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Previous Volume 360:1200-1210 March 19, 2009 Number 12 Next

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ABSTRACT

Background The 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.

Methods To 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.

Results Members 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 frameshift 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.

Conclusions NR5A1 mutations are associated with 46,XX primary ovarian insufficiency and 46,XY disorders of sex development.

Source Information

From Human Developmental Genetics, Institut Pasteur (D.L., R. Boudjenah, K.M., A.B.) and Université Paris Descartes and Assistance Publique–Hôpitaux de Paris (R. Brauner) — all in Paris; Hôpital Bicêtre, Le Kremlin-Bicêtre, France (R. Brauner); the Developmental Endocrinology Research Group, Clinical and Molecular Genetics Unit, UCL Institute of Child Health, London (L.L., J.C.A.); Laboratoire de Cytogénétique, Luxembourg City, Luxembourg (A.D.P.); Service d'Endocrinologie, Centre Hospitalier Universitaire Brabois, Vandoeuvre-lès-Nancy, France (G.W.); Unité d'Endocrinologie, Hôpital Notre-Dame de Bon Secours, Metz, France (M.M.); and the Departments of Pediatrics (G.G.-J.) and Medical Genetics (A.T.M.-G.), Faculty of Medical Sciences, University of Campinas, Campinas, Brazil.

Ms. Lourenço and Drs. Brauner and Lin contributed equally to this article.

This article (10.1056/NEJMoa0806228) was published at NEJM.org on February 25, 2009.

Address reprint requests to Dr. McElreavey or Dr. Bashamboo at Institut Pasteur, Human Developmental Genetics, 25 rue du Doctor Roux, Paris 75724, France, or at kenmce{at}pasteur.fr or anu.bashamboo{at}pasteur.fr.

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