Genetic landscape of a large cohort of Primary Ovarian Insufficiency: New genes and pathways and implications for personalized medicine
Abdelkader Heddar, Çağrı Oğur, Sabrina Corrêa da Costa, Inès Braham, Line Billaud-Rist, Necati Fındıklı, Claire Bénéteau, Rachel Reynaud, Khaled Mahmoud, Stéphanie Legrand, Maud Marchand, Isabelle Cédrin‐Durnerin, Adèle Cantalloube, Maëliss Peigné, Marion Bretault, Benedicte Dagher-Hayeck, Sandrine Pérol, Céline Droumaguet, Sabri Cavkaytar, Carole Nicolas-Bonne, Hanen Elloumi, Mohamed Khrouf, Charlotte Rougier-LeMasle, Mélanie Fradin, Elsa Le Boette, Perrine Luigi, Anne‐Marie Guerrot, Emmanuelle Ginglinger, Amandine Zampa, Anaïs Fauconnier, Nathalie Auger, Françoise Paris, Elise Brischoux‐Boucher, Christelle Cabrol, A. Brun, Laura Guyon, Melanie Berard, Axelle Rivière, Nicolas Gruchy, Sylvie Odent, Brigitte Gilbert‐Dussardier, Bertrand Isidor, Juliette Piard, Laëtitia Lambert, S. Hamamah, Anne Marie Guedj, Aude Brac de la Perrière, H. Fernandez, Marie‐Laure Raffin‐Sanson, Michel Polak, H. Letur, Sylvie Epelboin, Geneviève Plu‐Bureau, Sławomir Wołczyński, S. Hiéronimus, Kristiina Aittomäki, Sophie Catteau-Jonard, Micheline Misrahi
Abstract
BACKGROUND: Primary Ovarian Insufficiency (POI), a public health problem, affects 1-3.7% of women under 40 yielding infertility and a shorter lifespan. Most causes are unknown. Recently, genetic causes were identified, mostly in single families. We studied an unprecedented large cohort of POI to unravel its molecular pathophysiology. METHODS: 375 patients with 70 families were studied using targeted (88 genes) or whole exome sequencing with pathogenic/likely-pathogenic variant selection. Mitomycin-induced chromosome breakages were studied in patients' lymphocytes if necessary. FINDINGS: A high-yield of 29.3% supports a clinical genetic diagnosis of POI. In addition, we found strong evidence of pathogenicity for nine genes not previously related to a Mendelian phenotype or POI: ELAVL2, NLRP11, CENPE, SPATA33, CCDC150, CCDC185, including DNA repair genes: C17orf53(HROB), HELQ, SWI5 yielding high chromosomal fragility. We confirmed the causal role of BRCA2, FANCM, BNC1, ERCC6, MSH4, BMPR1A, BMPR1B, BMPR2, ESR2, CAV1, SPIDR, RCBTB1 and ATG7 previously reported in isolated patients/families. In 8.5% of cases, POI is the only symptom of a multi-organ genetic disease. New pathways were identified: NF-kB, post-translational regulation, and mitophagy (mitochondrial autophagy), providing future therapeutic targets. Three new genes have been shown to affect the age of natural menopause supporting a genetic link. INTERPRETATION: We have developed high-performance genetic diagnostic of POI, dissecting the molecular pathogenesis of POI and enabling personalized medicine to i) prevent/cure comorbidities for tumour/cancer susceptibility genes that could affect life-expectancy (37.4% of cases), or for genetically-revealed syndromic POI (8.5% of cases), ii) predict residual ovarian reserve (60.5% of cases). Genetic diagnosis could help to identify patients who may benefit from the promising in vitro activation-IVA technique in the near future, greatly improving its success in treating infertility. FUNDING: Université Paris Saclay, Agence Nationale de Biomédecine.