Abstract
CYP21A2 defects result in congenital adrenal hyperplasia (CAH), an autosomal recessive disorder characterized by impaired adrenal steroidogenesis. CYP21A2 lies within the major histocompatibility complex in an area of the genome highly susceptible to genetic variation. Alterations in the neighboring complement component 4 isotypes C4A and C4B have been associated with psychiatric and autoimmune disease. The purpose of this study was to evaluate C4A and C4B in patients with CAH in relation to CYP21A2 genotype and psychiatric and autoimmune comorbidity. We determined the copy numbers of C4A and C4B in 145 patients with CAH (median age: 15.5 years, IQR: 16.8) and 108 carrier relatives (median age: 41.5 years, IQR: 12.0) and evaluated serum C4 concentrations. Comorbidity was determined by medical record review. Only 30% of subjects had the expected two copies each of the two C4 genes. C4B copy number determined total C4 copy number and serum C4 concentration, negatively correlated with carriership of a 30-kb deletion (P < 10− 5), and positively correlated with carriership of p.V281L (P < 10− 5). High C4A copy number (≥ 3) was associated with increased risk of having an externalizing psychiatric condition (relative risk: 2.67, 95% CI: 1.03–6.89, P = 0.04). No association was found between C4 copy number and autoimmune disease. Mutation-specific C4 structural variations commonly occur in patients with CAH and may have important clinical consequences, including increased risk of psychiatric morbidity.
Trial registration NCT00250159 (November 7, 2005).
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References
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington
Banlaki Z, Doleschall M, Rajczy K, Fust G, Szilagyi A (2012) Fine-tuned characterization of RCCX copy number variants and their relationship with extended MHC haplotypes. Genes Immun 13:530–535. https://doi.org/10.1038/gene.2012.29
Blanchong CA, Zhou B, Rupert KL, Chung EK, Jones KN, Sotos JF, Zipf WB, Rennebohm RM, Yung CY (2000) Deficiencies of human complement component C4A and C4B and heterozygosity in length variants of RP-C4-CYP21-TNX (RCCX) modules in caucasians. The load of RCCX genetic diversity on major histocompatibility complex-associated disease. J Exp Med 191:2183–2196
Blanchong CA, Chung EK, Rupert KL, Yang Y, Yang Z, Zhou B, Moulds JM, Yu CY (2001) Genetic, structural and functional diversities of human complement components C4A and C4B and their mouse homologues, Slp and C4. Int Immunopharmacol 1:365–392
Burch GH, Gong Y, Liu W, Dettman RW, Curry CJ, Smith L, Miller WL, Bristow J (1997) Tenascin-X deficiency is associated with Ehlers-Danlos syndrome. Nat Genet 17:104–108. https://doi.org/10.1038/ng0997-104
Chen W, Xu Z, Nishitani M, Van Ryzin C, McDonnell NB, Merke DP (2012a) Complement component 4 copy number variation and CYP21A2 genotype associations in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Hum Genet 131:1889–1894. https://doi.org/10.1007/s00439-012-1217-8
Chen W, Xu Z, Sullivan A, Finkielstain GP, Van Ryzin C, Merke DP, McDonnell NB (2012b) Junction site analysis of chimeric CYP21A1P/CYP21A2 genes in 21-hydroxylase deficiency. Clin Chem 58:421–430. https://doi.org/10.1373/clinchem.2011.174037
Engberg H, Butwicka A, Nordenstrom A, Hirschberg AL, Falhammar H, Lichtenstein P, Nordenskjold A, Frisen L, Landen M (2015) Congenital adrenal hyperplasia and risk for psychiatric disorders in girls and women born between 1915 and 2010: a total population study. Psychoneuroendocrinology 60:195–205. https://doi.org/10.1016/j.psyneuen.2015.06.017
Falhammar H, Nordenstrom A (2015) Nonclassic congenital adrenal hyperplasia due to 21-hydroxylase deficiency: clinical presentation, diagnosis, treatment, and outcome. Endocrine 50:32–50. https://doi.org/10.1007/s12020-015-0656-0
Falhammar H, Butwicka A, Landen M, Lichtenstein P, Nordenskjold A, Nordenstrom A, Frisen L (2014) Increased psychiatric morbidity in men with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Clin Endocrinol Metab 99:E554–E560. https://doi.org/10.1210/jc.2013-3707
Finkielstain GP, Chen W, Mehta SP, Fujimura FK, Hanna RM, Van Ryzin C, McDonnell NB, Merke DP (2011) Comprehensive genetic analysis of 182 unrelated families with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Clin Endocrinol Metab 96:E161–E172. https://doi.org/10.1210/jc.2010-0319
Hannah-Shmouni F, Morissette R, Sinaii N, Elman M, Prezant TR, Chen W, Pulver A, Merke DP (2017) Revisiting the prevalence of nonclassic congenital adrenal hyperplasia in US Ashkenazi Jews and Caucasians. Genet Med 19:1276–1279. https://doi.org/10.1038/gim.2017.46
Law SK, Dodds AW, Porter RR (1984) A comparison of the properties of two classes, C4A and C4B, of the human complement component C4. Embo j 3:1819–1823
Li N, Zhang J, Liao D, Yang L, Wang Y, Hou S (2017) Association between C4, C4A, and C4B copy number variations and susceptibility to autoimmune diseases: a meta-analysis. Sci Rep 7:42628. https://doi.org/10.1038/srep42628
Merke DP, Chen W, Morissette R, Xu Z, Van Ryzin C, Sachdev V, Hannoush H, Shanbhag SM, Acevedo AT, Nishitani M, Arai AE, McDonnell NB (2013) Tenascin-X haploinsufficiency associated with Ehlers-Danlos syndrome in patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 98:E379–E387. https://doi.org/10.1210/jc.2012-3148
Morissette R, Chen W, Perritt AF, Dreiling JL, Arai AE, Sachdev V, Hannoush H, Mallappa A, Xu Z, McDonnell NB, Quezado M, Merke DP (2015) Broadening the spectrum of ehlers danlos syndrome in patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 100:E1143–E1152. https://doi.org/10.1210/jc.2015-2232
Mueller PW, Lyons J, Kerr G, Haase CP, Isett RB (2013) Standard enrichment methods for targeted next-generation sequencing in high-repeat genomic regions. Genet Med 15:910–911. https://doi.org/10.1038/gim.2013.119
Nordenstrom A, Butwicka A, Linden Hirschberg A, Almqvist C, Nordenskjold A, Falhammar H, Frisen L (2017) Are carriers of CYP21A2 mutations less vulnerable to psychological stress? A population-based national cohort study. Clin Endocrinol (Oxf) 86:317–324. https://doi.org/10.1111/cen.13242
R Core Team (2017) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/
Sekar A, Bialas AR, de Rivera H, Davis A, Hammond TR, Kamitaki N, Tooley K, Presumey J, Baum M, Van Doren V, Genovese G, Rose SA, Handsaker RE, Daly MJ, Carroll MC, Stevens B, McCarroll SA (2016) Schizophrenia risk from complex variation of complement component 4. Nature 530:177–183. https://doi.org/10.1038/nature16549
Speiser PW, Arlt W, Auchus RJ, Baskin LS, Conway GS, Merke DP, Meyer-Bahlburg HFL, Miller WL, Murad MH, Oberfield SE, White PC (2018) Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an endocrine society* clinical practice guideline. J Clin Endocrinol Metabol 103:4043–4088. https://doi.org/10.1210/jc.2018-01865
Wu YL, Yang Y, Chung EK, Zhou B, Kitzmiller KJ, Savelli SL, Nagaraja HN, Birmingham DJ, Tsao BP, Rovin BH, Hebert LA, Yu CY (2008) Phenotypes, genotypes and disease susceptibility associated with gene copy number variations: complement C4 CNVs in European American healthy subjects and those with systemic lupus erythematosus. Cytogenet Genome Res 123:131–141. https://doi.org/10.1159/000184700
Yang Y, Lhotta K, Chung EK, Eder P, Neumair F, Yu CY (2004) Complete complement components C4A and C4B deficiencies in human kidney diseases and systemic lupus erythematosus. J Immunol 173:2803–2814
Zorzetto M, Datturi F, Divizia L, Pistono C, Campo I, De Silvestri A, Cuccia M, Ricevuti G (2017) Complement C4A and C4B gene copy number study in Alzheimer’s disease patients. Curr Alzheimer Res 14:303–308. https://doi.org/10.2174/1567205013666161013091934
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This research was supported by the Intramural Research Program at the National Institutes of Health (NIH), Bethesda, Maryland. We would like to thank Dr. Ninet Sinaii for her statistical advice.
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Lao, Q., Jardin, M.D., Jayakrishnan, R. et al. Complement component 4 variations may influence psychopathology risk in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Hum Genet 137, 955–960 (2018). https://doi.org/10.1007/s00439-018-1959-z
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DOI: https://doi.org/10.1007/s00439-018-1959-z