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Hosomi SS, Salles IC, Bachega TASS. Mutation distributions among patients with congenital adrenal hyperplasia from five regions of Brazil: a systematic review. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:427-441. [PMID: 37011374 DOI: 10.20945/2359-3997000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is an autosomal recessive disorder caused by CYP21A2 gene mutations, and its molecular diagnosis is widely used in clinical practice to confirm the hormonal diagnosis. Hence, considering the miscegenation of the Brazilian population, it is important to determine a mutations panel to optimise the molecular diagnosis. The objective was to review the CYP21A2 mutations' distribution among Brazilian regions. Two reviewers screened Brazilian papers up to February 2020 in five databases. The pair-wise comparison test and Holm method were used in the statistical analysis. Nine studies were selected, comprising 769 patients from all regions. Low proportion of males and salt-wasters was identified in the North and Northeast regions, although without significant difference. Large gene rearrangements also had a low frequency, except in the Center-West and South regions (p < 0.05). The most frequent mutations were p.I172N, IVS2-13A/C>G, p.V281L and p.Q318X, and significant differences in their distributions were found: p.V281L was more frequent in the Southeast and p.Q318X in the Center-West and Northeast regions (p < 0.05). Thirteen new mutations were identified in 3.8%-15.2% of alleles, being more prevalent in the North region, and six mutations presented a founder effect gene. Genotype-phenotype correlation varied from 75.9%-97.3% among regions. The low prevalence of the salt-wasting form, affected males and severe mutations in some regions indicated pitfalls in the clinical diagnosis. The good genotype-phenotype correlation confirms the usefulness of molecular diagnosis; however, the Brazilian population also presents significant prevalence of novel mutations, which should be considered for a molecular panel.
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Essawi M, Mazen I, Fawaz L, Hassan H, ElBagoury N, Peter M, Gaafar K, Amer M, Nabil W, Hohmann G, Soliman H, Sippell W. Assessment of the most common CYP21A2 point mutations in a cohort of congenital adrenal hyperplasia patients from Egypt. J Pediatr Endocrinol Metab 2020; 33:893-900. [PMID: 32614782 DOI: 10.1515/jpem-2019-0575] [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: 12/13/2019] [Accepted: 05/08/2020] [Indexed: 11/15/2022]
Abstract
Objectives Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD) is a common autosomal recessive disorder caused by defects in the CYP21A2 gene. We aimed to determine the prevalence of the most commonly reported mutations among 21-OHD Egyptian patients and correlate genotype with phenotype. Methods Molecular analysis of the CYP21A2 gene was performed for the detection of the six most common point mutations (p.P30L, p.I172N, p.V281L, p.Q318X, the splice site mutation Int2 [IVS2-13A/C>G], and the cluster of three mutations [p.I236N, p.V237E, and p.M239K] designed as CL6). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was performed on 47 unrelated Egyptian 21α-OH deficiency patients and their available parents to detect the presence of the six most common point mutations. Results Screening for the six most common point mutations in CYP21A2 gene, revealed mutations in 87.2% (82/94) of the studied alleles corresponding to 47 Egyptian patients. The most common mutation among the studied cases was IVS2-13C/A>G that was found to be presented in a frequency of 46.8% (44/94). The genotype/phenotype correlations related to null, A, and B groups were with PPV of 100, 55.5, and 83.3%, respectively. Conclusions The described method diagnosed CAH in 80.8% of the studied patients. Good correlation between genotype and phenotype in salt wasting and simple virilizing forms is determined, whereas little concordance is seen in nonclassical one. Furthermore, studying the carrier frequency of 21-OHD among the normal population is of great importance.
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Affiliation(s)
- Mona Essawi
- Medical Molecular Genetics Department, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
| | - Inas Mazen
- Clinical Genetics Department, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
| | - Lubna Fawaz
- Diabetes, Endocrinology & Metabolic Pediatric Unit, Cairo University, Cairo, Egypt
| | - Heba Hassan
- Medical Molecular Genetics Department, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
| | - Nagham ElBagoury
- Medical Molecular Genetics Department, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
| | - Michael Peter
- Division of Paediatric Endocrinology & Diabetes, Department of Paediatrics, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Khadiga Gaafar
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Mahmoud Amer
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Wajeet Nabil
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Gisela Hohmann
- Division of Paediatric Endocrinology & Diabetes, Department of Paediatrics, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Hala Soliman
- Medical Molecular Genetics Department, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
| | - Wolfgang Sippell
- Division of Paediatric Endocrinology & Diabetes, Department of Paediatrics, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
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Prado MJ, de Castro SM, Kopacek C, de Mello MP, Rispoli T, Grandi T, da Silva CMD, Rossetti MLR. Development of CYP21A2 Genotyping Assay for the Diagnosis of Congenital Adrenal Hyperplasia. Mol Diagn Ther 2018; 21:663-675. [PMID: 28819757 DOI: 10.1007/s40291-017-0296-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Steroid 21-hydroxylase deficiency due to CYP21A2 gene mutations represents more than 90% of all congenital adrenal hyperplasia cases. This deficiency is screened by measuring levels of 17-hydroxyprogesterone, which may vary, causing false positive or false negative results. In order to assist the diagnosis, molecular methodologies have been employed. This work aimed to perform genotyping assays to detect mutations in the CYP21A2 gene and compare the findings with other population studies. METHODS The SNaPshot assay was developed to simultaneously detect 12 frequent point mutations in the CYP21A2 gene (p.Arg409Cys, p.Gln319Ter, p.Arg357Trp, p.Leu308PhefsTer6, p.Val237Glu, IVS2-13A/C > G, p.Ile173Asn, p.Pro31Leu, p.Pro454Ser, p.Val282Leu, p.Gly111ValfsTer21 and p.His63Leu). The direct sequencing and multiplex ligation-dependent probe amplification assays were used to confirm point mutations present in the developed method. The latter was also used to search large deletions and gene conversion, complementing the investigation. A total of 166 cases were studied. RESULTS The SNaPshot assay was successfully developed to detect the 12 mutations. The results of mutation analysis indicated 84 pathogenic alleles in 48 cases, with p.Val282Leu (27.1%) and IVS2-13A/C > G (20.8%) being the most frequently found mutations. Between the findings of this study and those of other South American studies, there were significant differences in frequency for p.Pro31Leu and p.Val282Leu (p < 0.001). A new variant T in IVS2-13A/C > G was identified in two patients via the SNaPshot assay. CONCLUSION The molecular strategy developed for CYP21A2 gene mutation screening allowed us to detect the principle mutations described around the world. Furthermore, the first Southern Brazilian mutation frequencies concerning the CYP21A2 gene were obtained.
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Affiliation(s)
- Mayara Jorgens Prado
- Departamento de Ação em Saúde, Centro de Desenvolvimento Científico e Tecnológico, Secretaria de Saúde do Rio Grande do Sul, Ipiranga Avenue 5400, Porto Alegre, CEP 90610-000, Brazil.,Universidade Federal do Rio Grande do Sul, Bento Gonçalves Avenue 9500, Porto Alegre, CEP 91501-970, Brazil
| | - Simone Martins de Castro
- Serviço de Referência em Triagem Neonatal, Hospital Materno Infantil Presidente Vargas, Independência Avenue 661, Porto Alegre, CEP 90035-074, Brazil.,Universidade Federal do Rio Grande do Sul, Bento Gonçalves Avenue 9500, Porto Alegre, CEP 91501-970, Brazil
| | - Cristiane Kopacek
- Serviço de Referência em Triagem Neonatal, Hospital Materno Infantil Presidente Vargas, Independência Avenue 661, Porto Alegre, CEP 90035-074, Brazil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Sarmento Leite Avenue 245, Porto Alegre, Rio Grande do Sul, CEP 90050-170, Brazil
| | - Maricilda Palandi de Mello
- Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Cândido Rondon Avenue 400, Campinas, CEP 13083-875, Brazil
| | - Thaiane Rispoli
- Departamento de Ação em Saúde, Centro de Desenvolvimento Científico e Tecnológico, Secretaria de Saúde do Rio Grande do Sul, Ipiranga Avenue 5400, Porto Alegre, CEP 90610-000, Brazil.,Universidade Federal do Rio Grande do Sul, Bento Gonçalves Avenue 9500, Porto Alegre, CEP 91501-970, Brazil
| | - Tarciana Grandi
- Departamento de Ação em Saúde, Centro de Desenvolvimento Científico e Tecnológico, Secretaria de Saúde do Rio Grande do Sul, Ipiranga Avenue 5400, Porto Alegre, CEP 90610-000, Brazil
| | - Cláudia Maria Dornelles da Silva
- Departamento de Ação em Saúde, Centro de Desenvolvimento Científico e Tecnológico, Secretaria de Saúde do Rio Grande do Sul, Ipiranga Avenue 5400, Porto Alegre, CEP 90610-000, Brazil.
| | - Maria Lucia Rosa Rossetti
- Departamento de Ação em Saúde, Centro de Desenvolvimento Científico e Tecnológico, Secretaria de Saúde do Rio Grande do Sul, Ipiranga Avenue 5400, Porto Alegre, CEP 90610-000, Brazil
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The spectrum of CYP21A2 mutations in Congenital Adrenal Hyperplasia in an Indian cohort. Clin Chim Acta 2016; 464:189-194. [PMID: 27890570 DOI: 10.1016/j.cca.2016.11.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/22/2022]
Abstract
Congenital Adrenal Hyperplasia (CAH) is a common autosomal recessive disorder of the adrenal steroidogenic pathway. The most common form of CAH is due to mutations in CYP21A2 gene. The incidence of mutations in the CYP21A2 gene and the genotype-phenotype correlations vary among different populations. Therefore, the aim of the study was to establish the spectrum of mutations and to evaluate genotype-phenotype correlation in Indian CAH population. Molecular defects were investigated in 110 alleles (55 patients) in the present study. Notably, we identified disease causing mutations in 106 of 110 (96.4%) alleles whereas the frequency of undetectable mutations was 3.6%. The i2g mutation (20%) was found to be the most common in CAH patients. The second most common mutation was p.R356W (14.5%). p.I172N and 8-bp deletion in exon 3 accounted for 12.7% of the mutated alleles. In descending order, the other mutations present were p.Q318X (9%), E6 Cluster (5.4%), p.V281L (3.6%) and large gene deletion (3.6%). Additionally, p.P267L and frameshift mutation (L307fs/F306+T) were also detected in the Indian cohort with frequency of 1.8% and 5.4% respectively.rare mutation/rare mutations in the CYP21A2 gene were detected viz., p.D234D (NCBI accession number - KF812549), p.F306V (NCBI accession number - KF534754), p.P357P (NCBI accession number - KF692099) and p.H365N (NCBI accession number - KF447378). The genotypes of the patients were categorized into four groups null, A, B and C. Of note, correlation between genotype and phenotype is sufficiently strong, to be of clinical significance in the genetic counseling.
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Anastasovska V, Kocova M. Genotype-phenotype correlation in CAH patients with severe CYP21A2 point mutations in the Republic of Macedonia. J Pediatr Endocrinol Metab 2010; 23:921-6. [PMID: 21175091 DOI: 10.1515/jpem.2010.147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Steroid 21-hydroxylase deficiency is a most frequent cause of congenital adrenal hyperplasia (CAH), due to mutations in the CYP21A2 gene. Approximately 75% of patients with classical form of CAH have severe impairment of 21-hydroxylase activity. METHODS We have performed direct molecular diagnosis of the nine common CYP21A2 point mutations in 24 Macedonian CAH patients from 20 unrelated families, using differential PCR and ACRS. RESULTS Five of the analysed mutations were detected in 23 patients: 15 patients were homozygous for one mutation, four patients were compound heterozygotes and four patients were heterozygotes. The most common was IVS2-13A/C mutation found in 60.4% of the alleles, followed by Q318X (22.9%), R356W (4.2%), V281L (2.1%) and P30L (2.1%). The concordance of genotype to phenotype in the patients was 83.3% with complete concordance in the genotypes predicting the SW and SV phenotype. CONCLUSION The distribution of the detected mutations in the Macedonian CAH patients was similar with those described in other European populations. The genotype-phenotype correlation observed in our patients strengthens the fact that the genotype cannot be completely predictive of phenotype.
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