Susumu Yokoya

Rationale and study design of the Japan environment and children’s study (JECS)

BackgroundThere is global concern over significant threats from a wide variety of environmental hazards to which children face. Large-scale and long-term birth cohort studies are needed for better environmental management based on sound science. The primary objective of the Japan Environment and Children’s Study (JECS), a nation-wide birth cohort study that started its recruitment in January 2011, is to elucidate environmental factors that affect children’s health and development.Methods/DesignApproximately 100,000 expecting mothers who live in designated study areas will be recruited over a 3-year period from January 2011. Participating children will be followed until they reach 13 years of age. Exposure to environmental factors will be assessed by chemical analyses of bio-specimens (blood, cord blood, urine, breast milk, and hair), household environment measurements, and computational simulations using monitoring data (e.g. ambient air quality monitoring) as well as questionnaires. JECS’ priority outcomes include reproduction/pregnancy complications, congenital anomalies, neuropsychiatric disorders, immune system disorders, and metabolic/endocrine system disorders. Genetic factors, socioeconomic status, and lifestyle factors will also be examined as covariates and potential confounders. To maximize representativeness, we adopted provider-mediated community-based recruitment.DiscussionThrough JECS, chemical substances to which children are exposed during the fetal stage or early childhood will be identified. The JECS results will be translated to better risk assessment and management to provide healthy environment for next generations.

Transactivation Function of an ∼800-bp Evolutionarily Conserved Sequence at the SHOX 3′ Region: Implication for the Downstream Enhancer

To the Editor: In the October 2005 issue of the Journal, Benito-Sanz et al. (2005) reported an association of Leri-Weill dyschondrosteosis (LWD [MIM 127300]) with a novel class of heterozygous pseudoautosomal region 1 (PAR1) deletions downstream of SHOX (short-stature homeobox-containing gene [MIM 312865]) in 12 patients with two copies of intact SHOX coding sequences. The deletions were variable in size, with the smallest region of overlapping deletion (SRO) of ∼30 kb between DXYS10086 and rs7067102. The results—in conjunction with the report of Flanagan et al. (2002) describing a monoallelic SHOX expression in the bone marrow fibroblasts taken from the distal radius of a patient with LWD with two copies of normal SHOX coding exons and hemizygosity for a region around DXYS233 downstream of SHOX—suggest the presence of a downstream enhancer for SHOX transcription around the ∼30-kb SRO. Consistent with this, Fukami et al. (2005) found that (1) a 240–350-kb deletion including DXYS233 is present in a heterozygous status in a mother with LWD and two copies of intact SHOX coding exons and (2) the same deletion is present in a hemizygous status in her daughter with Langer mesomelic dysplasia and a mosaic-ring X chromosome missing the PAR1. Here, we report that the putative SHOX enhancer may reside on an ∼800-bp evolutionarily conserved sequence (ECS). First, we analyzed the SHOX 3′ region in five Japanese families in which the proband and one of the parents had variable degrees of LWD and stature from short to low normal in the presence of two copies of intact SHOX-coding exons. The study was approved by the Institutional Review Board Committee at the National Center for Child Health and Development. Genotyping analysis was performed with primers and methods shown in table 1; results indicate that a deletion between SHOX-SNP792 on the 3′ UTR and DXYS85 was shared by the LWD-affected mother and daughter in family A and that a deletion between rs5946324 and rs4504827 was common to the LWD-affected father and daughter in family B (table 2 and fig. 1A). Furthermore, FISH analysis was performed with an RP13-167H21 BAC probe defining a region from rs5946324 to DXYS233 (Ensembl Genome Browser); results show only a single signal in the mother and the daughter of family A and an obviously different signal intensity in the father and the daughter of family B (fig. 2). The results, together with our previous data (Fukami et al. 2005), imply that an ∼40-kb region between rs5946326 and rs4504827 is the SRO in the Japanese patients (SRO-J) (fig. 1A). The SRO-J is in a close agreement with the ∼30-kb SRO in the white patients (SRO-W) (Benito-Sanz et al. 2005), and a region between rs5946326 and rs7067102 is shared by all the patients with SHOX 3′ deletions (fig. 1A). Figure 1 A, PAR1 deletions in the SHOX downstream region. Top, Pedigrees of families A and B. LWD is exhibited by the mother and the daughter in family A and by the father and the daughter in family B. The height of each subject is expressed as an SD score. Bottom, ... Figure 2 Results of the FISH analysis. Red signals indicate the RP13-167H21 region (thick arrows), and green signals represent DXZ1 (arrowheads) or DYZ3 (thin arrow). The RP13-167H21 region is deleted from one of the two X chromosomes of the mother and the daughter ... Table 1 Primer Sequences and PCR Conditions Used for Genotyping[Note] Table 2 Summary of Polymorphism Analyses[Note] Next, we searched the UCSC Genome Browser for the ECSs within the SROs. Seven ECSs (ECS1–ECS7) were present within the SRO-J, whereas ECS6 and ECS7 were found to reside outside the SRO-W (fig. 1B). ECS3–ECS7 were well conserved in chicken and dog, which preserve Shox, and were absent in mouse and rat, which lack Shox (Clement-Jones et al. 2000; Ensembl Genome Browser). ECS4 was also conserved in Fugu and zebrafish, which preserve Shox. By contrast, ECS1 was absent in chicken, and ECS2 was conserved in mouse and rat. Whereas ECS3 and ECS4 were not described in chimpanzee, the sequence analysis remains poor for the Shox 3′ region in chimpanzee, in contrast to the detailed analysis of that region in chicken and dog. These findings suggest that ECS3–ECS5 can be regarded as candidate regions harboring the putative downstream enhancer. In this regard, since ECS3–ECS5 reside between rs5988437 and rs5946533 (UCSC Genome Browser), they should be deleted from the patients in the three families defining the SRO-J (fig. 1A). Thus, we examined the transcription activity of ECS3–ECS5 as well as ECS6 with the dual-luciferase reporter assay system (Promega). Luciferase reporter constructs containing each ECS (ECS3, 861 bp; ECS4, 824 bp; ECS5, 441 bp; ECS6, 634 bp) inserted into the 3′ region of the luciferase gene were created using the pGL3 vector with the SV40 promoter or the human SHOX promoter on exon 2 (−432 to +5 bp) (Blaschke et al. 2003) (fig. 1B). The U2OS osteosarcoma cell line expressing SHOX (Rao et al. 2001) was transfected using lipofectamine (Invitrogen) with each reporter vector together with the pRL-CMV vector used as an internal control for the transfection, and luciferase assays were performed 36 h later. After the experiments were performed five times, the normalized luciferase activity was found to be significantly increased only when the reporter vector with ECS4 and the SHOX promoter was transfected to U2OS cells (empty vs. ECS4; P=.011 by t test) (fig. 1B). This implies that the putative SHOX enhancer resides in ECS4 and interacts with the SHOX promoter on exon 2. Finally, we searched ECS4 for potential binding sites for transcription factors relevant to bone development, using the MATINSPECTOR, TESS, and TFSEARCH programs. The putative binding sites with the maximum core similarity of 1.0 and a matrix similarity >0.75 were identified for HOXA9, HOXB9, PBX1, and MEIS1, as well as for PBX1-HOXA9 and MEIS1-HOXA9 heterodimers, which are known to be involved in limb development (Mercader et al. 1999; Shanmugam et al. 1999; Zakany and Duboule 1999) (fig. 3). Thus, the sequence-specific DNA binding of such a factor(s) might mediate the enhancer activity for SHOX. However, other potential binding sites were also detected for various transcription factors, and the relevance to skeletal development has not been studied or excluded in most of the transcription factors. In addition, the binding sites remain unidentified for many transcription factors. Thus, further studies are necessary to define the enhancer sequence. Figure 3 Nucleotide sequence of ECS4 and putative binding sites for several transcription factors relevant to skeletal development. The human sequence is aligned with the chicken sequence. In summary, the results suggest that the ∼800-bp ECS4 harbors the putative downstream enhancer for SHOX transcription. This information will provide a useful clue for the clarification of the molecular network involved in SHOX-dependent skeletal development.

A nationwide attempt to standardize growth hormone assays.

The Growth Hormone (GH) and Its Related Factors Study Committee of the Foundation for Growth Science, Japan, has been conducting a quality control study for 15 years to improve the equality of diagnosis of GH deficiency. It found that the greatest differences in measured GH values were due to the different potencies of the kit standards, which were primarily adjusted to WHO standards for human GH of pituitary origin. With the collaboration of kit makers and the Study Group of Hypothalamo-Pituitary Disorders of the Ministry of Health, Labor and Welfare, all GH kits in Japan have begun using the same recombinant human GH standard since April 2005. As a result the diagnostic cut-off peak GH has changed from 10 to 6 ng/ml.

Mutation and Gene Copy Number Analyses of Six Pituitary Transcription Factor Genes in 71 Patients with Combined Pituitary Hormone Deficiency: Identification of a Single Patient with LHX4 Deletion

CONTEXT Mutations of multiple transcription factor genes involved in pituitary development have been identified in a minor portion of patients with combined pituitary hormone deficiency (CPHD). However, copy number aberrations involving such genes have been poorly investigated in patients with CPHD. OBJECTIVE We aimed to report the results of mutation and gene copy number analyses in patients with CPHD. SUBJECTS AND METHODS Seventy-one Japanese patients with CPHD were examined for mutations and gene copy number aberrations affecting POU1F1, PROP1, HESX1, LHX3, LHX4, and SOX3 by PCR-direct sequencing and multiplex ligation-dependent probe amplification. When a deletion was indicated, it was further studied by fluorescence in situ hybridization, oligoarray comparative genomic hybridization, and serial sequencing for long PCR products encompassing the deletion junction. RESULTS We identified a de novo heterozygous 522,009-bp deletion involving LHX4 in a patient with CPHD (GH, TSH, PRL, LH, and FSH deficiencies), anterior pituitary hypoplasia, ectopic posterior pituitary, and underdeveloped sella turcica. We also identified five novel heterozygous missense substitutions (p.V201I and p.H387P in LHX4, p.T63M and p.A322T in LHX3, and p.V53L in SOX3) that were assessed as rare variants by sequencing analyses for control subjects and available parents and by functional studies and in silico analyses. CONCLUSIONS The results imply the rarity of abnormalities affecting the six genes in patients with CPHD and the significance of the gene copy number analysis in such patients.

Identification and Functional Characterization of Two Novel NPR2 Mutations in Japanese Patients With Short Stature

CONTEXT C-type natriuretic peptide-natriuretic peptide receptor B (NPR-B) signaling is critical for endochondral ossification, which is responsible for longitudinal growth in limbs and vertebrae. Biallelic NPR2 mutations cause acromesomelic dysplasia, type Maroteaux, which is bone dysplasia characterized by severe short stature and short limbs. A monoallelic NPR2 mutation has been suggested to mildly impair long bone growth. OBJECTIVE The goal of this study was to identify and characterize NPR2 mutations among Japanese patients with short stature. SUBJECTS AND METHODS We enrolled 101 unrelated Japanese patients with short stature. NPR2 and NPPC were sequenced, and the identified variants were characterized in vitro. RESULTS In two subjects, we identified two novel heterozygous NPR2 mutations (R110C and Q417E) causing a loss of C-type natriuretic peptide-dependent cGMP generation capacities and having dominant-negative effects. R110C was defective in trafficking from the endoplasmic reticulum to the Golgi apparatus. In contrast, Q417E showed clear cell surface expression. CONCLUSIONS We identified heterozygous NPR2 mutations in 2% of Japanese patients with short stature. Our in vitro findings indicate that NPR2 mutations have a dominant negative effect, and their dominant-negative mechanisms vary corresponding to the molecular pathogenesis of the mutations.

Short stature in a girl with partial monosomy of the pseudoautosomal region distal to DXYS15: further evidence for the assignment of the critical region for a pseudoautosomal growth gene(s)

This report describes a 12 year 10 month old girl with short stature and a non-mosaic 46,X,Xp+ karyotype. Her height remained below −2 SD of the mean, and her predicted adult height (143 cm) was below her target height (155·5 cm) and target range (147·5 cm−163·5 cm). Cytogenetic and molecular studies showed that the Xp+ chromosome was formed by an inverted duplication of the Xp21.3−Xp22.33 segment and was missing about 700 kb of DNA from the pseudoautosomal region distal to DXYS15. The results provide further support for the previously proposed hypothesis that the region between DXYS20 and DXYS15 is the critical region for a pseudoautosomal growth gene(s).

Two hyperandrogenic adolescent girls with congenital portosystemic shunt.

Abstract We describe two adolescent girls with a congenital portosystemic shunt who exhibited hyperandrogenism in addition to insulin resistant hyperinsulinaemia. Case 1 was referred to our clinic to undergo a routine clinical work-up prior to tonsillectomy at 14 years of age. Mild liver dysfunction was identified and hypogenesis of the portal vein with a congenital portosystemic shunt diagnosed. Primary amenorrhoea and virilization were evident and an endocrinological evaluation revealed hyperandrogenism and insulin resistant hyperinsulinaemia. Case 2 was referred at 15 years of age because of cardiomegaly. Mild liver dysfunction and hyperbilirubinaemia led to a diagnosis of agenesis of the portal vein with a congenital portosystemic shunt. Virilization was evident and an endocrinological evaluation revealed hyperandrogenism and insulin resistant hyperinsulinaemia. The haemodynamics of these patients were similar to those of secondary portosystemic shunt due to liver cirrhosis, which is often associated with hyperinsulinaemia and/or non-insulin dependent diabetes mellitus. On the other hand, hyperandrogenism is associated with certain insulin-resistant conditions with hyperinsulinaemia, including the polycystic ovary syndrome (PCO). Hyperinsulinaemia is believed to cause hyperandrogenism in patients with PCO by stimulating androgen production in both the ovary and adrenal gland. Therefore, in congenital portosystemic shunts, hyperinsulinaemia is also thought to cause hyperandrogenism due to the same mechanism. Conclusion A certain percentage of female patients with hyperandrogenism, likely including those with polycystic ovary syndrome may also have congenital portosystemic shunts. Our results indicate that serum levels of total bile acids and ammonia are prognostic indicators of this hepatic vascular anomaly.

Aromatase Excess Syndrome: Identification of Cryptic Duplications and Deletions Leading to Gain of Function of CYP19A1 and Assessment of Phenotypic Determinants

CONTEXT Aromatase excess syndrome (AEXS) is a rare autosomal dominant disorder characterized by gynecomastia. Although cryptic inversions leading to abnormal fusions between CYP19A1 encoding aromatase and its neighboring genes have been identified in a few patients, the molecular basis remains largely unknown. OBJECTIVE The objective of the study was to examine the genetic causes and phenotypic determinants in AEXS. PATIENTS Eighteen affected males from six families participated in the study. RESULTS We identified three types of heterozygous genomic rearrangements, i.e. a 79,156-bp tandem duplication involving seven of 11 noncoding CYP19A1 exons 1, a 211,631-bp deletion involving exons 2-43 of DMXL2 and exons 5-10 of GLDN, and a 165,901-bp deletion involving exons 2-43 of DMXL2. The duplicated exon 1 functioned as transcription start sites, and the two types of deletions produced the same chimeric mRNA consisting of DMXL2 exon 1 and CYP19A1 coding exons. The DMXL2 exon 1 harbored a translation start codon, and the DMXL2/CYP19A1 chimeric mRNA was identified in only 2-5% of CYP19A1-positive transcripts. This was in contrast to the inversion-mediated chimeric mRNA that had no coding sequence on the fused exon 1 and accounted for greater than 80% of CYP19A1-positive transcripts. CYP19A1 was expressed in a limited number of tissues, whereas its neighboring genes involved in the chimeric mRNA formation were expressed widely. CONCLUSIONS This study provides novel mechanisms leading to gain of function of CYP19A1. Furthermore, it appears that clinical severity of AEXS is primarily determined by the tissue expression pattern of relevant genes and by the structural property of promoter-associated exons of chimeric mRNA.

Rare pseudoautosomal copy-number variations involving SHOX and/or its flanking regions in individuals with and without short stature

Pseudoautosomal region 1 (PAR1) contains SHOX, in addition to seven highly conserved non-coding DNA elements (CNEs) with cis-regulatory activity. Microdeletions involving SHOX exons 1–6a and/or the CNEs result in idiopathic short stature (ISS) and Leri–Weill dyschondrosteosis (LWD). Here, we report six rare copy-number variations (CNVs) in PAR1 identified through copy-number analyzes of 245 ISS/LWD patients and 15 unaffected individuals. The six CNVs consisted of three microduplications encompassing SHOX and some of the CNEs, two microduplications in the SHOX 3′-region affecting one or four of the downstream CNEs, and a microdeletion involving SHOX exon 6b and its neighboring CNE. The amplified DNA fragments of two SHOX-containing duplications were detected at chromosomal regions adjacent to the original positions. The breakpoints of a SHOX-containing duplication resided within Alu repeats. A microduplication encompassing four downstream CNEs was identified in an unaffected father–daughter pair, whereas the other five CNVs were detected in ISS patients. These results suggest that microduplications involving SHOX cause ISS by disrupting the cis-regulatory machinery of this gene and that at least some of microduplications in PAR1 arise from Alu-mediated non-allelic homologous recombination. The pathogenicity of other rare PAR1-linked CNVs, such as CNE-containing microduplications and exon 6b-flanking microdeletions, merits further investigation.

High-dose growth hormone (GH) treatment in prepubertal GH-deficient children.

Yokoya S, Araki K, Igarashi Y, Kohno H, Nishi Y, Hasegawa Y, Fujita K, Iwatani N, Tachibana K, Ohyama Y, Seino Y, Satoh M, Fujieda K, Tanaka T. High‐dose growth hormone (GH) treatment in prepubertal GH‐deficient children. Acta Pædiatr 1999; Suppl 428: 76–9. Stockholm. ISSN 0803–5326