Androgen Receptor, Implications for Health and Wellbeing: Natural History Study of Individuals With Androgen Insensitivity

Androgen Receptor, Implications for Health and Wellbeing: Natural History Study of Individuals With Androgen Insensitivity

Sponsors

Lead Sponsor: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Source National Institutes of Health Clinical Center (CC)
Brief Summary

Background: Androgen effects in humans are usually (but not always) mediated by the androgen receptor which is coded for by the androgen receptor gene (AR gene). Androgen Insensitivity Syndrome (AIS) is a rare condition in which the body cannot sense the male hormones in the blood or tissue. Both women and men can be affected by AIS. Researchers want to learn more about the health of people with AIS over time. With a natural history study in individuals with AIS, data and tests may provide information regarding health risks (including the risks and benefits of gonadectomy and best ways to monitor for tumor) and optimal management of individuals with AIS as well as elucidate the role of the androgen receptor in human health. This study does not involve any interventions and we can provide clinical care while collecting data. Objective: The objective of this natural history study is to describe and define a comprehensive phenotype (characteristic) of patients with AIS based on confirmed androgen receptor (AR) gene difference. We will evaluate hormones, bone density and markers, cardiovascular and metabolic parameters, as well as quality of life and tumor formation risk and evaluation. The purpose is to obtain a better understanding of the overall health issues that people with AIS may have through the study procedures listed. Eligibility: People ages 0-99 with AIS and their adult relatives Design: Participants will go through a series of study procedures for data and specimen collection. This will be done to understand how AIS affects individuals since the androgen receptor is found in many tissues in the body including skin, bone, muscle, and the neurologic, immune and metabolic systems. All tests will be performed by skilled and trained study professionals. Participants will be screened with: Medical history Physical exam Medical record review Lab tests. Participants will have physical exams. Their body measurements will be taken. They will have blood and urine tests. They will have electrocardiograms to check heart health. They may complete questionnaires. They may have an Oral Glucose Tolerance Test. Participants may have x-rays taken of the hand, wrist, and other bones. Participants will have body scans to measure bone thickness. Participants will have magnetic resonance imaging (MRI) or sonogram of the pelvis. For MRI, they may get a contrast agent via intravenous (IV) catheter. Adult participants may have the following: MR elastography. It uses MRI and low-frequency vibrations to map stiffness of body tissues. MR spectroscopy. It uses MRI to take pictures of chemicals in the liver and body fat. Cardiac computed tomography scan. It uses x-rays to make pictures of the heart. Participants may get a contrast agent via IV. Optional genital exam. Participants will have visits every 1-2 years. Participation lasts indefinitely. Adult relatives will also be invited to participate but will have only 1 visit. It will include some of the above tests.

Detailed Description

Androgen effects in humans are usually (but not always) mediated by the androgen receptor which is coded for by the androgen receptor gene (AR gene). Individuals with abnormalities of this receptor gene can present with androgen insensitivity syndrome (AIS). There are a variety of phenotypes including complete female phenotype (complete androgen insensitivity or CAIS), ambiguous genitalia in cases of partial androgen insensitivity (PAIS) and male phenotype associated with infertility of hypospadias in mild cases of AIS. Complete androgen insensitivity is a rare condition with an estimated incidence of 1:20,000-64,000, while PAIS is rarer still and mild AIS has likely not been studied enough to ascertain it s prevalence. Individuals with complete and partial AIS present some management conundrums as traditionally they have undergone gonadectomy in order to avoid gonadal tumors as well as pubertal virilization in girls with PAIS. Because this is a rare condition, little is known regarding the risks and benefits of gonadectomy, optimal hormone replacement after gonadectomy as well as general health in individuals with these conditions. Furthermore, the androgen receptor is found in many tissues in the body including skin, bone, muscle, and the neurologic, immune and metabolic systems. Finally, some testosterone effects may be through mechanisms other than AR receptor and these are not well understood. A natural history study in individuals with AIS may provide information regarding health risks and optimal management of individuals with AIS as well as elucidate the role of the androgen receptor in human health.

Overall Status Recruiting
Start Date 2021-07-28
Completion Date 2040-02-01
Primary Completion Date 2040-02-01
Study Type Observational
Primary Outcome
Measure Time Frame
To define and describe a comprehensive phenotype in 500 patients with androgen insensitivity End of study
Secondary Outcome
Measure Time Frame
Evaluate Bone Health in individuals with Androgen Insensitivity End of study
Metabolic assessment in individuals with Androgen Insensitivity End of study
Gonadal Tumor evaluation in individuals with Androgen Insensitivity End of study
Quality of life measures (QoL) in individuals with Androgen Insensitivity End of study
Effects of hormone therapy in individuals with Androgen Insensitivity End of study
Enrollment 650
Condition
Eligibility

Sampling Method:

Non-Probability Sample

Criteria:

- INCLUSION CRITERIA: Inclusion Criteria for AIS subjects In order to be eligible to participate in this study, an individual must meet all the following criteria: 1. Individuals ages 0-99 years old with known androgen insensitivity based on pathologic androgen receptor gene mutation 2. Identify as male or female 3. Patients with both complete, partial and mild androgen insensitivity are eligible 4. Stated willingness to comply with all study procedures and availability for the duration of the study 5. Ability of subject or guardian to understand and the willingness to sign and date a written informed consent document. Inclusion Criteria for Relative of AIS subjects 1) Adult Relatives of patients with AIS EXCLUSION CRITERIA: Exclusion Criteria for AIS subjects 1. An individual who meets any of the following criteria will be excluded from participation in this study: Patients with other diagnosis such as partial or complete gonadal dysgenesis, 5-alpha reductase deficiency, and 46 XY. If, following a diagnostic work-up, a patient is determined to have causes for 46 XY DSD other than androgen insensitivity; they will no longer be followed on this protocol. They will have the opportunity to continue care with the team under the Data Collection Protocol or may be referred to an expert or multidisciplinary DSD team in the community 2. Patients with significant non-endocrine medical conditions. Exclusion Criteria for Relative of AIS subjects 1) Patients with significant non-endocrine medical conditions. INCLUSION OF VULNERABLE PARTICIPANTS Participation of Children Children will be included in this protocol as AIS is often diagnosed early in life and has effects on puberty and development. Every effort will be made to protect children s rights and safety. Participation of Employees NIH employees may be enrolled in this study as this population meets the study entry criteria. Neither participation nor refusal to participate as a subject in the research will have an effect, either beneficial or adverse, on the participant s employment or position at NIH.

Gender:

All

Minimum Age:

N/A

Maximum Age:

99 Years

Healthy Volunteers:

Accepts Healthy Volunteers

Overall Official
Last Name Role Affiliation
Veronica Gomez-Lobo, M.D. Principal Investigator Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Overall Contact

Last Name: Veronica Gomez-Lobo, M.D.

Phone: (301) 435-7567

Email: [email protected]

Location
Facility: Status: Contact: National Institutes of Health Clinical Center For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR) 800-411-1222 TTY8664111010 [email protected]
Location Countries

United States

Verification Date

2021-04-09

Responsible Party

Type: Sponsor

Keywords
Has Expanded Access No
Condition Browse
Arm Group

Label: Female subjects relatives who are carriers of the AR gene diff

Description: We will enroll 50 female subjects relatives AIS subjects who are carriers of the AR gene difference

Label: Female subjects relatives who are not carriers of the AR gene

Description: We will enroll 50 female subjects relatives of AIS subjects who are not carriers of the AR gene.

Label: Healthy male subjects relatives

Description: We will enroll 50 healthy male subjects of AIS relative subjects

Label: Subjects with androgen receptor mutations

Description: 500 Subjects with confirmed androgen receptor mutations

Study Design Info

Observational Model: Cohort

Time Perspective: Prospective

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