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Yuan X, Chen R, Zhang Y, Yang X, Lin X. Long-Term Treatment With Letrozole in a Boy With Familial Male-Limited Precocious Puberty. Front Endocrinol (Lausanne) 2022; 13:906852. [PMID: 35909557 PMCID: PMC9329579 DOI: 10.3389/fendo.2022.906852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The long-term follow-up in children with familial male-limited precocious puberty (FMPP) who were treated with letrozole, triptorelin, and spironolactone is limited, especially considering the efficiency and safety. OBJECTIVE We describe the clinical characteristics and long-term treatment with letrozole on adult height of a boy diagnosed with FMPP, confirmed by analysis of the LHCGR gene. METHODS Physical examinations, bone age (BA), testosterone, and gonadotropin levels were measured as well as gene sequencing of the proband and parents. RESULTS The boy was referred to the hospital at 3.1 years of age due to peripheral precocious puberty. His height was 116.8cm (+5.1SD) and BA was 9 years. Genetic analysis revealed a patrilineal c.1703C>T.(p.Ala568Val) mutation of the LHCGR gene. After treating with letrozole for 1.6 years, the height according to BA went from -3.52SD to -2.82SD. Triptorelin was added at age 4.7 years based on both the evidence of central puberty and his growth velocity according to BA. During the 6.9 years of treatment, he had a height gain of 51.9cm, and BA increased 5.2 years. At age 10, his present height is 168.7cm (0.05SD) and BA is 14.7 years. No adverse effects of treatment were encountered. CONCLUSION A patrilineal mutation of the LHCGR gene has been identified in a boy with FMPP. His height is 168.7cm (-0.05SD) which is approaching his adult height after long-term treatment with letrozole, triptorelin, and spironolactone.
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Althumairy D, Zhang X, Baez N, Barisas G, Roess DA, Bousfield GR, Crans DC. Glycoprotein G-protein Coupled Receptors in Disease: Luteinizing Hormone Receptors and Follicle Stimulating Hormone Receptors. Diseases 2020; 8:E35. [PMID: 32942611 PMCID: PMC7565105 DOI: 10.3390/diseases8030035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
Signal transduction by luteinizing hormone receptors (LHRs) and follicle-stimulating hormone receptors (FSHRs) is essential for the successful reproduction of human beings. Both receptors and the thyroid-stimulating hormone receptor are members of a subset of G-protein coupled receptors (GPCRs) described as the glycoprotein hormone receptors. Their ligands, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and a structurally related hormone produced in pregnancy, human chorionic gonadotropin (hCG), are large protein hormones that are extensively glycosylated. Although the primary physiologic functions of these receptors are in ovarian function and maintenance of pregnancy in human females and spermatogenesis in males, there are reports of LHRs or FSHRs involvement in disease processes both in the reproductive system and elsewhere. In this review, we evaluate the aggregation state of the structure of actively signaling LHRs or FSHRs, their functions in reproduction as well as summarizing disease processes related to receptor mutations affecting receptor function or expression in reproductive and non-reproductive tissues. We will also present novel strategies for either increasing or reducing the activity of LHRs signaling. Such approaches to modify signaling by glycoprotein receptors may prove advantageous in treating diseases relating to LHRs or FSHRs function in addition to furthering the identification of new strategies for modulating GPCR signaling.
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Affiliation(s)
- Duaa Althumairy
- Cell and Molecular Biology Program, Colorado State University, Fort Collins, CO 80523, USA; (D.A.); (G.B.)
- Department of Biological Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Xiaoping Zhang
- Department of Chemistry, Colorado State University, Fort Collins, CO 80523, USA; (X.Z.); (N.B.)
| | - Nicholas Baez
- Department of Chemistry, Colorado State University, Fort Collins, CO 80523, USA; (X.Z.); (N.B.)
| | - George Barisas
- Cell and Molecular Biology Program, Colorado State University, Fort Collins, CO 80523, USA; (D.A.); (G.B.)
- Department of Chemistry, Colorado State University, Fort Collins, CO 80523, USA; (X.Z.); (N.B.)
| | - Deborah A. Roess
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA;
| | - George R. Bousfield
- Department of Biological Sciences, Wichita State University, Wichita, KS 67260, USA;
| | - Debbie C. Crans
- Cell and Molecular Biology Program, Colorado State University, Fort Collins, CO 80523, USA; (D.A.); (G.B.)
- Department of Chemistry, Colorado State University, Fort Collins, CO 80523, USA; (X.Z.); (N.B.)
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Daussac A, Barat P, Servant N, Yacoub M, Missonier S, Lavran F, Gaspari L, Sultan C, Paris F. Testotoxicosis without Testicular Mass: Revealed by Peripheral Precocious Puberty and Confirmed by Somatic LHCGR Gene Mutation. Endocr Res 2020; 45:32-40. [PMID: 31394950 DOI: 10.1080/07435800.2019.1645163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Testotoxicosis is an autosomal dominant form of limited gonadotropin-independent precocious puberty in boys. It is caused by a heterozygous constitutively activating mutation of the LHCGR gene encoding the luteinizing/hormone receptor (LHR). Some twenty mutations of the LHCGR gene have been reported. Most of them are constitutive mutations isolated from blood leukocyte DNA, although others are somatic, found only in testicular tumoural tissue. In all the previously reported cases of these somatic mutations, the tumour, whether a nodular Leydig cell adenoma or hyperplasia, was easily visible on testicular ultrasonography. The aim of this study was to describe an unusual presentation of a patient with the clinical and hormonal characteristics of testotoxicosis but no well-circumscribed lesion at testicular ultrasonography.Materials and Methods: Molecular analysis of the LHCGR gene was performed by direct sequencing of DNA extracted from peripheral leucocytes and testicular biopsy.Results: Molecular analysis didn't find any LHR mutation in blood, whereas it revealed for the first time a somatic D578H mutation in testicular tissue despite no evidence of a nodular aspect at testis ultrasonography.Conclusions: This observation underlines the need to look for a somatic LHCGR gene mutation from the testicular biopsies of all boys with testotoxicosis with no constitutive LHCGR gene mutation identified from blood DNA, even in the absence of circumscribed testicular lesion at ultrasonography. In addition, based on the known link between LHR mutations and testicular tumourigenesis, yearly ultrasound monitoring of the testes should be considered for these patients.
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Affiliation(s)
- A Daussac
- Département de Pédiatrie, Endocrinologie Pédiatrique, CHU de Bordeaux, Bordeaux, France
| | - P Barat
- Département de Pédiatrie, Endocrinologie Pédiatrique, CHU de Bordeaux, Bordeaux, France
- Département de Pédiatrie, Centre d'Investigation Clinique (CIC 0005), CHU de Bordeaux, Bordeaux, France
| | - N Servant
- Département d'Hormonologie (Développement et Reproduction), CHU de Montpellier, Hôpital Lapeyronie, Université de Montpellier, Montpellier, France
| | - M Yacoub
- Unité d'Anatomo cytopathologie, CHU de Bordeaux, Bordeaux, France
| | - S Missonier
- Unité de Radiologie pédiatrique, CHU de Bordeaux, Bordeaux, France
| | - F Lavran
- Unité de Chirurgie viscérale pédiatrique, CHU de Bordeaux, Bordeaux, France
| | - L Gaspari
- Unité d'Endocrinologie-Gynécologie Pédiatriques, Département de Pédiatrie, CHU de Montpellier, Hôpital Arnaud de Villeneuve, Université Montpellier 1, Montpellier, France
| | - C Sultan
- Département d'Hormonologie (Développement et Reproduction), CHU de Montpellier, Hôpital Lapeyronie, Université de Montpellier, Montpellier, France
- Unité d'Endocrinologie-Gynécologie Pédiatriques, Département de Pédiatrie, CHU de Montpellier, Hôpital Arnaud de Villeneuve, Université Montpellier 1, Montpellier, France
| | - F Paris
- Département d'Hormonologie (Développement et Reproduction), CHU de Montpellier, Hôpital Lapeyronie, Université de Montpellier, Montpellier, France
- Unité d'Endocrinologie-Gynécologie Pédiatriques, Département de Pédiatrie, CHU de Montpellier, Hôpital Arnaud de Villeneuve, Université Montpellier 1, Montpellier, France
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Özcabı B, Tahmiscioğlu Bucak F, Ceylaner S, Özcan R, Büyükünal C, Ercan O, Tüysüz B, Evliyaoğlu O. Testotoxicosis: Report of Two Cases, One with a Novel Mutation in LHCGR Gene. J Clin Res Pediatr Endocrinol 2015; 7:242-8. [PMID: 26831561 PMCID: PMC4677562 DOI: 10.4274/jcrpe.2067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Testotoxicosis is a rare disorder which presents as isosexual peripheral precocious puberty in males. Despite the pattern of autosomal dominant inheritance, sporadic cases also may occur. Due to activating mutation in luteinizing hormone (LH))/choriogonadotropin receptor (LHCGR) gene, early virilization and advancement in bone age are common with increased serum testosterone levels above adult ranges, despite low LH and follicular-stimulating hormone (FSH) levels. There are different treatment regimens, such as combination of bicalutamide (antiandrogen agent) and a third-generation aromatase inhibitor, that are reported to be well-tolerated and successful in slowing bone age advancement and preventing progression of virilization. We report here two patients who presented with peripheral precocious puberty and an activating mutation in the LHCGR gene: one with a family history and previously determined mutation and the other without family history and with a novel mutation (c.830G>T). Combination of bicalutamide+anastrozole was ineffective in slowing pubertal progression and bone age. Short-term results were better with ketoconazole.
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Affiliation(s)
- Bahar Özcabı
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Feride Tahmiscioğlu Bucak
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | | | - Rahşan Özcan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Surgery, İstanbul, Turkey
| | - Cenk Büyükünal
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Surgery, İstanbul, Turkey
| | - Oya Ercan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Beyhan Tüysüz
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Genetic, İstanbul, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 212 414 30 00 E-mail:
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Stoy H, Gurevich VV. How genetic errors in GPCRs affect their function: Possible therapeutic strategies. Genes Dis 2015; 2:108-132. [PMID: 26229975 PMCID: PMC4516391 DOI: 10.1016/j.gendis.2015.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/07/2015] [Indexed: 01/14/2023] Open
Abstract
Activating and inactivating mutations in numerous human G protein-coupled receptors (GPCRs) are associated with a wide range of disease phenotypes. Here we use several class A GPCRs with a particularly large set of identified disease-associated mutations, many of which were biochemically characterized, along with known GPCR structures and current models of GPCR activation, to understand the molecular mechanisms yielding pathological phenotypes. Based on this mechanistic understanding we also propose different therapeutic approaches, both conventional, using small molecule ligands, and novel, involving gene therapy.
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Ramaswamy S, Weinbauer GF. Endocrine control of spermatogenesis: Role of FSH and LH/ testosterone. SPERMATOGENESIS 2014; 4:e996025. [PMID: 26413400 PMCID: PMC4581062 DOI: 10.1080/21565562.2014.996025] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 12/21/2022]
Abstract
Evaluation of testicular functions (production of sperm and androgens) is an important aspect of preclinical safety assessment and testicular toxicity is comparatively far more common than ovarian toxicity. This chapter focuses (1) on the histological sequelae of disturbed reproductive endocrinology in rat, dog and nonhuman primates and (2) provides a review of our current understanding of the roles of gonadotropins and androgens. The response of the rodent testis to endocrine disturbances is clearly different from that of dog and primates with different germ cell types and spermatogenic stages being affected initially and also that the end-stage spermatogenic involution is more pronounced in dog and primates compared to rodents. Luteinizing hormone (LH)/testosterone and follicle-stimulating hormone (FSH) are the pivotal endocrine factors controlling testicular functions. The relative importance of either hormone is somewhat different between rodents and primates. Generally, however, both LH/testosterone and FSH are necessary for quantitatively normal spermatogenesis, at least in non-seasonal species.
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Affiliation(s)
- Suresh Ramaswamy
- Center for Research in Reproductive Physiology (CRRP); Department of Obstetrics, Gynecology & Reproductive Sciences; University of Pittsburgh School of Medicine; Magee-Womens Research Institute; Pittsburgh, PA USA
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Dubey S, Idicula-Thomas S, Anwaruddin M, Saravanan C, Varma RR, Maitra A. A novel 9-bp insertion detected in steroid 21-hydroxylase gene (CYP21A2): prediction of its structural and functional implications by computational methods. J Biomed Sci 2009; 16:3. [PMID: 19272182 PMCID: PMC2653521 DOI: 10.1186/1423-0127-16-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 01/08/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Steroid 21-hydroxylase deficiency is the most common cause of congenital adrenal hyperplasia (CAH). Detection of underlying mutations in CYP21A2 gene encoding steroid 21-hydroxylase enzyme is helpful both for confirmation of diagnosis and management of CAH patients. Here we report a novel 9-bp insertion in CYP21A2 gene and its structural and functional consequences on P450c21 protein by molecular modeling and molecular dynamics simulations methods. METHODS A 30-day-old child was referred to our laboratory for molecular diagnosis of CAH. Sequencing of the entire CYP21A2 gene revealed a novel insertion (duplication) of 9-bp in exon 2 of one allele and a well-known mutation I172N in exon 4 of other allele. Molecular modeling and simulation studies were carried out to understand the plausible structural and functional implications caused by the novel mutation. RESULTS Insertion of the nine bases in exon 2 resulted in addition of three valine residues at codon 71 of the P450c21 protein. Molecular dynamics simulations revealed that the mutant exhibits a faster unfolding kinetics and an overall destabilization of the structure due to the triple valine insertion was also observed. CONCLUSION The novel 9-bp insertion in exon 2 of CYP21A2 genesignificantly lowers the structural stability of P450c21 thereby leading to the probable loss of its function.
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Affiliation(s)
- Sudhisha Dubey
- Department of Molecular Endocrinology, National Institute for Research in Reproductive Health, Indian Council of Medical Research, J M Street, Parel, Mumbai, Maharashtra, India
| | - Susan Idicula-Thomas
- Biomedical Informatics Centre of Indian Council of Medical Research, National Institute for Research in Reproductive Health, J M Street, Parel, Mumbai, Maharashtra, India
| | - Mohammad Anwaruddin
- Biomedical Informatics Centre of Indian Council of Medical Research, National Institute for Research in Reproductive Health, J M Street, Parel, Mumbai, Maharashtra, India
| | - Chinnaraj Saravanan
- Department of Molecular Endocrinology, National Institute for Research in Reproductive Health, Indian Council of Medical Research, J M Street, Parel, Mumbai, Maharashtra, India
| | - R Raveendra Varma
- Department of Pediatrics and Neonatology, Mother's Hospital Trissur, Kerala, India
| | - Anurupa Maitra
- Department of Molecular Endocrinology, National Institute for Research in Reproductive Health, Indian Council of Medical Research, J M Street, Parel, Mumbai, Maharashtra, India
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Tao YX. Constitutive activation of G protein-coupled receptors and diseases: insights into mechanisms of activation and therapeutics. Pharmacol Ther 2008; 120:129-48. [PMID: 18768149 DOI: 10.1016/j.pharmthera.2008.07.005] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 07/22/2008] [Indexed: 01/17/2023]
Abstract
The existence of constitutive activity for G protein-coupled receptors (GPCRs) was first described in 1980s. In 1991, the first naturally occurring constitutively active mutations in GPCRs that cause diseases were reported in rhodopsin. Since then, numerous constitutively active mutations that cause human diseases were reported in several additional receptors. More recently, loss of constitutive activity was postulated to also cause diseases. Animal models expressing some of these mutants confirmed the roles of these mutations in the pathogenesis of the diseases. Detailed functional studies of these naturally occurring mutations, combined with homology modeling using rhodopsin crystal structure as the template, lead to important insights into the mechanism of activation in the absence of crystal structure of GPCRs in active state. Search for inverse agonists on these receptors will be critical for correcting the diseases cause by activating mutations in GPCRs. Theoretically, these inverse agonists are better therapeutics than neutral antagonists in treating genetic diseases caused by constitutively activating mutations in GPCRs.
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Affiliation(s)
- Ya-Xiong Tao
- Department of Anatomy, Physiology and Pharmacology, 212 Greene Hall, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA.
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Zhang M, Mizrachi D, Fanelli F, Segaloff DL. The formation of a salt bridge between helices 3 and 6 is responsible for the constitutive activity and lack of hormone responsiveness of the naturally occurring L457R mutation of the human lutropin receptor. J Biol Chem 2005; 280:26169-76. [PMID: 15908694 PMCID: PMC1237128 DOI: 10.1074/jbc.m502102200] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The human lutropin receptor (hLHR) plays a pivotal role in reproductive endocrinology. A number of naturally occurring mutations of the hLHR have been identified that cause the receptor to become constitutively active. To gain further insights into the structural basis for the activation of the hLHR by activating mutations, we chose to examine a particularly strong constitutively activating mutation of this receptor, L457R, in which a leucine that is highly conserved among rhodopsin-like G protein-coupled receptors in helix 3 has been substituted with arginine. Using both disruptive as well as reciprocal mutagenesis strategies, our studies demonstrate that the ability of L457R to stabilize an active form of the hLHR is because of the formation of a salt bridge between the replacing amino acid and Asp-578 in helix 6. Such a lock between the transmembrane portions of helices 3 and 6 is concurrent with weakening the connections between the cytosolic ends of the same helices, including the interaction found in the wild-type receptor between Arg-464, of the (E/D)R(Y/W) motif, and Asp-564. This structural effect is properly marked by the increase in the solvent accessibility of selected amino acids at the cytosolic interfaces between helices 3 and 6. The integrity of the conserved amino acids Asn-615 and Asn-619 in helix 7 is required for the transfer of the structural change from the activating mutation site to the cytosolic interface between helices 3 and 6. The results of in vitro and computational experiments further suggest that the structural trigger of the constitutive activity of the L457R mutant may also be responsible for its lack of hormone responsiveness.
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Affiliation(s)
- Meilin Zhang
- From the Department of Physiology and Biophysics, The University of Iowa, Iowa City, Iowa 52242 and
| | - Dario Mizrachi
- From the Department of Physiology and Biophysics, The University of Iowa, Iowa City, Iowa 52242 and
| | - Francesca Fanelli
- the Dulbecco Telethon Institute and Department of Chemistry, University of Modena e Reggio Emilia, Via Campi 183, 41100 Modena, Italy
| | - Deborah L. Segaloff
- From the Department of Physiology and Biophysics, The University of Iowa, Iowa City, Iowa 52242 and
- ** To whom correspondence should be addressed: Dept. of Physiology and Biophysics, 5–470 Bowen Science Bldg., The University of Iowa, IA City, IA 52242. Tel.: 319-335-7850; Fax: 319-335-7330; E-mail:
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Affiliation(s)
- Paul A Fowler
- Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen AB25 2ZD, Scotland, UK
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