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Mol Endocrinol. 2016 Jan;30(1):62-76. doi: 10.1210/me.2015-1205. Epub 2015 Nov 10.

Misfolding Ectodomain Mutations of the Lutropin Receptor Increase Efficacy of Hormone Stimulation.

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Division of Endocrinology, Metabolism and Diabetes (E.C., G.P.C., A.C.S.), First Department of Pediatrics, University of Athens Medical School, Aghia Sophia Children's Hospital, and Division of Endocrinology and Metabolism (E.C., G.P.C., A.C.S.), Clinical Research Center, Biomedical Research Foundation of the Academy of Athens, Athens 11527, Greece; Department of Pharmacology (Q.R.F.), Columbia University Medical Center, New York, New York 10032; Unidade de Endocrinologia do Desenvolvimento (L.G.S., A.C.L.), Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; and Department of Molecular Physiology and Biophysics (M.Z., R.G., D.L.S.), The University of Iowa Carver College of Medicine, Iowa City, Iowa 52242.


We demonstrate 2 novel mutations of the LHCGR, each homozygous, in a 46,XY patient with severe Leydig cell hypoplasia. One is a mutation in the signal peptide (p.Gln18_Leu19ins9; referred to here as SP) that results in an alteration of the coding sequence of the N terminus of the mature mutant receptor. The other mutation (p.G71R) is also within the ectodomain. Similar to many other inactivating mutations, the cell surface expression of recombinant human LHR(SP,G71R) is greatly reduced due to intracellular retention. However, we made the unusual discovery that the intrinsic efficacy for agonist-stimulated cAMP in the reduced numbers of receptors on the cell surface was greatly increased relative to the same low number of cell surface wild-type receptor. Remarkably, this appears to be a general attribute of misfolding mutations in the ectodomains, but not serpentine domains, of the gonadotropin receptors. These findings suggest that there must be a common, shared mechanism by which disparate mutations in the ectodomain that cause misfolding and therefore reduced cell surface expression concomitantly confer increased agonist efficacy to those receptor mutants on the cell surface. Our data further suggest that, due to their increased agonist efficacy, extremely small changes in cell surface expression of misfolded ectodomain mutants cause larger than expected alterations in the cellular response to agonist. Therefore, for inactivating LHCGR mutations causing ectodomain misfolding, the numbers of cell surface mutant receptors on fetal Leydig cells of 46,XY individuals exert a more exquisite effect on the relative severity of the clinical phenotypes than already appreciated.

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