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Factors controlling testis descent

I Hughes, Dept. of Pediatrics / Box 116, Level E8, Addenbrookes Hospital, Cambridge, CB2 2QQ, United Kingdom
C Acerini, Department of Pediatrics, Addenbrookes Hospital, Cambridge , United Kingdom

Correspondence: Ieuan Hughes, Email: iah1000{at}cam.ac.uk

Abstract

Descent of the testis from an intra-abdominal site in fetal life to an extra-corporeal location after birth is a mandatory developmental process to ensure the mature testis promotes normal spermatogenesis. The two phases of transabdominal and inguinoscrotal descent occur approximately during the first and last thirds of gestation, respectively. Key anatomical events to release the testis from its urogenital ridge location and to guide the free gonad in to the scrotum are degeneration of the cranio-suspensory ligament and a thickening of the gubernaculum. Androgens play a role in both these processes, particularly with respect to enabling the testis to traverse the inguinal canal in the final phase of descent. Experiments in animals suggest that androgens mediate this effect via release of calcitonin gene-related peptide by the genito-femoral nerve, but direct evidence for such a mechanism is lacking in humans. The transabdominal phase of descent is under the control of insulin-like factor 3 (INSL3), a product of the Leydig cells. Definitive evidence of its role in rodent testis descent is illustrated by the phenotype of bilateral cryptorchidism in insl3-/- null mice. Circulating levels of INSL3 are higher in boys at puberty, are undetectable in girls and are lower in boys with undescended testes. A minority also have a mutation either in the INSL3 gene or affecting its receptor gene, LGRF8. Other factors which may play a role in testis descent include the anti-Mullerian hormone (AMH) and members of the HOX gene family.