title: A rapidly progressive defective spermatogenesis in a Mexican family affected by spino-bulbar muscular atrophy.
abstract: Spino-bulbar muscular atrophy (SBMA) is an X-linked recessive adult progressive disorder affecting motor neurons. It is caused by a poly-glutamine tract expansion in the androgen receptor (AR) which generates protein aggregates that cannot be processed by proteasomes. A secondary mild androgen resistance is developed by AR dysfunction and patients present endocrine abnormalities including gynecomastia and poor function of testosterone in tissues; however, normally they are fertile. In this report we describe a Mexican family with three affected brothers with primary infertility caused by a progressive impairment of spermatogenesis leading to azoospermia before 40 years of age. They presented common features associated to patients affected by SMBA, such as gynecomastia, high level of CPK, muscle cramps, fasciculations, muscle wastage, and impaired swallowing. Two intracytoplasmic sperm injection (ICSI) cycles were performed in one of the patients resulting in fertilization failure. Molecular analysis of AR gene exon 1 revealed 54 CAG repeats in DNA extracted from leukocytes in affected patients and 22 repeats in the fertile non-affected brother. Severe impaired spermatogenesis of rapid progression has not been associated before to SBMA. This is the first report of assisted reproduction techniques indicated by male infertility in patients with this rare disorder. Further studies are required to confirm the unusual result of intracytoplasmic sperm injection cycles. We discuss the implications and possible pathogenesis of these unique features of SBMA in this family.
authors.affiliation: a Medical Genomics Division , Centro Médico Nacional "20 de Noviembre" ISSSTE , México City , México.
authors.forename: Raul Eduardo
authors.initials: RE
authors.lastname: Piña-Aguilar
authors.affiliation: b Department of Human Reproduction , Centro Médico Nacional "20 de Noviembre" ISSSTE , Mexico City , México.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Regalado-Hernández
authors.affiliation: b Department of Human Reproduction , Centro Médico Nacional "20 de Noviembre" ISSSTE , Mexico City , México.
authors.forename: Jesús Daniel
authors.initials: JD
authors.lastname: Moreno-García
authors.affiliation: c Department of Genetics-Research Unit , Instituto de Oftalmología "Conde de Valenciana" , Mexico City , México.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Buentello-Volante
authors.affiliation: c Department of Genetics-Research Unit , Instituto de Oftalmología "Conde de Valenciana" , Mexico City , México.
authors.forename: Oscar Francisco
authors.initials: OF
authors.lastname: Chacón-Camacho
authors.affiliation: d Service of Medical Genetics , UMAE Hospital de Gineco-Pediatría No. 48, IMSS , León , México.
authors.forename: Mayra Celina
authors.initials: MC
authors.lastname: Gallegos-Rivas
authors.affiliation: e Medical Genetics Department , Centro Médico Nacional "20 de Noviembre", ISSSTE , Mexico City , México.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Kazakova
authors.affiliation: f Department of Biochemistry, Facultad de Medicina , Universidad Nacional Autónoma de México (UNAM) , Mexico City , México.
authors.forename: Yuritzi
authors.initials: Y
authors.lastname: Santillán-Hernández
authors.affiliation: c Department of Genetics-Research Unit , Instituto de Oftalmología "Conde de Valenciana" , Mexico City , México.|f Department of Biochemistry, Facultad de Medicina , Universidad Nacional Autónoma de México (UNAM) , Mexico City , México.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Zenteno
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000209:etiology* / Q000235:genetics; D004247:DNA; D005260:Female; D006801:Humans; D008297:Male; D009134:Muscular Atrophy, Spinal / Q000150:complications* / Q000235:genetics; D011944:Receptors, Androgen / Q000235:genetics; D012091:Repetitive Sequences, Nucleic Acid; D035781:Siblings; D020554:Sperm Injections, Intracytoplasmic; D013091:Spermatogenesis
chemical_list: D011944:Receptors, Androgen; D004247:DNA
keywords: Androgen receptor; ICSI; azoospermia; male infertility