A mutation of the 13-domain in POU1F1 causes pituitary deficiency due to dominant PIT-113 expression

Background: POU1F1 encodes both PIT-1 alpha, which plays pivotal roles in pituitary development and GH, PRL and TSHB expression, and the alternatively spliced isoform PIT-1 beta, which contains an insertion of 26-amino acids (beta-domain) in the transactivation domain of PIT-1 alpha due to the use of an alternative splice acceptor at the end of the first intron. PIT-1 beta is expressed at much lower levels than PIT-1 alpha and represses endogenous PIT-1 alpha transcriptional activity. Although POU1F1 mutations lead to combined pituitary hormone deficiency (CPHD), no patients with beta-domain mutations have been reported. Results: Here, we report that a three-generation family exhibited different degrees of CPHD, including growth hormone deficiency with intrafamilial variability of prolactin/TSH insufficiency and unexpected prolactinoma occurrence. The CPHD was due to a novel POU1F1 heterozygous variant (c.143-69T>G) in intron 1 of PIT-1 alpha (RefSeq number NM_000306) or as c.152T>G (p.Ile51Ser) in exon 2 of PIT-1 beta (NM_001122757). Gene splicing experiments showed that this mutation yielded the PIT-1 beta transcript without other transcripts. The lymphocyte PIT-1 beta mRNA expression was significantly higher in the patients with the heterozygous mutation than a control. A luciferase reporter assay revealed that the PIT-1 beta-Ile51Ser mutant repressed PIT-1 alpha and abolished transactivation capacity for the rat prolactin promoter in GH3 pituitary cells. Conclusions: We describe, for the first time, that the PIT-1 beta mutation can cause CPHD through a novel genetic mechanism, such as PIT-1 beta overexpression, and that POU1F1 mutation might be associated with a prolactinoma. Analysis of new patients and long-term follow-up are needed to clarify the characteristics of PIT-1 beta mutations.

Automated summary

This study reported a three-generation family with varying degrees of CPHD, including growth hormone deficiency and intrafamilial variability of prolactin/TSH insufficiency, as well as unexpected prolactinoma occurrence. The findings suggest that PIT-1 beta mutation can cause CPHD through a novel genetic mechanism, such as PIT-1 beta overexpression, and indicate that POU1F1 mutation might be associated with prolactinoma. Further analysis and long-term follow-up of new patients are needed to clarify the characteristics of PIT-1 beta mutations.