Aberrant GDF9 Expression and Activation Are Associated With Common Human Ovarian Disorders

Context: Growth differentiation factor 9 (GDF9) is a central regulator of folliculogenesis and ovulation rate. Fourteen mutations in human (h) GDF9 have been reported in women with premature ovarian failure or polycystic ovarian syndrome as well as in mothers of dizygotic twins, implicating GDF9 in the etiology of these conditions. We sought to determine how these mutations alter the biological activity of hGDF9. Objective: The objective of the study was to determine whether aberrant GDF9 expression or activation is associated with common ovarian disorders. Design: Homology modeling was used to predict the location of individual mutations within structurally important regions of the pro domains and mature domains of hGDF9. Each hGDF9 variant was generated by site-directed mutagenesis, expressed from human embryonic kidney 293T cells and assessed as to whether it resulted in defective production or the enhanced activation of mature hGDF9 in an in vitro granulosa cell proliferation bioassay. Results: Mutations observed in mothers of dizygotic twins (P103S and P374L) completely abrogated GDF9 expression, suggesting that women heterozygous for these mutations would have a 50% reduction in GDF9 levels. Comparable declines in GDF9 in ewes result in a 2-fold increase in ovulation rate and fecundity. Remarkably, three prodomain mutations associated with premature ovarian failure (S186Y, V216M, and T238A) all resulted in the activation of hGDF9. Mechanistically, these mutations reduced the affinity of the prodomain for mature hGDF9, allowing the growth factor to more readily access its signaling receptors. Conclusions: Together these findings indicate that alterations to hGDF9 synthesis and activity can contribute to the most common ovarian pathologies.