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Ürel Demir G, Doğan ÖA, Şimşek Kiper PÖ, Utine GE, Boduroğlu K, Gucer S, Alikaşifoğlu M. Coexistence of Trisomy 13 and SRY (-) XX Ovotesticular Disorder of Sex Development. Fetal Pediatr Pathol 2017; 36:445-451. [PMID: 29220612 DOI: 10.1080/15513815.2017.1379039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Ovotesticular disorder of sex development (OT-DSD) is a rare disorder of sexual differentiation characterized by the presence of both testicular and ovarian tissue in an individual and the majority of cases have been reported with 46,XX karyotype. In 46,XX cases, testicular differentiation may occur due to the translocation of SRY to the X chromosome or to an autosome. CASE REPORT Herein, we present a female newborn with a combination of trisomy 13 and SRY (-) XX OT-DSD. CONCLUSION Trisomy 13 is a relatively common and well-known chromosomal disorder in which disorders of sexual differentiation are not frequent. In the absence of SRY, overexpression of pro-testis genes, or decreased expression of pro-ovarian/anti-testis genes have been suggested as underlying mechanisms of testicular formation. The findings in this patient were suggestive of an underlying genomic disorder associated with FGF9 and/or SPRY2.
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Affiliation(s)
| | | | | | | | | | - Safak Gucer
- a Hacettepe Universitesi Tip Fakultesi , Ankara , Turkey
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Igarashi M, Takasawa K, Hakoda A, Kanno J, Takada S, Miyado M, Baba T, Morohashi KI, Tajima T, Hata K, Nakabayashi K, Matsubara Y, Sekido R, Ogata T, Kashimada K, Fukami M. IdenticalNR5A1Missense Mutations in Two Unrelated 46,XX Individuals with Testicular Tissues. Hum Mutat 2016; 38:39-42. [DOI: 10.1002/humu.23116] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 08/24/2016] [Accepted: 09/01/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Maki Igarashi
- Department of Molecular Endocrinology; National Research Institute for Child Health and Development; Tokyo Japan
| | - Kei Takasawa
- Department of Pediatrics and Developmental Biology; Tokyo Medical and Dental University (TMDU); Tokyo Japan
| | - Akiko Hakoda
- Department of Endocrinology; Miyagi Children's Hospital; Sendai Japan
| | - Junko Kanno
- Department of Endocrinology; Miyagi Children's Hospital; Sendai Japan
| | - Shuji Takada
- Department of Systems BioMedicine; National Research Institute for Child Health and Development; Tokyo Japan
| | - Mami Miyado
- Department of Molecular Endocrinology; National Research Institute for Child Health and Development; Tokyo Japan
| | - Takashi Baba
- Department of Molecular Biology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Ken-ichirou Morohashi
- Department of Molecular Biology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Toshihiro Tajima
- Department of Pediatrics; Hokkaido University School of Medicine; Sapporo Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development; Tokyo Japan
| | - Kazuhiko Nakabayashi
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development; Tokyo Japan
| | - Yoichi Matsubara
- National Research Institute for Child Health and Development; Tokyo Japan
| | - Ryohei Sekido
- Institute of Medical Sciences; University of Aberdeen; Aberdeen United Kingdom
| | - Tsutomu Ogata
- Department of Molecular Endocrinology; National Research Institute for Child Health and Development; Tokyo Japan
- Department of Pediatrics; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology; Tokyo Medical and Dental University (TMDU); Tokyo Japan
| | - Maki Fukami
- Department of Molecular Endocrinology; National Research Institute for Child Health and Development; Tokyo Japan
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Abstract
In the female gonad, distinct signalling pathways activate ovarian differentiation while repressing the formation of testes. Human disorders of sex development (DSDs), such as 46,XX DSDs, can arise when this signalling is aberrant. Here we review the current understanding of the genetic mechanisms that control gonadal development, with particular emphasis on those that drive or inhibit ovarian differentiation. We discuss how disruption to these molecular pathways can lead to 46,XX disorders of ovarian development. Finally, we look at recently characterized novel genes and pathways that contribute and speculate how advances in technology will aid in further characterization of normal and disrupted human ovarian development.
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Ríos O, Frias S, Rodríguez A, Kofman S, Merchant H, Torres L, Mendoza L. A Boolean network model of human gonadal sex determination. Theor Biol Med Model 2015; 12:26. [PMID: 26573569 PMCID: PMC4647291 DOI: 10.1186/s12976-015-0023-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/30/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Gonadal sex determination (GSD) in humans is a complex biological process that takes place in early stages of embryonic development when the bipotential gonadal primordium (BGP) differentiates towards testes or ovaries. This decision is directed by one of two distinct pathways embedded in a GSD network activated in a population of coelomic epithelial cells, the Sertoli progenitor cells (SPC) and the granulosa progenitor cells (GPC). In males, the pathway is activated when the Sex-Determining Region Y (SRY) gene starts to be expressed, whereas in females the WNT4/ β-catenin pathway promotes the differentiation of the GPCs towards ovaries. The interactions and dynamics of the elements that constitute the GSD network are poorly understood, thus our group is interested in inferring the general architecture of this network as well as modeling the dynamic behavior of a set of genes associated to this process under wild-type and mutant conditions. METHODS We reconstructed the regulatory network of GSD with a set of genes directly associated with the process of differentiation from SPC and GPC towards Sertoli and granulosa cells, respectively. These genes are experimentally well-characterized and the effects of their deficiency have been clinically reported. We modeled this GSD network as a synchronous Boolean network model (BNM) and characterized its attractors under wild-type and mutant conditions. RESULTS Three attractors with a clear biological meaning were found; one of them corresponding to the currently known gene expression pattern of Sertoli cells, the second correlating to the granulosa cells and, the third resembling a disgenetic gonad. CONCLUSIONS The BNM of GSD that we present summarizes the experimental data on the pathways for Sertoli and granulosa establishment and sheds light on the overall behavior of a population of cells that differentiate within the developing gonad. With this model we propose a set of regulatory interactions needed to activate either the SRY or the WNT4/ β-catenin pathway as well as their downstream targets, which are critical for further sex differentiation. In addition, we observed a pattern of altered regulatory interactions and their dynamics that lead to some disorders of sex development (DSD).
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Affiliation(s)
- Osiris Ríos
- Instituto Nacional de Pediatría, Laboratorio de Citogenética, Av. Insurgentes Sur 3700 C, México City, 04530, México. .,Programa de Doctorado en Ciencias Biológicas, UNAM, Mexico City, México.
| | - Sara Frias
- Instituto Nacional de Pediatría, Laboratorio de Citogenética, Av. Insurgentes Sur 3700 C, México City, 04530, México. .,Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 04510, México.
| | - Alfredo Rodríguez
- Instituto Nacional de Pediatría, Laboratorio de Citogenética, Av. Insurgentes Sur 3700 C, México City, 04530, México. .,Programa de Doctorado en Ciencias Biomédicas, UNAM, Mexico City, México.
| | - Susana Kofman
- Facultad de Medicina/Hospital General de Mexico, Mexico City, México
| | - Horacio Merchant
- Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 04510, México.
| | - Leda Torres
- Instituto Nacional de Pediatría, Laboratorio de Citogenética, Av. Insurgentes Sur 3700 C, México City, 04530, México.
| | - Luis Mendoza
- Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 04510, México. .,C3, Centro de Ciencias de la Complejidad, UNAM, Mexico City, 04510, México.
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5
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Hyon C, Chantot-Bastaraud S, Harbuz R, Bhouri R, Perrot N, Peycelon M, Sibony M, Rojo S, Piguel X, Bilan F, Gilbert-Dussardier B, Kitzis A, McElreavey K, Siffroi JP, Bashamboo A. Refining the regulatory region upstream ofSOX9associated with 46,XX testicular disorders of Sex Development (DSD). Am J Med Genet A 2015; 167A:1851-8. [DOI: 10.1002/ajmg.a.37101] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/05/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Capucine Hyon
- AP-HP; Hôpitaux Universitaires Est Parisien; Hôpital Trousseau; Service de Génétique et d'Embryologie médicales; Paris France
- INSERM UMR_S933; Paris France
- UPMC Univ Paris 06; UFR de Médecine Pierre et Marie Curie; Paris France
| | - Sandra Chantot-Bastaraud
- AP-HP; Hôpitaux Universitaires Est Parisien; Hôpital Trousseau; Service de Génétique et d'Embryologie médicales; Paris France
| | - Radu Harbuz
- Service Génétique Médicale; CHU Poitiers; France
| | - Rakia Bhouri
- AP-HP; Hôpitaux Universitaires Est Parisien; Hôpital Trousseau; Service de Génétique et d'Embryologie médicales; Paris France
| | - Nicolas Perrot
- Department of Radiology; AP-HP; Hôpitaux Universitaires Est Parisien; Hôpital Tenon; Paris France
| | | | - Mathilde Sibony
- Department of Pathology; AP-HP; Hôpitaux Universitaires Est Parisien; Hôpital Tenon; Paris France
| | - Sandra Rojo
- Institut Pasteur; Human Developmental Genetics; Paris France
| | | | | | - Brigitte Gilbert-Dussardier
- Service Génétique Médicale; CHU Poitiers; France
- Centre de Référence Anomalies du Développement Ouest; CHU Poitiers; France
| | - Alain Kitzis
- Service Génétique Médicale; CHU Poitiers; France
| | - Ken McElreavey
- Institut Pasteur; Human Developmental Genetics; Paris France
| | - Jean-Pierre Siffroi
- AP-HP; Hôpitaux Universitaires Est Parisien; Hôpital Trousseau; Service de Génétique et d'Embryologie médicales; Paris France
- INSERM UMR_S933; Paris France
- UPMC Univ Paris 06; UFR de Médecine Pierre et Marie Curie; Paris France
| | - Anu Bashamboo
- Institut Pasteur; Human Developmental Genetics; Paris France
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Laino L, Majore S, Preziosi N, Grammatico B, De Bernardo C, Scommegna S, Rapone AM, Marrocco G, Bottillo I, Grammatico P. Disorders of sex development: a genetic study of patients in a multidisciplinary clinic. Endocr Connect 2014; 3:180-92. [PMID: 25248670 PMCID: PMC4195882 DOI: 10.1530/ec-14-0085] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sex development is a process under genetic control directing both the bi-potential gonads to become either a testis or an ovary, and the consequent differentiation of internal ducts and external genitalia. This complex series of events can be altered by a large number of genetic and non-genetic factors. Disorders of sex development (DSD) are all the medical conditions characterized by an atypical chromosomal, gonadal, or phenotypical sex. Incomplete knowledge of the genetic mechanisms involved in sex development results in a low probability of determining the molecular definition of the genetic defect in many of the patients. In this study, we describe the clinical, cytogenetic, and molecular study of 88 cases with DSD, including 29 patients with 46,XY and disorders in androgen synthesis or action, 18 with 46,XX and disorders in androgen excess, 17 with 46,XY and disorders of gonadal (testicular) development, 11 classified as 46,XX other, eight with 46,XX and disorders of gonadal (ovarian) development, and five with sex chromosome anomalies. In total, we found a genetic variant in 56 out of 88 of them, leading to the clinical classification of every patient, and we outline the different steps required for a coherent genetic testing approach. In conclusion, our results highlight the fact that each category of DSD is related to a large number of different DNA alterations, thus requiring multiple genetic studies to achieve a precise etiological diagnosis for each patient.
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Affiliation(s)
- Luigi Laino
- Department of Molecular MedicineMedical Genetics, San Camillo-Forlanini Hospital, Sapienza University, A.O. San Camillo-Forlanini, Padiglione Morgagni, I piano, UOC Laboratorio di Genetica Medica, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatrics and HematologySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, ItalyPsychology DepartmentSan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Dipartimento di Pscicologia, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatric SurgerySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, Italy
| | - Silvia Majore
- Department of Molecular MedicineMedical Genetics, San Camillo-Forlanini Hospital, Sapienza University, A.O. San Camillo-Forlanini, Padiglione Morgagni, I piano, UOC Laboratorio di Genetica Medica, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatrics and HematologySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, ItalyPsychology DepartmentSan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Dipartimento di Pscicologia, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatric SurgerySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, Italy
| | - Nicoletta Preziosi
- Department of Molecular MedicineMedical Genetics, San Camillo-Forlanini Hospital, Sapienza University, A.O. San Camillo-Forlanini, Padiglione Morgagni, I piano, UOC Laboratorio di Genetica Medica, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatrics and HematologySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, ItalyPsychology DepartmentSan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Dipartimento di Pscicologia, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatric SurgerySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, Italy
| | - Barbara Grammatico
- Department of Molecular MedicineMedical Genetics, San Camillo-Forlanini Hospital, Sapienza University, A.O. San Camillo-Forlanini, Padiglione Morgagni, I piano, UOC Laboratorio di Genetica Medica, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatrics and HematologySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, ItalyPsychology DepartmentSan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Dipartimento di Pscicologia, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatric SurgerySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, Italy
| | - Carmelilia De Bernardo
- Department of Molecular MedicineMedical Genetics, San Camillo-Forlanini Hospital, Sapienza University, A.O. San Camillo-Forlanini, Padiglione Morgagni, I piano, UOC Laboratorio di Genetica Medica, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatrics and HematologySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, ItalyPsychology DepartmentSan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Dipartimento di Pscicologia, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatric SurgerySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, Italy
| | - Salvatore Scommegna
- Department of Molecular MedicineMedical Genetics, San Camillo-Forlanini Hospital, Sapienza University, A.O. San Camillo-Forlanini, Padiglione Morgagni, I piano, UOC Laboratorio di Genetica Medica, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatrics and HematologySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, ItalyPsychology DepartmentSan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Dipartimento di Pscicologia, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatric SurgerySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, Italy
| | - Anna Maria Rapone
- Department of Molecular MedicineMedical Genetics, San Camillo-Forlanini Hospital, Sapienza University, A.O. San Camillo-Forlanini, Padiglione Morgagni, I piano, UOC Laboratorio di Genetica Medica, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatrics and HematologySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, ItalyPsychology DepartmentSan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Dipartimento di Pscicologia, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatric SurgerySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, Italy
| | - Giacinto Marrocco
- Department of Molecular MedicineMedical Genetics, San Camillo-Forlanini Hospital, Sapienza University, A.O. San Camillo-Forlanini, Padiglione Morgagni, I piano, UOC Laboratorio di Genetica Medica, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatrics and HematologySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, ItalyPsychology DepartmentSan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Dipartimento di Pscicologia, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatric SurgerySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, Italy
| | - Irene Bottillo
- Department of Molecular MedicineMedical Genetics, San Camillo-Forlanini Hospital, Sapienza University, A.O. San Camillo-Forlanini, Padiglione Morgagni, I piano, UOC Laboratorio di Genetica Medica, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatrics and HematologySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, ItalyPsychology DepartmentSan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Dipartimento di Pscicologia, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatric SurgerySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, Italy
| | - Paola Grammatico
- Department of Molecular MedicineMedical Genetics, San Camillo-Forlanini Hospital, Sapienza University, A.O. San Camillo-Forlanini, Padiglione Morgagni, I piano, UOC Laboratorio di Genetica Medica, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatrics and HematologySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, ItalyPsychology DepartmentSan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Dipartimento di Pscicologia, Circonvallazione Gianicolense 87, Rome 00152, ItalyDepartment of Pediatric SurgerySan Camillo-Forlanini Hospital, A.O. San Camillo-Forlanini, Padiglione Baccelli, II piano, Pediatria ed Ematologia Pediatrica, Circonvallazione Gianicolense 87, Rome 00152, Italy
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Sánchez Fuentes S, Amaya García MJ, Enciso Izquierdo FJ, Moyano Calvente SL. [46 XX Male syndrome]. ACTA ACUST UNITED AC 2012; 59:276-8. [PMID: 22226495 DOI: 10.1016/j.endonu.2011.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 09/21/2011] [Accepted: 09/26/2011] [Indexed: 10/14/2022]
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Mustafa O, Mehmet E. A 46, XX SRY - negative man with infertility, and co-existing with chronic autoimmune thyroiditis. Gynecol Endocrinol 2010; 26:413-5. [PMID: 20170343 DOI: 10.3109/09513591003632225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
46, XX male (de la Chapelle syndrome) is a rare syndrome with a frequency of 1 in 20,000-25,000 males. 46, XX males exist in different clinical categories with ambiguous genitalia or partially to fully mature male genitalia, in combination with complete or incomplete masculinisation. We herein report a case of SRY-negative XX male with complete masculinisation but with infertility, and co-existing with autoimmune thyroiditis. The patient had fully mature male genitalia with descended but small testes and no signs of undervirilisation. Peripheral blood culture for chromosome studies revealed 46 chromosomes with XX constitution. Repeat polymerase chain reaction analysis, using Y-specific sequence tagged sites analysing about 40 metaphases of genomic DNA, confirmed the absence of the Y chromosome, including any detectable SRY gene. We herein report a case of a man 46, XX male SRY with normal male phenotype and infertility. This case is the first reported case, co-existing with chronic autoimmune thyroiditis.
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Affiliation(s)
- Ozbek Mustafa
- Department of Endocrinology and Metabolism Disease, Ministry of Health, Diskapi Y.B. Education and Research Hospital, Ankara, Turkey
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Minor A, Mohammed F, Farouk A, Hatakeyama C, Johnson K, Chow V, Ma S. Genetic characterization of two 46,XX males without gonadal ambiguities. J Assist Reprod Genet 2008; 25:547-52. [PMID: 18972202 DOI: 10.1007/s10815-008-9265-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 10/07/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate hypotheses which explain phenotypic variability in sex determining region Y positive 46,XX males. We investigate two 46,XX males without gonadal ambiguities. METHODS Cytogenetic and molecular analyses were used to identify the presence of Y chromosome material and to map the translocation breakpoint. Finally, the pattern of X chromosome inactivation was studied using the methylation assay at the androgen receptor locus. RESULTS The presence of Y chromosome material, including the sex determining region Y gene, was demonstrated in both men. However, the amount of translocated Y chromosome material differed between the patients. Different X chromosome inactivation patterns were found in the patients; random in one patient and non-random in the other. CONCLUSIONS We found a lack of association between phenotype and X chromosome inactivation pattern. Our cytogenetic and molecular analyses show support for the position effect hypothesis explaining the phenotypic variability in XX males.
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Affiliation(s)
- Agata Minor
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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Carcavilla A, Alonso M, Ezquieta B, García-Galloway E, Barrio R, Nistal M. An XX male with an intratubular undifferentiated germ cell neoplasia. Fertil Steril 2008; 90:2005.e3-5. [PMID: 18701099 DOI: 10.1016/j.fertnstert.2008.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 06/30/2008] [Accepted: 07/01/2008] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report a case of a 46,XX male with an intratubular undifferentiated germ cell neoplasia within an extra-abdominal gonad. DESIGN Case report. SETTING Molecular, cytogenetic, pathologic, and clinical units of three tertiary hospitals. PATIENT(S) A male with ambiguous genitalia at birth and descended testes observed in a pediatric endocrinology setting. INTERVENTION(S) Physical examination, hormonal assays, cytogenetic investigation, molecular analysis, surgical intervention for biopsies and bilateral orchiectomy, and pathologic evaluation. MAIN OUTCOME MEASURE(S) Pathologic evaluation with immunostaining for placental alkaline phosphatase and C-kit. RESULT(S) Conventional chromosome analysis revealed a 46,XXq- karyotype, and fluorescence in situ hybridization experiments with the SRY probe found a signal at the short arm of the deleted X chromosome. Molecular analysis indicated the presence of a portion of the short arm of the Y chromosome including the proto-oncogene TSPY. Pathologic evaluation of the gonads revealed an intratubular undifferentiated germ cell neoplasia. CONCLUSION(S) This is the first case of a 46,XX male with descended testes in whom an intratubular undifferentiated germ cell neoplasia developed. When proposals of management in this subgroup of disorders of sexual differentiation are formulated, the risk of germ cell malignancy must be taken into account.
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Affiliation(s)
- Atilano Carcavilla
- Pediatrics Department, Pediatric Endocrinology Unit, Hospital Ramón y Cajal, Madrid, Spain.
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Ergun-Longmire B, Vinci G, Alonso L, Matthew S, Tansil S, Lin-Su K, McElreavey K, New MI. Clinical, hormonal and cytogenetic evaluation of 46,XX males and review of the literature. J Pediatr Endocrinol Metab 2005; 18:739-48. [PMID: 16200839 DOI: 10.1515/jpem.2005.18.8.739] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The main factor influencing the sex determination of an embryo is the genetic sex determined by the presence or absence of the Y chromosome. However, some individuals carry a Y chromosome but are phenotypically female (46,XY females) or have a female karyotype but are phenotypically male (46,XX males). 46,XX maleness is a rare sex reversal syndrome affecting 1 in 20,000 newborn males. Molecular analysis of sex-reversed patients led to the discovery of the SRY gene (sex-determining region on Y). The presence of SRY causes the bipotential gonad to develop into a testis. The majority of 46, SRY-positive XX males have normal genitalia; in contrast SRY-negative XX males usually have genital ambiguity. A small number of SRY-positive XX males also present with ambiguous genitalia. Phenotypic variability observed in 46,XX sex reversed patients cannot be explained only by the presence or absence of SRY despite the fact that SRY is considered to be the major regulatory factor for testis determination. There must be some other genes either in the Y or other autosomal chromosomes involved in the definition of phenotype. In this article, we evaluate four patients with 46,XX male syndrome with various phenotypes. Two of these cases are among the first reported to be diagnosed prenatally.
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Affiliation(s)
- Berrin Ergun-Longmire
- Department of Pediatrics, The New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY, USA
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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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Abstract
The case of a 28 year old male with normal male phenotype, in whom repeated seminal analysis showed complete azoospermia, is presented. Peripheral blood culture for chromosome studies revealed 46 chromosomes with XX constitution. Polymerase chain reaction (PCR) analysis of genomic DNA failed to detect the presence of the sex-determining region of the Y chromosome (SRY). A literature review of all SRY-negative XX males with normal male phenotype showed that this case is the sixth reported case but the first to be diagnosed during the investigations of infertility. The frequency, aetiology and diagnosis of this rare syndrome are also reviewed.
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Blackless M, Charuvastra A, Derryck A, Fausto-Sterling A, Lauzanne K, Lee E. How sexually dimorphic are we? Review and synthesis. Am J Hum Biol 2000; 12:151-166. [PMID: 11534012 DOI: 10.1002/(sici)1520-6300(200003/04)12:2%3c151::aid-ajhb1%3e3.0.co;2-f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
The belief that Homo sapiens is absolutely dimorphic with the respect to sex chromosome composition, gonadal structure, hormone levels, and the structure of the internal genital duct systems and external genitalia, derives from the platonic ideal that for each sex there is a single, universally correct developmental pathway and outcome. We surveyed the medical literature from 1955 to the present for studies of the frequency of deviation from the ideal male or female. We conclude that this frequency may be as high as 2% of live births. The frequency of individuals receiving "corrective" genital surgery, however, probably runs between 1 and 2 per 1,000 live births (0.1-0.2%). Am. J. Hum. Biol. 12:151-166, 2000. Copyright 2000 Wiley-Liss, Inc.
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Affiliation(s)
- Melanie Blackless
- Department of Molecular and Cell Biology and Biochemistry, Brown University, Providence, Rhode Island
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Blackless M, Charuvastra A, Derryck A, Fausto-Sterling A, Lauzanne K, Lee E. How sexually dimorphic are we? Review and synthesis. Am J Hum Biol 2000; 12:151-166. [PMID: 11534012 DOI: 10.1002/(sici)1520-6300(200003/04)12:2<151::aid-ajhb1>3.0.co;2-f] [Citation(s) in RCA: 160] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The belief that Homo sapiens is absolutely dimorphic with the respect to sex chromosome composition, gonadal structure, hormone levels, and the structure of the internal genital duct systems and external genitalia, derives from the platonic ideal that for each sex there is a single, universally correct developmental pathway and outcome. We surveyed the medical literature from 1955 to the present for studies of the frequency of deviation from the ideal male or female. We conclude that this frequency may be as high as 2% of live births. The frequency of individuals receiving "corrective" genital surgery, however, probably runs between 1 and 2 per 1,000 live births (0.1-0.2%). Am. J. Hum. Biol. 12:151-166, 2000. Copyright 2000 Wiley-Liss, Inc.
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Affiliation(s)
- Melanie Blackless
- Department of Molecular and Cell Biology and Biochemistry, Brown University, Providence, Rhode Island
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Kusz K, Kotecki M, Wojda A, Szarras-Czapnik M, Latos-Bielenska A, Warenik-Szymankiewicz A, Ruszczynska-Wolska A, Jaruzelska J. Incomplete masculinisation of XX subjects carrying the SRY gene on an inactive X chromosome. J Med Genet 1999. [DOI: 10.1136/jmg.36.6.452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
46,XX subjects carrying the testis determining SRY gene usually have a completely male phenotype. In this study, five very rare cases of SRY carrying subjects (two XX males and three XX true hermaphrodites) with various degrees of incomplete masculinisation were analysed in order to elucidate the cause of sexual ambiguity despite the presence of the SRY gene. PCR amplification of 20 Y chromosome specific sequences showed the Yp fragment to be much longer in XX males than in true hermaphrodites. FISH analysis combined with RBG banding of metaphase chromosomes of four patients showed that in all three true hermaphrodites and in one XX male the Yp fragment was translocated onto a late replicating inactive X chromosome in over 90% of their blood lymphocytes. However, in a control classical XX male with no ambiguous features, the Yp fragment (significantly shorter than in the XX male with sexual ambiguity and only slightly longer than in XX hermaphrodites) was translocated onto the active X chromosome in over 90% of cells.These studies strongly indicate that inactivation on the X chromosome spreading into a translocated Yp fragment could be the major mechanism causing a sexually ambiguous phenotype in XX (SRY+) subjects.
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Plöchl E, Vlasak I, Rittinger O, Bergendi E, Stopar M, Kurnik P, Nachtigall M, Zierler H, Rappold GA, Schiebel K. Clinical, cytogenetic and molecular analysis of three 46,XX males. J Pediatr Endocrinol Metab 1999; 12:389-95. [PMID: 10821218 DOI: 10.1515/jpem.1999.12.3.389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cytogenetic analysis, fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR) were applied to characterize the Y-chromosomal breakpoints of three XX male patients. Two of these patients show a breakpoint within a protein kinase gene, PRKY, previously described as a hotspot of ectopic recombination between homologous regions on X and Y chromosomes during male meiosis. The slightly different clinical phenotypes of the three patients cannot be correlated with the localization of the breakpoints.
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Affiliation(s)
- E Plöchl
- Clinical Genetics, Children's Hospital, Salzburg, Austria
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Tomomasa H, Adachi Y, Iwabuchi M, Tohyama Y, Yotsukura M, Oshio S, Yazaki T, Umeda T, Takano T, Yamanouchi Y, Nakahori Y. XX-male syndrome bearing the sex-determining region Y. ARCHIVES OF ANDROLOGY 1999; 42:89-96. [PMID: 10101575 DOI: 10.1080/014850199262922] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The case of a 25-year-old man who presented for evaluation of infertility is described. The physical examination revealed testicular atrophy without gynecomastia. Repeated seminal analyses showed azoospermia, and serum hormonal levels suggested a state of a hypergonadotropic hypogonadism. Chromosomal analysis demonstrated 46XX. Polymerase chain reaction revealed the existence of a sex-determining region Y. The etiology of this rare sex reversal syndrome is discussed and cases reported in Japan are reviewed.
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Affiliation(s)
- H Tomomasa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan.
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Abstract
Sexual dimorphism in humans has been the subject of wonder for centuries. In 355 BC, Aristotle postulated that sexual dimorphism arose from differences in the heat of semen at the time of copulation. In his scheme, hot semen generated males, whereas cold semen made females (Jacquart, D., and C. Thomasset. Sexuality and Medicine in the Middle Ages, 1988). In medieval times, there was great controversy about the existence of a female pope, who may have in fact had an intersex phenotype (New, M. I., and E. S. Kitzinger. J. Clin. Endocrinol. Metab. 76: 3-13, 1993.). Recent years have seen a resurgence of interest in mechanisms controlling sexual differentiation in mammals. Sex differentiation relies on establishment of chromosomal sex at fertilization, followed by the differentiation of gonads, and ultimately the establishment of phenotypic sex in its final form at puberty. Each event in sex determination depends on the preceding event, and normally, chromosomal, gonadal, and somatic sex all agree. There are, however, instances where chromosomal, gonadal, or somatic sex do not agree, and sexual differentiation is ambiguous, with male and female characteristics combined in a single individual. In humans, well-characterized patients are 46, XY women who have the syndrome of pure gonadal dysgenesis, and a subset of true hermaphrodites are phenotypic men with a 46, XX karyotype. Analysis of such individuals has permitted identification of some of the molecules involved in sex determination, including SRY (sex-determining region Y gene), which is a Y chromosomal gene fulfilling the genetic and conceptual requirements of a testis-determining factor. The purpose of this review is to summarize the molecular basis for syndromes of sexual ambiguity seen in human patients and to identify areas where further research is needed. Understanding how sex-specific gene activity is orchestrated may provide insight into the molecular basis of other cell fate decisions during development which, in turn, may lead to an understanding of aberrant cell fate decisions made in patients with birth defects and during neoplastic change.
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Affiliation(s)
- C M Haqq
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, USA
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XX Sex Reversal. J Urol 1997. [DOI: 10.1097/00005392-199709000-00170] [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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Méndez JP, Ulloa-Aguirre A, Kofman-Alfaro S, Canto P, Reyes E, Díaz-Cueto L, Pérez-Palacios G. Phenotypical expression in XX males correlates with testicular response to exogenous choriogonadotropin in early infancy: does a variable degree of testicular failure determine the degree of genital ambiguity? ARCHIVES OF ANDROLOGY 1996; 37:19-26. [PMID: 8827344 DOI: 10.3109/01485019608988498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The 46,XX male syndrome is characterized by the presence of testicular development in subjects who lack a Y chromosome. The majority of patients have male external genitalia without ambiguity; however, 10-15% show diverse degrees of hypospadias. Testicular function is normal at birth but deteriorates thereafter. However, it has not been clarified why some cases exhibit genital ambiguity. This study examined 10 affected patients, including 4 prepubertal (< 1 year old) with hypospadias (1 glandular, 1 penile, and 2 penoscrotal). In all subjects, testicular function was evaluated by performing a stimulation with choriogonadotropin. In the postpubertal individuals, basal and poststimuli testosterone were below the reference values. Prepubertal patients had age-appropriate basal test-osterone concentrations. All responded to the choriogonadotropin challenge; however, the most significant response was observed in the patient with the glandular hypospadias, the second highest response was presented by the patient with the penile hypospadias, while both patients with the penoscrotal hypospadias had the poorest responses. These results suggest that the degree of genital ambiguity is correlated with the impairment in testosterone response to choriogonadotropin in early infancy, indicating a defect in testosterone production in XX males with genital ambiguity.
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Affiliation(s)
- J P Méndez
- Unidad de Investigación Médica en Biología del Desarrollo, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, México DF, México
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