Diverse phenotypes and fertility outcomes of patients with androgen insensitivity syndrome in a Chinese family harboring identical AR gene variant

• Published in: BMC medical genomics Vol. 17; no. 1; pp. 249 - 8
• Main Authors: Geng, Hao, Tang, Dongdong, Li, Kuokuo, Xu, Chuan, Wang, Chao, Zhang, Xiansheng, He, Xiaojin, Cao, Yunxia
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 11.10.2024; BioMed Central; BMC
• Subjects: Adult; Amenorrhea; Analysis; Androgen insensitivity syndrome; Androgen receptors; Androgen-Insensitivity Syndrome - genetics; Androgens; Androgens concentration; Care and treatment; China; Cryptorchidism; Diagnosis; East Asian People - genetics; Exome Sequencing; Female; Females; Fertility; Fertility - genetics; Fertility outcomes; Gene mutations; Genes; Genetic aspects; Genetic counseling; Genetic disorders; Genetic diversity; Genetic variation; Genotype & phenotype; Genotypes; Health aspects; Hormones; Humans; Infertility; Male; Mutation; Mutation, Missense; Patients; Pedigree; Phenotype; Phenotype diversity; Phenotypes; Phenotypic variations; Point mutation; Proteins; Receptors, Androgen - genetics; Reproductive technologies; Sperm; Spermatogenesis; Whole genome sequencing; China; Androgen insensitivity syndrome; Phenotype diversity; AR; Androgens concentration; Fertility outcomes
• ISSN: 1755-8794; 1755-8794
• DOI: 10.1186/s12920-024-01990-9

Androgen insensitivity syndrome (AIS) is a rare genetic disorder characterized by resistance to androgens, mainly due to mutations in the androgen receptor (AR) gene. It can manifest as complete AIS, partial AIS and mild AIS. While there have been studies linking specific AR gene mutations to AIS phenotypes, different clinical AIS phenotypes are also reported in patients with the same AR gene mutation. So far, the precise correlations between phenotypes and genotypes remain incompletely understood. We conducted a thorough investigation involving four patients diagnosed with different types of AIS from a single Chinese family. Clinical manifestations, laboratory examinations, and fertility outcomes were well-documented. Furthermore, we performed genetic sequencing to detect possible pathogenetic variants. Whole exome sequencing identified a hemizygous missense variant (c.2263T > C; p.Phe755Leu) of AR gene in all four affected patients with different degrees of undermasculinisation and heterogeneous spermatogenesis. The proband, diagnosed with partial AIS, opted for treatment with donated sperm due to non-obstructive azoospermia, while their older sibling, diagnosed with complete AIS, was raised as a girl. His two maternal uncles were both diagnosed with mild AIS, the older uncle fathered two girls naturally, whereas the younger uncle utilized assisted reproductive technology to conceive a boy because of severe oligoasthenozoospermia. Our study first identified the same AR variant (c.2263T > C;p.Phe755Leu) in four affected patients displaying highly diverse phenotypes of AIS and fertility outcomes, thereby significantly expanding the phenotypic spectrum of AIS. Notably, we presented a clear insight into different fertility outcomes of AIS patients with identical AR (c.2263T > C;p.Phe755Leu) variant, which provided reliable evidence that males harboring this variant may obtain biological offspring naturally or in combination with assisted reproductive technology. Furthermore, our study underscored the potential role of androgen concentration in shaping the phenotypic diversity of AIS, warranting further investigation.