Abstract

BackgroundSteroid 21-hydroxylase deficiency is the most common cause of congenital adrenal hyperplasia (CAH). Detection of underlying mutations in CYP21A2 gene encoding steroid 21-hydroxylase enzyme is helpful both for confirmation of diagnosis and management of CAH patients. Here we report a novel 9-bp insertion in CYP21A2 gene and its structural and functional consequences on P450c21 protein by molecular modeling and molecular dynamics simulations methods.MethodsA 30-day-old child was referred to our laboratory for molecular diagnosis of CAH. Sequencing of the entire CYP21A2 gene revealed a novel insertion (duplication) of 9-bp in exon 2 of one allele and a well-known mutation I172N in exon 4 of other allele. Molecular modeling and simulation studies were carried out to understand the plausible structural and functional implications caused by the novel mutation.ResultsInsertion of the nine bases in exon 2 resulted in addition of three valine residues at codon 71 of the P450c21 protein. Molecular dynamics simulations revealed that the mutant exhibits a faster unfolding kinetics and an overall destabilization of the structure due to the triple valine insertion was also observed.ConclusionThe novel 9-bp insertion in exon 2 of CYP21A2 genesignificantly lowers the structural stability of P450c21 thereby leading to the probable loss of its function.

Highlights

  • Steroid 21-hydroxylase deficiency is the most common cause of congenital adrenal hyperplasia (CAH)

  • Using SeqScape v2.1.1, forward and reverse sequences were aligned against the reference sequence that confirmed the insertion as highlighted sequences

  • The shift in the insertion site was clearly observed in the forward and reverse strand that further confirmed this insertion as duplication of TGTGGTGGT base pairs in exon 2, at nucleotide position 306 of CYP21A2 gene

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Summary

Introduction

Steroid 21-hydroxylase deficiency is the most common cause of congenital adrenal hyperplasia (CAH). Detection of underlying mutations in CYP21A2 gene encoding steroid 21hydroxylase enzyme is helpful both for confirmation of diagnosis and management of CAH patients. Congenital adrenal hyperplasia (CAH; OMIM# 201910) is an autosomal recessive disorder caused by deficiency of one of the five steroidogenic enzymes involved in cortisol biosynthesis. In addition to decreased cortisol, aldosterone biosynthesis is impaired in these patients resulting in severe renal salt loss and hypotonic shock, unless treated during the neonatal period [2]. Patients with SV form do not have aldosterone deficiency and salt loss is not present. The milder non-classical form is asymptomatic at birth and presents with various degrees of late onset features of hyperandrogenism

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