Disorders of sex development: challenges for the future

No abstract available

Mutations involving the SRY-related gene SOX8 are associated with a spectrum of human reproductive anomalies.

© The Author(s) 2018. Published by Oxford University Press. All rights reserved. SOX8 is an HMG-box transcription factor closely related to SRY and SOX9. Deletion of the gene encoding Sox8 in mice causes reproductive dysfunction but the role of SOX8 in humans is unknown. Here, we show that SOX8 is expressed in the somatic cells of the early developing gonad in the human and influences human sex determination. We identified two individuals with 46, XY disorders/differences in sex development (DSD) and chromosomal rearrangements encompassing the SOX8 locus and a third individual with 46, XY DSD and a missense mutation in the HMG-box of SOX8. In vitro functional assays indicate that this mutation alters the biological activity of the protein. As an emerging body of evidence suggests that DSDs and infertility can have common etiologies, we also analysed SOX8 in a cohort of infertile men (n=274) and two independent cohorts of women with primary ovarian insufficiency (POI; n=153 and n=104). SOX8 mutations were found at increased frequency in oligozoospermic men (3.5%; P < 0.05) and POI (5.06%; P=4.5×10 -5 ) as compared with fertile/normospermic control populations (0.74%). The mutant proteins identified altered SOX8 biological activity as compared with the wild-type protein. These data demonstrate that SOX8 plays an important role in human reproduction and SOX8 mutations contribute to a spectrum of phenotypes including 46, XY DSD, male infertility and 46, XX POI.Link_to_subscribed_fulltex

Mutations in NR5A1 Associated with Ovarian Insufficiency

BackgroundThe genetic causes of nonsyndromic ovarian insufficiency are largely unknown. A nuclear receptor, NR5A1 (also called steroidogenic factor 1), is a key transcriptional regulator of genes involved in the hypothalamic-pituitary-steroidogenic axis. Mutation of NR5A1 causes 46, XY disorders of sex development, with or without adrenal failure, but growing experimental evidence from studies in mice suggests a key role for this factor in ovarian development and function as well.MethodsTo test the hypothesis that mutations in NR5A1 cause disorders of ovarian development and function, we sequenced NR5A1 in four families with histories of both 46, XY disorders of sex development and 46, XX primary ovarian insufficiency and in 25 subjects with sporadic ovarian insufficiency. None of the affected subjects had clinical signs of adrenal insufficiency.ResultsMembers of each of the four families and 2 of the 25 subjects with isolated ovarian insufficiency carried mutations in the NR5A1 gene. In-frame deletions and frame-shift and missense mutations were detected. Functional studies indicated that these mutations substantially impaired NR5A1 transactivational activity. Mutations were associated with a range of ovarian anomalies, including 46, XX gonadal dysgenesis and 46, XX primary ovarian insufficiency. We did not observe these mutations in more than 700 control alleles.ConclusionsNR5A1 mutations are associated with 46, XX primary ovarian insufficiency and 46, XY disorders of sex development.March of Dimes FoundationNational Institute for Health ResearchWellcome Trust Senior Research Fellowship in Clinical ScienceInst Pasteur, F-75724 Paris, FranceUniv Paris 05, Paris, FranceAP HP, Paris, FranceHop Bicetre, Le Kremlin Bicetre, FranceUCL Inst Child Hlth, Clin & Mol Genet Unit, Dev Endocrinol Res Grp, London, EnglandLab Cytogenet, Luxembourg, LuxembourgCHU Brabois, Serv Endocrinol, Vandoeuvre Les Nancy, FranceHop Notre Dame de Bon Secours, Unite Endocrinol, Metz, FranceUniv Estadual Campinas, Dept Pediat, Fac Med Sci, Campinas, BrazilUniv Estadual Campinas, Dept Med Genet, Fac Med Sci, Campinas, BrazilMarch of Dimes Foundation: 1-FY07-490)Wellcome Trust Senior Research Fellowship in Clinical Science: 079666Web of Scienc

Genomics of the human Y chromosome and molecular diagnosis

The human Y chromosome carries a few functional genes as against a plethora of non-coding DNA sequences and shows a high degree of geographical and ethnic variations for a range of loci manifested as genetic polymorphisms. Y-chromosome linked sequence tagged sites (STS) and short tandem repeat (STR) marker systems offer infallible tool for gender identification, paternity testing, genome individualization and assessing male fertility status. Population-specific Y haplotypes and Single Nucleotide Polymorphisms (SNPs) are envisaged to be useful in establishing a correlation between diseased phenotypes with genetic polymorphisms. We discuss genomics of the human Y-chromosome and its possible applications in biology, medical and forensic sciences

Mutations involving the SRY-related gene SOX8 are associated with a spectrum of human reproductive anomalies

SOX8 is an HMG-box transcription factor closely related to SRY and SOX9. Deletion of the gene encoding Sox8 in mice causes reproductive dysfunction but the role of SOX8 in humans is unknown. Here, we show that SOX8 is expressed in the somatic cells of the early developing gonad in the human and influences human sex-determination. We identified two individuals with 46,XY disorders/differences in sex development (DSD) and chromosomal rearrangements encompassing the SOX8 locus and a third individual with 46,XY DSD and a missense mutation in the HMG-box of SOX8. In-vitro functional assays indicate that this mutation alters the biological activity of the protein. As an emerging body of evidence suggests that DSDs and infertility can have common etiologies, we also analyzed SOX8 in a cohort of infertile men (n = 274) and two independent cohorts of women with primary ovarian insufficiency (POI; n = 153 and n = 104). SOX8 mutations were found at increased frequency in oligozoospermic men (3.5%; p<0.05) and POI (5.06%; p=4.5x10-5) as compared to fertile/normospermic control populations (0.74%). The mutant proteins identified altered SOX8 biological activity as compared to the wild-type protein. These data demonstrate that SOX8 plays an important role in human reproduction and SOX8 mutations contribute to a spectrum of phenotypes including 46,XY DSD, male infertility and 46,XX POI

New Technologies for the Identification of Novel Genetic Markers of Disorders of Sex Development (DSD)

Although the genetic basis of human sexual determination and differentiation has advanced considerably in recent years, the fact remains that in most subjects with disorders of sex development (DSD) the underlying genetic cause is unknown. Where pathogenic mutations have been identified, the phenotype can be highly variable, even within families, suggesting that other genetic variants are influencing the expression of the phenotype. This situation is likely to change, as more powerful and affordable tools become widely available for detailed genetic analyses. Here, we describe recent advances in comparative genomic hybridisation, sequencing by hybridisation and next generation sequencing, and we describe how these technologies will have an impact on our understanding of the genetic causes of DSD

A recurrent p.Arg92Trp variant in steroidogenic factor-1 (NR5A1) can act as a molecular switch in human sex development

Cell lineages of the early human gonad commit to one of the two mutually antagonistic organogenetic fates, the testis or the ovary. Some individuals with a 46,XX karyotype develop testes or ovotestes (testicular or ovotesticular disorder of sex development; TDSD/OTDSD), due to the presence of the testis-determining gene, SRY Other rare complex syndromic forms of TDSD/OTDSD are associated with mutations in pro-ovarian genes that repress testis development (e.g. WNT4); however, the genetic cause of the more common non-syndromic forms is unknown. Steroidogenic factor-1 (known as NR5A1) is a key regulator of reproductive development and function. Loss-of-function changes in NR5A1 in 46,XY individuals are associated with a spectrum of phenotypes in humans ranging from a lack of testis formation to male infertility. Mutations in NR5A1 in 46,XX women are associated with primary ovarian insufficiency, which includes a lack of ovary formation, primary and secondary amenorrhoea as well as early menopause. Here, we show that a specific recurrent heterozygous missense mutation (p.Arg92Trp) in the accessory DNA-binding region of NR5A1 is associated with variable degree of testis development in 46,XX children and adults from four unrelated families. Remarkably, in one family a sibling raised as a girl and carrying this NR5A1 mutation was found to have a 46,XY karyotype with partial testicular dysgenesis. These unique findings highlight how a specific variant in a developmental transcription factor can switch organ fate from the ovary to testis in mammals and represents the first missense mutation causing isolated, non-syndromic 46,XX testicular/ovotesticular DSD in humans

Molecular characterization of a Y-derived marker chromosome and identification of indels in the DYS1 region in a patient with stigmata of Turner syndrome

Presence of the Y chromosome in human female and its absence in the male is an abnormal condition, implying a spectrum of genetic abnormalities. In this communication, we describe studies conducted on a 17-year-old patient (HK-459) with stigmata of Turner syndrome. We analysed the hormonal profile of the subject, chromosomal constitution and DNA for the five different loci encompassing both the arms of the Y chromosome. Chromosomal analysis showed mosaicism containing 45,X/46,X,+mar but no Y chromosome. The X chromosome and all the autosomes of the patient and her parents were normal. The Southern analysis of the patient's genomic DNA with probes specific to DYZ1 locus did not detect the corresponding Y-specific signal. Similarly, primers RG4, RG7 and PABY, corresponding to SRY gene and pseudoautosomal boundary regions respectively, failed to generate Y-specific amplicons. However, primers DYZ3 and DYS1, representing centromeric heterochromatic and euchromatic regions respectively, on the long arm of the Y chromosome uncovered Y-specific signals in the patient and her mother. Sequence analysis of DYS1-specific (710 bp) amplicon from the patient, both of her parents and two normal males showed insertion/deletion mutation in the patient. It is inferred that the Y-derived marker chromosome in the patient is of maternal origin and had undergone post-zygotic mutational events. The possible prognostic implications of this combined approach in the patient(s) with stigmata of Turner syndrome are discussed here

Editorial: 46,XX differences of sex development (DSD) outside congenital adrenal hyperplasia (CAH)

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Biallelic and monoallelic ESR2 variants associated with 46,XY disorders of sex development

Purpose: Disorders or differences of sex development (DSDs) are rare congenital conditions characterized by atypical sex development. Despite advances in genomic technologies, the molecular cause remains unknown in 50% of cases. Methods: Homozygosity mapping and whole-exome sequencing revealed an ESR2 variant in an individual with syndromic 46, XY DSD. Additional cases with 46, XY DSD underwent whole-exome sequencing and targeted next-generation sequencing of ESR2. Functional characterization of the identified variants included luciferase assays and protein structure analysis. Gonadal ESR2 expression was assessed in human embryonic data sets and immunostaining of estrogen receptor-beta (ER-beta) was performed in an 8-week-old human male embryo. Results: We identified a homozygous ESR2 variant, c.541_543del p. (Asn181del), located in the highly conserved DNA-binding domain of ER-beta, in an individual with syndromic 46, XY DSD. Two additional heterozygous missense variants, c.251G>T p.(Gly84Val) and c.1277T>G p.(Leu426Arg), located in the N-terminus and the ligand-binding domain of ER-beta, were found in unrelated, nonsyndromic 46, XY DSD cases. Significantly increased transcriptional activation and an impact on protein conformation were shown for the p.(Asn181del) and p.(Leu426Arg) variants. Testicular ESR2 expression was previously documented and ER-beta immunostaining was positive in the developing intestine and eyes. Conclusion: Our study supports a role for ESR2 as a novel candidate gene for 46, XY DSD