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Jiali C, Huifang P, Yuqing J, Xiantao Z, Hongwei J. Worldwide cohort study of 46, XY differences/disorders of sex development genetic diagnoses: geographic and ethnic differences in variants. Front Genet 2024; 15:1387598. [PMID: 38915825 PMCID: PMC11194351 DOI: 10.3389/fgene.2024.1387598] [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: 02/26/2024] [Accepted: 05/14/2024] [Indexed: 06/26/2024] Open
Abstract
Differences/disorders of sex development (DSDs) in individuals with a 46, XY karyotype are a group of congenital disorders that manifest as male gonadal hypoplasia or abnormalities of the external genitalia. Approximately 50% of patients with 46, XY DSDs cannot obtain a molecular diagnosis. The aims of this paper were to review the most common causative genes and rare genes in patients with 46, XY DSDs, analyze global molecular diagnostic cohorts for the prevalence and geographic distribution of causative genes, and identify the factors affecting cohort detection results. Although the spectrum of genetic variants varies across regions and the severity of the clinical phenotype varies across patients, next-generation sequencing (NGS), the most commonly used detection method, can still reveal genetic variants and aid in diagnosis. A comparison of the detection rates of various sequencing modalities revealed that whole-exome sequencing (WES) facilitates a greater rate of molecular diagnosis of the disease than panel sequencing. Whole-genome sequencing (WGS), third-generation sequencing, and algorithm advancements will contribute to the improvement of detection efficiency. The most commonly mutated genes associated with androgen synthesis and action are AR, SR5A2, and HSD17B3, and the most commonly mutated genes involved in gonadal formation are NR5A1 and MAP3K1. Detection results are affected by differences in enrollment criteria and sequencing technologies.
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Affiliation(s)
- Chen Jiali
- Henan Key Laboratory of Rare Diseases, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Peng Huifang
- Henan Key Laboratory of Rare Diseases, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jiang Yuqing
- Henan Key Laboratory of Rare Diseases, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Zeng Xiantao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiang Hongwei
- Henan Key Laboratory of Rare Diseases, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
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Jiang W, Yu J, Mao Y, Tang Y, Cao L, Du Q, Li J, Yang J. Identification and functional analysis of a rare variant of gene DHX37 in a patient with 46,XY disorders of sex development. Mol Genet Genomic Med 2024; 12:e2453. [PMID: 38769888 PMCID: PMC11106588 DOI: 10.1002/mgg3.2453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/20/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND 46,XY sex reversal 11 (SRXY11) [OMIM#273250] is characterized by genital ambiguity that may range from mild male genital defects to gonadal sex reversal in severe cases. DHX37 is an RNA helicase that has recently been reported as a cause of SRXY11. So far, a total of 21 variants in DHX37 have been reported in 58 cases with 46,XY disorders of sex development (DSD). METHODS Whole exome sequencing (WES) was conducted to screen for variations in patients with 46,XY DSD. The subcellular localization of mutant DHX37 proteins was detected by immunofluorescence. And the levels of mutant DHX37 proteins were detected via Western blotting. RESULTS A novel pathogenic variant of DHX37 was identified in a patient with 46,XY DSD c.2012G > C (p.Arg671Thr). Bioinformatics analysis showed that the protein function of the variant was impaired. Compared with the structure of the wild-type DHX37 protein, the number of hydrogen bonds and interacting amino acids of the variant protein were changed to varying degrees. In vitro assays revealed that the variant had no significant effect on the intracellular localization of the protein but significantly reduced the expression level of the protein. CONCLUSIONS Our finding further expands the spectrum of the DHX37 variant and could assist in the molecular diagnosis of 46,XY DSD patients.
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Affiliation(s)
- Wei Jiang
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Centre for Medical Genetics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical SciencesChengduChina
| | - Jing Yu
- Meishan Women and Children's HospitalAlliance Hospital of West China Second University Hospital, Sichuan UniversityMeishanChina
| | - Yu Mao
- Department of Pediatric Surgery, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Yunman Tang
- Department of Pediatric Surgery, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Li Cao
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Centre for Medical Genetics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical SciencesChengduChina
| | - Qin Du
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Centre for Medical Genetics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical SciencesChengduChina
| | - Jianan Li
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Centre for Medical Genetics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical SciencesChengduChina
| | - Jiyun Yang
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Centre for Medical Genetics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical SciencesChengduChina
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Fujisawa Y, Masunaga Y, Tanikawa W, Nakashima S, Ueda D, Sano S, Fukami M, Saitsu H, Yazawa T, Ogata T. Serum steroid metabolite profiling by LC-MS/MS in two phenotypic male patients with HSD17B3 deficiency: Implications for hormonal diagnosis. J Steroid Biochem Mol Biol 2023; 234:106403. [PMID: 37741351 DOI: 10.1016/j.jsbmb.2023.106403] [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] [Received: 07/04/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 09/25/2023]
Abstract
Although 17β-hydroxysteroid dehydrogenase type 3 (HSD17B3) deficiency is diagnosed when a testosterone/androstenedione (T/A-dione) ratio after human chorionic gonadotropin (hCG) stimulation is below 0.8, this cut-off value is primarily based on hormonal data measured by conventional immunoassay (IA) in patients with feminized or ambiguous genitalia. We examined two 46,XY Japanese patients with undermasculinized genitalia including hypospadias (patient 1 and patient 2). Endocrine studies by IA showed well increased serum T value after hCG stimulation (2.91 ng/mL) and a high T/A-dione ratio (4.04) in patient 1 at 2 weeks of age and sufficiently elevated basal serum T value (2.60 ng/mL) in patient 2 at 1.5 months of age. Despite such partial androgen insensitivity syndrome-like findings, whole exome sequencing identified biallelic ″pathogenic″ or ″likely pathogenic″ variants in HSD17B3 (c .188 C>T:p.(Ala63Val) and c .194 C>T:p.(Ser65Leu) in patient 1, and c.139 A>G:p.(Met47Val) and c.672 + 1 G>A in patient 2) (NM_000197.2), and functional analysis revealed reduced HSD17B3 activities of the missense variants (∼ 43% for p.Met47Val, ∼ 14% for p.Ala63Val, and ∼ 0% for p.Ser65Leu). Thus, we investigated hCG-stimulated serum steroid metabolite profiles by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in patient 1 at 7 months of age and in patient 2 at 11 months of age as well as in five control males with idiopathic micropenis aged 1 - 8 years, and found markedly high T/A-dione ratios (12.3 in patient 1 and 5.4 in patient 2) which were, however, obviously lower than those in the control boys (25.3 - 56.1) and sufficiently increased T values comparable to those of control males. The elevated T/A-dione ratios are considered be due to the residual HSD17B3 function and the measurement by LC-MS/MS. Thus, it is recommended to establish the cut-off value for the T/A-dione ratio according to the phenotypic sex reflecting the residual function and the measurement method.
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Affiliation(s)
- Yasuko Fujisawa
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Yohei Masunaga
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Regional Medical Care Support, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Wataru Tanikawa
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shinichi Nakashima
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Ueda
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shinichiro Sano
- Department of Pediatric Endocrinology and Metabolism, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Maki Fukami
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hirotomo Saitsu
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takashi Yazawa
- Department of Biochemistry, Asahikawa Medical University, Asahikawa, Japan
| | - Tsutomu Ogata
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Pediatrics, Hamamatsu Medical Center, Hamamatsu, Japan.
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Faradz SMH, Listyasari N, Utari A, Ariani MD, Juniarto AZ, Santosa A, Ediati A, Rinne TK, Westra D, Claahsen-van der Grinten H, de Jong FH, Drop SLS, Ayers K, Sinclair A. Lessons Learned from 17 Years of Multidisciplinary Care for Differences of Sex Development Patients at a Single Indonesian Center. Sex Dev 2023; 17:170-180. [PMID: 37699373 PMCID: PMC11232949 DOI: 10.1159/000534085] [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: 08/07/2022] [Accepted: 09/08/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Our multidisciplinary team (MDT) is a large specialized team based in Semarang, Indonesia, that cares for a wide variety of pediatric and adult individuals with differences of sex development (DSD) from across Indonesia. Here, we describe our work over the last 17 years. METHODS We analyzed phenotypic, hormonal, and genetic findings from clinical records for all patients referred to our MDT during the period 2004-2020. RESULTS Among 1,184 DSD patients, 10% had sex chromosome DSD, 67% had 46,XY DSD, and 23% had 46,XX DSD. The most common sex chromosome anomaly was Turner syndrome (45,X) (55 cases). For patients with 46,XY DSD under-masculinization was the most common diagnosis (311 cases), and for 46,XX DSD, a defect of Müllerian development was most common (131 cases) followed by congenital adrenal hyperplasia (CAH) (116 cases). Sanger sequencing, MLPA, and targeted gene sequencing of 257 patients with 46,XY DSD found likely causative variants in 21% (55 cases), with 13 diagnostic genes implicated. The most affected gene codes for the androgen receptor. Molecular analysis identified a diagnosis for 69 of 116 patients with CAH, with 62 carrying variants in CYP21A2 including four novel variants, and 7 patients carrying variants in CYP11B1. In many cases, these genetic diagnoses influenced the clinical management of patients and their families. CONCLUSIONS Our work has highlighted the occurrence of different DSDs in Indonesia. By applying sequencing technologies as part of our clinical care, we have delivered a number of genetic diagnoses and identified novel pathogenic variants in some genes, which may be clinically specific to Indonesia. Genetics can inform many aspects of DSD clinical management, and while many of our patients remain undiagnosed, we hope that future testing may provide answers for even more.
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Affiliation(s)
- Sultana M H Faradz
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro/Diponegoro National Hospital, Semarang, Indonesia
- Post Graduate School, Universitas YARSI, Jakarta, Indonesia
| | - Nurin Listyasari
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro/Diponegoro National Hospital, Semarang, Indonesia,
| | - Agustini Utari
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro/Diponegoro National Hospital, Semarang, Indonesia
- Department of Pediatrics, Diponegoro National Hospital/Dr. Kariadi Hospital, Semarang, Indonesia
| | - Mahayu Dewi Ariani
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro/Diponegoro National Hospital, Semarang, Indonesia
| | - Achmad Zulfa Juniarto
- Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro/Diponegoro National Hospital, Semarang, Indonesia
| | - Ardy Santosa
- Department of Urology, Dr. Kariadi Hospital, Semarang, Indonesia
| | | | - Tuula K Rinne
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dineke Westra
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Frank H de Jong
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Stenvert L S Drop
- Division of Endocrinology, Department of Pediatrics, Sophia Children's Hospital/Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Katie Ayers
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Sinclair
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Johnson EK, Whitehead J, Cheng EY. Differences of Sex Development: Current Issues and Controversies. Urol Clin North Am 2023; 50:433-446. [PMID: 37385705 DOI: 10.1016/j.ucl.2023.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Differences of sex development (DSD) encompass a broad range of conditions in which the development of chromosomal, gonadal, or anatomic sex is not typically male or female. Terms used to describe DSD are controversial, and continuously evolving. An individualized, multidisciplinary approach is key to both the diagnosis and management of DSD. Recent advances in DSD care include expanded genetic testing options, a more nuanced approach to gonadal management, and an emphasis on shared decision-making, particularly related to external genital surgical procedures. The timing of DSD surgery is currently being questioned and debated in both medical and advocacy/activism spheres.
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Affiliation(s)
- Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 2300, Chicago, IL, 60611, USA.
| | - Jax Whitehead
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 54, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 86, Chicago, IL 60611, USA
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 2300, Chicago, IL, 60611, USA
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Correa Brito L, Grinspon RP, Lopez Dacal J, Scaglia P, Esnaola Azcoiti M, Izquierdo A, Ropelato MG, Rey RA. Identification of a Novel Variant in Myelin Regulatory Growth Factor by Next-Generation Sequencing Led to the Detection of a Clinically Inapparent Congenital Heart Defect in a Patient with a 46,XY Disorder of Sex Development. J Pers Med 2023; 13:1158. [PMID: 37511771 PMCID: PMC10381246 DOI: 10.3390/jpm13071158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
In patients with 46,XY disorders of sex development (DSDs), next-generation sequencing (NGS) has high diagnostic efficiency. One contribution to this diagnostic approach is the possibility of applying reverse phenotyping when a variant in a gene associated with multiple organ hits is found. Our aim is to report a case of a patient with 46,XY DSDs in whom the identification of a novel variant in MYRF led to the detection of a clinically inapparent congenital heart defect. A full-term newborn presented with ambiguous genitalia, as follows: a 2 cm phallus, penoscrotal hypospadias, partially fused labioscrotal folds, an anogenital distance of 1.2 cm, and non-palpable gonads. The karyotype was 46,XY, serum testosterone and AMH were low, whereas LH and FSH were high, leading to the diagnosis of dysgenetic DSD. Whole exome sequencing identified a novel, heterozygous, nonsense variant in MYRF, classified as pathogenic according to the ACMG criteria. MYRF encodes a membrane-bound transcriptional factor expressed in several tissues associated with OCUGS syndrome (ophthalmic, cardiac, and urogenital anomalies). In the patient, oriented clinical assessment ruled out ophthalmic defects, but ultrasonography confirmed meso/dextrocardia. We report a novel MYRF variant in a patient with 46,XY DSDs, allowing us to identify a clinically inapparent congenital heart defect by reverse phenotyping.
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Affiliation(s)
- Lourdes Correa Brito
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, Buenos Aires C1425EFD, Argentina
| | - Romina P Grinspon
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, Buenos Aires C1425EFD, Argentina
| | - Jimena Lopez Dacal
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, Buenos Aires C1425EFD, Argentina
| | - Paula Scaglia
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, Buenos Aires C1425EFD, Argentina
- Unidad de Medicina Traslacional, Hospital de Niños Ricardo Gutiérrez, Buenos Aires C1425EFD, Argentina
| | - María Esnaola Azcoiti
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, Buenos Aires C1425EFD, Argentina
- Unidad de Medicina Traslacional, Hospital de Niños Ricardo Gutiérrez, Buenos Aires C1425EFD, Argentina
| | - Agustín Izquierdo
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, Buenos Aires C1425EFD, Argentina
- Unidad de Medicina Traslacional, Hospital de Niños Ricardo Gutiérrez, Buenos Aires C1425EFD, Argentina
| | - María Gabriela Ropelato
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, Buenos Aires C1425EFD, Argentina
- Unidad de Medicina Traslacional, Hospital de Niños Ricardo Gutiérrez, Buenos Aires C1425EFD, Argentina
| | - Rodolfo A Rey
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, Buenos Aires C1425EFD, Argentina
- Unidad de Medicina Traslacional, Hospital de Niños Ricardo Gutiérrez, Buenos Aires C1425EFD, Argentina
- Departamento de Histología, Biología Celular, Embriología y Genética Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires C1121ABG, Argentina
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de Oliveira FR, Mazzola TN, de Mello MP, Francese-Santos AP, Lemos-Marini SHVD, Maciel-Guerra AT, Hiort O, Werner R, Guerra-Junior G, Fabbri-Scallet H. DHX37 and NR5A1 Variants Identified in Patients with 46,XY Partial Gonadal Dysgenesis. Life (Basel) 2023; 13:life13051093. [PMID: 37240737 DOI: 10.3390/life13051093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
The group of disorders known as 46,XY gonadal dysgenesis (GD) is characterized by anomalies in testis determination, including complete and partial GD (PGD) and testicular regression syndrome (TRS). Several genes are known to be involved in sex development pathways, however approximately 50% of all cases remain elusive. Recent studies have identified variants in DHX37, a gene encoding a putative RNA helicase essential in ribosome biogenesis and previously associated with neurodevelopmental disorders, as a cause of PGD and TRS. To investigate the potential role of DHX37 in disorders of sexual development (DSD), 25 individuals with 46,XY DSD were analyzed and putative pathogenic variants were found in four of them. WES analyses were performed on these patients. In DHX37, the variant p.(Arg308Gln), recurrent associated with DSD, was identified in one patient; the p.(Leu467Val), predicted to be deleterious, was found together with an NR5A1 loss-of-function variant in patient 2; and, the p.(Val999Met) was identified in two unrelated patients, one of whom (patient 3) also carried a pathogenic NR5A1 variant. For both patients carrying DHX37 and NR5A1 pathogenic variants, a digenic inheritance is suggested. Our findings support the importance of DHX37 variants as a cause of disorders of sex development, implying a role in testis development.
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Affiliation(s)
- Felipe Rodrigues de Oliveira
- Center for Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Campinas 13083-875, Brazil
- Postgraduate Program in Child and Adolescent Health, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
| | - Taís Nitsch Mazzola
- Center for Investigation in Paediatric, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
| | - Maricilda Palandi de Mello
- Center for Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Campinas 13083-875, Brazil
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
| | - Ana Paula Francese-Santos
- Department of Translational Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
| | - Sofia Helena V de Lemos-Marini
- Department of Pediatrics, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
| | - Andrea Trevas Maciel-Guerra
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
- Department of Translational Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
| | - Olaf Hiort
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatric and Adolescent Medicine, University of Lübeck, 23562 Lübeck, Germany
| | - Ralf Werner
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatric and Adolescent Medicine, University of Lübeck, 23562 Lübeck, Germany
- Institute of Molecular Medicine, University of Lübeck, 23562 Lübeck, Germany
| | - Gil Guerra-Junior
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
- Department of Pediatrics, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
| | - Helena Fabbri-Scallet
- Center for Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Campinas 13083-875, Brazil
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
- Department of Translational Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, Brazil
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8
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Hattori A, Fukami M. Nuclear Receptor Gene Variants Underlying Disorders/Differences of Sex Development through Abnormal Testicular Development. Biomolecules 2023; 13:691. [PMID: 37189438 PMCID: PMC10135730 DOI: 10.3390/biom13040691] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Gonadal development is the first step in human reproduction. Aberrant gonadal development during the fetal period is a major cause of disorders/differences of sex development (DSD). To date, pathogenic variants of three nuclear receptor genes (NR5A1, NR0B1, and NR2F2) have been reported to cause DSD via atypical testicular development. In this review article, we describe the clinical significance of the NR5A1 variants as the cause of DSD and introduce novel findings from recent studies. NR5A1 variants are associated with 46,XY DSD and 46,XX testicular/ovotesticular DSD. Notably, both 46,XX DSD and 46,XY DSD caused by the NR5A1 variants show remarkable phenotypic variability, to which digenic/oligogenic inheritances potentially contribute. Additionally, we discuss the roles of NR0B1 and NR2F2 in the etiology of DSD. NR0B1 acts as an anti-testicular gene. Duplications containing NR0B1 result in 46,XY DSD, whereas deletions encompassing NR0B1 can underlie 46,XX testicular/ovotesticular DSD. NR2F2 has recently been reported as a causative gene for 46,XX testicular/ovotesticular DSD and possibly for 46,XY DSD, although the role of NR2F2 in gonadal development is unclear. The knowledge about these three nuclear receptors provides novel insights into the molecular networks involved in the gonadal development in human fetuses.
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Affiliation(s)
- Atsushi Hattori
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo 157-8535, Japan;
- Division of Diversity Research, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo 157-8535, Japan
| | - Maki Fukami
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo 157-8535, Japan;
- Division of Diversity Research, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo 157-8535, Japan
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Zhang D, Wang D, Tong Y, Li M, Meng L, Song Q, Xin Y. A novel c.64G > T (p.G22C) NR5A1 variant in a Chinese adolescent with 46,XY disorders of sex development: a case report. BMC Pediatr 2023; 23:182. [PMID: 37072715 PMCID: PMC10114376 DOI: 10.1186/s12887-023-03974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/27/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Adolescents with 46,XY disorders of sex development (DSD) face additional medical and psychological challenges. To optimize management and minimize hazards, correct and early clinical and molecular diagnosis is necessary. CASE PRESENTATION We report a 13-year-old Chinese adolescent with absent Müllerian derivatives and suspected testis in the inguinal area. History, examinations, and assistant examinations were available for clinical diagnosis of 46,XY DSD. The subsequent targeting specific disease-causing genes, comprising 360 endocrine disease-causing genes, was employed for molecular diagnosis. A novel variation in nuclear receptor subfamily 5 group A member 1 (NR5A1) [c.64G > T (p.G22C)] was identified in the patient. In vitro functional analyses of the novel variant suggested no impairment to NR5A1 mRNA or protein expression relative to wild-type, and immunofluorescence confirmed similar localization of NR5A1 mutant to the cell nucleus. However, we observed decreased DNA-binding affinity by the NR5A1 variant, while dual-luciferase reporter assays showed that the mutant effectively downregulated the transactivation capacity of anti-Müllerian hormone. We described a novel NR5A1 variant and demonstrated its adverse effects on the functional integrity of the NR5A1 protein resulting in serious impairment of its modulation of gonadal development. CONCLUSIONS This study adds one novel NR5A1 variant to the pool of pathogenic variants and enriches the adolescents of information available about the mutation spectrum of this gene in Chinese population.
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Affiliation(s)
- Dan Zhang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Dajia Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Yajie Tong
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Mingyu Li
- Department of Clinical Laboratory, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Lingzhe Meng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Qiutong Song
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Ying Xin
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China.
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10
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Man E, Mushtaq I, Barnicoat A, Carmichael P, Hughes CR, Davies K, Aitkenhead H, Amin R, Buchanan CR, Cherian A, Costa NJ, Creighton SM, Duffy PG, Hewson E, Hindmarsh PC, Monzani LC, Peters CJ, Ransley PG, Smeulders N, Spoudeas HA, Wood D, Hughes IA, Katugampola H, Brain CE, Dattani MT, Achermann JC. A Single-Center, Observational Study of 607 Children and Young People Presenting With Differences of Sex Development (DSD). J Endocr Soc 2022; 7:bvac165. [DOI: 10.1210/jendso/bvac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract
Context
Differences of sex development (DSD) represent a wide range of conditions presenting at different ages to various health professionals. Establishing a diagnosis, supporting the family, and developing a management plan are important.
Objective
We aimed to better understand the presentation and prevalence of pediatric DSD.
Methods
A retrospective, observational cohort study was undertaken in a single tertiary pediatric center of all children and young people (CYP) referred to a DSD multidisciplinary team over 25 years (1995-2019). In total, 607 CYP (520 regional referrals) were included. Data were analyzed for diagnosis, sex-assignment, age and mode of presentation, additional phenotypic features, mortality, and approximate point prevalence.
Results
Among the 3 major DSD categories, sex chromosome DSD was diagnosed in 11.2% (68/607) (most commonly 45,X/46,XY mosaicism), 46,XY DSD in 61.1% (371/607) (multiple diagnoses often with associated features), while 46,XX DSD occurred in 27.7% (168/607) (often 21-hydroxylase deficiency). Most children (80.1%) presented as neonates, usually with atypical genitalia, adrenal insufficiency, undescended testes or hernias. Those presenting later had diverse features. Rarely, the diagnosis was made antenatally (3.8%, n = 23) or following incidental karyotyping/family history (n = 14). Mortality was surprisingly high in 46,XY children, usually due to complex associated features (46,XY girls, 8.3%; 46,XY boys, 2.7%). The approximate point prevalence of neonatal referrals for investigation of DSD was 1 in 6347 births, and 1 in 5101 overall throughout childhood.
Conclusion
DSD represent a diverse range of conditions that can present at different ages. Pathways for expert diagnosis and management are important to optimize care.
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Affiliation(s)
- Elim Man
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London , London WC1N 1EH , UK
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital , Hong Kong SAR , People’s Republic of China
| | - Imran Mushtaq
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
| | - Angela Barnicoat
- Department of Clinical Genetics, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Polly Carmichael
- Department of Clinical Psychology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust , London NW3 5BA , UK
| | - Claire R Hughes
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London , London EC1M 6BQ , UK
| | - Kate Davies
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
- Institute of Health and Social Care, London South Bank University , London SE1 0AA , UK
| | - Helen Aitkenhead
- Department of Chemical Pathology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Rakesh Amin
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Charles R Buchanan
- Department of Child Health, King's College Hospital NHS Foundation Trust , London SE5 9RS , UK
| | - Abraham Cherian
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
| | - Nikola J Costa
- Department of Chemical Pathology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Sarah M Creighton
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust , London NW1 2BU , UK
| | - Patrick G Duffy
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
| | - Emma Hewson
- Department of Clinical Psychology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Peter C Hindmarsh
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
- Department of Paediatrics, University College London Hospitals NHS Foundation Trust , London NW1 2BU , UK
| | - Louisa C Monzani
- Department of Clinical Psychology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Catherine J Peters
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Philip G Ransley
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
| | - Naima Smeulders
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
| | - Helen A Spoudeas
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London , London WC1N 1EH , UK
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Dan Wood
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
- Department of Urology, University College London Hospitals NHS Foundation Trust , London NW1 2BU , UK
- Department of Urology, Children's Hospital Colorado and University of Colorado , Aurora, Colorado 80045 , USA
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge , Cambridge CB2 0QQ , UK
| | - Harshini Katugampola
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Caroline E Brain
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Mehul T Dattani
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London , London WC1N 1EH , UK
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - John C Achermann
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London , London WC1N 1EH , UK
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
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11
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Elias FM, Nishi MY, Sircili MHP, Bastista RL, Gomes NL, Ferrari MTM, Costa EMF, Denes FT, Mendonca BB, Domenice S. Elevated plasma miR-210 expression is associated with atypical genitalia in patients with 46,XY differences in sex development. Mol Genet Genomic Med 2022; 10:e2084. [PMID: 36369742 PMCID: PMC9747552 DOI: 10.1002/mgg3.2084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/09/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Differences of sex development (DSD) is a term used for conditions in which the chromosomal, gonadal or phenotypical sex is atypical. 46,XY DSD patients frequently present undervirilized external genitalia. The expression of different miRNAs in many organs of the male genital system has been reported, and these miRNAs have been associated with testicular function and its disorders, but no description has been related to DSD conditions. This study aimed to evaluate the plasma expression of miR-210 in 46,XY DSD patients who presented atypical genitalia at birth. METHODS Eighteen 46,XY DSD patients who presented atypical genitalia (undescended testis and/or hypospadias, bifid scrotum or micropenis) at birth and 36 male control individuals were selected. Plasma levels of miR-210 and reference miR-23a were measured using RT-qPCR and the data were analysed by the 2-ΔCt method. RESULTS MiR-210 plasma levels were significantly higher in 46,XY DSD patients with atypical genitalia than in male control subjects (p = 0.0024). A positive association between miR-210 levels and the presence of cryptorchidism and hypospadias (p = 0.0146 and p = 0.0223) was found in these patients. Significantly higher levels of miR-210 were observed in patients with 46,XY DSD and cryptorchidism than in control subjects (p = 0.0118). These results are in agreement with previous literature reports, in which increased levels of miR-210 expression were observed in human testicular tissue from adult males with undescended testes in comparison with samples of descended testes. CONCLUSION Our study showed a positive association between the presence of atypical genitalia and plasma levels of miR-210 expression in the group of patients with 46,XY DSD of unknown aetiology studied. These findings contribute to reveal a new perspective on the role of miRNAs in the development of male external genitalia and the broad spectrum of phenotypes presented by patients with 46,XY DSD.
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Affiliation(s)
- Felipe Martins Elias
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Mirian Yumi Nishi
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Maria Helena Palma Sircili
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil,Departamento de Urologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Rafael Loch Bastista
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Nathalia Lisboa Gomes
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Maria Tereza Martins Ferrari
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Elaine Maria Frade Costa
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Francisco Tibor Denes
- Departamento de Urologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Berenice Bilharinho Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Sorahia Domenice
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
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12
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Rey RA. Next-Generation Sequencing as First-Line Diagnostic Test in Patients With Disorders of Sex Development? J Clin Endocrinol Metab 2022; 107:e2628-e2629. [PMID: 35254448 DOI: 10.1210/clinem/dgac133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Rodolfo A Rey
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Histología, Embriología, Biología Celular y Genética, C1121ABG Buenos Aires, Argentina
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