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ResearchIn-Press PreviewCell biologyReproductive biology Open Access | 10.1172/JCI201124

Single-cell analysis of fetal testis reveals dysfunction of human Leydig cells in Klinefelter syndrome

Tong Yan,1 Guancheng Chen,1 Jie Zhang,2 Wenjing Jia,3 Nan Lu,4 Shuping Jin,5 Haotian Zhang,1 Yichen Zhao,1 Lu Jiang,5 Jing Wu,6 Qing Liu,6 Chenghao Situ,1 Hui Zhu,1 Yan Li,7 Quan Wang,3 Xiaoyu Yang,4 Chao Qin,8 Xiaofeng Song,3 Qing Cheng,5 and Xuejiang Guo1

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Yan, T. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Chen, G. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Zhang, J. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Jia, W. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Lu, N. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Jin, S. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Zhang, H. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Zhao, Y. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Jiang, L. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Wu, J. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Liu, Q. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Wang, Q. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Yang, X. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Song, X. in: PubMed | Google Scholar

1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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1Department of Histology and Embryology, State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China

2Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

3Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China

4State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

5Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China

6School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China

7Department of Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China

8Department of Urology, State Key Laboratory of Reproductive Medicine and Offspring Health, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Find articles by Guo, X. in: PubMed | Google Scholar |

Published June 9, 2026 - More info

J Clin Invest. https://doi.org/10.1172/JCI201124.
Copyright © 2026, Yan et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published June 9, 2026 - Version history
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Abstract

Klinefelter syndrome (KS), the most common sex chromosome aneuploidy (affecting approximately 1 in 650 live male births), causes severe infertility. The extra X chromosome can impair the development of fetal germ cells, but its effects on somatic cells, especially the Leydig cells, are still not well known. We performed single-cell transcriptome analysis of fetal KS and control testicular cells, and found that two clusters of KS Sertoli cells with the XIST-negative cluster showing distinct gene expression pattern and abnormally increased G2/M ratio. Fetal KS Leydig cells showed increased proliferation and immature differentiation with high level of MAPK signaling pathway and X-linked EIF1AX. Inhibition of MAPK signaling partially rescued overproliferation and defective differentiation and androgen secretion in KS Leydig cells, while overexpression of EIF1AX recapitulated the phenotype of increased proliferation and decline in testosterone synthesis capacity in the Leydig cell line. These findings revealed the early pathological mechanisms of KS somatic cells, and lay the groundwork for developing novel early intervention strategies.

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Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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