ESPE2019 Free Communications Sex Differentiation, Gonads and Gynaecology or Sex Endocrinology (6 abstracts)
Mutations in the DEAH-box RNA Helicase DHX37 are a Frequent Cause of 46,XY Gonadal Dysgenesis and 46,XY Testicular Regression Syndrome
Ken McElreavey 1 , Anne Jorgensen 2 , Caroline Eozenou 1 , Tiphanie Merel 1 , Joelle Bignon-Topalovic 1 , Daisy Tan 3 , Denis Houzelstein 1 , Federica Buonocore 4 , Nigel Warr 5 , Raissa Kay 5 , Mathieu Peycelon 6 , Jean-Pierre Siffroi 6 , Inas Mazen 7 , John Achermann 4 , Yuliya Shcherbak 8 , Julienne Leger 9 , Agnes Sallai 10 , Jean-Claude Carel 9 , Laetitia Martinerie 9 , Romain Le Ru 11 , Gerald Conway 4 , Brigitte Mignot 11 , Lionel Van Maldergem 11 , Rita Bertalan 10 , Evgenia Globa 12 , Raja Brauner 13 , Ralf Jauch 3 , Serge Nef 14 , Andy Greenfield 5 & Anu Bashamboo 1
1Institut Pasteur, Paris, France. 2Rigshospitalet, Copenhagen, Denmark. 3University of Hong Kong, Hong Kong, Hong Kong. 4UCL GOS Institute of Child Health, London, United Kingdom. 5Medical Research Council Harwell Institute, Oxfordshire, United Kingdom. 6Sorbonne Université, Paris, France. 7National Research Center, Cairo, Egypt. 8National Hospital OHMATDYT, Kyiv, Ukraine. 9Hospital Robert Debre, Paris, France. 10Semmelweis University, Budapest, Hungary. 11University of Franche-Comté, Besancon, France. 12Ukrainian Center of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MoH of Ukraine, Kyiv, Ukraine. 13Fondation Ophtalmologique Adolphe de Rothschild, Paris, France. 14University of Geneva, Geneva, Switzerland
XY individuals with Disorders/Differences of Sex development (DSD) are characterized by reduced androgenization caused, in some children, by gonadal dysgenesis or, more rarely, testis regression during early fetal development. The genetic etiology for most patients with 46,XY gonadal dysgenesis and for all patients with testicular regression syndrome (TRS) is unknown. Identification of novel genes involved in DSD is crucial for providing an accurate clinical diagnosis, aiding patient management and understanding the biological processes involved. We performed exome and/or Sanger sequencing in 145 individuals with 46,XY DSD of unknown etiology gonadal dysgenesis (n=81), TRS (n=16), boys with penoscrotal hypospadias (n=33) or anorchia (n=15). Thirteen children carried heterozygous missense mutations involving the RNA helicase DHX37, which is essential for ribosome biogenesis in yeast. Enrichment of rare/novel DHX37 missense mutations in 46,XY DSD is highly significant compared to controls (P value = 5.8x10-10). Five mutations are de novo (P value = 1.5x10-5). Twelve mutations are grouped in two highly conserved functional domains and are predicted to disrupt biological function. Mutations were specifically associated with gonadal dysgenesis (9/81, 11%) and TRS (4/16, 25%). Consistent with a role in early testis development, DHX37 is expressed specifically in somatic cells of the developing human and mouse testis. DHX37 mutations are a relatively common cause of an autosomal dominant form of 46,XY DSD, which includes both gonadal dysgenesis and TRS, showing that these conditions are part of a clinical spectrum. This raises the possibility that some forms of DSD may be a ribosomopathy.
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