Abstract
Patients with congenital adrenal hyperplasia (CAH) are at risk of long-term cognitive and metabolic sequelae with some of the effects being attributed to the chronic glucocorticoid treatment that they receive. Our pilot study investigates genome-wide DNA methylation in patients with CAH to determine whether there is preliminary evidence for epigenomic reprogramming as well as any relationship to patient outcome. Here, we analysed CD4+ T cell DNA from 28 patients with CAH (mean age = 18.5 +/- 6.5 years [y]) and 37 population controls (mean age = 17.0 +/- 6.1 y) with the Infinium-HumanMethylation450 BeadChip array to measure genome-wide locus-specific DNA methylation levels. Effects of CAH, phenotype and CYP21A2 genotype on methylation were investigated as well as the association between differentially methylated CpGs and glucose homeostasis, blood lipid profile, and cognitive functions. In addition, we report data on a small cohort of 11 patients (mean age= 19.1, +/- 6.0 y) with CAH who were treated prenatally with dexamethasone (DEX) in addition to postnatal glucocorticoid treatment.
We identified two CpGs to be associated with patient phenotype: cg18486102 (located in the FAIM2 gene; rho= 0.58, adjusted p= 0.027) and cg02404636 (located in the SFI1 gene; rho= 0.58, adjusted p= 0.038). cg02404636 was also associated with genotype (rho= 0.59, adjusted p= 0.024). Higher levels of serum C-peptide was also observed in patients with CAH (p= 0.044). Additionally, levels of C-peptide and HbA1c were positively correlated with patient phenotype (p= 0.044 and p= 0.034) and genotype (p= 0.044 and p= 0.033), respectively. No significant association was found between FAIM2 methylation and cognitive or metabolic outcome. However, SFI1 TSS methylation was associated with fasting plasma HDL cholesterol levels (p= 0.035).
In conclusion, in this pilot study, higher methylation levels in CpG sites covering FAIM2 and SFI1 were associated with disease severity. Hypermethylation in these genes may have implications for long-term cognitive and metabolic outcome in patients with CAH, although the data must be interpreted with caution due to the small sample size. Additional studies in larger cohorts are therefore warranted.