Mayara Jorgens Prado1,2, Simone Martins de Castro3,2, Cristiane Kopacek3,4, Maricilda Palandi de Mello5, Thaiane Rispoli1,2, Tarciana Grandi1, Cláudia Maria Dornelles da Silva6, Maria Lucia Rosa Rossetti1. 1. Departamento de Ação em Saúde, Centro de Desenvolvimento Científico e Tecnológico, Secretaria de Saúde do Rio Grande do Sul, Ipiranga Avenue 5400, Porto Alegre, CEP 90610-000, Brazil. 2. Universidade Federal do Rio Grande do Sul, Bento Gonçalves Avenue 9500, Porto Alegre, CEP 91501-970, Brazil. 3. Serviço de Referência em Triagem Neonatal, Hospital Materno Infantil Presidente Vargas, Independência Avenue 661, Porto Alegre, CEP 90035-074, Brazil. 4. Universidade Federal de Ciências da Saúde de Porto Alegre, Sarmento Leite Avenue 245, Porto Alegre, Rio Grande do Sul, CEP 90050-170, Brazil. 5. Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Cândido Rondon Avenue 400, Campinas, CEP 13083-875, Brazil. 6. Departamento de Ação em Saúde, Centro de Desenvolvimento Científico e Tecnológico, Secretaria de Saúde do Rio Grande do Sul, Ipiranga Avenue 5400, Porto Alegre, CEP 90610-000, Brazil. cmdornelles@gmail.com.
Abstract
BACKGROUND: Steroid 21-hydroxylase deficiency due to CYP21A2 gene mutations represents more than 90% of all congenital adrenal hyperplasia cases. This deficiency is screened by measuring levels of 17-hydroxyprogesterone, which may vary, causing false positive or false negative results. In order to assist the diagnosis, molecular methodologies have been employed. This work aimed to perform genotyping assays to detect mutations in the CYP21A2 gene and compare the findings with other population studies. METHODS: The SNaPshot assay was developed to simultaneously detect 12 frequent point mutations in the CYP21A2 gene (p.Arg409Cys, p.Gln319Ter, p.Arg357Trp, p.Leu308PhefsTer6, p.Val237Glu, IVS2-13A/C > G, p.Ile173Asn, p.Pro31Leu, p.Pro454Ser, p.Val282Leu, p.Gly111ValfsTer21 and p.His63Leu). The direct sequencing and multiplex ligation-dependent probe amplification assays were used to confirm point mutations present in the developed method. The latter was also used to search large deletions and gene conversion, complementing the investigation. A total of 166 cases were studied. RESULTS: The SNaPshot assay was successfully developed to detect the 12 mutations. The results of mutation analysis indicated 84 pathogenic alleles in 48 cases, with p.Val282Leu (27.1%) and IVS2-13A/C > G (20.8%) being the most frequently found mutations. Between the findings of this study and those of other South American studies, there were significant differences in frequency for p.Pro31Leu and p.Val282Leu (p < 0.001). A new variant T in IVS2-13A/C > G was identified in two patients via the SNaPshot assay. CONCLUSION: The molecular strategy developed for CYP21A2 gene mutation screening allowed us to detect the principle mutations described around the world. Furthermore, the first Southern Brazilian mutation frequencies concerning the CYP21A2 gene were obtained.
BACKGROUND: Steroid 21-hydroxylase deficiency due to CYP21A2 gene mutations represents more than 90% of all congenital adrenal hyperplasia cases. This deficiency is screened by measuring levels of 17-hydroxyprogesterone, which may vary, causing false positive or false negative results. In order to assist the diagnosis, molecular methodologies have been employed. This work aimed to perform genotyping assays to detect mutations in the CYP21A2 gene and compare the findings with other population studies. METHODS: The SNaPshot assay was developed to simultaneously detect 12 frequent point mutations in the CYP21A2 gene (p.Arg409Cys, p.Gln319Ter, p.Arg357Trp, p.Leu308PhefsTer6, p.Val237Glu, IVS2-13A/C > G, p.Ile173Asn, p.Pro31Leu, p.Pro454Ser, p.Val282Leu, p.Gly111ValfsTer21 and p.His63Leu). The direct sequencing and multiplex ligation-dependent probe amplification assays were used to confirm point mutations present in the developed method. The latter was also used to search large deletions and gene conversion, complementing the investigation. A total of 166 cases were studied. RESULTS: The SNaPshot assay was successfully developed to detect the 12 mutations. The results of mutation analysis indicated 84 pathogenic alleles in 48 cases, with p.Val282Leu (27.1%) and IVS2-13A/C > G (20.8%) being the most frequently found mutations. Between the findings of this study and those of other South American studies, there were significant differences in frequency for p.Pro31Leu and p.Val282Leu (p < 0.001). A new variant T in IVS2-13A/C > G was identified in two patients via the SNaPshot assay. CONCLUSION: The molecular strategy developed for CYP21A2 gene mutation screening allowed us to detect the principle mutations described around the world. Furthermore, the first Southern Brazilian mutation frequencies concerning the CYP21A2 gene were obtained.
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