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ZP2 Pathogenic Variants Cause in Vitro Fertilization Failure and Female Infertility

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ZP2 Pathogenic Variants Cause in Vitro Fertilization Failure and Female Infertility © American College of Medical Genetics and Genomics ARTICLE ZP2 pathogenic variants cause in vitro fertilization failure and female infertility Can Dai, PhD1, Liang Hu, MD,PhD1,2,3,4, Fei Gong, MD, PhD1,2,3, Yueqiu Tan, PhD1,2,3, Sufen Cai, MD1,2, Shuoping Zhang, MD1,2, Jing Dai, MS1,2, Changfu Lu, PhD1,2,3, Jing Chen, MS2, Yongzhe Chen, MS2, Guangxiu Lu, MD1,3,4, Juan Du, PhD1,2,3 and Ge Lin, MD, PhD1,2,3,4 Purpose: The oocyte-borne genetic causes leading to fertilization families. All oocytes carrying PV were surrounded by a thin ZP that failure are largely unknown. We aimed to identify novel human was defective for sperm-binding. Immunostaining indicated a lack pathogenic variants (PV) and genes causing fertilization failure. of ZP2 protein in the thin ZP. Studies in CHO cells showed that Methods: We performed exome sequencing for a consanguineous both PV resulted in a truncated ZP2 protein, which might be family with a recessive inheritance pattern of female infertility intracellularly sequestered and prematurely interacted with other characterized by oocytes with a thin zona pellucida (ZP) and ZP proteins. fertilization failure in routine in vitro fertilization. Subsequent Conclusion: We identified loss-of-function PV of ZP2 causing a PV screening of ZP2 was performed in additional eight unrelated structurally abnormal and dysfunctional ZP, resulting in fertiliza- infertile women whose oocytes exhibited abnormal ZP and similar tion failure and female infertility. fertilization failure. Expression of ZP proteins was assessed in mutant oocytes by immunostaining, and functional studies of the wild-type Genetics in Medicine (2019) 21:431–440; https://doi.org/10.1038/s41436- and mutant proteins were carried out in CHO-K1 cells. 018-0064-y Results: Two homozygous s PV (c.1695-2A>G, and c.1691_1694dup (p.C566Wfs*5), respectively) of ZP2 were identi- Keywords: Fertilization failure; Zona pellucida; ZP2; Causative fied in the affected women from two unrelated consanguineous gene; Exome sequencing INTRODUCTION receptors during fertilization.5,6 Knockout of either Zp27 or Female infertility is a worldwide health problem that affects Zp38 in female mice produced eggs without a ZP, as well as an estimated 48 million women.1 A healthy oocyte is a major infertility. Whereas, knockout of Zp19, which crosslinks determinant of female fertility, defects in which usually lead to individual filaments, resulted in the formation of a loosely fertilization failure, as well as zygotic or embryonic arrest. organized ZP and fertile, but less fecund, female mice. However, it is very difficult to discover the oocyte anomalies The human ZP is composed of four glycoproteins: via routine examinations until they are retrieved for in vitro ZP1–ZP4.10,11 Until now, variants in ZP1 and ZP3 genes fertilization (IVF). have been reported to be the causes for oocyte maturation Despite the improvement of IVF techniques in the past defect (MIM: 615774 and 617712) and female infertility.12,13 years, total fertilization failure (TFF) is still a recurrent In a consanguineous Chinese family, an autosomal recessive problem for 5–10% of routine IVF cycles2 and produces no homozygous truncating mutation in ZP1 was identified in zygote. Although fertilization failure occurs at different IVF infertile females with abnormal oocytes lacking a ZP, and this stages, defective sperm–zona binding and penetration is a was suggested to explain infertility.12 This suggests that ZP chief cause.3,4 However, in cases for which fertilization fails at proteins play different roles across species but limited human pre–sperm penetration stages, no genetic cause tied to oocytes studies suggest that this hypothesis warrants study. In has been identified. addition, no definitely deleterious variant in either ZP2 or In mammals, normal fertilization depends on structural and ZP4 gene had been found to be responsible for female functional integrity of the zona pellucida (ZP), which is an infertility. extracellular matrix surrounding oocytes. In mice, the ZP Here, we identified two homozygous truncating pathogenic consists of three glycoproteins: mZP1–mZP3. mZP2 and variants (PV) in ZP2 (GenBank NM_003460.2) in two mZP3 are building blocks of ZP filaments and are sperm unrelated consanguineous families as likely causes of 1Reproductive and Genetic Hospital of CITIC–Xiangya, Changsha, China; 2Institute of Reproductive and Stem Cell Engineering, School of Basic Medicine, Central South University, Changsha, China; 3Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, Changsha, China; 4National Engineering and Research Center of Human Stem Cell, Changsha, China. Correspondence: Juan Du ([email protected]) or Ge Lin ([email protected]) Can Dai, Liang Hu and Fei Gong contributed equally to this work. Submitted 19 February 2018; accepted: 3 May 2018 Published online: 12 June 2018 GENETICS in MEDICINE | Volume 21 | Number 2 | February 2019 431 ARTICLE DAI et al fertilization failure and infertility of the female members. We California–Santa Cruz Genome Browser hg19) with the also assessed each for loss-of-function effects by in vitro Burrows–Wheeler Aligner.15 Genotypes were called by studies. Genome Analysis Toolkit (GATK).16 Sequence variants including single-nucleotide variants (SNVs) and small inser- MATERIALS AND METHODS tions or deletions (INDELs) were annotated by ANNOVAR Study subjects software. Candidate variants were identified according to the All infertile individuals and the control group included in this following filtering criteria: (1) rare variants with a minor allele study were from the Reproductive and Genetic Hospital of frequency below 1% in the three public databases: the CITIC-Xiangya. The control group consisted of 100 women National Heart, Lung, and Blood Institute (NHLBI) Exome with proven fertility and at least one child. All blood samples, Sequencing Project Exome Variant Serve (EVS), 1000 immature or mature oocytes unfertilized after insemination Genomes, and the Exome Aggregation Consortium (ExAC) were used with consent from subjects and spouses. Study Browser; (2) exonic nonsynonymous or splice site variants, or ethical approval and oversight was obtained from our hospital coding INDELs; (3) due to the first cousin consanguinity of (reference LL-SC-2016-003). family 1, homozygous variants were prioritized; and (4) homozygous variants shared by both infertile women II-3 and Transmission electron microscopy (TEM) II-4, but absent in two fertile women I-2 and II-2 in family 1. Normal control and patient oocytes were treated as described Meanwhile, homozygosity mapping was performed using previously.14 Briefly, oocytes were fixed with glutaraldehyde HomozygosityMapper,17 and homozygous variants located in (Sigma-Aldrich, St. Louis, MO, USA) and osmium tetroxide, homozygous regions greater than 5.0 Mb were considered postfixed with OsO4 and sucrose, dehydrated with graded with priority. concentrations of ethanol, and then embedded in Epon812, 1234567890():,; dodecenylsuccinic anhydride, methylnadic anhydride, and Sanger sequencing dimethylaminomethyl phenol. Ultrathin 70–90-nm-thick sec- Each exon and its flanking intron sequence of the ZP2 gene tions were contrasted with uranyl acetate and lead citrate and were amplified by primers listed in Supplementary Table S1. examined using a HT7700 Hitachi transmission electron polymerase chain reaction (PCR) products were analyzed by microscope (Hitachi, Tokyo, Japan). MegaView III digital agarose gel electrophoresis, purified, and analyzed by camera (Munster, Germany) was used to capture digital images. bidirectional sequencing. Polarized light microscopy (polscope) Single-cell reverse transcription and 3’ rapid amplification To image zona pellucida, each oocyte was placed in a 5-µl of cDNA end (RACE) drop of G-MOPS (Vitrolife, Goteborg, Sweden) handling A single immature oocyte from patients or normal controls medium covered with paraffin oil in a glass-bottomed (0.17 was dispensed in lysis buffer and complementary DNA mm thick) Petri dish (20 mm diameter; Delta TPG dish, (cDNA) libraries were generated using Smart-seq218. Briefly, Bioptechs, Butler, PA, USA). Dishes were maintained at 37 ℃ following cell lysis, Poly-A(+) RNA was reverse transcribed during examination with a thermal plate (IVF-1200, Pacific by Superscript II reverse transcriptase (Invitrogen, Carlsbad, Contrast Co., San Diego, CA, USA) and objective heater CA, USA) and an oligo-dT adapter primer, utilizing a strand- (HT300, Minitube, Tiefenbach, Germany). Oocytes were switch reaction to add a reverse primer for the second-strand examined with an inverted microscope (Nikon TE-2000U, synthesis. The cDNA was amplified by PCR (18 cycles) using Tokyo, Japan) equipped with Hoffman interference optics KAPA HiFi HotStart ReadyMix (KAPA Biosystems, Wil- 20× objective lenses equipped with LC-Polscope filters, analog mington, MA, USA) and purified with Ampure XP beads video camera (COHU, Cambridge Research and Instrumen- (Beckman Coulter, Kraemer Boulevard Brea, CA, USA). The tation, Woburn, MA, USA), and a personal computer (Dell, quantity and quality of the cDNA libraries were assessed Round Rock, TX, USA) running image analysis software (LC- using an Agilent 2100 BioAnalyzer. 3’ end of ZP2 cDNA, Polscope pro 4.4; Cambridge Research and Instrumentation, containing the PV sites, was then amplified by PCR using a Woburn, MA, USA). sense primer specific to exon 14 (1935F) and a reverse primer (Adapter-R) that targets the adapter region of the
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