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Rodríguez-Carrillo A, Remy S, Koppen G, Wauters N, Mustieles V, Desalegn A, Iszatt N, den Hond E, Verheyen VJ, Fábelová L, Murinova LP, Pedraza-Díaz S, Esteban M, Poyatos RM, Govarts E, van Nuijs ALN, Covaci A, Schoeters G, Olea N, Fernández MF. Urinary phthalate/DINCH metabolites associations with kisspeptin and reproductive hormones in teenagers: A cross-sectional study from the HBM4EU aligned studies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 929:172426. [PMID: 38631641 DOI: 10.1016/j.scitotenv.2024.172426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Exposure to phthalate/DINCH metabolites can induce human reproductive toxicity, however, their endocrine-disrupting mechanisms are not fully elucidated. OBJECTIVE To investigate the association between concentrations of phthalate/DINCH metabolites, serum kisspeptin, and reproductive hormones among European teenagers from three of the HBM4EU Aligned Studies. METHODS In 733 Belgian (FLEHS IV study), Slovak (PCB cohort follow-up), and Spanish (BEA study) teenagers, ten phthalate and two DINCH metabolites were measured in urine by high-performance liquid chromatography-tandem mass spectrometry. Serum kisspeptin (kiss54) protein, follicle-stimulating hormone (FSH), total testosterone (TT), estradiol (E2), and sex hormone-binding globulin (SHBG) levels were measured by immunosorbent assays. Free Androgen Index (FAI) was calculated as a proxy of free testosterone. Adjusted sex-stratified linear regression models for individual studies, mixed effect models (LME) accounting for random effects for pooled studies, and g-computation and Bayesian kernel machine regression (BKMR) models for the phthalate/DINCH mixture were performed. RESULTS The LME suggested that each IQR increase in ln-transformed levels of several phthalates was associated with lower kisspeptin [MnBP: %change (95%CI): -2.8 (-4.2;-0.4); MEHP: -1.4 (-3.4,0.2)] and higher FSH [∑DINP: 11.8 (-0.6;25.1)] levels in females from pooled studies. G-computation showed that the phthalates/DINCH mixture was associated with lower kisspeptin [-4.28 (-8.07;-0.34)] and higher FSH [22.13 (0.5;48.4)] also in females; BKMR showed similar although non-significant pattern. In males, higher phthalates metabolites [MEHP: -12.22 (-21.09;-1.18); oxo-MEHP: -12.73 (-22.34;-1.93)] were associated with lower TT and FAI, although higher DINCH [OH-MINCH: 16.31 (6.23;27.35), cx-MINCH: 16.80 (7.03;27.46), ∑DINCH: 17.37 (7.26;29.74)] were associated with higher TT levels. No mixture associations were found in males. CONCLUSION We observed sex-specific associations between urinary concentrations of phthalate/DINCH metabolites and the panel of selected effect biomarkers (kisspeptin and reproductive hormones). This suggests that exposure to phthalates would be associated with changes in kisspeptin levels, which would affect the HPG axis and thus influence reproductive health. However, further research is needed, particularly for phthalate replacements such as DINCH.
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Affiliation(s)
- Andrea Rodríguez-Carrillo
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium; Toxicological Centre, University of Antwerp, Universiteitsplein, 1, 2610 Wilrijk, Belgium
| | - Sylvie Remy
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Gudrun Koppen
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Natasha Wauters
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Vicente Mustieles
- Biomedical Research Center & School of Medicine, University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Anteneh Desalegn
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Norway
| | - Nina Iszatt
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Norway
| | | | - Veerle J Verheyen
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Lucia Fábelová
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia
| | - Lubica Palkovicova Murinova
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia
| | - Susana Pedraza-Díaz
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Esteban
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael M Poyatos
- Unidad de Gestión Clínica de Laboratorios, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Eva Govarts
- VITO Health, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | | | - Adrian Covaci
- Toxicological Centre, University of Antwerp, Universiteitsplein, 1, 2610 Wilrijk, Belgium
| | - Greet Schoeters
- Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain
| | - Nicolás Olea
- Biomedical Research Center & School of Medicine, University of Granada, 18016 Granada, Spain; Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Mariana F Fernández
- Biomedical Research Center & School of Medicine, University of Granada, 18016 Granada, Spain; Department of Radiology and Physical Medicine, School of Medicine, University of Granada, 18016 Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain.
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Onsoi W, Numsriskulrat N, Aroonparkmongkol S, Supornsilchai V, Srilanchakon K. Kisspeptin and DLK1 levels for monitoring treatment of girls with central precocious puberty. Clin Exp Pediatr 2024; 67:296-302. [PMID: 38772409 DOI: 10.3345/cep.2023.01361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/28/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Kisspeptin and delta-like 1 homolog (DLK1) are neuropeptides that reportedly play an important role in pubertal timing by activating and inhibiting the hypothalamic-pituitary-gonadal axis, respectively. Consequently, serum kisspeptin and DLK1 levels may be novel biomarkers for differentiating between central precocious puberty (CPP) and premature thelarche (PT) in girls and used to monitor CPP treatment. PURPOSE To compare baseline serum kisspeptin and DLK1 levels in girls with CPP at diagnosis and after treatment to age-matched girls with PT. METHODS This prospective longitudinal study included girls with precocious puberty and girls with PT who experienced breast development before 8 years of age and peak luteinizing hormone levels of ≥6 versus <6 IU/L after a gonadotropin-releasing hormone (GnRH) stimulation test. Serum kisspeptin and DLK1 levels were determined in both groups at baseline and after 6 months of GnRH analog treatment in the CPP group and analyzed by enzyme-linked immunosorbent assay. RESULTS The study divided a total of 48 girls into CPP (n=24; mean age, 7.7±0.7 years) and PT (n=24; mean age, 7.4±0.8 years) groups. The baseline median serum kisspeptin levels were 50.5 pg/mL (range, 38.2-77 pg/mL) and 49.5 pg/mL (range, 39.7-67.6 pg/mL), respectively (P=0.89), while the baseline median serum DLK1 levels were 6.5 ng/mL (range, 5.9-7.5 ng/mL) and 6 ng/mL (4.4-14.4 ng/mL), respectively (P=0.68). After 6 months of GnRH analog treatment in the CPP group, the median serum kisspeptin level was lower (46.4 ng/mL; range, 37.1-60 ng/mL) than that at baseline (P=0.002), while the median serum DLK1 level was higher (7 ng/mL; range, 6.7-8.9) than that at baseline (P=0.002). CONCLUSION Our findings suggest that baseline serum kisspeptin and DLK1 levels are not reliable biomarkers for differentiating between CPP and PT. However, significant changes in serum kisspeptin and DLK1 levels may be used to monitor CPP treatment.
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Affiliation(s)
- Witchuwan Onsoi
- Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattakarn Numsriskulrat
- Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suphab Aroonparkmongkol
- Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vichit Supornsilchai
- Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khomsak Srilanchakon
- Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Zevin EL, Eugster EA. Central precocious puberty: a review of diagnosis, treatment, and outcomes. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:886-896. [PMID: 37973253 DOI: 10.1016/s2352-4642(23)00237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/23/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
Central precocious puberty (CPP) refers to early activation of the hypothalamic-pituitary-gonadal (HPG) axis and is manifested by breast development in girls or testicular enlargement in boys before the normal physiological age ranges. CPP can be precipitated by intracranial pathology, exposure to high levels of sex steroids, or environmental risk factors, but most cases are idiopathic. Monogenic causes have also been identified. In this Review, we summarise pathophysiology, risk factors, diagnosis, and management of CPP. Concern for CPP should prompt referral to paediatric endocrinology where diagnosis is confirmed by clinical, biochemical, radiological, and genetic testing. CPP is treated with a gonadotropin-releasing hormone analogue, the primary aims of which are to increase adult height and postpone development of secondary sexual characteristics to an age that is more commensurate with peers. Although long-term outcomes of treatment with gonadotropin-releasing hormone analogues are reassuring, additional research on the psychological effect of CPP is needed.
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Affiliation(s)
- Erika L Zevin
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Erica A Eugster
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
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