Mulibrey nanism is an autosomal recessive
growth disorder caused by mutations in the TRIM37 gene encoding a
protein of unknown function. More than half of female patients with
Mulibrey nanism develop benign mesenchymal
tumors of ovarian sex cord-stromal origin. In this work, we characterize the gynecological
tumors of female patients with
Mulibrey nanism in detail. In addition to
tumors of the fibrothecoma group, 18% (4/22) of the patients were observed with epithelial
neoplasias, including 2 ovarian
adenofibromas, 1 ovarian poorly differentiated
adenocarcinoma and 1 endometrial
adenocarcinoma. To investigate the possible involvement of TRIM37 alterations in the pathogenesis of sporadic fibrothecomas, we analyzed the TRIM37
cDNA for mutations and alternatively spliced transcripts and TRIM37 expression in fibrothecomas of women without
Mulibrey nanism. No mutations in the open-reading frame of TRIM37 were detected. Two alternatively spliced variants were found, one lacking exon 23 and one exon 2. TRIM37del2 was also found in normal ovary but in a proportion of sporadic fibrothecomas, the TRIM37del2:TRIM37 ratio was increased. In normal ovary, TRIM37 was localized in the cytoplasm of stromal cells, especially theca cells surrounding developing follicles. TRIM37 transcript was found in all sporadic fibrothecomas examined, but 80% (20/25) of the
tumors showed reduced or absent expression of TRIM37
protein. Allelic loss at the TRIM37 locus (17q22-23) was observed in 6% of sporadic fibrothecomas. Nearly half of the sporadic fibrothecomas showed evidence of CpG promoter methylation, suggesting promoter downregulation as one mechanism of reduced TRIM37 expression. In conclusion, inherited biallelic inactivation of TRIM37 (
Mulibrey nanism) predisposes to both mesenchymal and epithelial ovarian
tumors and dysregulation of TRIM37 may also be involved in the pathogenesis of sporadic fibrothecomas.