SRY, a master regulatory gene located at the Y chromosome. This gene initiates the male pathway or represses the female pathway by regulating the transcription of downstream genes; however, the precise mechanisms by which SRY acts are largely unknown. Moreover, several genes have recently been implicated in the development of the bipotential gonad even before SRY is expressed. In some individuals, the normal process of sexual differentiation is altered and a sex reversal disorder is observed. These subjects present the chromosomes of one sex but the physical attributes of the other. Over the past years, considerable progress has been achieved in the molecular characterization of these disorders by using a combination of strategies including cell biology, animal models, and by studying patients with these pathologic entities.
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MESH Headings
- Animal Diseases/embryology
- Animal Diseases/genetics
- Animals
- DNA-Binding Proteins/physiology
- Disorders of Sex Development/genetics
- Disorders of Sex Development/pathology
- Female
- Genes, sry
- Genotype
- Gonadal Dysgenesis, 46,XX/embryology
- Gonadal Dysgenesis, 46,XX/epidemiology
- Gonadal Dysgenesis, 46,XX/genetics
- Gonadal Dysgenesis, 46,XX/pathology
- Gonadal Dysgenesis, 46,XX/therapy
- Gonadal Dysgenesis, 46,XX/veterinary
- Gonads/embryology
- High Mobility Group Proteins/genetics
- High Mobility Group Proteins/physiology
- Humans
- Karyotyping
- Mice
- Mice, Knockout
- Mosaicism
- Mutation
- Nuclear Proteins
- Phenotype
- SOX9 Transcription Factor
- Sex Determination Processes
- Sex Differentiation/genetics
- Sex Differentiation/physiology
- Sex-Determining Region Y Protein
- Transcription Factors/genetics
- Transcription Factors/physiology
- Translocation, Genetic/genetics
- Vertebrates/physiology
- X Chromosome/ultrastructure
- Y Chromosome/genetics
- Y Chromosome/ultrastructure
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Affiliation(s)
- J C Zenteno-Ruiz
- Department of Genetics, Hospital General de Mexico-Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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