Mayer-Rokitansky-Küster-Hauser syndrome discordance in monozygotic twins: matrix metalloproteinase 14, low-density lipoprotein receptor-related protein 10, extracellular matrix, and neoangiogenesis genes identified as candidate genes in a tissue-specific mosaicism

Fertil Steril. 2015 Feb;103(2):494-502.e3. doi: 10.1016/j.fertnstert.2014.10.053. Epub 2014 Dec 6.

Abstract

Objective: To find a potential underlying cause for Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) discordance in monozygotic twins.

Design: Prospective comparative study.

Setting: University hospital.

Patient(s): Our study genetically analyzed 5 MRKHS-discordant monozygotic twin pairs with the unique opportunity to include saliva and rudimentary uterine tissue.

Intervention(s): Blood, saliva, or rudimentary uterine tissue from five MRKHS-discordant twins was analyzed and compared between twin pairs as well as within the same individual where applicable. We used copy number variations (CNVs) to identify differences.

Main outcome measure(s): CNVs in blood, rudimentary uterine tissue, and saliva, network analysis, and review of the literature.

Result(s): One duplication found in the affected twin included two genes, matrix metalloproteinase 14 (MMP14) and low-density lipoprotein receptor-related protein 10 (LRP10), which have known functions in the embryonic development of the uterus and endometrium. The duplicated region was detected in rudimentary uterine tissue from the same individual but not in saliva, making a tissue-specific mosaicism a possible explanation for twin discordance. Additional network analysis revealed important connections to differentially expressed genes from previous studies. These genes encode several molecules involved in extracellular matrix (ECM) remodeling and neoangiogenesis.

Conclusion(s): MMP-14, LRP-10, ECM, and neoangiogenesis genes are identified as candidate genes in a tissue-specific mosaicism. The detected clusters provide evidence of deficient vascularization during uterine development and/or disturbed reorganization of ECM components, potentially during müllerian duct elongation signaled by the embryologically relevant phosphatidylinositol 3-kinase/protein kinase B pathway. Therefore, we consider these genes to be new candidates in the manifestation of MRKHS.

Keywords: CNV; MRKH syndrome; Uterovaginal aplasia; monozygotic discordant twins; mosaicism.

Publication types

  • Comparative Study
  • Twin Study

MeSH terms

  • 46, XX Disorders of Sex Development / diagnosis
  • 46, XX Disorders of Sex Development / genetics*
  • Congenital Abnormalities / diagnosis
  • Congenital Abnormalities / genetics*
  • Extracellular Matrix / genetics*
  • Female
  • Gene Regulatory Networks / genetics
  • Genetic Association Studies / methods*
  • Humans
  • LDL-Receptor Related Proteins / genetics*
  • Matrix Metalloproteinase 14 / genetics*
  • Mosaicism*
  • Mullerian Ducts / abnormalities*
  • Neovascularization, Pathologic / diagnosis
  • Neovascularization, Pathologic / genetics
  • Prospective Studies
  • Twins, Monozygotic / genetics*

Substances

  • LDL-Receptor Related Proteins
  • LRP10 protein, human
  • MMP14 protein, human
  • Matrix Metalloproteinase 14

Supplementary concepts

  • Mullerian aplasia