Horm Metab Res 2015; 47(05): 312-320
DOI: 10.1055/s-0035-1548831
Review
© Georg Thieme Verlag KG Stuttgart · New York

New Genomic Technologies: An Aid for Diagnosis of Disorders of Sex Development

H. Barseghyan
1   Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
,
E. Délot
1   Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
2   Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
,
E. Vilain
1   Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
2   Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
› Author Affiliations
Further Information

Publication History

received 30 October 2014

accepted 13 March 2015

Publication Date:
13 May 2015 (online)

Abstract

The Chicago Consensus Conference of 2005 defined Disorders of Sex Development (DSD) as “congenital conditions in which the development of chromosomal, gonadal or anatomic sex is atypical.” DSD diagnoses are difficult to establish. A lack of standardization of anatomical and endocrine phenotyping and the limited number of known DSD genes and genotype/correlation has long hampered the field, leaving many patients without a definitive diagnosis. The resulting uncertainty may intrinsically pose a great amount of discomfort to affected individuals and their families. DSD-causative genes have historically been identified thanks to positional cloning of disease-associated variants segregating in families or chromosomal rearrangements. Recent advances of chromosomal microarray and exome sequencing technologies are allowing for higher rates of diagnostic success for DSD patients and are changing clinical practice. In this review, we discuss the application of these technologies and their findings as an upcoming model for clinical diagnosis of DSD. We show that exome sequencing is a valuable tool and we propose that it should be used as a first-stage diagnostic technique because it allows for early identification of a genetic cause that may be critical for patient management.

 
  • References

  • 1 Berta P, Hawkins JR, Sinclair AH, Taylor A, Griffiths BL, Goodfellow PN, Fellous M. Genetic evidence equating SRY and the testis-determining factor. Nature 1990; 348: 448-450
  • 2 Koopman P, Gubbay J, Vivian N, Goodfellow PN, Lovell-Badge R. Male development of chromosomally female mice transgenic for Sry. Nature 1991; 351: 117-121
  • 3 Sinclair AH, Berta P, Palmer MS, Hawkins JR, Griffiths BL, Smith MJ, Foster JW, Frischauf AM, Lovell-Badge R, Goodfellow PN. A gene from the human sex-determining region encodes a protein with homology to a conserved DNA-binding motif. Nature 1990; 346: 240-244
  • 4 Sekido R, Lovell-Badge R. Sex determination involves synergistic action of SRY and SF1 on a specific Sox9 enhancer. Nature 2008; 453: 930-934
  • 5 Parma P, Radi O, Vidal V, Chaboissier MC, Dellambra E, Valentini S, Guerra L, Schedl A, Camerino G. R-spondin1 is essential in sex determination, skin differentiation and malignancy. Nat Genet 2006; 38: 1304-1309
  • 6 Biason-Lauber A. WNT4, RSPO1, and FOXL2 in sex development. Semin Reprod Med 2012; 30: 387-395
  • 7 Biason-Lauber A, Konrad D, Navratil F, Schoenle EJ. A WNT4 mutation associated with Mullerian-duct regression and virilization in a 46,XX woman. N Engl J Med 2004; 351: 792-798
  • 8 Jordan BK, Mohammed M, Ching ST, Delot E, Chen XN, Dewing P, Swain A, Rao PN, Elejalde BR, Vilain E. Up-regulation of WNT-4 signaling and dosage-sensitive sex reversal in humans. Am J Hum Genet 2001; 68: 1102-1109
  • 9 Barbaro M, Oscarson M, Schoumans J, Staaf J, Ivarsson SA, Wedell A. Isolated 46,XY gonadal dysgenesis in two sisters caused by a Xp21.2 interstitial duplication containing the DAX1 gene. J Clin Endocrinol Metab 2007; 92: 3305-3313
  • 10 Lee PA, Houk CP, Ahmed SF, Hughes IA. S. International Consensus Conference on Intersex organized by the Lawson Wilkins Pediatric Endocrine, and E. the European Society for Paediatric, Consensus statement on management of intersex disorders. International Consensus Conference on Intersex. Pediatrics 2006; 118: e488-e500
  • 11 Lux A, Kropf S, Kleinemeier E, Jurgensen M, Thyen U. D.S.D.N.W. Group . Clinical evaluation study of the German network of disorders of sex development (DSD)/intersexuality: study design, description of the study population, and data quality. BMC Public Health 2009; 9: 110
  • 12 Sandberg DE, Gardner M, Cohen-Kettenis PT. Psychological aspects of the treatment of patients with disorders of sex development. Semin Reprod Med 2012; 30: 443-452
  • 13 Warne GL. Long-term outcome of disorders of sex development. Sex Dev 2008; 2: 268-277
  • 14 Cameron FJ, Sinclair AH. Mutations in SRY and SOX9: testis-determining genes. Hum Mutat 1997; 9: 388-395
  • 15 Hawkins JR. Mutational analysis of SRY in XY females. Hum Mutat 1993; 2: 347-350
  • 16 Veitia R, Ion A, Barbaux S, Jobling MA, Souleyreau N, Ennis K, Ostrer H, Tosi M, Meo T, Chibani J, Fellous M, McElreavey K. Mutations and sequence variants in the testis-determining region of the Y chromosome in individuals with a 46,XY female phenotype. Hum Genet 1997; 99: 648-652
  • 17 Ostrer H. 46,XY Disorder of Sex Development and 46,XY Complete Gonadal Dysgenesis. In: GeneReviews® . Pagon RA. (ed.) Seattle (WA): University of Washington; 1993
  • 18 Baxter RM, Arboleda VA, Lee H, Barseghyan H, Adam MP, Fechner PY, Bargman R, Keegan C, Travers S, Schelley S, Hudgins L, Mathew RP, Stalker HJ, Zori R, Gordon OK, Ramos-Platt L, Pawlikowska-Haddal A, Eskin A, Nelson SF, Delot E, Vilain E. Exome Sequencing for the Diagnosis of 46,XY Disorders of Sex Development. J Clin Endocrinol Metab 2015; 100: E333-E344
  • 19 Pearlman A, Loke J, Le Caignec C, White S, Chin L, Friedman A, Warr N, Willan J, Brauer D, Farmer C, Brooks E, Oddoux C, Riley B, Shajahan S, Camerino G, Homfray T, Crosby AH, Couper J, David A, Greenfield A, Sinclair A, Ostrer H. Mutations in MAP3K1 cause 46,XY disorders of sex development and implicate a common signal transduction pathway in human testis determination. Am J Hum Genet 2010; 87: 898-904
  • 20 Délot E, Vilain E. Non-syndromic 46,XX Testicular Disorders of Sex Development. GeneReviews. 2015. [in press]
  • 21 Zenteno-Ruiz JC, Kofman-Alfaro S, Mendez JP. 46,XX sex reversal. Arch Med Res 2001; 32: 559-566
  • 22 McElreavey K, Rappaport R, Vilain E, Abbas N, Richaud F, Lortat-Jacob S, Berger R, Le Coniat M, Boucekkine C, Kucheria K, Temtamy S, Nihoul-Fekete C, Brauner R, Fellous M. A minority of 46,XX true hermaphrodites are positive for the Y-DNA sequence including SRY. Hum Genet 1992; 90: 121-125
  • 23 Baxter RM, Vilain E. Translational genetics for diagnosis of human disorders of sex development. Annu Rev Genomics Hum Genet 2013; 14: 371-392
  • 24 Muscatelli F, Strom TM, Walker AP, Zanaria E, Recan D, Meindl A, Bardoni B, Guioli S, Zehetner G, Rabl W, Schwarz HP, Kaplan J-C, Camerino G, Meitinger T, Monaco AP. Mutations in the DAX-1 gene give rise to both X-linked adrenal hypoplasia congenita and hypogonadotropic hypogonadism. Nature 1994; 372: 672-676
  • 25 Bardoni B, Zanaria E, Guioli S, Floridia G, Worley KC, Tonini G, Ferrante E, Chiumello G, McCabe ER, Fraccaro M, Zuffardi O, Camerino G. A dosage sensitive locus at chromosome Xp21 is involved in male to female sex reversal. Nat Genet 1994; 7: 497-501
  • 26 Ledig S, Hiort O, Scherer G, Hoffmann M, Wolff G, Morlot S, Kuechler A, Wieacker P. Array-CGH analysis in patients with syndromic and non-syndromic XY gonadal dysgenesis: evaluation of array CGH as diagnostic tool and search for new candidate loci. Hum Reprod 2010; 25: 2637-2646
  • 27 White S, Ohnesorg T, Notini A, Roeszler K, Hewitt J, Daggag H, Smith C, Turbitt E, Gustin S, van den Bergen J, Miles D, Western P, Arboleda V, Schumacher V, Gordon L, Bell K, Bengtsson H, Speed T, Hutson J, Warne G, Harley V, Koopman P, Vilain E, Sinclair A. Copy number variation in patients with disorders of sex development due to 46,XY gonadal dysgenesis. PLoS One 2011; 6: e17793
  • 28 Weiss J, Meeks JJ, Hurley L, Raverot G, Frassetto A, Jameson JL. Sox3 is required for gonadal function, but not sex determination, in males and females. Mol Cell Biol 2003; 23: 8084-8091
  • 29 Sutton E, Hughes J, White S, Sekido R, Tan J, Arboleda V, Rogers N, Knower K, Rowley L, Eyre H, Rizzoti K, McAninch D, Goncalves J, Slee J, Turbitt E, Bruno D, Bengtsson H, Harley V, Vilain E, Sinclair A, Lovell-Badge R, Thomas P. Identification of SOX3 as an XX male sex reversal gene in mice and humans. J Clin Invest 2011; 121: 328-341
  • 30 Moalem S, Babul-Hirji R, Stavropolous DJ, Wherrett D, Bagli DJ, Thomas P, Chitayat D. XX male sex reversal with genital abnormalities associated with a de novo SOX3 gene duplication. Am J Med Genet A 2012; 158A: 1759-1764
  • 31 Vetro A, Dehghani MR, Kraoua L, Giorda R, Beri S, Cardarelli L, Merico M, Manolakos E, Bustamante AP, Castro A, Radi O, Camerino G, Brusco A, Sabaghian M, Sofocleous C, Forzano F, Palumbo P, Palumbo O, Calvano S, Zelante L, Grammatico P, Giglio S, Basly M, Chaabouni M, Carella M, Russo G, Bonaglia MC, Zuffardi O. Testis development in the absence of SRY: chromosomal rearrangements at SOX9 and SOX3. Eur J Hum Genet 2014; Nov 5 DOI: 10.1038/ejhg.2014.237. [Epub ahead of print]
  • 32 White S, Hewitt J, Turbitt E, van der Zwan Y, Hersmus R, Drop S, Koopman P, Harley V, Cools M, Looijenga L, Sinclair A. A multi-exon deletion within WWOX is associated with a 46,XY disorder of sex development. Eur J Hum Genet 2012; 20: 348-351
  • 33 Ludes-Meyers JH, Kil H, Nunez MI, Conti CJ, Parker-Thornburg J, Bedford MT, Aldaz CM. WWOX hypomorphic mice display a higher incidence of B-cell lymphomas and develop testicular atrophy. Gens Chromosomes Cancer 2007; 46: 1129-1136
  • 34 Lecointre C, Pichon O, Hamel A, Heloury Y, Michel-Calemard L, Morel Y, David A, Le Caignec C. Familial acampomelic form of campomelic dysplasia caused by a 960 kb deletion upstream of SOX9. Am J Med Genet A 2009; 149A: 1183-1189
  • 35 Cox JJ, Willatt L, Homfray T, Woods CG. A SOX9 duplication and familial 46,XX developmental testicular disorder. N Engl J Med 2011; 364: 91-93
  • 36 Benko S, Gordon CT, Mallet D, Sreenivasan R, Thauvin-Robinet C, Brendehaug A, Thomas S, Bruland O, David M, Nicolino M, Labalme A, Sanlaville D, Callier P, Malan V, Huet F, Molven A, Dijoud F, Munnich A, Faivre L, Amiel J, Harley V, Houge G, Morel Y, Lyonnet S. Disruption of a long distance regulatory region upstream of SOX9 in isolated disorders of sex development. J Med Genet 2011; 48: 825-830
  • 37 Vetro A, Ciccone R, Giorda R, Patricelli MG, Della Mina E, Forlino A, Zuffardi O. XX males SRY negative: a confirmed cause of infertility. J Med Genet 2011; 48: 710-712
  • 38 Kim GJ, Sock E, Buchberger A, Just W, Denzer F, Hoepffner W, German J, Cole T, Mann J, Seguin JH, Zipf W, Costigan C, Schmiady H, Rostasy M, Kramer M, Kaltenbach S, Rosler B, Georg I, Troppmann E, Teichmann AC, Salfelder A, Widholz SA, Wieacker P, Hiort O, Camerino G, Radi O, Wegner M, Arnold HH, Scherer G. Copy number variation of two separate regulatory regions upstream of SOX9 causes isolated 46,XY or 46,XX disorder of sex development. J Med Genet 2015; 52: 240-247
  • 39 Quinonez SC, Park JM, Rabah R, Owens KM, Yashar BM, Glover TW, Keegan CE. 9p partial monosomy and disorders of sex development: review and postulation of a pathogenetic mechanism. Am J Med Genet A 2013; 161A: 1882-1896
  • 40 Igarashi M, Dung VC, Suzuki E, Ida S, Nakacho M, Nakabayashi K, Mizuno K, Hayashi Y, Kohri K, Kojima Y, Ogata T, Fukami M. Cryptic genomic rearrangements in three patients with 46,XY disorders of sex development. PLoS One 2013; 8: e68194
  • 41 Tannour-Louet M, Han S, Corbett ST, Louet JF, Yatsenko S, Meyers L, Shaw CA, Kang SH, Cheung SW, Lamb DJ. Identification of de novo copy number variants associated with human disorders of sexual development. PLoS One 2010; 5: e15392
  • 42 Tannour-Louet M, Han S, Louet JF, Zhang B, Romero K, Addai J, Sahin A, Cheung SW, Lamb DJ. Increased gene copy number of VAMP7 disrupts human male urogenital development through altered estrogen action. Nat Med 2014; 20: 715-724
  • 43 Lee H, Deignan JL, Dorrani N, Strom SP, Kantarci S, Quintero-Rivera F, Das K, Toy T, Harry B, Yourshaw M, Fox M, Fogel BL, Martinez-Agosto JA, Wong DA, Chang VY, Shieh PB, Palmer CG, Dipple KM, Grody WW, Vilain E, Nelson SF. Clinical Exome Sequencing for Genetic Identification of Rare Mendelian Disorders. JAMA 2014; 312: 1880-1887
  • 44 Genomes Project C . Abecasis GR, Altshuler D, Auton A, Brooks LD, Durbin RM, Gibbs RA, Hurles ME, McVean GA. A map of human genome variation from population-scale sequencing. Nature 2010; 467: 1061-1073
  • 45 Richards CS, Bale S, Bellissimo DB, Das S, Grody WW, Hegde MR, Lyon E, Ward BE. A.L.Q.A.C . Molecular Subcommittee of the ACMG recommendations for standards for interpretation and reporting of sequence variations: Revisions 2007. Genet Med 2008; 10: 294-300
  • 46 Biesecker LG, Green RC. Diagnostic clinical genome and exome sequencing. N Engl J Med 2014; 370: 2418-2425
  • 47 Yang Y, Muzny DM, Xia F, Niu Z, Person R, Ding Y, Ward P, Braxton A, Wang M, Buhay C, Veeraraghavan N, Hawes A, Chiang T, Leduc M, Beuten J, Zhang J, He W, Scull J, Willis A, Landsverk M, Craigen WJ, Bekheirnia MR, Stray-Pedersen A, Liu P, Wen S, Alcaraz W, Cui H, Walkiewicz M, Reid J, Bainbridge M, Patel A, Boerwinkle E, Beaudet AL, Lupski JR, Plon SE, Gibbs RA, Eng CM. Molecular findings among patients referred for clinical whole-exome sequencing. JAMA 2014; 312: 1870-1879
  • 48 Fogel BL, Lee H, Deignan JL, Strom SP, Kantarci S, Wang X, Quintero-Rivera F, Vilain E, Grody WW, Perlman S, Geschwind DH, Nelson SF. Exome sequencing in the clinical diagnosis of sporadic or familial cerebellar ataxia. JAMA Neurol 2014; 71: 1237-1246
  • 49 Srivastava S, Cohen JS, Vernon H, Baranano K, McClellan R, Jamal L, Naidu S, Fatemi A. Clinical whole exome sequencing in child neurology practice. Ann Neurol 2014; 76: 473-483
  • 50 Yang Y, Muzny DM, Reid JG, Bainbridge MN, Willis A, Ward PA, Braxton A, Beuten J, Xia F, Niu Z, Hardison M, Person R, Bekheirnia MR, Leduc MS, Kirby A, Pham P, Scull J, Wang M, Ding Y, Plon SE, Lupski JR, Beaudet AL, Gibbs RA, Eng CM. Clinical whole-exome sequencing for the diagnosis of mendelian disorders. N Engl J Med 2013; 369: 1502-1511
  • 51 Gottlieb B, Beitel LK, Trifiro MA. Androgen Insensitivity Syndrome. In: GeneReviews® . Pagon RA. (ed.) Seattle (WA): University of Washington; 1993
  • 52 Lek N, Miles H, Bunch T, Pilfold-Wilkie V, Tadokoro-Cuccaro R, Davies J, Ong KK, Hughes IA. Low frequency of androgen receptor gene mutations in 46 XY DSD, and fetal growth restriction. Arch Dis Child 2014; 99: 358-361
  • 53 El-Khairi R, Achermann JC. Steroidogenic factor-1 and human disease. Semin Reprod Med 2012; 30: 374-381
  • 54 Philibert P, Paris F, Audran F, Kalfa N, Polak M, Thibaud E, Pinto G, Houang M, Zenaty D, Leger J, Mas JC, Pienkowski C, Einaudi S, Damiani D, Ten S, Sinha S, Poulat F, Sultan C. Phenotypic variation of SF1 gene mutations. Adv Exp Med Biol 2011; 707: 67-72
  • 55 Allali S, Muller JB, Brauner R, Lourenco D, Boudjenah R, Karageorgou V, Trivin C, Lottmann H, Lortat-Jacob S, Nihoul-Fekete C, De Dreuzy O, McElreavey K, Bashamboo A. Mutation analysis of NR5A1 encoding steroidogenic factor 1 in 77 patients with 46, XY disorders of sex development (DSD) including hypospadias. PLoS One 2011; 6: e24117
  • 56 Green RC, Berg JS, Grody WW, Kalia SS, Korf BR, Martin CL, McGuire AL, Nussbaum RL, O’Daniel JM, Ormond KE, Rehm HL, Watson MS, Williams MS, Biesecker LG. American College of Medical, and Genomics, ACMG recommendations for reporting of incidental findings in clinical exome and genome sequencing. Genet Med 2013; 15: 565-574
  • 57 Allyse M, Michie M. Not-so-incidental findings: the ACMG recommendations on the reporting of incidental findings in clinical whole genome and whole exome sequencing. Trends Biotechnol 2013; 31: 439-441
  • 58 Relations AM. ACMG Updates Recommendation on “Opt Out” for Genome Sequencing Return of Results. 2014
  • 59 Loke J, Pearlman A, Radi O, Zuffardi O, Giussani U, Pallotta R, Camerino G, Ostrer H. Mutations in MAP3K1 tilt the balance from SOX9/FGF9 to WNT/beta-catenin signaling. Hum Mol Genet 2014; 23: 1073-1083
  • 60 Arboleda VA, Vilain E. Disorders of Sex Development. In Yen and Jaffe’s Reproductive Endocrinology. 6th edn Amsterdam: Saunders Elsevier; 2009. Ch.16 367-393