4.7 Article

Homozygous pathogenic variants in ACTL9 cause fertilization failure and male infertility in humans and mice

期刊

AMERICAN JOURNAL OF HUMAN GENETICS
卷 108, 期 3, 页码 469-481

出版社

CELL PRESS
DOI: 10.1016/j.ajhg.2021.02.004

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资金

  1. National Key Research and Development Program of China [2016YFC1000200]
  2. Science and Technology Major Project of the Ministry of Science and Technology of Hunan Province, China [2017SK1032]
  3. Hunan Provincial Grant for Innovative Province Construction [2019SK4012]
  4. Scientific Research Foundation of Reproductive and Genetic Hospital of China International Trust Investment Corporation (CITIC) Xiangya [YNXM-201907, YNXM-201810]

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Genetic variations in the ACTL9 gene in male individuals have been found to cause total fertilization failure (TFF). These variations disrupt the perinuclear theca structure and affect the localization of PLCz in sperm, leading to abnormal calcium oscillations in oocytes and subsequent TFF. Overcoming TFF can be achieved through assisted oocyte activation with calcium ionophore exposure.
Total fertilization failure (TFF) can occur during in vitro fertilization (IVF) treatments, even following intracytoplasmic sperm injection (ICSI). Various male or female factors could contribute to TFF. Increasing evidence suggested that genetic variations in PLCZ1, which encodes 1-phosphatidylinositol 4,5-bisphosphate phosphodiesterase zeta-1 (PLCz), is involved in oocyte activation and is a key male factor in TFF. In the present study, we explored the genetic variants in male individuals that led to TFF. A total of 54 couples with TFF or poor fertilization (fertilization rate < 20%) were screened, and 21 couples were determined to have a male infertility factor by the mouse oocyte activation test. Whole-exome sequencing of these 21 male individuals identified three homozygous pathogenic variants in ACTL9 (actin like 9) in three individuals. ACTL9 variations led to abnormal ultrastructure of the perinuclear theca (PT), and PLCz was absent in the head and present in the neck of the mutant sperm, which contributed to failed normal calcium oscillations in oocytes and subsequent TFF. The key roles of ACTL9 in the PT structure and TFF after ICSI were further confirmed in an Actl9-mutated mouse model. Furthermore, assisted oocyte activation by calcium ionophore exposure successfully overcame TFF and achieved live births in a couple with an ACTL9 variant. These findings identified the role of ACTL9 in the PT structure and the correct localization of PLCz. The results also provide a genetic marker and a therapeutic option for individuals who have undergone ICSI without successful fertilization.

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