Haploinsufficiency of Dmxl2, encoding a synaptic protein, causes infertility associated with a loss of GnRH neurons in mouse

PLoS Biol. 2014 Sep 23;12(9):e1001952. doi: 10.1371/journal.pbio.1001952. eCollection 2014 Sep.

Abstract

Characterization of the genetic defects causing gonadotropic deficiency has made a major contribution to elucidation of the fundamental role of Kisspeptins and Neurokinin B in puberty onset and reproduction. The absence of puberty may also reveal neurodevelopmental disorders caused by molecular defects in various cellular pathways. Investigations of these neurodevelopmental disorders may provide information about the neuronal processes controlling puberty onset and reproductive capacity. We describe here a new syndrome observed in three brothers, which involves gonadotropic axis deficiency, central hypothyroidism, peripheral demyelinating sensorimotor polyneuropathy, mental retardation, and profound hypoglycemia, progressing to nonautoimmune insulin-dependent diabetes mellitus. High-throughput sequencing revealed a homozygous in-frame deletion of 15 nucleotides in DMXL2 in all three affected patients. This homozygous deletion was associated with lower DMXL2 mRNA levels in the blood lymphocytes of the patients. DMXL2 encodes the synaptic protein rabconnectin-3α, which has been identified as a putative scaffold protein for Rab3-GAP and Rab3-GEP, two regulators of the GTPase Rab3a. We found that rabconnectin-3α was expressed in exocytosis vesicles in gonadotropin-releasing hormone (GnRH) axonal extremities in the median eminence of the hypothalamus. It was also specifically expressed in cells expressing luteinizing hormone (LH) and follicle-stimulating hormone (FSH) within the pituitary. The conditional heterozygous deletion of Dmxl2 from mouse neurons delayed puberty and resulted in very low fertility. This reproductive phenotype was associated with a lower number of GnRH neurons in the hypothalamus of adult mice. Finally, Dmxl2 knockdown in an insulin-secreting cell line showed that rabconnectin-3α controlled the constitutive and glucose-induced secretion of insulin. In conclusion, this study shows that low levels of DMXL2 expression cause a complex neurological phenotype, with abnormal glucose metabolism and gonadotropic axis deficiency due to a loss of GnRH neurons. Our findings identify rabconectin-3α as a key controller of neuronal and endocrine homeostatic processes.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptor Proteins, Signal Transducing / deficiency
  • Adaptor Proteins, Signal Transducing / genetics*
  • Adolescent
  • Animals
  • Base Sequence
  • Diabetes Mellitus, Type 1 / genetics*
  • Diabetes Mellitus, Type 1 / metabolism
  • Diabetes Mellitus, Type 1 / pathology
  • Follicle Stimulating Hormone / genetics
  • Follicle Stimulating Hormone / metabolism
  • Gonadotropin-Releasing Hormone / genetics
  • Gonadotropin-Releasing Hormone / metabolism
  • Haploinsufficiency
  • Homozygote
  • Humans
  • Hypoglycemia / genetics*
  • Hypoglycemia / metabolism
  • Hypoglycemia / pathology
  • Hypothalamus / growth & development
  • Hypothalamus / metabolism
  • Hypothalamus / pathology
  • Hypothyroidism / genetics*
  • Hypothyroidism / metabolism
  • Hypothyroidism / pathology
  • Infertility, Male / genetics*
  • Infertility, Male / metabolism
  • Infertility, Male / pathology
  • Intellectual Disability / genetics*
  • Intellectual Disability / metabolism
  • Intellectual Disability / pathology
  • Luteinizing Hormone / genetics
  • Luteinizing Hormone / metabolism
  • Male
  • Mice
  • Mice, Knockout
  • Molecular Sequence Data
  • Nerve Tissue Proteins / deficiency
  • Nerve Tissue Proteins / genetics*
  • Neurons / metabolism
  • Neurons / pathology
  • Pituitary Gland / growth & development
  • Pituitary Gland / metabolism
  • Pituitary Gland / pathology
  • Polyneuropathies / genetics*
  • Polyneuropathies / metabolism
  • Polyneuropathies / pathology
  • Sequence Deletion*
  • Sexual Maturation
  • Syndrome
  • Testis / growth & development
  • Testis / metabolism
  • Testis / pathology
  • Young Adult

Substances

  • Adaptor Proteins, Signal Transducing
  • DMXL2 protein, human
  • Nerve Tissue Proteins
  • Gonadotropin-Releasing Hormone
  • Luteinizing Hormone
  • Follicle Stimulating Hormone

Grants and funding

Institut national de la santé et de la recherche médicale, La société Française d'Endocrinologie, La Fondation Maladies rares, Le département hospitalo-universitaire “promoting research toward early CNS therapies”, and The Domaine d'intérêt majeur “Cerveau et Pensée”. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.