Human Reproduction Update Advance Access originally published online on July 11, 2006
Human Reproduction Update 2006 12(5):573-584; doi:10.1093/humupd/dml031
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Pathophysiology of impaired ovarian function in galactosaemia
1 Department of Reproductive Medicine, Maternité Régionale Universitaire, Nancy Cedex, France, 2 Research Unit EA 4002, Université Nancy I, Vandoeuvre les Nancy Cedex and 3 Paediatric Intensive Care Unit, Hôpital Sainte Justine, Montréal, Québec, Canada
4 To whom correspondence should be addressed at: Department of Reproductive Medicine, Maternite Regionale Universitaire, 10, rue Dr Heydenreich BP74213, F-54042 Nancy Cedex, France. E-mail: t.forges{at}maternite.chu-nancy.fr
Classical galactosaemia is an inherited inborn error of the major galactose assimilation pathway, caused by galactose-1-phosphate uridyltransferase (GALT) deficiency. Many GALT mutations have been described, with different clinical consequences. In severe forms, newborns present with a life-threatening, acute toxic syndrome that rapidly regresses under a galactose-restricted diet. However, long-term complications, particularly cognitive and motor abnormalities, as well as hypergonadotrophic hypogonadism in female patients are still unavoidable. The pathogenesis of galactose-induced ovarian toxicity remains unclear but probably involves galactose itself and its metabolites such as galactitol and UDP-galactose. Possible mechanisms of ovarian damage include direct toxicity of galactose and metabolites, deficient galactosylation of glycoproteins and glycolipids, oxidative stress and activation of apoptosis. As there is no aetiological treatment, clinical management of ovarian failure in galactosaemic patients principally relies on hormonal replacement therapy to induce pubertal development and to prevent bone loss and other consequences of estrogen deprivation. Further investigations will be necessary to better understand the metabolic flux of galactose through its biochemical pathways and the mechanisms of these secondary complications. The aim of this article is to present an extensive review on the pathogenesis and clinical management of galactose-induced premature ovarian failure.
Key words: apoptosis / galactitol / galactosaemia / galactose / premature ovarian failure
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