|
1
|
Martínez de LaPiscina I, Mahmoud RAA, Sauter KS, Esteva I, Alonso M, Costa I, Rial-Rodriguez JM, Rodríguez-Estévez A, Vela A, Castano L, Flück CE. Variants of STAR, AMH and ZFPM2/FOG2 May Contribute towards the Broad Phenotype Observed in 46,XY DSD Patients with Heterozygous Variants of NR5A1. Int J Mol Sci 2020; 21:E8554. [PMID: 33202802 PMCID: PMC7696449 DOI: 10.3390/ijms21228554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 12/21/2022] Open
Abstract
Variants of NR5A1 are often found in individuals with 46,XY disorders of sex development (DSD) and manifest with a very broad spectrum of clinical characteristics and variable sex hormone levels. Such complex phenotypic expression can be due to the inheritance of additional genetic hits in DSD-associated genes that modify sex determination, differentiation and organ function in patients with heterozygous NR5A1 variants. Here we describe the clinical, biochemical and genetic features of a series of seven patients harboring monoallelic variants in the NR5A1 gene. We tested the transactivation activity of novel NR5A1 variants. We additionally included six of these patients in a targeted diagnostic gene panel for DSD and identified a second genetic hit in known DSD-causing genes STAR, AMH and ZFPM2/FOG2 in three individuals. Our study increases the number of NR5A1 variants related to 46,XY DSD and supports the hypothesis that a digenic mode of inheritance may contribute towards the broad spectrum of phenotypes observed in individuals with a heterozygous NR5A1 variation.
Collapse
Affiliation(s)
- Idoia Martínez de LaPiscina
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, ENDO-ERN. Plaza de Cruces 12, 48903 Barakaldo, Spain; (I.M.d.L.); (A.R.-E.); (A.V.); (L.C.)
| | - Rana AA Mahmoud
- Department of Pediatrics, Endocrinology Section, Ain Shams University, 38 Abbasia, Nour Mosque, El-Mohamady, Al Waili, Cairo 11591, Egypt;
| | - Kay-Sara Sauter
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland;
| | - Isabel Esteva
- Endocrinology Section, Gender Identity Unit, Regional University Hospital of Malaga, Av. de Carlos Haya, s/n, 29010 Málaga, Spain;
| | - Milagros Alonso
- Pediatric Endocrinology Department, Ramon y Cajal University Hospital, Ctra. de Colmenar Viejo km. 9, 100, 28034 Madrid, Spain;
| | - Ines Costa
- Pediatric Department, Manises Hospital, Avda. Generalitat Valenciana 50, 46940 Manises, Spain;
| | - Jose Manuel Rial-Rodriguez
- Pediatric Endocrinology Department, Nuestra Señora de Candelaria University Hospital, Ctra general del Rosario 145, 38010 Santa Cruz de Tenerife, Spain;
| | - Amaia Rodríguez-Estévez
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, ENDO-ERN. Plaza de Cruces 12, 48903 Barakaldo, Spain; (I.M.d.L.); (A.R.-E.); (A.V.); (L.C.)
- Pediatric Endocrinology Department, Cruces University Hospital, Plaza de Cruces 12, 48903 Barakaldo, Spain
| | - Amaia Vela
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, ENDO-ERN. Plaza de Cruces 12, 48903 Barakaldo, Spain; (I.M.d.L.); (A.R.-E.); (A.V.); (L.C.)
- Pediatric Endocrinology Department, Cruces University Hospital, Plaza de Cruces 12, 48903 Barakaldo, Spain
| | - Luis Castano
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, ENDO-ERN. Plaza de Cruces 12, 48903 Barakaldo, Spain; (I.M.d.L.); (A.R.-E.); (A.V.); (L.C.)
- Pediatric Endocrinology Department, Cruces University Hospital, Plaza de Cruces 12, 48903 Barakaldo, Spain
| | - Christa E. Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland;
| |
Collapse
|