Clinical, genetic, and enzymatic characterization of P450 oxidoreductase deficiency in four patients

Taninee Sahakitrungruang, Ningwu Huang, Meng Kian Tee, Vishal Agrawal, William E. Russell, Patricia Crock, Nuala Murphy, Claude J. Migeon, Walter L. Miller

Research output: Contribution to journalArticle

Abstract

Context: P450 oxidoreductase (POR) deficiency causes disordered steroidogenesis; severe mutations cause genital ambiguity in both sexes plus the Antley-Bixler skeletal malformation syndrome, whereas mild mutations can cause adult infertility. Objective: We describe four patients with POR deficiency and identify and characterize the activities of their mutations. A 46,XY male with micropenis and two 46,XX female infants with genital ambiguity presented with skeletal malformations, and a 46,XX adolescent presented with primary amenorrhea, elevated 17α-hydroxyprogesterone, and low sex steroids. Methods: The coding regions of the POR gene were sequenced, and the identified mutations were recreated in human POR cDNA expression vectors lacking 27 N-terminal residues. POR and human P450c17 were expressed in bacteria. POR activity was measured by four assays: reduction of cytochrome c, oxidation of reduced nicotinamide adenine dinucleotide phosphate, and support of the 17α-hydroxylase and 17,20 lyase activities of P450c17. Results: All four patients were compound heterozygotes for POR mutations, including five novel mutations: L577R, N185K, delE217, and frameshift mutations 1363delC and 697-698insGAAC. N185K and delE217 lacked measurable activity in the assays based on P450c17 but retained partial activity in the assays based on cytochrome c. As assessed by Vmax/Km, L577R supported 46% of 17α-hydroxylase activity but only 27% of 17,20 lyase activity. Computational modeling of these novel mutants revealed the structural basis for their reduced or absent activities. Conclusion: These patients illustrate the broad clinical spectrum of POR deficiency, including amenorrhea and infertility as the sole manifestation. POR assays based on P450c17 correlate well with hormonal and clinical phenotypes.

Original languageEnglish (US)
Pages (from-to)4992-5000
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume94
Issue number12
DOIs
StatePublished - Dec 2009

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Oxidoreductases
Mutation
Assays
Steroid 17-alpha-Hydroxylase
Disorders of Sex Development
Amenorrhea
Mixed Function Oxygenases
Cytochromes c
Infertility
17-alpha-Hydroxyprogesterone
Frameshift Mutation
Heterozygote
NADP
Bacteria
Complementary DNA
Genes
Steroids
Phenotype
Oxidation

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Sahakitrungruang, T., Huang, N., Tee, M. K., Agrawal, V., Russell, W. E., Crock, P., ... Miller, W. L. (2009). Clinical, genetic, and enzymatic characterization of P450 oxidoreductase deficiency in four patients. Journal of Clinical Endocrinology and Metabolism, 94(12), 4992-5000. https://doi.org/10.1210/jc.2009-1460

Clinical, genetic, and enzymatic characterization of P450 oxidoreductase deficiency in four patients. / Sahakitrungruang, Taninee; Huang, Ningwu; Tee, Meng Kian; Agrawal, Vishal; Russell, William E.; Crock, Patricia; Murphy, Nuala; Migeon, Claude J.; Miller, Walter L.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 94, No. 12, 12.2009, p. 4992-5000.

Research output: Contribution to journalArticle

Sahakitrungruang, T, Huang, N, Tee, MK, Agrawal, V, Russell, WE, Crock, P, Murphy, N, Migeon, CJ & Miller, WL 2009, 'Clinical, genetic, and enzymatic characterization of P450 oxidoreductase deficiency in four patients', Journal of Clinical Endocrinology and Metabolism, vol. 94, no. 12, pp. 4992-5000. https://doi.org/10.1210/jc.2009-1460
Sahakitrungruang, Taninee ; Huang, Ningwu ; Tee, Meng Kian ; Agrawal, Vishal ; Russell, William E. ; Crock, Patricia ; Murphy, Nuala ; Migeon, Claude J. ; Miller, Walter L. / Clinical, genetic, and enzymatic characterization of P450 oxidoreductase deficiency in four patients. In: Journal of Clinical Endocrinology and Metabolism. 2009 ; Vol. 94, No. 12. pp. 4992-5000.
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abstract = "Context: P450 oxidoreductase (POR) deficiency causes disordered steroidogenesis; severe mutations cause genital ambiguity in both sexes plus the Antley-Bixler skeletal malformation syndrome, whereas mild mutations can cause adult infertility. Objective: We describe four patients with POR deficiency and identify and characterize the activities of their mutations. A 46,XY male with micropenis and two 46,XX female infants with genital ambiguity presented with skeletal malformations, and a 46,XX adolescent presented with primary amenorrhea, elevated 17α-hydroxyprogesterone, and low sex steroids. Methods: The coding regions of the POR gene were sequenced, and the identified mutations were recreated in human POR cDNA expression vectors lacking 27 N-terminal residues. POR and human P450c17 were expressed in bacteria. POR activity was measured by four assays: reduction of cytochrome c, oxidation of reduced nicotinamide adenine dinucleotide phosphate, and support of the 17α-hydroxylase and 17,20 lyase activities of P450c17. Results: All four patients were compound heterozygotes for POR mutations, including five novel mutations: L577R, N185K, delE217, and frameshift mutations 1363delC and 697-698insGAAC. N185K and delE217 lacked measurable activity in the assays based on P450c17 but retained partial activity in the assays based on cytochrome c. As assessed by Vmax/Km, L577R supported 46{\%} of 17α-hydroxylase activity but only 27{\%} of 17,20 lyase activity. Computational modeling of these novel mutants revealed the structural basis for their reduced or absent activities. Conclusion: These patients illustrate the broad clinical spectrum of POR deficiency, including amenorrhea and infertility as the sole manifestation. POR assays based on P450c17 correlate well with hormonal and clinical phenotypes.",
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