RANKL regulates male reproductive function

Nat Commun. 2021 Apr 23;12(1):2450. doi: 10.1038/s41467-021-22734-8.


Infertile men have few treatment options. Here, we demonstrate that the transmembrane receptor activator of NF-kB ligand (RANKL) signaling system is active in mouse and human testis. RANKL is highly expressed in Sertoli cells and signals through RANK, expressed in most germ cells, whereas the RANKL-inhibitor osteoprotegerin (OPG) is expressed in germ and peritubular cells. OPG treatment increases wild-type mouse sperm counts, and mice with global or Sertoli-specific genetic suppression of Rankl have increased male fertility and sperm counts. Moreover, RANKL levels in seminal fluid are high and distinguishes normal from infertile men with higher specificity than total sperm count. In infertile men, one dose of Denosumab decreases RANKL seminal fluid concentration and increases serum Inhibin-B and anti-Müllerian-hormone levels, but semen quality only in a subgroup. This translational study suggests that RANKL is a regulator of male reproductive function, however, predictive biomarkers for treatment-outcome requires further investigation in placebo-controlled studies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anti-Mullerian Hormone / blood
  • Anti-Mullerian Hormone / metabolism
  • Denosumab / pharmacology
  • Fertility / drug effects
  • Fertility / physiology*
  • Humans
  • Inhibins / antagonists & inhibitors
  • Inhibins / blood
  • Inhibins / metabolism
  • Male
  • Mice
  • Mice, Inbred C57BL
  • Mice, Knockout
  • Mice, Transgenic
  • Osteoprotegerin / pharmacology
  • RANK Ligand / antagonists & inhibitors
  • RANK Ligand / genetics
  • RANK Ligand / metabolism*
  • Semen / drug effects
  • Semen / metabolism
  • Semen Analysis / methods*
  • Sertoli Cells / drug effects
  • Sertoli Cells / metabolism*
  • Sperm Count
  • Spermatozoa / cytology
  • Spermatozoa / drug effects
  • Spermatozoa / metabolism*


  • Osteoprotegerin
  • RANK Ligand
  • inhibin B
  • Denosumab
  • Inhibins
  • Anti-Mullerian Hormone