Predicted structural destabilisation of GnRHR Arg139His pathogenic variant in a boy with Hypogonadotrophic Hypogonadism

URRUTIA M,; BRUNELLO FG; SANSÓ GE; CASTRO S; SCAGLIA P; AZCOITI ME; ROPELATO MG; GRINSPON RP; REY RA

CABA

Congreso; 11th International Meeting of Paediatric Endocrinology (IMPE); 2023

The genetic defects of hypogonadotrophic hypogonadism (HH) are known in approximately 50% of cases. In normosmic patients, abnormal GnRH production or action may be due to defects in regulatory factors or in the genes encoding GnRH or GnRHR. Although many gene variants have been described in GnRHR (4q13.2), the potential impact of structural alterations of the resulting mutant proteins have not been studied. Here, we analysed the 3D-structure of the variant GnRHR Arg139His found in a boy with pubertal delay due to hypogonadotrophic hypogonadism.A 15-year-old boy consulted for micro-orchidism and pubertal delay. Serum LH, FSH, T and AMH were low for age. At 16 years he was diagnosed with isolated HH following a GnRH test (LH and FSH peaks: 0,57 IU/L and 0,19 respectively). After ruling out organic or functional HH, a congenital aetiology was suspected. Genomic DNA study by next-generation sequencing (NGS), using the TruSight One capture kit (4811 genes) and filters related to variant frequency and quality of the reads, identified the homozygous variant GnRHR: c.416G>A, Arg139His (alt/ref alleles: 86/90, GnomAD genome frequency:1/3138 and exome frequency:1/6966). The variant was classified as pathogenic according to ACMG criteria. Both parents were heterozygous for the variant.The GnRHR is a special type of the seven transmembrane helices G-protein-coupled receptor (GPCR) superfamily, which uses primarily the Gq protein for downstream signalling and lacks a cytoplasmic C-terminal helix. The conserved Asp-Arg-Tyr motif in most GPCRs corresponds to the Asp-Arg-Ser motif in GnRHR, containing Arg139. The positively charged Arg139, located between the third transmembrane helix and the second intracellular loop, is conserved among species. The 3D crystallographic structure of the GnRHR-GnRH antagonist (elagolix) at 2.80 Å of resolution (PDB 7BR) was analysed using Pymol. The Arg139 of the wild-type GnRHR forms an intrahelical salt bridge with Asp138 and a polar interaction with Thr265. Instead, in the Arg139His variant, the histidine side chain is shorter as compared to the arginine one. Consequently, the His139-Thr265 pair is further apart, which is predicted to weaken the His139-Thr265 interhelix interaction. In addition, the absence of the positive charge of Arg139 predicted a loss of the intrahelical salt bridge with Asp138, resulting in further intrahelix destabilisation.In summary, through NGS and protein structure analysis, we identified a GnRHR Arg139His variant in a boy with HH and characterised the underlying 3D structural alteration destabilising the conformational structure of the receptor.