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Giraudo F, Salinas A, Merino PM, Iñiguez G, López P, Castro A, Lardone MC, Cavada G, Cassorla F, Codner E. Subdermal Progestin Implant and an Oral Combined Hormonal Contraceptive in Youth with Type 1 Diabetes. J Pediatr Adolesc Gynecol 2024; 37:177-183. [PMID: 38012981 DOI: 10.1016/j.jpag.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
STUDY OBJECTIVE To determine the metabolic effects of the subcutaneous etonogestrel implant compared with an oral contraceptive in adolescents and young adults (AYAs) with type 1 diabetes (T1D) on body weight, body composition, glucose, lipids, and C-reactive protein levels. METHODS This was a non-randomized, interventional, prospective study. Thirty-nine AYAs with T1D participated; 20 used the implant (Implant-T1D), and 19 used an oral combined contraceptive (OC-T1D). Body composition, HbA1c, intermittent continuous glucose monitoring, lipids, and high-sensitivity C-reactive protein (hsCRP) levels were evaluated. RESULTS All participants were followed for at least 12 months, and 26 completed the 24-month follow-up. No women discontinued the intervention due to adverse effects. Body weight increased by 0.8 ± 3.5 and 1 ± 2.9 kg in the OC-T1D and the Implant-T1D group at 12 months and by 2.6 ± 3.9 and 3.3 ± 3.6 kg at 24 months, respectively. OC-T1D and Implant-T1D had similar HbA1c, mean interstitial glucose levels, and time in range throughout the study; no significant difference over time was observed. hsCRP levels increased in both groups and were associated with BMI and HbA1c (P < .001 for both variables). Women in the OC-T1D group had higher total cholesterol, HDL-C, and triglyceride levels compared with the Implant-T1D. CONCLUSION Glucose levels were similar in youth using the subdermal progestin implant and an OC. However, both AYA groups showed increased BMI, fat mass, and subclinical inflammation. Changes in lipid levels were associated with the OC method. These data highlight the importance of weight gain prevention in young women with T1D using hormonal contraception.
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Affiliation(s)
- Franco Giraudo
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Abril Salinas
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Chilean Institute of Reproductive Medicine (ICMER), Santiago, Chile, 8320165
| | - Paulina M Merino
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Germán Iñiguez
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Patricia López
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Andrea Castro
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - María Cecilia Lardone
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Gabriel Cavada
- Public Health, School of Medicine, University of Chile, Santiago, Chile, 8380453
| | - Fernando Cassorla
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160.
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Rodríguez F, Godoy MJ, Ortiz E, Benítez-Filselcker A, López MT, Cassorla F, Castro A. CAG and GGN repeat polymorphisms in the androgen receptor gene of a Chilean pediatric cohort with idiopathic inguinal cryptorchidism. Andrology 2024; 12:289-296. [PMID: 37377277 DOI: 10.1111/andr.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/02/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Cryptorchidism is one of the most common congenital disorders in boys and it is associated with a higher risk of sub-fertility and testicular cancer. Testicular descent occurs during embryo-fetal development in two phases, transabdominal and inguino-scrotal. In the latter process, androgens play a leading role. The androgen receptor has in its N-terminal domain, two aminoacidic repeats encoded by polymorphic nucleotide repetitions: (CAG)nCAA and GGN. The number of repetitions of these trinucleotides has been associated with different transactivation capacities and sensitivities of the androgen receptor response. OBJECTIVE To determine whether pediatric Chilean individuals with idiopathic inguinal cryptorchidism have a different number of CAG and/or GGN repeats polymorphisms compared with controls. MATERIALS AND METHODS A total of 109 cases with idiopathic inguinal cryptorchidism (26 bilateral and 83 unilateral) were studied by polymerase chain reaction amplification from DNA extracted from peripheral blood, followed by fragment size analysis by capillary electrophoresis, which were compared with 140 controls. RESULTS The CAG26 repeats allele was increased in the total cases (8.3% vs. 1.4%; p = 0.012; odds ratio = 6.21, 95% confidence interval 1.31-29.4), and in bilateral cases compared to controls (11.5% vs. 1.4%; p = 0.028; odds ratio = 9 CI 95% 1.43-56.8). Similarly, CAG > 22 alleles were increased in the total cases (62.4% vs. 49.3%, p = 0.041), and more significantly in bilateral cases (73.1% vs. 49.3%; p = 0.032; odds ratio = 2.79, 95% confidence interval 1.1-7.1). In addition, CAG < 18 alleles were not observed among cases, but were present in 5.7% of controls (p = 0.01). Regarding the GGN repeats, no differences were observed between cases and controls either when analyzing separately unilateral and bilateral cryptorchidism. The joint analysis of the distribution of CAG and GGN alleles showed that the CAG26 allele was present with GGN23, hence the combination CAG26/GGN23 alleles was equally increased in bilateral cases compared with controls (11.5% vs. 1.4%). In contrast, CAG < 18 was preferably observed in the combination CAG < 18/GGN≠23 and was absent in the total cases (4.3% vs. 0%; p = 0.037). DISCUSSION These results suggest that greater lengths of CAG alleles may contribute to a diminished androgen receptor function. The CAG26 allele alone or in combination with GGN23 was associated with a higher risk of bilateral cryptorchidism. On the other hand, CAG < 18 and the CAG < 18/GGN≠23 allele combination may reduce the probability of cryptorchidism.
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Affiliation(s)
- Fernando Rodríguez
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
| | - María José Godoy
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
| | - Eliana Ortiz
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
| | - Andrés Benítez-Filselcker
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
| | - María Teresa López
- Pediatric Urology Department, San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
| | - Andrea Castro
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
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Harnois-Leblanc S, Hernandez MI, Codner E, Cassorla F, Oberfield SE, Leibel NI, Mathew RP, Ten S, Magoffin DA, Lane CJ, Goran MI, Azziz R, Baillargeon JP, Geller DH. Profile of Daughters and Sisters of Women With Polycystic Ovary Syndrome: The Role of Proband's Glucose Tolerance. J Clin Endocrinol Metab 2022; 107:e912-e923. [PMID: 34752621 PMCID: PMC8851929 DOI: 10.1210/clinem/dgab812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT First-degree relatives of women with polycystic ovary syndrome (PCOS) present hormonal and metabolic alterations compared to girls unrelated to PCOS. It is unknown whether glucose intolerance in the PCOS proband confers a more severe metabolic predisposition on their first-degree relatives. OBJECTIVE To determine whether glucose tolerance status in women with PCOS is associated with worsened glucose metabolism and sex hormone levels in their peripubertal daughters or sisters. DESIGN Cross-sectional study. SETTING Seven academic centers in North America, South America, and Europe. PATIENTS Sixty-four pairs of women with PCOS and their daughters or younger sisters aged between 8 and 14 years were recruited. Twenty-five mothers or older sisters with PCOS were glucose intolerant (GI) and 39 were normal glucose tolerant (NGT). MAIN OUTCOME MEASURES Beta-cell function estimated by the insulin secretion-sensitivity index-2 (ISSI-2) during an oral glucose tolerance test and by the disposition index during a frequently sampled IV glucose tolerance test. Free testosterone and 17-hydroxyprogesterone (17-OHP) levels. RESULTS Being related to a GI PCOS proband was associated with a lower ISSI-2 (P-value = 0.032) after adjusting for ethnicity, body mass index z-score, and pubertal stage. They also had higher free testosterone (P-value = 0.011) and 17-OHP levels compared to girls with an NGT proband, the latter becoming significant after adjusting for confounders (P-value = 0.040). CONCLUSIONS Compared to first-degree female relatives of women with PCOS and NGT, first-degree relatives of women with PCOS and GI display lower beta-cell function and hyperandrogenemia, putting them at higher risk of GI and PCOS development.
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Affiliation(s)
- Soren Harnois-Leblanc
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Preventive and Social Medicine, School of Public Health, Université de Montréal, Montréal, QC, H3T 1J4, Canada
- Current Affiliation: The current affiliation of S. H-L is the Department of Preventive and Social Medicine, School of Public Health, Université de Montréal, Montréal, QC, H3T 1J4, Canada
| | - Maria Isabel Hernandez
- Department of Preventive and Social Medicine, School of Public Health, Université de Montréal, Montréal, QC, H3T 1J4, Canada
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, School of Medicine, University of Chile, Santiago, Chile
| | - Fernando Cassorla
- Instituto de Investigaciones Materno Infantil, School of Medicine, University of Chile, Santiago, Chile
| | - Sharon E Oberfield
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Natasha I Leibel
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Revi P Mathew
- Division of Pediatric Endocrinology, School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Svetlana Ten
- Richmond University Medical Center, Staten Island, NY, USA
| | - Denis A Magoffin
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christianne J Lane
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael I Goran
- Center for Endocrinology, Diabetes and Metabolism, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ricardo Azziz
- Departments of Obstetrics and Gynecology, and Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, ALUSA
- Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, SUNY, Rensselaer, NYUSA
| | - Jean-Patrice Baillargeon
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Correspondence: Jean-Patrice Baillargeon, Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
| | - David H Geller
- Center for Endocrinology, Diabetes and Metabolism, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
- David H. Geller, Children’s Hospital Los Angeles, CA 90027, USA.
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Abstract
Noonan syndrome is characterized by multiple phenotypic features, including growth retardation, which represents the main cause of consultation to the clinician. Longitudinal growth during childhood and adolescence depends on several factors, among them an intact somatotrophic axis, which is characterized by an adequate growth hormone (GH) secretion by the pituitary, subsequent binding to its receptor, proper function of the post-receptor signaling pathway for this hormone (JAK-STAT5b and RAS/MAPK), and ultimately by the production of its main effector, insulin like growth factor 1 (IGF-1). Several studies regarding the function of the somatotrophic axis in patients with Noonan syndrome and data from murine models, suggest that partial GH insensitivity at a post-receptor level, as well as possible derangements in the RAS/MAPK pathway, are the most likely causes for the growth failure in these patients. Treatment with recombinant human growth hormone (rhGH) has been used extensively to promote linear growth in these patients. Numerous treatment protocols have been employed so far, but the published studies are quite heterogeneous regarding patient selection, length of treatment, and dose of rhGH utilized, so the true benefit of GH therapy is somewhat difficult to establish. This review will discuss the possible etiologies for the growth delay, as well as the outcomes following rhGH treatment in patients with Noonan syndrome.
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Affiliation(s)
- Fernando Rodríguez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Ximena Gaete
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
- Pediatrics Department, Hospital Clínico San Borja – Arriarán, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
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Ocaranza P, Íñiguez G, Johnson MC, Cassorla F. Differential effects of androgens and estrogens over cellular GH sensitivity in HEPG2 cells. Growth Horm IGF Res 2021; 57-58:101390. [PMID: 33975196 DOI: 10.1016/j.ghir.2021.101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/20/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED Testosterone and estrogen concentrations progressively increase during puberty, and in association with growth hormone (GH), lead to the increase in height velocity known as the pubertal growth spurt. Very limited information is available however, regarding the possible effects of sex steroids over GH cellular sensitivity. OBJECTIVE To investigate the effects of different concentrations of testosterone, estradiol and dihydrotestosterone over the GH intracellular signaling pathway. METHODS We evaluated the effects of these sex steroids on the nuclear phosphorylation of STAT5b and IGF-1 expression, in HEPG2 human hepatoma cells. In addition, we studied whether Tamoxifen (TAM), can modulate these effects. RESULTS The highest concentration of T tested (10 ng/mL) co-incubated with a fixed concentration of GH (40 ng/mL) increased nuclear STAT5b phosphorylation compared with GH alone (1.34 ± 0.2 vs 0.6 ± 0.09 AU; *p < 0.05), as well as IGF-1 expression (0.6 ± 0.03 vs 0.32 ± 0.05 AU; *p < 0.05). This effect was not observed with lower concentrations of T tested (1 and 5 ng/mL). A similar increase in nuclear STAT5b phosphorylation was observed with the lowest concentration of E2 tested (20 pg/mL), co-incubated with the same fixed concentration of GH (3.6 ± 0.5 vs 1.28 ± 0.33 AU; *p < 0.05). This effect was also associated with an increase in IGF-1 expression (0.73 ± 0.02 vs 0.39 ± 0.04 AU; *p < 0.05). These results were not observed with higher concentrations of E2 tested (75 and 200 pg/mL). DHT at concentrations of 0.1, 0.25 and 0.5 ng/mL, co-stimulated with GH, did not change cytoplasmic STAT5b phosphorylation, nuclear STAT5b or IGF-1 expression. In addition, the co-incubation of TAM with the highest concentration of T tested (10 ng/mL) and GH (40 ng/mL) did not change cytoplasmic, nuclear pSTAT5 levels or IGF-1 expression. CONCLUSIONS T and E2 potentiate the GH signaling pathway in a concentration-dependent fashion. The observation that the non-aromatizable androgen dihydrotestosterone does not stimulate this pathway, and that the effects of T are blocked with TAM, suggests that the effects of T over the GH signaling pathway appear to be mediated by estrogen.
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Affiliation(s)
- Paula Ocaranza
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile.
| | - Germán Íñiguez
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
| | - M Cecilia Johnson
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
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Gaete X, Rodríguez F, Cassorla F. Growth Hormone Treatment for Patients with Noonan Syndrome. Pediatr Endocrinol Rev 2019; 16:100-104. [PMID: 30378787 DOI: 10.17458/per.vol16.2018.grc.ghnoonansyndrome] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Noonan syndrome (NS) is a genetic disorder, which can present clinically with a variable phenotype. Proportional post natal short stature is a common manifestation of NS, with the majority of affected patients having an adult height below the third percentile. Some investigators have reported minor abnormalities in GH secretion and/or action, suggesting that recombinant growth hormone (rhGH) therapy may be useful for the treatment of their short stature. Our review of the literature regarding rhGH therapy in children with NS indicates that this therapy improves height velocity, but relatively few controlled clinical trials reporting adult height are available. rhGH treatment does not appear to be associated with adverse effects in these patients, but data on the possible development of malignancy during treatment are somewhat limited. Therefore, we believe that there is a need for large controlled clinical trials in patients with this condition, in order to accurately assess the effects of rhGH therapy over adult height.
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Affiliation(s)
- Ximena Gaete
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile, Clinica Alemana, Santiago, Chile
| | - Fernando Rodríguez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile, E-mail:
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Rodríguez F, Ponce D, Berward FJ, Lopetegui B, Cassorla F, Aracena M. RAF1 variant in a patient with Noonan syndrome with multiple lentigines and craniosynostosis. Am J Med Genet A 2019; 179:1598-1602. [PMID: 31145547 DOI: 10.1002/ajmg.a.61203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/10/2019] [Accepted: 05/09/2019] [Indexed: 12/30/2022]
Abstract
We report the case of a 14 years and 8 months girl, who is the first child of nonconsanguineous parents, with short stature, obstructive hypertrophic cardiomyopathy, multiple facial lentigines, high and wide forehead, downslanting palpebral fissures, low-set ears, short neck, and pectus excavatum; all features suggestive of Noonan syndrome with multiple lentigines (NSML). In addition, the patient exhibited craniosynostosis. Molecular analysis of rats sarcoma (RAS)/mitogen-activated protein kinase (MAPK) pathway genes with high-resolution melting curve analysis followed by sequencing showed a RAF1 amino acid substitution of valine to glycine at position 263 (p.V263G). The present report provides clinical data regarding the first association of a RAF1 variant and craniosynostosis in a patient with clinical diagnosis of NSML.
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Affiliation(s)
- Fernando Rodríguez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Diana Ponce
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Francisco J Berward
- Department of Neurosurgery, Unit of Neuro Oncology, Clinica Las Condes, Santiago, Chile
| | - Bernardita Lopetegui
- Department of Pediatrics and Children's Surgery, Hospital Luis Calvo Mackenna, School of Medicine, University of Chile, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Mariana Aracena
- Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Unit of Genetics, Hospital Luis Calvo Mackenna, Santiago, Chile
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Merino PM, Lopez P, Salinas A, Pastene C, Muñoz A, Cassorla F, Codner E. Ovarian Function in Adolescents Conceived Using Assisted Reproductive Technologies. J Pediatr Adolesc Gynecol 2019; 32:117-121. [PMID: 30502496 DOI: 10.1016/j.jpag.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/04/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To compare ovarian function between adolescents conceived using assisted reproductive technology (AcART) and adolescents who were conceived spontaneously (AcSP). DESIGN Multicenter study of ovarian function in AcART because of male or tubal infertility. SETTING University Hospital. PARTICIPANTS We evaluated 22 AcART and 53 AcSP at 1-2 years after menarche. The participants were born at term (≥37 weeks of gestation) with normal birth weights (≥2500 g) from singleton pregnancies. INTERVENTIONS None. MAIN OUTCOME MEASURES Differences in ovulation, reproductive hormones, and ovarian morphology. RESULTS AcART had an older age of menarche than that of AcSP, even after adjusting for maternal age at menarche, gestational age, and birth weight (P = .027). AcART had lower incidence of ovulation (P = .021) and higher luteinizing hormone serum levels (P = .01) than those of AcSP. The incidence of oligomenorrhea and the cycle length were similar between AcART and AcSP. AcART had levels of anti-Müllerian hormone, inhibin B, follicle-stimulating hormone, estradiol, and androgens similar to those of AcSP. The ovarian morphology, ovarian volume, and follicle counts were similar in both groups. CONCLUSION AcART had later menarche, lower ovulation rates, and higher luteinizing hormone levels than those of AcSP. Future studies should investigate whether these findings are indicative of a risk of ovarian dysfunction later in life for AcART.
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Affiliation(s)
- Paulina M Merino
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.
| | - Patricia Lopez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile; Cytogenetics Laboratory, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Abril Salinas
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Carolina Pastene
- Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
| | - Alex Muñoz
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile; Cytogenetics Laboratory, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Rodríguez F, Vallejos C, Bolanos-Garcia VM, Ponce D, Unanue N, Garay F, Cassorla F, Aracena M. Co-occurrence of Noonan and Cardiofaciocutaneous Syndrome Features in a Patient with KRAS Variant. J Pediatr Genet 2018; 7:158-163. [PMID: 30430033 DOI: 10.1055/s-0038-1653977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/09/2018] [Indexed: 10/16/2022]
Abstract
We report the case of a 3-year-old girl, who is the third child of nonconsanguineous parents, with short stature, hypertrophic cardiomyopathy, and mild dysmorphic features; all suggestive of Noonan syndrome. In addition, the patient presents with feeding difficulties, deep palmar and plantar creases, sparse hair, and delayed psychomotor and language development, all characteristics frequently observed in cardiofaciocutaneous syndrome. Molecular analysis of the Ras/ MAPK pathway genes using high-resolution melting curve analysis and gene sequencing revealed a de novo KRAS amino acid substitution of leucine to tryptophan at codon 53 (p.L53W). This substitution was recently described in an Iranian patient with Noonan syndrome. The findings described in this report expand the phenotypic heterogeneity observed in RASopathy patients harboring a KRAS substitution, and advocate for the inclusion of genes with low mutational frequency in genetic screening protocols for Noonan syndrome and other RASopathies.
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Affiliation(s)
- Fernando Rodríguez
- School of Medicine, Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Carla Vallejos
- School of Medicine, Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Víctor M Bolanos-Garcia
- Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Diana Ponce
- School of Medicine, Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Nancy Unanue
- School of Medicine, Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Francisco Garay
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Cassorla
- School of Medicine, Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Mariana Aracena
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Unidad de Genética, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
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Rodríguez F, Vallejos C, Ponce D, Unanue N, Hernández MI, Célis S, Arcos K, Belmar F, López MT, Cassorla F. Study of Ras/MAPK pathway gene variants in Chilean patients with Cryptorchidism. Andrology 2018; 6:579-584. [DOI: 10.1111/andr.12501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 11/26/2022]
Affiliation(s)
- F. Rodríguez
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - C. Vallejos
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - D. Ponce
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - N. Unanue
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - M. I. Hernández
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - S. Célis
- Pediatric Urology Department; Hospital Clínico San Borja - Arriarán; Santiago Chile
| | - K. Arcos
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - F. Belmar
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - M. T. López
- Pediatric Urology Department; Hospital Clínico San Borja - Arriarán; Santiago Chile
| | - F. Cassorla
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
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Iñiguez G, Gallardo P, Castro JJ, Gonzalez R, Garcia M, Kakarieka E, San Martin S, Johnson MC, Mericq V, Cassorla F. Klotho Gene and Protein in Human Placentas According to Birth Weight and Gestational Age. Front Endocrinol (Lausanne) 2018; 9:797. [PMID: 30697189 PMCID: PMC6340928 DOI: 10.3389/fendo.2018.00797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/19/2018] [Indexed: 01/02/2023] Open
Abstract
Introduction: Fetal growth restriction may be the consequence of maternal, fetal, or placental factors. The insulin-like growth factors (IGFs) are major determinants of fetal growth, and are expressed in the mother, fetus and placenta in most species. Previously we reported higher placental protein content of IGF-I, IGF-IR, and AKT in small (SGA) compared with those from appropriate for gestational age (AGA) placentas. The protein Klotho, has been reported in placenta and may regulate IGF-I activity. In this study we determined Klotho gene expression and protein immunostaining in term (T-SGA y T-AGA) and preterm (PT-SGA y PT-AGA) human placentas. In addition, we assessed the effect of Klotho on the IGF-IR and AKT activation induced by IGF-I. Methods: Placentas (n = 1 17) from 32 T-SGA (birth weight (BW) = -1.74 ± 0.08 SDS), 37 T-AGA (BW = 0.12 ± 0.12 SDS), 20 PT-SGA (BW = -2.08 ± 0.14 SDS), and 28 PT-AGA (BW = -0.43 ± 0.13 SDS) newborns were collected. mRNA expression by RT-PCR in the chorionic (CP) and basal (BP) plates of the placentas, and the presence of Klotho was evaluated by immunohistochemistry (integral optical density, IOD). In addition, we developed placental explants that were incubated with IGF-I in the presence or absence of Klotho. Results: We found a lower mRNA expression and protein immunoreactivity of Klotho in the CP of SGA (term and preterm) compared with AGA placentas. We also observed a significant reduction in IGF-IR tyrosine activation induced by IGF-I 10 nM when preincubated with 2.0 nM of Klotho (2.4 ± 0.5 arbitrary units vs. 1.3 ± 0.3 AU), and similar results we observed on AKT and ERK42/44 activation. Conclusion: We describe for the first time that Klotho mRNA and protein varies according to fetal growth and gestational age. In addition, Klotho appears to down-regulate the activation induced by IGF-I on IGF-IR and AKT, suggesting that Klotho may be regulating IGF-I activity in human placentas according to intrauterine fetal growth.
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Affiliation(s)
- Germán Iñiguez
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
- *Correspondence: Germán Iñiguez
| | - Pedro Gallardo
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
| | - Juan Jose Castro
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
| | - Rene Gonzalez
- Biomedical Research Centre, School of Medicine, University of Valparaíso, Valparaíso, Chile
| | - Mirna Garcia
- Neonatology Unit, San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - Elena Kakarieka
- Pathology Unit, San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - Sebastian San Martin
- Biomedical Research Centre, School of Medicine, University of Valparaíso, Valparaíso, Chile
| | - Maria Cecilia Johnson
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
| | - Verónica Mericq
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
| | - Fernando Cassorla
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
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Rodríguez F, Vallejos C, Giraudo F, Unanue N, Hernández MI, Godoy P, Célis S, Martín-Arenas R, Palomares-Bralo M, Heath KE, López MT, Cassorla F. Copy number variants of Ras/MAPK pathway genes in patients with isolated cryptorchidism. Andrology 2017; 5:923-930. [PMID: 28914499 DOI: 10.1111/andr.12390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 01/02/2023]
Abstract
Cryptorchidism is the most common congenital disorder in boys, but the cause for most cases remains unknown. Patients with Noonan Syndrome are characterized by a typical face, growth retardation, congenital heart defects, learning disabilities and cryptorchidism. Copy number variations of Ras/MAPK pathway genes are unusual in patients with several clinical features of Noonan Syndrome; however, they have not been studied in patients with only one feature of this condition, such as cryptorchidism. Our aim was to determine whether patients with isolated cryptorchidism exhibit Ras/MAPK pathway gene copy number variations (CNVs). Fifty-nine patients with isolated cryptorchidism and negative for mutations in genes associated with Noonan Syndrome were recruited. Determination of Ras/MAPK pathway gene CNVs was performed by Comparative Genome Hybridization array. A CNV was identified in two individuals, a ~175 kb microduplication at 3p25.2, partially including RAF1. A similar RAF1 microduplication has been observed in a patient with testicular aplasia. This suggests that some patients with isolated cryptorchidism may harbor Ras/MAPK pathway gene CNVs.
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Affiliation(s)
- F Rodríguez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - C Vallejos
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - F Giraudo
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - N Unanue
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - M I Hernández
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - P Godoy
- Pediatric Service, Hospital Base San José, Osorno, Chile
| | - S Célis
- Pediatric Urology Department, Hospital Clínico San Borja - Arriarán, Santiago, Chile
| | - R Martín-Arenas
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, UAM and CIBERER, ISCIII, Madrid, Spain
| | - M Palomares-Bralo
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, UAM and CIBERER, ISCIII, Madrid, Spain
| | - K E Heath
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, UAM and CIBERER, ISCIII, Madrid, Spain
| | - M T López
- Pediatric Urology Department, Hospital Clínico San Borja - Arriarán, Santiago, Chile
| | - F Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Hernandez MI, López P, Gaete X, Villarroel C, Cavada G, Avila A, Iñiguez G, Cassorla F. Hyperandrogenism in adolescent girls: relationship with the somatotrophic axis. J Pediatr Endocrinol Metab 2017; 30:561-568. [PMID: 28593921 DOI: 10.1515/jpem-2016-0340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 03/06/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND During puberty there is a physiologic increase in adrenal and ovarian androgens. It has been suggested that the somatotrophic axis may be related to the development of hyperandrogenism and anovulation in non-obese adult women with polycystic ovarian syndrome (PCOS). The objective of the study was to investigate whether ovarian androgen secretion in young postmenarchal girls is related to the function of their somatotropic axis. METHODS This was a cross-sectional study of adolescent girls. We studied non-obese adolescent girls with hyperandrogenism (HA; n = 21) matched with control girls (C; n = 25) for chronological age, age at menarche and body mass index. We obtained a fasting blood sample for measurement of serum glucose, insulin, 17-hydroxyprogesterone (17OH-Prog), dehydroepiandrosterone-sulfate (DHEA-S), androstenedione, sex hormone-binding globulin (SHBG), total testosterone, IGF-I, IGF-II, IGFBP-1, IGFBP-3, ghrelin, leptin, AMH (antiMüllerian hormone), luteinizing hormone (LH) and follicle stimulating hormone (FSH) during the follicular phase of the menstrual period. We performed an oral glucose tolerance test to determine blood glucose, insulin and ghrelin levels and urine samples to measure urinary GH (growth hormone) levels. RESULTS As expected, the hyperandrogenic girls had significantly higher Ferriman scores, basal total testosterone, free androgen index (FAI), androstenedione, AMH, and basal LH levels compared with the girls in controls. Serum IGF-I, IGF-II, IGFBP-3 and urinary GH did not differ between HA and C. There was a correlation between urinary GH and FAI in all girls (r 0.29, p < 0.05). In addition, in HA girls FAI correlated with insulin, homeostasis model assessment (HOMA) and ghrelin. CONCLUSIONS We observed a correlation between urinary GH and FAI in the hyperandrogenic and control girls, suggesting that the function of the somatotrophic axis may influence the secretion of androgens in adolescent girls.
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Affiliation(s)
- María Isabel Hernandez
- School of Medicine, University of Chile, Institute of Maternal and Child Research, Santiago de Chile, Chile, P.O. Box 226-3, Santiago
| | - Patricia López
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago
| | - Ximena Gaete
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago
| | - Claudio Villarroel
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago
| | - Gabriel Cavada
- Department of Public Health, University of Chile and University of los Andes, Santiago
| | - Alejandra Avila
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago
| | - German Iñiguez
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago
| | - Fernando Cassorla
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago
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Castro A, Rodríguez F, Flórez M, López P, Curotto B, Martínez D, Maturana A, Lardone MC, Palma C, Mericq V, Ebensperger M, Cassorla F. Pseudoautosomal abnormalities in terminal AZFb+c deletions are associated with isochromosomes Yp and may lead to abnormal growth and neuropsychiatric function. Hum Reprod 2017; 32:465-475. [PMID: 28057878 DOI: 10.1093/humrep/dew333] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/23/2016] [Accepted: 12/07/2016] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Are copy number variations (CNVs) in the pseudoautosomal regions (PARs) frequent in subjects with Y-chromosome microdeletions and can they lead to abnormal stature and/or neuropsychiatric disorders? SUMMARY ANSWER Only subjects diagnosed with azoospermia factor (AZF)b+c deletions spanning to the end of the Y chromosome (i.e. terminal deletions) harbor Y isochromosomes and/or cells 45,X that lead to pseudoautosomal gene CNVs, which were associated with abnormal stature and/or neuropsychiatric disorders. WHAT IS KNOWN ALREADY The microdeletions in the long arm of the Y chromosome (Yq) that include the loss of one to three AZF regions, referred to as Yq microdeletions, constitute the most important known etiological factor for primary spermatogenic failure. Recently, controversy has arisen about whether Yq microdeletions are associated with gain or loss of PAR genes, which are implicated in skeletal development and neuropsychiatric function. STUDY DESIGN, SIZE, DURATION We studied a cohort of 42 Chilean patients with complete AZF deletions (4 AZFa, 4 AZFb, 23 AZFc, 11 AZFb+c) from a university medical center, diagnosed over a period of 15 years. The subjects underwent complete medical examinations with special attention to their stature and neuropsychiatric function. PARTICIPANTS/MATERIALS, SETTING, METHODS All subjects were characterized for Yq breakpoints by PCR, and for CNVs in PARs by multiplex ligation-dependent probe amplification (MLPA), followed by qPCR analysis for genes in PAR1 (SHOX and ZBED1), PAR2 (IL9R) and two single copy genes (SRY and DDX3Y, respectively located in Yp11.3 and AZFa). In addition, karyotypes revision and fluorescence in situ hybridization (FISH) for SRY and centromeric probes for X (DXZ1) and Y (DYZ3) chromosomes were performed in males affected with CNVs. MAIN RESULTS AND THE ROLE OF CHANCE We did not detect CNVs in any of the 35 AZF-deleted men with interstitial deletions (AZFa, AZFb, AZFc or AZFb+c). However, six of the seven patients with terminal AZFb+c deletions showed CNVs: two patients showed a loss and four patients showed a gain of PAR1 genes, with the expected loss of VAMP-7 in PAR2. In these patients, the Yq breakpoints localized to the palindromes P8, P5 or P4. In the four cases with gain of PAR1, qPCR analysis showed duplicated signals for SRY and DDX3Y and one copy of IL9R, indicating isodicentric Yp chromosomes [idic(Y)] with breakpoint in Yq11.22. The two patients who had loss of PAR1, as shown by MLPA, had an additional reduction for SRY and DDX3Y, as shown by qPCR, associated with a high proportion of 45,X cells, as determined by FISH and karyotype. In agreement with the karyotype analysis, we detected DYZ3++ and DYZ3+ cells by FISH in the six patients, confirming idic(Y) and revealing additional monocentric Y chromosome [i(Y)]. Five patients had a history of major depressive disorders or bipolar disorder, and three had language impairment, whereas two patients showed severe short stature (Z score: -2.75 and -2.62), while a man with bipolar disorder was very tall (Z score: +2.56). LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION The number of males studied with Y-chromosome microdeletions and normozoospermic controls with normal karyotypes may not be enough to rule out an association between AZF deletions and PAR abnormalities. The prevalence of Y isochromosomes and/or 45,X cells detected in peripheral blood does not necessarily reflect the variations of PAR genes in target tissues. WIDER IMPLICATIONS OF THE FINDINGS This study shows that CNVs in PARs were present exclusively in patients with terminal AZFb+c deletions associated with the presence of Y isochromosomes and 45,X cells, and may lead to neuropsychiatric and growth disorders. In contrast, we show that men with interstitial Yq microdeletions with normal karyotypes do not have an increased risk of PAR abnormalities and of phenotypical consequences. Moreover, our results highlight the importance of performing molecular studies, which are not considered in the usual screening for patients with Yq microdeletions. STUDY FUNDING/COMPETING INTERESTS This work was supported by the National Fund for Scientific and Technological Development of Chile (FONDECYT), grant no. 1120176 (A.C.). The authors declare that no conflicting interests exist.
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Affiliation(s)
- A Castro
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - F Rodríguez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - M Flórez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - P López
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - B Curotto
- Laboratorio de Genética y Enfermedades Metabólicas, Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago 7830490, Chile
| | - D Martínez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - A Maturana
- Psychiatric Unit, Clínica Las Condes, Santiago 7591046, Chile
| | - M C Lardone
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - C Palma
- Department of Urology, José Joaquín Aguirre Clinical Hospital, School of Medicine, University of Chile, Santiago 8380453, Chile
- Department of Urology, Clínica Las Condes, Santiago 7591046, Chile
| | - V Mericq
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - M Ebensperger
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - F Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
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15
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Ocaranza P, Golekoh MC, Andrew SF, Guo MH, Kaplowitz P, Saal H, Rosenfeld RG, Dauber A, Cassorla F, Backeljauw PF, Hwa V. Expanding Genetic and Functional Diagnoses of IGF1R Haploinsufficiencies. Horm Res Paediatr 2017; 87:412-422. [PMID: 28395282 PMCID: PMC5509495 DOI: 10.1159/000464143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/24/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The growth-promoting effects of IGF-I is mediated through the IGF-I receptor (IGF1R), a widely expressed cell-surface tyrosine kinase receptor. IGF1R copy number variants (CNV) can cause pre- and postnatal growth restriction or overgrowth. METHODS Whole exome sequence (WES), chromosomal microarray, and targeted IGF1R gene analyses were performed on 3 unrelated children who share features of small for gestational age, short stature, and elevated serum IGF-I, but otherwise had clinical heterogeneity. Fluorescence-activated cell sorting (FACS) analysis of cell-surface IGF1R was performed on live primary cells derived from the patients. RESULTS Two novel IGF1R CNV and a heterozygous IGF1R nonsense variant were identified in the 3 patients. One CNV (4.492 Mb) was successfully called from WES, utilizing eXome-Hidden Markov Model (XHMM) analysis. FACS analysis of cell-surface IGF1R on live primary cells derived from the patients demonstrated a ∼50% reduction in IGF1R availability associated with the haploinsufficiency state. CONCLUSION In addition to conventional methods, IGF1R CNV can be identified from WES data. FACS analysis of live primary cells is a promising method for efficiently evaluating and screening for IGF1R haploinsufficiency. Further investigations are necessary to delineate how comparable IGF1R availability leads to the wide spectrum of clinical phenotypes and variable responsiveness to rhGH therapy.
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Affiliation(s)
- Paula Ocaranza
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | | | - Shayne F. Andrew
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael H. Guo
- Division of Endocrinology, Boston Children’s Hospital and Department of Genetics, Harvard Medical School, Boston, MA
| | - Paul Kaplowitz
- Division of Pediatric Endocrinology and Diabetes, Children’s National Health System, Washington, DC
| | - Howard Saal
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Ron G. Rosenfeld
- Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Andrew Dauber
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Fernando Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Philippe F. Backeljauw
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Vivian Hwa
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Corresponding author: Vivian Hwa, Ph.D., EPSE member 267115, Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, 240 Albert Sabin Way, Cincinnati, OH 45229, Ph: 513-803-7337, Fax: 513-803-1174,
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16
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Klein K, Yang J, Aisenberg J, Wright N, Kaplowitz P, Lahlou N, Linares J, Lundström E, Purcea D, Cassorla F. Efficacy and safety of triptorelin 6-month formulation in patients with central precocious puberty. J Pediatr Endocrinol Metab 2016; 29:1241-1248. [PMID: 26887034 DOI: 10.1515/jpem-2015-0376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Triptorelin is an established treatment for central precocious puberty (CPP) as 1- and 3-month formulations. The current triptorelin 22.5 mg 6-month formulation is approved for prostate cancer therapy. This is the first study in patients with CPP. METHODS The efficacy and safety of the triptorelin 6-month formulation in CPP were investigated. The primary objective was to evaluate the efficacy in achieving luteinizing hormone (LH) suppression to pre-pubertal levels at month 6. This was an international, non-comparative phase III study over 48 weeks. Eighteen medical centers in the US, Chile and Mexico participated. Forty-four treatment naïve patients (39 girls and five boys) aged at treatment start 2-8 years for girls and 2-9 years for boys with an advancement of bone age over chronological age ≥1 year were to be included. Triptorelin was administered im twice at an interval of 24 weeks. LH, follicle stimulating hormone (FSH) (basal and stimulated), estradiol (girls), testosterone (boys), auxological parameters, clinical signs of puberty and safety were assessed. RESULTS Forty-one patients (93.2%) showed pre-pubertal LH levels (stimulated LH ≤5 IU/L) at month 6 and maintained LH suppression through month 12. The percentage of patients with LH suppression exceeded 93% at each time point and reached 97.7% at month 12. No unexpected drug-related adverse events were reported. CONCLUSIONS The triptorelin 6-month formulation was safe and effective in suppressing the pituitary-gonadal axis in children with CPP. The extended injection interval may improve compliance and increase comfort in the management of CPP.
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Martínez D, Castro A, Merino PM, López P, Lardone MC, Iñiguez G, Cassorla F, Codner E. Oestrogen activity of the serum in adolescents with Type 1 diabetes. Diabet Med 2016; 33:1366-73. [PMID: 26802741 DOI: 10.1111/dme.13078] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 01/01/2023]
Abstract
AIMS To assess serum oestrogen levels and oestrogenic activity in adolescents with Type 1 diabetes compared with a healthy control group. METHODS We conducted a cross-sectional study that evaluated adolescents with Type 1 diabetes (n = 38) and healthy adolescents (control group; n = 32). Serum oestrogens, urinary oestrogen metabolites and serum oestrogenic activity were assessed. Oestrogenic activity was evaluated in an in vitro cell proliferation assay using a modified E-screen assay with MCF-7/BUS cells. RESULTS Adolescents with Type 1 diabetes had lower oestrogenic activity levels in both phases of the menstrual cycle compared with the control group (follicular phase: 76 vs 94%; luteal phase: 97 vs 131%; P < 0.01), even after adjusting for BMI, oestradiol and oestrone levels. Postmenarcheal adolescents with Type 1 diabetes had lower oestradiol levels compared with control subjects in the follicular phase (63.3 pmol/l vs 89.4 pmol/l; P < 0.01) and higher oestrone levels compared with controls in the luteal phase (196 vs 151.9 pmol/l; P < 0.05). CONCLUSIONS Adolescents with Type 1 diabetes had lower levels of serum oestrogenic activity, and these were lower than expected based on their serum oestradiol levels. We postulate that changes in the serum milieu of oestrogens in patients with Type 1 diabetes may explain their decreased oestrogenic activity and may play a role in their adverse metabolic profile.
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Affiliation(s)
- D Martínez
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - A Castro
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - P M Merino
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - P López
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
- Hospital San Borja Arriarán, Servicio Salud Metropolitano Central, Santiago, Chile
| | - M C Lardone
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - G Iñiguez
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - F Cassorla
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - E Codner
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile.
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18
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Ocaranza P, Morales F, Matamala Á, Gaete X, Román R, Lammoglia JJ, Cassorla F. Growth hormone signaling in fibroblasts from newborn boys and prepubertal boys. Growth Horm IGF Res 2016; 27:18-27. [PMID: 26843474 DOI: 10.1016/j.ghir.2016.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/06/2016] [Accepted: 01/16/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND/AIM Responsiveness to GH in target cells is mediated by its receptor, which activates the Janus kinase-2 (JAK2) and STAT5 (signal transducers and activators of transcription 5) leading to the expression of IGF-1 and IGFALS. The aim of this study was to compare the GH signaling pathway in newborns and prepubertal boys. SUBJECTS AND METHODS We determined the GHR protein content and the effect of stimulation with recombinant human GH (rhGH; 200ng/mL) on JAK2 and STAT5 phosphorylation in skin fibroblast cultures obtained from newborns and prepubertal boys. The transcript levels of IGFALS and IGF-I, were also studied and compared after 16h or 24h of stimulation with GH in both study groups. RESULTS Newborn infants showed less GHR protein than the prepubertal boys. After rhGH stimulation, JAK2 and STAT5 phosphorylation was absent in skin fibroblasts from newborns, but was clearly detectable in prepubertal boys. After 16h of treatment with rhGH, IGFALS and IGF-I transcript levels increased in the prepubertal boys when compared to baseline. In newborns, however, we did not observe a response after 16 and 24h of rhGH stimulation. CONCLUSION The significant attenuation of the GH signaling pathway observed in fibroblasts from newborn boys appears to be related to a reduction in GHR content and lack of phosphorylation of JAK2 and STAT5 in response to rhGH. This might impair STAT5 dimer formation, leading to a reduction in the transcript levels of IGFALS and IGF-I during the newborn period.
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Affiliation(s)
- Paula Ocaranza
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.
| | - Fernanda Morales
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Álvaro Matamala
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Ximena Gaete
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Rossana Román
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Juan Javier Lammoglia
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Codner E, Merino PM, Martínez D, Lopez P, Godoy C, Iñiguez G, Cassorla F, Perez-Bravo F. C-Reactive protein and insulin growth factor 1 serum levels during the menstrual cycle in adolescents with Type 1 diabetes. Diabet Med 2016; 33:70-6. [PMID: 26043285 DOI: 10.1111/dme.12829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 01/15/2023]
Abstract
AIMS To evaluate C-reactive protein, insulin growth factor 1 and lipid levels during the follicular and luteal phases in adolescents with Type 1 diabetes. METHODS Adolescents with Type 1 diabetes (N = 40) and healthy controls (C; N = 43) were studied during the follicular and luteal phases of their menstrual cycles. C-Reactive protein, insulin growth factor 1 and lipid levels were measured. RESULTS Adolescents with Type 1 diabetes exhibited higher C-reactive protein levels than the C group during the follicular (P < 0.0001) and luteal phases (P < 0.01). The elevation of C-reactive protein levels was more pronounced in overweight adolescents with Type 1 diabetes than in adolescents in the C group. More adolescents with Type 1 diabetes were classified as having an elevated risk of cardiovascular disease (C-reactive protein > 3 mg/l) in the luteal phase than in the follicular phase (37.5% and 17.5%, respectively); half of the overweight adolescents with Type 1 diabetes in the luteal phase reached this level. BMI was the only significant factor affecting follicular and luteal phase C-reactive protein levels in adolescents with Type 1 diabetes. Lower insulin growth factor 1 levels were observed during both phases of the menstrual cycle in adolescents with Type 1 diabetes compared with controls. An elevation in insulin growth factor 1 levels in the luteal phase relative to the follicular phase was observed in controls, but not in adolescents with Type 1 diabetes. Luteal insulin growth factor 1 and C-reactive protein exhibited an inverse correlation (r = -0.4, P = 0.01). CONCLUSIONS Adolescents with Type 1 diabetes have higher C-reactive protein levels and lower insulin growth factor 1 levels relative to controls, especially during the luteal phase. Type 1 diabetes diminishes the natural elevation in insulin growth factor 1 levels observed during the luteal phase in controls. Excess weight exacerbates the subclinical inflammatory state observed during both phases of the menstrual cycle in adolescents with Type 1 diabetes.
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Affiliation(s)
- E Codner
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - P M Merino
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - D Martínez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - P Lopez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
- Cytogenetics Laboratory, Hospital San Borja Arriarán, Santiago, Chile
| | - C Godoy
- Pediatric Endocrine Unit, Hospital Sótero del Rio, Santiago, Chile
| | - G Iñiguez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - F Cassorla
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - F Perez-Bravo
- Nutrigenomics Laboratory, Nutrition Department, University of Chile, Santiago, Chile
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Merino PM, Martínez D, Iñiguez G, Lopez P, Cassorla F, Perez-Bravo F, Codner E. Elevation of C-reactive protein during the luteal phase in healthy adolescents. Gynecol Endocrinol 2015; 31:260-3. [PMID: 25392126 DOI: 10.3109/09513590.2014.982086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Variations in inflammatory markers have been reported in adult women during the luteal phase, but whether these findings are observed during adolescence is unknown. We postulate that higher ultrasensitive C-reactive protein (usCRP) and lower 2-hydroxyestrone (2OHE) levels, an estrogen metabolite with cardioprotective actions, are present during the luteal phase in young women. AIM To evaluate usCRP levels during the menstrual cycle and to determine its association with 2OHE and 16α-hydroxyestrone (16OHE) in adolescents. METHODS Healthy postmenarcheal adolescents (N = 37) were studied during one menstrual cycle in follicular phase (FP) and luteal phase-like period (LP-L). RESULTS Elevations in usCRP levels in the LP-L were observed in the entire group and in anovulatory cycles (1.9 ± 1.1 mg/L in FP to 2.5 ± 1.8 mg/L in LP-L; p < 0.0001). Increases in estrone, estradiol, free and bioavailable estradiol, testosterone, usCRP and 2OHE levels were observed in LP-L compared with FP (p < 0.01), with a borderline elevation in IFG-I levels (p = 0.06). CONCLUSIONS We report an elevation of usCRP and 2OHE levels during the luteal phase in healthy adolescents. Elevations of this inflammatory marker in anovulatory adolescents without an increase in 2OHE may play a role in metabolic risks associated with chronic anovulation.
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Affiliation(s)
- Paulina M Merino
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile , Santiago , Chile
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García RJ, Iñiguez G, Gaete X, Linares J, Ocaranza P, Avila A, Roman R, Cassorla F. Effects of levothyroxine on growth hormone (gh) sensitivity in children with idiopathic short stature. Growth Horm IGF Res 2014; 24:119-122. [PMID: 24857397 DOI: 10.1016/j.ghir.2014.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/10/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The possible relationship between the circulating concentrations of T4 and GH sensitivity has not been elucidated. OBJECTIVE The aim of this study is to evaluate the effect of levothyroxine supplementation on GH sensitivity in prepubertal boys with idiopathic short stature (ISS). METHODS We selected 28 prepubertal boys with ISS (mean age 8.2±0.5years) and free T4 (Ft4) concentrations between the 3rd and the 25th percentiles (Ft4: 0.8-1.5ng/dl). They were randomly divided into two groups: Group A received thyroid supplementation (1-3μg/kg/day) for 120days, and Group B received placebo for the same period. To evaluate GH sensitivity, an IGF-I generation test (GH: 33μg/kg/day sc for 3days) was performed in both groups: under basal conditions, and after 120days of levothyroxine supplementation (or placebo). RESULTS After thyroid supplementation, Group A had higher Ft4 concentrations compared with Group B (2.14±0.06 vs 1.48±0.06ng/dl, p=0.01), their growth velocity was significantly higher (2.3±0.1 vs 1.5±0.2cm/4months), and they exhibited a greater increase in IGF-I after GH administration (Group A: 32.5±3.8% vs Group B 17.3±2.6%). CONCLUSION Supplementation with levothyroxine for 120days promotes an increase in growth velocity, and a greater IGF-I response to short-term GH administration in prepubertal boys with ISS and low-normal thyroid hormone concentrations.
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Affiliation(s)
- Roberto J García
- Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
| | - German Iñiguez
- Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
| | | | - Jeannette Linares
- Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
| | - Paula Ocaranza
- Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
| | | | - Rossana Roman
- Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile.
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Iñiguez G, Castro JJ, Garcia M, Kakarieka E, Johnson MC, Cassorla F, Mericq V. IGF-IR signal transduction protein content and its activation by IGF-I in human placentas: relationship with gestational age and birth weight. PLoS One 2014; 9:e102252. [PMID: 25050889 PMCID: PMC4106823 DOI: 10.1371/journal.pone.0102252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/16/2014] [Indexed: 02/05/2023] Open
Abstract
Introduction The human placenta expresses the IGF-I and IGF-IR proteins and their intracellular signal components (IRS-1, AKT and mTOR). The aim of this study was to assess the IGF-IR content and activation of downstream signaling molecules in placentas from newborns who were classified by gestational age and birth weight. We studied placentas from 25 term appropriate (T-AGA), 26 term small (T-SGA), 22 preterm AGA (PT-AGA), and 20 preterm SGA (PT-SGA) newborns. The total and phosphorylated IGF-IR, IRS-1, AKT, and mTOR contents were determined by Western Blot and normalized by actin or with their respective total content. The effect of IGF-I was determined by stimulating placental explants with recombinant IGF-I 10-8 mol/L for 15, 30, and 60 minutes. Results The IGF-IR content was higher in T-SGA compared to T-AGA placentas, and the IRS-1 content was higher in PT-placentas compared with their respective T-placentas. The effect of IGF-I on the phosphorylated forms of IGF-IR was increased in T-SGA (150%) and PT-SGA (300%) compared with their respective AGA placentas. In addition, AKT serine phosphorylation was higher in PT-SGA compared to PT-AGA and T-SGA placentas (90% and 390% respectively). Conclusion The higher protein content and response to IGF-I of IGF-IR, IRS-1, and AKT observed in SGA placentas may represent a compensatory mechanism in response to fetal growth restriction.
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Affiliation(s)
- Germán Iñiguez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
- * E-mail:
| | - Juan José Castro
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Mirna Garcia
- Hospital Clínico San Borja-Arriarán, University of Chile, Santiago, Chile
| | - Elena Kakarieka
- Hospital Clínico San Borja-Arriarán, University of Chile, Santiago, Chile
| | - M. Cecilia Johnson
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Verónica Mericq
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
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Codner E, Iñíguez G, López P, Mujica V, Eyzaguirre FC, Asenjo S, Torrealba I, Cassorla F. Metformin for the treatment of hyperandrogenism in adolescents with type 1 diabetes mellitus. Horm Res Paediatr 2014; 80:343-9. [PMID: 24280743 DOI: 10.1159/000355513] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 09/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A high prevalence of hyperandrogenism has been reported in women with type 1 diabetes (T1D). Metformin has been used as a therapeutic agent in patients with polycystic ovarian syndrome and in T1D patients without hyperandrogenism. This study sought to determine the effect of metformin on hyperandrogenism and ovarian function in adolescents with T1D. METHODS We recruited 24 girls with T1D. The participants had hyperandrogenism and displayed suboptimal metabolic control. The patients were enrolled in a randomized, double-blind, placebo-controlled trial. One group received metformin (850 mg bid) and the other group received a placebo. Treatment was administered for 9 months. Ovulation, steroids and gonadotropin levels were evaluated. RESULTS Metformin treatment was associated with decreases in testosterone, free androgen index, androstenedione, 17-OH progesterone and estradiol levels. The girls who were treated with placebo showed stable steroid, gonadotropin and sex hormone-binding globulin levels during the analysis. No differences were observed in the Ferriman-Gallwey scores, ovulation rates, HbA1c levels or daily insulin doses of the girls treated with metformin compared with the placebo group. CONCLUSION Treating hyperandrogenic T1D adolescents with metformin significantly decreased the serum androgens compared to the placebo, but metformin therapy did not significantly affect clinical parameters, such as hirsutism, ovulation and metabolic control.
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Affiliation(s)
- Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Hernandez MI, Castro A, Bacallao K, Avila A, Espinoza A, Trejo L, Iñiguez G, Codner E, Cassorla F. Hormonal profile and androgen receptor study in prepubertal girls with hypertrichosis. Int J Pediatr Endocrinol 2014; 2014:6. [PMID: 24745883 PMCID: PMC3998739 DOI: 10.1186/1687-9856-2014-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/18/2014] [Indexed: 11/26/2022]
Abstract
Background Prepubertal hypertrichosis is a reportedly benign condition characterized by an excessive growth of vellous hair in non-androgen dependent areas of the body compared to the amount usually present in normal subjects of the same age, race and sex. Although this condition is usually considered idiopathic and regarded as benign, it may be very disturbing cosmetically, causing significant patient and parental anxiety. Method We performed a hormonal and androgen receptor study in 42 prepubertal girls with hypertrichosis and 29 control girls from 2 to 8 years of age. Both groups underwent a determination of basal LH, FSH, 17OH progesterone, androstenedione, testosterone, estradiol and SHBG, abdominal ultrasound to assess ovarian morphology, and the number of androgen receptor CAG/GGC repeats in DNA obtained from peripheral leukocytes. Results The hypertrichosis score was higher in the cases compared to controls. Serum gonadotropins and sex steroids were similar in both groups, but SHBG was significantly lower in the girls with hypertrichosis (71.1 ± 2.9 vs 81.9 ± 3.0 nmol/L, p < 0.02). The distribution of shorter, larger and total alleles was not statistically different between cases and controls. The combined analysis of CAG/GGC, however, showed a significantly higher prevalence of the most androgen-sensitive haplotypes (1–2: <22CAG + 17/17GGC- < 14CAG + 17/18GGC) in girls with hypertrichosis compared to controls. Conclusions We conclude that girls with hypertrychosis exhibit AR(s) with enhanced sensitivity, which may facilitate the growth of their body hair.
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Affiliation(s)
- Maria Isabel Hernandez
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2nd floor IDIMI, Casilla, 226-3 Santiago, Chile
| | - Andrea Castro
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2nd floor IDIMI, Casilla, 226-3 Santiago, Chile
| | - Ketty Bacallao
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2nd floor IDIMI, Casilla, 226-3 Santiago, Chile
| | - Alejandra Avila
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2nd floor IDIMI, Casilla, 226-3 Santiago, Chile ; Departments of Pediatrics, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Aníbal Espinoza
- Department of Radiology, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Leon Trejo
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2nd floor IDIMI, Casilla, 226-3 Santiago, Chile
| | - Germán Iñiguez
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2nd floor IDIMI, Casilla, 226-3 Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2nd floor IDIMI, Casilla, 226-3 Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2nd floor IDIMI, Casilla, 226-3 Santiago, Chile
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Gonçalves FT, Fridman C, Pinto EM, Guevara-Aguirre J, Shevah O, Rosembloom AL, Hwa V, Cassorla F, Rosenfeld RG, Lins TSS, Damiani D, Arnhold IJP, Laron Z, Jorge AAL. The E180splice mutation in the GHR gene causing Laron syndrome: witness of a Sephardic Jewish exodus from the Iberian Peninsula to the New World? Am J Med Genet A 2014; 164A:1204-8. [PMID: 24664892 DOI: 10.1002/ajmg.a.36444] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 12/29/2013] [Indexed: 11/05/2022]
Abstract
Laron syndrome (LS) is a genetic disorder caused by mutations in the growth hormone receptor (GHR) gene. The most frequent GHR mutation is E180splice (rs121909360), which was initially found in an inbred population of Spanish descent in Ecuador and subsequently in Israel, Brazil, Chile, and the United States. The aim of the present study is to determine if the E180splice mutation arose from a common origin. We studied 22 patients with LS from Ecuador, Israel (of Moroccan origin), Brazil, Chile, and the United States (of Mexican origin) who were homozygous for the E180splice mutation and compared them to control individuals for markers surrounding the GHR, intragenic polymorphisms, and Y-chromosome STR. An identical haplotype was found in all but one of the subjects carrying the E180splice mutation: D5S665: 150/150; D5S2082: 192/192; D5S2087: 246/246; rs6179 G/G; and rs6180 C/C. One patient differed from the others only at D5S2082 (168/192). This haplotype is rare (~1%) in control individuals and confirmed that the E180splice-associated haplotype was not derived from independent origins but represented recombination from a common ancestor. The analysis of paternal lineage markers showed that 50% belong to haplogroup R1b (found in Portugal and Spain) and 40% to haplogroups J and E (typical in the Middle East and in Eastern European Jews). The germline E180Splice mutation appears to have originated from a single common ancestor. The presence of Y-chromosome markers associated with Sephardic populations in persons harboring the E180splice mutation provides genetic evidence in support of the historical tracking of the exodus of this specific population.
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Affiliation(s)
- Fernanda T Gonçalves
- Laboratório de Imunohematologia e Hematologia Forense (LIM40), Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Rodríguez FA, Unanue N, Hernández MI, Heath KE, Cassorla F. Molecular characterization of Chilean patients with a clinical diagnosis of Noonan syndrome. J Pediatr Endocrinol Metab 2014; 27:305-9. [PMID: 24150203 DOI: 10.1515/jpem-2013-0176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/29/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Noonan syndrome (NS) is an autosomal dominant syndrome characterized by typical dysmorphic features, cardiac anomalies as well as postnatal growth retardation, and is associated with Ras-MAPK pathway gene mutations. The purpose of this study was to improve the diagnosis of Chilean patients with suspected NS through molecular analysis. METHODS We screened 18 Chilean patients with a clinical diagnosis of NS for mutations in PTPN11 by high resolution melting (HRM) and subsequent sequencing. RESULTS Three PTPN11 missense mutations were detected in 22% of analyzed patients. Of these, two (c.181G>A and c.1510A>G) were previously reported and one was the novel substitution c.328G>A (p.E110K) affecting the linker stretch between the N-SH2 and C-SH2 domains of SHP-2 protein. CONCLUSION Molecular studies confirmed the clinical diagnosis of NS in 4 of 18 patients, which provided support for therapeutic decisions and improved genetic counseling for their families.
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Ocaranza P, Lammoglia JJ, Iñiguez G, Román R, Cassorla F. Effects of thyroid hormone on the GH signal transduction pathway. Growth Horm IGF Res 2014; 24:42-46. [PMID: 24439614 DOI: 10.1016/j.ghir.2014.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/30/2013] [Accepted: 01/06/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIM The importance of thyroid hormone on growth and development in children is well recognized. In addition, linear growth is highly dependent on the response of peripheral tissues to growth hormone, a process known as GH sensitivity, but little is known about the possible effects of T4 on this process. METHODS We determined the effect of stimulation with recombinant human GH (rhGH; 200 ng/mL) alone or in combination with two different concentrations of T4 (250 nM and 500 nM for 24 h) on JAK2 and STAT5 activation in skin fibroblast cultures obtained from prepubertal boys with normal height. RESULTS JAK2 and STAT5 were activated under co-incubation with T4 (at both concentrations) and rhGH in the non-nuclear fraction of the fibroblasts. In addition, after 24h of co-incubation with rhGH and T4 (500 nM), we observed an increase in phospho-STAT5 in the nuclear fraction, when compared to GH and T4 stimulation alone. This effect was not observed when the fibroblasts were co-incubated with GH and the lower concentration of T4 (250 nM). CONCLUSION Combined stimulation with GH and T4 at a concentration of 500 nM increases synergistically nuclear phospho-STAT5 in skin fibroblasts, which may amplify tissue sensitivity to GH. These findings may help to explain the effect of T4 administration on growth velocity in some children with idiopathic short stature.
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Affiliation(s)
- Paula Ocaranza
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.
| | - Juan Javier Lammoglia
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Germán Iñiguez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Rossana Román
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Zacharin M, Chanoine JP, Cassorla F, Brink S, Hanas R, Fideleff HL, Oduwole A, Shah N, Hochberg Z. Promoting excellence in the care of pediatric endocrine diseases in the developing world. Pediatrics 2013; 131:e573-8. [PMID: 23339226 DOI: 10.1542/peds.2012-0848] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
On behalf of the Global Pediatric Endocrinology and Diabetes group, the authors provide a perspective on the rights of a child as enshrined in the United Nations Convention on the Rights of the Child (1989) concerning the care of pediatric endocrine disorders and diabetes mellitus, throughout the world, with particular reference to care in resource-constrained settings. In this article, we define the spectrum of health care needs of the child with an endocrine disorder and how they may be addressed, in terms of education, research, and development of sustainable programs for improved health outcomes. We emphasize the responsibilities of medical communities, the pharmaceutical industry, and relevant governments in promoting and supporting such concepts.
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Affiliation(s)
- Margaret Zacharin
- Department of Endocrinology, Royal Children's Hospital, Victoria 3052, Australia.
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Rodríguez FA, Unanue N, Hernandez MI, Basaure J, Heath KE, Cassorla F. Clinical and molecular characterization of Chilean patients with Léri-Weill dyschondrosteosis. J Pediatr Endocrinol Metab 2013; 26:729-34. [PMID: 23729538 DOI: 10.1515/jpem-2013-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/01/2013] [Indexed: 11/15/2022]
Abstract
AIM Léri-Weill dyschondrosteosis (LWD) is a mesomelic dysplasia with disproportionate short stature associated with short stature homeobox-containing gene (SHOX) haploinsufficiency. The objective of this study was to improve the diagnosis of patients with suspected LWD through molecular analysis. METHODS Twelve patients from 11 families with a clinical diagnosis of LWD were analyzed with multiplex ligation-dependent probe amplification to detect deletions and duplications of SHOX and its enhancer regions. High resolution melting and sequencing was employed to screen for mutations in SHOX coding exons. RESULTS The molecular-based screening strategy applied in these patients allowed detection of five SHOX deletions and two previously unreported SHOX missense mutations. CONCLUSION Molecular studies confirmed the clinical diagnosis of LWD in seven out of 12 patients, which provided support for therapeutic decisions and improved genetic counseling in their families.
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Ocaranza P, Gaete X, Román R, Morales F, Íñiguez G, Cassorla F. Phosphotyrosine phosphatases in GH-stimulated skin fibroblasts from children with idiopathic short stature. J Pediatr Endocrinol Metab 2013; 26:833-40. [PMID: 23729600 DOI: 10.1515/jpem-2013-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/18/2013] [Indexed: 02/03/2023]
Abstract
AIM Some cases of idiopathic short stature (ISS) may be caused by defects in the modulation of the negative feedback regulation of the growth hormone receptor (GHR)/ Janus kinase (JAK)2/signal transducers and activators of transcription (STAT)5 signaling pathway. The cytosolic tyrosine phosphatases, protein tyrosine phosphatase 1B (PTP1B) and Src homology 2 (SH2) domain-containing protein-tyrosine phosphatase-1 (SHP-1), the later which translocates to the nucleus after activation, interact with JAK2 in a GH-dependent manner. The possible contribution of PTP1B and SHP-1 to GH signaling in fibroblasts from ISS patients has not been studied. METHODS We determined the basal protein content of PTP1B and SHP-1 in the presence of recombinant human GH (rhGH) for 24 h in skin fibroblast cultures, obtained from patients with ISS, and were compared with a normal height control children group. JAK2 activation was determined in both groups. RESULTS JAK2 activation was delayed in fibroblasts from ISS patients compared to controls. Under basal conditions, the protein content of SHP-1 was lower in ISS, and after incubation with rhGH, it decreased in the non-nuclear and nuclear fraction of controls, but not in ISS patients. The protein content of PTP1B, however, increased in a similar fashion in fibroblasts from both ISS and control children. CONCLUSION The delayed activation of JAK2 and the lack of response of SHP-1 after incubation with GH in fibroblasts from ISS patients, suggests that the growth retardation observed in some of these children may be mediated in part by this phosphotyrosine phosphatase.
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Merino PM, Codner E, Cassorla F. A rational approach to the diagnosis of polycystic ovarian syndrome during adolescence. ACTA ACUST UNITED AC 2012; 55:590-8. [PMID: 22218441 DOI: 10.1590/s0004-27302011000800013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 10/19/2011] [Indexed: 11/21/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is a lifelong disorder characterized by hyperandrogenism and ovulatory dysfunction, with a wide spectrum of clinical symptoms and signs. Three different sets of diagnostic criteria have been established in order to define this disease in adult women, but there is controversy regarding the use of these criteria in adolescence. During puberty, the adult criteria for ovulatory dysfunction does not seem applicable, because an irregular menstrual pattern and a decreased ovulatory rate is a physiologic event during this period of life. Also, a higher prevalence of polycystic ovarian morphology (PCOM) may be observed during this period, so PCOM is not a useful criterion to define PCOS in young women. These findings suggest that a key factor to diagnose to PCOS during adolescence is hyperandrogenism. In addition, since PCOM is not clearly associated with hyperandrogenism during this period of life, the term "polycystic ovarian syndrome" during adolescence creates confusion and may be misleading.
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Affiliation(s)
- Paulina M Merino
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Chile.
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Kuehn D, Aros S, Cassorla F, Avaria M, Unanue N, Henriquez C, Kleinsteuber K, Conca B, Avila A, Carter TC, Conley MR, Troendle J, Mills JL. A prospective cohort study of the prevalence of growth, facial, and central nervous system abnormalities in children with heavy prenatal alcohol exposure. Alcohol Clin Exp Res 2012; 36:1811-9. [PMID: 22823161 DOI: 10.1111/j.1530-0277.2012.01794.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 01/19/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most children who are exposed to large quantities of alcohol in utero do not develop fetal alcohol syndrome (FAS). Population-based prospective data on the risk of developing components of fetal alcohol spectrum disorders (FASD), however, are limited. METHODS This was a prospective cohort study of 9,628 women screened during their first prenatal appointment in Chile, which identified 101 who consumed at least 4 drinks/d (exposed) matched with 101 women with no reported alcohol consumption during pregnancy (unexposed). Detailed alcohol consumption data were collected during the pregnancy. Children were evaluated up to 8.5 years of age by clinicians masked to exposure status. RESULTS One or more functional central nervous system abnormalities were present in 44.0% (22/50) of the exposed children compared to 13.6% (6/44) of the unexposed (p = 0.002). Growth restriction was present in 27.2% (25/92) of the exposed and 12.5% (12/96) of the unexposed (p = 0.02). Abnormal facial features were present in 17.3% (14/81) of the exposed children compared to 1.1% (1/89) of the unexposed children (p = 0.0002) by direct examination. Of the 59 exposed children with data available to detect at least 1 abnormality, 12 (20.3%) had no abnormalities. Binge drinking from conception to recognition of pregnancy (OR = 1.48 per day, 95% CI: 1.15 to 1.91, p = 0.002) and after recognition of pregnancy (OR= 1.41 per day, 95% CI: 1.01 to 1.95, p = 0.04) and total number of drinks consumed per week from conception to recognition of pregnancy (OR = 1.02 per drink, 95% CI: 1.01 to 1.04, p = 0.0009) were significantly associated with abnormal child outcome. CONCLUSIONS After exposure to heavy alcohol consumption during pregnancy, 80% of children had 1 or more abnormalities associated with alcohol exposure. Patterns of alcohol use that posed the greatest risk of adverse outcomes were binge drinking and high total weekly intake. Functional neurologic impairment occurred most frequently and may be the only sign to alert physicians to prenatal alcohol exposure.
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Affiliation(s)
- Devon Kuehn
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Sir-Petermann T, Ladrón de Guevara A, Codner E, Preisler J, Crisosto N, Echiburú B, Maliqueo M, Sánchez F, Perez-Bravo F, Cassorla F. Relationship between anti-Müllerian hormone (AMH) and insulin levels during different tanner stages in daughters of women with polycystic ovary syndrome. Reprod Sci 2012; 19:383-90. [PMID: 22344736 DOI: 10.1177/1933719111424444] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT We have previously described increased serum levels of anti-Müllerian hormone (AMH) and stimulated insulin in daughters of women with polycystic ovary syndrome (PCOS), suggesting that these girls may have an altered ovarian follicular development which may be modulated by insulin. However, the specific relationship between serum AMH and insulin levels during each Tanner stage of puberty in this cohort has not been established. OBJECTIVE The aim of our study was to establish the relationship between AMH and poststimulated insulin serum concentrations during each stage of puberty in daughters of women with PCOS (PCOSd), compared to daughters of control women (Cd). DESIGN We studied 135 PCOSd and 93 Cd classified according to their Tanner stage. Gonadotrophins, sex steroids, sex hormone-binding globulin (SHBG), and AMH were determined in a fasting sample. Ovarian volume was measured by pelvic ultrasound. In addition, in both groups we performed an oral glucose tolerance test with measurements of glucose and insulin. RESULTS Anti-Müllerian hormone levels were significantly higher in PCOSd compared to Cd at all Tanner stages. Daughters of women with PCOS having AMH concentrations greater than 2 standard deviation (SD) above the mean AMH value for the Cd group showed decreased serum follicle-stimulating hormone (FSH) concentrations and increased stimulated levels of insulin during Tanner stages I, II, and III. CONCLUSIONS Anti-Müllerian hormone levels are increased in PCOSd during all stages of puberty. We suggest that those PCOSd with the highest AMH levels probably represent a group of girls with more severe ovarian dysfunction and metabolic derangements.
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Affiliation(s)
- Teresa Sir-Petermann
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Santiago, Chile.
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Parada-Bustamante A, Lardone MC, Madariaga M, Johnson MC, Codner E, Cassorla F, Castro A. Androgen receptor CAG and GGN polymorphisms in boys with isolated hypospadias. J Pediatr Endocrinol Metab 2012; 25:157-62. [PMID: 22570967 DOI: 10.1515/jpem.2011.379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The etiology of hypospadias is multifactorial. Abnormal androgenic secretion and/or action during the development of external genitalia may be involved in the etiology of this congenital malformation. This study explored CAG and GGN polymorphisms in the androgen receptor (AR) gene, which may affect its transcriptional activity, in patients with isolated hypospadias. METHODS The length of the CAG/GGN polymorphisms was determined in 44 boys with non-severe (glandular) or severe (penile or penoscrotal) isolated hypospadias and with a normal hormonal evaluation. In addition, 79 healthy men, as controls, were studied. RESULTS Mean CAG repeats were significantly higher in total and severe cases compared to controls (24.4 +/- 2.8 and 24.7 +/- 3.1 vs. 22.7 +/- 3.3, respectively; p<0.05, Student's t and Bonferroni test). In addition, a frequency of CAG alleles >23 was significantly different in total and severe cases compared to controls (70.5% and 74.1% vs. 39.2%, respectively, p<0.05, chi2 and Bonferroni test). The median number and the distribution of GGN polymorphisms were similar in cases and controls. CONCLUSION Boys with isolated hypospadias have longer CAG alleles in their AR, which may be related with the development of this congenital malformation.
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Affiliation(s)
- Alexis Parada-Bustamante
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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35
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Kalfa N, Cassorla F, Audran F, Oulad Abdennabi I, Philibert P, Béroud C, Guys JM, Reynaud R, Alessandrini P, Wagner K, Bréaud J, Valla JS, Morisson Lacombe G, Daures JP, Baskin L, Fukami M, Ogata T, Sultan C. Polymorphisms of MAMLD1 gene in hypospadias. J Pediatr Urol 2011; 7:585-91. [PMID: 22030455 DOI: 10.1016/j.jpurol.2011.09.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Mastermind-like domain containing 1 (MAMLD1) is a causative gene for the fetal development of male external genitalia. Almost 10% of patients with both severe and non-severe hypospadias exhibit mutations of MAMLD1. The aim of this work was to determine whether polymorphisms of MAMLD1 are a genetic risk factor for hypospadias. MATERIAL AND METHODS This study included 150 hypospadias with a range of severities and 150 controls. Direct sequencing of the MAMLD1 coding exons and their flanking splice sites was performed. In silico secondary and tertiary structure prediction and accessibility of changed amino acids were evaluated using JPred, Netsurf and PHYRE software. Functional studies of the transactivation of haplotypes on Hes3 promoter were performed in vitro using cDNAs of missense variants of MAMLD1. RESULTS The p.P286S polymorphism was identified in 17/150 patients and 12/150 controls (11.3% vs. 8.0%, p = 0.32). The p.N589S polymorphism was identified in 22/150 patients and 12/150 controls (14.6% vs. 8.0%, p = 0.068). The double polymorphism (S-S haplotype) was present in 16/150 patients and 6/150 controls (10.6% vs. 4.0%, p = 0.044, OR = 2.87, CI from 1.09 to 7.55). The association of polymorphisms consistently revealed a modification in the structure prediction or amino acid accessibility in all three in silico models. The P286S, N589S and P286S + N589S proteins did not exhibit reduced transactivating activity on Hes3 promoter. CONCLUSION Polymorphisms of MAMLD1 gene are frequent in patients with hypospadias. Although no change in transactivation was noted on Hes3 promoter, the in silico studies and the significantly increased incidence of the S-S haplotype in hypospadiac patients raise the hypothesis of a particular susceptibility conferred by these variants.
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Affiliation(s)
- N Kalfa
- Service d'Hormonologie, Hôpital Lapeyronie, CHU de Montpellier et UM1, Montpellier, France
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Cassorla F, Cianfarani S, Haverkamp F, Labarta JI, Loche S, Luo X, Maghnie M, Mericq V, Muzsnai A, Norgren S, Ojaniemi M, Pribilincova Z, Quinteiro S, Savendahl L, Spinola e Castro A, Gasteyger C. Growth hormone and treatment outcomes: expert review of current clinical practice. Pediatr Endocrinol Rev 2011; 9:554-565. [PMID: 22397140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although there are guidelines for treatment of short stature, open questions regarding optimal management of growth hormone therapy still exist. Experts attending six international meetings agree that successful therapy results in the patient attaining mid-parental height, and relies on correct diagnosis and early intervention. Experts advocate patient followup every 3-6 months, and that growth and adherence should be monitored at each visit. Growth response is variable, and an accepted definition of good/poor response is lacking. Combined with patient education and regular patient follow-up, a definition of treatment response could lead to improved treatment outcomes. Few experts use prediction models in clinical practice, but all agree that pharmacogenetics might improve prediction, enable early therapy modulation, and promote growth. Poor growth is often due to low adherence. Guidance on optimal management of growth hormone therapy is required, with focus on early diagnosis, dosing, treatment monitoring, adherence, and motivation.
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Affiliation(s)
- Fernando Cassorla
- Institute of Maternal and Child Research, University of Chile, Santa Rosa 1234, Santiago, Chile
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Cornman-Homonoff J, Kuehn D, Aros S, Carter TC, Conley MR, Troendle J, Cassorla F, Mills JL. Heavy prenatal alcohol exposure and risk of stillbirth and preterm delivery. J Matern Fetal Neonatal Med 2011; 25:860-3. [PMID: 21728738 DOI: 10.3109/14767058.2011.587559] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We prospectively identified 96 women consuming at least 4 drinks/day during pregnancy by screening 9628 pregnant women. In these women with heavy prenatal alcohol use, there were three stillbirths and one preterm delivery; 98 matched nondrinking women had no stillbirths and two preterm births. Preterm rates did not differ significantly. The stillbirth rate was higher in the exposed group (p = 0.06). Additional investigation showed the stillbirth rate in the exposed population (3.1%) was significantly higher (p = 0.019) than the reported Chilean population rate (0.45%). Our data suggest that heavy alcohol consumption may increase the risk for stillbirth but not preterm delivery.
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Affiliation(s)
- Joshua Cornman-Homonoff
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
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Aros S, Mills JL, Iñiguez G, Avila A, Conley MR, Troendle J, Cox C, Cassorla F. Effects of prenatal ethanol exposure on postnatal growth and the insulin-like growth factor axis. Horm Res Paediatr 2011; 75:166-73. [PMID: 20847545 PMCID: PMC3068754 DOI: 10.1159/000319706] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 07/23/2010] [Indexed: 11/19/2022] Open
Abstract
AIMS To study the effect of in-utero alcohol exposure on the insulin-like growth factor axis (IGF) and leptin during infancy and childhood, considering that exposed children may exhibit pre- and postnatal growth retardation. METHODS We prospectively identified heavily drinking pregnant women who consumed on average 4 or more drinks of ethanol per day (≥ 48 g/day) and assessed growth in 69 of their offspring and an unexposed control group of 83 children, measuring serum IGF-I (radioimmunoassay), IGF-II (immunoradiometric assay, IRMA), insulin-like growth factor-binding protein 3 (IGFBP-3) (IRMA) and leptin (IRMA) at 1 month and 1, 2, 3, 4, and 5 years of age. RESULTS IGF-II levels increased with age in both groups, but the rate of increase was significantly higher in exposed children, and levels were significantly higher in ethanol-exposed children at 3, 4, and 5 years of age. In exposed children, IGF-I levels were higher at 3 and 4 years and leptin levels were significantly lower at 1 and 2 years. Exposed subjects showed a much lower correlation between IGF-I and growth parameters than unexposed subjects. CONCLUSION Exposure to ethanol during pregnancy increases IGF-I and IGF-II and decreases leptin during early childhood. The increase in serum IGF-II concentrations in ethanol-exposed children suggests that this hormone should be explored as a potential marker for prenatal alcohol exposure.
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Affiliation(s)
- Sofía Aros
- Department of Pediatrics, Faculty of Medicine, University of Chile, San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - James L. Mills
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Md., USA,*James L. Mills, MD, MS, 6100 Bldg. Room 7 B03. NICHD, NIH, DHHS, Bethesda, MD 20892 (USA), Tel. +1 301 496 5394, Fax +1 301 402 2084, E-Mail
| | - Germán Iñiguez
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Alejandra Avila
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Mary R. Conley
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Md., USA
| | - James Troendle
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Md., USA
| | - Christopher Cox
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Md., USA
| | - Fernando Cassorla
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
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Iñiguez G, Román R, Youlton R, Cassorla F, Mericq V. Ghrelin plasma levels in patients with idiopathic short stature. Horm Res Paediatr 2011; 75:94-100. [PMID: 20861603 DOI: 10.1159/000317429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 06/15/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Novel molecular insights have suggested that ghrelin may be involved in the pathogenesis of some forms of short stature. Recently, growth hormone secretagogue receptor (GHSR) mutations that segregate with short stature have been reported. AIM To study plasma ghrelin levels in prepubertal patients with idiopathic short stature (ISS). METHODS Fasting total plasma ghrelin levels (radioimmunoassay) in 41 prepubertal patients with ISS (18 females, age 7.9 ± 0.5 years) compared with 42 age- and sex-matched controls (27 females, age 8.0 ± 0.3 years) with normal height. In a subset of 28 patients, the ghrelin receptor was sequenced. RESULTS ISS patients exhibited a higher level of ghrelin (1,458 ± 137 vs. 935 ± 55 pg/ml, p < 0.01) and similar IGF-I levels (-0.66 ± 1.29 vs. -0.32 ± 0.78 SDS) compared to controls. Ten patients with ISS had ghrelin levels greater than +2 SDS compared to controls. These patients did not differ in height, BMI or IGF-I SDS compared to ISS patients with ghrelin levels within the normal range. Molecular analysis of GHSR did not show any mutations, but showed some polymorphisms. CONCLUSION These results suggest that in ISS patients, short stature does not appear to be frequently caused by abnormalities in ghrelin signaling.
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Affiliation(s)
- Germán Iñiguez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
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Soto N, Pruzzo R, Eyzaguirre F, Iñiguez G, López P, Mohr J, Pérez-Bravo F, Cassorla F, Codner E. Bone mass and sex steroids in postmenarcheal adolescents and adult women with Type 1 diabetes mellitus. J Diabetes Complications 2011; 25:19-24. [PMID: 19955005 DOI: 10.1016/j.jdiacomp.2009.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 10/08/2009] [Accepted: 10/24/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to compare the bone mass in young adolescents and adult women with Type 1 diabetes mellitus (T1DM) and determine its relationship with sex steroid and sex hormone-binding globulin (SHBG) levels. DESIGN Cross-sectional study. PATIENTS We studied a group of adolescents and adult women with T1DM (n=45) and 50 healthy controls (C) matched by gynecological age and body mass index in a case-control study. Girls with menarche within the last 18-40 months (n=17 T1DM and 32 C) and adult women (age=30.4+1.4 years; n=28 T1DM and 18 C) were recruited. MEASUREMENTS Bone mass was evaluated with a GE Lunar Prodigy densitometer. Sex steroid levels were measured by radioimmunoassay. RESULTS Bone mass was lower in adolescents with T1DM than in control adolescents, but was similar in both groups of postmenarcheal girls after adjusting for age, lean, and fat mass. However, adult T1DM women exhibited lower adjusted and unadjusted (P<.05) Z-femoral neck (-0.2±0.2 vs. 0.4±0.2) and bone mineral content (BMC) (2306±61 vs. 2645±79 g) than adult controls. Adult controls and T1DM adults showed higher whole body BMC than adolescent controls and T1DM adolescents, respectively. Bone mass in T1DM did not correlate with estradiol, free estradiol, testosterone, SHBG, or HbA1c levels. CONCLUSIONS The diminished bone mass observed in adult T1DM women does not appear to be related to sex steroid levels. In young adolescents with T1DM, the observed decrease in bone mass appears to be related to differences in body composition and age.
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Affiliation(s)
- Néstor Soto
- Endocrinology Unit, San Borja-Arriarán Hospital Santiago, Chile
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Sotomayor K, Iñiguez G, Ugarte F, Villarroel C, López P, Avila A, Codner E, Cassorla F. Ovarian function in adolescents with McCune-Albright syndrome. J Pediatr Endocrinol Metab 2011; 24:525-8. [PMID: 21932592 DOI: 10.1515/jpem.2011.265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate ovarian function, especially ovulation rate, in adolescents with McCune-Albright syndrome (MAS) and a history of peripheral precocious puberty. DESIGN Prospective cross-sectional study. SETTING Academic center. PATIENT(S) A total of eight adolescents with MAS were compared with 15 healthy adolescents matched by age, Tanner stage and body mass index. INTERVENTION(S) We determined basal gonadotropins, sex steroids, sex hormone binding globulin, anti-Müllerian hormone, glucose and insulin. A leuprolide acetate test was performed to measure luteinizing hormone (LH) and follicle stimulating hormone (FSH) (at 0 and 3 h), and 17B-estradiol, testosterone and 17-OH-progesterone (at 0 and 24 h). Salivary progesterone levels were used to assess ovulation during the 13th, 18th, 23rd and 28th days of each menstrual cycle for three to five consecutive cycles, and one pelvic ultrasound was performed during the follicular phase. MAIN OUTCOME MEASURE(S) Ovulation rate in adolescents with MAS. RESULT(S) The proportion of ovulatory cycles was 52.6% in controls compared with 35.7% in patients with MAS. CONCLUSION(S) The adolescent girls with MAS appear to have a lower ovulatory rate compared with controls.
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Affiliation(s)
- Karina Sotomayor
- Institute of Maternal and Child Research, University of Chile, Hospital San Borja Arriaran, Santiago, Chile
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Iñiguez G, Argandoña F, Medina P, González C, San Martín S, Kakarieka E, Johnson MC, Cassorla F. Acid-labile subunit (ALS) gene expression and protein content in human placentas: differences according to birth weight. J Clin Endocrinol Metab 2011; 96:187-91. [PMID: 20943791 DOI: 10.1210/jc.2010-0244] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT In humans, IGF-I and -II have an important role in pre- and postnatal growth. The IGFs circulate in plasma principally as a ternary complex with the IGF binding protein-3 and an acid-labile subunit (ALS), which increases their half life. OBJECTIVES The objectives of the study were to determine whether the human placenta expresses the mRNA and protein for ALS and to evaluate any possible differences in the mRNA and protein for ALS in placentas from small (SGA) and appropriate (AGA) or gestational age newborns. SUBJECTS/METHODS We studied the placentas from 47 AGA and 42 SGA pregnancies. IGF-I, IGF-II, IGF binding protein-3, and ALS placental mRNA and protein contents were determined in both the basal and the chorionic plates of the placenta. RESULTS We observed that the human placenta expresses the gene and protein for ALS. The ALS mRNA in SGA was higher compared with AGA placentas (0.15 ± 0.01 vs. 0.12 ± 0.01 arbitrary units, respectively, P < 0.05). In addition, the ALS protein content in SGA (31.7 ± 3.3 pmol/g) was higher compared with AGA (22.1 ± 2.3 pmol/g, P < 0.05) placentas. CONCLUSION We describe that the human placenta expresses the mRNA and the protein for ALS, and we observed an increase in ALS mRNA expression and protein content in SGA compared with AGA placentas.
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Affiliation(s)
- Germán Iñiguez
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile.
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Codner E, Eyzaguirre FC, Iñiguez G, López P, Pérez-Bravo F, Torrealba IM, Cassorla F. Ovulation rate in adolescents with type 1 diabetes mellitus. Fertil Steril 2011; 95:197-202, 202.e1. [DOI: 10.1016/j.fertnstert.2010.10.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 10/04/2010] [Accepted: 10/26/2010] [Indexed: 12/19/2022]
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Codner E, Villarroel C, Eyzaguirre FC, López P, Merino PM, Pérez-Bravo F, Iñiguez G, Cassorla F. Polycystic ovarian morphology in postmenarchal adolescents. Fertil Steril 2010; 95:702-6.e1-2. [PMID: 20650451 DOI: 10.1016/j.fertnstert.2010.06.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 05/26/2010] [Accepted: 06/03/2010] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the association of polycystic ovary morphology (PCOM) with ovarian function in adolescents and to determine its time course during two years of follow-up. DESIGN Prospective study. SETTING Academic center. PATIENT(S) Twenty healthy adolescents were followed from 2-4 years after menarche. INTERVENTION(S) We performed annual ultrasonographic and hormonal studies. Ovulation was assessed during 6 consecutive months by measuring salivary progesterone levels. MAIN OUTCOME MEASURE(S) Persistence of PCOM during the years following menarche; ovulation in girls with PCOM. RESULT(S) PCOM was observed in 40%, 35%, and 33.3% of the ultrasonographic studies performed at 2, 3, and 4 years after menarche, respectively. The concordance between ultrasonographic diagnosis at 2 and 4 years postmenarche (50%) was nonsignificant (kappa = 0.08). PCOM was not associated with abnormalities in ovulatory rate, menstrual cycle duration, lipid levels, or homeostatic model assessment of insulin resistance. However, lower FSH (4.8 ± 1.3 vs. 6.1 ± 1.9 mUI/ml) were observed in girls with PCOM compared with those without PCOM. Similar T and stimulated 17-hydroxyprogesterone on the leuprolide test were observed in girls with and without PCOM. CONCLUSION(S) PCOM is an inconstant finding in healthy adolescents and does not appear to be associated with decreased ovulatory rate or metabolic abnormalities in healthy adolescents. This finding suggests that PCOM may correspond to a physiologic condition during early adolescence.
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Affiliation(s)
- Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.
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Iñiguez G, González CA, Argandoña F, Kakarieka E, Johnson MC, Cassorla F. Expression and protein content of IGF-I and IGF-I receptor in placentas from small, adequate and large for gestational age newborns. Horm Res Paediatr 2010; 73:320-7. [PMID: 20389101 DOI: 10.1159/000308163] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 06/20/2009] [Indexed: 11/19/2022] Open
Abstract
In humans, a direct relationship between IGF-I cord blood levels and birth weight has been demonstrated. To determine the placental IGF-I, IGF-II and IGF-IR mRNA and protein contents in full-term pregnancies from appropriate for gestational age (AGA), small for gestational age (SGA) and large for gestational age (LGA) newborns, we studied the placentas from 35 AGA, 30 SGA and 28 LGA pregnancies. The IGF-I, IGF-II and IGF-I receptor (IGF-IR) placental mRNA and protein contents were determined in the basal and chorionic plates of the placenta. IGF1 and IGF1R mRNA was higher in SGA compared to AGA and LGA placentas and lower in LGA compared with AGA placentas. In addition, a higher protein content of IGF-I and IGF-IR was observed in SGA compared with AGA and LGA placentas and lower contents in LGA compared with AGA placentas. These results suggest that the higher IGF-I and IGF-IR contents observed in SGA placentas and the lower contents observed in LGA placentas compared with AGA placentas may be influencing human fetal growth.
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Affiliation(s)
- G Iñiguez
- Institute of Maternal and Child Research, and Hospital Clínico San Borja-Arriarán, University of Chile, Santiago, Chile.
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Martínez Pinto J, Salazar T, Ocaranza P, Fuentes A, Román R, Cassorla F. Cytoplasmic and nuclear STAT3 in GH-stimulated fibroblasts of children with idiopathic short stature. Horm Res Paediatr 2010; 74:251-258. [PMID: 20395672 DOI: 10.1159/000313415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 10/09/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND STAT5, which plays an important role in GH signal transduction, has been studied extensively in children with growth retardation, but there is scarce information regarding STAT3. AIM We determined total and phosphorylated STAT3 after GH stimulation in fibroblasts from children with idiopathic short stature (ISS) and control children with normal stature. SUBJECTS AND METHODS We studied 15 prepubertal children (age 7.6 ± 0.4 years) with short stature (height -2.8 ± 0.2 SDS), decreased growth velocity ( 10 ng/ml to the clonidine stimulation test and decreased serum IGF-I concentrations (<-1 SDS), and 19 control children with normal stature (age 6.7 ± 0.3 years). We determined the levels of total and phosphorylated STAT3 in the cytoplasmic and nuclear fractions of fibroblast cultures obtained from a skin biopsy, stimulated with GH (200 ng/ml) for 15-60 min. RESULTS We observed a reduction in nuclear pSTAT3 levels and a lower nuclear/cytoplasmic STAT3 phosphorylated ratio in 3 patients from the study group compared to the control children. CONCLUSION These results suggest that some children with ISS may exhibit a reduction in the nuclear content of their phosphorylated STAT3.
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Lanes R, Boguszewski CL, Calzada R, Cassorla F, Fideleff H, Boquete H. Growth hormone deficiency: transition from adolescence to adulthood. Highlights from a Latin-American Serono Symposia International Foundation Conference. J Pediatr Endocrinol Metab 2010; 23:225-33. [PMID: 20480720 DOI: 10.1515/jpem.2010.23.3.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Roberto Lanes
- Pediatric Endocrine Unit, Hospital de Clinicas Caracas, Caracas, Venezuela.
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Sir-Petermann T, Márquez L, Cárcamo M, Hitschfeld C, Codner E, Maliqueo M, Echiburú B, Aranda P, Crisosto N, Cassorla F. Effects of birth weight on anti-mullerian hormone serum concentrations in infant girls. J Clin Endocrinol Metab 2010; 95:903-10. [PMID: 19934359 DOI: 10.1210/jc.2009-1771] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
CONTEXT We previously demonstrated that low birth weight (BW) infant girls show increased serum anti-Müllerian hormone (AMH) concentrations and poststimulated estradiol levels compared to normal-BW infants, suggesting an altered follicular development. However, the impact of high BW on reproductive function is less known. OBJECTIVE To evaluate the effect of BW on AMH, we determined the concentrations of this hormone in low-BW, normal-BW, and high-BW female infants during the first 3 months of life. DESIGN Twenty-seven low-BW, 29 normal-BW, and 28 high-BW infant girls were studied. We measured serum gonadotropins, steroid hormones, AMH, glucose, insulin, free fatty acids, IGF-I, and adiponectin in a fasting blood sample. In addition, in a subgroup of normal-BW (n = 23) and high-BW infants (n = 10), a GnRH analog leuprolide acetate test was performed. RESULTS Serum concentrations of AMH were higher in low-BW and high-BW infants compared to normal-BW infants (P = 0.028 and 0.022, respectively). In addition, in high-BW infants, adiponectin concentrations were lower (P = 0.018), and poststimulated FSH and estradiol levels were higher compared to normal-BW infants (P = 0.024 and 0.047, respectively). CONCLUSIONS Serum AMH and poststimulated estradiol concentrations are increased in low-BW and high-BW female infants, suggesting that these girls may show evidence of an altered follicular development. However, the increased poststimulated FSH levels and low adiponectin concentrations observed in high-BW infants suggest that ovarian function is perturbed through a different mechanism from that in low-BW infants.
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Affiliation(s)
- Teresa Sir-Petermann
- Laboratory of Endocrinology, Department of Medicine, West Division, School of Medicine, Las Palmeras 299, Interior Quinta Normal, Casilla 33052, Correo 33, Santiago, Chile.
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Iñiguez G, Ormazabal P, López T, Maldonado D, Avila A, Román R, Cassorla F. IGF-IR/ERK content and response to IGF-I and insulin in adipocytes from small for gestational age children. Growth Horm IGF Res 2009; 19:256-261. [PMID: 19217812 DOI: 10.1016/j.ghir.2008.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 05/20/2008] [Accepted: 12/02/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND/AIMS The GH-IGF-I axis plays an important role on pre/postnatal growth in humans, and IGF-I regulates cell proliferation, differentiation, and metabolic homeostasis. The adipose tissue has an important function in energy storage, and plays an endocrine role through the production of several hormones and growth factors. There are few studies in humans regarding IGF-I and Insulin receptor signaling in adipocytes, particularly from AGA and SGA children. METHODS We studied 22 healthy prepubertal children (6.1+/-0.4 years), born at term (11 SGA and 11 AGA), and normal BMI at the time of the study. Primary cell cultures were established from subcutaneous adipose tissue biopsies. Preadipocytes were differentiated and stimulated with IGF-I or insulin and we studied IGF-IR, IR, AKT, and ERK content and phosphorylation. RESULTS The SGA children were shorter than the AGA children (height SDS -2.14+/-0.11 vs. 0.02+/-0.19, p<0.05). A lower content of IGF-IR, IR, AKT, and ERK was observed in adipocytes from SGA compared with AGA children. IGF-I stimulation increased IGF-IR and ERK phosphorylation in adipocytes from AGA, but not from SGA children. CONCLUSION The lower content and reduced phosphorylation of IGF-I signaling observed in adipocytes from SGA children may be related to the metabolic abnormalities described in these children.
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Affiliation(s)
- German Iñiguez
- Institute for Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile.
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Sir-Petermann T, Codner E, Pérez V, Echiburú B, Maliqueo M, Ladrón de Guevara A, Preisler J, Crisosto N, Sánchez F, Cassorla F, Bhasin S. Metabolic and reproductive features before and during puberty in daughters of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2009; 94:1923-30. [PMID: 19223518 PMCID: PMC2730345 DOI: 10.1210/jc.2008-2836] [Citation(s) in RCA: 186] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT A significant proportion of the first-degree female relatives of women with polycystic ovary syndrome (PCOS) may be at risk for developing PCOS. However, it is not known at which stage of pubertal development the hormonal and metabolic abnormalities ensue in PCOS. OBJECTIVE The aim of the study was to assess the reproductive and metabolic profiles of daughters of women with PCOS (PCOSd) during the peripubertal period, a stage during which the gonadal axis is activated and PCOS may become clinically manifest. DESIGN Ninety-nine PCOSd [30 prepubertal and 69 pubertal (Tanner II-V)] and 84 daughters of control women (Cd) (20 prepubertal and 64 pubertal) were studied. An oral glucose tolerance test, a GnRH agonist test (leuprolide acetate, 10 microg/kg sc), and a transabdominal ultrasound were performed. Gonadotropins, sex steroids, SHBG, glucose, insulin, and lipids were determined. RESULTS Both groups had similar chronological ages and body mass index sd scores according to Tanner stage distribution. Ovarian volume and 2-h insulin were significantly higher in PCOSd compared to Cd at all Tanner stages. In Tanner stages IV and V, basal testosterone and poststimulated LH, testosterone, and 17-hydroxyprogesterone concentrations were significantly higher in PCOSd compared to Cd. CONCLUSIONS Hyperinsulinemia and an increased ovarian volume are present in PCOSd before the onset of puberty and persist during pubertal development. The biochemical abnormalities of PCOS appear during late puberty. Considering the early onset and the nature of the alterations, PCOSd constitute a high-risk group for metabolic and reproductive derangements.
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Affiliation(s)
- Teresa Sir-Petermann
- Endocrinology and Metabolism Laboratory, Department of Medicine, West Division, School of Medicine, Las Palmeras 299, Interior Quinta Normal, Casilla 33052, Correo 33, Santiago 8320000, Chile.
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