Depuis le début des années 1990, de nombreuses équipes de recherche ont consacré leurs travaux à étudier les effets des perturbateurs endocriniens (PEs) sur l'homme et les espèces animales. Plusieurs polluants libérés dans l’environnement tels que les pesticides, les herbicides, les plastifiants industriels ou les résidus de médicaments ont ainsi le potentiel de perturber les équilibres hormonaux des organismes, induisant ainsi de graves conséquences sur leur développement et leur reproduction. Pour lutter contre ces dommages, diverses réglementations spécifiques et des systèmes de criblages se mettent en place pour détecter ces molécules. Ces systèmes doivent être rapides et fiables et les poissons téléostéens comme le medaka ou le poisson zèbre constituent d'excellents modèles pour détecter la présence de ces molécules et étudier leurs effets in vivo. Durant cette thèse nous avons étudié l’impact de certains PEs sur le développement embryonnaire en utilisant le poisson zèbre et le médaka comme modèle. Nous avons pu caractériser l'action du Bisphenol A sur la formation des otholites de l’oreille interne du poisson zèbre. En alliant des approches pharmacologiques et génétiques, nous avons identifié le récepteur nucléaire orphelin ERR comme une nouvelle cible in vivo de cette molécule. En parallèle, nous avons développé des lignées transgéniques rapportrices de médaka permettant de détecter la présence de polluants à activités androgénique ou anti-androgénique ce qui accroît ainsi la gamme des outils disponibles pour évaluer la présence des PEs dans les effluents liquides. / Since the early 1990s, many research teams have devoted their work to study the effects of endocrine disruptors (EDCs) in humans and animal species. Many pollutants released into the environment such as pesticides, herbicides, industrial plasticizers or drug residues have the potential to disrupt bodies’ hormonal balances, thus inducing a severe impact on their development and reproduction. To fight against these damages, various specific regulations and screening systems are setting up to detect these molecules. These systems must be fast, reliable. Teleost fish such as medaka and zebrafish are excellent models to detect the presence of these molecules and study their effects in vivo. In this thesis, we studied the impact of certain EDCs on the embryonic development using zebrafish and medaka as models. We characterized the action of Bisphenol A on the otoliths formation in the inner ear of zebrafish. By combining genetic and pharmacological approaches, we identified the orphan nuclear receptor ERRγas a new target of this molecule in vivo. In parallel, we have developed reporter transgenic lines of medaka to detect the presence of pollutants containing androgenic or anti-androgenic activities and thereby increasing the range of tools available to assess the presence of EDCs in liquid effluents.

<p> The age at which a juvenile female reaches sexual maturity can be modulated by a variety of environmental and social factors. Experiments described in this thesis were designed to enhance the current understanding of the relationships among three variables that influence the onset of sexual maturation in female mice (Mus musculus), including: [1] exposure to dietary phytoestrogens during development, [2] variations in prenatal androgens, and [3] the presence or absence of genetically-unrelated males after weaning. For the first time, age at onset of male-induced female puberty was investigated using non-invasive behavioural and fertility measures. Through enzyme immunoassay procedures, daily output of urinary creatinine, 17P-estradiol, and progesterone was profiled in developing females that were either isolated or exposed to adult males. Uterine and ovarian tissue was also measured in such females, and male exposure was observed to increase reproductive tissue mass and was influenced by prior androgen exposure in interaction with diet and male presence. Male-exposed females fed a diet containing phytoestrogens immediately became sexually receptive when housed directly with males, and they conceived earlier than females in other conditions. Females with longer anogenital distance, which reflects higher in utero androgen exposure, displayed more escape attempts and aggressive posturing in the direct presence of males, especially when they had been housed near males and fed the phytoestrogen-containing diet. Urinary 17P-estradiol was substantially reduced in females raised on the phytoestrogenfree diet. Urinary output of progesterone was not strongly influenced by diet. Maleexposed females ' output of progesterone and 17P-estradiol was more dynamic in comparison to that of isolated females. The size of this effect depended on diet, prior androgen exposure, and whether urinary steroid measures were adjusted by urinary creatinine. Urinary creatinine was elevated by the low phytoestrogen diet and reduced by male exposure. These data suggest that dietary phytoestrogens and in utero androgen exposure interact with presence or absence of males in determining the age at onset of sexual maturity in developing females. </p> <p> A final experiment was designed to examine two components of adult male urine, preputial gland emissions and unconjugated estrogens, that have been posited to act on females to advance reproductive maturation. Intact and preputialectomized males were compared in their output of urinary creatinine, 17~-estradiol, and testosterone, and in their influence on reproductive tissue in juvenile females. Lack of preputial glands did not hinder the capacity of males to induce uterine and ovarian growth in females. Male urinary creatinine was reduced by exposure to juvenile females. Creatinine-adjusted 17~estradiol and testosterone were greater in female-exposed males, regardless of whether the preputial glands were present. Based on these findings and those reported elsewhere, it is probable that male excreted urinary steroids are important in regulating reproductive changes in developing females exposed to males. </p> / Thesis / Doctor of Philosophy (PhD)

No description available.

No description available.

No / Dystroglycan is frequently lost in adenocarcinoma, but the mechanisms and consequences are poorly understood. We report an analysis of beta-dystroglycan in prostate cancer in human tissue samples and in LNCaP cells in vitro. There is progressive loss of beta-dystroglycan immunoreactivity from basal and lateral surfaces of prostate epithelia which correlates significantly with increasing Gleason grade. In about half of matched bone metastases there is significant dystroglycan re-expression. In tumour tissue and in LNCaP cells there is also a tyrosine phosphorylation-dependent translocation of beta-dystroglycan to the nucleus. Analysis of gene expression data by microarray, reveals that nuclear targeting of beta-dystroglycan in LNCaP cells alters the transcription of relatively few genes, the most unregulated being the transcription factor ETV1. These data suggest that proteolysis, tyrosine phosphorylation and translocation of dystroglycan to the nucleus resulting in altered gene transcription could be important mechanisms in the progression of prostate cancer.

A deficiência da 21-hidroxilase é uma freqüente doença autossômica recessiva caracterizada por manifestações hiperandrogênicas, que se iniciam na infância, puberdade ou vida adulta. Observa-se existência de forte correlação do comprometimento da atividade enzimática conferido pelo genótipo com a forma clínica e com as concentrações basais e pós-estímulo da 17OH-progesterona. Entretanto, não se observa a mesma correlação com a intensidade, idade de início das manifestações e com as concentrações séricas de testosterona. Sugere-se que variações individuais na sensibilidade periférica aos andrógenos ou no metabolismo da testosterona poderiam estar implicadas na variabilidade fenotípica desta doença. Porém, os possíveis mecanismos nunca foram estudados na literatura. Os andrógenos têm sua ação mediada pelo receptor de andrógenos (AR), cujo gene apresenta um trato polimórfico de repetições CAG, o qual modula sua atividade de transativação. Em tecidos periféricos a ação androgênica pode ser ainda potencializada pela enzima 5 alfa-redutase, que transforma testosterona em dihidrotestosterona. O seu gene codificador (SRD5A2) possui vários polimorfismos que alteraram esta atividade de biotransformação nos tecidos periféricos. No clearance da testosterona, os citocromos hepáticos P4503a4, P4503a5 p4503a7 e P4502c19 são os principais envolvidos. Além disso, outro citocromo, o P450c17 representa uma enzima chave na via de produção de andrógenos. Para os citocromos P450 tipo 2, tanto da via de clearance como de síntese dos andrógenos, é necessário ainda a interação com o P450 óxido-redutase para realizar suas reações de hidroxilação. São descritos polimorfismos em todos os genes acima referidos, que alteram sua expressão ou a eficiência catalítica e, consequentemente, tem sido envolvidos na etiologia de doenças andrógeno-dependentes. Consideramos que alterações nos genes codificadores das proteínas relacionadas ao metabolismo e/ou ação periférica dos andrógenos possam atuar na modulação do fenótipo da forma não clássica. Objetivos: Correlacionar o nCAG do gene AR e os polimorfismos nos genes CYP3A5, CYP3A7, CYP3A4, CYP2C19 e CYP17A1, POR e SRD5A2 com a idade de aparecimento dos sintomas, score de Ferriman do hirsutismo ao diagnóstico, presença de virilização, com as concentrações séricas basais de testosterona, bem como com a ausência ou presença de sintomas. Casuística: Selecionamos 122 pacientes com diagnóstico de forma não clássica confirmado por 17OH-progesterona basal ou pós-estímulo com ACTH 10 ng/mL. Todos os pacientes tiveram o diagnóstico molecular, ou seja, mutações identificadas nos dois alelos do gene CYP21A2. As pacientes foram divididas de acordo com o comprometimento da atividade da 21-OH predito pelo genótipo em grupos A/C (grave) e C/C (moderado). As pacientes também foram divididas em grupos pediátrico e adulto, início das manifestações antes e após os 12 anos, respectivamente. Metodologia: O DNA foi extraído de leucócitos periféricos. As regiões de repetições CAG foram amplificadas por PCR e os produtos submetidos à eletroforese capilar e análise pelo software GeneScan. Amostras de DNA das pacientes heterozigotas para o número de repetições CAG foram digeridas com a enzima Hpa II e os produtos submetidos à amplificação da região CAG para se determinar o padrão de inativação do cromossomo X. Os genes CYP3A5, CYP3A4, CYP3A7, CYP17A1, CYP2C19, POR e SRD5A2 foram amplificados por PCR e submetidos à reação de seqüenciamento ou à reação de digestão enzimática para rastreamento das variantes alélicas. Os resultados foram comparados com as respectivas seqüências selvagens depositadas no GeneBank. Na análise estatística foram empregados os testes t de Student, ANOVA, Wilcoxon rank-sun, Kruskall Wallis rank e regressão linear. Resultados: Observamos uma frequência significativamente menor de alelos longos (> 26 repetições) do trato CAG do AR no grupo pediátrico em relação ao de adultos com genótipo 21-OH do grupo C/C (p=0,01). Adicionalmente, a média ponderada do trato CAG foi significativamente menor nas pacientes com clitoromegalia (19,1 ± 2,7) em comparação com a de pacientes sem virilização (21,6 ± 2,5), correlação que independeu do genótipo da 21-OH. A mediana das concentrações séricas de testosterona foi significativamente maior nas carreadoras da variante CYP17A1*A2 (145,7 ng/dL, 126-153) em relação às carreadoras da variante selvagem (57 ng/dL, 36-87) com genótipo 21-OH do grupo A/C. As demais variantes não se correlacionaram com os fenótipos clínico e hormonal. Conclusão: Observamos que o trato CAG apresentou efeito na modulação do fenótipo de virilização de mulheres com forma não clássica. Além disso, o trato CAG pode ter contribuído no período de início das manifestações, uma vez que o grupo pediátrico com genótipo C/C teve freqüência menor de alelos longos em relação às adultas. Dentre as variantes alélicas pesquisadas, que alteram a síntese e/ou metabolismo dos andrógenos, identificamos associação do alelo CYP17A1*A2 com concentrações maiores de testosterona. Embora tenhamos avaliado uma casuística expressiva para esta patologia, para as demais correlações com resultados negativos, não podemos afastar um efeito do tamanho da amostra. / Introduction: The 21-hydroxylase deficiency is a common autosomal recessive disease characterized by clinical hyperandrogenism, which could begin at childhood, puberty or adulthood. There is a strong correlation among impairment of enzymatic activity conferred by genotypes, clinical forms, basal and post-stimulation 17OH-progesterone (17-OHP) levels. However, we did not observe the same correlation with the intensity, age at onset of manifestations and basal testosterone levels. It is suggested that individual variations in the androgen peripheral sensitivity and/or metabolism could be implicated in the phenotypic variability of this disease. However, potential mechanisms have never been studied before. The androgen action is mediated by the androgen receptor (AR), whose gene has a polymorphic CAG repeat that modulates its transactivation activity. In the peripheral tissues, the androgen action is modified by the 5 alpha-reductase type 2 activity, which converts testosterone into a potent androgen, dihydrotestosterone. Its coding gene (SRD5A2) carries several polymorphisms altering its catalytic activity in the peripheral tissues. Regarding the testosterone clearance, hepatic cytochromes P4503a4, P4503a5 p4503a7 P4502c19 are the most important. In addition, another cytochrome, P450c17, is a key enzyme in the androgen production pathway. For the cytochrome P450 type 2 activities, involved in the androgen clearance and/or synthesis, an interaction with the P450 oxidoreductase is still necessary. Polymorphisms are described in all the aforementioned genes, which change their expression and/or catalytic efficiencies; consequently, they have been implicated in the etiology of androgen-dependent diseases. We supposed that changes in the coding genes for the aforesaid proteins could act in modulating the nonclassical phenotype. Objectives: To compare the nCAG of AR gene and polymorphisms of CYP3A5, CYP3A7, CYP3A4, CYP2C19, and CYP17A1, SRD5A2 and POR genes with the age of onset of symptoms, Ferriman score of hirsutism at diagnosis, presence of virilization, basal testosterone levels, as well as with the absence or the presence of symptoms. Patients: We selected 122 patients with basal or post-ACTH 17-OHP 10 ng/mL. All patients had confirmed nonclassical molecular diagnoses. Patients were divided according to the impairment of 21-OH activity predicted by genotype groups into A/C (severe) and C/C (moderate). Patients were also classified according to the onset of manifestations into pediatric and adult groups, younger than or older than 12 years, respectively. Methods: DNA was extracted from peripheral leukocytes. CAG repeat regions were PCR amplified, products submitted to capillary electrophoresis and analyzed by GeneScan software. DNA samples from CAG heterozygous patients were digested with the Hpa II enzyme and also submitted to PCR, in order to determine X-chromosome inactivation pattern. The CYP3A5, CYP3A4, CYP3A7, CYP17A1, CYP2C19, POR and SRD5A2 genes were PCR amplified and submitted to sequencing or enzymatic assays to screen the allelic variants. The results were compared with their wild sequences in the GenBank. Statistical comparisons employed Student\'s t tests, ANOVA, Wilcoxon rank-sun, Kruskal Wallis rank and linear regression. Results: We observed a significantly lower frequency of longer CAG alleles (> 26 repeats) of AR in the pediatric group compared to the adults carrying the 21-OH genotype from group C/C (p = 0.01). Additionally, the weighted biallelic mean of the CAG tract was considerably lower in patients with clitoromegaly (19.1 ± 2.7) in comparison to patients without it (21.6 ± 2.5), a correlation that was independent of the 21-OH genotype severity. The median of testosterone levels was significantly higher in the CYP17A1*A2 carriers (145.7 ng/dL, 126-153) compared to the ones carrying the wild allele (57 ng/dL, 36-87), from the group A/C of 21-OH genotype. The other variants did not show a correlation with clinical and hormonal phenotypes. Conclusions: We observed that the CAG tract was effective in modulating the phenotype of virilization in nonclassical women as well as influenced the period of onset of manifestations of patients carrying moderate CYP21A2 genotype. Considering the remaining allelic variants, which alter the androgen synthesis or metabolism, we identified the association of CYP17A1*A2 alleles with higher testosterone levels. Although we evaluated a significant number of patients with 21-OHD, we cannot rule out a sample size effect.

Hormonell wirksame Chemikalien, wie Pflanzenschutzmittel oder Pharmaka gelangen durch Abwässer in die Umwelt und akkumulieren vor allem in Oberflächengewässern. Ein erhöhtes Augenmerk liegt auf Substanzen, die durch (anti)androgene und (anti)östrogene Wirkungsweise die Reproduktion von Tieren und Menschen beeinträchtigen. Bei den bisherigen Nachweismethoden für diese Stoffe handelt es sich um invasive Methoden, die das Töten der Tiere beinhalten. Diesen Methoden mangelt es jedoch an der nötigen Sensitivität, um umweltrelevante Konzentrationen der endokrinen Disruptoren (EDs) nach Kurzzeitexposition nachweisen zu können, sowie am Vermögen, alle vier Wirkmechanismen (androgen, antiandrogen, östrogen und antiöstrogen) mit einer einzelnen Testmethode feststellen und unterscheiden zu können. In dieser Studie wurde deshalb mit Hilfe männlicher Afrikanischer Krallenfrösche (Xenopus laevis) eine Testmethode entwickelt, bei der die Frösche verschiedenen (anti)androgenen und (anti)östrogenen EDs ausgesetzt wurden und ihr Rufverhalten untersucht wurde. Diese nicht-invasive Methode erwies sich als schnell und höchst sensitiv. Zudem war es erstmals möglich, die vier verschiedenen Wirkmechanismen allein anhand veränderter Ruftypen und Rufparameter zu bestimmen und zu unterscheiden. Darüber hinaus konnte gezeigt werden, dass bei Anwendung dieser Methode die Möglichkeit besteht, die Versuchstiere in weiteren Tests wiederzuverwenden, da die Rufparameter nach einer expositionsfreien Zeit von sechs Wochen wieder Kontrollwerte erreichten. Zusammengefasst kann die hier vorgestellte verhaltensphysiologische und damit nicht-invasive Methode als Biomarker für den Nachweis von (anti)androgenen und (anti)östrogenen EDs verwendet werden. Ferner zeigt die hohe Sensitivität des Tests, sowie die Möglichkeit der vollautomatischen Analyse enormer Datenmengen, dass dieser schnelle Verhaltenstest ein großes Potential hat, ein sensitiver, standardisierter und nicht-invasiver Biomarker zu werden. / Endocrine disrupting compounds (EDCs), such as herbicides, pesticides or pharmaceuticals enter the environment via sewage effluents and especially accumulate in surface waters. Research efforts so far mainly focused on EDCs with (anti)androgenic and (anti)estrogenic modes of action (MOAs), which can interfere with reproductive biology of vertebrates. To date, biomarkers for the assessment of such compounds are invasive techniques, which are not sensitive enough to detect EDCs after short-term exposures and which cannot distinguish between the four MOAs. Hence, in this study a non-invasive method for the assessment of EDCs was developed using male African clawed frogs (Xenopus laevis) as model species. Frogs were exposed to individual (anti)androgenic and (anti)estrogenic EDCs in the surrounding water and their calling behavior was analyzed. This non-invasive method turned out to be a fast and highly sensitive biomarker for the detection of (anti)androgenic and (anti)estrogenic EDCs. Moreover, this method was able to differentiate between the four different MOAs solely by determining affected parameters of the calling behavior. It was also shown that by using this method, it might be possible to reuse already tested experimental animals, because the measured affected parameters were reversed after a period of six weeks under control conditions. Taken together the here established non-invasive behavioral method can be used as biomarker for the detection of (anti)androgenic and (anti)estrogenic EDCs. Furthermore, the high sensitivity of this testing method, as well as the possibility of analyzing vast datasets rapidly in a completely automated fashion indicate the huge potential for this rapid behavior test to become a sensitive, standardized, non-invasive biomarker.

Die Reifung der Zona reticularis der Nebennieren-Rinden (NNR) und ihrer Androgen-Sekretion vor der Pubertät unterscheidet sich bei Menschen und höheren Primaten von der NNR-Reifung anderer Species, z.B. der Nager. Die Sekretion der NNR-Androgene leitet die Pubertätsentwicklung ein. Die NNR-Androgene erlangen medizinische Bedeutung dadurch, dass sie bei Frauen zu Hirsutismus und Fertilitätsstörungen führen können. Neben diesen Symptomen stellen sie einen Risikofaktor für die Entwicklung eines Polycystischen-Ovar-Syndroms (PCOS) dar, das ungefähr 7 % der prämenopausalen Frauen betrifft. Lange Zeit war nicht bekannt, wie die Differenzierung der Zona reticularis beim Menschen reguliert wird. Sicher ist ACTH bei weitem das bedeutsamste übergeordnete Hormon für die globale adrenocorticale Differenzierung und Funktion. Weitere Faktoren sind speziell für die Androgensekretion verantwortlich, aber nicht genau definiert. Nun wurde zunächst in zellbiologischen Experimenten belegt, dass die ACTH-Wirkung durch ein Spezies-spezifisches Muster von Wachstumsfaktoren autokrin moduliert wird und so die postnatale Entwicklung der Nebenniere steuern kann. Die vorliegenden Untersuchungen an menschlichen NNR-Zellen von Kindern und Erwachsenen in Primärkultur zeigen erstmals, dass IGF-I und IGF-II differenzierte Funktionen dieser Zellen aufrecht erhalten. IGF-I und, mehr noch, IGF-II steigern die Steroid-Biosynthese und ACTH-Ansprechbarkeit, und sie fördern die Bildung von Androstendion, einem delta5-Androgen der Zona reticularis. Darüberhinaus bewirkt Insulin in physiologischen sowie in micromolaren Konzentrationen den IGFs ähnliche Änderungen der Steroidsynthese. In Querschnittsuntersuchungen an gesunden Kindern vor der Pubertät sowie Kindern mit einfacher Adipositas konnte gezeigt werden, dass die Körperzusammensetzung mit den NNR-Androgenen zusammenhängt. Über die Mediatoren IGF-I, Insulin und Leptin wird offensichtlich der NNR der Zustand von Gewicht und Wachstum des Kindes signalisiert, auch bei pathologischer Körperzusammensetzung, wie dem Prader-Willi-Syndrom. Während die Adipositas die Androgen-Bildung steigern kann, ist sie jedoch selbst nicht der kausale Faktor einer vorzeitigen Nebennierenrindenreifung. Der Prämaturen Pubarche können in 5 - 10 % der untersuchten weiblichen Population ein nicht-klassisches AGS oder NNR-Tumoren zugrunde liegen. Bei den verbleibenden Kindern besteht eine eigentlich harmlose Reifungsbeschleunigung mit normaler Wachstumsprognose. Betrachtet man diese Kinder mit idiopatischer Prämaturer Adrenarche jedoch genauer, so finden sich zwei Untergruppen mit langfristigen Risiken: erstens zeigen Kinder mit einer sogenannte manifesten Heterozygotie für einen 21-Hydroxylase-Defekt Auffälligkeiten des Wachstums, die eine Endgrössenreduktion bewirken könnten, und zweitens wird bei Jugendlichen mit einer Überstimulierbarkeit der NNR diese "Exaggerated Adrenarche" für ein nachfolgendes PCOS verantwortlich gemacht. Schliesslich scheint es vor dem Hintergrund der sich epidemieartig ausbreitenden Zunahme des Übergewichts im Kindesalter angezeigt, den Bezug dieser NNR-Störungen zur Adipositas und der Hyperinsulinämie weiter zu klären. / The prepubertal maturation of the zona reticularis of the adrenal cortex and its androgen secretion in man and higher primates differs from other species, e.g. rodents. The secretion of adrenal androgens induces the pubertal development. The importance of adrenal androgens is derived from them being the cause for hirsutism and fertility disorders in women. In addition they represent a risk factor for the development of the polycystic ovary syndrome (PCOS), that affects about 7% of all pre-menopausal women. The regulation of the differentiation of the zona reticularis was unknown for a long time. However, ACTH is by far the most important hormone to regulate the global adrenocortical differentiation and function. In addition, other yet undefined factors are specifically responsible for the secretion of adrenal androgens. The cell-biological experiments presented here demonstrate that the effects of ACTH can be modulated in an autocrine manner by a species-specific pattern of growth factors so as to allow for the control of the postnatal development of the adrenal gland. The present investigations in human adrenocortical cells of children and adults in primary culture show for the first time that IGF-I and IGF-II maintain the differentiated function of these cells. IGF-I and to an even greater extent IGF-II enhance the biosynthesis of steroids and ACTH-responsiveness, and they promote the production of androstenedione, a delta5-androgen of the zona reticularis. Moreover, insulin, in physiological as well as in micromolar concentrations, induces changes in steroid production similar to the IGFs. In cross-sectional studies of healthy pre-pubertal children and children with simple obesity, it was shown that body composition is associated with adrenal androgens. Mediated by IGF-I, insulin and leptin, body composition apparently signals the child's state of weight and growth to the adrenals, even in patients with abnormal body composition, e.g. the Prader-Willi syndrome. While obesity may enhance androgen production, it is not the direct causal factor to induce premature adrenal maturation. In 5-10% of the female population investigated, premature pubarche is caused by non-classical adrenal hyperplasia or an adrenocortical tumour. In the remaining children, there is merely a harmless acceleration of maturation with normal growth prediction. A closer look at the children with idiopathic premature adrenarche, however, reveals two subgroups with long-term risks: First, children with a so called manifest heterozygosity of a 21-hydroxylase-defect show growth abnormalities, possibly reducing final height. Second, in adolescents with enhanced stimulation of the adrenal cortex, this 'exaggerated adrenarche' is held responsible for the subsequent development of PCOS. Finally, with regard to the rapidly spreading epidemic of overweight in children, it seems essential to study into greater depth the relationship between these adrenal dysfunctions and obesity or hyperinsulinism.

Introdução: O desenvolvimento psicossexual humano inicia no período pré-natal e é composto pelo papel de gênero (PG), pela identidade de gênero (IG) e pela orientação sexual (OS). Em indivíduos com DDS 46,XY, vários fatores podem comprometer esse desenvolvimento, levando a incongruência de identidade de gênero e à mudança de gênero. Nesses pacientes, a exposição androgênica pré-natal e o grau de virilização da genitália externa tem sido avaliados como possíveis influenciadores destes desfechos, mas seu papel ainda não foi esclarecido. Objetivos: Avaliar os desfechos psicossexuais - IG, PG e OS - e aspectos da vida sexual em uma coorte de indivíduos com DDS 46,XY na idade adulta com diagnostico etiológico caracterizado do ponto de vista clínico e molecular e investigar a influência da exposição androgênica pré-natal e do grau de virilização da genitália externa nesses desfechos e na prevalência de disforia de gênero (DG). Pacientes: 144 pacientes com diagnóstico etiológico confirmado de DDS 46,XY acompanhados do HCFMUSP com idade entre 16 e 60 anos foram incluídos neste estudo. Métodos: Os componentes do desenvolvimento psicossexual (IG, PG, OS) foram avaliados usando questionários e por teste psicológico projetivo (HTP - House-Tree-Person). O escore de Sinnecker foi utilizado para a mensuração do grau de virilização da genitália externa. A exposição androgênica pré-natal foi estimada de acordo com a etiologia do DDS 46,XY. Aspectos da vida sexual foram avaliados através de questionário específico.Todas as variáveis categóricas foram analisadas usando teste X². A força de associação foi avaliada pelo cálculo do V de Cramer. O índice kappa foi usado para avaliar concordância entre resultados dos testes. Resultados: Houve uma associação positiva entre exposição androgênica pré-natal e a maior incidência de desfechos psicossexuais masculinos em indivíduos com maior exposição. O grau de virilização da genitália externa não interferiu nos desfechos psicossexuais. Houve uma prevalência de 19% (27/144) de disforia de gênero em toda a coorte. Em 93% (25/27), a DG foi do sexo feminino para o masculino e ocorreu em 50% (16/32) de casos de deficiência de 5alfa-RD2, seguido de 33% (5/15) dos casos de deficiência da 17beta-HSD3 e se associou com exposição androgênica pré-natal (p < 001; V=0,461), mas não com a virilização da genitália externa. A mediana de idade do desejo de mudar de sexo foi de 8 anos (5 - 9) enquanto que a da idade da mudança de sexo foi 15 anos (10.5 - 20). Os desfechos psicossexuais mostraram maior concordância com o sexo social final (PG - k=0.81; IG - k=0.65 e OS - k=0.85) do que com o sexo de registro (PG - k=0.1; IG - k=0.25 e OS - k=0.15). Quanto a sexualidade, alguns parâmetros (fantasias sexuais, masturbação e parceiro sexual fixo) foram melhores no sexo masculino comparado ao feminino. No entanto, não houveram diferenças em relação aos parâmetros da vida sexual comparando indivíduos do sexo feminino com e sem atipia genital e indivíduos do sexo masculino que mantiveram o sexo social com os que mudaram para este sexo. Conclusões: A exposição androgênica pré-natal influenciou o desenvolvimento psicossexual em indivíduos com DDS 46,XY, de uma forma exposição-dependente, favorecendo desfechos masculinos, enquanto que o grau de virilização da genitália externa não influenciou estes desfechos. A DG do feminino para o masculino foi comum entre esses indivíduos e também foi influenciada pela exposição androgênica pré-natal. Os parâmetros psicossexuais nesses pacientes concorda muito mais com o sexo social final do que com o sexo de registro. A sexualidade dos indivíduos do sexo masculino tem aspectos mais satisfatórios que o feminino. Atipia genital no sexo feminino não afetou a sexualidade destas pacientes assim a sexualidade dos indivíduos que mudaram para o sexo masculino são semelhantes aos que foram registrados no sexo masculino Behavioral and Psychosexual Aspects of 46,XY DSD Individuals At Adulthood / Introduction: The human psychosexual development begins at prenatal period and is composed by gender role, gender identity and sexual orientation. In 46,XY DSD individuals a variety of factors may jeopardize an adequate psychosexual development and sometimes results in desire to change the gender. The effects of prenatal androgen exposure and the impact of atypical genitalia in the psychosexual outcomes have been suggested as influencing factors in the human psychosexual development but there is not conclusive evidence, especially in DDS 46, XY. Methods: We evaluated the psychosexual compounds - gender role (GR) at childhood gender identity (GI) and sexual orientation (SO) in individuals a large cohort of 144 46,XY DSD individuals, 86% of them raised in the female social sex, from a single tertiary medical center. The same psychologist, specialized in DSD, performed the psychosexual evaluation. We used a questionnaire and a projective psychological test (HTP test) to measure the psychosexual compounds. Prenatal androgen exposure was estimated considering the 46,XY etiology. Sinnecker\'s score was used to measure the external genitalia virilization. All ordinal variables were analyzed using Wilcoxon test. Categorical variables were analyzed using X2 test with posterior Cramer\'s V to measure the association strength. The kappa index was calculated as a concordance measure. Results: We found an association between prenatal androgen exposure and major prevalence of male psychosexual outcomes and a higher incidence of female to male gender dysphoria. There was not difference in the psychosexual outcomes according by external genitalia virilization in male and in female individuals. There was an incidence of 19% of gender dysphoria (27 out from 144). In 93% (n=25), the gender change was from female to male (F to M). The ethological diagnosis related with F to M GD were 5alpha-RD2 deficiency (5ARD2) in 16/32 (50%), followed by 5/15 (33%) in 17beta-HSD3 deficiency (17betaHSD3). Others diagnosis related with F to M GD were: partial gonadal dysgenesis (n=3/24; 12%) and 3betaHSD2 (n=1/3; 33%). Both cases of male to female (M to F) GD occurred in partial gonadal dysgenesis (8%; n=2/24). The median of GD age (desire to belong to another gender) was 8 years old (5-9), and the median of gender change itself was 15 years old (10.5 - 20). In F to M GD, gender change was associated with prenatal androgen exposure (p < 001; V=0,461). The psychosexual components showed higher concordance index with final gender (GI - k=0.81; GI - k=0.65 and SO - k=0.85) then with the assigned sex (GI - k=0.1; GI - k=0.25 and SO - k=0.15). Conclusion: Prenatal androgen exposure affects the psychosexual development, favoring more male outcomes. This influence was observed in GI, GR and SO. The degree of external genitalia virilization did not influence the psychosexual development. Female to Male GD is common in 46,XY DSD raised in female social sex, especially in 5ARD2 and 17?HSD3 deficiencies. There is a strong relationship between prenatal androgen exposure and F to M GD. On the other hand, M to F gender change was rare in 46,XY DSD and occurred only in partial gonadal dysgenesis patients

This PhD aimed to elucidate the mechanisms by which polymorphisms may alter androgen-induced transactivation of androgen receptor (AR) target genes which may be important in prostate cancer aetiology. The second aspect of this PhD focused on identifying and characterising functional polymorphisms that may have utility as predictive risk indicators for prostate cancer and which may aid in earlier therapeutic intervention and better disease management. Analyses were carried out on the kallikrein-related peptidase 3 (KLK3), also known as the prostate specific antigen (PSA), gene and the kallikrein-related peptidase 4 (KLK4) gene. The PSA and KLK4 genes are part of the serine protease family that have trypsin or chymotrypsin like activity and are thought to play a role in the development of hormone-dependent cancers in tissues such as those in the prostate, breast, endometrium and ovaries. In the prostate, PSA is regulated by androgens and three androgen response elements (AREs) have been described in the promoter and upstream enhancer region. The PSA ARE I harbours a polymorphism at -158 bp from the transcription initiation site (TIS) that results in a G to A transition (G-158A). This PhD investigated the functional significance of the PSA G-158A polymorphism which has been reported to be associated with prostate cancer risk. Electromobility shift assays (EMSAs) investigating the interaction of ARE I variants with the AR DNA binding domain (AR-DBD) demonstrated that the A allele had a two-fold increased binding affinity for the AR-DBD when compared with the G allele. This was confirmed with endogenous AR in limited proteolysis-EMSA experiments. The limited proteolysis-EMSA experiments also demonstrated differential sensitivities of PSA ARE I alleles to trypsin digestion, which suggests that the G-158A polymorphism has an allosteric effect on the AR that alters AR/ARE I complex stability. Furthermore, Chromatin Immunoprecipitation (ChIP) assays suggest that the A allele more readily recruited the AR in vivo when compared with the G allele and is consistent with the in vitro binding data. Luciferase reporter assays carried out in both LNCaP and 22Rv1 prostate cancer cells, and using the natural (dihydrotestosterone; DHT) ligand demonstrated that the A allele was more responsive to androgens in LNCaP cells. Hence, this study has elucidated the potential mechanisms by which the G-158A polymorphism may differentially regulate PSA expression (of which up-regulation of PSA is thought to be important in prostate cancer development and progression). KLK4 has similar tissue-restricted expression as PSA and is up-regulated by steroid hormones in many endocrine cells including those in the prostate. A putative ARE (KLK4-pARE) located at -1,005 to -1019 relative to the more predominantly used transcription initiation site, TIS3, was initially found in supershift assays using AR antibodies to interact with endogenous AR. However, subsequent EMSA analysis using purified AR-DBD suggest that KLK4-pARE may be interacting with the AR indirectly. To investigate this hypothesis, a tandem construct of KLK4-pARE was cloned into the pGL3-Promoter vector for hormone-induced reporter assays. However, reporter assays did not demonstrate any responsiveness of KLK4-pARE to androgens, estradiol or progestins. Consequently, Real-Time PCR was carried out to reassess the hormonal regulation of KLK4 at the mRNA level. Consistent with the literature, data from this study suggests that KLK4 may be up-regulated by androgens, progestins and estradiol in a cyclical manner. Hormone-induced luciferase reporter assays were then carried out on seven promoter constructs that span 2.8 kb of the KLK4 promoter from TIS3. However, none of the seven promoter constructs demonstrated any significant responsiveness to androgens, estradiol or progestins. This study suggests that hormone response elements (HREs) that may drive the hormonal regulation of KLK4 in prostate cancer may be located further upstream from the promoter region investigated in this PhD, or alternatively, may lie 3' of TIS3. The characterisation of KLK4 promoter polymorphisms and their flanking sequences were also carried out in parallel to the functional work with the intent to assess the functional significance of any polymorphisms that may be located within HREs. In total 19 polymorphisms were identified from the public databases and from direct sequencing within 2.8 kb of the KLK4 promoter from TIS3. However, the functional and clinical significance of these 19 polymorphisms were not further pursued given the negative findings from the functional work. The PSA AR enhancer region was also assessed for potential polymorphisms that may be associated with prostate cancer risk. A total of 12 polymorphisms were identified in the PSA enhancer of which two (A-4643G and T-5412C) have been reported to alter functionality of the enhancer region and thus, prioritised for further analysis. Association analysis for prostate cancer risk was then carried out on these PSA enhancer polymorphisms as none of the KLK4 promoter polymorphisms were found in functional HREs. No significant association for either the A-4643G or T-5412C polymorphism with prostate cancer risk was found at the P = 0.05 level. However, under an age-adjusted dominant model a 1.22- (95% CI = 1.16-1.26) and 1.23-fold (95% CI = 1.17-1.29) increased risk for prostate cancer was found for the A-4643G or T-5412C polymorphisms, respectively. Both polymorphisms were also assessed for association with tumour grade and stage and PSA levels. Genotypes were significantly different for the A-4643G and T-5412C polymorphisms with tumour stage and PSA levels, respectively. However, these results are likely to be biased by the case population which consist primarily of men who presented with incidental (pT1) and organ-confined (pT2) tumours. To summarise, the A-4643G and T-5412C polymorphisms are unlikely to be associated with prostate cancer risk, PSA levels or stage/grade of disease. However, further analyses in a larger cohort is warranted given that these polymorphisms alter androgen responsiveness of the PSA enhancer and that elevated PSA levels are indicative of men with prostate cancer. To summarise, this PhD has elucidated the functional significance of the PSA G-158A polymorphism in prostate cancer and which may be important in prostate cancer patho-physiology. This PhD has also furthered the understanding of the hormonal regulation of KLK4 in prostate cancer cells. Finally, this PhD has carried out a pilot study on two functional PSA enhancer polymorphisms (A-4643G and T-5412C) with prostate cancer risk.