The MKRN3 Gene
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A P ABREU and others MKRN3 deficiency causes CPP 54:3 R131–R139 Review A new pathway in the control of the initiation of puberty: the MKRN3 gene Ana Paula Abreu, Delanie B Macedo1, Vinicius N Brito1, Ursula B Kaiser and Ana Claudia Latronico1 Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women’s Hospital, Correspondence Boston, Massachusetts, USA should be addressed 1Unidade de Endocrinologia do Desenvolvimento, Disciplina de Endocrinologia e Metabologia, Laborato´ rio de to A C Latronico Hormoˆ nios e Gene´ tica Molecular, LIM 42, Hospital das Clı´nicas, Faculdade de Medicina da Universidade Email de Sa˜ o Paulo, Avenida Dr Ene´ as de Carvalho Aguiar, 255, 78 andar, sala 7037, CEP: 05403-900, Sa˜ o Paulo, Brazil [email protected] Abstract Pubertal timing is influenced by complex interactions among genetic, nutritional, Key Words environmental, and socioeconomic factors. The role of MKRN3, an imprinted gene located " hypothalamus and in the Prader–Willi syndrome critical region (chromosome 15q11–13), in pubertal initiation neuroendocrinology was first described in 2013 after the identification of deleterious MKRN3 mutations in five " gonadotropins families with central precocious puberty (CPP) using whole-exome sequencing analysis. " mutations Since then, additional loss-of-function mutations of MKRN3 have been associated with the " secretion inherited premature sexual development phenotype in girls and boys from different ethnic groups. In all of these families, segregation analysis clearly demonstrated autosomal dominant inheritance with complete penetrance, but with exclusive paternal transmission, Journal of Molecular Endocrinology consistent with the monoallelic expression of MKRN3 (a maternally imprinted gene). Interestingly, the hypothalamic Mkrn3 mRNA expression pattern in mice correlated with a putative inhibitory input on puberty initiation. Indeed, the initiation of puberty depends on a decrease in factors that inhibit the release of GnRH combined with an increase in stimulatory factors. These recent human and animal findings suggest that MKRN3 plays an Journal of Molecular inhibitory role in the reproductive axis to represent a new pathway in pubertal regulation. Endocrinology (2015) 54, R131–R139 Introduction Puberty, a complex biological process involving sexual are superimposed upon substantial genetic control. maturation and accelerated linear growth, is initiated Similar timing of puberty shared by mothers and her when the pulsatile secretion of gonadotropin-releasing children, and within racial groups, suggests a genetic hormone (GnRH) increases after a quiescent period during component to the onset of puberty (Zacharias & Wurtman childhood. The regulation of puberty initiation remains 1969, Herman-Giddens et al. 1997). Substantial efforts as one of the great mysteries of human biology and it is have been made to identify genes that are responsible thought that a conjunction of factors plays a role to for the initiation of puberty (Ojeda & Lomniczi 2014). initiate puberty. The identification of these genes is critical for advancing Environmental and metabolic factors are important the understanding of the neuroendocrine regulation of regulators of pubertal development, but these influences puberty initiation. http://jme.endocrinology-journals.org Ñ 2015 Society for Endocrinology Published by Bioscientifica Ltd. DOI: 10.1530/JME-14-0315 Printed in Great Britain Downloaded from Bioscientifica.com at 09/28/2021 04:54:59AM via free access Review A P ABREU and others MKRN3 deficiency causes CPP 54:3 R132 In an attempt to identify genes operating within the Prader–Willi syndrome (PWS) critical region and is neuroendocrine brain that ultimately regulate the repro- maternally imprinted (discussed later). Subsequently, we ductive axis, researchers have been studying patients with showed that mutations in MKRN3 are also the cause of CPP pubertal disorders. The hypothalamic–pituitary–gonadal in apparently sporadic cases (Macedo et al. 2014). These axis regulates puberty initiation and reproduction. GnRH findings were significant contributions to the field and is produced and secreted by the hypothalamus in a will advance the understanding of the pubertal process. pulsatile manner during the embryonic and neonatal We will review the genetic defects identified in patients phases of life. GnRH secretion is actively inhibited during with CPP and their clinical implications, and discuss herein infancy and puberty begins with the reactivation of its the possible role of MKRN3 within the reproductive axis. secretion. GnRH deficiency results in hypogonadotropic hypogonadism, in which patients fail to develop puberty Loss-of-function mutations of MKRN3 cause and are usually infertile. Conversely, early reactivation of familial CPP GnRH secretion results in central precocious puberty (CPP). While several genes have been detected in asso- TheroleofMKRN3 in pubertal initiation was first ciation with GnRH deficiency and have contributed to the described in 2013 after a comprehensive genetic study current knowledge of GnRH regulation (Bianco & Kaiser of several families with CPP (Abreu et al. 2013). In this 2009, Semple & Topaloglu 2010), genes linked to CPP study, the authors investigated 40 members of 15 families have until recently only been identified subsequent to with CPP from different ethnic groups (12 Brazilian, their association with hypogonadotropic hypogonadism, two American, and one Belgian families), and applying such as KISS1 and KISS1R. However, only rare genetic whole-exome sequencing four deleterious MKRN3 defects in KISS1 and its receptor have been identified in mutations – three frameshift and a missense mutation patients with CPP (Teles et al. 2008, Silveira et al. 2010). (Fig. 1) – were detected in five of these families (33%). Both The advances in sequencing methods permitted the sexes were equally affected by MKRN3 mutations (eight detection of new genes implicated in the neuroendocrine girls and seven boys) (Table 1). regulation of puberty. Using exome sequencing analysis More recently, Macedo et al. (2014) studied 215 and studying familial cases of CPP, genetic defects in a unrelated children (207 girls and eight boys) with CPP gene with no previous link to the hypothalamic–pituitary– from three different University Medical Centers and gonadal axis, Makorin ring finger 3 (MKRN3), were identified five novel heterozygous mutations in eight identified as the cause of premature sexual development unrelated Brazilian girls, including four frameshift Journal of Molecular Endocrinology in one-third of the families (Abreu et al. 2013). MKRN3 variants and one missense variant (Fig. 1 and Table 1). is located on the long arm of chromosome 15 in the No family history of premature sexual development was Pro161Argfs*10 Pro161Argfs*16 Ala162Glyfs*14 Glu256Glyfs*36 Arg365Ser Phe417Ile MKRN type Ring Finger Cys-His C3HC4 H C C C C C C C C C Zn Zn C H Zn Zn Zn C C C H Zn C H C H C H C C 1 95 122 238 265 266 293 311 365 394 423 507 aa Glu111* Arg213Glyfs*73 Cys340Gly Tyr391* His420Gln Gln226Thrfs*6 Figure 1 MKRN3 protein structure and mutations identified in patients with central correspond to the amino acid positions in the protein. Blue mutation labels precocious puberty. Zn, zinc; H, histidine; C, cysteine. The three C3H zinc and arrows indicate the location of frameshift mutations; red mutation finger motifs are shown in red, the C3HC4 RING finger motif is in blue, labels and arrows indicate the location of the missense mutations. and the MKRN-specific Cys–His domain is shown in green. The numbers http://jme.endocrinology-journals.org Ñ 2015 Society for Endocrinology Published by Bioscientifica Ltd. DOI: 10.1530/JME-14-0315 Printed in Great Britain Downloaded from Bioscientifica.com at 09/28/2021 04:54:59AM via free access Journal of Molecular Endocrinology http://jme.endocrinology-journals.org DOI: 10.1530/JME-14-0315 Printed in Great Britain Review Table 1 MKRN3 mutations identified in children with CPP. (Gonadarche or testicular enlargement. Breast/Genital development according to Tanner stage and bone age assessed at the time of diagnosis) Characteristics at time of diagnosis MKRN3 mutation Breast/Genital Family Patient Initial clinical manifestation Age development Bone age number Origin number Sex (age in years) (years) Tanner stage (years) DNA Protein References 1 USA I F Thelarche (5.7) 6.5 2 7.7 637delC Arg213Glyfs*73 Abreu et al. (2013) II M Gonadarche (8.0) 8.7 3 11 637delC Arg213Glyfs*73 III F Thelarche (6.5) 6.7 2 7.8 637delC Arg213Glyfs*73 A P ABREU Ñ 2 Brazil I F Thelarche (6.2) 7.0 3 7.0 1171_1172insA Tyr391* Abreu et al. (2013) 2015 Society for Endocrinology II F Thelarche (5.7) 6.0 3 6.0 1171_1172insA Tyr391* 3 Brazil I M Gonadarche and pubarche (5.9) 8.1 3 10 475_476insC Ala162Glyfs*14 Abreu et al. (2013) and others II M Gonadarche and pubarche 9.7 3 9.7 475_476insC Ala162Glyfs*14 unknown 4 USA I M Gonadarche and pubarche (8.5) 8.8 3 11 475_476insC Ala162Glyfs*14 Abreu et al. (2013) II F Thelarche (5.0) 6.5 2 8.3 475_476insC Ala162Glyfs*14 5 Belgium I F Thelarche (6.2) 6.4 2 9.4a 1095GOT Arg365Ser Abreu et al. (2013) II M Gonadarche and pubarche 9.7 3 12 1095GOT Arg365Ser unknown III F Thelarche and pubarche (5.4) 5.7 2 8.5 1095GOT Arg365Ser 6 Brazil I F Thelarche and pubarche (6.4) 7.8 3 11 482delC Pro161Argfs*10 Macedo et al. (2014) MKRN3 deficiency causes CPP Published by Bioscientifica Ltd. 7 Brazil I F Thelarche (5.4) 6.1 3 8.8 482_483insC Pro161Argfs*16 Macedo et al. (2014) 8 Brazil I F Thelarche (6.0) 7.9 4 11 482_483insC Pro161Argfs*16 Macedo et al. (2014) 9 Brazil I F Thelarche (3.0) and pubarche (6.0) 6.7 3 8.8 482delC Pro161Argfs*10 Macedo et al. (2014) 10 Brazil I F Thelarche (4.0) 6.8 4 12 675_676insA Gln226Thrfs*6 Macedo et al. (2014) 11 Brazil I F Thelarche and pubarche (6.0) 6.6 3 7.8 766_767delA Glu256Glyfs*36 Macedo et al.