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Table 1.

Hormonal and clinical data of patients.

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Fig 1.

Electropherogram of NR5A1 mutations.

Electropherogram of the heterozygous c.118A>C mutation in patient 1 (A), the nonframeshift deletion c.51_65delGGACAAGGTGTCCGG in patient 2 (B), the frame-shift deletion c.630_636delGTACGGC in patient 3 (C) and the pedigree of the family of patient 3 and 4 (D). Circles denote phenotypic females, squares denote phenotypic males. Filled squares and circles correspond to a DSD condition, dots to a carrier status.

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Fig 2.

Schematic view of NR5A1.

Scheme of the DNA-binding domain containing the zinc finger domain (ZnF) and the Ftz-F1 box, the hinge region (HR) and the ligand binding domain (LBD) with activation function 2 (AF2) of NR5A1. Positions of the mutation p.T40P, p.D18_G22del and amino acid Y211 are indicated.

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Fig 3.

Transactivation of the human AMH- and STAR-promoter.

The transactivation capacity of mutant NR5A1-T40P and NR5A1-18DKVSG22del were compared to wt-NR5A1 using human AMH- (A) and STAR-promoter (B) containing reporter genes. The empty pCMV-Myc vector represents background activity. Wild type (WT) activity was set 100%. RLU = relative luciferase activity. Error bars represent standard deviations, ***P = <0.001, t-test comparison of WT and mutant. C: Immunoblot detection of myc-tagged NR5A1 proteins. Equal loadings were verified by detection of total proteins using the TGX Stain Free system (BioRad). D: statistical analysis of 3 western blots of three different experiments showing an approximately equal protein accumulation of NR5A1-WT and mutant 18DKVSG22del, while mutant T40P showed an 2–3 fold enhanced accumulation. Images were quantified and normalized to total protein using Image Lab 5.2.1 (BioRad).

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Fig 4.

Electrophoretic mobility shift assay of NR5A1 mutants.

A) DNA-binding capability of mutant NR5A1-T40P and NR5A1-18DKVSG22del were compared to wt-NR5A1 using a SF-1 responsive element of the mouse Amh promoter. Nuclear extracts containing WT-SF1 shifted the labelled probe (arrow). A 200 fold excess of unlabelled competitor abolished the shifted signal, while a 200 fold excess of unlabelled mutated competitor rescues the shifted signal. Both mutant proteins have lost their DNA-binding capability. B) Aliquots of the nuclear extracts used in EMSA were separated by SDS gel electrophoresis, transferred to a nitrocellulose membrane and stained with Ponceau S and anti-myc antibodies to verify equal SF-1 protein concentrations.

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Fig 4 Expand