Mosaicism due to a somatic mutation of the androgen receptor gene determines phenotype in androgen insensitivity syndrome

J Clin Endocrinol Metab. 1997 Nov;82(11):3584-9. doi: 10.1210/jcem.82.11.4375.

Abstract

Premature stop codons of the human androgen receptor (AR) gene are usually associated with a complete androgen insensitivity syndrome. We, however, identified an adult patient with a 46,XY karyotype carrying a premature stop codon in exon 1 of the AR gene presenting with signs of partial virilization: pubic hair Tanner stage 4 and clitoral enlargement. No other family members were affected. A point mutation at codon position 172 of the AR gene was detected that replaced the original TTA (Leu) with a premature stop codon TGA (opal). Careful examination of the sequencing gel, however, also identified a wild-type allele, indicating a mosaicism. In addition, elimination of the unique AflII recognition site induced by the mutation was incomplete, thus confirming the coexistence of mutant and wild-type AR alleles in the patient. Normal R1881 binding and a normal 110/112-kDa AR doublet in Western immunoblots consolidated the molecular genetic data by demonstrating the expression of the wild-type AR in the patient's genital skin fibroblasts. Transfection analysis revealed that only relatively high plasmid concentrations carrying the mutated AR complementary DNA lead to expression of a shortened AR due to downstream reinitiation at methionine 189. Thus, reinitiation does not play a role in the presentation of the phenotype; rather, the partial virilization is caused by the expression of the wild-type AR due to a somatic mosaic. We conclude that somatic mosaicism of the AR gene can represent a substantial factor for the individual phenotype by shifting it to a higher degree of virilization than expected from the genotype of the mutant allele alone.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Androgen-Insensitivity Syndrome / genetics*
  • Base Sequence
  • Blotting, Western
  • DNA / analysis
  • Gene Expression
  • Humans
  • Male
  • Metribolone / metabolism
  • Mosaicism*
  • Mutation*
  • Phenotype*
  • Polymerase Chain Reaction
  • Receptors, Androgen / genetics*
  • Receptors, Androgen / metabolism
  • Transcriptional Activation
  • Transfection

Substances

  • Receptors, Androgen
  • Metribolone
  • DNA