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Jelley H, Meder M, Timme K. Virilization at Puberty: A Rare Cause. Clin Pediatr (Phila) 2023; 62:946-950. [PMID: 36797848 DOI: 10.1177/00099228221146508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Hannah Jelley
- Division of Pediatric Diabetes & Endocrinology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Primary Children's Hospital, Salt Lake City, UT, USA
| | - Michelle Meder
- Division of Pediatric Diabetes & Endocrinology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Primary Children's Hospital, Salt Lake City, UT, USA
| | - Kathleen Timme
- Division of Pediatric Diabetes & Endocrinology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Primary Children's Hospital, Salt Lake City, UT, USA
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Zhu H, Yao H, Liu X, Xu Y, Liu Y, Luo Q, Chen Y, Shi Y, Chen F, Zhao S, Song H, Han B, Qiao J. Lessons from 17β-HSD3 deficiency: Clinical spectrum and complex molecular basis in Chinese patients. J Steroid Biochem Mol Biol 2023; 225:106191. [PMID: 36154887 DOI: 10.1016/j.jsbmb.2022.106191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023]
Abstract
17β-Hydroxysteroid dehydrogenase type 3 (17β-HSD3) deficiency is rarely reported in Chinese patients with 46, XY disorders of sexual development (DSD). Seven subjects with 17β-HSD3 deficiency were identified from 206 Chinese 46, XY DSD patients using targeted next-generation sequencing (NGS). Serum AD and T levels were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). In silico and functional studies were performed to evaluate the enzymatic activity impairment of HSD17B3 variants. A minigene assay was performed in an exonic splicing variant. Our results showed that four novel and five reported HSD17B3 variants were identified in 7 unrelated patients. The patients showed cryptic presentation during childhood and classical virilization after puberty with T/AD ratio< 0.4. A heterozygous large deletion from the 5'UTR to exon 1 was identified in a patient with a monoallelic variant of p.N130S. Although predicted to be 'likely pathogenic', only p. S232P and p. S160F drastically reduced the enzymatic activity of 17β-HSD3. A previously reported 'missense' variant c 0.277 G>A (p. E93K) was revealed to have no impact on enzyme activity but resulted in aberrant splicing of exon 3 and was reclassified as an exonic splicing variant. In our study, one nonsense, one exonic splicing, one deletion, one large deletion and five missense variants were detected in patients with 17β-HSD3 deficiency, expanding the clinical and molecular profile of this disorder. In silico analysis should be cautiously interpreted when the heredity pattern and functional study are inconsistent.
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Affiliation(s)
- Hui Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Haijun Yao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xuemeng Liu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yue Xu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yang Liu
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Qingqiong Luo
- Department of Clinical Laboratory, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yan Chen
- Department of Obstetrics and Gynecology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yuanping Shi
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Fuxiang Chen
- Department of Clinical Laboratory, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Shuangxia Zhao
- Research Centre for Clinical Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Huaidong Song
- Research Centre for Clinical Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Bing Han
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
| | - Jie Qiao
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
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Disorder of Sex Development Due to 17-Beta-Hydroxysteroid Dehydrogenase Type 3 Deficiency: A Case Report and Review of 70 Different HSD17B3 Mutations Reported in 239 Patients. Int J Mol Sci 2022; 23:ijms231710026. [PMID: 36077423 PMCID: PMC9456484 DOI: 10.3390/ijms231710026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
The 17-beta-hydroxysteroid dehydrogenase type 3 (17-β-HSD3) enzyme converts androstenedione to testosterone and is encoded by the HSD17B3 gene. Homozygous or compound heterozygous HSD17B3 mutations block the synthesis of testosterone in the fetal testis, resulting in a Disorder of Sex Development (DSD). We describe a child raised as a female in whom the discovery of testes in the inguinal canals led to a genetic study by whole exome sequencing (WES) and to the identification of a compound heterozygous mutation of the HSD17B3 gene (c.608C>T, p.Ala203Val, and c.645A>T, p.Glu215Asp). Furthermore, we review all HSD17B3 mutations published so far in cases of 17-β-HSD3 deficiency. A total of 70 different HSD17B3 mutations have so far been reported in 239 patients from 187 families. A total of 118 families had homozygous mutations, 63 had compound heterozygous mutations and six had undetermined genotypes. Mutations occurred in all 11 exons and were missense (55%), splice-site (29%), small deletions and insertions (7%), nonsense (5%), and multiple exon deletions and duplications (2%). Several mutations were recurrent and missense mutations at codon 80 and the splice-site mutation c.277+4A>T each represented 17% of all mutated alleles. These findings may be useful to those involved in the clinical management and genetic diagnosis of this disorder.
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de Omena Filho RL, Petroli RJ, Soardi FC, de Paula Michelatto D, Mazzola TN, Fabbri-Scallet H, de Mello MP, Zanotti SV, Gubert IC, Monlleo I. So, and if it is not congenital adrenal hyperplasia? Addressing an undiagnosed case of genital ambiguity. Ital J Pediatr 2022; 48:89. [PMID: 35689291 PMCID: PMC9188102 DOI: 10.1186/s13052-022-01284-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Congenital Adrenal Hyperplasia due to 21 hydroxylase deficiency is the most common cause of genital ambiguity in persons with XX sexual chromosomes. Genital ambiguity among persons with XY sexual chromosomes comprises diverse and rare etiologies. The deficiency of 17-beta-hydroxysteroid dehydrogenase type 3 enzyme (HSD17B3) is a rare autosomal recessive disorder due to functionally altered variants of the HSD17B3 gene. In this disorder/difference of sex development, the conversion of androstenedione into testosterone is impaired. The appearance of external genitalia of 46,XY individuals varies from typically male to almost female. Case presentation We report on a child presenting severe ambiguous genitalia. Due to access constraints, specialized care did not start until the child was 10 months old. Parents are consanguineous and were born in an area of high isonymy that is a cluster for rare recessive diseases. A new homozygous missense variant c.785G > T was found in exon 10 of the HSD17B3 gene. Conclusions Researchers-clinicians and researchers-researchers collaborative efforts to elucidate the genetic basis of this disease were critical since this etiologic investigation is not available through the public health system. This case exemplifies the families’ pilgrimage in cases of genital ambiguity due to a rare genetic condition. Recognizing the etiology was the baseline to provide information on prognosis and treatment options, and to shelter family and child doubts and hopes in order to better support their decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01284-9.
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Affiliation(s)
- Reinaldo Luna de Omena Filho
- Maternal, Child and Adolescent Health Center, State University of Health Sciences of Alagoas, Postgraduate Program in Health Sciences of the Institute of Biological and Health Sciences of the Federal University of Alagoas, Maceió, Brazil
| | - Reginaldo José Petroli
- Medical Genetics Sector, Faculty of Medicine, Federal University of Alagoas, Maceió, Brazil
| | - Fernanda Caroline Soardi
- Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering, State University of Campinas, Campinas, Brazil
| | | | - Taís Nitsch Mazzola
- Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering, State University of Campinas, Campinas, Brazil
| | - Helena Fabbri-Scallet
- Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering, State University of Campinas, Campinas, Brazil
| | - Maricilda Palandi de Mello
- Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering, State University of Campinas, Campinas, Brazil
| | | | | | - Isabella Monlleo
- Clinical Genetics Service, Medical Genetics Sector, Faculty of Medicine, University Hospital, Federal University of Alagoas, Avenida Lourival Melo Mota, S/N, Tabuleiro 23 do Martins, 57072-970, Maceió, Alagoas, Brasil.
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Cocchetti C, Baldinotti F, Romani A, Ristori J, Mazzoli F, Vignozzi L, Maggi M, Fisher AD. A Novel Compound Heterozygous Mutation of HSD17B3 Gene Identified in a Patient With 46,XY Difference of Sexual Development. Sex Med 2022; 10:100522. [PMID: 35588601 PMCID: PMC9386624 DOI: 10.1016/j.esxm.2022.100522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Deficiency of the 17β-hydroxysteroid dehydrogenase type 3 (17 β-HSD3) is a rare autosomal recessive 46,XY Difference of sex development (DSD), resulting from pathogenetic variants in the HSD17B3 gene, which lead to absent or reduced ability to convert Δ4-androstenedione to testosterone in the fetal testes. AIM This study aimed to present the clinical and genetic characteristics of an Italian patient receiving a diagnosis of 17 β-HSD3 deficiency in adulthood. The patient was raised as female and underwent early surgical interventions to correct virilized genitalia, leading to a significant sexual distress. METHODS At the time of the referral, a 20-gene Next Generation Sequencing custom-panel for DSD was performed on patient's genomic DNA. RESULTS A novel compound heterozygous mutation in HSD17B3 gene was identified, detecting a new variant (c.257_265delAGGCCATTG, p.) CONCLUSION: Novel genotype causing 17 β-HSD3 deficiency is presented. Furthermore, the patient's clinical history stresses the importance to actively involve these individuals in the decision-making process avoiding surgical intervention when the patient is not able to give fully informed consent. Cocchetti C, Baldinotti F, Romani A, et al. A Novel Compound Heterozygous Mutation of HSD17B3 Gene Identified in a Patient With 46,XY Difference of Sexual Development. Sex Med 2022;10:100522.
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Affiliation(s)
- Carlotta Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Fulvia Baldinotti
- Laboratory of Molecular genetics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessia Romani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Jiska Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Francesca Mazzoli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Mario Maggi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Alessandra Daphne Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy.
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De Falco L, Piscopo C, D’Angelo R, Evangelista E, Suero T, Sirica R, Ruggiero R, Savarese G, Di Carlo A, Furino G, Scarpato C, Fico A. Detection of 46, XY Disorder of Sex Development (DSD) Based on Plasma Cell-Free DNA and Targeted Next-Generation Sequencing. Genes (Basel) 2021; 12:genes12121890. [PMID: 34946839 PMCID: PMC8700836 DOI: 10.3390/genes12121890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 12/03/2022] Open
Abstract
Mutations in the HSD17B3 gene cause HSD17B3 deficiency and result in 46, XY Disorders of Sex Development (46, XY DSD). The diagnosis of 46, XY DSD is very challenging and not rarely is confirmed only at older ages, when an affected XY female presents with primary amenorrhea or develops progressive virilization. The patient described in this paper represents a case of discrepancies between non-invasive prenatal testing (NIPT) and ultrasound based fetal sex determination detected during prenatal screening. Exome sequencing was performed on the cell free fetal DNA (cffDNA), amniotic fluid, and the parents. Libraries were generated according to the manufacturer’s protocols using TruSight One Kits (Illumina Inc., San Diego, CA, USA). Sequencing was carried out on NEXT Seq 500 (Illumina) to mean sequencing depth of at least 100×. A panel of sexual disease genes was used in order to search for a causative variant. The finding of a mutation (c.645 A>T, p.Glu215Asp) in HSD17B3 gene in amniotic fluid as well as in cffDNA and both parents supported the hypothesis of the HSD17B3 deficiency. In conclusion, we used clinical exome sequencing and non-invasive prenatal detection, providing a solution for NIPT of a single-gene disorder. Early genetic diagnoses are useful for patients and clinicians, contribute to clinical knowledge of DSD, and are invaluable for genetic counseling of couples contemplating future pregnancies.
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Affiliation(s)
- Luigia De Falco
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy; (R.D.); (E.E.); (T.S.); (R.S.); (R.R.); (G.S.); (A.D.C.); (G.F.); (A.F.)
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
- Correspondence:
| | - Carmelo Piscopo
- Medical and Laboratory Genetic Unit, A. Cardarelli Hospital, 80131 Naples, Italy;
| | - Rossana D’Angelo
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy; (R.D.); (E.E.); (T.S.); (R.S.); (R.R.); (G.S.); (A.D.C.); (G.F.); (A.F.)
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Eloisa Evangelista
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy; (R.D.); (E.E.); (T.S.); (R.S.); (R.R.); (G.S.); (A.D.C.); (G.F.); (A.F.)
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Teresa Suero
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy; (R.D.); (E.E.); (T.S.); (R.S.); (R.R.); (G.S.); (A.D.C.); (G.F.); (A.F.)
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Roberto Sirica
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy; (R.D.); (E.E.); (T.S.); (R.S.); (R.R.); (G.S.); (A.D.C.); (G.F.); (A.F.)
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Raffaella Ruggiero
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy; (R.D.); (E.E.); (T.S.); (R.S.); (R.R.); (G.S.); (A.D.C.); (G.F.); (A.F.)
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Giovanni Savarese
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy; (R.D.); (E.E.); (T.S.); (R.S.); (R.R.); (G.S.); (A.D.C.); (G.F.); (A.F.)
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Antonella Di Carlo
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy; (R.D.); (E.E.); (T.S.); (R.S.); (R.R.); (G.S.); (A.D.C.); (G.F.); (A.F.)
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Giulia Furino
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy; (R.D.); (E.E.); (T.S.); (R.S.); (R.R.); (G.S.); (A.D.C.); (G.F.); (A.F.)
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Ciro Scarpato
- Ambulatorio Medicina Prenatale, PO S. Giuliano, 80014 Naples, Italy;
| | - Antonio Fico
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy; (R.D.); (E.E.); (T.S.); (R.S.); (R.R.); (G.S.); (A.D.C.); (G.F.); (A.F.)
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
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Faienza MF, Baldinotti F, Marrocco G, TyuTyusheva N, Peroni D, Baroncelli GI, Bertelloni S. 17β-hydroxysteroid dehydrogenase type 3 deficiency: female sex assignment and follow-up. J Endocrinol Invest 2020; 43:1711-1716. [PMID: 32297288 DOI: 10.1007/s40618-020-01248-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Deficiency of 17β-hydroxysteroid dehydrogenase type 3 (17β-HSD3) is a rare autosomal recessive 46,XY disorder of sex development (DSD). It is due to pathogenetic variants in the HSD17B3 gene. Mutated genes encode an abnormal enzyme with absent or reduced ability to convert Δ4-androstenedione (Δ4-A) to testosterone (T) in the fetal testis. Affected individuals are usually raised as females and diagnosis is made at puberty, when they show virilization. METHODS A girl with a presumptive diagnosis of complete androgen insensitivity syndrome underwent endocrine and genetic assessment. Long-term follow-up was reported. RESULTS The diagnosis of 17β-HSD3 deficiency was made (stimulated T/Δ4-A ratio: 0.15; HSD17B3 gene analysis: c.277+4A>T in intron 3/c.640_645del (p.Glu214_Glu215del) in exon 9. After extensive information, parents decided to maintain female sex. Gonadal removal was performed and histological evaluation demonstrated deep fibrosis of testicular tissue. Follow-up till 8.5 years of age showed somatic and neuro-psychological development fitting with the female sex. CONCLUSIONS Management of a child with the rare 17β-HSD3 deficiency remains challenging. Any decision must be carefully evaluated with parents. Long-term follow-up must be warranted by a multidisciplinary DSD team to evaluate the adequacy of the choices made on quality of life in later life.
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Affiliation(s)
- M F Faienza
- Pediatric Section, Department of Biomedical Sciences and Human Oncology, University "A. Moro" of Bari, Piazza G. Cesare, 11, 70124, Bari, Italy.
| | - F Baldinotti
- Laboratory of Molecular Genetics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - G Marrocco
- UOC Chirurgia Pediatrica, Fondazione Policlinico Gemelli, Rome, Italy
| | - N TyuTyusheva
- Pediatric and Adolescent Endocrinology, Pediatric Unit, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, 56126, Pisa, Italy
| | - D Peroni
- Pediatric and Adolescent Endocrinology, Pediatric Unit, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, 56126, Pisa, Italy
| | - G I Baroncelli
- Pediatric and Adolescent Endocrinology, Pediatric Unit, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, 56126, Pisa, Italy
| | - S Bertelloni
- Pediatric and Adolescent Endocrinology, Pediatric Unit, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, 56126, Pisa, Italy.
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Das S, Saikia UK, Saikia KK, Sarma D, Choudhury BK, Bhuyan AK, Baro A, Das DV, Appaiah S. "Spectrum of 46 XY Disorders of Sex Development": A Hospital-based Cross-sectional Study. Indian J Endocrinol Metab 2020; 24:360-365. [PMID: 33088761 PMCID: PMC7540835 DOI: 10.4103/ijem.ijem_98_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/25/2020] [Accepted: 06/26/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Disorders of sex development (DSD) are a wide range of relatively rare conditions having diverse pathophysiology. Identification of an underlying cause can help in treating any coexisting hormone deficiencies and can help with anticipating any other immediate or long-term health concerns. OBJECTIVE To study the clinical and biochemical profile of patients with 46 XY DSD along with androgen receptor (AR) gene mutation status in selected group of patients. METHODS A cross-sectional study was conducted after enrolling the eligible DSD patients. Thorough elicitation of history and detailed clinical examination was done. Assays for luteinizing hormone, follicle-stimulating hormone, testosterone, dihydrotestosterone, androstenedione, AMH & Inhibin B (where indicated), and human chorionic gonadotropin stimulation were done as per protocol. RESULTS In total, 48 patients were included in the study. Ambiguous genitalia (58.3%) followed by hypospadias (33.3%) were common presentation. Androgen biosynthetic defect were the most commonly encountered diagnosis followed by androgen insensitivity syndrome (AIS). Swyer syndrome was diagnosed in 4.2% of cases; partial gonadal dysgenesis, ovotesticular DSD, and vanishing testis syndrome contributed to 2% of cases each. Eight cases (16.7%) who presented with isolated proximal and midshaft hypospadias for whom no diagnosis was found were categorized in the "etiology unclear" group. AR gene mutation analysis designed against specific exons did not yield any results. CONCLUSION 46 XY DSD is a heterogeneous group of patients with a varying age of presentation and a diverse clinical profile. Most patients are reared as males and maintained the same gender identity except in isolated cases. Diagnosis of AIS remains a clinical challenge as a definite hormonal criterion does not exist and genetic mutations in AR gene may be negative. Flanking region sequencing, whole genome sequencing, and promoter region sequencing may reveal pathogenic variants. Variations in other genes regulating AR pathway may also be candidates to be studied.
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Affiliation(s)
- Samiran Das
- Department of Endocrinology, Gauhati Medical College, Guwahati, India
| | - Uma K. Saikia
- Department of Endocrinology, Gauhati Medical College, Guwahati, India
| | - Kandarpa K. Saikia
- Department of Bioengineering and Technology, GUIST, Gauhati University, Assam, India
| | - Dipti Sarma
- Department of Endocrinology, Gauhati Medical College, Guwahati, India
| | | | - Ashok K. Bhuyan
- Department of Endocrinology, Gauhati Medical College, Guwahati, India
| | - Abhamoni Baro
- Department of Endocrinology, Gauhati Medical College, Guwahati, India
| | - Darvin V. Das
- Department of Endocrinology, Trivandrum Medical College, Thiruvananthapuram, Kerala, India
| | - Sonali Appaiah
- Department of Endocrinology, St Johns Medical College, Banglore, Karnataka, India
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Yazawa T, Imamichi Y, Uwada J, Sekiguchi T, Mikami D, Kitano T, Ida T, Sato T, Nemoto T, Nagata S, Islam Khan MR, Takahashi S, Ushikubi F, Suzuki N, Umezawa A, Taniguchi T. Evaluation of 17β-hydroxysteroid dehydrogenase activity using androgen receptor-mediated transactivation. J Steroid Biochem Mol Biol 2020; 196:105493. [PMID: 31614207 DOI: 10.1016/j.jsbmb.2019.105493] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022]
Abstract
17β-Hydroxysteroid dehydrogenases (17β-HSDs) catalyze the reduction of 17-ketosteroids and the oxidation of 17β-hydroxysteroids to regulate the production of androgens and estrogens. Among them, 17β-HSD type 3 (HSD17B3) is expressed almost exclusively in testicular Leydig cells and contributes to development of male sexual characteristics by converting androstenedione (A4) to testosterone (T). Mutations of HSD17B3 genes cause a 46,XY disorder of sexual development (46,XY DSD) as a result of low T production. Therefore, the evaluation of 17β-HSD3 enzymatic activity is important for understanding and diagnosing this disorder. We adapted a method that easily evaluates enzymatic activity of 17β-HSD3 by quantifying the conversion from A4 to T using androgen receptor (AR)-mediated transactivation. HEK293 cells were transduced to express human HSD17B3, and incubated medium containing A4. Depending on the incubation time with HSD17B3-expressing cells, the culture media progressively increased luciferase activities in CV-1 cells, transfected with the AR expression vector and androgen-responsive reporter. Culture medium from HSD17B1 and HSD17B5-expressing cells also increased the luciferase activities. This system is also applicable to detect the conversion of 11-ketoandrostenedione to 11-ketotestosterone by HSD17B3. Establishment of HEK293 cells expressing various missense mutations in the HSD17B3 gene associated with 46,XY DSD revealed that this system is effective to evaluate the enzymatic activities of mutant proteins.
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Affiliation(s)
- Takashi Yazawa
- Department of Biochemistry, Asahikawa Medical University, Hokkaido 078-8510, Japan.
| | - Yoshitaka Imamichi
- Department of Pharmacology, Asahikawa Medical University, Hokkaido 078-8510, Japan
| | - Junsuke Uwada
- Department of Biochemistry, Asahikawa Medical University, Hokkaido 078-8510, Japan
| | - Toshio Sekiguchi
- Noto Marine Laboratory, Division of Marine Environmental Studies, Institute of Nature and Environmental Technology, Kanazawa University, Ishikawa 927-0553, Japan
| | - Daisuke Mikami
- Department of Nephrology, University of Fukui, Fukui 910-1193, Japan
| | - Takeshi Kitano
- Department of Biological Sciences, Graduate School of Science and Technology, Kumamoto University 860-8555, Japan
| | - Takanori Ida
- Department of Bioactive Peptides, Frontier Science Research Center, University of Miyazaki, Miyazaki 889-1692, Japan
| | - Takahiro Sato
- Divsion of Molecular Genetics, Institute of Life Science, Kurume University, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Takahiro Nemoto
- Department of Physiology, Nippon Medical School, Tokyo 113-8602, Japan
| | - Sayaka Nagata
- Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan
| | - Md Rafiqul Islam Khan
- Department of Biochemistry, Asahikawa Medical University, Hokkaido 078-8510, Japan; Department of Pharmacy, University of Rajshahi, Rajshahi, Bangladesh
| | - Satoru Takahashi
- Department of Pediatrics,Asahikawa Medical University, Hokkaido 078-8510, Japan
| | - Fumitaka Ushikubi
- Department of Pharmacology, Asahikawa Medical University, Hokkaido 078-8510, Japan
| | - Nobuo Suzuki
- Noto Marine Laboratory, Division of Marine Environmental Studies, Institute of Nature and Environmental Technology, Kanazawa University, Ishikawa 927-0553, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, Center for Regenerative Medicine, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan
| | - Takanobu Taniguchi
- Department of Biochemistry, Asahikawa Medical University, Hokkaido 078-8510, Japan
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10
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Folsom LJ, Hjaige M, Liu J, Eugster EA, Auchus RJ. Germ cell neoplasia in situ complicating 17β-hydroxysteroid dehydrogenase type 3 deficiency. Mol Cell Endocrinol 2019; 489:3-8. [PMID: 30508571 PMCID: PMC6511466 DOI: 10.1016/j.mce.2018.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 01/08/2023]
Abstract
17β-hydroxysteroid dehydrogenase type 3 (17βHSD3) deficiency is an autosomal recessive disorder of male sex development that results in defective testosterone biosynthesis. Although mutations in the cognate HSD17B3 gene cause a spectrum of phenotypic manifestations, the majority of affected patients are genetic males having female external genitalia. Many cases do not present until puberty, at which time peripheral conversion of androgen precursors causes progressive virilization. Measurement of the testosterone-to-androstenedione ratio is useful to screen for 17βHSD3 deficiency, and genetic analysis can confirm the diagnosis. As some individuals with 17βHSD3 deficiency transition from a female sex assignment to identifying as males, providers should ensure stable gender identity prior to recommending irreversible treatments. Gonadectomy is indicated to prevent further virilization if a female gender identity is established. The risk of testicular neoplasia is unknown, a point which should be discussed if patients elect to transition into a male gender role.
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Affiliation(s)
- Lisal J Folsom
- Division of Endocrinology, Diabetes, and Metabolism University of Louisville, Louisville, KY, USA; Division of Pediatric Endocrinology, University of Louisville, Louisville, KY, USA.
| | - Mariam Hjaige
- Division of Metabolism, Endocrinology, & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jiayan Liu
- Division of Metabolism, Endocrinology, & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erica A Eugster
- Section of Pediatric Endocrinology, Riley Hospital for Children, Indiana University, Indiana, IN, USA
| | - Richard J Auchus
- Division of Metabolism, Endocrinology, & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
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11
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Parivesh A, Barseghyan H, Délot E, Vilain E. Translating genomics to the clinical diagnosis of disorders/differences of sex development. Curr Top Dev Biol 2019; 134:317-375. [PMID: 30999980 PMCID: PMC7382024 DOI: 10.1016/bs.ctdb.2019.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The medical and psychosocial challenges faced by patients living with Disorders/Differences of Sex Development (DSD) and their families can be alleviated by a rapid and accurate diagnostic process. Clinical diagnosis of DSD is limited by a lack of standardization of anatomical and endocrine phenotyping and genetic testing, as well as poor genotype/phenotype correlation. Historically, DSD genes have been identified through positional cloning of disease-associated variants segregating in families and validation of candidates in animal and in vitro modeling of variant pathogenicity. Owing to the complexity of conditions grouped under DSD, genome-wide scanning methods are better suited for identifying disease causing gene variant(s) and providing a clinical diagnosis. Here, we review a number of established genomic tools (karyotyping, chromosomal microarrays and exome sequencing) used in clinic for DSD diagnosis, as well as emerging genomic technologies such as whole-genome (short-read) sequencing, long-read sequencing, and optical mapping used for novel DSD gene discovery. These, together with gene expression and epigenetic studies can potentiate the clinical diagnosis of DSD diagnostic rates and enhance the outcomes for patients and families.
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Affiliation(s)
- Abhinav Parivesh
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, United States
| | - Hayk Barseghyan
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, United States; Department of Genomics and Precision Medicine, The George Washington University, Washington, DC, United States
| | - Emmanuèle Délot
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, United States; Department of Genomics and Precision Medicine, The George Washington University, Washington, DC, United States.
| | - Eric Vilain
- Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC, United States; Department of Genomics and Precision Medicine, The George Washington University, Washington, DC, United States.
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12
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17-β-hydroxysteroid dehydrogenase type 3 deficiency: Identifying a rare cause of 46, XY female phenotype in adulthood. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.jecr.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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13
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Walia R, Singla M, Vaiphei K, Kumar S, Bhansali A. Disorders of sex development: a study of 194 cases. Endocr Connect 2018; 7:364-371. [PMID: 29386228 PMCID: PMC5825923 DOI: 10.1530/ec-18-0022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study the clinical profile and the management of patients with disorders of sex development (DSD). DESIGN AND SETTING Retrospective study from a tertiary care hospital of North India. METHODS AND PATIENTS One hundred ninety-four patients of DSD registered in the Endocrine clinic of Postgraduate Institute of Medical Education and Research, Chandigarh between 1995 and 2014 were included. RESULTS One hundred and two patients (52.5%) had 46,XY DSD and seventy-four patients (38.1%) had 46,XX DSD. Sex chromosome DSD was identified in seven (3.6%) patients. Of 102 patients with 46,XY DSD, 32 (31.4%) had androgen insensitivity syndrome and 26 (25.5%) had androgen biosynthetic defect. Of the 74 patients with 46,XX DSD, 52 (70.27%) had congenital adrenal hyperplasia (CAH) and eight (10.8%) had ovotesticular DSD. Five patients with sex chromosome DSD had mixed gonadal dysgenesis. Excluding CAH, majority of the patients (90%) presented in the post-pubertal period. One-fourth of the patients with simple virilising CAH were reared as males because of strong male gender identity and behaviour and firm insistence by the parents. Corrective surgeries were performed in twenty patients (20%) of 46,XY DSD without hormonal evaluation prior to the presentation. CONCLUSION Congenital adrenal hyperplasia is the most common DSD in the present series. Most common XY DSD is androgen insensitivity syndrome, while CAH is the most common XX DSD. Delayed diagnosis is a common feature, and corrective surgeries are performed without seeking a definite diagnosis.
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Affiliation(s)
- R Walia
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research, Chandigarh, India
| | - M Singla
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research, Chandigarh, India
| | - K Vaiphei
- Department of HistopathologyPostgraduate Institute of Medical Education & Research, Chandigarh, India
| | - S Kumar
- Department of UrologyPostgraduate Institute of Medical Education & Research, Chandigarh, India
| | - A Bhansali
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research, Chandigarh, India
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14
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de Calais FL, Smith LD, Raponi M, Maciel-Guerra AT, Guerra-Junior G, de Mello MP, Baralle D. A study of splicing mutations in disorders of sex development. Sci Rep 2017; 7:16202. [PMID: 29176693 PMCID: PMC5701223 DOI: 10.1038/s41598-017-16296-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/10/2017] [Indexed: 11/09/2022] Open
Abstract
The presence of splicing sequence variants in genes responsible for sex development in humans may compromise correct biosynthesis of proteins involved in the normal development of gonads and external genitalia. In a cohort of Brazilian patients, we identified mutations in HSD17B3 and SRD5A2 which are both required for human sexual differentiation. A number of these mutations occurred within regions potentially critical for splicing regulation. Minigenes were used to validate the functional effect of mutations in both genes. We evaluated the c.277 + 2 T > G mutation in HSD17B3, and the c.544 G > A, c.548-44 T > G and c.278delG mutations in SRD5A2. We demonstrated that these mutations altered the splicing pattern of these genes. In a genomic era these results illustrate, and remind us, that sequence variants within exon-intron boundaries, which are primarily identified for diagnostic purposes and have unknown pathogenicity, need to be assessed with regards to their impact not only on protein expression, but also on mRNA splicing.
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Affiliation(s)
- Flavia Leme de Calais
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, Brazil
| | - Lindsay D Smith
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Michela Raponi
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andréa Trevas Maciel-Guerra
- Departamento de Genética, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brazil
| | - Gil Guerra-Junior
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brazil
| | | | - Diana Baralle
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- Wessex Clinical Genetics Service, Southampton University Hospitals NHS Trust, Southampton, UK.
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15
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Yu B, Liu Z, Mao J, Wang X, Zheng J, Xiong S, Cui M, Ma W, Huang Q, Xu H, Huang B, Nie M, Wu X. Novel mutations of HSD17B3 in three Chinese patients with 46,XY Disorders of Sex Development. Steroids 2017; 126:1-6. [PMID: 28774765 DOI: 10.1016/j.steroids.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/03/2017] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
Abstract
17β-Hydroxysteroid dehydrogenase type 3 (17β-HSD3) converts the inactive Δ4-androstenedione (A) to testosterone (T). Its deficiency is the most common testosterone biosynthesis defect that results in 46,XY Disorders Of Sex Development (DSD). However, the disease is difficult to distinguish from other 46,XY DSD for similar clinical phenotypes. Therefore, genetic testing provides good criteria for the diagnosis of the disease. In this study, HSD17B3 gene was examined in 3 unrelated Chinese patients with 46,XY DSD. Direct sequencing and quantitative PCR of HSD17B3 gene revealed the presence of a compound heterozygous mutation (p.I60T/exon1 deletion) in Patient 1, a homozygous (p.I60T) mutation in Patient 2 and a frameshift mutation (p.V25Efs∗54) and an exon1 deletion in Patient 3. All of the mutations have not been reported previously. These novel mutations may expand the mutation database of HSD17B3 gene and provide us new insights into the molecular mechanism of 17β-HSD3 deficiency. It is noteworthy that when direct sequence analysis showed a rare homozygous mutation in patients with non-consanguineous parents, "apparent homozygosity" should be taken into an account and the intragenic deletion should be screened. In addition, when single mutation was found in patients with disease in recessive heredity mode, the intragenic deletion should also be screened.
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Affiliation(s)
- Bingqing Yu
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Zhaoxiang Liu
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Jiangfeng Mao
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Xi Wang
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Junjie Zheng
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Shuyu Xiong
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Mingxuan Cui
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Wanlu Ma
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Qibin Huang
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Hongli Xu
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Bingkun Huang
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Min Nie
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China.
| | - Xueyan Wu
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China.
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16
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Biochemical Analysis of Four Missense Mutations in the HSD17B3 Gene Associated With 46,XY Disorders of Sex Development in Egyptian Patients. J Sex Med 2017; 14:1165-1174. [DOI: 10.1016/j.jsxm.2017.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/15/2017] [Accepted: 07/11/2017] [Indexed: 11/21/2022]
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17
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Özen S, Onay H, Atik T, Solmaz AE, Özkınay F, Gökşen D, Darcan Ş. Rapid Molecular Genetic Diagnosis with Next-Generation Sequencing in 46,XY Disorders of Sex Development Cases: Efficiency and Cost Assessment. Horm Res Paediatr 2017; 87:81-87. [PMID: 27898418 DOI: 10.1159/000452995] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/02/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/AIM The aim of this study was to use targeted next-generation sequencing (TNGS) including all known genes associated with 46,XY disorders of sex development (DSD) for a fast molecular genetic diagnosis. METHODS Twenty pediatric patients were recruited, and 56 genes related to 46,XY DSD were sequenced using TNGS. The time elapsed between initial appointment and final diagnosis as well as the mean expenditure was determined. RESULTS A total of 9 (45%) mutations in 4 different genes were identified. Mutations in the HSD17B3 gene were observed in 6 (30%) patients. A heterozygous mutation in WT1 gene and a hemizygous mutation in SRY gene were detected in patients with gonadal dysgenesis. One patient had a homozygous mutation in LHCGR gene. Prior to the molecular diagnosis, the mean number of clinical visits, time elapsed until diagnosis, and expenditure were 27.4 ± 14.6 visits, 5.9 ± 4.1 years per patient, and USD 2,142 ± 1,038, respectively. With TNGS, time elapsed until diagnosis was significantly reduced (3 days), and expenditure per patient was only one third of the conventional approach (USD 761). CONCLUSIONS TNGS is an efficient, rapid, and cost-effective technique for mutation detection in 46,XY DSD.
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Affiliation(s)
- Samim Özen
- Department of Pediatric Endocrinology, School of Medicine, Ege University, Izmir, Turkey
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18
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Ben Rhouma B, Kallabi F, Mahfoudh N, Ben Mahmoud A, Engeli RT, Kamoun H, Keskes L, Odermatt A, Belguith N. Novel cases of Tunisian patients with mutations in the gene encoding 17β-hydroxysteroid dehydrogenase type 3 and a founder effect. J Steroid Biochem Mol Biol 2017; 165:86-94. [PMID: 26956191 DOI: 10.1016/j.jsbmb.2016.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/13/2016] [Accepted: 03/03/2016] [Indexed: 11/17/2022]
Abstract
17β-Hydroxysteroid dehydrogenase type 3 (17β-HSD3) is expressed almost exclusively in the testis and converts Δ4-androstene-3,17-dione to testosterone. Mutations in the HSD17B3 gene causing 17β-HSD3 deficiency are responsible for a rare recessive form of 46, XY Disorders of Sex Development (46, XY DSD). We report novel cases of Tunisian patients with 17β-HSD3 deficiency due to previously reported mutations, i.e. p.C206X and p.G133R, as well as a case with the novel compound heterozygous mutations p.C206X and p.Q176P. Moreover, the previously reported polymorphism p.G289S was identified in a heterozygous state in combination with a novel non-coding variant c.54G>T, also in a heterozygous state, in a male patient presenting with micropenis and low testosterone levels. The identification of four different mutations in a cohort of eight patients confirms the generally observed genetic heterogeneity of 17β-HSD3 deficiency. Nevertheless, analysis of DNA from 272 randomly selected healthy controls from the same geographic area (region of Sfax) revealed a high carrier frequency for the p.C206X mutation of approximately 1 in 40. Genotype reconstruction of the affected pedigree members revealed that all p.C206X mutation carriers harbored the same haplotype, indicating inheritance of the mutation from a common ancestor. Thus, the identification of a founder effect and the elevated carrier frequency of the p.C206X mutation emphasize the importance to consider this mutation in the diagnosis and genetic counseling of affected 17β-HSD3 deficiency pedigrees in Tunisia.
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Affiliation(s)
- Bochra Ben Rhouma
- Human Molecular Genetic Laboratory, Faculty of Medicine of Sfax, 3030, University of Sfax, Tunisia.
| | - Fakhri Kallabi
- Human Molecular Genetic Laboratory, Faculty of Medicine of Sfax, 3030, University of Sfax, Tunisia
| | - Nadia Mahfoudh
- Department of Immunology, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Afif Ben Mahmoud
- Human Molecular Genetic Laboratory, Faculty of Medicine of Sfax, 3030, University of Sfax, Tunisia
| | - Roger T Engeli
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, Pharmacenter, University of Basel, Basel, Switzerland
| | - Hassen Kamoun
- Department of Medical Genetics, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Leila Keskes
- Human Molecular Genetic Laboratory, Faculty of Medicine of Sfax, 3030, University of Sfax, Tunisia
| | - Alex Odermatt
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, Pharmacenter, University of Basel, Basel, Switzerland.
| | - Neila Belguith
- Human Molecular Genetic Laboratory, Faculty of Medicine of Sfax, 3030, University of Sfax, Tunisia; Department of Medical Genetics, Hedi Chaker Hospital, 3029 Sfax, Tunisia
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19
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Mendonca BB, Gomes NL, Costa EMF, Inacio M, Martin RM, Nishi MY, Carvalho FM, Tibor FD, Domenice S. 46,XY disorder of sex development (DSD) due to 17β-hydroxysteroid dehydrogenase type 3 deficiency. J Steroid Biochem Mol Biol 2017; 165:79-85. [PMID: 27163392 DOI: 10.1016/j.jsbmb.2016.05.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 12/14/2022]
Abstract
17β-hydroxysteroid dehydrogenase 3 deficiency consists of a defect in the last phase of steroidogenesis, in which androstenedione is converted into testosterone and estrone into estradiol. External genitalia range from female-like to atypical genitalia and most affected males are raised as females. Virilization in subjects with 17β-HSD3 deficiency occurs at the time of puberty and several of them change to male social sex. In male social sex patients, testes can be safely maintained, as long as they are positioned inside the scrotum The phenotype of 46,XY DSD due to 17β-HSD3 deficiency is extremely variable and clinically indistinguishable from other causes of 46,XY DSD such as partial androgen insensitivity syndrome and 5α-reductase 2 deficiency. Laboratory diagnosis is based on a low testosterone/androstenedione ratio due to high serum levels of androstenedione and low levels of testosterone. The disorder is caused by a homozygous or compound heterozygous mutations in the HSD17B3 gene that encodes the 17β-HSD3 isoenzyme leading to an impairment of the conversion of 17-keto into 17-hydroxysteroids. Molecular genetic testing confirms the diagnosis and provides the orientation for genetic counseling. Our proposal in this article is to review the previously reported cases of 17β-HSD3 deficiency adding our own cases.
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Affiliation(s)
- Berenice B Mendonca
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil.
| | - Nathalia Lisboa Gomes
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Elaine M F Costa
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Marlene Inacio
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Regina M Martin
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Mirian Y Nishi
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | | | - Francisco Denes Tibor
- Urology Division, Surgery Department, Medical School, University of São Paulo, Brazil
| | - Sorahia Domenice
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
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20
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Khorashad BS, Aghili Z, Kreukels BP, Hiradfar M, Roshan GM, Afkhamizadeh M, Abbaszadegan MR, Ghaemi N, Khazai B, Cohen-Kettenis P. Psychosexual Outcome Among Iranian Individuals With 5α-Reductase Deficiency Type 2 and Its Relationship With Parental Sexism. J Sex Med 2016; 13:1629-1641. [DOI: 10.1016/j.jsxm.2016.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/26/2016] [Accepted: 09/05/2016] [Indexed: 01/22/2023]
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21
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Wei C, Davis N, Honour J, Crowne E. The investigation of children and adolescents with abnormalities of pubertal timing. Ann Clin Biochem 2016; 54:20-32. [DOI: 10.1177/0004563216668378] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Concerns with pubertal development are common and can cause considerable distress to patients and their carers. Many presentations reflect normal variations of pubertal timing and primarily require reassurance, although patients may opt for interventions. Other presentations need active management to avoid significant adverse effects on growth and psychosocial development. All should undergo careful assessment, particularly as some children or adolescents presenting with abnormalities in pubertal timing may have serious pathology which requires urgent investigations and treatment. This review describes the appropriate investigations and their interpretation for young people presenting with disorders in pubertal timing.
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Affiliation(s)
- Christina Wei
- Department of Paediatric Endocrinology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Nikki Davis
- Department of Paediatric Endocrinology, University Hospital Southampton, NHS Foundation Trust, Hampshire, UK
| | - John Honour
- Institute of Women's Health, University College London, London, UK
| | - Elizabeth Crowne
- Department of Paediatric Endocrinology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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22
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Hassan HA, Mazen I, Gad YZ, Ali OS, Mekkawy M, Essawi ML. Mutational Profile of 10 Afflicted Egyptian Families with 17-β-HSD-3 Deficiency. Sex Dev 2016; 10:66-73. [DOI: 10.1159/000445311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 11/19/2022] Open
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23
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Engeli RT, Rhouma BB, Sager CP, Tsachaki M, Birk J, Fakhfakh F, Keskes L, Belguith N, Odermatt A. Biochemical analyses and molecular modeling explain the functional loss of 17β-hydroxysteroid dehydrogenase 3 mutant G133R in three Tunisian patients with 46, XY Disorders of Sex Development. J Steroid Biochem Mol Biol 2016; 155:147-54. [PMID: 26545797 DOI: 10.1016/j.jsbmb.2015.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/21/2015] [Accepted: 10/29/2015] [Indexed: 12/13/2022]
Abstract
Mutations in the HSD17B3 gene resulting in 17β-hydroxysteroid dehydrogenase type 3 (17β-HSD3) deficiency cause 46, XY Disorders of Sex Development (46, XY DSD). Approximately 40 different mutations in HSD17B3 have been reported; only few mutant enzymes have been mechanistically investigated. Here, we report novel compound heterozygous mutations in HSD17B3, composed of the nonsense mutation C206X and the missense mutation G133R, in three Tunisian patients from two non-consanguineous families. Mutants C206X and G133R were constructed by site-directed mutagenesis and expressed in HEK-293 cells. The truncated C206X enzyme, lacking part of the substrate binding pocket, was moderately expressed and completely lost its enzymatic activity. Wild-type 17β-HSD3 and mutant G133R showed comparable expression levels and intracellular localization. The conversion of Δ4-androstene-3,17-dione (androstenedione) to testosterone was almost completely abolished for mutant G133R compared with wild-type 17β-HSD3. To obtain further mechanistic insight, G133 was mutated to alanine, phenylalanine and glutamine. G133Q and G133F were almost completely inactive, whereas G133A displayed about 70% of wild-type activity. Sequence analysis revealed that G133 on 17β-HSD3 is located in a motif highly conserved in 17β-HSDs and other short-chain dehydrogenase/reductase (SDR) enzymes. A homology model of 17β-HSD3 predicted that arginine or any other bulky residue at position 133 causes steric hindrance of cofactor NADPH binding, whereas substrate binding seems to be unaffected. The results indicate an essential role of G133 in the arrangement of the cofactor binding pocket, thus explaining the loss-of-function of 17β-HSD3 mutant G133R in the patients investigated.
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Affiliation(s)
- Roger T Engeli
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, Pharmacenter, University of Basel, Basel, Switzerland
| | - Bochra Ben Rhouma
- Human Molecular Genetics Laboratory, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Christoph P Sager
- Molecular Modeling, Department of Pharmaceutical Sciences, Pharmacenter, University of Basel, Basel, Switzerland
| | - Maria Tsachaki
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, Pharmacenter, University of Basel, Basel, Switzerland
| | - Julia Birk
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, Pharmacenter, University of Basel, Basel, Switzerland
| | - Faiza Fakhfakh
- Human Molecular Genetics Laboratory, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Leila Keskes
- Human Molecular Genetics Laboratory, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Neila Belguith
- Human Molecular Genetics Laboratory, Faculty of Medicine, University of Sfax, Sfax, Tunisia; Department of Medical Genetics, HediChaker Hospital, Sfax, Tunisia.
| | - Alex Odermatt
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, Pharmacenter, University of Basel, Basel, Switzerland.
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24
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Alikaşifoğlu A, Vurallı D, Hiort O, Gönç N, Özön A, Kandemir N. Severe Undervirilisation in a 46,XY Case Due to a Novel Mutation in HSD17B3 Gene. J Clin Res Pediatr Endocrinol 2015; 7:249-52. [PMID: 26831562 PMCID: PMC4677563 DOI: 10.4274/jcrpe.2069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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
17-β-hydroxysteroid dehydrogenase type 3 (17β-HSD3) is an important enzyme involved in the final steps of androgen synthesis and is required for the development of normal male external genitalia. 46,XY individuals with deficiency of this enzyme present a wide clinical spectrum from a female appearance of the external genitalia through ambiguous genitalia to a predominantly male genitalia with micropenis or hypospadias. This paper reports a one-year-old 46,XY patient with 17β-HSD3 deficiency who presented with female external genitalia and bilaterally palpable gonads in the inguinal region. The low T/Δ4 ratio after human chorionic gonadotropin (hCG) stimulation suggested 17β-HSD3 deficiency. A homozygous mutation, c.761_762delAG, was determined at the intron 9/exon 10 splice site of the HSD17B3 gene. To the best of our knowledge, this mutation has not been reported thus far, but its localization and type would imply a complete disruption of the 17β-HSD3 which may explain the phenotype of our patient.
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Affiliation(s)
- Ayfer Alikaşifoğlu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey
| | - Doğuş Vurallı
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey Phone: +90 312 305 11 24 E-mail:
| | - Olaf Hiort
- University of Lübeck Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Lübeck, Germany
| | - Nazlı Gönç
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey
| | - Alev Özön
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey
| | - Nurgün Kandemir
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey
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25
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Azevedo MF, Moisés RS, Antonini SRR. Special issue on molecular genetics in endocrinology. ACTA ACUST UNITED AC 2013; 56:471-2. [PMID: 23295283 DOI: 10.1590/s0004-27302012000800001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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26
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Hassan H, Mazen I, Gad Y, Ali O, Mekkawy M, Essawi M. A Novel Nonsense Mutation in Exon 1 ofHSD17B3Gene in an Egyptian 46,XY Adult Female Presenting with Primary Amenorrhea. Sex Dev 2013; 7:277-81. [DOI: 10.1159/000351822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2013] [Indexed: 11/19/2022] Open
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