Abstract
Purpose
Anti-Müllerian hormone (AMH) is crucial for folliculogenesis. Prenatal exposure to AMH in mice produces a phenocopy of polycystic ovary syndrome (PCOS) in the adult female offspring. The aim of this study was to determine whether genetic variation in AMH gene contribute to PCOS in women of Chinese ancestry.
Methods
We conducted a case–control genetic study in 383 PCOS case and 433 control women of Chinese ancestry. The exons and the 5′ flanking region of AMH were sanger sequenced. Bioinformatic prediction of variant deleteriousness was performed.
Results
Seven novel heterozygous variants along with 15 rare known variants in AMH were identified in women with PCOS but not in controls. The novel variants included one frameshift variant (c.125_129delACTTG), one synonymous variant (c.1095C>T), one variant (c.-14T>C) in the 5’-untranslated region (UTR), four variants(c.-775C>T, c.-682C>T, c.-333A>G, c.-137A>T) in 5′ flanking sequence. Of all the AMH variants identified in women with PCOS, eight were predicted to be deleterious by bioinformatic analysis. The PCOS carriers of predicted-to-be-deleterious PCOS-specific AMH variants had increased total follicle numbers compared to PCOS noncarriers (p = 0.021).
Conclusions
Our findings suggest the AMH plays a role in the development of PCOS. The exact mechanisms by which the predicted-to-be-deleterious novel and rare AMH variants described in our study affect AMH function requires further study.
Similar content being viewed by others
Data availability
All the data generated and analyses during the current study are available from the corresponding author on reasonable request.
References
M.O. Goodarzi, D.A. Dumesic, G. Chazenbalk, R. Azziz, Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat. Rev. Endocrinol. 7(4), 219–231 (2011). https://doi.org/10.1038/nrendo.2010.217
S. Franks, L.J. Webber, M. Goh, A. Valentine, D.M. White, G.S. Conway, S. Wiltshire, M.I. McCarthy, Ovarian morphology is a marker of heritable biochemical traits in sisters with polycystic ovaries. J. Clin. Endocrinol. Metab. 93(9), 3396–3402 (2008). https://doi.org/10.1210/jc.2008-0369
R. Azziz, Polycystic ovary syndrome is a family affair. J. Clin. Endocrinol. Metab. 93(5), 1579–1581 (2008). https://doi.org/10.1210/jc.2008-0477
Z.J. Chen, H. Zhao, L. He, Y. Shi, Y. Qin, Y. Shi, Z. Li, L. You, J. Zhao, J. Liu, X. Liang, X. Zhao, J. Zhao, Y. Sun, B. Zhang, H. Jiang, D. Zhao, Y. Bian, X. Gao, L. Geng, Y. Li, D. Zhu, X. Sun, J.E. Xu, C. Hao, C.E. Ren, Y. Zhang, S. Chen, W. Zhang, A. Yang, J. Yan, Y. Li, J. Ma, Y. Zhao, Genome-wide association study identifies susceptibility loci for polycystic ovary syndrome on chromosome 2p16.3, 2p21 and 9q33.3. Nat. Genet. 43(1), 55–59 (2011). https://doi.org/10.1038/ng.732
F.R. Day, D.A. Hinds, J.Y. Tung, L. Stolk, U. Styrkarsdottir, R. Saxena, A. Bjonnes, L. Broer, D.B. Dunger, B.V. Halldorsson, D.A. Lawlor, G. Laval, I. Mathieson, W.L. McCardle, Y. Louwers, C. Meun, S. Ring, R.A. Scott, P. Sulem, A.G. Uitterlinden, N.J. Wareham, U. Thorsteinsdottir, C. Welt, K. Stefansson, J.S.E. Laven, K.K. Ong, J.R.B. Perry, Causal mechanisms and balancing selection inferred from genetic associations with polycystic ovary syndrome. Nat. Commun. 6(1), 8464 (2015). https://doi.org/10.1038/ncomms9464
Y. Shi, H. Zhao, Y. Shi, Y. Cao, D. Yang, Z. Li, B. Zhang, X. Liang, T. Li, J. Chen, J. Shen, J. Zhao, L. You, X. Gao, D. Zhu, X. Zhao, Y. Yan, Y. Qin, W. Li, J. Yan, Q. Wang, J. Zhao, L. Geng, J. Ma, Y. Zhao, G. He, A. Zhang, S. Zou, A. Yang, J. Liu, W. Li, B. Li, C. Wan, Y. Qin, J. Shi, J. Yang, H. Jiang, J.-e Xu, X. Qi, Y. Sun, Y. Zhang, C. Hao, X. Ju, D. Zhao, C.-e Ren, X. Li, W. Zhang, Y. Zhang, J. Zhang, D. Wu, C. Zhang, L. He, Z.-J. Chen, Genome-wide association study identifies eight new risk loci for polycystic ovary syndrome. Nat. Genet. 44(9), 1020–1025 (2012). https://doi.org/10.1038/ng.2384
M.G. Hayes, M. Urbanek, D.A. Ehrmann, L.L. Armstrong, J.Y. Lee, R. Sisk, T. Karaderi, T.M. Barber, M.I. McCarthy, S. Franks, C.M. Lindgren, C.K. Welt, E. Diamanti-Kandarakis, D. Panidis, M.O. Goodarzi, R. Azziz, Y. Zhang, R.G. James, M. Olivier, A.H. Kissebah, N. Reproductive Medicine, E. Stener-Victorin, R.S. Legro, A. Dunaif, Genome-wide association of polycystic ovary syndrome implicates alterations in gonadotropin secretion in European ancestry populations. Nat. Commun. 6, 7502 (2015). https://doi.org/10.1038/ncomms8502
H.F. Escobar-Morreale, Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat. Rev. Endocrinol. 14(5), 270–284 (2018). https://doi.org/10.1038/nrendo.2018.24
I.B. Carlsson, J.E. Scott, J.A. Visser, O. Ritvos, A.P. Themmen, O. Hovatta, Anti-Mullerian hormone inhibits initiation of growth of human primordial ovarian follicles in vitro. Hum. Reprod. 21(9), 2223–2227 (2006). https://doi.org/10.1093/humrep/del165
C. Weenen, J.S. Laven, A.R. Von Bergh, M. Cranfield, N.P. Groome, J.A. Visser, P. Kramer, B.C. Fauser, A.P: Themmen, Anti-Mullerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol. Hum. Reprod. 10(2), 77–83 (2004). https://doi.org/10.1093/molehr/gah015
R. Fanchin, L.M. Schonauer, C. Righini, J. Guibourdenche, R. Frydman, J. Taieb, Serum anti-Mullerian hormone is more strongly related to ovarian follicular status than serum inhibin B, estradiol, FSH and LH on day 3. Hum. Reprod. 18(2), 323–327 (2003). https://doi.org/10.1093/humrep/deg042
D. Dewailly, H. Gronier, E. Poncelet, G. Robin, M. Leroy, P. Pigny, A. Duhamel, S. Catteau-Jonard, Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum. Reprod. 26(11), 3123–3129 (2011). https://doi.org/10.1093/humrep/der297
L.K. Gorsic, G. Kosova, B. Werstein, R. Sisk, R.S. Legro, M.G. Hayes, J.M. Teixeira, A. Dunaif, M. Urbanek, Pathogenic anti-Mullerian hormone variants in polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 102(8), 2862–2872 (2017). https://doi.org/10.1210/jc.2017-00612
B. Tata, N.E.H. Mimouni, A.L. Barbotin, S.A. Malone, A. Loyens, P. Pigny, D. Dewailly, S. Catteau-Jonard, I. Sundstrom-Poromaa, T.T. Piltonen, F. Dal Bello, C. Medana, V. Prevot, J. Clasadonte, P. Giacobini, Elevated prenatal anti-Mullerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood. Nat. Med. 24(6), 834–846 (2018). https://doi.org/10.1038/s41591-018-0035-5
E.A.-S.Pcwg Rotterdam, Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum. Reprod. 19(1), 41–47 (2004). https://doi.org/10.1093/humrep/deh098
M. Kircher, D.M. Witten, P. Jain, B.J. O’Roak, G.M. Cooper, J. Shendure, A general framework for estimating the relative pathogenicity of human genetic variants. Nat. Genet. 46(3), 310–315 (2014). https://doi.org/10.1038/ng.2892
J.M. Schwarz, D.N. Cooper, M. Schuelke, D. Seelow, MutationTaster2: mutation prediction for the deep-sequencing age. Nat. Methods 11(4), 361–362 (2014). https://doi.org/10.1038/nmeth.2890
I.A. Adzhubei, S. Schmidt, L. Peshkin, V.E. Ramensky, A. Gerasimova, P. Bork, A.S. Kondrashov, S.R. Sunyaev, A method and server for predicting damaging missense mutations. Nat. Methods 7(4), 248–249 (2010). https://doi.org/10.1038/nmeth0410-248
P.C. Ng, S. Henikoff, SIFT: predicting amino acid changes that affect protein function. Nucleic Acids Res. 31(13), 3812–3814 (2003). https://doi.org/10.1093/nar/gkg509
R.J. Norman, D. Dewailly, R.S. Legro, T.E. Hickey, Polycystic ovary syndrome. Lancet 370(9588), 685–697 (2007). https://doi.org/10.1016/S0140-6736(07)61345-2
A.M. Gray, A.J. Mason, Requirement for activin A and transforming growth factor-beta 1 pro-regions in homodimer assembly. Science 247(4948), 1328–1330 (1990). https://doi.org/10.1126/science.2315700
N. di Clemente, S.P. Jamin, A. Lugovskoy, P. Carmillo, C. Ehrenfels, J.Y. Picard, A. Whitty, N. Josso, R.B. Pepinsky, R.L. Cate, Processing of anti-mullerian hormone regulates receptor activation by a mechanism distinct from TGF-beta. Mol. Endocrinol. 24(11), 2193–2206 (2010). https://doi.org/10.1210/me.2010-0273
A.L. Durlinger, P. Kramer, B. Karels, F.H. de Jong, J.T. Uilenbroek, J.A. Grootegoed, A.P. Themmen, Control of primordial follicle recruitment by anti-Mullerian hormone in the mouse ovary. Endocrinology 140(12), 5789–5796 (1999). https://doi.org/10.1210/endo.140.12.7204
D. Dewailly, C.Y. Andersen, A. Balen, F. Broekmans, N. Dilaver, R. Fanchin, G. Griesinger, T.W. Kelsey, A. La Marca, C. Lambalk, H. Mason, S.M. Nelson, J.A. Visser, W.H. Wallace, R.A. Anderson, The physiology and clinical utility of anti-Mullerian hormone in women. Hum. Reprod. Update 20(3), 370–385 (2014). https://doi.org/10.1093/humupd/dmt062
B. Alvaro Mercadal, R. Imbert, I. Demeestere, C. Gervy, A. De Leener, Y. Englert, S. Costagliola, A. Delbaere, AMH mutations with reduced in vitro bioactivity are related to premature ovarian insufficiency. Hum. Reprod. 30(5), 1196–1202 (2015). https://doi.org/10.1093/humrep/dev042
L.R. Hoyos, J.A. Visser, A. McLuskey, G.D. Chazenbalk, T.R. Grogan, D.A. Dumesic, Loss of anti-Mullerian hormone (AMH) immunoactivity due to a homozygous AMH gene variant rs10417628 in a woman with classical polycystic ovary syndrome (PCOS). Hum. Reprod. (2020). https://doi.org/10.1093/humrep/deaa199
L.K. Gorsic, M. Dapas, R.S. Legro, M.G. Hayes, M. Urbanek, Functional genetic variation in the anti-Mullerian hormone pathway in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 104(7), 2855–2874 (2019). https://doi.org/10.1210/jc.2018-02178
Q. Fu, M. Meyer, X. Gao, U. Stenzel, H.A. Burbano, J. Kelso, S. Paabo, DNA analysis of an early modern human from Tianyuan Cave, China. Proc. Natl Acad. Sci. USA 110(6), 2223–2227 (2013). https://doi.org/10.1073/pnas.1221359110
Acknowledgements
The authors thank Yuehong Bian, Shizhen Su for their technical assistance. They appreciate Zhao Wang, Changming Zhang, Ying Wang, and Xin Zhang, for sample collection. The authors also thank all the patients who participated in this study.
Funding
This study was supported by the National Key Research and Development Program of China (2017YFC1001000), the National Natural Science Foundation of China (31871509, 81622021, 31571548, 31601199), the US National Institutes of Health grants (R01 HD085227) and the Foundation for Distinguished Young Scholars of Shandong Province (JQ201816).
Author information
Authors and Affiliations
Contributions
H.Z., A.D., and Z-J.C. designed, supported the study; Y.Z.C. and J.T.Z. collected clinical data and blood samples; L.Q. performed experiments; L.Q, S.G.Z., and P.Y analyzed the data; L.Q. drafted the manuscript; H.Z. and A.D. revised the article. All authors gave their final approval of the version to be published.
Corresponding authors
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Consent to participate
Written informed consent was obtained from all participants.
Consent for publication
All the authors have reviewed the final version of the manuscript and approved the publication of the manuscript.
Ethics approval
The study was approved by the institutional review board of Reproductive Medicine, Shandong University.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
About this article
Cite this article
Qin, L., Zhao, S., Yang, P. et al. Variation analysis of anti-Müllerian hormone gene in Chinese women with polycystic ovary syndrome. Endocrine 72, 287–293 (2021). https://doi.org/10.1007/s12020-020-02538-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-020-02538-4