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Reyes AP, León NY, Frost ER, Harley VR. Genetic control of typical and atypical sex development. Nat Rev Urol 2023:10.1038/s41585-023-00754-x. [PMID: 37020056 DOI: 10.1038/s41585-023-00754-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/07/2023]
Abstract
Sex development relies on the sex-specific action of gene networks to differentiate the bipotential gonads of the growing fetus into testis or ovaries, followed by the differentiation of internal and external genitalia depending on the presence or absence of hormones. Differences in sex development (DSD) arise from congenital alterations during any of these processes, and are classified depending on sex chromosomal constitution as sex chromosome DSD, 46,XY DSD or 46,XX DSD. Understanding the genetics and embryology of typical and atypical sex development is essential for diagnosing, treating and managing DSD. Advances have been made in understanding the genetic causes of DSD over the past 10 years, especially for 46,XY DSD. Additional information is required to better understand ovarian and female development and to identify further genetic causes of 46,XX DSD, besides congenital adrenal hyperplasia. Ongoing research is focused on the discovery of further genes related to typical and atypical sex development and, therefore, on improving diagnosis of DSD.
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Affiliation(s)
- Alejandra P Reyes
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Genetics Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Nayla Y León
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Emily R Frost
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Vincent R Harley
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
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2
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Five-alpha-reductase type 2 deficiency in Spain. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2023; 70:74-75. [PMID: 36690525 DOI: 10.1016/j.endien.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/07/2022] [Indexed: 01/22/2023]
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Rafigh M, Salmaninejad A, Sorouri Khorashad B, Arabi A, Milanizadeh S, Hiradfar M, Abbaszadegan MR. Novel Deleterious Mutation in Steroid-5α-Reductase-2 in 46, XY Disorders of Sex Development: Case Report Study. Fetal Pediatr Pathol 2022; 41:141-148. [PMID: 32449406 DOI: 10.1080/15513815.2020.1745974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Steroid-5α-reductase-2 (SRD5A2) and 17β-hydroxysteroid dehydrogenase type 3 (17β-HSD3) enzyme deficiencies are frequent causes of 46, XY disorder of sex development (46, XY DSD), where an infant with 46, XY has a female phenotype. We assessed the hydroxy-steroid-17β-dehydrogenase-3 (HSD17B3)and SRD5A2 genes in twenty Iranian phenotypic females with 46,XY DSD. Materials and methods: All exons in HSD17B3 and SRD5A2 genes were subjected to PCR amplification followed by sequencing. Results: Of 20 identified 46, XY DSD patients, one had a homozygous missense 17β-HSD3 mutation Ser65Leu (c.194C > T). We found 1 SRD5A2 novel homozygous missense mutation of Tyr242Asp (c.891T > G) in exon 5, which in-silico analyses revealed that this mutation may have deleterious impact on ligand binding site of SRD5A2 protein. Three other individuals harbored 17β-HSD3 deficiencies without identified mutations. Conclusions: SRD5A2 and 17β-HSD3 mutations are found in 10% of 46, XY DSD Iranian patients.
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Affiliation(s)
- Mahboobeh Rafigh
- Medical Genetics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arash Salmaninejad
- Medical Genetics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Sorouri Khorashad
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Azadeh Arabi
- Medical Genetics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saman Milanizadeh
- Medical Genetics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehran Hiradfar
- Department of Pediatric Surgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Abbaszadegan
- Medical Genetics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Division of Human Genetics, Immunology Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Han B, Zhu H, Yao H, Ren J, O'Day P, Wang H, Zhu W, Cheng T, Auchus RJ, Qiao J. Differences of adrenal-derived androgens in 5α-reductase deficiency versus androgen insensitivity syndrome. Clin Transl Sci 2021; 15:658-666. [PMID: 34755921 PMCID: PMC8932821 DOI: 10.1111/cts.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/27/2022] Open
Abstract
Steroid 5α‐reductase type 2 deficiency (5α‐RD2) and androgen insensitivity syndrome (AIS) are difficult to distinguish clinically and biochemically, and adrenal‐derived androgens have not been investigated in these conditions using modern methods. The objective of the study was to compare Chinese patients with 5α‐RD2, AIS, and healthy men. Sixteen patients with 5α‐RD2, 10 patients with AIS, and 39 healthy men were included. Serum androgen profiles were compared in these subjects using liquid chromatography/tandem mass spectrometry (LC‐MS/MS). Based on clinical features and laboratory tests, 5α‐RD2 and AIS were diagnosed and confirmed by genotyping. Dihydrotestosterone (DHT) and testosterone (T) were both significantly lower in patients with 5α‐RD2 than AIS (p < 0.0001). The T/DHT ratio was higher in 5α‐RD2 (4.5–88.6) than AIS (13.4–26.7) or healthy men (7.6–40.5). Using LC‐MS/MS, a cutoff T/DHT value of 27.3 correctly diagnosed 5α‐RD2 versus AIS with sensitivity 93.8% and specificity 100%. Among the adrenal‐derived 11‐oxygenated androgens, 11β‐hydroxyandrostenedione (11OHA4) and 11‐ketoandrostenedione (11KA4) were also lower in patients with 5α‐RD2 than those of patients with AIS. In contrast, 11β‐hydroxytestosterone (11OHT) was higher in 5α‐RD2 than AIS. Furthermore, a 11OHT/11OHA4 cutoff value of 0.048 could also distinguish 5α‐RD2 from AIS. Thus, both elevated T/DHT values above 27.3 and the unexpected 11‐oxygenated androgen profile, with a 11OHT/11OHA4 ratio greater than 0.048, distinguished 5α‐RD2 from AIS. These data suggest that the metabolism of both gonadal and adrenal‐derived androgens is altered in 5α‐RD2.
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Affiliation(s)
- Bing Han
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijun Yao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianwei Ren
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, Department of Pharmacology, the Program for Disorders of Sexual Development, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick O'Day
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, Department of Pharmacology, the Program for Disorders of Sexual Development, University of Michigan, Ann Arbor, Michigan, USA
| | - Hao Wang
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjiao Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tong Cheng
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Richard J Auchus
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, Department of Pharmacology, the Program for Disorders of Sexual Development, University of Michigan, Ann Arbor, Michigan, USA
| | - Jie Qiao
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Marzuki NS, Idris FP, Kartapradja H, Renata S, Harahap A, Batubara JRL. Accuracy of Urinary Etiocholanolone/Androsterone Ratio as Alternative to Serum Testosterone/Dihydrotestosterone Ratio for Diagnosis of 5 Alpha-reductase Type 2 Deficiency Patients and Carriers in Indonesia. Int J Endocrinol Metab 2021; 19:e109510. [PMID: 34149847 PMCID: PMC8198621 DOI: 10.5812/ijem.109510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The 5 Alpha-reductase type 2 deficiency (5ARD2) is an inherited condition, which clinically presents as variable degrees of under virilization in affected 46,XY individuals. In the diagnostic pathway of 5ARD2, the testosterone/dihydrotestosterone (T/DHT) ratio is broadly employed before molecular analysis of the SRD5A2 gene. However, due to cost-benefit considerations, the DHT test in our country is routinely lacking in clinical settings; therefore, we considered applying the urinary etiocholanolone/androsterone (Et/An) ratio as an alternative test. OBJECTIVES We aimed to determine the diagnostic value of the urinary Et/An ratio versus the T/DHT ratio in diagnosing 5ARD2 patients and carriers. METHODS Sixty-six suspected 5ARD2 46,XY disorders of sex development (DSD) individuals and 95 family members were recruited in the study. Their clinical manifestations, T/DHT and urinary Et/An ratios, and SRD5A2 genes were analyzed. Using molecular analysis of the SRD5A2 gene as the gold standard, we compared the accuracy of both ratios in diagnosing 5ARD2 patients and carriers with receiver operating characteristic (ROC) curve analysis. RESULTS Thirty-seven patients were confirmed molecularly to have 5ARD2, and the rest (n = 29) were assessed as normal controls, while in the carrier group, 53 were molecularly confirmed as carriers and 42 as controls. The AUCs (areas under the curve) of the T/DHT and urinary Et/An ratios were 57.7% (95% CI 43.0 - 72.4%, P > 0.05) and 79.7% (95% CI 69.0 - 90.4%, P < 0.001), respectively, in diagnosing 5ARD2 patients and 54.1% (95% CI 42.4 - 65.8%, P > 0.05) and 75.1% (95% CI 65.1 - 85.1%, P < 0.001), respectively, in diagnosing carriers. The cutoff value of the urinary Et/An ratio was set at ≥ 0.95 for detecting 5ARD2 patients and ≥ 0.99 for detecting carriers. CONCLUSIONS The testosterone/DHT ratio was inaccurate in diagnosing 5ARD2 patients. When molecular analysis for the SRD5A2 gene is lacking, the urinary Et/An ratio may be a useful test to diagnose 5ARD2 patients and carriers.
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Affiliation(s)
- Nanis Sacharina Marzuki
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- Corresponding Author: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
| | | | | | - Shirley Renata
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Alida Harahap
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
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Cheng T, Wang H, Han B, Zhu H, Yao HJ, Zhao SX, Zhu WJ, Zhai HL, Chen FG, Song HD, Cheng KX, Liu Y, Qiao J. Identification of three novel SRD5A2 mutations in Chinese patients with 5α-reductase 2 deficiency. Asian J Androl 2020; 21:577-581. [PMID: 31031332 PMCID: PMC6859664 DOI: 10.4103/aja.aja_113_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this study, we investigated the genetics, clinical features, and therapeutic approach of 14 patients with 5α-reductase deficiency in China. Genotyping analysis was performed by direct sequencing of PCR products of the steroid 5α-reductase type 2 gene (SRD5A2). The 5α-reductase activities of three novel mutations were investigated by mutagenesis and an in vitro transfection assay. Most patients presented with a microphallus, variable degrees of hypospadias, and cryptorchidism. Eight of 14 patients (57.1%) were initially reared as females and changed their social gender from female to male after puberty. Nine mutations were identified in the 14 patients. p.G203S, p.Q6X, and p.R227Q were the most prevalent mutations. Three mutations (p.K35N, p.H162P, and p.Y136X) have not been reported previously. The nonsense mutation p.Y136X abolished enzymatic activity, whereas p.K35N and p.H162P retained partial enzymatic activity. Topical administration of dihydrotestosterone during infancy or early childhood combined with hypospadia repair surgery had good therapeutic results. In conclusion, we expand the mutation profile of SRD5A2 in the Chinese population. A rational clinical approach to this disorder requires early and accurate diagnosis, especially genetic diagnosis.
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Affiliation(s)
- Tong Cheng
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hao Wang
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Bing Han
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hui Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hai-Jun Yao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Shuang-Xia Zhao
- Central Laboratory, Clinical Research Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Wen-Jiao Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hua-Ling Zhai
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Fu-Guo Chen
- Department of Plastic Surgery, Research Center of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Huai-Dong Song
- Central Laboratory, Clinical Research Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Kai-Xiang Cheng
- Department of Plastic Surgery, Research Center of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yang Liu
- Department of Plastic Surgery, Research Center of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jie Qiao
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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7
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Ramos L, Vilchis F, Chávez B, Mares L. Mutational analysis of SRD5A2: From gene to functional kinetics in individuals with steroid 5α-reductase 2 deficiency. J Steroid Biochem Mol Biol 2020; 200:105691. [PMID: 32380235 DOI: 10.1016/j.jsbmb.2020.105691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023]
Abstract
Human steroid 5α-reductase 2 (SRD5A2) plays a determinative role in the masculinization of external genitalia. To date, approximately 114 different mutations of the SRD5A2 gene have been reported; however, little information is available about their impact on catalytic function or their three-dimensional (3D) structures. We determined the effect of point mutations on the testosterone-depend kinetic constants (Km,app and Vmax,app) and structural characteristics of SRD5A2 from Mexican patients with 46,XY-steroid 5α-reductase 2 deficiency. PCR-SSCP assays identified ten distinct gene variants and sequencing analysis identified missense mutations [p.V3I, p.S14R, p.A52T, p.F118L, p.R145W, p.R171S, p.L226P, p.F229S, p.S245Y, and p.A248V]. Mutations were re-created by site-directed mutagenesis and expressed in HEK293 cells. Functional studies demonstrated that 8 variants led to partial (Km,app = 0.16-2.6 μM; Vmax,app = 224-2640 pmol/mg P/min) or complete losses of activity compared to the wild-type enzyme (Km,app = 0.7 μM; Vmax,app = 4044 pmol/mg P/min). All the mutations were assessed using multiple software tools and the results predicted that all of the mutations were associated with disease or damage. Mapping mutations on the model of a 3D structure of SRD5A2 demonstrated alterations in contact sites with their proximal amino acids. Our data show that mutations affect the catalytic efficiency (Vmax/Km) or result in residual enzymatic activity, which could be due to erroneous interactions between amino acid residues, the substrate testosterone, or NADPH.
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Affiliation(s)
- L Ramos
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - F Vilchis
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - B Chávez
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - L Mares
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico.
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Gui B, Song Y, Su Z, Luo FH, Chen L, Wang X, Chen R, Yang Y, Wang J, Zhao X, Fan L, Liu X, Wang Y, Chen S, Gong C. New insights into 5α-reductase type 2 deficiency based on a multi-centre study: regional distribution and genotype-phenotype profiling of SRD5A2 in 190 Chinese patients. J Med Genet 2019; 56:685-692. [PMID: 31186340 DOI: 10.1136/jmedgenet-2018-105915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The 5α-reductase type 2 (5α-RD2) deficiency caused by mutations in the steroid 5α-reductase 2 (SRD5A2) gene results in variable degrees of undervirilisation in patients with 46,XY disorders of sex development. This study aims to profile the regional distribution and phenotype-genotype characteristics of SRD5A2 in a large Chinese 5α-RD2 deficiency cohort through multi-centre analysis. METHODS 190 subjects diagnosed with 5α-RD2 deficiency were consecutively enrolled from eight medical centres in China. Their clinical manifestations and genetic variants were analysed. RESULTS Hypospadias (isolated or combined with microphallus and/or cryptorchidism) was fairly common in the enrolled subjects (66.32%). 42 variants, including 13 novel variants, were identified in SRD5A2. Homozygous and compound heterozygous mutations presented in 38.42% and 61.58% of subjects, respectively, and predominated in exons 1, 4 and 5. The most prevalent variant was c.680G > A (52.37%), followed by c.16C > T, (10.79%), c.607G > A, (9.21%) and c.737G > A, (8.95%). However, their distributions were different: c.680G > A was more common in South China than in North China (62.62% vs 39.16%, p < 0.001), whereas the regional prevalence of c.16C > T was reversed (6.07% vs 16.87%, p = 0.001). Furthermore, c.680G > A prevailed in cases with normal meatus (68.75%) or distal hypospadias (66.28%), compared with those with proximal hypospadias (35.54%, p < 0.001). However, cases with proximal hypospadias showed a higher frequency of c.16C > T (20.48%) than those with normal meatus (3.13%) or distal hypospadias (3.49%, p < 0.001). CONCLUSIONS This study profiled variable phenotypic presentation and wide mutational spectrum of SRD5A2, revealing its distinctive regional distribution in Chinese patients and further shaping the founder effect and genotype-phenotype correlation of SRD5A2.
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Affiliation(s)
- Baoheng Gui
- Department of Genetics and Metabolism, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yanning Song
- Center of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, The Capital Medical University, Beijing, China
| | - Zhe Su
- Department of Endocrinology and Metabolism, Shenzhen Children's Hospital, Shenzhen, China
| | - Fei-Hong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Shanghai Jiao Tong Univ, Shanghai, China
| | - Linqi Chen
- Department of Endocrinology, Metabolism, and Genetic Diseases, Children's Hospital of Soochow University, Suzhou, China
| | - Xiumin Wang
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruimin Chen
- Department of Endocrinology, Fuzhou Children's Hospital of Fujian, Fujian Medical University Teaching Hospital, Fuzhou, China
| | - Yu Yang
- Department of Endocrine Genetics and Metabolism, Children's Hospital of Jiangxi Province, Nanchang, China
| | - Jin Wang
- Department of Genetics and Metabolism, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xiu Zhao
- Department of Endocrinology, Metabolism, and Genetic Diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Lijun Fan
- Center of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, The Capital Medical University, Beijing, China
| | - Xia Liu
- Department of Endocrinology and Metabolism, Shenzhen Children's Hospital, Shenzhen, China
| | - Yi Wang
- Center of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, The Capital Medical University, Beijing, China
| | - Shaoke Chen
- Department of Pediatrics Endocrinology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chunxiu Gong
- Center of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, The Capital Medical University, Beijing, China .,Beijing Key Laboratory for Genetics of Birth Defects, Beijing Children's Hospital, The Capital Medical University, Beijing, China
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9
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Ahmadifard M, Kajbafzadeh A, Panjeh‐Shahi S, Vand‐Rajabpour F, Ahmadi‐Beni R, Arshadi H, Setoodeh A, Rostami P, Tavakkoly‐Bazzaz J, Tabrizi M. Molecular investigation of mutations in androgen receptor and 5‐alpha‐reductase‐2 genes in 46,XY Disorders of Sex Development with normal testicular development. Andrologia 2019; 51:e13250. [DOI: 10.1111/and.13250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Mohamadreza Ahmadifard
- Medical Genetics Department, School of Medicine Tehran University of Medical Sciences Tehran Iran
- Medical Genetics Department, School of Medicine Babol University of Medical Sciences Babol Iran
| | - Abdolmohamad Kajbafzadeh
- Pediatric Urology Research Center Children's Medical Center, Tehran University of Medical Sciences Tehran Iran
| | - Samareh Panjeh‐Shahi
- Medical Genetics Department, School of Medicine Babol University of Medical Sciences Babol Iran
| | - Fatemeh Vand‐Rajabpour
- Medical Genetics Department, School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Reza Ahmadi‐Beni
- Medical Genetics Department, School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Hamid Arshadi
- Pediatric Urology Research Center Children's Medical Center, Tehran University of Medical Sciences Tehran Iran
| | - Aria Setoodeh
- Growth and Development Research Center, Division of Endocrinology and Metabolism, Children’s Medical Center Tehran University of Medical Sciences Tehran Iran
| | - Parastoo Rostami
- Growth and Development Research Center, Division of Endocrinology and Metabolism, Children’s Medical Center Tehran University of Medical Sciences Tehran Iran
| | - Javad Tavakkoly‐Bazzaz
- Medical Genetics Department, School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Mina Tabrizi
- Medical Genetics Department, School of Medicine Tehran University of Medical Sciences Tehran Iran
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10
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Marzuki NS, Idris FP, Kartapradja HD, Harahap AR, Batubara JRL. Characterising SRD5A2 Gene Variants in 37 Indonesian Patients with 5-Alpha-Reductase Type 2 Deficiency. Int J Endocrinol 2019; 2019:7676341. [PMID: 31885560 PMCID: PMC6914983 DOI: 10.1155/2019/7676341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/08/2019] [Accepted: 10/18/2019] [Indexed: 11/24/2022] Open
Abstract
The 5-alpha-reductase type 2 deficiency (5ARD2) is an autosomal recessive condition associated with impairment in the conversion of testosterone to dihydrotestosterone. This condition leads to undervirilisation in 46,XY individuals. To date, there have been more than 100 variations identified in the gene responsible for 5ARD2 development (steroid 5-alpha-reductase 2, SRD5A2). However, few studies have examined the molecular characterisation of Indonesian 5ARD2 cases. In the current study, we analysed 37 subjects diagnosed with 46,XY DSD (disorders of sex development) with confirmed variations in the SRD5A2 gene. We examined results from testosterone/dihydrotestosterone (T/DHT) and urinary etiocholanolone/androsterone (Et/An) ratios, as well as from molecular and clinical analyses. Twelve variants in the SRD5A2 gene were identified, and 6 of which were novel, namely, c.34-38delGinsCCAGC, p.Arg50His, p.Tyr136 ∗ , p.Gly191Arg, p.Phe194Ile, and p.Ile253Val variants. Moreover, we determined that 20 individuals contained harmful mutations, while the remaining 17 variants were benign. Those containing harmful mutations exhibited more severe phenotypes with median external genitalia masculinisation scores (EMS) of 3 (1.5-9) and were more likely to be diagnosed at a later age, reared as female, and virilised at pubertal age. In addition, the respective sensitivities for detecting severe 5ARD2 cases using T/DHT (cutoff: 10) and urinary Et/An ratios (cutoff: 0.95) were 85% and 90%, whereas mild cases were only identified with 64.7% and 47.1% sensitivity, respectively. Although we were unable to identify clear correlations between genotypic and phenotypic characteristics in this study, we clearly showed that individuals who were homozygous or compound heterozygous for any of the harmful mutations were more likely to exhibit classic 5ARD2 phenotypes, lower EMS, female assignment at birth, and virilisation during puberty. These results serve to inform the development of improved clinical and molecular 5ARD2 diagnostic approaches, specifically in Indonesian patients.
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Affiliation(s)
- Nanis S. Marzuki
- Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia
- Doctoral Program in Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Firman P. Idris
- Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia
| | | | - Alida R. Harahap
- Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia
- Doctoral Program in Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Jose R. L. Batubara
- Doctoral Program in Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
- Department of Child Health, Universitas Indonesia, Jakarta 10430, Indonesia
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Avendaño A, Paradisi I, Cammarata-Scalisi F, Callea M. 5-α-Reductase type 2 deficiency: is there a genotype-phenotype correlation? A review. Hormones (Athens) 2018; 17:197-204. [PMID: 29858846 DOI: 10.1007/s42000-018-0013-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/05/2018] [Indexed: 12/12/2022]
Abstract
5-α-Reductase type 2 enzyme catalyzes the conversion of testosterone into dihydrotestosterone, a potent androgen responsible for male sexual development during the fetal period and later during puberty. Its deficiency causes an autosomal recessive disorder of sex development characterized by a wide range of under-virilization of external genitalia in patients with a 46,XY karyotype. Mutations in the SRD5A2 gene cause 5-α-Reductase deficiency; although it is an infrequent disorder, it has been reported worldwide, with mutational heterogeneity. Furthermore, it has been proposed that there is no genotype-phenotype correlation, even in patients carrying the same mutation. The aim of this review was to perform an extensive search in various databases and to select those articles with a comprehensive genotype and phenotype description of the patients, classifying their phenotypes using the external masculinization score (EMS). Thus, it was possible to objectively compare the eventual genotype-phenotype correlation between them. The analysis showed that for most of the studied mutations no correlation can be established, although the specific location of the mutation in the protein has an effect on the severity of the phenotype. Nevertheless, even in patients carrying the same homozygous mutation, a variable phenotype was observed, suggesting that additional genetic factors might be influencing it. Due to the clinical variability of the disorder, an accurate diagnosis and adequate medical management might be difficult to carry out, as is highlighted in the review.
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MESH Headings
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/blood
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/deficiency
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/genetics
- Disorder of Sex Development, 46,XY/blood
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/pathology
- Disorder of Sex Development, 46,XY/therapy
- Genitalia/abnormalities
- Genotype
- Humans
- Hypospadias/blood
- Hypospadias/genetics
- Hypospadias/pathology
- Hypospadias/therapy
- Phenotype
- Steroid Metabolism, Inborn Errors/blood
- Steroid Metabolism, Inborn Errors/genetics
- Steroid Metabolism, Inborn Errors/pathology
- Steroid Metabolism, Inborn Errors/therapy
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Affiliation(s)
- Andrea Avendaño
- Medicine Faculty, Medical Genetics Unit, Los Andes University, Mérida, Venezuela
| | - Irene Paradisi
- Human Genetics Laboratory, Venezuelan Institute for Scientific Research (IVIC), Caracas, Venezuela.
| | | | - Michele Callea
- Unit of Dentistry, Bambino Gesù Children's Hospital, Rome, Italy
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12
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Fernández-Cancio M, Camats N, Flück CE, Zalewski A, Dick B, Frey BM, Monné R, Torán N, Audí L, Pandey AV. Mechanism of the Dual Activities of Human CYP17A1 and Binding to Anti-Prostate Cancer Drug Abiraterone Revealed by a Novel V366M Mutation Causing 17,20 Lyase Deficiency. Pharmaceuticals (Basel) 2018; 11:ph11020037. [PMID: 29710837 PMCID: PMC6027421 DOI: 10.3390/ph11020037] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 01/01/2023] Open
Abstract
The CYP17A1 gene regulates sex steroid biosynthesis in humans through 17α-hydroxylase/17,20 lyase activities and is a target of anti-prostate cancer drug abiraterone. In a 46, XY patient with female external genitalia, together with a loss of function mutation S441P, we identified a novel missense mutation V366M at the catalytic center of CYP17A1 which preferentially impaired 17,20 lyase activity. Kinetic experiments with bacterially expressed proteins revealed that V366M mutant enzyme can bind and metabolize pregnenolone to 17OH-pregnenolone, but 17OH-pregnenolone binding and conversion to dehydroepiandrosterone (DHEA) was impaired, explaining the patient’s steroid profile. Abiraterone could not bind and inhibit the 17α-hydroxylase activity of the CYP17A1-V366M mutant. Molecular dynamics (MD) simulations showed that V366M creates a “one-way valve” and suggests a mechanism for dual activities of human CYP17A1 where, after the conversion of pregnenolone to 17OH-pregnenolone, the product exits the active site and re-enters for conversion to dehydroepiandrosterone. The V366M mutant also explained the effectiveness of the anti-prostate cancer drug abiraterone as a potent inhibitor of CYP17A1 by binding tightly at the active site in the WT enzyme. The V366M is the first human mutation to be described at the active site of CYP17A1 that causes isolated 17,20 lyase deficiency. Knowledge about the specificity of CYP17A1 activities is of importance for the development of treatments for polycystic ovary syndrome and inhibitors for prostate cancer therapy.
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Affiliation(s)
- Mónica Fernández-Cancio
- Growth and Development Research Unit, Vall d'Hebron Research Institute (VHIR), Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Autonomous University of Barcelona, Barcelona 08035, Spain.
| | - Núria Camats
- Growth and Development Research Unit, Vall d'Hebron Research Institute (VHIR), Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Autonomous University of Barcelona, Barcelona 08035, Spain.
- Pediatric Endocrinology Unit, Department of Paediatrics, University Children's Hospital Bern, Bern 3010, Switzerland.
- Department of Biomedical Research, University of Bern, Bern 3010, Switzerland.
| | - Christa E Flück
- Pediatric Endocrinology Unit, Department of Paediatrics, University Children's Hospital Bern, Bern 3010, Switzerland.
- Department of Biomedical Research, University of Bern, Bern 3010, Switzerland.
| | - Adam Zalewski
- Pediatric Endocrinology Unit, Department of Paediatrics, University Children's Hospital Bern, Bern 3010, Switzerland.
- Department of Biomedical Research, University of Bern, Bern 3010, Switzerland.
| | - Bernhard Dick
- Department of Nephrology and Hypertension, University of Bern, Bern 3010, Switzerland.
| | - Brigitte M Frey
- Department of Nephrology and Hypertension, University of Bern, Bern 3010, Switzerland.
| | - Raquel Monné
- Pediatric Service, Hospital Joan XXIII, Tarragona 43005, Spain.
| | - Núria Torán
- Pathology Department, Hospital Universitari Vall d'Hebron, CIBERER, Barcelona 08035, Spain.
| | - Laura Audí
- Growth and Development Research Unit, Vall d'Hebron Research Institute (VHIR), Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Autonomous University of Barcelona, Barcelona 08035, Spain.
| | - Amit V Pandey
- Pediatric Endocrinology Unit, Department of Paediatrics, University Children's Hospital Bern, Bern 3010, Switzerland.
- Department of Biomedical Research, University of Bern, Bern 3010, Switzerland.
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13
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Kaupert LC, Gomes LG, Brito VN, Lemos-Marini SHV, de Mello MP, Longui CA, Kochi C, de Castro M, Guerra G, Mendonca BB, Bachega TASS. A Single Nucleotide Variant in the Promoter Region of 17β-HSD Type 5 Gene Influences External Genitalia Virilization in Females with 21-Hydroxylase Deficiency. Horm Res Paediatr 2017; 85:333-8. [PMID: 27082632 DOI: 10.1159/000445684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 21-hydroxylase deficiency (21-OHD), there is an influence of genotype on the severity of external genitalia virilization. However, females carrying mutations predicting a similar impairment of enzymatic activity present a wide variability of genital phenotypes. In such cases, interindividual variability in genes related to the sex steroid hormone pathway could play a role. OBJECTIVE To evaluate the influence of POR, HSD17B5 and SRD5A2 variants on the severity of external genitalia virilization in 21-OHD females. DESIGN AND PATIENTS Prader stages were evaluated in 178 females with 21-OHD from a multicenter study. The 21-OHD genotypes were divided into two groups according to their severity: severe and moderate. The influences of the POR p.A503V, HSD17B5 c.-71A>G, HSD17B5 c.-210A>C, and SRD5A2 p.A49T and p.V89L variants on the degree of external genitalia virilization were analyzed. RESULTS The POR p.A503V, HSD17B5 c.-71A>G, HSD17B5 c.-210A>C, and SRD5A2 p.A49T and p.V89L variants were found in 25, 33, 17, 1, and 31% of the alleles, respectively. In uni- and multilinear regression, HSD17B5 c.-210A>C has a significant influence on the degree of external genitalia virilization. This variant was also identified with a higher frequency in the most severely virilized females. CONCLUSION We demonstrated that a variant in the promoter region of HSD17B5 related to fetal androgen synthesis influences the genital phenotype in 21-OHD females.
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Affiliation(s)
- Laura C Kaupert
- Laboratx00F3;rio de Hormx00F4;nios e Genx00E9;tica Molecular - LIM/42, Unidade de Suprarrenal, Disciplina de Endocrinologia, Hospital das Clx00ED;nicas, Faculdade de Medicina, Universidade de Sx00E3;o Paulo, Sx00E3;o Paulo, Brazil
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14
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McNamara ER, Swartz JM, Diamond DA. Initial Management of Disorders of Sex Development in Newborns. Urology 2016; 101:1-8. [PMID: 27538800 DOI: 10.1016/j.urology.2016.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 12/25/2022]
Abstract
Disorders of sex development are challenging to evaluate and diagnose in the newborn. As pediatric urologists, our goals are to (1) identify patients who should be evaluated; (2) rule out life-threatening syndromes; and (3) involve a multidisciplinary team for evaluation, diagnosis, and gender assignment. This review briefly goes over the newborn differential diagnosis in disorders of sex development, highlights the important laboratory and imaging data needed, and discusses the multidisciplinary approach to gender assignment and care of these patients. Early involvement of the family in decision-making with the multidisciplinary team is paramount to a timely evaluation and diagnosis in these patients.
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Affiliation(s)
- Erin R McNamara
- Department of Urology, Boston Children's Hospital, Boston, MA.
| | - Jonathan M Swartz
- Department of Medicine, Division of Endocrinology, Boston Children's Hospital, Boston, MA
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Boston, MA
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15
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Human MAMLD1 Gene Variations Seem Not Sufficient to Explain a 46,XY DSD Phenotype. PLoS One 2015; 10:e0142831. [PMID: 26580071 PMCID: PMC4646284 DOI: 10.1371/journal.pone.0142831] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/26/2015] [Indexed: 12/31/2022] Open
Abstract
MAMLD1 is thought to cause disordered sex development in 46,XY patients. But its role is controversial because some MAMLD1 variants are also detected in normal individuals, several MAMLD1 mutations have wild-type activity in functional tests, and the male Mamld1-knockout mouse has normal genitalia and reproduction. Our aim was to search for MAMLD1 variations in 108 46,XY patients with disordered sex development, and to test them functionally. We detected MAMDL1 variations and compared SNP frequencies in controls and patients. We tested MAMLD1 transcriptional activity on promoters involved in sex development and assessed the effect of MAMLD1 on androgen production. MAMLD1 expression in normal steroid-producing tissues and mutant MAMLD1 protein expression were also assessed. Nine MAMLD1 mutations (7 novel) were characterized. In vitro, most MAMLD1 variants acted similarly to wild type. Only the L210X mutation showed loss of function in all tests. We detected no effect of wild-type or MAMLD1 variants on CYP17A1 enzyme activity in our cell experiments, and Western blots revealed no significant differences for MAMLD1 protein expression. MAMLD1 was expressed in human adult testes and adrenals. In conclusion, our data support the notion that MAMLD1 sequence variations may not suffice to explain the phenotype in carriers and that MAMLD1 may also have a role in adult life.
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16
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Cheng J, Lin R, Zhang W, Liu G, Sheng H, Li X, Zhou Z, Mao X, Liu L. Phenotype and molecular characteristics in 45 Chinese children with 5α-reductase type 2 deficiency from South China. Clin Endocrinol (Oxf) 2015; 83:518-26. [PMID: 25899528 DOI: 10.1111/cen.12799] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/26/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022]
Abstract
CONTEXT Affected by steroid 5α-reductase type 2 deficiency (5α-RD2), 46, XY individuals present divergent phenotypes characterized by undervirilization of male external genitalia. To identify the disorder, mutational analysis of 5α-reductase type 2 gene (SRD5A2) is a reliable approach. The genotype-phenotype relationship has not been elucidated. OBJECTIVE To improve the diagnosis and expand the knowledge of the disease, we collected and analysed relevant data of clinical diagnosis, biological investigation and molecular determination in 45 children with the SRD5A2 gene mutations from South China in our centre. SUBJECTS AND METHODS We studied a cohort of 45 Chinese children with SRD5A2 gene mutations. RESULTS Isolated microphallus (35·6%) and microphallus associated with various degrees of hypospadias (55·6%) were frequent phenotype. Female external genitalia with clitoromegaly (8·9%) were rare. 16 of 18 (88·9%) cases had hCG-stimulated T/DHT ratio above 10. In 45 patients, we identified 15 different mutations. Five have never been described: p.His90ThrfsX31, p.Gly21Arg, p.Gly149Asp, p.Arg145Leu and p.Gly66Arg. The p.Arg227Gln mutation was detected in 41 (91·1%) patients. The p.Leu89Val polymorphism was found in 38 (84·4%) patients. Homozygous mutations were presented in 16 (35·6%) patients, compound heterozygous mutations in 20 (44·4%) patients, compound heterozygous mutations alone with the p.Leu89Val polymorphism in nine (20·0%) patients. Exons 1 and 4 were most affected, and the number of mutant alleles per exon was 78·1% and 12·2%, respectively. CONCLUSIONS The study demonstrated a wide spectrum of phenotypes, biological profiles and genotypes in the children with 5α-RD2 from South China. The heterozygous mutation p.Arg227Gln is presumably a hot spot mutation and suggests a founder effect in the population of South China that may explain a moderate phenotype among our patients. Our report provides new insights into the molecular mechanism of 5α-RD2 and help to the diagnosis and treatment of this disease.
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Affiliation(s)
- Jing Cheng
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Ruizhu Lin
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Wen Zhang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Guochang Liu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Huiying Sheng
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Xiuzhen Li
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Zhihong Zhou
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Xiaojian Mao
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Li Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
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17
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Phelan N, Williams EL, Cardamone S, Lee M, Creighton SM, Rumsby G, Conway GS. Screening for mutations in 17β-hydroxysteroid dehydrogenase and androgen receptor in women presenting with partially virilised 46,XY disorders of sex development. Eur J Endocrinol 2015; 172:745-51. [PMID: 25740850 DOI: 10.1530/eje-14-0994] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/04/2015] [Indexed: 01/01/2023]
Abstract
CONTEXT AND OBJECTIVE The precise diagnosis of partially virilised women with 46,XY disorders of sex development (DSD) is often obscure. In practice, this group often comes under the poorly defined, clinically based label of partial androgen insensitivity syndrome (PAIS). In a previous study, we found that 5α-reductase 2 (SRD5A2) mutations occurred in 43% of women in this subgroup. We expand this work to include biochemical and genetic screening for 17β-hydroxysteroid dehydrogenase (HSD17B3) and androgen receptor (AR) mutations. METHODS Analysis of serum androgens (androstenedione and testosterone) and genetic analyses for HSD17B3 and AR were performed in 42 women from 36 pedigrees with partially virilised 46,XY DSD in whom SRD5A2 deficiency had been excluded by urine steroid profiling. RESULTS Out of 36 unrelated women, 14 (38%) were found to have HSD17B3 mutations and one (2.7%) to have an AR defect. Six novel pathogenic HSD17B3 mutations were identified: three splice site mutations and three missense changes. Seven patients with HSD17B3 deficiency tested before gonadectomy had basal testosterone/androstenedione (T/A) ratio <0.8 (sensitivity 100% and specificity 91%). CONCLUSIONS HSD17B3 deficiency is prevalent in the adolescent and adult 46,XY female DSD population and is often associated with lesser degrees of virilisation compared with those with 5α-reductase deficiency. This diagnosis should be considered for individuals labelled as PAIS, particularly, but not exclusively, those who present with virilisation at puberty or primary amenorrhoea. Before gondadectomy, T/A ratio is useful to aid diagnosis, but after gonadectomy sequencing of HSD17B3 must be performed to confirm the diagnosis.
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Affiliation(s)
- Niamh Phelan
- Departments of EndocrinologyClinical BiochemistryGynaecologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKClinical BiochemistryImperial College Healthcare, London, UK
| | - Emma L Williams
- Departments of EndocrinologyClinical BiochemistryGynaecologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKClinical BiochemistryImperial College Healthcare, London, UK Departments of EndocrinologyClinical BiochemistryGynaecologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKClinical BiochemistryImperial College Healthcare, London, UK
| | - Stefanie Cardamone
- Departments of EndocrinologyClinical BiochemistryGynaecologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKClinical BiochemistryImperial College Healthcare, London, UK
| | - Marilyn Lee
- Departments of EndocrinologyClinical BiochemistryGynaecologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKClinical BiochemistryImperial College Healthcare, London, UK
| | - Sarah M Creighton
- Departments of EndocrinologyClinical BiochemistryGynaecologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKClinical BiochemistryImperial College Healthcare, London, UK
| | - Gill Rumsby
- Departments of EndocrinologyClinical BiochemistryGynaecologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKClinical BiochemistryImperial College Healthcare, London, UK
| | - Gerard S Conway
- Departments of EndocrinologyClinical BiochemistryGynaecologyUniversity College London Hospitals, 250 Euston Road, London NW1 2BU, UKClinical BiochemistryImperial College Healthcare, London, UK
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18
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Zhu H, Liu W, Han B, Fan M, Zhao S, Wang H, Lu Y, Pan C, Chen F, Chen M, Song H, Cheng K, Qiao J. Phenotypic and molecular characteristics in eleven Chinese patients with 5α-reductase Type 2 deficiency. Clin Endocrinol (Oxf) 2014; 81:711-20. [PMID: 24665940 DOI: 10.1111/cen.12456] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 11/11/2013] [Accepted: 03/21/2014] [Indexed: 11/30/2022]
Abstract
CONTEXT Steroid 5α-reductase type 2 deficiency (5α-RD2) is a male-limited, autosomal recessive inherited disease. Affected 46, XY individuals usually present with ambiguous genitalia at birth. An early and precise diagnosis is of great value to the long-term prognosis of the disease. OBJECTIVE To describe the clinical features and molecular determinants in 11 Chinese patients with the SRD5A2 gene mutation and to investigate the functional alteration arising from a novel splicing site mutation identified in one of the patients. SUBJECTS AND METHODS Eleven subjects born with abnormal external genitalia from 10 unrelated families were recruited. Among them, nine patients who were reared as girls underwent virilization and gender change after puberty. Genotyping analysis of the SRD5A2 gene was performed in each of the patients. Haplotype analysis was performed in five patients with a prevalent mutation of p.G203S to illustrate the founder effect in China. Functional impairment of the new variant was explored by an in vitro splicing study and enzymatic activity assay. RESULTS Nine mutations in the SRD5A2 gene were detected in the eleven patients. In addition to the previously reported p.G203S, p.R227Q, p.N193S, p.R246Q, p.Q6X, p.A228V, c.655delT and IVS1-2 A>G, a novel splicing site mutation (IVS4 + 2 T>C) was identified. From an in vitro functional study, this mutation was found to result in a skipping of exon 4 in the course of mRNA splicing, leading to a truncated protein of 205 amino acids that lacks the catalysing activity. Two siblings with the same compound heterozygous mutation (IVS1-2A>G/p.G203S) exhibited differing phenotypes and opposite patterns of gender rearing. A prevalent variation p.V89L combined with c.655delT was revealed to cause a mild phenotype of 5α-RD2 with a micropenis. CONCLUSION This cohort study describes the phenotypic, biochemical and long-term outcome in 11 Chinese patients with 5α-RD2 deficiency and defines the genotypic spectrum of SRD5A2 mutations in China.
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Affiliation(s)
- Hui Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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19
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Akcay T, Fernandez-Cancio M, Turan S, Güran T, Audi L, Bereket A. AR and SRD5A2 gene mutations in a series of 51 Turkish 46,XY DSD children with a clinical diagnosis of androgen insensitivity. Andrology 2014; 2:572-8. [PMID: 24737579 DOI: 10.1111/j.2047-2927.2014.00215.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/19/2014] [Accepted: 03/18/2014] [Indexed: 11/27/2022]
Abstract
46,XY disorders of sex development (DSD) are caused by disorders of gonadal development, androgen biosynthesis and receptor (AR) defects. Although, clinical/biochemical features help in distinguishing specific aetiologies, there are overlaps which necessitate molecular analyses for the definitive diagnosis. To test precision of our clinical diagnosis of androgen insensitivity (AIS) by analysing AR and then SRD5A2 genes, patients were recruited at Marmara University Hospital and molecular analyses were performed at Vall d'Hebron Research Institute. Among 101 46,XY DSD patients, 46 index and five siblings (nine complete, 42 partial) with clinical/biochemical data suggestive of AIS and stimulated T/DHT ratio <25 were selected. AR and then SRD5A2 genes were sequenced. We detected AR mutations in 11 patients [seven index and four siblings (22% of all and 15% of index patients)] and SRD5A2 mutations in six [five index and one sibling (12% of all and 11% of index)]. AR mutation detection rate was 6/9 in all CAIS and 4/7 in the index (67 and 57% respectively) and 5/42 in all PAIS and 3/40 in the index (12 and 7.5% respectively). The eight mutations detected in the AR gene were as follows: p.Q58L, p.P392S, p.R609K, p.R775H, p.R856H, p.A871A, p.V890M and p.F892L, with p.A871A and p.F892L being novel. Further six patients had SRD5A2 mutations which were as follows: p.L73WfsX59, p.Y91H, p.R171S and p.G196S, the first being novel. Hormonal data in those with AR mutations, SRD5A2 mutations and no mutations were not statistically different. In conclusion, a significant proportion of children with presumptive diagnosis of AIS has a normal AR gene. The less severe the phenotype, the less likely is the chance of demonstrating a mutation. Furthermore, a significant number of children with presumptive diagnosis of AIS have mutations in SRD5A2 gene and are clinically and biochemically indistinguishable from AIS.
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Affiliation(s)
- T Akcay
- Division of Pediatric Endocrinology, Department of Pediatrics, Marmara University School of Medicine, İstanbul, Turkey
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20
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Chávez B, Ramos L, Gómez R, Vilchis F. 46,XY disorder of sexual development resulting from a novel monoallelic mutation (p.Ser31Phe) in the steroid 5α-reductase type-2 (SRD5A2) gene. Mol Genet Genomic Med 2014; 2:292-6. [PMID: 25077171 PMCID: PMC4113269 DOI: 10.1002/mgg3.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/07/2014] [Accepted: 02/11/2014] [Indexed: 12/21/2022] Open
Abstract
Inactivating mutations of the 5α-steroid reductase type-2 (SRD5A2) gene result in a broad spectrum of masculinization defects, ranging from a male phenotype with hypospadias to a female phenotype with Wolffian structures. Molecular studies of the SRD5A2 revealed a new heterozygous gene variant within the coding region that results in phenotypic expression. A c.92C>T transition changing serine to phenylalanine at codon 31 of exon 1 (p.Ser31Phe) was identified in a patient with 46,XY disorder of sexual development who displayed glandular hypospadias with micropenis and bilateral cryptorchidism. The restoration of the p.Ser31Phe mutation by site-directed mutagenesis and transient expression assays using cultured HEK-293 cells showed that this novel substitution does not abolish but does deregulate the catalytic efficiency of the enzyme. Thus, the maximum velocity (Vmax) value was higher for the mutant enzyme (22.5 ± 6.9 nmol DHT mg protein−1 h−1) than for the wild-type enzyme (9.8 ± 2.0 nmol DHT mg protein−1 h−1). Increased in vitro activity of the p.Ser31Phe mutant suggested an activating effect. This case provides evidence that heterozygous missense mutations in SRD5A2 may induce the abnormal development of male external genitalia.
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Affiliation(s)
- Bertha Chávez
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición S. Z. México City, México
| | - Luis Ramos
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición S. Z. México City, México
| | - Rita Gómez
- Department of Clinical Epidemiology Medical Research Unit, Hospital de Especialidades, CMN Siglo XXI, Instituto Mexicano del Seguro Social México City, México
| | - Felipe Vilchis
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición S. Z. México City, México
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21
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Abstract
A number of factors have contributed to a sharp increase in the number of publications related to disorders of sex development (DSD) in the past 5 years, namely: the establishment of a consensus in 2006 about nomenclature, investigations and the need to treat these patients in a multidisciplinary setting; increase of the knowledge base about genetic mechanisms of normal and abnormal sex development; critical appraisal about the timing and nature of genital surgery in patients with DSD. Herein, the authors present a comprehensive review with up-to-date data about the approach to the newborn with ambiguous genitalia as well as the diagnosis and management of the most common DSD.
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Affiliation(s)
- Rodrigo L P Romao
- Division of Urology, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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de Calais FL, Soardi FC, Petroli RJ, Lusa ALG, de Paiva e Silva RB, Maciel-Guerra AT, Guerra-Júnior G, de Mello MP. Molecular diagnosis of 5α-reductase type II deficiency in Brazilian siblings with 46,XY disorder of sex development. Int J Mol Sci 2011; 12:9471-80. [PMID: 22272144 PMCID: PMC3257141 DOI: 10.3390/ijms12129471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 11/28/2011] [Accepted: 12/13/2011] [Indexed: 01/19/2023] Open
Abstract
The steroid 5α-reductase type II enzyme catalyzes the conversion of testosterone (T) to dihydrotestosterone (DHT), and its deficiency leads to undervirilization in 46,XY individuals, due to an impairment of this conversion in genital tissues. Molecular analysis in the steroid 5α-reductase type II gene (SRD5A2) was performed in two 46,XY female siblings. SRD5A2 gene sequencing revealed that the patients were homozygous for p.Gln126Arg missense mutation, which results from the CGA > CAA nucleotide substitution. The molecular result confirmed clinical diagnosis of 46,XY disorder of sex development (DSD) for the older sister and directed the investigation to other family members. Studies on SRD5A2 protein structure showed severe changes at NADPH binding region indicating that structural modeling analysis can be useful to evaluate the deleterious role of a mutation as causing 5α-reductase type II enzyme deficiency.
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Affiliation(s)
- Flávia Leme de Calais
- Center of Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Avenida Cândido Rondon 400, 13083-875, Campinas, SP, Brazil; E-Mails: (F.L.C.); (F.C.S.); (R.J.P.); (A.L.G.L.)
- Interdisciplinary Group of Studies in Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Fernanda Caroline Soardi
- Center of Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Avenida Cândido Rondon 400, 13083-875, Campinas, SP, Brazil; E-Mails: (F.L.C.); (F.C.S.); (R.J.P.); (A.L.G.L.)
- Interdisciplinary Group of Studies in Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Reginaldo José Petroli
- Center of Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Avenida Cândido Rondon 400, 13083-875, Campinas, SP, Brazil; E-Mails: (F.L.C.); (F.C.S.); (R.J.P.); (A.L.G.L.)
- Interdisciplinary Group of Studies in Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Ana Letícia Gori Lusa
- Center of Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Avenida Cândido Rondon 400, 13083-875, Campinas, SP, Brazil; E-Mails: (F.L.C.); (F.C.S.); (R.J.P.); (A.L.G.L.)
- Interdisciplinary Group of Studies in Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Roberto Benedito de Paiva e Silva
- Interdisciplinary Group of Studies in Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Center of Studies and Researches in Rehabilitation (CEPRE), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, 13083-970, Campinas, SP, Brazil; E-Mail:
| | - Andréa Trevas Maciel-Guerra
- Interdisciplinary Group of Studies in Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Department of Medical Genetics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, 13083-970, Campinas, SP, Brazil; E-Mail:
| | - Gil Guerra-Júnior
- Interdisciplinary Group of Studies in Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Department of Pediatrics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, 13083-970, Campinas, SP, Brazil; E-Mail:
| | - Maricilda Palandi de Mello
- Center of Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Avenida Cândido Rondon 400, 13083-875, Campinas, SP, Brazil; E-Mails: (F.L.C.); (F.C.S.); (R.J.P.); (A.L.G.L.)
- Interdisciplinary Group of Studies in Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +55-19-3521-1146; Fax: +55-19-3521-1189
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