Cytochromes P450 represent a large group of proteins metabolizing variety of substrates. Many of them are responsible for metabolism of xenobiotics including drugs and chemical carcinogens. Heme-protein cytochrome b5 is a single-electron donor cooperating with a NADPH:cytochrome P450 reductase and NADH:cytochrome b5 reductase 3 enzyme. Cytochrome b5 can affect the xenobiotic metabolism via modulation of the cytochromes P450 activity. One of the goals of the Ph.D. thesis was to utilize site directed mutagenesis of cytochromes P450 family 1 to elucidate the mechanism of their nitroreductase activity. Another aim was to study the interaction between cytochrome b5 and cytochromes P450 of the 1A subfamily using site directed mutagenesis on presumed protein-protein contact interface. Another goal was to utilize the combination of theoretical and experimental approaches to explain variance in the reduction state of several human cytochromes P450 heterologously expressed in intact bacterial cells. The results found in the thesis show that nitroreductase activity of CYP1A1, CYP1A2 and CYP1B1 is mediated by the presence of a particular hydroxyl group in their active centre. Single mutation introducing a hydroxyl group to the specific part of CYP1B1 active site to the active site turned on its artificial...

Abstract Liquid chromatography (LC) combined with mass spectrometry (MS) is one of the most widely used techniques in modern analytical laboratories. Remarkable developments during the two previous decades in both techniques has made LC-MS the method of choice in various environmental, pharmaceutical and biochemical laboratories due to selectivity, sensitivity and versatility. The main focuses in this study were to develop new LC-MS methods to identify and quantify phenolic secondary metabolites in bilberry, lingonberry and hybrid bilberry, to study the biosynthesis of the main secondary metabolites (hypericin and hyperforin and their derivatives) in St John’s wort (SJW) both in vitro and in vivo (in plant), to identify in vitro metabolites of hyperforin in human liver microsomes and to identify the cytochrome P450 (CYP) enzymes responsible for their formation. Both high-performance liquid chromatography (HPLC) and ultra high-performance liquid chromatography (U-HPLC) in combination with time-of-flight (TOF) and triple quadrupole (QqQ) mass spectrometry were used in this study. Identification of 52 phenolic compounds from the leaves of bilberry, lingonberry and hybrid bilberry was accomplished. In total, seven of the identified compounds were reported for the first time in Vaccinium plants and several other compounds were reported for the first time in the studied plants. Incorporation of valine and isoleucine into acyl side chains of phloroglucinols (hyperforin and adhyperforin) via biosynthesis in shoot cultures of SJW was confirmed by using isotopically labeled amino acids and HPLC-MS/MS. Also, 29 biosynthetic in vitro products for HpPKS2 enzyme originating from SJW were identified based on accurate mass data. The metabolism of hyperforin was studied in human liver microsomes (HLM) for the first time. 57 metabolites for hyperforin were identified in the incubations with HLMs, using a substrate concentration of 1 μM. The phase I metabolism of hyperforin was suggested to rely mainly on CYP3A4 and on CYP2C family. / Tiivistelmä Nestekromatografia (LC) yhdistettynä massaspektrometriaan (MS) on yksi eniten käytetyistä analyysimenetelmistä nykyaikaisissa analytiikkalaboratorioissa. Viimeisten parin vuosikymmenen aikana LC-MS -laitteet ovat kehittyneet merkittävästi, ja nykyään LC-MS onkin paras menetelmä moniin ympäristö-, lääkeaine- ja biokemiallisiin laboratorioihin sen selektiivisyyden, herkkyyden ja monipuolisuuden vuoksi. Tässä väitöskirjassa kehitettiin uusia LC-MS –menetelmiä mustikan, puolukan ja mustikkapuolukan fenolisten sekundäärimetaboliittien tunnistamiseksi ja kvantitoimiseksi, mäkikuisman pääasiallisten sekundäärimetaboliittien (hyperisiini, hyperforiini ja niiden johdannaiset) tutkimiseksi in vitro- ja kasvinäytteistä sekä hyperforiinin aineenvaihduntatuotteiden tunnistamiseksi ja niitä muodostavien sytokromi P450 (CYP) entsyymien tunnistamiseksi ihmisen maksamikrosomeissa in vitro -menetelmin. Tässä työssä käytettiin sekä korkean erotuskyvyn nestekromatografia (HPLC) että ultra-korkean erotuskyvyn nestekromatografia (U-HPLC) yhdistettynä lentoaikamassaspektrometriin (TOF-MS) ja kolmoiskvadrupolimassaspektrometriin (QqQ-MS). Mustikan, puolukan ja mustikkapuolukan lehdistä tunnistettiin yhteensä 52 fenolista yhdistettä. Seitsemää näistä tunnistetuista yhdisteistä ei oltu aiemmin löydetty Vaccinium -suvun kasveista ja useat muut yhdisteistä löydettiin ensimmäistä kertaa nyt tutkituista kasveista. Valiinin ja isoleusiinin liittyminen floroglusinolien (hyperforiini ja adhyperforiini) asyylisivuketjuihin biosynteesin välityksellä varmistettiin isotoppileimattujen aminohappojen ja HPLC-MS/MS –mittausten avulla. Tässä työssä tunnistettiin myös 29 mäkikuismasta peräisin olevan HpPKS2 -entsyymin in vitro biosynteesituotetta tarkan massan mittausten avulla. Hyperforiinin metaboliaa tutkittiin ensimmäistä kertaa ihmisen maksamikrosomeissa (HLM). Hyperforiinille tunnistettiin yhteensä 57 aineenvaihduntatuotetta ihmisen maksamikrosomi-inkubaatioissa, kun hyperforiinin alkukonsentraatio oli 1 μM. Tämän tutkimuksen tulosten perusteella hyperforiinin faasi I metabolia tapahtuu pääasiassa CYP3A4:n ja CYP2C-perheen välityksellä.

Les insectes ont développé un système chimiosensoriel gustatif leur permettant de discriminer les stimuli sensoriels indispensables à leur survie et à leur reproduction. Afin d’être efficace, le système gustatif doit être sensible et permettre une élimination rapide des molécules sensorielles afin d’éviter la saturation des récepteurs et ainsi assurer la détection et l’intégration des signaux chimiosensoriels. Présentes dans l’espace péri-récepteur, les enzymes du métabolisme des xénobiotiques (EMX), impliquées principalement dans la détoxication des organismes, pourraient avoir un rôle central dans la modification et/ou l’arrêt du signal sensoriel en catalysant la biotransformation de ces molécules et en favorisant leur élimination.Afin d’analyser l’implication des EMX dans les processus chimiosensoriels, nous avons centré notre étude sur le rôle potentiel des Cytochromes P450 (CYP), dans la perception et le métabolisme de la caféine chez Drosophila melanogaster. Nous avons identifié plusieurs CYP dont l’expression est fortement modulée dans les organes sensoriels et dans le corps par la caféine. L’inhibition ciblée de l’expression de certains CYP dans les neurones sensoriels provoque une perturbation de la perception de la caféine, mettant ainsi en évidence le rôle crucial de ces enzymes dans les mécanismes chimiosensoriels. En parallèle, nous avons caractérisé le métabolisme de la caféine chez la drosophile puis, nous avons mis en évidence l’implication directe de CYP6d5 dans la dégradation de la caféine en théobromine.L’ensemble de ces travaux montre pour la première fois, l’implication directe des cytochromes P450 dans les mécanismes de perception sensorielle et dans le métabolisme de la caféine chez la drosophile. / Insects have developed a gustatory system, allowing them to detect sensory molecules essential to their survival and their reproduction. In order to be efficient, the gustatory system must be sensitive, allowing a rapid elimination of sensory molecules in order to avoid the receptor saturation and insuring the detection and the integration of chemosensory signals.Located in the peri-receptor environment, xenobiotic metabolizing enzymes (EMX), mainly implicated in detoxification, could have a crucial role in the modulation of the sensory signal by catalyzing the biotransformation of sensory molecules and promoting their elimination.To analyze the involvement of XME in chemosensory processes, we focused our project on the putative role of Cytochromes P450 (CYP) in caffeine sensory perception and metabolism in Drosophila melanogaster. We identified several CYP, which the expression is strongly modulated in sensory organs and in the body by caffeine. The specific-targeted silencing of some CYP expression in sensory neurons leads to an alteration of caffeine perception, revealing the crucial role of these enzymes in chemoperceptive processes. In parallel, we characterized the caffeine metabolism in Drosophila, and highlighted a direct involvement of CYP6d5 in the degradation of caffeine into theobromine. This work shows for the first time, a direct implication of cytochromes P450 in sensory perception mechanisms and in the metabolism of caffeine in Drosophila.

A synthetic estrogen 17α-ethinylestradiol (EE2) is the main active component of the hormonal contraceptive pills. The rise of consumption of hormonal contraceptives has increased the risk of the back negative effects of EE2 to aquatic organisms. EE2 belongs to the endocrine disruptive compounds known for mimicking natural hormones. A more detailed examination of the transformation of this compound in vivo and in vitro can contribute to a better understanding of its negative effects. This master thesis is therefore devoted to the study of the metabolism of EE2 in two selected model organisms. The ligninolytic fungus Pleurotus ostreatus is the type of fungi with promising biodegradation ability to a lot of pollutants. These properties have led to numerous studies of the degradation potential of P. ostreatus towards EE2, with the possibility of removing this compound from the environment. EE2 has been degraded by the fungus P. ostreatus in vivo resulting in one hydroxylated metabolite, which estrogenic activity is in need for further study. In vitro studies were carried out with a microsomal fraction isolated from the mycelium of this fungus. The conversion of EE2 in vitro via CYPs dependent on NADPH has not been demonstrated, however using KHP as a cofactor, there was one metabolite of EE2 found,...

La fusariose des épis est l’une de maladies les plus dommageables des céréales tempérées et est principalement causée par le champignon toxinogène Fusarium graminearum (Fg). Ces dix dernières années, de nombreuses études ont rapporté l’induction transcriptionnelle de gènes de la plante codant pour des cytochromes P450 (P450) en réponse l’infection par Fg. Les P450s constituent une famille enzymatique impliquée dans de nombreuses voies métaboliques, certaines avec des intérêts potentiels dans la résistance face aux maladies. Nous avons utilisé la petite graminée modèle Brachypodium distachyon (Bd) pour caractériser fonctionnellement le premier gène codant pour un P450 induit chez la plante au cours de la fusariose des épis par l’utilisation de lignées altérées dans la séquence ou l’expression du gène Bradi1g75310 codant le P450 BdCYP711A29. Nous avons montré qu’en plus d’être un facteur de sensibilité à la maladie, le gène Bradi1g75310 est impliqué dans une voie de biosynthèse hormonale chez Bd, celle des strigolactones (SLs). En effet, en plus de complémenter génétiquement les phénotypes aériens de la lignée mutante max1-1 d’Arabidopsis thaliana altérée dans le gène homologue MAX1 (AtCYP711A1), une lignée de Bd surexprimant Bradi1g75310 (lignée OE) exsude davantage d’orobanchol, une SL spécifique, que la lignée sauvage ou mutante. Une analyse préliminaire de l’impact direct de l’orobanchol sur la croissance de Fg semble indiquer une activation des étapes précoces du développement du champignon (germination) qui pourrait être à l’origine de l’induction plus rapide de gènes de défenses observée chez une lignée OE de Bradi1g75310. Nous avons également montré que les 4 paralogues de Bradi1g75310 chez Bd, qui codent également pour des CYP711A, sont tous capable de complémenter la lignée max1-1 et avons généré du matériel végétal fondamental pour la poursuite de l’étude de la diversification des SLs chez la plante monocotylédone modèle Bd. Au global, ce projet constitue une première étape dans la caractérisation de l’implication des P450 dans la réponse de la plante face à l’infection par Fg en plus de donner de nouveaux indices concernant le rôle des SLs dans les interactions plante-pathogène. Les résultats obtenus au cours de ce travail de thèse pourront permettre l’amélioration de caractères tant développementaux que de résistance à la fusariose chez les céréales cultivées. / Fusarium Head Blight (FHB) is one of the most important diseases of temperate cereals and is mostly caused by the toxin producing-fungus Fusarium graminearum (Fg). This last decade, several studies reported the transcriptional activation of cereal cytochrome P450-encoding genes (P450s) in response to Fg infection. P450s constitute an enzymatic family participating in very diverse metabolic pathways with potential interest for disease resistance. We used the model temperate cereal Brachypodium distachyon (Bd) to functionally characterize the first FHB-induced P450- encoding gene using Bd lines altered in the locus or gene expression of the Bradi1g75310 gene encoding the BdCYP711A29 P450. We showed that in addition to be a plant susceptibility factor towards the disease, the Bradi1g75310 gene is involved in the hormonal biosynthetic pathway of strigolactones (SLs) in Bd. Indeed, in addition to genetically complement the shoot phenotypes of the Arabidopsis thaliana mutant line for the homologous gene MAX1 (AtCYP711A1, max1-1 line), a Bd linewhich overexpresses the Bradi1g75310 gene (OE) exudes more orobanchol, a specific SL, compared to wild-type or mutant lines. Preliminary analysis of the direct impact of orobanchol on Fg growth suggests an activation of early fungal development (germination) likely to induce faster induction of defense-related genes during FHB, observed in Bradi1g75310 OE line. We showed that the four paralogs of Bradi1g75310 encoding BdCYP711A P450s are all able to genetically complement max1-1 line and provide important plant material for studying SLs diversification in the model monocot B. distachyon. Overall, this project constitutes a first step in the characterization of P450s involvement in plant response towards Fg infection in addition to give new evidences about the role of SLs in plant-pathogen interactions. Results obtained during this Ph.D. project will allow the improvement of both developmental and FHB-related traits in cereal crops.

Les cytochromes P450 (CYP450) sont des hémoprotéines intervenant généralement dans la détoxication de l’organisme sous forme de biodégradation de molécules xénobiotiques et participent à la décomposition de certains médicaments. Cependant, les gènes codant pour les protéines CYP450 sont souvent sous-analysés dans les études génomiques à grande échelle en raison de leur difficulté d’analyse due à un haut taux de polymorphisme. Deux sous-familles seront étudiées plus en profondeur: les sous-familles CYP3A et CYP4F. La sous-famille CYP3A métabolise environ 50% des médicaments alors que les enzymes CYP4F, quant à eux, sont impliquées dans le métabolisme de composés endogènes, de nutriments et de médicaments. Les gènes de ces sous-familles sont fortement polymorphes et ce, à travers les populations humaines. Ainsi, la variabilité entre les différentes populations peut affecter la réponse aux médicaments et autres fonctions métaboliques. Dans ce projet, deux grands jeux de données, l’un en génétique des populations (le Projet des 1000 Génomes) et l’autre en transcriptomique (GTEx) seront utilisés afin d’identifier des signatures de sélection naturelle dans les gènes CYP3A et CYP4F, ainsi que leur impact sur l’expression génique de ces gènes. Nous avons détecté différentes forces de sélection (positive et balancée) dans les deux sous-familles. Certains polymorphismes identifiés comme étant sous pression sélective sont associés à une expression différentielle des gènes des deux sous-familles. Ce projet permet de mieux comprendre l’impact des mutations sous pression sélective se situant dans les gènes des sous-familles CYP3A et CYP4F. Cette caractérisation génétique permettra d’obtenir des prédictions plus fiables en pharmacogénomique et en génomique humaine, en raison de l’influence de ces gènes sur la réponse aux médicaments. / Cytochromes P450 (CYP450) are hemoproteins generally involved in the detoxification of the body of xenobiotic molecules and participate in the metabolism of many drugs. Genetic polymorphisms have been found to impact drugs responses and metabolic functions. However, genes encoding CYP450 proteins are often under-analyzed in large-scale genomic studies because the difficulty of analysis due to of their high rate of polymorphism. In this study, we investigate the genetic diversity for CYP450 genes. We found that two clusters, CYP3A and CYP4F, are notably differentiated across human populations with evidence for selective pressures acting on both clusters. The CYP3A subfamily metabolizes approximately 50\% of drugs while CYP4F enzymes are involved in the metabolism of endogenous compounds, nutrients and drugs. Indeed, we found signals of recent positive selection in CYP3A and CYP4F genes and signals of balancing selection in CYP4F genes. Futhermore, unusual linkage disequilibrium is detected in both cluster, suggesting co-evolution. eQTLs were also found in both clusters which indicate co-regulation and epistasis.

Une résistance aux agents anticancéreux utilisés dans le traitement du cancer du sein est souvent associée à un échec de traitement. Des variations dans le devenir des agents anticancéreux dans l’organisme, sont des facteurs pouvant expliquer des phénomènes de résistance. Notre but était d’évaluer l’impact des isoenzymes du CYP450s, dans le métabolisme local des agents anticancéreux. Notre premier objectif était de valider un gène rapporteur pour nos analyses de PCR en temps réel. Pour ce faire, nous avons criblé l’expression de 6 gènes rapporteurs dans 23 lignées cellulaires. NUP-214 a été démontré comme étant le gène rapporteur le plus stable avec un écart-type de seulement 0.55 Ct. Notre deuxième objectif était de déterminer le niveau d’expression des ARNm de 19 isoformes du CYP450 dans plusieurs lignées cellulaires du cancer du sein. Les ARNm des CYP450s ont démontré une très grande variabilité entre les lignées cellulaires. Les isoformes CYP1B1 et CYP2J2 démontrent l’expression la plus importante pour la majorité des lignées. Notre troisième objectif était d’évaluer la corrélation entre l’expression des isoformes des CYP450s et leur activité métabolique en utilisant les substrats spécifiques du CYP1B1 et 2J2, 7-éthoxyrésorufine et ébastine, respectivement. Une forte corrélation (r2=0.99) fut observée entre l’activité métabolique vis-à-vis l’ébastine et l’expression du CYP2J2. De même, le métabolisme du 7-éthoxyrésorufine était fortement corrélé (r2=0.98) avec l’expression du CYP1B1. En résumé, ces résultats suggèrent que le métabolisme local des agents anticancéreux pourrait significativement moduler le devenir des agents anticancéreux dans l’organisme, et pourrait être ainsi, une source de résistance. / Several types of cancer cells have shown an innate or accute resistance to anti-cancer agents which in turn causes a failure in treatment. This resistance has been suggested to be caused by the expression of membrane transporters in cancer cells, as well as inter-individual variability in metabolism. Our interest was to evaluate the implication of CYP450 enzymes in the local metabolism of cancer cells. Our first objective was to screen the expression level of six housekeeping genes (HKG) using 23 different cell lines to determine which gene was the most stable. We found that NUP-214 was the most stable HKG across the panel of cell lines tested, with a standard deviation of only 0.55 Ct. Our second objective was to determine the expression level of 19 CYP450 mRNA isoforms in various breast cancer cell lines by RT-PCR. The CYP450 mRNAs showed a large variability between the different cell lines analyzed, where CYP1B1 and 2J2 were strongly expressed in most cell lines. Our third objective was to determine if measurable metabolic activity was present and correlates with mRNA expression in these same breast cancer cell lines using the specific substrates 7-ethoxyresorufin and ebastine for CYP1B1 and 2J2 activities, respectively. The metabolism of 7-ethoxyresorufin showed an excellent correlation of 0.98 with CYP1B1 expression while ebastine demonstrates a strong correlation (r2=0.99) with 2J2 expression. Overall, these results suggest that local metabolism of anti-cancer agents could significantly affect drug disposition and be a source of chemoresistance.

Aristolochic acids (AA) are human carcinogens which have also very strong nephrotoxic properties. A mixture of AA is present in Aristolochiacae plant species. These plants were and still are used in traditional medicine in some countries, particularly in Asia. Aristolochic acids participate in development of two types of nephropathies. The first disease is designated as Aristolochic Acid Nephropathy (AAN), the second one is Balkan Endemic Nephropathy (BEN). Both nephropathies are associated with urothelial malignancies, which are caused by AA. One of the common features of ANN and BEN is that not all individuals exposed to AA suffer from nephropathy and tumour development. One cause for these different responses may be individual differences in the activities and expression levels of the enzymes catalyzing the biotransformation of AAI, the major toxic component of AA contained in Aristolochia species. Detailed knowledge of enzymes which participate in metabolism of AAI may contribute to elucidation of inter-individual susceptibility to AAN, BEN and later urothelial malignancies. Aristolochic acid I is either oxidative detoxicated or reductive activated by biotransformation enzymes. Reductive bioactiovation of AAI leads to formation of covalent AA-DNA adducts in organism which result in producing of...

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.

A deficiência da 21-hidroxilase é uma doença genética comum, causada por mutações no gene CYP21A2, que codifica a enzima 21-hidroxilase (P450c21). A deficiência da 21-hidroxilase afeta a síntese de cortisol e aldosterona e promove acúmulo de precursores, que são desviados para a síntese de andrógenos. Observa-se três principais fenótipos: a forma clássica virilizante simples (VS), na qual as meninas nascem com virilização da genitália externa e ambos os sexos apresentam virilização pós-natal; a forma perdedora de sal (PS), na qual além da virilização, ambos os sexos apresentam crise de perda de sal no período neonatal; e a forma não clássica (NC), na qual os sintomas de hiperandrogenismo iniciam-se mais tardiamente, na infância, adolescência ou idade adulta. Os estudos in vitro das mutações do CYP21A2 demonstram que existe uma boa correlação do grau de comprometimento da atividade enzimática conferido pelo genótipo com o fenótipo. Entretanto, existem algumas divergências como: pacientes que apresentam quadro clínico e hormonal de forma não clássica, nos quais mutações não são identificadas em um ou em ambos os alelos do CYP21A2, e pacientes que apresentam o fenótipo mais leve do que o predito pelo genótipo. Essas divergências sugerem a presença de fatores moduladores do fenótipo na deficiência da 21-hidroxilase. A primeira hipótese foi de que houvesse mutações no gene P450 óxido-redutase (POR), que codifica uma flavoproteína que doa elétrons para as enzimas microssomais P450, inclusive a P450c21, passo fundamental para a atividade enzimática das mesmas. A segunda hipótese foi de que outras enzimas P450, que não a P450c21, tivessem a capacidade de realizar a 21-hidroxilação extra-adrenal da progesterona e 17OH-progesterona (17OHP), sendo então capazes de modular o fenótipo da perda de sal e/ou virilização. Os citocromos P450 hepáticos CYP2C19 e CYP3A4, responsáveis pelo metabolismo de drogas, são capazes de realizar 21-hidroxilação da progesterona, porém essa atividade nunca foi comparada com a atividade de 21-hidroxilação da P450c21, a fim de que se possa extrapolar a importância dessa atividade extra-adrenal in vivo. A casuística desse estudo constou de 11 pacientes com a forma NC e genótipo incompleto, e 6 pacientes com fenótipo discordante do genótipo (5 com genótipo predizendo forma PS e manifestando forma VS, e 1 com genótipo predizendo VS e apresentando forma NC). O gene POR foi sequenciado em todos 17 pacientes e 10/30 alelos não relacionados apresentavam o polimorfismo A503V. O estudo funcional foi realizado através da expressão em bactéria do P450c21, do POR selvagem (PORwt) e da variante do POR A503V, e de estudo enzimático in vitro comparando a 21-hidroxilação da P450c21 promovida pela PORwt e POR A503V. Essa comparação foi realizada através de cálculos dos parâmetros que avaliam cinética enzimática (Km, Vmax e Vmax/Km). Apesar da variante POR A503V diminuir significativamente a atividade da P450c17 in vitro, nosso estudo demonstrou que ela não altera a capacidade de 21-hidroxilase da P450c21. Portanto, não existem substituições no POR que justifiquem as discordâncias de fenótipo/genótipo na deficiência da 21-hidroxilase nesta casuística. Para avaliarmos o papel da 21-hidroxilação extra-adrenal, as enzimas P450c21, as enzimas P450 hepáticas CYP2C19 e CYP3A4 e o POR foram expressos em bactéria. A capacidade das enzimas P450c21, CYP2C19 e CYP3A4 de 21- hidroxilar progesterona e 17OHP foram avaliadas in vitro e medidas através dos mesmos parâmetros de cinética enzimática. Comparado com a P450c21, o Vmax/Km da 21-hidroxilação da progesterona pelos CYP2C19 e CYP3A4 foram 17% e 10%, respectivamente. Os citocromos hepáticos não apresentaram atividade de 21-hidroxilação da 17OHP. Considerando que uma atividade residual mínima de 21-hidroxilação da progesterona é satisfatória para produzir quantidades suficientes de aldosterona para se evitar a perda de sal, este estudo sugere que a atividade de 21-hidroxilação extra-adrenal do CYP2C19 e CYP3A4 é capaz de melhorar o fenótipo de perda de sal, mas não o da deficiência de glicocorticóide. O gene CYP2C19, ao contrário do CYP3A4, é extremamente polimórfico, e são descritos vários haplótipos com diferentes atividades enzimáticas, os quais explicam as diferenças no metabolismo de várias drogas utilizadas na prática clínica. O único polimorfismo ultra-metabolizador é o CYP2C19*17, representado por duas substituições na região promotora que aumentam a transcrição do gene em 2-4 vezes. Os indivíduos que apresentam o haplótipo ultra-metabolizador podem ter maior atividade de 21-hidroxilação extraadrenal da progesterona e, dessa forma, não apresentarem a crise de perda de sal. O gene CYP2C19 foi sequenciado nos cinco pacientes com genótipo de forma perdedora de sal e que não desidrataram como predito, e encontramos o haplótipo ultra-metabolizador em homozigose em 1/5 pacientes e em heterozigose em 1/5 pacientes. Heterozigose para o CYP2C19*17 também foi encontrada no grupo controle (indivíduos perdedores de sal com genótipo/fenótipo concordantes). Portanto, o haplótipo CYP2C19*17 em heterozigose é insuficiente para modular a perda de sal e, provavelmente, em homozigose pode evitar a perda de sal. Em conclusão, pela primeira vez descrevemos o efeito modulador de uma variante alélica dos citocromos hepáticos P450 melhorando o fenótipo da forma perdedora de sal; no entanto, os demais casos permanecem com indefinição do genótipo. Estes resultados sugerem que não apenas uma única enzima, mas múltiplas enzimas extra-adrenais estão possivelmente envolvidas na modulação do fenótipo da deficiência da 21-hidroxilase. / Adrenal 21-hydroxylase deficiency is a common genetic disorder, caused by mutations in the CYP21A2 gene, which encodes the 21-hydroxylase P450c21. The 21-hydroxylase deficiency disrupts cortisol and aldosterone biosynthesis and leads to accumulation of androgen precursors. There are 3 main phenotypes: the simple virilizing (SV) form, in which girls present with virilized external genitalia at birth and both sexes present with precocious pseudopuberty; the salt wasting (SW) form, characterized by additional salt-wasting crisis in the neonatal period in both sexes; and the nonclassic (NC) form, in which the hyperandrogenic signs occur later in life, during childhood, adolescence or adulthood. In vitro studies show a good correlation between the degree of enzymatic impairment determined by genotype and phenotype. However, there are some discrepancies as: patients with clinical and hormonal profiles of nonclassic form in whom mutations are not found in one or both alleles, and patients with milder phenotype than the ones predicted by genotyping. These discrepancies suggest the existence of modulatory factors in 21- hydroxylase deficiency phenotype. The first hypothesis was that there were mutations in P450 oxidoreductase (POR), a gene which encodes a flavoprotein that donates electrons for all microsomal P450s, including P450c21, an essential step for P450s activity. The second hypothesis was that other enzymes that not P450c21 could perform extra-adrenal 21-hydroxylation of progesterone and 17OHprogesterone (17OHP), modulating salt balance and virilization. Hepatic drugmetabolizing P450 enzymes CYP2C19 and CYP3A4 can 21-hydroxylate progesterone; however, this activity was never compared to 21-hydroxylation performed by P450c21, in order to determine the importance of this extra-adrenal activity in vivo. The present cohort consisted of 11 patients with nonclassic form and incomplete genotype and 6 patients with genotype/phenotype discrepancies (genotype-predicted SW form and manifested SV form, n=5; genotyped-predicted SV form and manifested NC form, n=1). The POR gene was sequenced in these 17 patients, and 10/30 alleles presented the polymorphism A503V. P450c21, PORwt and POR A503V were expressed in bacteria, assayed in vitro, and the kinetics parameters Km, Vmax and Vmax/Km were calculated. Although POR A503V variant decreases the activity of P450c17, our study showed that it does not alter the 21-hydroxylation by P450c21. Therefore, there are no POR variants in this cohort that could explain discrepancies between genotype and phenotype in 21- hydroxylase deficiency. To evaluate the hypothesis of extra-adrenal 21- hydroxylation, P450c21, CYP2C19, CYP3A4, and POR were expressed in bacteria, assayed in vitro, and kinetic parameters assessed. Compared to P450c21, the Vmax/Km of 21-hydroxylation of progesterone by CYP2C19 and CYP3A4 was 17% and 10%, respectively. Neither CYP2C19 nor CYP3A4 were able to 21-hydroxylate 17OHP. Considering that little 21-hydroxylation activity is enough to produce sufficient amount of aldosterone to avoid the dehydration, this study suggests that extra-adrenal 21-hydroxylation by CYP2C19 and CYP3A4 may be able to ameliorate the mineralocorticoid, but not the glucocorticoid deficiency. CYP2C19 is very polymorphic, and some haplotypes can modify enzymatic activity. For example, the unique ultrametabolizer allele CYP2C19*17 has two polymorphisms in the promoter region that increase gene transcription in 2-4 times. Thus, patients harboring the CYP2C19 ultra-metabolizer allele could present an increased extraadrenal 21-hydroxylation of progesterone, and hence be able to avoid salt wasting crisis. CYP2C19 gene was sequenced in the 5 patients who did not present salt wasting crisis as expected, and 1/5 patients was homozygous and 1/5 patients was heterozygous for the CYP2C19*17 allele. Heterozygosity was also present in the control group (patients with salt wasting form and genotype/phenotype concordance). Therefore, heterozygosity for CYP2C19*17 seems to be insufficient to modulate salt balance but homozygosity might be able to avoid salt wasting crisis. In conclusion, we described for the first time the modulatory effect of an allelic variant of an extra-adrenal P450 enzyme ameliorating the salt wasting phenotype in a patient with 21-hydroxylase deficiency. Taken together with the remaining undefined genotypes, these results suggest that multiple extra-adrenal enzymes, rather than a single one, modulate the phenotypic expression of defects in 21-hydroxylase.