A complete form of testicular feminisation syndrome; a light and electron microscopy study

Androgen receptor roles in spermatogenesis and fertility: lessons from testicular cell-specific androgen receptor knockout mice

Androgens are critical steroid hormones that determine the expression of the male phenotype, including the outward development of secondary sex characteristics as well as the initiation and maintenance of spermatogenesis. Their actions are mediated by the androgen receptor (AR), a member of the nuclear receptor superfamily. AR functions as a ligand-dependent transcription factor, regulating expression of an array of androgen-responsive genes. Androgen and the AR play important roles in male spermatogenesis and fertility. The recent generation and characterization of male total and conditional AR knockout mice from different laboratories demonstrated the necessity of AR signaling for both external and internal male phenotype development. As expected, the male total AR knockout mice exhibited female-typical external appearance (including a vagina with a blind end and a clitoris-like phallus), the testis was located abdominally, and germ cell development was severely disrupted, which was similar to a human complete androgen insensitivity syndrome or testicular feminization mouse. However, the process of spermatogenesis is highly dependent on autocrine and paracrine communication among testicular cell types, and the disruption of AR throughout an experimental animal cannot answer the question about how AR in each type of testicular cell can play roles in the process of spermatogenesis. In this review, we provide new insights by comparing the results of cell-specific AR knockout in germ cells, peritubular myoid cells, Leydig cells, and Sertoli cells mouse models that were generated by different laboratories to see the consequent defects in spermatogenesis due to AR loss in different testicular cell types in spermatogenesis. Briefly, this review summarizes these results as follows: 1) the impact of lacking AR in Sertoli cells mainly affects Sertoli cell functions to support and nurture germ cells, leading to spermatogenesis arrest at the diplotene primary spermatocyte stage prior to the accomplishment of first meiotic division; 2) the impact of lacking AR in Leydig cells mainly affects steroidogenic functions leading to arrest of spermatogenesis at the round spermatid stage; 3) the impact of lacking AR in the smooth muscle cells and peritubular myoid cells in mice results in similar fertility despite decreased sperm output as compared to wild-type controls; and 4) the deletion of AR gene in mouse germ cells does not affect spermatogenesis and male fertility. This review tries to clarify the useful information regarding how androgen/AR functions in individual cells of the testis. The future studies of detailed molecular mechanisms in these in vivo animals with cell-specific AR knockout could possibly lead to useful insights for improvements in the treatment of male infertility, hypogonadism, and testicular dysgenesis syndrome, and in attempts to create safe as well as effective male contraceptive methods.

Differential effects of spermatogenesis and fertility in mice lacking androgen receptor in individual testis cells

Using a Cre-Lox conditional knockout strategy, we generated a germ cell-specific androgen receptor (AR) knockout mouse (G-AR(-/y)) with normal spermatogenesis. Sperm count and motility in epididymis from AR(-/y) mice are similar to that of WT (G-AR(+/y)) mice. Furthermore, fertility tests show there was no difference in fertility, and almost 100% of female pups sired by G-AR(-/y) males younger than 15 weeks carried the deleted AR allele, suggesting the efficient AR knockout occurred in germ cells during meiosis. Together, these data provide in vivo evidence showing male mice without AR in germ cells can still have normal spermatogenesis and fertility, suggesting the essential roles of AR during spermatogenesis might come from indirect cell-cell communication in a paracrine fashion. We then compared the consequences of AR loss in the spermatogenesis and fertility of G-AR(-/y) mice with two other testicular cell-specific AR(-/y) mice and total AR knockout male mice. The results provide clear in vivo evidence that androgen/AR signaling in Sertoli cells plays a direct important role in spermatogenesis and in Leydig cells plays an autocrine regulatory role to modulate Leydig cell steroidogenic function. Total AR knockout male mice have the most severe defects among these mice. These contrasting data with G-AR(-/y) mice suggest AR might have different roles in the various cells within testis to contribute to normal spermatogenesis and male fertility in mice.

Male pseudohermaphroditism in XY children with female phenotype

Twenty-two children with female external genitalia, testes, and 46,XY karyotype, most presenting with inguinal lumps or hernias, underwent bilateral gonadal excision (21 patients) or biopsy. On clinical and biochemical grounds, 13 were classed as androgen resistance (AR), 6 as testosterone biosynthetic defect, 2 as XY gonadal dysgenesis, and 1 as 5 alpha-reductase deficiency. The main pathological difference between the groups was that in AR the gonocytes were present in normal numbers, whereas in testosterone biosynthetic defect, gonocytes, though present in infancy, were rare or absent by 12 years. In all groups, Leydig cells, normally not recognizable between 1 year and puberty, were often present and could not always be attributed to a gonadotropin stimulation test. In four cases the tubules were more heterogeneous than those seen in control testes, but tubular atrophy and increased stroma were indistinguishable from those in age-matched cryptorchid controls. Small Sertoli cell nodules were found in three children, but no carcinoma in situ was identified. The epididymis, said to be absent in adult cases of AR, was consistently present but often cystic or atrophic. Oviduct-like structures were found in three cases of AR, and smooth muscle resembling round ligament in four. Because of the difficulty in distinguishing the types of male pseudohermaphroditism microscopically, we recommend that XY female children should undergo thorough endocrinologic investigation before orchidectomy.

Immunohistochemical and ultrastructural study of Sertoli cells in androgen insensitivity

The ultrastructure of a perfusion-fixed gonad in a case of androgen insensitivity was studied using thin sections and freeze-fracture replicas. The distribution and arrangement of intermediate filaments in Sertoli cells was visualized immunohistochemically using an antibody against vimentin. Leydig cells lacked Reinke crystals, but contained all of the cytoplasmic organelles involved in steroid synthesis and additionally several lysosomes. The basement membrane and the basal lamina of the testicular tubules were considerably thickened. The testicular tubules consisted of gonocytes and Sertoli cells which had an immature nuclear structure, incomplete development of intercellular junctions and a primitive distribution pattern of intermediate cytoplasmic filaments. The previously reported differences in electron density of Sertoli cell cytoplasm are a non-specific feature without significance to Sertoli cell maturation.