TAC3/TACR3 mutations reveal preferential activation of gonadotropin-releasing hormone release by neurokinin B in neonatal life followed by reversal in adulthood

Abstract

Context: Mutations in TAC3 and TACR3 (encoding neurokinin B and its receptor) have been identified in Turkish patients with idiopathic hypogonadotropic hypogonadism (IHH), but broader populations have not yet been tested and genotype-phenotype correlations have not been established.

Objective: A broad cohort of normosmic IHH probands was screened for mutations in TAC3/TACR3 to evaluate the prevalence of such mutations and define the genotype/phenotype relationships.

Design and setting: The study consisted of sequencing of TAC3/TACR3, in vitro functional assays, and neuroendocrine phenotyping conducted in tertiary care centers worldwide.

Patients or other participants: 345 probands, 18 family members, and 292 controls were studied.

Intervention: Reproductive phenotypes throughout reproductive life and before and after therapy were examined.

Main outcome measure: Rare sequence variants in TAC3/TACR3 were detected.

Results: In TACR3, 19 probands harbored 13 distinct coding sequence rare nucleotide variants [three nonsense mutations, six nonsynonymous, four synonymous (one predicted to affect splicing)]. In TAC3, one homozygous single base pair deletion was identified, resulting in complete loss of the neurokinin B decapeptide. Phenotypic information was available on 16 males and seven females with coding sequence variants in TACR3/TAC3. Of the 16 males, 15 had microphallus; none of the females had spontaneous thelarche. Seven of the 16 males and five of the seven females were assessed after discontinuation of therapy; six of the seven males and four of the five females demonstrated evidence for reversibility of their hypogonadotropism.

Conclusions: Mutations in the neurokinin B pathway are relatively common as causes of hypogonadism. Although the neurokinin B pathway appears essential during early sexual development, its importance in sustaining the integrity of the hypothalamic-pituitary-gonadal axis appears attenuated over time.

Figure 1

Pedigrees of familial cases of TACR3 and TAC3 mutations. With only one exception, all the affected family members had the same change as their respective probands. A, Proband 4; B, proband 7; C, proband 2; D, proband 11; E, proband 20.

Figure 2

A, Schematic of mutations in NK3-R. B, Effects of mutations in TACR3 on NKB-mediated activation of signal transduction. COS-7 cells transfected with wild-type (WT), G18D, I249V, Y256H, R295S, and Y315C NK3-R or EV were treated with NKB (10⁻⁷ m) for 1 h. A significant increase in IP accumulation occurred in cells transfected with WT, G18D, or I249V NK3-R. In contrast, there was a marked reduction in NKB-stimulated IP production in cells transfected with Y256H, R295S, or Y315C NK3-R, or with EV. a, b, and c denote significantly different fold increases in IP accumulation.

Figure 3

Blood sampling every 10 min regarding reversal probands. Left, Studies before treatment. Right, Studies after discontinuation of treatment. *, T value represents a single blood sample taken within 5 months of the sampling study.