PREVALENCE OF AN IMMUNOLOGICAL LH BETA-SUBUNIT VARIANT IN A UK POPULATION OF HEALTHY WOMEN AND WOMEN WITH POLYCYSTIC-OVARY-SYNDROME

OBJECTIVE An immunological LH beta-subunit variant has been described, which is undetectable using monoclonal antibodies directed to the intact LH molecule alone. Subjects have been found homozygous or heterozygous for nucleotide mutations within codons 8 and 15 in the LH beta-subunit gene. The prevalence of the variant LH beta-subunit has been estimated in a healthy UK population of women of reproductive age and in women with polycystic ovary syndrome (PCOS). The relationship of the variant molecule to the clinical and hormonal parameters of the subjects has been evaluated. DESIGN The control and PCOS subjects were screened for the presence of the mutation by using a ratio of two immunofluorometric assays using monoclonal antibodies (Mab). One assay, not detecting the LH variant, uses a Mab directed to the intact LH molecule and a beta-specific Mab. The other assay, detecting both the variant and wildtype LH, uses two beta-subunit specific Mabs. The mutations in the LH beta-subunit gene were confirmed by restriction fragment length polymorphism. The relationship of the presence of the variant to the clinical and hormonal parameters was assessed by ANOVA. PATIENTS Two hundred and twelve normal ovulatory women, of whom 66 (31%) were obese (body mass index >25) and 146 (69%) non-obese, and 153 women with PCOS, 115 (75%) obese and 38 (25%) non-obese participated in the study. RESULTS The variant LH was detected in 31 (15%) controls and 32 (21%) PCOS subjects (P=0.124) using specific Mab. Obese PCOS had a higher incidence of the heterozygous LH variant compared to obese controls (odds ratio 2.5, P=0.03), and compared to non-obese PCOS (odds ratio 6.3, P=0.01). The previously described two mutations in codon 8 and codon 15 were present in all subjects detected to be mutant hetero or homo-zygous by RFLP. There was no relationship between the presence of the variant LH and the clinical and hormonal parameters in the PCOS subjects; however, in the controls the presence of the variant LH was associated with a higher serum total testosterone (P=0.046), oestradiol (P=0.03) and SHBG (P=0.002). CONCLUSIONS The results of this study show that the variant LH beta-subunit is a common polymorphism occurring in 15% of a healthy UK population of women. The prevalence was not higher in women with PCOS, though it was over represented in obese women with PCOS. The presence of the variant did not alter the clinical or hormonal expression of the disorder in women with PCOS. Its presence in the controls was however associated with higher serum oestradiol and probably secondary elevation of SHBG and testosterone, suggesting that the variant form of LH may be associated with subtle changes in the function of the hypothalamic-pituitary-gonadal axis.