Genetic mutations resulting in estrogen insufficiency in the male

The biosynthesis of estrogens is catalyzed by an enzyme known as aromatase (aromatase cytochrome P450; P450 arom; the product of the CYP19 gene). In recent years a number of patients have been described suffering from aromatase deficiency due to mutations in the CYP19 gene, resulting in the synthesis of a non-functional gene product and a resulting failure to synthesize estrogens. Males with this condition have sustained linear growth into adulthood resulting from failure of epiphyseal closure. Osteopenia and reduced bone mineral density and bone age are also characteristic. Lack of circulating estrogens is accompanied by elevated testosterone and gonadotropins. One of the men had macroorchidism with testicular volumes in excess of 25 ml (Morishima et al. J. Clin. Endocrinol. Metab. 80, 3689, 1995). Semen analysis was not performed on this patient, but it is of note that the one patient described with estrogen insensitivity due to a mutation in the estrogen receptor had a normal sperm count, although motility was decreased (Smith et al., New England J. Med. 331. 1056, 1994). By contrast, the other man with aromatase deficiency had testicular volumes of only 8 ml per testes, and was infertile. Sperm analysis revealed a count of 1 million/ml with 100% immotile sperm (Carani et al. New England J. Med. 337, 91, 1997). However, his clinical picture is confused by the fact that another male sibling has azoospermia, but has no CYP19 mutation, suggesting that the infertility problem may be due to a second genetic condition in this consanguineous family. Recently mice have been generated in which the aromatase (CYP19) gene and the gene encoding the estrogen receptor-alpha have been inactivated by targeted disruption (ArKO and ERKO mice, respectively). Male ERKO mice are infertile with atrophy of the testes and seminiferous tubule dysmorphogenesis resulting in decreased spermatogenesis and inacive sperm. By contrast the ArKO mice are initially fertile and sire litters of normal size ad frequency, however with advancing age the number of litters sired decreases relative to those of wild type litter ates. In contrast to the ERKO mice, light microscopic analysis of the testes of the ArKO mice reveals no gross morphological abnormalties and the testes are of normal size. Following recent observations that the estrogen receptor-beta isoform is highly expressed in seminiferous epthelium, spermatids and spermatocytes, it is conceivable that the relatively high levels of estrogens present in the ERKO mice can act through the ER-beta to cause infertility by a direct action on the testes. In this context it is well known that administration of high levels of estrogen to men results in infertility. It is apparent that studies of human and mouse models with disruptions of aromatase and the estrogen receptor have as yet failed to clarify the role of estrogens in male fertility and testicular function. Development of an ER-beta knockout mouse, or else a double, or even triple, knockout model, may be required in order to resolve these issues.