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Yuan X, Chen R, Zhang Y, Yang X, Lin X. Long-Term Treatment With Letrozole in a Boy With Familial Male-Limited Precocious Puberty. Front Endocrinol (Lausanne) 2022; 13:906852. [PMID: 35909557 PMCID: PMC9329579 DOI: 10.3389/fendo.2022.906852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The long-term follow-up in children with familial male-limited precocious puberty (FMPP) who were treated with letrozole, triptorelin, and spironolactone is limited, especially considering the efficiency and safety. OBJECTIVE We describe the clinical characteristics and long-term treatment with letrozole on adult height of a boy diagnosed with FMPP, confirmed by analysis of the LHCGR gene. METHODS Physical examinations, bone age (BA), testosterone, and gonadotropin levels were measured as well as gene sequencing of the proband and parents. RESULTS The boy was referred to the hospital at 3.1 years of age due to peripheral precocious puberty. His height was 116.8cm (+5.1SD) and BA was 9 years. Genetic analysis revealed a patrilineal c.1703C>T.(p.Ala568Val) mutation of the LHCGR gene. After treating with letrozole for 1.6 years, the height according to BA went from -3.52SD to -2.82SD. Triptorelin was added at age 4.7 years based on both the evidence of central puberty and his growth velocity according to BA. During the 6.9 years of treatment, he had a height gain of 51.9cm, and BA increased 5.2 years. At age 10, his present height is 168.7cm (0.05SD) and BA is 14.7 years. No adverse effects of treatment were encountered. CONCLUSION A patrilineal mutation of the LHCGR gene has been identified in a boy with FMPP. His height is 168.7cm (-0.05SD) which is approaching his adult height after long-term treatment with letrozole, triptorelin, and spironolactone.
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2
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Daussac A, Barat P, Servant N, Yacoub M, Missonier S, Lavran F, Gaspari L, Sultan C, Paris F. Testotoxicosis without Testicular Mass: Revealed by Peripheral Precocious Puberty and Confirmed by Somatic LHCGR Gene Mutation. Endocr Res 2020; 45:32-40. [PMID: 31394950 DOI: 10.1080/07435800.2019.1645163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Testotoxicosis is an autosomal dominant form of limited gonadotropin-independent precocious puberty in boys. It is caused by a heterozygous constitutively activating mutation of the LHCGR gene encoding the luteinizing/hormone receptor (LHR). Some twenty mutations of the LHCGR gene have been reported. Most of them are constitutive mutations isolated from blood leukocyte DNA, although others are somatic, found only in testicular tumoural tissue. In all the previously reported cases of these somatic mutations, the tumour, whether a nodular Leydig cell adenoma or hyperplasia, was easily visible on testicular ultrasonography. The aim of this study was to describe an unusual presentation of a patient with the clinical and hormonal characteristics of testotoxicosis but no well-circumscribed lesion at testicular ultrasonography.Materials and Methods: Molecular analysis of the LHCGR gene was performed by direct sequencing of DNA extracted from peripheral leucocytes and testicular biopsy.Results: Molecular analysis didn't find any LHR mutation in blood, whereas it revealed for the first time a somatic D578H mutation in testicular tissue despite no evidence of a nodular aspect at testis ultrasonography.Conclusions: This observation underlines the need to look for a somatic LHCGR gene mutation from the testicular biopsies of all boys with testotoxicosis with no constitutive LHCGR gene mutation identified from blood DNA, even in the absence of circumscribed testicular lesion at ultrasonography. In addition, based on the known link between LHR mutations and testicular tumourigenesis, yearly ultrasound monitoring of the testes should be considered for these patients.
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Affiliation(s)
- A Daussac
- Département de Pédiatrie, Endocrinologie Pédiatrique, CHU de Bordeaux, Bordeaux, France
| | - P Barat
- Département de Pédiatrie, Endocrinologie Pédiatrique, CHU de Bordeaux, Bordeaux, France
- Département de Pédiatrie, Centre d'Investigation Clinique (CIC 0005), CHU de Bordeaux, Bordeaux, France
| | - N Servant
- Département d'Hormonologie (Développement et Reproduction), CHU de Montpellier, Hôpital Lapeyronie, Université de Montpellier, Montpellier, France
| | - M Yacoub
- Unité d'Anatomo cytopathologie, CHU de Bordeaux, Bordeaux, France
| | - S Missonier
- Unité de Radiologie pédiatrique, CHU de Bordeaux, Bordeaux, France
| | - F Lavran
- Unité de Chirurgie viscérale pédiatrique, CHU de Bordeaux, Bordeaux, France
| | - L Gaspari
- Unité d'Endocrinologie-Gynécologie Pédiatriques, Département de Pédiatrie, CHU de Montpellier, Hôpital Arnaud de Villeneuve, Université Montpellier 1, Montpellier, France
| | - C Sultan
- Département d'Hormonologie (Développement et Reproduction), CHU de Montpellier, Hôpital Lapeyronie, Université de Montpellier, Montpellier, France
- Unité d'Endocrinologie-Gynécologie Pédiatriques, Département de Pédiatrie, CHU de Montpellier, Hôpital Arnaud de Villeneuve, Université Montpellier 1, Montpellier, France
| | - F Paris
- Département d'Hormonologie (Développement et Reproduction), CHU de Montpellier, Hôpital Lapeyronie, Université de Montpellier, Montpellier, France
- Unité d'Endocrinologie-Gynécologie Pédiatriques, Département de Pédiatrie, CHU de Montpellier, Hôpital Arnaud de Villeneuve, Université Montpellier 1, Montpellier, France
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Haddad NG, Eugster EA. Peripheral precocious puberty including congenital adrenal hyperplasia: causes, consequences, management and outcomes. Best Pract Res Clin Endocrinol Metab 2019; 33:101273. [PMID: 31027974 DOI: 10.1016/j.beem.2019.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Peripheral precocious puberty results from peripheral production of sex steroids independent of activation of the hypothalamic-pituitary gonadal axis. It is much less common than central precocious puberty. Causes are variable and can be congenital or acquired. In this review, we will discuss the diagnosis and management of the most common etiologies including congenital adrenal hyperplasia, McCune Albright syndrome, familial male-limited precocious puberty, and adrenal and gonadal tumors.
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Affiliation(s)
- Nadine G Haddad
- Riley Hospital for Children, 705 Barnhill Dr, Rm 5960, Indianapolis, IN 46202, USA.
| | - Erica A Eugster
- Riley Hospital for Children, 705 Barnhill Dr, Rm 5960, Indianapolis, IN 46202, USA.
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Lane LC, Flowers J, Johnstone H, Cheetham T. Adult height in patients with familial male-limited precocious puberty and the role of an aromatase inhibitor in patient management. J Pediatr Endocrinol Metab 2018; 31:551-560. [PMID: 29654692 DOI: 10.1515/jpem-2017-0363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/12/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is little adult height data in patients with familial male-limited precocious puberty (FMPP) and no management consensus. We assessed the treatment and adult height in local patients with FMPP and those reported in the literature. METHODS Growth data were obtained on four local patients with FMPP and a search performed to obtain management details and adult height data on cases in the literature. UK (90) population standards were used to calculate standard deviation scores (SDS). RESULTS Adult height data were available on 25 men with FMPP of whom 21 were treated. Median adult height SDS of patients was -1.5 SD with a mid-parental target of -0.6 SD (p=0.1). Eight patients (32%) had an adult height above the mid-parental target and seven patients (28%) had a height >2 SD below the mean. The median height SD was -0.03 in untreated patients and +0.5 SD in those receiving an aromatase inhibitor. There was no relationship between height and age at presentation. CONCLUSIONS Aromatase inhibitor therapy is associated with a positive height outcome in FMPP but the outcome with and without intervention is unpredictable. Clinicians need to be cautious when counselling families about the potential height outcome in FMPP.
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Affiliation(s)
- Laura C Lane
- Department of Paediatric Endocrinology, Great North Children's Hospital, Newcastle-Upon-Tyne, UK
| | - Josephine Flowers
- Department of Paediatrics, Sunderland Royal Hospital, Sunderland, UK
| | - Helen Johnstone
- Department of Paediatric Endocrinology, Great North Children's Hospital, Newcastle-Upon-Tyne, UK
| | - Tim Cheetham
- Department of Paediatric Endocrinology, Great North Children's Hospital, Newcastle-Upon-Tyne, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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Abstract
There are many etiologies of peripheral precocious puberty (PPP) with diverse manifestations resulting from exposure to androgens, estrogens, or both. The clinical presentation depends on the underlying process and may be acute or gradual. The primary goals of therapy are to halt pubertal development and restore sex steroids to prepubertal values. Attenuation of linear growth velocity and rate of skeletal maturation in order to maximize height potential are additional considerations for many patients. McCune-Albright syndrome (MAS) and familial male-limited precocious puberty (FMPP) represent rare causes of PPP that arise from activating mutations in GNAS1 and the LH receptor gene, respectively. Several different therapeutic approaches have been investigated for both conditions with variable success. Experience to date suggests that the ideal therapy for precocious puberty secondary to MAS in girls remains elusive. In contrast, while the number of treated patients remains small, several successful therapeutic options for FMPP are available.
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6
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Özcabı B, Tahmiscioğlu Bucak F, Ceylaner S, Özcan R, Büyükünal C, Ercan O, Tüysüz B, Evliyaoğlu O. Testotoxicosis: Report of Two Cases, One with a Novel Mutation in LHCGR Gene. J Clin Res Pediatr Endocrinol 2015; 7:242-8. [PMID: 26831561 PMCID: PMC4677562 DOI: 10.4274/jcrpe.2067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Testotoxicosis is a rare disorder which presents as isosexual peripheral precocious puberty in males. Despite the pattern of autosomal dominant inheritance, sporadic cases also may occur. Due to activating mutation in luteinizing hormone (LH))/choriogonadotropin receptor (LHCGR) gene, early virilization and advancement in bone age are common with increased serum testosterone levels above adult ranges, despite low LH and follicular-stimulating hormone (FSH) levels. There are different treatment regimens, such as combination of bicalutamide (antiandrogen agent) and a third-generation aromatase inhibitor, that are reported to be well-tolerated and successful in slowing bone age advancement and preventing progression of virilization. We report here two patients who presented with peripheral precocious puberty and an activating mutation in the LHCGR gene: one with a family history and previously determined mutation and the other without family history and with a novel mutation (c.830G>T). Combination of bicalutamide+anastrozole was ineffective in slowing pubertal progression and bone age. Short-term results were better with ketoconazole.
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Affiliation(s)
- Bahar Özcabı
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Feride Tahmiscioğlu Bucak
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | | | - Rahşan Özcan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Surgery, İstanbul, Turkey
| | - Cenk Büyükünal
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Surgery, İstanbul, Turkey
| | - Oya Ercan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Beyhan Tüysüz
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Genetic, İstanbul, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 212 414 30 00 E-mail:
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Lenz AM, Shulman D, Eugster EA, Rahhal S, Fuqua JS, Pescovitz OH, Lewis KA. Bicalutamide and third-generation aromatase inhibitors in testotoxicosis. Pediatrics 2010; 126:e728-33. [PMID: 20713483 PMCID: PMC4096839 DOI: 10.1542/peds.2010-0596] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Testotoxicosis, a form of gonadotropin-independent precocious puberty, results from an activating mutation of the luteinizing hormone receptor expressed in testicular Leydig cells. Affected males experience early testosterone secretion, virilization, advancing bone age, and resultant short stature. Recently, the use of combination therapy with a potent antiandrogen agent (bicalutamide) and a third-generation aromatase inhibitor (anastrozole or letrozole) was reported to yield encouraging short-term results. We present here the results of longer-term treatment (4.5 and 5 years) with this combination therapy in 2 boys who demonstrated that it is well tolerated, slows bone-age advancement in the face of continued linear growth, and prevents progression of virilization.
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Affiliation(s)
- Anne M. Lenz
- Department of Pediatric Endocrinology, Diabetes and Metabolism, All Children’s Hospital and University of South Florida, St Petersburg, Florida
| | - Dorothy Shulman
- Department of Pediatric Endocrinology, Diabetes and Metabolism, All Children’s Hospital and University of South Florida, St Petersburg, Florida
| | - Erica A. Eugster
- Section of Pediatric Endocrinology, James Whitcomb Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - Samar Rahhal
- Department of Pediatric Endocrinology, Peyton Manning Children’s Hospital at St Vincent, Indianapolis, Indiana
| | - John S. Fuqua
- Section of Pediatric Endocrinology, James Whitcomb Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - Ora H. Pescovitz
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Katherine A. Lewis
- Section of Pediatric Endocrinology, James Whitcomb Riley Hospital for Children, Indiana University, Indianapolis, Indiana
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8
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Hamdy DA, Brocks DR. Nonlinear stereoselective pharmacokinetics of ketoconazole in rat after administration of racemate. Chirality 2009; 21:704-12. [DOI: 10.1002/chir.20669] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Almeida MQ, Brito VN, Lins TSS, Guerra-Junior G, de Castro M, Antonini SR, Arnhold IJP, Mendonca BB, Latronico AC. Long-term treatment of familial male-limited precocious puberty (testotoxicosis) with cyproterone acetate or ketoconazole. Clin Endocrinol (Oxf) 2008; 69:93-8. [PMID: 18088394 DOI: 10.1111/j.1365-2265.2007.03160.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Familial male-limited precocious puberty (FMPP) or testotoxicosis is a rare gonadotrophin-independent form of sexual precocity caused by constitutively activating mutations of the LH receptor. Several clinical therapeutic approaches have been reported for this disorder, but with a paucity of long-term outcome data. OBJECTIVE To evaluate the long-term treatment of testotoxicosis with cyproterone acetate or ketoconazole. DESIGN A multicentric retrospective clinical study. PATIENTS Ten boys from eight unrelated Brazilian families who carried known LH-receptor activating mutations were treated with 70 mg/m(2) cyproterone acetate (n = 5) or 10 mg/kg ketoconazole (n = 5) for a mean period of 5 and 8 years, respectively. MEASUREMENTS Chronological and bone ages, bone age/chronological age ratio, target height (TH) range, adult height, basal and GnRH-stimulated gonadotrophin levels and basal testosterone levels were assessed. RESULTS Growth velocity decreased significantly during treatment with cyproterone acetate or ketoconazole when compared to pretreatment value in each group (P < 0.05). Bone age/chronological age ratio decreased significantly after cyproterone acetate or ketoconazole therapy. Basal testosterone levels were significantly lower in patients undergoing ketoconazole compared to cyproterone acetate treatment [0.6 +/- 0.3 nmol/l (42 +/- 21 ng/dl) vs. 5.6 +/- 4.0 nmol/l (392 +/- 280 ng/dl); P < 0.05], as expected. Secondary gonadotrophin-dependent precocious puberty occurred at a similar frequency (40%) in both groups. Five patients have attained adult height and two patients have already reached 90% of their adult height. Two of them achieved their TH range and one patient, for whom TH was not available, had an adult height of 0.3 SDS. Four boys (two in each group) did not attain their TH range. CONCLUSION Long-term treatment with cyproterone acetate or ketoconazole resulted in similar outcomes without important side-effects in boys with testotoxicosis. However, both therapies showed limited efficacy in attaining normal adult height.
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Affiliation(s)
- Madson Queiroz Almeida
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42 da Disciplina de Endocrinologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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10
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Kreher NC, Pescovitz OH, Delameter P, Tiulpakov A, Hochberg Z. Treatment of familial male-limited precocious puberty with bicalutamide and anastrozole. J Pediatr 2006; 149:416-20. [PMID: 16939760 DOI: 10.1016/j.jpeds.2006.04.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 03/14/2006] [Accepted: 04/18/2006] [Indexed: 11/29/2022]
Abstract
This report describes the use of bicalutamide and anastrozole in two subjects with familial male-limited precocious puberty. Clinical improvements include decreased facial acne and pubic hair. Most importantly, a marked decrease in growth velocity and skeletal advancement has been achieved.
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Affiliation(s)
- Nerissa C Kreher
- Department of Pediatrics, Section of Pediatric Endocrinology and Diabetology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
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12
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Abstract
Aromatase inhibitors have been used in the treatment of selective forms of precocious puberty since the mid-1980s. The primary aim of therapy is attenuation of the effects of estrogen on growth, skeletal maturation, and secondary sexual development. The first-generation agent, testolactone, has been demonstrated to be tolerable and effective in the treatment of familial male precocious puberty, while mixed results with testolactone have been achieved in girls with McCune-Albright syndrome. A favorable outcome with the use of testolactone in conjunction with conventional therapy in children with congenital adrenal hyperplasia has also been suggested. Although a few anecdotal reports of the use of newer generation aromatase inhibitors in precocious puberty exist, the extreme rarity of the relevant disorders remains a limiting factor in clinical investigation. In this review, the pathophysiology, presentation, and treatment of precocious puberty are described. Particular attention is devoted to the specific disorders in which aromatase inhibitors have been utilized, which are forms of peripheral (gonadotropin-independent) precocious puberty. The impact of untreated precocious puberty on growth and adult stature is discussed, and the actions of estrogen in the human skeleton are summarized. Finally, a detailed description of the existing literature pertaining to aromatase inhibitors in the pediatric population is provided. Emerging potential new indications are discussed. In conclusion, aromatase inhibitors, particularly testolactone, have a proven track record in the treatment of a few forms of precocious puberty. Continued exploration with new generation aromatase inhibitors in these disorders is ongoing. The wider application of aromatase inhibitors for the purposes of delaying skeletal maturation and increasing adult height in several conditions leading to short stature is currently a subject of intense investigation.
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Affiliation(s)
- Erica A Eugster
- Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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13
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Li AP. A review of the common properties of drugs with idiosyncratic hepatotoxicity and the "multiple determinant hypothesis" for the manifestation of idiosyncratic drug toxicity. Chem Biol Interact 2002; 142:7-23. [PMID: 12399152 DOI: 10.1016/s0009-2797(02)00051-0] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Idiosyncratic drug toxicity is generally believed to be a phenomenon that cannot be readily evaluated experimentally. Reasons for this difficulty include the following: 1. It is a rare event (<1/5,000) and therefore impossible to be studied in clinical trials; 2. It is a human-specific event not detectable in experimental animals. To aid the understanding of idiosyncratic toxicity and to develop an experimental strategy for this phenomenon, a hypothesis is proposed. The hypothesis states that the low frequency of idiosyncratic drug toxicity is due to the requirements for the occurrence of multiple critical and discrete events, with the probability for the occurrence of idiosyncratic drug toxicity as a product of the probabilities of each event. The key determinants of these critical events are proposed to be: 1. Chemical properties; 2. exposure; 3. environmental factors; and 4. genetic factors. Based on this hypothesis, idiosyncratic drug toxicity can be evaluated experimentally via studying these key determinants. The chemical properties critical to idiosyncratic drug toxicity are identified via a review of the common properties of drugs that cause idiosyncratic liver toxicity. These properties include: 1. Formation of reactive metabolites. 2. Metabolism by P450 isoforms. 3. Preponderance of P450 inducers, and 4. Occurrence of clinically significant pharmacokinetic interactions with co-administered drugs. Based on this review, it is proposed that these common properties may be useful experimental endpoints for the prediction and therefore avoidance of the selection of drug candidates with idiosyncratic drug toxicity for further development.
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Affiliation(s)
- Albert P Li
- Phase 1 Molecular Technologies, Inc., 2904 West Rodeo Park, Santa Fe, NM 87505, USA.
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14
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Affiliation(s)
- E A Eugster
- Department of Endocrinology, Section of Pediatric Endocrinology, James Whitcomb Riley Hospital for Children, Room #5960, 702 Barnhill Drive, Indianapolis, IN 46202, USA.
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15
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Huhtaniemi IT. Mutations of gonadotropins and gonadotropin receptors: elucidating the physiology and pathophysiology of pituitary-gonadal function. Endocr Rev 2000; 21:551-83. [PMID: 11041448 DOI: 10.1210/edrv.21.5.0409] [Citation(s) in RCA: 423] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The recent unraveling of structures of genes for the gonadotropin subunits and gonadotropin receptors has provided reproductive endocrinologists with new tools to study normal and pathological functions of the hypothalamic-pituitary-gonadal axis. Rare inactivating mutations that produce distinctive phenotypes of isolated LH or FSH deficiency have been discovered in gonadotropin subunit genes. In addition, there is a common polymorphism in the LHbeta subunit gene with possible clinical significance as a contributing factor to pathologies of LH-dependent gonadal functions. Both activating and inactivating mutations have been detected in the gonadotropin receptor genes, a larger number in the LH receptor gene, but so far only a few in the gene for the FSH receptor. These mutations corroborate and extend our knowledge of clinical consequences of gonadotropin resistance and inappropriate gonadotropin action. The information obtained from human mutations has been complemented by animal models with disrupted or inappropriately activated gonadotropin ligand or receptor genes. These clinical and experimental genetic disease models form a powerful tool for exploring the physiology and pathophysiology of gonadotropin function and provide an excellent example of the power of molecular biological approaches in the study of pathogenesis of diseases.
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MESH Headings
- Amino Acid Sequence
- Animals
- Female
- Gonadotropins, Pituitary/chemistry
- Gonadotropins, Pituitary/genetics
- Gonadotropins, Pituitary/physiology
- Humans
- Mice
- Mice, Knockout
- Mutation
- Ovary/physiology
- Pituitary Gland/physiology
- Receptors, FSH/chemistry
- Receptors, FSH/genetics
- Receptors, FSH/physiology
- Receptors, Gonadotropin/chemistry
- Receptors, Gonadotropin/genetics
- Receptors, Gonadotropin/physiology
- Receptors, LH/chemistry
- Receptors, LH/genetics
- Receptors, LH/physiology
- Structure-Activity Relationship
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16
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Ho YS, Tsai PW, Yu CF, Liu HL, Chen RJ, Lin JK. Ketoconazole-induced apoptosis through P53-dependent pathway in human colorectal and hepatocellular carcinoma cell lines. Toxicol Appl Pharmacol 1998; 153:39-47. [PMID: 9875298 DOI: 10.1006/taap.1998.8467] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this study, we first demonstrated that the widely used oral antifungal drug, ketoconazole (KT), can induce apoptosis in various type of human cancer cells and in a primary culture of rat liver cells. We further investigated the molecular mechanisms of KT-induced apoptosis. It was found that KT induced nuclear accumulation of p53 protein in a dose- and time-dependent manner. The level of p53 protein was elevated approximately three times as much in treated cells 24 h after KT (5 microM) exposure as in cells receiving mock treatment. We found that cells containing wild-type p53 (COLO 205 and Hep G2) were more sensitive to KT exposure. The bax protein was induced and the bcl-2 protein was inhibited by KT in cells containing wild-type p53 (Hep G2, COLO 205) but not in cells without p53 (Hep 3B). The caspase-3 was activated 24 h after KT treatment. The Poly-(ADP ribose) polymerase (PARP) and the lamin A degradation was induced by KT, which promoted nuclear membrane disassembly and eventually caused apoptosis. Our results also indicated that none of the PKC gene family was involved in KT-induced apoptosis.
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Affiliation(s)
- Y S Ho
- School of Medical Technology, Taipei Medical College, Taiwan, Republic of China
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17
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Abstract
The glycoprotein hormones luteinizing hormone (LH) and human chorionic gonadotropin (hCG), both of which act through the LH receptor, play an important role in the regulation of both male and female gonadal function. Testicular androgen production by the Leydig cells is almost entirely dependent on LH/hCG action, while in the ovary LH triggers both oestrogen and progestin secretion and ovulation of the Graaffian follicles. In this review we discuss the various mutations that have been found in the LH receptor gene in the human and the lessons that can be learned from the phenotypes of the carriers of these mutations.
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Affiliation(s)
- A P Themmen
- Department of Endocrinology and Reproduction, Erasmus University Rotterdam, The Netherlands.
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18
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Müller J, Gondos B, Kosugi S, Mori T, Shenker A. Severe testotoxicosis phenotype associated with Asp578-->Tyr mutation of the lutrophin/choriogonadotrophin receptor gene. J Med Genet 1998; 35:340-1. [PMID: 9598734 PMCID: PMC1051288 DOI: 10.1136/jmg.35.4.340] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Testotoxicosis is a form of male precocious puberty caused by heterogeneous activating mutations in the gene for the lutrophin/choriogonadotrophin receptor (LHR). A patient with an unusually early and severe presentation of testotoxicosis, including profound Leydig cell hyperplasia, was found to have a sporadic mutation encoding Asp578-->Tyr. The severe testotoxicosis phenotype appears to be related to the strongly activating nature of the Tyr substitution.
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Affiliation(s)
- J Müller
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
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19
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Abstract
Recent developments in biochemistry, genetics, and clinical research have produced a profound effect on the understanding of normal and abnormal puberty. This article is intended to point out selected new developments that affect the understanding of puberty and clinical practice in disorders of puberty.
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Affiliation(s)
- D M Styne
- Department of Pediatrics, University of California, Davis, School of Medicine, USA
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Laue L, Chan WY, Hsueh AJ, Kudo M, Hsu SY, Wu SM, Blomberg L, Cutler GB. Genetic heterogeneity of constitutively activating mutations of the human luteinizing hormone receptor in familial male-limited precocious puberty. Proc Natl Acad Sci U S A 1995; 92:1906-10. [PMID: 7892197 PMCID: PMC42391 DOI: 10.1073/pnas.92.6.1906] [Citation(s) in RCA: 179] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Genomic DNA from 32 unrelated families with male-limited precocious puberty was examined for the previously described Asp-578-->Gly, Met-571-->Ile, and Thr-577-->Ile mutations in transmembrane helix 6 of the human luteinizing hormone receptor (hLHR). Twenty-eight families had the inherited form of the disorder, and of these, 24 were found to have the Asp-578-->Gly mutation. Four additional mutations were found among the remaining four families with the inherited form and in four sporadic cases of the disorder: an A-->C transversion resulting in substitution of leucine for Ile-542 in the fifth transmembrane helix, an A-->G transition resulting in substitution of glycine for Asp-564 in the third cytoplasmic loop, a G-->T transversion resulting in substitution of tyrosine for Asp-578 in the sixth transmembrane helix, and a T-->C transition resulting in substitution of arginine for Cys-581 in the sixth transmembrane helix. Human embryonic kidney cells transfected with cDNAs for each of the mutant hLHRs, created by PCR-based mutagenesis of the wild-type hLHR cDNA, exhibited increased levels of basal cAMP production in the absence of agonist, indicating constitutive activation of the mutation hLHRs. Three of the additional mutations had specific features: Ile-542-->Leu and Cys-581-->Arg appeared ligand-unresponsive, whereas Asp-578-->Tyr appeared to correlate genotype with phenotype. We conclude that the region spanning nt 1624-1741 of exon 11 is a hotspot for heterogeneous point mutations that constitutively activate the hLHR and cause male-limited precocious puberty.
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Affiliation(s)
- L Laue
- Department of Pediatrics, Georgetown University Medical Center, Washington, D.C. 20007
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