Androgen receptor mutations in familial androgen insensitivity syndrome: A metabolic reprogramming pathway to type 2 diabetes susceptibility

Abstract

Familial androgen insensitivity syndrome (AIS), resulting from inherited mutations in the androgen receptor (AR) gene, has traditionally been examined within the framework of disorders of sex development. However, growing evidence indicates that AR dysfunction also disrupts systemic metabolic homeostasis, predisposing affected individuals to insulin resistance and type 2 diabetes mellitus. This article synthesizes recent advances in genetics, transcriptomics, and physiology to elucidate how AR mutations drive tissue-specific metabolic reprogramming in key organs, including pancreatic β-cells, skeletal muscle, liver, and adipose tissue. Particular attention is given to a newly identified familial AR variant (c.2117A>G; p.Asn706Ser), which not only broadens the known mutational spectrum of AIS but also underscores the clinical importance of early metabolic risk screening in this population. We further examine how pubertal stage, hormone replacement therapy, and sex-specific signaling pathways interact to influence long-term metabolic outcomes. Lastly, we propose an integrative management framework that incorporates genetic diagnosis, endocrine surveillance, and personalized pharmacological strategies aimed at reducing the risk of type 2 diabetes mellitus and cardiometabolic complications in individuals with AIS. Distinct from previous AIS-centered reviews, this work integrates metabolic and endocrine perspectives into the traditional developmental paradigm, offering a more comprehensive understanding of disease risk and translational management.

Keywords: Androgen insensitivity syndrome; Androgen receptor; Gene mutation; Metabolic reprogramming; Type 2 diabetes

Core Tip: Familial androgen insensitivity syndrome (AIS), caused by androgen receptor gene mutations, has long been viewed as a disorder of sex development. However, recent findings revealed that androgen receptor dysfunction also drives metabolic reprogramming in key tissues - pancreatic β-cells, skeletal muscle, liver, and adipose tissue - leading to insulin resistance and increased susceptibility to type 2 diabetes mellitus. This article highlights emerging evidence of glucagon-like peptide-1 signaling disruption, mitochondrial dysfunction, and inflammatory imbalance in AIS. We propose an integrated framework of genetic screening, endocrine surveillance, and individualized therapy to improve long-term metabolic outcomes and prevent cardiometabolic complications in AIS patients.