A homozygous FANCM frameshift pathogenic variant causes male infertility

Purpose: Fanconi anemia (FA) genes play important roles in spermatogenesis. In mice, disruption of Fancm impairs male fertility and testicular integrity, but whether FANCM pathogenic variants (PV) similarly affect fertility in men is unknown. Here we characterize a Pakistani family having three infertile brothers, two manifesting oligoasthenospermia and one exhibiting azoospermia, born to first-cousin parents. A homozygous PV in FANCM (c. 1946_1958del, p. P648Lfs*16) was found cosegregating with male infertility. Our objective is to validate that FANCM p. P648Lfs*16 is the PV causing infertility in this family. Methods: Exome and Sanger sequencing were used for PV screening. DNA interstrand crosslink (ICL) sensitivity was assessed in lymphocytes from patients. A mouse model carrying a PV nearly equivalent to that in the patients (Fancm(Delta C/Delta C)) was generated, followed by functional analysis in spermatogenesis. Results: The loss-of-function FANCM PV increased ICL sensitivity in lymphocytes of patients and Fancm(Delta C/Delta C) spermatogonia. Adult Fancm(Delta C/C) mice showed spermatogenic failure, with germ cell loss in 50.2% of testicular tubules and round-spermatid maturation arrest in 43.5% of tubules. In addition, neither bone marrow failure nor cancer/tumor was detected in all the patients or adult Fancm(Delta C/Delta C) ice. Conclusion: These findings revealed male infertility to be a novel phenotype of human patients with a biallelic FANCM PV.