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Rojas RA, Kutateladze AA, Plummer L, Stamou M, Keefe DL, Salnikov KB, Delaney A, Hall JE, Sadreyev R, Ji F, Fliers E, Gambosova K, Quinton R, Merino PM, Mericq V, Seminara SB, Crowley WF, Balasubramanian R. Phenotypic continuum between Waardenburg syndrome and idiopathic hypogonadotropic hypogonadism in humans with SOX10 variants. Genet Med 2023; 25:100855. [PMID: 37272927 DOI: 10.1016/j.gim.2023.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Rebecca A Rojas
- Harvard Reproductive Sciences Center, The Reproductive Endocrine Unit and The Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Anna A Kutateladze
- Harvard Reproductive Sciences Center, The Reproductive Endocrine Unit and The Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Lacey Plummer
- Harvard Reproductive Sciences Center, The Reproductive Endocrine Unit and The Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Maria Stamou
- Harvard Reproductive Sciences Center, The Reproductive Endocrine Unit and The Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - David L Keefe
- Harvard Reproductive Sciences Center, The Reproductive Endocrine Unit and The Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kathryn B Salnikov
- Harvard Reproductive Sciences Center, The Reproductive Endocrine Unit and The Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Angela Delaney
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Janet E Hall
- National Institute of Environmental Health Sciences, Research Triangle, NC
| | - Ruslan Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA
| | - Fei Ji
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA
| | - Eric Fliers
- Amsterdam University Medical Center, location AMC, Department of Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Katarina Gambosova
- Stormont-Vail Health, Cotton O'Neil Diabetes and Endocrinology, Topeka, KS
| | - Richard Quinton
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-tyne, UK
| | - Paulina M Merino
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Veronica Mericq
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Stephanie B Seminara
- Harvard Reproductive Sciences Center, The Reproductive Endocrine Unit and The Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - William F Crowley
- Harvard Reproductive Sciences Center, The Reproductive Endocrine Unit and The Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ravikumar Balasubramanian
- Harvard Reproductive Sciences Center, The Reproductive Endocrine Unit and The Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, MA
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Dwyer AA, Stamou MI, Anghel E, Hornstein S, Chen D, Salnikov KB, McDonald IR, Plummer L, Seminara SB, Balasubramanian R. Reproductive Phenotypes and Genotypes in Men With IHH. J Clin Endocrinol Metab 2023; 108:897-908. [PMID: 36268624 PMCID: PMC10211495 DOI: 10.1210/clinem/dgac615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/17/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Isolated hypogonadotropic hypogonadism (IHH) is phenotypically and genetically heterogeneous. OBJECTIVE This work aimed to determine the correlation between genotypic severity with pubertal and neuroendocrine phenotypes in IHH men. METHODS A retrospective study was conducted (1980-2020) examining olfaction (Kallmann syndrome [KS] vs normosmic IHH [nHH]), baseline testicular volume (absent vs partial puberty), neuroendocrine profiling (pulsatile vs apulsatile luteinizing hormone [LH] secretion), and genetic variants in 62 IHH-associated genes through exome sequencing (ES). RESULTS In total, 242 men (KS: n = 131 [54%], nHH: n = 111 [46%]) were included. Men with absent puberty had significantly lower gonadotropin levels (P < .001) and were more likely to have undetectable LH (P < .001). Logistic regression showed partial puberty as a statistically significant predictor of pulsatile LH secretion (R2 = 0.71, P < .001, OR: 10.8; 95% CI, 3.6-38.6). Serum LH of 2.10 IU/L had a 95% true positive rate for predicting LH pulsatility. Genetic analyses in 204 of 242 IHH men with ES data available revealed 36 of 204 (18%) men carried protein-truncating variants (PTVs) in 12 IHH genes. Men with absent puberty and apulsatile LH were enriched for oligogenic PTVs (P < .001), with variants in ANOS1 being the predominant PTV in this genotype-phenotype association. Men with absent puberty were enriched for ANOS1 PTVs compared to partial puberty counterparts (P = .002). PTVs in other IHH genes imparted more variable reproductive phenotypic severity. CONCLUSION Partial puberty and LH greater than or equal to 2.10 IU/L are proxies for pulsatile LH secretion. ANOS1 PTVs confer severe reproductive phenotypes. Variable phenotypic severity in the face of severe genetic variants in other IHH genes point to significant neuroendocrine plasticity of the HPG axis in IHH men.
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Affiliation(s)
- Andrew A Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts 02467, USA
- Massachusetts General Hospital—Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Maria I Stamou
- Massachusetts General Hospital—Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Ella Anghel
- Department of Measurement, Evaluation, Statistics and Assessment, Boston College Lynch School of Education and Human Development, Chestnut Hill, Massachusetts 02467, USA
| | - Shira Hornstein
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Danna Chen
- Massachusetts General Hospital—Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Kathryn B Salnikov
- Massachusetts General Hospital—Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Isabella R McDonald
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts 02467, USA
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Lacey Plummer
- Massachusetts General Hospital—Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Stephanie B Seminara
- Massachusetts General Hospital—Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Ravikumar Balasubramanian
- Massachusetts General Hospital—Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Cassin J, Stamou MI, Keefe KW, Sung KE, Bojo CC, Tonsfeldt KJ, Rojas RA, Ferreira Lopes V, Plummer L, Salnikov KB, Keefe DL, Ozata M, Genel M, Georgopoulos NA, Hall JE, Crowley WF, Seminara SB, Mellon PL, Balasubramanian R. Heterozygous mutations in SOX2 may cause idiopathic hypogonadotropic hypogonadism via dominant-negative mechanisms. JCI Insight 2023; 8:e164324. [PMID: 36602867 PMCID: PMC9977424 DOI: 10.1172/jci.insight.164324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Pathogenic SRY-box transcription factor 2 (SOX2) variants typically cause severe ocular defects within a SOX2 disorder spectrum that includes hypogonadotropic hypogonadism. We examined exome-sequencing data from a large, well-phenotyped cohort of patients with idiopathic hypogonadotropic hypogonadism (IHH) for pathogenic SOX2 variants to investigate the underlying pathogenic SOX2 spectrum and its associated phenotypes. We identified 8 IHH individuals harboring heterozygous pathogenic SOX2 variants with variable ocular phenotypes. These variant proteins were tested in vitro to determine whether a causal relationship between IHH and SOX2 exists. We found that Sox2 was highly expressed in the hypothalamus of adult mice and colocalized with kisspeptin 1 (KISS1) expression in the anteroventral periventricular nucleus of adult female mice. In vitro, shRNA suppression of mouse SOX2 protein in Kiss-expressing cell lines increased the levels of human kisspeptin luciferase (hKiss-luc) transcription, while SOX2 overexpression repressed hKiss-luc transcription. Further, 4 of the identified SOX2 variants prevented this SOX2-mediated repression of hKiss-luc. Together, these data suggest that pathogenic SOX2 variants contribute to both anosmic and normosmic forms of IHH, attesting to hypothalamic defects in the SOX2 disorder spectrum. Our study describes potentially novel mechanisms contributing to SOX2-related disease and highlights the necessity of SOX2 screening in IHH genetic evaluation irrespective of associated ocular defects.
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Affiliation(s)
- Jessica Cassin
- Department of Obstetrics, Gynecology, and Reproductive Sciences; Center for Reproductive Science and Medicine; and
- Center for Circadian Biology, University of California, San Diego, La Jolla, California, USA
| | - Maria I. Stamou
- Massachusetts General Hospital Harvard Center for Reproductive Medicine and Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimberly W. Keefe
- Center for Infertility and Reproductive Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kaitlin E. Sung
- Department of Obstetrics, Gynecology, and Reproductive Sciences; Center for Reproductive Science and Medicine; and
| | - Celine C. Bojo
- Department of Obstetrics, Gynecology, and Reproductive Sciences; Center for Reproductive Science and Medicine; and
| | - Karen J. Tonsfeldt
- Department of Obstetrics, Gynecology, and Reproductive Sciences; Center for Reproductive Science and Medicine; and
- Center for Circadian Biology, University of California, San Diego, La Jolla, California, USA
| | - Rebecca A. Rojas
- Massachusetts General Hospital Harvard Center for Reproductive Medicine and Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vanessa Ferreira Lopes
- Massachusetts General Hospital Harvard Center for Reproductive Medicine and Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lacey Plummer
- Center for Infertility and Reproductive Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kathryn B. Salnikov
- Massachusetts General Hospital Harvard Center for Reproductive Medicine and Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David L. Keefe
- Center for Infertility and Reproductive Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Myron Genel
- Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Neoklis A. Georgopoulos
- Division of Endocrinology, Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Janet E. Hall
- National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - William F. Crowley
- Endocrine Unit, Department of Medicine, and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephanie B. Seminara
- Massachusetts General Hospital Harvard Center for Reproductive Medicine and Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pamela L. Mellon
- Department of Obstetrics, Gynecology, and Reproductive Sciences; Center for Reproductive Science and Medicine; and
- Center for Circadian Biology, University of California, San Diego, La Jolla, California, USA
| | - Ravikumar Balasubramanian
- Massachusetts General Hospital Harvard Center for Reproductive Medicine and Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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Dwyer AA, Stamou M, McDonald IR, Anghel E, Cox KH, Salnikov KB, Plummer L, Seminara SB, Balasubramanian R. Reversible hypogonadotropic hypogonadism in men with the fertile eunuch/Pasqualini syndrome: A single-center natural history study. Front Endocrinol (Lausanne) 2022; 13:1054447. [PMID: 36407308 PMCID: PMC9666691 DOI: 10.3389/fendo.2022.1054447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Congenital hypogonadotropic hypogonadism (HH) is a heterogeneous genetic disorder characterized by disrupted puberty and infertility. In most cases, HH is abiding yet 10-15% undergo reversal. Men with HH and absent and partial puberty (i.e., testicular volume <4mL and >4mL respectively) have been well-studied, but the rare fertile eunuch (FE) variant remains poorly characterized. This natural history study of 240 men with HH delineates the clinical presentation, neuroendocrine profile, rate of reversal and genetics of the FE variant. We compared three HH groups: FE (n=38), absent puberty (n=139), and partial puberty (n=63). The FE group had no history of micropenis and 2/38 (5%) had cryptorchidism (p<0.0001 vs. other groups). The FE group exhibited higher rates of detectable gonadotropins, higher mean LH/FSH levels, and higher serum inhibin B levels (all p<0.0001). Neuroendocrine profiling showed pulsatile LH secretion in 30/38 (79%) of FE men (p<0.0001) and 16/36 (44%) FE men underwent spontaneous reversal of HH (p<0.001). The FE group was enriched for protein-truncating variants (PTVs) in GNRHR and FGFR1 and 4/30 (13%) exhibited oligogenic PTVs. Findings suggest men with the FE variant exhibit the mildest neuroendocrine defects of HH men and the FE sub-type represents the first identified phenotypic predictor for reversible HH.
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Affiliation(s)
- Andrew A. Dwyer
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, United States
- Massachusetts General Hospital – Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Maria Stamou
- Massachusetts General Hospital – Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA, United States
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States
| | - Isabella R. McDonald
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, United States
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States
| | - Ella Anghel
- Boston College Lynch School of Education and Human Development, Department of Measurement, Evaluation, Statistics and Assessment, Chestnut Hill, MA, United States
| | - Kimberly H. Cox
- Massachusetts General Hospital – Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA, United States
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States
| | - Kathryn B. Salnikov
- Massachusetts General Hospital – Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA, United States
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States
| | - Lacey Plummer
- Massachusetts General Hospital – Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA, United States
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States
| | - Stephanie B. Seminara
- Massachusetts General Hospital – Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA, United States
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States
| | - Ravikumar Balasubramanian
- Massachusetts General Hospital – Harvard Center for Reproductive Medicine, Massachusetts General Hospital, Boston, MA, United States
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States
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5
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Delaney A, Volochayev R, Meader B, Lee J, Almpani K, Noukelak GY, Henkind J, Chalmers L, Law JR, Williamson KA, Jacobsen CM, Buitrago TP, Perez O, Cho CH, Kaindl A, Rauch A, Steindl K, Garcia JE, Russell BE, Prasad R, Mondal UK, Reigstad HM, Clements S, Kim S, Inoue K, Arora G, Salnikov KB, DiOrio NP, Prada R, Capri Y, Morioka K, Mizota M, Zechi-Ceide RM, Kokitsu-Nakata NM, Tonello C, Vendramini-Pittoli S, da Silva Dalben G, Balasubramanian R, Dwyer AA, Seminara SB, Crowley WF, Plummer L, Hall JE, Graham JM, Lin AE, Shaw ND. Insight Into the Ontogeny of GnRH Neurons From Patients Born Without a Nose. J Clin Endocrinol Metab 2020; 105:dgaa065. [PMID: 32034419 PMCID: PMC7108682 DOI: 10.1210/clinem/dgaa065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/06/2020] [Indexed: 02/05/2023]
Abstract
CONTEXT The reproductive axis is controlled by a network of gonadotropin-releasing hormone (GnRH) neurons born in the primitive nose that migrate to the hypothalamus alongside axons of the olfactory system. The observation that congenital anosmia (inability to smell) is often associated with GnRH deficiency in humans led to the prevailing view that GnRH neurons depend on olfactory structures to reach the brain, but this hypothesis has not been confirmed. OBJECTIVE The objective of this work is to determine the potential for normal reproductive function in the setting of completely absent internal and external olfactory structures. METHODS We conducted comprehensive phenotyping studies in 11 patients with congenital arhinia. These studies were augmented by review of medical records and study questionnaires in another 40 international patients. RESULTS All male patients demonstrated clinical and/or biochemical signs of GnRH deficiency, and the 5 men studied in person had no luteinizing hormone (LH) pulses, suggesting absent GnRH activity. The 6 women studied in person also had apulsatile LH profiles, yet 3 had spontaneous breast development and 2 women (studied from afar) had normal breast development and menstrual cycles, suggesting a fully intact reproductive axis. Administration of pulsatile GnRH to 2 GnRH-deficient patients revealed normal pituitary responsiveness but gonadal failure in the male patient. CONCLUSIONS Patients with arhinia teach us that the GnRH neuron, a key gatekeeper of the reproductive axis, is associated with but may not depend on olfactory structures for normal migration and function, and more broadly, illustrate the power of extreme human phenotypes in answering fundamental questions about human embryology.
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Affiliation(s)
- Angela Delaney
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Rita Volochayev
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Brooke Meader
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Janice Lee
- National Institute of Dental and Craniofacial Research, Bethesda, Maryland
| | | | - Germaine Y Noukelak
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | | | - Laura Chalmers
- Department of Pediatrics, University of Oklahoma College of Medicine, Tulsa, Oklahoma
| | - Jennifer R Law
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen A Williamson
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh Western General Hospital, Edinburgh, UK
| | - Christina M Jacobsen
- Divisions of Endocrinology and Genetic and Genomics, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Orlando Perez
- Academia Nacional de Medicina de Colombia, Bogotá, Colombia
| | - Chie-Hee Cho
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Angela Kaindl
- Biology & Neurobiology, Charité-University Medicine Berlin and Berlin Institute of Health, Berlin, Germany
| | - Anita Rauch
- Institute of Medical Genetics and Radiz-Rare Disease Initiative Zurich, Clinical Research Priority Program for Rare Diseases, University of Zurich, Schlieren-Zurich, Switzerland
| | - Katharina Steindl
- Institute of Medical Genetics and Radiz-Rare Disease Initiative Zurich, Clinical Research Priority Program for Rare Diseases, University of Zurich, Schlieren-Zurich, Switzerland
| | - Jose Elias Garcia
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Mexico
| | - Bianca E Russell
- Department of Pediatrics, Division of Genetics, University of California, Los Angeles, California
| | - Rameshwar Prasad
- Department of Neonatology, IPGME&R and SSKM Hospital, Kolkata, India
| | - Uttam K Mondal
- Department of Neonatology, IPGME&R and SSKM Hospital, Kolkata, India
| | - Hallvard M Reigstad
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Scott Clements
- Division of Endocrinology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Susan Kim
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Kaoru Inoue
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Gazal Arora
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Kathryn B Salnikov
- Harvard Reproductive Endocrine Sciences Center and NICHD Center of Excellence in Translational Research in Fertility and Infertility, Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Nicole P DiOrio
- Harvard Reproductive Endocrine Sciences Center and NICHD Center of Excellence in Translational Research in Fertility and Infertility, Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Rolando Prada
- Department of Craniofacial Surgery, Children’s University Hospital of San Jose, Bogotá, Colombia
| | - Yline Capri
- Service de Génétique Clinique, CHU Robert Debré, Paris, France
| | - Kosuke Morioka
- Department of Plastic and Reconstructive Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Michiyo Mizota
- Department of Pediatrics, University of Kagoshima Hospital, Kagoshima, Japan
| | - Roseli M Zechi-Ceide
- Department of Clinical Genetics, Hospital for Rehabilitation of Craniofacial Anomalies (HRCA), University of São Paulo, Bauru, Brazil
| | - Nancy M Kokitsu-Nakata
- Department of Clinical Genetics, Hospital for Rehabilitation of Craniofacial Anomalies (HRCA), University of São Paulo, Bauru, Brazil
| | | | - Siulan Vendramini-Pittoli
- Department of Clinical Genetics, Hospital for Rehabilitation of Craniofacial Anomalies (HRCA), University of São Paulo, Bauru, Brazil
| | | | - Ravikumar Balasubramanian
- Harvard Reproductive Endocrine Sciences Center and NICHD Center of Excellence in Translational Research in Fertility and Infertility, Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew A Dwyer
- Harvard Reproductive Endocrine Sciences Center and NICHD Center of Excellence in Translational Research in Fertility and Infertility, Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Stephanie B Seminara
- Harvard Reproductive Endocrine Sciences Center and NICHD Center of Excellence in Translational Research in Fertility and Infertility, Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - William F Crowley
- Harvard Reproductive Endocrine Sciences Center and NICHD Center of Excellence in Translational Research in Fertility and Infertility, Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lacey Plummer
- Harvard Reproductive Endocrine Sciences Center and NICHD Center of Excellence in Translational Research in Fertility and Infertility, Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Janet E Hall
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
- Harvard Reproductive Endocrine Sciences Center and NICHD Center of Excellence in Translational Research in Fertility and Infertility, Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - John M Graham
- Department of Pediatrics, Cedars Sinai Medical Center, Los Angeles, California
| | - Angela E Lin
- Medical Genetics, MassGeneral Hospital for Children and Harvard Medical School, Boston, Massachusetts
| | - Natalie D Shaw
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
- Harvard Reproductive Endocrine Sciences Center and NICHD Center of Excellence in Translational Research in Fertility and Infertility, Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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