Hypersecretion of androgens by polycystic ovaries: the role of genetic factors in the regulation of cytochrome P450c17 alpha.

A single base change has been found in the promoter region of CYP17, the gene encoding P450c17 alpha, which appears to be a significant factor in the expression of hyperandrogenism in PCO but which can be excluded as the primary genetic defect. These findings are consistent with the biochemical data from the studies of patients with PCOS reported above, in which the production of ovarian 17 hydroxyprogesterone and androstenedione were observed to be greatly increased but the generation of progesterone was also exaggerated in PCO theca. Thus, genetic factors may well be involved in the observed dysregulation of 17 hydroxylase/17,20 lyase, but this does not appear to be the whole story. It remains a tenable hypothesis that a single-gene effect is the major cause of PCOS and that a gene involved in the expression of androgen production will be implicated. On the other hand, increased androgen production may be a reflection of an 'upstream' abnormality in the ovary, perhaps involving the fundamental processes of proliferation, differentiation and atresia in ovarian follicles. It is also possible that PCOS is truly polygenic and that CYP17 is one of several genes-including those related to insulin secretion and action-that contribute to the PCOS phenotype. Further candidate genes will need to be investigated using well-characterized, large families, but if several predisposing genes are involved, other approaches may be applicable, for example analysis of shared alleles by affected sibling pairs, which has proved valuable in understanding the genetics of type 1 diabetes (Davies et al, 1994). In conclusion, PCOS--one of the most common endocrinopathies--remains an enigmatic condition but one which may prove to be an important model for understanding the interaction of genetic and environmental factors in the aetiology of endocrine disorders.