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Wang L, Xi C, Zheng X, Huang Y, Xu H, Miao Y, Cheng Y. Familial 46, XY Disorder of Sexual Development identified in a Ph+ BCR::ABL1P210+ Acute Lymphoblastic Leukemia septuagenarian female with RCBTB2::LPAR6 fusion gene: a case report. Front Oncol 2024; 14:1339737. [PMID: 39091920 PMCID: PMC11291305 DOI: 10.3389/fonc.2024.1339737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
Background Familial 46, XY Disorder of Sexual Development (DSD) was discovered in a Ph+, BCR::ABL1P210+ Acute Lymphoblastic Leukemia (ALL) female with RCBTB2::LPAR6 fusion gene. Siblings developing 46, XY DSD are extremely rare. Patients with 46, XY DSD have much higher rates of gonadal cancers. Nevertheless, the incidence of hematologic malignancies in patients with DSDs has received little attention. RCBTB2::LPAR6 is a rarely reported fusion gene in ALL. Case presentation Herein, we report a rare case of a newly diagnosed Ph+, BCR::ABL1P210+ ALL patient who was 77 years old and female by social sex. Whole Exome Sequencing (WES) and RNA sequencing revealed TET2 and NF1 mutations in addition to a rarely reported RCBTB2::LPAR6 fusion gene and 17 other genes with uncertain clinical significance. The patient was surprisingly found to have a male karyotype. On ultrasound, neither the uterus nor the ovaries were discernible. A detailed family and marital history revealed that the patient had undergone surgery at an early age for an unexplained inguinal mass. She had slow pubertal development, scanty menstruation, and few overtly feminine characteristics. She had three marriages, but none succeeded in getting pregnant. The patient had never sought therapy for infertility due to the inaccessibility of medical treatment and a lack of medical knowledge. Her sister, 73 years old and female by social sex, who had amenorrhea in adolescence and was unable to conceive, had the same experience. To our surprise, she also had a male karyotype. Conclusions Due to the absence of long-term social attention and follow-up, studies on the incidence of hematologic malignancies in patients with 46, XY DSD are incredibly uncommon. Siblings developing 46, XY DSD is extremely rare. We report the oldest patient diagnosed with 46, XY DSD. There have not yet been any reports of familial 46, XY DSD with a concurrent diagnosis of Ph+BCR::ABL1P210+ ALL with a rarely reported RCBTB2::LPAR6 fusion gene.
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Affiliation(s)
- Lingling Wang
- Department of Hematology, The First People’s Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China
| | - Conglin Xi
- Department of Oncology, The Second People’s Hospital of Huai’an, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Xinyu Zheng
- Department of Hematology, The First People’s Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China
| | - Yongfen Huang
- Department of Hematology, The First People’s Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China
| | - Hao Xu
- Department of Hematology, The First People’s Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China
| | - Yuqing Miao
- Department of Hematology, The First People’s Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China
| | - Yuexin Cheng
- Department of Hematology, The First People’s Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China
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Ramgir SS, Annamalai S, Abilash VG. In Silico Analysis of Functional SNPs in Genes of Complete Androgen Insensitivity Syndrome (CAIS): A Retrospective, Case-Control Study. J Obstet Gynaecol India 2024; 74:136-143. [PMID: 38707871 PMCID: PMC11065807 DOI: 10.1007/s13224-023-01876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 10/04/2023] [Indexed: 05/07/2024] Open
Abstract
Background Complete androgen insensitivity syndrome (CAIS) is one of the categories of androgen insensitivity syndrome (AIS) described as complete failure of the cell to react to androgens with external genitalia of a normal female. People with AIS condition are genetically male, with XY karyotype in each cell, but their bodies are unable to respond to male sex hormones (called androgens). It is associated with infertility as well as developing cancerous conditions. The genetic association of CAIS involves polymorphism of genes such as NR5A1, SOX9, SRD5A2, CBX2, GATA4, and SRY. Their mutation and participation in genetics of CAIS can be studied by Single Nucleotide polymorphism (SNP) analysis which is a way to detect genetic variations. SNP in coding region leads to synonymous and non-synonymous mutations. Hence, this study highlights analysis of SNPs associated with CAIS. Our aim is to study SNP analysis of NR5A1, SOX9, SRD5A2, CBX2, GATA4, SRY genes in Complete Androgen Insensitivity Syndrome. Methods SIFT and Polyphen analysis was performed for all the genes and samples were subjected for PCR-SSCP technique. Results SNPs were analyzed for the genes associated with CAIS. Benign and damaging SNPs were identified. DNA Samples were amplified using PCR technique and they will be analyzed using Single-strand conformation polymorphism (SSCP). Conclusions As SNPs have decreased stability, damaging and benign character, they can be used as candidate hallmarks in study of Complete Androgen Insensitivity Syndrome.
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Affiliation(s)
- Shalaka S. Ramgir
- Assistant professor at Symbiosis Institute of Health Sciences (SIHS), Symbiosis International (Deemed University), Mulshi, Lavale, Maharashtra 412115 India
| | - Sivakumar Annamalai
- Quality Assurance-Executive, GLR Laboratories Pvt. Ltd., Chennai, Tamilnadu 600068 India
| | - V. G. Abilash
- Associate Professor, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamilnadu 632014 India
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Guaragna-Filho G, Calixto AR, Astur ABLDV, de Paula GB, de Oliveira LC, Morcillo AM, Gonçalves EM, de Mello MP, Maciel-Guerra AT, Guerra-Junior G. Leydig and Sertoli cell function in individuals with genital ambiguity, 46,XY karyotype, palpable gonads and normal testosterone secretion: a case-control study. SAO PAULO MED J 2022; 140:163-170. [PMID: 35137906 PMCID: PMC9610247 DOI: 10.1590/1516-3180.2021.0042.r1.08062021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Because normal male sexual differentiation is more complex than normal female sexual differentiation, there are more cases of disorders of sex development (DSDs) with 46,XY karyotype that have unclear etiology. However, Leydig and Sertoli cell markers are rarely used in distinguishing such individuals. OBJECTIVES To evaluate the function of Leydig and Sertoli cells in individuals with genital ambiguity, 46,XY karyotype, palpable gonads and normal testosterone secretion. STUDY DESIGN AND SETTING Case-control study with 77 patients, including eight with partial androgen insensitivity syndrome, eight with 5α-reductase deficiency type 2 (5ARD2) and 19 with idiopathic 46,XY DSD, and 42 healthy controls, from the Interdisciplinary Study Group for Sex Determination and Differentiation (GIEDDS), at the State University of Campinas (UNICAMP), Campinas, Brazil. METHODS Baseline levels of gonadotropins, anti-Müllerian hormone (AMH), inhibin B, insulin-like 3 (INSL3), testosterone and dihydrotestosterone in cases, and AMH, inhibin B, and INSL3 levels in controls, were assessed. RESULTS There was no significant difference in age between cases and controls (P = 0.595). AMH and inhibin B levels were significantly lower in cases than in controls (P = 0.031 and P < 0.001, respectively). INSL3 levels were significantly higher in cases than in controls (P = 0.003). Inhibin B levels were lower in 5ARD2 patients (P = 0.045) and idiopathic patients (P = 0.001), in separate comparisons with the controls. CONCLUSION According to our findings, we can speculate that inhibin B levels may be used to differentiate among DSD cases.
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Affiliation(s)
- Guilherme Guaragna-Filho
- MD, PhD. Adjunct Professor, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Antônio Ramos Calixto
- PhD. Researcher, Laboratory of Investigation in Metabolism and Diabetes (LIMED), Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Anna Beatriz Lima do Valle Astur
- MD. Attending Physician, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Georgette Beatriz de Paula
- MD, MSc. Attending Physician, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Laurione Cândido de Oliveira
- PhD. Researcher, Laboratory of Physiology, Clinical Hospital, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - André Moreno Morcillo
- MD, PhD. Associate Professor, Department of Pediatrics, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Ezequiel Moreira Gonçalves
- PhD. Adjunct Professor, Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Maricilda Palandi de Mello
- PhD. Researcher, Center of Molecular Biology and Genetic Engineering (CBMEG), Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Andrea Trevas Maciel-Guerra
- MD, PhD. Full Professor, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Gil Guerra-Junior
- MD, PhD. Full Professor, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
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Mönig I, Schneidewind J, Johannsen TH, Juul A, Werner R, Lünstedt R, Birnbaum W, Marshall L, Wünsch L, Hiort O. Pubertal development in 46,XY patients with NR5A1 mutations. Endocrine 2022; 75:601-613. [PMID: 34613524 PMCID: PMC8816419 DOI: 10.1007/s12020-021-02883-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Mutations in the NR5A1 gene, encoding the transcription factor Steroidogenic Factor-1, are associated with a highly variable genital phenotype in patients with 46,XY differences of sex development (DSD). Our objective was to analyse the pubertal development in 46,XY patients with NR5A1 mutations by the evaluation of longitudinal clinical and hormonal data at pubertal age. METHODS We retrospectively studied a cohort of 10 46,XY patients with a verified NR5A1 mutation and describe clinical features including the external and internal genitalia, testicular volumes, Tanner stages and serum concentrations of LH, FSH, testosterone, AMH, and inhibin B during pubertal transition. RESULTS Patients who first presented in early infancy due to ambiguous genitalia showed spontaneous virilization at pubertal age accompanied by a significant testosterone production despite the decreased gonadal volume. Patients with apparently female external genitalia at birth presented later in life at pubertal age either with signs of virilization and/or absence of female puberty. Testosterone levels were highly variable in this group. In all patients, gonadotropins were constantly in the upper reference range or elevated. Neither the extent of virilization at birth nor the presence of Müllerian structures reliably correlated with the degree of virilization during puberty. CONCLUSION Patients with NR5A1 mutations regardless of phenotype at birth may demonstrate considerable virilization at puberty. Therefore, it is important to consider sex assignment carefully and avoid irreversible procedures during infancy.
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Affiliation(s)
- Isabel Mönig
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatric and Adolescent Medicine, University of Lübeck, Lübeck, Germany.
| | - Julia Schneidewind
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatric and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Trine H Johannsen
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ralf Werner
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatric and Adolescent Medicine, University of Lübeck, Lübeck, Germany
- Institute for Molecular Medicine, University of Lübeck, Lübeck, Germany
| | - Ralf Lünstedt
- Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Wiebke Birnbaum
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatric and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Louise Marshall
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatric and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Lutz Wünsch
- Department of Paediatric Surgery, University of Lübeck, Lübeck, Germany
| | - Olaf Hiort
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatric and Adolescent Medicine, University of Lübeck, Lübeck, Germany
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Identification and functional analysis of fourteen NR5A1 variants in patients with the 46 XY disorders of sex development. Gene 2020; 760:145004. [PMID: 32738419 DOI: 10.1016/j.gene.2020.145004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/21/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
Human sex determination and differentiation is a complex process, during which NR5A1 plays a central role via the transcriptional regulation of key modulators involved in steroidogenesis. Approximately 8-15% of 46,XY DSD are caused by variants in the NR5A1 gene. Therefore, screening for variants in the NR5A1 gene was performed in a Chinese cohort of sixty-two 46,XY DSD patients with no AR or SRD5A2 variants via next-generation sequencing (NGS). Fourteen variants in the NR5A1 gene were identified in 16 patients from 14 unrelated families, including nine novel variants. These variants included eight heterozygote missense variants, two heterozygote frameshift variants, two heterozygote nonsense variants, one heterozygote nonframeshift deletion-insertion variant, and one homozygous missense variant. Functional assays showed that the transcriptional activity of the 11 variants was significantly reduced. In this study, 11 NR5A1 pathogenic variants were identified. These novel variants further expand the existing spectrum of the NR5A1 variants associated with 46,XY DSD, which will, in turn, assist in the molecular diagnosis of DSD.
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Yahaya TO, Liman UU, Abdullahi H, Koko YS, Ribah SS, Adamu Z, Abubakar S. Genes predisposing to syndromic and nonsyndromic infertility: a narrative review. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2020. [DOI: 10.1186/s43042-020-00088-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
Advanced biological techniques have helped produce more insightful findings on the genetic etiology of infertility that may lead to better management of the condition. This review provides an update on genes predisposing to syndromic and nonsyndromic infertility.
Main body
The review identified 65 genes linked with infertility and infertility-related disorders. These genes regulate fertility. However, mutational loss of the functions of the genes predisposes to infertility. Twenty-three (23) genes representing 35% were linked with syndromic infertility, while 42 genes (65%) cause nonsyndromic infertility. Of the 42 nonsyndromic genes, 26 predispose to spermatogenic failure and sperm morphological abnormalities, 11 cause ovarian failures, and 5 cause sex reversal and puberty delay. Overall, 31 genes (48%) predispose to male infertility, 15 genes (23%) cause female infertility, and 19 genes (29%) predispose to both. The common feature of male infertility was spermatogenic failure and sperm morphology abnormalities, while ovarian failure has been the most frequently reported among infertile females. The mechanisms leading to these pathologies are gene-specific, which, if targeted in the affected, may lead to improved treatment.
Conclusions
Mutational loss of the functions of some genes involved in the development and maintenance of fertility may predispose to syndromic or nonsyndromic infertility via gene-specific mechanisms. A treatment procedure that targets the affected gene(s) in individuals expressing infertility may lead to improved treatment.
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Functional study of a novel c.630delG (p.Y211Tfs*85) mutation in NR5A1 gene in a Chinese boy with 46,XY disorders of sex development. J Assist Reprod Genet 2020; 37:477-486. [PMID: 31938931 DOI: 10.1007/s10815-019-01676-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This study aimed to present the clinical features and gene mutation characteristics of a child with 46,XY disorders of sex development (DSD) caused by a novel heterozygous mutation in the NR5A1 gene to determine the potential association between this heterozygous mutation and the pathogenesis of 46,XY DSD. METHODS We present the case of a Chinese child with ambiguous genitalia at birth but a normal adrenal gland. Targeted next-generation sequencing, comprising 163 candidate genes involved in sexual differentiation and development, was performed, followed by the functional evaluation of the novel NR5A1 mutation. RESULT The patient had a novel heterozygous mutation in the NR5A1 gene, c.630delG (p.Y211Tfs*85). Results revealed that overexpression of p.Y211Tfs*85 impaired steroidogenic factor-1 (SF-1) protein synthesis. Immunofluorescence analysis revealed that both SF-1 wild-type and p.Y211Tfs*85 mutation proteins were localized in the cell nucleus. Furthermore, dual-luciferase reporter assay results revealed that the p.Y211Tfs*85 mutation could effectively downregulate the transcriptional activation of anti-Müllerian hormone and steroidogenic acute regulatory protein genes (P < 0.01). Additionally, the p.Y211Tfs*85 mutation changed three-dimensional conformation of SF-1, and three conformations could be constructed with the mutated amino acid sequences. Therefore, the novel frameshift mutation could result in decreased protein expression of SF-1. CONCLUSION We described a novel mutation in NR5A1 and showed that it might affect protein structure, thereby seriously compromising the role of SF-1 in regulating gonadal development. The novel p.Y211Tfs*85 mutation in the NR5A1 gene enriches the boy of information available regarding the mutation spectrum of this gene in the Chinese population.
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Fabbri‐Scallet H, Sousa LM, Maciel‐Guerra AT, Guerra‐Júnior G, Mello MP. Mutation update for theNR5A1gene involved in DSD and infertility. Hum Mutat 2019; 41:58-68. [DOI: 10.1002/humu.23916] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/29/2019] [Accepted: 09/09/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Helena Fabbri‐Scallet
- Center for Molecular Biology and Genetic Engineering‐CBMEGState University of Campinas São Paulo Brazil
| | - Lizandra Maia Sousa
- Center for Molecular Biology and Genetic Engineering‐CBMEGState University of Campinas São Paulo Brazil
| | - Andréa Trevas Maciel‐Guerra
- Department of Medical Genetics and Genomic Medicine, Faculty of Medical SciencesState University of Campinas São Paulo Brazil
- Interdisciplinary Group for the Study of Sex Determination and Differentiation‐GIEDDSState University of Campinas São Paulo Brazil
| | - Gil Guerra‐Júnior
- Interdisciplinary Group for the Study of Sex Determination and Differentiation‐GIEDDSState University of Campinas São Paulo Brazil
- Department of Pediatrics, Faculty of Medical SciencesState University of Campinas São Paulo Brazil
| | - Maricilda Palandi Mello
- Center for Molecular Biology and Genetic Engineering‐CBMEGState University of Campinas São Paulo Brazil
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Song Y, Fan L, Gong C. Phenotype and Molecular Characterizations of 30 Children From China With NR5A1 Mutations. Front Pharmacol 2018; 9:1224. [PMID: 30425642 PMCID: PMC6218886 DOI: 10.3389/fphar.2018.01224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/08/2018] [Indexed: 01/31/2023] Open
Abstract
Background: Patients harboring NR5A1 mutations have a wide spectrum of phenotypes. Objective: To investigate the phenotype of patients with NR5A1 gene mutations from a 30 Chinese patient cohort. Methods: We reported the clinical features of children with NR5A1 gene mutations and compared them between two groups of patients with social genders of male (boys group) and female (girls group). Results: Thirty patients with NR5A1 mutations ranging from 2 months to 17 years of age were studied. There were 11 boys and 19 girls who were identified when they visited the hospital. The patients were verified as having testes without a uterus and ovaries by B-mode ultrasound. There was no difference between boys and girls in terms of the Prader stage (p = 0.086), but the position of the testes was higher in girls than in boys (p = 0.013). The patients’ average height is −0.43 SDS according to the normal boys’ height with SDS (while their average target height was 0.07 SDS). However, there was no such difference between boys and girls (p > 0.05). Although the basal LH and post-hCG testosterone (T) levels were not different (p > 0.05), but the basal FSH level, LH/FSH ratio, and INHB level were decreased in girls (p = 0.002; p = 0.001; p = 0.006). All of the mothers of the patients reported to have normal pregnancies. We found 24 patients (80%) with de novo mutations in the NR5A1 gene; 5 patients had inherited mutations from their mothers, and one inherited from the father. Only the mothers of patients 16 and 18 showed premature ovarian failure at the time of reporting. Among 26 disease associated mutations, 14 novel mutations that have been reported the first time and p.R87C is the most common Among the other 12 had had been reported,the p.R313C is the most common. Conclusion: Patients with 46, XY NR5A1 mutations presented a wide spectrum of external genitalia characteristics and severe Sertoli cell impairment. The p.R87C and p.R313C mutations appeared to be common (10%) in this group, and 14 new mutations were identified, improving our understanding the genotype phenotype correlations.
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Affiliation(s)
- Yanning Song
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lijun Fan
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chunxiu Gong
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory for Genetics of Birth Defects, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Guaragna-Filho G, Calixto AR, De Paula GB, De Oliveira LC, Morcillo AM, De Mello MP, Maciel-Guerra AT, Guerra-Junior G. Comparison between two inhibin B ELISA assays in 46,XY testicular disorders of sex development (DSD) with normal testosterone secretion. J Pediatr Endocrinol Metab 2018; 31:191-194. [PMID: 29306929 DOI: 10.1515/jpem-2017-0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/01/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inhibin B is a hormone produced by the Sertoli cells that can provide important information for the investigation of disorders of sex development (DSD) with 46,XY karyotype. The aim of this study is to compare two enzyme-linked immunosorbent assay (ELISA) assays for dosage of serum inhibin B in patients with 46,XY DSD with normal testosterone secretion. METHODS Twenty-nine patients with 46,XY DSD and normal testosterone secretion (partial androgen insensitivity syndrome [PAIS] [n=8]; 5α-reductase deficiency [n=7] and idiopathic 46,XY DSD [n=14]) were included. Molecular analysis of the AR and SRD5A2 genes were performed in all patients and the NR5A1 gene analysis in the idiopathic group. Measurements of inhibin B were performed by two second-generation ELISA assays (Beckman-Coulter and AnshLabs). Assays were compared using the interclass correlation coefficient (ICC) and the Bland-Altman method. RESULTS ICC was 0.915 [95% confidence interval (CI): 0.828-0.959], however, a discrepancy was observed between trials, which is more evident among higher values when analyzed by the Bland-Altman method. CONCLUSIONS It is recommended to perform the inhibin B measurement always using the same ELISA kit when several evaluations are required for a specific patient.
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Affiliation(s)
- Guilherme Guaragna-Filho
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), School of Medicine, State University of Campinas (UNICAMP),R. Tessalia Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brazil
| | - Antônio Ramos Calixto
- Laboratory of Investigation in Metabolism and Diabetes (LIMED), UNICAMP, Campinas, São Paulo, Brazil
| | - Georgette Beatriz De Paula
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medicine, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | | | - Andrea Trevas Maciel-Guerra
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medicine, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Gil Guerra-Junior
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medicine, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Jedidi I, Ouchari M, Yin Q. Autosomal single-gene disorders involved in human infertility. Saudi J Biol Sci 2017; 25:881-887. [PMID: 30108436 PMCID: PMC6088112 DOI: 10.1016/j.sjbs.2017.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/06/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022] Open
Abstract
Human infertility, defined as the inability to conceive after 1 year of unprotected intercourse, is a healthcare problem that has a worldwide impact. Genetic causes of human infertility are manifold. In addition to the chromosomal aneuploidies and rearrangements, single-gene defects can interfere with human fertility. This paper provides a review of the most common autosomal recessive and autosomal dominant single-gene disorders involved in human infertility. The genes reviewed are CFTR, SPATA16, AURKC, CATSPER1, GNRHR, MTHFR, SYCP3, SOX9, WT1 and NR5A1 genes. These genes may be expressed throughout the hypothalamic-pituitary–gonadal-outflow tract axis, and the phenotype of affected individuals varies considerably from varying degrees of spermatogenic dysfunction leading to various degrees of reduced sperm parameters, through hypogonadotropic hypogonadism reslting in pubertal deficiencies, until gonadal dysgenesis and XY and XX sex reversal. Furthermore, congenital bilateral absence of the vas deferens, as well as premature ovarian failure, have been reported to be associated with some single-gene defects.
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Affiliation(s)
- Ines Jedidi
- Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Mouna Ouchari
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Qinan Yin
- Clinical Center, National Institutes of Health, Bethesda, MD, USA.,Department of Obstetrics and Gynecology, China Meitan General Hospital, Beijing, China
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Fabbri-Scallet H, de Mello MP, Guerra-Júnior G, Maciel-Guerra AT, de Andrade JGR, de Queiroz CMC, Monlleó IL, Struve D, Hiort O, Werner R. Functional characterization of five NR5A1
gene mutations found in patients with 46,XY disorders of sex development. Hum Mutat 2017; 39:114-123. [DOI: 10.1002/humu.23353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Helena Fabbri-Scallet
- Center for Molecular Biology and Genetic Engineering - CBMEG; State University of Campinas; São Paulo Brazil
| | - Maricilda Palandi de Mello
- Center for Molecular Biology and Genetic Engineering - CBMEG; State University of Campinas; São Paulo Brazil
| | - Gil Guerra-Júnior
- Department of Pediatrics; Faculty of Medical Sciences; State University of Campinas; São Paulo Brazil
- Interdisciplinary Group for the Study of Sex Determination and Differentiation - GIEDDS; State University of Campinas; São Paulo Brazil
| | - Andréa Trevas Maciel-Guerra
- Interdisciplinary Group for the Study of Sex Determination and Differentiation - GIEDDS; State University of Campinas; São Paulo Brazil
- Department of Medical Genetics; Faculty of Medical Sciences; State University of Campinas; São Paulo Brazil
| | - Juliana Gabriel Ribeiro de Andrade
- Interdisciplinary Group for the Study of Sex Determination and Differentiation - GIEDDS; State University of Campinas; São Paulo Brazil
- Department of Medical Genetics; Faculty of Medical Sciences; State University of Campinas; São Paulo Brazil
| | | | - Isabella Lopes Monlleó
- Clinical Genetics Service; Faculty of Medicine; Federal University of Alagoas; Maceió Alagoas Brazil
| | - Dagmar Struve
- Department of Paediatric and Adolescent Medicine; Division of Paediatric Endocrinology and Diabetes; Center of Brain; Behavior and Metabolism; University of Luebeck; Luebeck Germany
| | - Olaf Hiort
- Department of Paediatric and Adolescent Medicine; Division of Paediatric Endocrinology and Diabetes; Center of Brain; Behavior and Metabolism; University of Luebeck; Luebeck Germany
| | - Ralf Werner
- Department of Paediatric and Adolescent Medicine; Division of Paediatric Endocrinology and Diabetes; Center of Brain; Behavior and Metabolism; University of Luebeck; Luebeck Germany
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13
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Robevska G, van den Bergen JA, Ohnesorg T, Eggers S, Hanna C, Hersmus R, Thompson EM, Baxendale A, Verge CF, Lafferty AR, Marzuki NS, Santosa A, Listyasari NA, Riedl S, Warne G, Looijenga L, Faradz S, Ayers KL, Sinclair AH. Functional characterization of novel NR5A1 variants reveals multiple complex roles in disorders of sex development. Hum Mutat 2017; 39:124-139. [PMID: 29027299 PMCID: PMC5765430 DOI: 10.1002/humu.23354] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 12/23/2022]
Abstract
Variants in the NR5A1 gene encoding SF1 have been described in a diverse spectrum of disorders of sex development (DSD). Recently, we reported the use of a targeted gene panel for DSD where we identified 15 individuals with a variant in NR5A1, nine of which are novel. Here, we examine the functional effect of these changes in relation to the patient phenotype. All novel variants tested had reduced trans‐activational activity, while several had altered protein level, localization, or conformation. In addition, we found evidence of new roles for SF1 protein domains including a region within the ligand binding domain that appears to contribute to SF1 regulation of Müllerian development. There was little correlation between the severity of the phenotype and the nature of the NR5A1 variant. We report two familial cases of NR5A1 deficiency with evidence of variable expressivity; we also report on individuals with oligogenic inheritance. Finally, we found that the nature of the NR5A1 variant does not inform patient outcomes (including pubertal androgenization and malignancy risk). This study adds nine novel pathogenic NR5A1 variants to the pool of diagnostic variants. It highlights a greater need for understanding the complexity of SF1 function and the additional factors that contribute.
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Affiliation(s)
| | | | | | | | - Chloe Hanna
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Remko Hersmus
- Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Elizabeth M Thompson
- SA Clinical Genetics Service, SA Pathology at the Women's and Children's Hospital, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - Anne Baxendale
- SA Clinical Genetics Service, SA Pathology at the Women's and Children's Hospital, Adelaide, Australia
| | - Charles F Verge
- Sydney Children's Hospital, Sydney, Australia.,School of Women's and Children's Health, UNSW, Sydney, Australia
| | - Antony R Lafferty
- Centenary Hospital for Women and Children, Canberra, Australia.,ANU Medical School, Canberra, Australia
| | | | - Ardy Santosa
- Division of Urology, Department of Surgery, Dr. Kariadi Hospital, Semarang, Indonesia
| | - Nurin A Listyasari
- Division of Human Genetics, Centre for Biomedical Research Faculty of Medicine Diponegoro University (FMDU), Semarang, Indonesia
| | - Stefan Riedl
- St Anna Children's Hospital, Department of Paediatrics, Medical University of Vienna, Wien, Austria.,Division of Paediatric Pulmology, Allergology, and Endocrinology, Department of Paediatrics, Medical University of Vienna, Wien, Austria
| | - Garry Warne
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Leendert Looijenga
- Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sultana Faradz
- Division of Human Genetics, Centre for Biomedical Research Faculty of Medicine Diponegoro University (FMDU), Semarang, Indonesia
| | - Katie L Ayers
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Andrew H Sinclair
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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14
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Clinical follow-up of the first SF-1 insufficient female patient. ANNALES D'ENDOCRINOLOGIE 2017. [PMID: 28624161 DOI: 10.1016/j.ando.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Steroidogenic factor 1 (SF-1/NR5A1) plays a crucial role in regulating adrenal development, gonad determination and differentiation, and in the hypothalamic-pituitary control of reproduction and metabolism. In men (46, XY), it is known that mutations in SF-1/NR5A1 gene cause a wide phenotypic spectrum with variable degrees of undervirilization. In recent years, the role of SF-1 in the ovarian function was increasingly discussed and alterations in the gene were related to primary ovarian insufficiency. We describe the follow-up of a 46, XX affected woman with a SF-1 mutation and by comparing our case with the known manifestations reported in the literature, we try to further elucidate the function of SF-1 in the ovary. RESULTS During infancy, adrenal insufficiency was the only clinical sign of the loss-of-function as ovarian development and function seemed normal. To date, this young woman aged 16.5 years shows normal growth, normal BMI and psychomotor development, has a normal puberty and regular menstruation. CONCLUSION This report shows one, to date uniquely described, phenotypic variant of SF-1 mutation in a 46, XX affected person with adrenocortical insufficiency but no ovarian dysfunction nor disturbance of pubertal development. To follow the natural history of SF-1 mutation in a 46, XX individual will further shed light on its role in the ovarian function and thus will help to counsel affected patients in future.
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15
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Werner R, Mönig I, Lünstedt R, Wünsch L, Thorns C, Reiz B, Krause A, Schwab KO, Binder G, Holterhus PM, Hiort O. New NR5A1 mutations and phenotypic variations of gonadal dysgenesis. PLoS One 2017; 12:e0176720. [PMID: 28459839 PMCID: PMC5411087 DOI: 10.1371/journal.pone.0176720] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/15/2017] [Indexed: 02/01/2023] Open
Abstract
Mutations in NR5A1 have been reported as a frequent cause of 46,XY disorders of sex development (DSD) associated to a broad phenotypic spectrum ranging from infertility, ambiguous genitalia, anorchia to gonadal dygenesis and female genitalia. Here we present the clinical follow up of four 46,XY DSD patients with three novel heterozygous mutations in the NR5A1 gene leading to a p.T40P missense mutation and a p.18DKVSG22del nonframeshift deletion in the DNA-binding domain and a familiar p.Y211Tfs*83 frameshift mutation. Functional analysis of the missense and nonframeshift mutation revealed a deleterious character with loss of DNA-binding and transactivation capacity. Both, the mutations in the DNA-binding domain, as well as the familiar frameshift mutation are associated with highly variable endocrine values and phenotypic appearance. Phenotypes vary from males with spontaneous puberty, substantial testosterone production and possible fertility to females with and without Müllerian structures and primary amenorrhea. Exome sequencing of the sibling’s family revealed TBX2 as a possible modifier of gonadal development in patients with NR5A1 mutations.
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Affiliation(s)
- Ralf Werner
- Department of Paediatrics and Adolescent Medicine, Division of Experimental Paediatric Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - Isabel Mönig
- Department of Paediatrics and Adolescent Medicine, Division of Experimental Paediatric Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - Ralf Lünstedt
- Department of Paediatrics and Adolescent Medicine, Division of Experimental Paediatric Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - Lutz Wünsch
- Department of Paediatric Surgery, University Hospital of Lübeck, Germany
| | - Christoph Thorns
- Department of Pathology, University Hospital of Lübeck, Lübeck, Germany
| | - Benedikt Reiz
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Alexandra Krause
- Department of Paediatrics and Adolescent Medicine, Paediatric Endocrinology and Diabetes, University Hospital Freiburg, Freiburg, Germany
| | - Karl Otfried Schwab
- Department of Paediatrics and Adolescent Medicine, Paediatric Endocrinology and Diabetes, University Hospital Freiburg, Freiburg, Germany
| | - Gerhard Binder
- Department of Paediatrics and Adolescent Medicine, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | - Paul-Martin Holterhus
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Christian-Albrechts-University, Kiel, Germany
| | - Olaf Hiort
- Department of Paediatrics and Adolescent Medicine, Division of Experimental Paediatric Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- * E-mail:
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16
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Colson C, Aubry E, Cartigny M, Rémy AA, Franquet H, Leroy X, Kéchid G, Lefèvre C, Besson R, Cools M, Spinoit A, Sultan C, Manouvrier S, Philibert P, Ghoumid J. SF1 and spleen development: new heterozygous mutation, literature review and consequences for NR5A1-
mutated patient's management. Clin Genet 2017; 92:99-103. [DOI: 10.1111/cge.12957] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 11/26/2022]
Affiliation(s)
- C. Colson
- CHU Lille; Clinique de Génétique Guy Fontaine; Lille France
- EA 7364, RADEME, Maladies RAres du Développement et du Métabolisme: du phénotype au génotype et à la Fonction; Université de Lille; Lille France
| | - E. Aubry
- CHU Lille; Service de Chirurgie Viscérale Pédiatrique; Lille France
| | - M. Cartigny
- EA 7364, RADEME, Maladies RAres du Développement et du Métabolisme: du phénotype au génotype et à la Fonction; Université de Lille; Lille France
- CHU Lille; Service d'Endocrinologie Pédiatrique; Lille France
| | - A.-A. Rémy
- CHU Lille; Clinique de Génétique Guy Fontaine; Lille France
- CHU Lille; Service d'Endocrinologie Pédiatrique; Lille France
| | - H. Franquet
- CHU Lille; Institut de pathologie; Lille France
| | - X. Leroy
- EA 7364, RADEME, Maladies RAres du Développement et du Métabolisme: du phénotype au génotype et à la Fonction; Université de Lille; Lille France
- CHU Lille; Institut de pathologie; Lille France
| | - G. Kéchid
- CHU Lille; Pédopsychiatrie; Lille France
| | - C. Lefèvre
- CHU Lille; Service d'Endocrinologie Pédiatrique; Lille France
| | - R. Besson
- CHU Lille; Service de Chirurgie Viscérale Pédiatrique; Lille France
| | - M. Cools
- Endocrinologie & Diabetologie voor kinderen en adolescenten; Universitair Ziekenhuis Gent; Belgium
| | | | - C. Sultan
- Département de Biochimie et Hormonologie; CHU Montpellier; France
- Université de Montpellier; CNRS UPR 1142 Institut de génétique Humaine, Equipe “Développement et Pathologie de la Gonade”; Montpellier France
| | - S. Manouvrier
- CHU Lille; Clinique de Génétique Guy Fontaine; Lille France
- EA 7364, RADEME, Maladies RAres du Développement et du Métabolisme: du phénotype au génotype et à la Fonction; Université de Lille; Lille France
| | - P. Philibert
- Département de Biochimie et Hormonologie; CHU Montpellier; France
- Université de Montpellier; CNRS UPR 1142 Institut de génétique Humaine, Equipe “Développement et Pathologie de la Gonade”; Montpellier France
| | - J. Ghoumid
- CHU Lille; Clinique de Génétique Guy Fontaine; Lille France
- EA 7364, RADEME, Maladies RAres du Développement et du Métabolisme: du phénotype au génotype et à la Fonction; Université de Lille; Lille France
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17
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Bashamboo A, McElreavey K. Mechanism of Sex Determination in Humans: Insights from Disorders of Sex Development. Sex Dev 2016; 10:313-325. [DOI: 10.1159/000452637] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 12/13/2022] Open
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18
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Fabbri HC, Ribeiro de Andrade JG, Maciel-Guerra AT, Guerra-Júnior G, de Mello MP. NR5A1 Loss-of-Function Mutations Lead to 46,XY Partial Gonadal Dysgenesis Phenotype: Report of Three Novel Mutations. Sex Dev 2016; 10:191-199. [DOI: 10.1159/000448013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Indexed: 11/19/2022] Open
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19
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Tuhan H, Anik A, Catli G, Onay H, Aykut A, Abaci A, Bober E. A novel mutation in steroidogenic factor (SF1/NR5A1) gene in a patient with 46 XY DSD without adrenal insufficiency. Andrologia 2016; 49. [PMID: 27135758 DOI: 10.1111/and.12589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 11/30/2022] Open
Abstract
Steroidogenic factor-1 (SF-1), also known as nuclear receptor subfamily 5 group A member 1 (NR5A1), is a member of orphan receptor subfamily and located on chromosome 9 (9q33). In 46, XY individuals with mutation of SF-1 gene, adrenal failure, testis dysgenesis, androgen synthesis defects, hypospadias and anorchia with microphallus, infertility can occur from severe to mild. We report a case of a 20-day-old male who is admitted to our clinic due to ambiguous genitalia. In this report, we describe a novel heterozygous c.814A > C (p. T272P) NR5A1 mutation in a patient with 46, XY DSD without adrenal insufficiency. We describe a novel missense mutation c.814A > C (p. T272P) in NR5A1 gene which had not previously been reported. Also this report highlights that the potential diagnostic utility of next-generation sequencing is an effective strategy versus Sanger sequencing to identify genetic mosaicism in clinical practice.
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Affiliation(s)
- H Tuhan
- Department of Pediatric Endocrinology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - A Anik
- Department of Pediatric Endocrinology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - G Catli
- Department of Pediatric Endocrinology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - H Onay
- Department of Medical Genetics, School of Medicine, Ege University, Izmir, Turkey
| | - A Aykut
- Department of Medical Genetics, School of Medicine, Ege University, Izmir, Turkey
| | - A Abaci
- Department of Pediatric Endocrinology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - E Bober
- Department of Pediatric Endocrinology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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20
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De Paula GB, Barros BA, Carpini S, Tincani BJ, Mazzola TN, Sanches Guaragna M, Piveta CSDC, de Oliveira LC, Andrade JGR, Guaragna-Filho G, Barbieri PP, Ferreira NM, Miranda ML, Gonçalves EM, Morcillo AM, Viguetti-Campos NL, Lemos-Marini SHV, Silva RBDP, Marques-de-Faria AP, De Mello MP, Maciel-Guerra AT, Guerra-Junior G. 408 Cases of Genital Ambiguity Followed by Single Multidisciplinary Team during 23 Years: Etiologic Diagnosis and Sex of Rearing. Int J Endocrinol 2016; 2016:4963574. [PMID: 28018429 PMCID: PMC5149677 DOI: 10.1155/2016/4963574] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. To evaluate diagnosis, age of referral, karyotype, and sex of rearing of cases with disorders of sex development (DSD) with ambiguous genitalia. Methods. Retrospective study during 23 years at outpatient clinic of a referral center. Results. There were 408 cases; 250 (61.3%) were 46,XY and 124 (30.4%) 46,XX and 34 (8.3%) had sex chromosomes abnormalities. 189 (46.3%) had 46,XY testicular DSD, 105 (25.7%) 46,XX ovarian DSD, 95 (23.3%) disorders of gonadal development (DGD), and 19 (4.7%) complex malformations. The main etiology of 46,XX ovarian DSD was salt-wasting 21-hydroxylase deficiency. In 46,XX and 46,XY groups, other malformations were observed. In the DGD group, 46,XY partial gonadal dysgenesis, mixed gonadal dysgenesis, and ovotesticular DSD were more frequent. Low birth weight was observed in 42 cases of idiopathic 46,XY testicular DSD. The average age at diagnosis was 31.7 months. The final sex of rearing was male in 238 cases and female in 170. Only 6.6% (27 cases) needed sex reassignment. Conclusions. In this large DSD sample with ambiguous genitalia, the 46,XY karyotype was the most frequent; in turn, congenital adrenal hyperplasia was the most frequent etiology. Malformations associated with DSD were common in all groups and low birth weight was associated with idiopathic 46,XY testicular DSD.
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Affiliation(s)
- Georgette Beatriz De Paula
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Beatriz Amstalden Barros
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Stela Carpini
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Department of Pediatrics, FCM, UNICAMP, Campinas, SP, Brazil
| | - Bruna Jordan Tincani
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Tais Nitsch Mazzola
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), FCM, UNICAMP, Campinas, SP, Brazil
- Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering (CBMEG), UNICAMP, Campinas, SP, Brazil
| | - Mara Sanches Guaragna
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering (CBMEG), UNICAMP, Campinas, SP, Brazil
| | - Cristiane Santos da Cruz Piveta
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering (CBMEG), UNICAMP, Campinas, SP, Brazil
| | - Laurione Candido de Oliveira
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Laboratory of Clinical Pathology, Clinical Hospital, FCM, UNICAMP, Campinas, SP, Brazil
| | - Juliana Gabriel Ribeiro Andrade
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Guilherme Guaragna-Filho
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Pedro Perez Barbieri
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), FCM, UNICAMP, Campinas, SP, Brazil
| | - Nathalia Montibeler Ferreira
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), FCM, UNICAMP, Campinas, SP, Brazil
| | - Marcio Lopes Miranda
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Pediatric Surgery, Department of Surgery, FCM, UNICAMP, Campinas, SP, Brazil
| | - Ezequiel Moreira Gonçalves
- Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), FCM, UNICAMP, Campinas, SP, Brazil
| | - Andre Moreno Morcillo
- Department of Pediatrics, FCM, UNICAMP, Campinas, SP, Brazil
- Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), FCM, UNICAMP, Campinas, SP, Brazil
| | | | - Sofia Helena Valente Lemos-Marini
- Department of Pediatrics, FCM, UNICAMP, Campinas, SP, Brazil
- Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), FCM, UNICAMP, Campinas, SP, Brazil
| | - Roberto Benedito de Paiva Silva
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Antonia Paula Marques-de-Faria
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Department of Medical Genetics, FCM, UNICAMP, Campinas, SP, Brazil
| | - Maricilda Palandi De Mello
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering (CBMEG), UNICAMP, Campinas, SP, Brazil
| | - Andrea Trevas Maciel-Guerra
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Department of Medical Genetics, FCM, UNICAMP, Campinas, SP, Brazil
| | - Gil Guerra-Junior
- Interdisciplinary Group of Study of Sex Determination and Differentiation (GIEDDS), School of Medicine (FCM), State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Department of Pediatrics, FCM, UNICAMP, Campinas, SP, Brazil
- Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), FCM, UNICAMP, Campinas, SP, Brazil
- *Gil Guerra-Junior:
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21
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Tremblay JJ. Molecular regulation of steroidogenesis in endocrine Leydig cells. Steroids 2015; 103:3-10. [PMID: 26254606 DOI: 10.1016/j.steroids.2015.08.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/19/2015] [Accepted: 08/04/2015] [Indexed: 02/06/2023]
Abstract
Steroid hormones regulate essential physiological processes and inadequate levels are associated with various pathological conditions. Consequently, the process of steroid hormone biosynthesis is finely regulated. In the testis, the main steroidogenic cells are the Leydig cells. There are two distinct populations of Leydig cells that arise during development: fetal and adult Leydig cells. Fetal Leydig cells are responsible for masculinizing the male urogenital tract and inducing testis descent. These cells atrophy shortly after birth and do not contribute to the adult Leydig cell population. Adult Leydig cells derive from undifferentiated precursors present after birth and become fully steroidogenic at puberty. The differentiation of both Leydig cell populations is controlled by locally produced paracrine factors and by endocrine hormones. In fully differentially and steroidogenically active Leydig cells, androgen production and hormone-responsiveness involve various signaling pathways and downstream transcription factors. This review article focuses on recent developments regarding the origin and function of Leydig cells, the regulation of their differentiation by signaling molecules, hormones, and structural changes, the signaling pathways, kinases, and transcription factors involved in their differentiation and in mediating LH-responsiveness, as well as the fine-tuning mechanisms that ensure adequate production steroid hormones.
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Affiliation(s)
- Jacques J Tremblay
- Reproduction, Mother and Child Health, Centre de recherche du centre hospitalier universitaire de Québec, Québec City, Québec G1V 4G2, Canada; Centre for Research in Biology of Reproduction, Department of Obstetrics, Gynaecology, and Reproduction, Faculty of Medicine, Université Laval, Québec City, Québec G1V 0A6, Canada.
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22
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Abstract
The adrenal gland consists of two distinct parts, the cortex and the medulla. Molecular mechanisms controlling differentiation and growth of the adrenal gland have been studied in detail using mouse models. Knowledge also came from investigations of genetic disorders altering adrenal development and/or function. During embryonic development, the adrenal cortex acquires a structural and functional zonation in which the adrenal cortex is divided into three different steroidogenic zones. Significant progress has been made in understanding adrenal zonation. Recent lineage tracing experiments have accumulated evidence for a centripetal differentiation of adrenocortical cells from the subcapsular area to the inner part of the adrenal cortex. Understanding of the mechanism of adrenocortical cancer (ACC) development was stimulated by knowledge of adrenal gland development. ACC is a rare cancer with a very poor overall prognosis. Abnormal activation of the Wnt/β-catenin as well as the IGF2 signaling plays an important role in ACC development. Studies examining rare genetic syndromes responsible for familial ACT have played an important role in identifying genetic alterations in these tumors (like TP53 or CTNNB1 mutations as well as IGF2 overexpression). Recently, genomic analyses of ACT have shown gene expression profiles associated with malignancy as well as chromosomal and methylation alterations in ACT and exome sequencing allowed to describe the mutational landscape of these tumors. This progress leads to a new classification of these tumors, opening new perspectives for the diagnosis and prognostication of ACT. This review summarizes current knowledge of adrenocortical development, growth, and tumorigenesis.
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Affiliation(s)
- Lucile Lefèvre
- Inserm, U1016, Institut Cochin, Paris, France Cnrs, UMR8104, Paris, France Université Paris Descartes, Sorbonne Paris Cité, France Department of Endocrinology, Referral Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
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23
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Pedace L, Laino L, Preziosi N, Valentini MS, Scommegna S, Rapone AM, Guarino N, Boscherini B, De Bernardo C, Marrocco G, Majore S, Grammatico P. Longitudinal hormonal evaluation in a patient with disorder of sexual development, 46,XY karyotype and oneNR5A1mutation. Am J Med Genet A 2014; 164A:2938-46. [DOI: 10.1002/ajmg.a.36729] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/09/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Lucia Pedace
- Medical Genetics, Department of Molecular Medicine; Sapienza University, S. Camillo-Forlanini Hospital; Rome Italy
| | - Luigi Laino
- Medical Genetics, Department of Molecular Medicine; Sapienza University, S. Camillo-Forlanini Hospital; Rome Italy
| | - Nicoletta Preziosi
- Medical Genetics, Department of Molecular Medicine; Sapienza University, S. Camillo-Forlanini Hospital; Rome Italy
| | - Maria Stella Valentini
- Medical Genetics, Department of Molecular Medicine; Sapienza University, S. Camillo-Forlanini Hospital; Rome Italy
| | - Salvatore Scommegna
- Pediatrics and Pediatric Hematology, S. Camillo-Forlanini Hospital; Rome Italy
| | - Anna Maria Rapone
- Medical Genetics, Department of Molecular Medicine; Sapienza University, S. Camillo-Forlanini Hospital; Rome Italy
| | - Nino Guarino
- Pediatric Surgery; S. Camillo-Forlanini Hospital; Rome Italy
| | | | - Carmelilia De Bernardo
- Medical Genetics, Department of Molecular Medicine; Sapienza University, S. Camillo-Forlanini Hospital; Rome Italy
| | | | - Silvia Majore
- Medical Genetics, Department of Molecular Medicine; Sapienza University, S. Camillo-Forlanini Hospital; Rome Italy
| | - Paola Grammatico
- Medical Genetics, Department of Molecular Medicine; Sapienza University, S. Camillo-Forlanini Hospital; Rome Italy
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Gabriel Ribeiro de Andrade J, Marques-de-Faria AP, Fabbri HC, de Mello MP, Guerra-Júnior G, Maciel-Guerra AT. Long-Term Follow-Up of Patients with 46,XY Partial Gonadal Dysgenesis Reared as Males. Int J Endocrinol 2014; 2014:480724. [PMID: 25580123 PMCID: PMC4279723 DOI: 10.1155/2014/480724] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/31/2014] [Accepted: 11/28/2014] [Indexed: 01/26/2023] Open
Abstract
Background/Aims. Studies on 46,XY partial gonadal dysgenesis (PGD) have focused on molecular, gonadal, genital, and hormone features; little is known about follow-up. Our aim was to analyze long-term outcomes of PGD. Methods. Retrospective longitudinal study conducted at a reference service in Brazil. Ten patients were first evaluated in the 1990s and followed up until the 2010s; follow-up ranged from 13.5 to 19.7 years. All were reared as males and had at least one scrotal testis; two bore NR5A1 mutations. Main outcomes were: associated conditions, pubertal development, and growth. Results. All patients had normal motor development but three presented cognitive impairment; five had various associated conditions. At the end of the prepubertal period, FSH was high or high-normal in 3/6 patients; LH was normal in all. At the last evaluation, FSH was high or high-normal in 8/10; LH was high or high-normal in 5/10; testosterone was decreased in one. Final height in nine cases ranged from -1.57 to 0.80 SDS. All had spontaneous puberty; only one needed androgen therapy. Conclusions. There is good prognosis for growth and spontaneous pubertal development but not for fertility. Though additional studies are required, screening for learning disabilities is advisable.
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Affiliation(s)
- Juliana Gabriel Ribeiro de Andrade
- Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo 126, 13083-887 Campinas, SP, Brazil
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas, Campinas, SP, Brazil
| | - Antonia Paula Marques-de-Faria
- Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo 126, 13083-887 Campinas, SP, Brazil
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas, Campinas, SP, Brazil
| | - Helena Campos Fabbri
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas, Campinas, SP, Brazil
- Center for Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas, Campinas, SP, Brazil
| | - Maricilda Palandi de Mello
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas, Campinas, SP, Brazil
- Center for Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas, Campinas, SP, Brazil
| | - Gil Guerra-Júnior
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas, Campinas, SP, Brazil
- Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Andréa Trevas Maciel-Guerra
- Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo 126, 13083-887 Campinas, SP, Brazil
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas, Campinas, SP, Brazil
- *Andréa Trevas Maciel-Guerra:
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