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Carrier detection and prenatal diagnosis of congenital adrenal hyperplasia must identify ‘apparently mild’ CYP21A2 alleles which associate neonatal salt‐wasting disease
Author(s) -
Ezquieta Begoña,
Santomé Luis,
Barrio Raquel,
Barrionuevo Jose L.,
LópezSiguero Juan P.,
Oliver Antonio,
Ramírez Joaquín,
Rodríguez Ildefonso,
MuñozPacheco Rafael
Publication year - 2010
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.2537
Subject(s) - congenital adrenal hyperplasia , allele , prenatal diagnosis , genetic counseling , genetics , compound heterozygosity , medicine , biology , gene , fetus , pregnancy
Abstract Objective Couples at risk of severe congenital adrenal hyperplasia (CAH) may be offered prenatal treatment or preimplantation diagnosis. However, proper genetic counselling requires the accurate identification of apparently ‘mild alleles’ in partners of CAH‐carriers/patients. Methods CYP21A2 gene analyses were performed in 255 patients with severe 21‐hydroxylase deficiency (21‐OHD), 94 with mild 21‐OHD, 752 parental samples, 233 clinically unaffected partners and 253 historic DNA samples. GENSCAN and ClustalX2.0 software were used for in silico analyses, and Epidat 3.1 software for statistical calculations. Results Twenty‐seven partners were carriers of p.Val282Leu (alias p.Val281Leu, allele frequency 11.7%, 7.4–16.1). ‘Val282Leu alleles’ were detected in 30 patients with salt‐wasting (SW) disease, 21 with other pseudogene‐derived and rare coding cis severe mutations, and 9 without. These CYP21A2 genes were compared to those of 94 fully characterized patients with mild deficiency carrying p.Val282Leu in compound heterozygosity with a severe allele. A rare intronic variant, c.292+5G>A, was detected in the nine ‘severe Val282Leu alleles’ and that was not seen in mild p.Val282Leu alleles, in other deficient alleles or in normal chromosomes. The in silico documented effect on splicing and the clinical association (p < 0.0001) confirmed p.Val282Leu; c.292+5G>A as a severe allele. Conclusion As only severe alleles require clinical intervention, CAH‐carrier detection of p.Val282Leu should be followed by the analysis of c.292+5G>A. Copyright © 2010 John Wiley & Sons, Ltd.