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Mostafa T, Bocu K, Malhotra V. A review of testicular histopathology in nonobstructive azoospermia. Asian J Androl 2024:00129336-990000000-00215. [PMID: 39091128 DOI: 10.4103/aja202454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/19/2024] [Indexed: 08/04/2024] Open
Abstract
One major challenge in male factor infertility is nonobstructive azoospermia (NOA), which is characterized by spermatozoa-deficient semen without physical duct blockage. This review offers a thorough overview of the histopathology of the testes in NOA cases, clarifying its complex etiology and emphasizing the possible value of histopathology inspection for both diagnosis and treatment. Variable histopathological findings have been linked to NOA, such as tubular hyalinization, Sertoli cell-only syndrome, hypospermatogenesis, and germ cell arrest. Understanding the pathophysiology and forecasting the effectiveness of treatment are further enhanced by both morphometric and ultrastructural analyses. The potential significance of testicular biopsy in forecasting reproductive outcomes is assessed, especially concerning assisted reproductive technologies like intracytoplasmic sperm injection (ICSI). Besides, testicular microlithiasis, serum hormone profiles, and testicular size are investigated concerning NOA histopathology. It is concluded that understanding the histopathological patterns in NOA is crucial for its accurate diagnosis and appropriate management. Further research is still warranted to improve understanding of the complex pathophysiology underlying NOA.
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Affiliation(s)
- Taymour Mostafa
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Kadir Bocu
- Department of Urology, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde 51240, Türkiye
| | - Vineet Malhotra
- Department of Urology and Andrology, VNA Hospital, New Delhi 110017, India
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Tan J, Jia S, Xu Q, Lin C, Cao Y, Shen J, Han S, Li Z, Zhou X. Hydrogel encapsulation facilitates a low-concentration cryoprotectant for cryopreservation of mouse testicular tissue. Colloids Surf B Biointerfaces 2024; 242:114096. [PMID: 39053031 DOI: 10.1016/j.colsurfb.2024.114096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/28/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
Cryopreserved testicular tissue offers a promising method to restore fertility in male infertility patients. Current protocols rely on high concentrations of penetrating cryoprotectants (pCPAs), such as dimethyl sulfoxide (DMSO), which necessitating complex washing procedures and posing risks of toxicity. Hydrogel encapsulation presents a non-toxic alternative for cellular cryopreservation. This study investigates the effects of various types, concentrations, and thicknesses of hydrogel encapsulation on the cryopreservation of mouse testicular tissue. Testicular tissues loaded with varying concentrations of DMSO were encapsulated in alginate or gelatin-methacryloyl (GelMA) hydrogels. We evaluated hydrogels as potential CPAs to reduce pCPA concentrations and determine optimal combinations for cryopreservation. Post-cryopreservation, tissues were cultured using organ culture methods to assess spermatogenesis progression. Cryomicroscopy and differential scanning calorimetry (DSC) were used to examine ice crystal formation, melting enthalpy, and non-freezing water content in different hydrogels during cooling. Results indicate that 3 % alginate or 5 % GelMA hydrogel with thin encapsulation optimally preserves mouse testicular tissue. Using 20 % DMSO in 5 % GelMA thin encapsulation showed comparable apoptosis rates, improved morphology, higher mitochondrial activity, and enhanced antioxidant capacity compared to conventional 30 % DMSO without encapsulation. This suggests that hydrogel encapsulation reduces pCPA concentration by 10 %, thereby mitigating toxic damage. Hydrogel encapsulation can reduce basement membrane shrinkage of testicular tissue during cryopreservation. Moreover, frozen tissues remained viable with preserved germ cells after being cultured for one week on alginate methacryloyl (AlgMA) hydrogel using the gas-liquid interphase method. Cryomicroscopy and DSC studies confirmed the hydrogel's ability to inhibit ice crystal growth. In conclusion, this study introduces novel strategies for male fertility preservation and advances cryopreservation technology for clinical applications in assisted reproduction.
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Affiliation(s)
- Jia Tan
- Institute of Biothermal Science & Technology, University of Shanghai for Science and Technology, Shanghai 200093, China; Shanghai Co-innovation Center for Energy Therapy of Tumors, Shanghai 200093, China; Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai 200093, China
| | - Shuqin Jia
- Institute of Biothermal Science & Technology, University of Shanghai for Science and Technology, Shanghai 200093, China; Shanghai Co-innovation Center for Energy Therapy of Tumors, Shanghai 200093, China; Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai 200093, China
| | - Qiang Xu
- Institute of Biothermal Science & Technology, University of Shanghai for Science and Technology, Shanghai 200093, China; Shanghai Co-innovation Center for Energy Therapy of Tumors, Shanghai 200093, China; Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai 200093, China
| | - Chunyan Lin
- Institute of Biothermal Science & Technology, University of Shanghai for Science and Technology, Shanghai 200093, China; Shanghai Co-innovation Center for Energy Therapy of Tumors, Shanghai 200093, China; Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai 200093, China
| | - Yukun Cao
- Institute of Biothermal Science & Technology, University of Shanghai for Science and Technology, Shanghai 200093, China; Shanghai Co-innovation Center for Energy Therapy of Tumors, Shanghai 200093, China; Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai 200093, China
| | - Jing Shen
- Institute of Biothermal Science & Technology, University of Shanghai for Science and Technology, Shanghai 200093, China; Shanghai Co-innovation Center for Energy Therapy of Tumors, Shanghai 200093, China; Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai 200093, China
| | - Sha Han
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Zheng Li
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xinli Zhou
- Institute of Biothermal Science & Technology, University of Shanghai for Science and Technology, Shanghai 200093, China; Shanghai Co-innovation Center for Energy Therapy of Tumors, Shanghai 200093, China; Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai 200093, China.
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Atiakshin D, Kulchenko N, Kostin A, Ignatyuk M, Protasov A, Klabukov I, Baranovskii D, Faniev M, Korovyakova E, Chekmareva I, Buchwalow I, Tiemann M. Cyto- and Histopographic Assessment of CPA3-Positive Testicular Mast Cells in Obstructive and Non-Obstructive Azoospermia. Cells 2024; 13:833. [PMID: 38786055 PMCID: PMC11120214 DOI: 10.3390/cells13100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Infertility is an important personal and society disease, of which the male factor represents half of all causes. One of the aspects less studied in male infertility is the immunological testicular microenvironment. Mast cells (MCs), having high potential for regulating spermatogenesis due to fine-tuning the state of the integrative buffer metabolic environment, are one of the most crucial cellular subpopulations of the testicular interstitium. One important component of the MC secretome is proteases that can act as proinflammatory agents and in extracellular matrix (ECM) remodeling. In the testis, MCs are an important cell component of the testicular interstitial tissue (TIT). However, there are still no studies addressing the analysis of a specific MC protease-carboxypeptidase A3 (CPA3)-in cases with altered spermatogenesis. The cytological and histotopographic features of testicular CPA3+ MCs were examined in a study involving 34 men with azoospermia. As revealed, in cases with non-obstructive azoospermia, a higher content of CPA3+ MCs in the TIT and migration to the microvasculature and peritubular tissue of seminiferous tubules were observed when compared with cases with obstructive azoospermia. Additionally, a high frequency of CPA3+ MCs colocalization with fibroblasts, Leydig cells, and elastic fibers was detected in cases with NOA. Thus, CPA3 seems to be of crucial pathogenetic significance in the formation of a profibrogenic background of the tissue microenvironment, which may have direct and indirect effects on spermatogenesis.
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Affiliation(s)
- Dmitrii Atiakshin
- RUDN University, 117198 Moscow, Russia; (N.K.); (A.K.); (M.I.); (A.P.); (M.F.); (E.K.); (I.C.); (I.B.)
- Research Institute of Experimental Biology and Medicine, Burdenko Voronezh State Medical University, 394036 Voronezh, Russia
| | - Nina Kulchenko
- RUDN University, 117198 Moscow, Russia; (N.K.); (A.K.); (M.I.); (A.P.); (M.F.); (E.K.); (I.C.); (I.B.)
| | - Andrey Kostin
- RUDN University, 117198 Moscow, Russia; (N.K.); (A.K.); (M.I.); (A.P.); (M.F.); (E.K.); (I.C.); (I.B.)
| | - Michael Ignatyuk
- RUDN University, 117198 Moscow, Russia; (N.K.); (A.K.); (M.I.); (A.P.); (M.F.); (E.K.); (I.C.); (I.B.)
| | - Andrey Protasov
- RUDN University, 117198 Moscow, Russia; (N.K.); (A.K.); (M.I.); (A.P.); (M.F.); (E.K.); (I.C.); (I.B.)
| | - Ilya Klabukov
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Koroleva St. 4, 249036 Obninsk, Russia (D.B.)
| | - Denis Baranovskii
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Koroleva St. 4, 249036 Obninsk, Russia (D.B.)
| | - Mikhail Faniev
- RUDN University, 117198 Moscow, Russia; (N.K.); (A.K.); (M.I.); (A.P.); (M.F.); (E.K.); (I.C.); (I.B.)
| | - Elina Korovyakova
- RUDN University, 117198 Moscow, Russia; (N.K.); (A.K.); (M.I.); (A.P.); (M.F.); (E.K.); (I.C.); (I.B.)
| | - Irina Chekmareva
- RUDN University, 117198 Moscow, Russia; (N.K.); (A.K.); (M.I.); (A.P.); (M.F.); (E.K.); (I.C.); (I.B.)
| | - Igor Buchwalow
- RUDN University, 117198 Moscow, Russia; (N.K.); (A.K.); (M.I.); (A.P.); (M.F.); (E.K.); (I.C.); (I.B.)
- Institute for Hematopathology, Fangdieckstr, 75a, 22547 Hamburg, Germany;
| | - Markus Tiemann
- Institute for Hematopathology, Fangdieckstr, 75a, 22547 Hamburg, Germany;
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Zhang D, Yao W, Zhang M, Yang L, Li L, Liu S, Jiang X, Sun Y, Hu S, Huang Y, Xue J, Zheng X, Xiong Q, Chen S, Zhu H. Safety evaluation of single-sperm cryopreservation technique applied in intracytoplasmic sperm injection. ZYGOTE 2024; 32:175-182. [PMID: 38629180 DOI: 10.1017/s0967199424000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Intracytoplasmic sperm injection (ICSI) is a technique that directly injects a single sperm into the cytoplasm of mature oocytes. Here, we explored the safety of single-sperm cryopreservation applied in ICSI. This retrospective study enrolled 186 couples undergoing ICSI-assisted pregnancy. Subjects were allocated to the fresh sperm (group A)/single-sperm cryopreservation (group B) groups based on sperm type, with their clinical baseline/pathological data documented. We used ICSI-compliant sperm for subsequent in vitro fertilization and followed up on all subjects. The recovery rate/cryosurvival rate/sperm motility of both groups, the pregnancy/outcome of women receiving embryo transfer, and the delivery mode/neonatal-related information of women with successful deliveries were recorded. The clinical pregnancy rate, cumulative clinical pregnancy rate, abortion rate, ectopic pregnancy rate, premature delivery rate, live birth delivery rate, neonatal birth defect rate, and average birth weight were analyzed. The two groups showed no significant differences in age, body mass index, ovulation induction regimen, sex hormone [anti-Müllerian hormone (AMH)/follicle-stimulating hormone (FSH)/luteinizing hormone (LH)] levels, or oocyte retrieval cycles. The sperm recovery rate (51.72%-100.00%) and resuscitation rate (62.09% ± 16.67%) in group B were higher; the sperm motility in the two groups demonstrated no significant difference and met the ICSI requirements. Group B exhibited an increased fertilization rate, decreased abortion rate, and increased safety versus group A. Compared with fresh sperm, the application of single-sperm cryopreservation in ICSI sensibly improved the fertilization rate and reduced the abortion rate, showing higher safety.
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Affiliation(s)
- Duanjun Zhang
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Wenliang Yao
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Mingliang Zhang
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Lijuan Yang
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Lin Li
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Shujuan Liu
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Xianglong Jiang
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Yingli Sun
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Shuonan Hu
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Yufang Huang
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Jie Xue
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Xiaoting Zheng
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Qi Xiong
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Shenghui Chen
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Haiqin Zhu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang City, 330000, Jiangxi Province, China
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Hashemi Karoii D, Azizi H. Functions and mechanism of noncoding RNA in regulation and differentiation of male mammalian reproduction. Cell Biochem Funct 2023; 41:767-778. [PMID: 37583312 DOI: 10.1002/cbf.3838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023]
Abstract
Noncoding RNAs (ncRNAs) are active regulators of a wide range of biological and physiological processes, including the majority of mammalian reproductive events. Knowledge of the biological activities of ncRNAs in the context of mammalian reproduction will allow for a more comprehensive and comparative understanding of male sterility and fertility. In this review, we describe recent advances in ncRNA-mediated control of mammalian reproduction and emphasize the importance of ncRNAs in several aspects of mammalian reproduction, such as germ cell biogenesis and reproductive organ activity. Furthermore, we focus on gene expression regulatory feedback loops including hormones and ncRNA expression to better understand germ cell commitment and reproductive organ function. Finally, this study shows the role of ncRNAs in male reproductive failure and provides suggestions for further research.
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Affiliation(s)
- Danial Hashemi Karoii
- Department of Cell and Molecular Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
- Faculty of Biotechnology, Amol University of Special Modern Technologies, Amol, Iran
| | - Hossein Azizi
- Faculty of Biotechnology, Amol University of Special Modern Technologies, Amol, Iran
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GamalEl Din SF, Shaker OG, Fawzy Megawer A, Abdel Salam MA, Abdelhalim AN, Adel A. Galectin-1 (Gal-1) and Galectin-3 (Gal-3) levels in seminal plasma and serum in azoospermic patients versus fertile men: A cross-sectional study. Arch Ital Urol Androl 2023; 95:11462. [PMID: 37668553 DOI: 10.4081/aiua.2023.11462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/20/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Galectin-1 (Gal-1) and galectin-3 (Gal-3) are expressed by many immune cells and receive considerable attention in the context of immunity. We aimed to compare between seminal plasma and serum levels of Gal-1 and Gal-3 in azoospermic patients and fertile men. MATERIALS AND METHODS This cross-sectional study was conducted at the andrology outpatient clinic from January (2022) to September (2022). A total of 90 participants were enrolled and divided into two equal groups: azoospermic and normal group. Semen analysis was done for all participants. Hormonal profile including FSH, LH, serum prolactin, total testosterone and estradiol was performed as well as assessment of serum and seminal levels of Gal-1 and Gal-3 by ELISA commercial kits. Finally, scrotal Duplex was done in standing and supine position. RESULTS Serum and seminal levels of Gal-1 and Gal-3 were statistically significant higher in azoospermic patients compared with normal individuals (p < 0.001 for all). In addition, in healthy individuals there were statistically significant positive correlations between serum levels of Gal-1 and age, FSH, LH levels (r = 0.296, p = 0.005; r = 0.333, p = < 0.001; r = 0.312, p = 0.003, respectively) and serum levels of Gal-2 and FSH and LH (r = 0.436, p < 0.001; r = 0.350, p < 0.001, respectively), whereas serum Gal-3 showed a borderline positive correlation with age (r = 0.2, p = 0.059). Additionally, statistically significant positive correlations between seminal levels of Gal-1 and Gal-3 and free testosterone in healthy individuals were reported (r = 0.205, p = 0.053; r = 0.219, p = 0.038, respectively). On the other hand, there were negative correlations between serum and seminal levels of Gal-1 and Gal-3, total and progressive sperm motility, sperm count and abnormal sperm forms in healthy individuals (r = -0.382, p < 0.001; r = -0.405, p < 0.001; r = -0.376, p < 0.001; r = -0.364, p < 0.001) (r = -0.394, p < 0.001; r = -0.467, p < 0.001; r = -0.413, p < 0.001; r = -0.433, p < 0.001); (r = -0.372, p < 0.001; r = -0.377, p < 0.001; r = -0.317, p = 0.002; r = -0.311, p = 0.003)(r = -0.445, p < 0.001; r = -0.498, p < 0.001; r = -0.453, p < 0.001; r = -0.463, p < 0.001, respectively). Furthermore, statistically significant positive correlations between serum levels of Gal-1 and Gal-3 and age in azoospermic patients were reported (r = 0.511, p < 0.001; r = 0.390, p = 0.008, respectively). On the other hand, there were negative correlations between seminal Gal-1 and estradiol (E2) and seminal Gal-3 and FSH and LH in azoospermic patients (r= -0.318, p = 0.033; r = -0.322, p = 0.031; r = -0.477, p < 0.001, respectively). Also, negative correlations between serum Gal-3 and total and free testosterone in azoospermic patients were detected (r = -0.396, p = 0.007; r = -0.375, p = 0.011, respectively). CONCLUSIONS Elevated serum and seminal levels of Gal-1 and Gal-3 have detrimental effects on spermatogenesis. Furthermore, the current study demonstrated potential regulatory effects of reproductive hormones on Gal-1 and Gal-3. Thus, future studies are needed to confirm such findings.
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Affiliation(s)
- Sameh Fayek GamalEl Din
- Department of Andrology, Sexology and STDs, Kasr AlAiny Faculty of Medicine, Cairo University.
| | - Olfat Gamil Shaker
- Department of Medical Biochemistry and Molecular Biology, Kasr AlAiny Faculty of Medicine, Cairo University.
| | - Ahmad Fawzy Megawer
- Department of Andrology, Sexology and STDs, Kasr AlAiny Faculty of Medicine, Cairo University.
| | | | | | - Ahmed Adel
- Department of Andrology, Sexology and STDs, Kasr AlAiny Faculty of Medicine, Cairo University.
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Gao S, Chen Z, Shi J, Chen Z, Yun D, Li X, Wu X, Sun F. Sperm immotility is associated with epididymis metabolism disorder in mice under obstructive azoospermia. FASEB J 2023; 37:e23081. [PMID: 37410071 DOI: 10.1096/fj.202201862rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
Obstructive azoospermia (OA) accounts for approximately 40% of males who suffer from azoospermia of male infertility. Currently, available treatment for OA consists of reproductive tract surgical reconstruction and sperm retrieval from the testis. However, both treatments result in low fertility compared to normal pregnancy, and the main reason remains largely unknown. Previous studies have shown that the quality of sperm retrieved from OA patients is poor compared with normal adult males but without an in-depth study. Herein, we generated a mouse OA model with vasectomy to evaluate sperm quality systematically. Our results showed that the testis had normal spermatogenesis but increased apoptotic activity in both OA patients and mice. More importantly, epididymal morphology was abnormal, with swollen epididymal tubules and vacuole-like principal cells. Especially, sperm retrieved from the epididymis of OA mice showed poor motility and low fertilization ability in vitro. Using mass spectrometry in epididymal fluid, we found differences in the expression of key proteins for sperm maturation, such as Angiotensinogen (AGT), rhophilin-associated tail protein 1 (ROPN1), NPC intracellular cholesterol transporter 2 (NPC2), and prominin 1 (PROM1). Furthermore, our results demonstrated that AGT, secreted by epididymal principal cells, could regulate sperm motility by managing PKCα expression to modify sperm phosphorylation. In conclusion, our data evaluate sperm quality systematically in OA mice and contribute to the understanding between the sperm and epididymis, which may provide novel insight into treating male infertility.
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Affiliation(s)
- Sheng Gao
- Institute of Reproductive Medicine, Medical School of Nantong University, Nantong, China
| | - Zhengru Chen
- Institute of Reproductive Medicine, Medical School of Nantong University, Nantong, China
| | - Jie Shi
- Institute of Reproductive Medicine, Medical School of Nantong University, Nantong, China
| | - Zifeng Chen
- Institute of Reproductive Medicine, Medical School of Nantong University, Nantong, China
| | - Damin Yun
- Institute of Reproductive Medicine, Medical School of Nantong University, Nantong, China
| | - Xinyao Li
- Institute of Reproductive Medicine, Medical School of Nantong University, Nantong, China
| | - Xiaolong Wu
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fei Sun
- Institute of Reproductive Medicine, Medical School of Nantong University, Nantong, China
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Peng F, Muhuitijiang B, Zhou J, Liang H, Zhang Y, Zhou R. An artificial neural network model to diagnose non-obstructive azoospermia based on RNA-binding protein-related genes. Aging (Albany NY) 2023; 15:3120-3140. [PMID: 37116198 PMCID: PMC10188335 DOI: 10.18632/aging.204674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/15/2023] [Indexed: 04/30/2023]
Abstract
Non-obstructive azoospermia (NOA) is a severe form of male infertility, but its pathological mechanisms and diagnostic biomarkers remain obscure. Since the dysregulation of RNA-binding proteins (RBPs) had nonnegligible effects on spermatogenesis, we aimed to investigate the functions and diagnosis values of RBPs in NOA. 58 testicular samples (control = 11, NOA = 47) from Gene Expression Omnibus (GEO) were set as the training cohort. Three public datasets, containing GSE45885 (control = 4, NOA = 27), GSE45887 (control = 4, NOA = 16), and GSE145467 (control = 10, NOA = 10), and 44 clinical samples from the local hospital (control = 27, NOA = 17) were used for validation. Through a series of bioinformatical analyses and machine learning algorithms, including genomic difference detection, protein-protein interaction network analysis, LASSO, SVM-RFE, and Boruta, DDX20 and NCBP2 were determined as significant predictors of NOA. Single-cell RNA sequencing of 432 testicular cell samples from NOA patients indicated that DDX20 and NCBP2 were associated with spermatogenesis (false discovery rate < 0.05). Based on the transcriptome expressions of DDX20 and NCBP2, we constructed multiple diagnosis models using logistic regression, random forest, and artificial neural network (ANN). The ANN model exhibited the most reliable predictive performance in the training cohort (AUC = 0.840), GSE45885 (AUC = 0.731), GSE45887 (AUC = 0.781), GSE145467 (AUC = 0.850), and local cohort (AUC = 0.623). Totally, an ANN diagnosis model based on RBP DDX20 and NCBP2 was developed and externally validated in NOA, functioning as a promising tool in clinical practice.
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Affiliation(s)
- Fan Peng
- Department of Urology, Baoan Central Hospital of Shen Zhen, Shenzhen 518102, China
| | - Bahaerguli Muhuitijiang
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510000, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510000, China
| | - Jiawei Zhou
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510000, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510000, China
| | - Haoyu Liang
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510000, China
| | - Yu Zhang
- Department of Urology, Baoan Central Hospital of Shen Zhen, Shenzhen 518102, China
| | - Ranran Zhou
- Department of Urology, Baoan Central Hospital of Shen Zhen, Shenzhen 518102, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510000, China
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Micro-TESE surgery combined with ICSI regimen in the treatment of non-obstructive azoospermia patients and its effect analysis. ZYGOTE 2023; 31:55-61. [PMID: 36268556 DOI: 10.1017/s096719942200051x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study aimed to analyze the clinical effects of microdissection testicular sperm extraction (micro-TESE) surgery combined with an intracytoplasmic sperm injection (ICSI) regimen in the treatment of non-obstructive azoospermia (NOA) patients with different etiologies. In total, 128 NOA patients participated in this study, in which they received infertility treatment by micro-TESE surgery combined with an ICSI regimen, and all patients were divided into three groups [the Klinefelter syndrome (KS), the idiopathic and the secondary NOA groups]. In addition, the sperm retrieval rate (SRR), fertilization rate, embryo development status and clinical treatment effects were analyzed. Among the 128 NOA patients, the SRR of KS NOA patients was 48.65%, those of idiopathic and the secondary patients were 33.82% and 73.91%, respectively. Regardless of etiologies, there was no correlation with age, hormone value or testicular volume. Further analysis showed that the SRR of the KS group was positively related with testosterone (T) values, and the SRR of the secondary group had a positive relationship with follicle-stimulating hormone or luteinizing hormone values. In the subsequent clinical treatment, the retrieved sperm was subjected to ICSI and achieved good treatment effects, especially in the secondary group, and the implantation rate (55.56%) and clinical pregnancy rate (68.42%) were both higher than those of the idiopathic group (28.75% and 40.00%) and KS group (22.05% and 30.77%). Micro-TESE surgery combined with ICSI insemination is the most effective treatment regimen for NOA patients. The SRR of NOA patients with different etiologies are related to certain specific factors, and micro-TESE surgery seems to be the ideal and only way to have biological children.
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A 3-Gene Random Forest Model to Diagnose Non-obstructive Azoospermia Based on Transcription Factor-Related Henes. Reprod Sci 2023; 30:233-246. [PMID: 35715550 DOI: 10.1007/s43032-022-01008-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/10/2022] [Indexed: 01/11/2023]
Abstract
Non-obstructive azoospermia (NOA) is one of the most severe forms of male infertility, but its diagnosis biomarkers with high sensitivity and specificity are largely unknown. Transcription factors (TFs) play essential roles in many pathological processes in different diseases. Herein, we aimed to identify the TFs showing high diagnosis ability for NOA through machine learning algorithms. The transcriptome data of the testicular tissue from 11 control and 47 NOA subjects were set as the training dataset; meanwhile, 1665 TFs were retrieved from the HumanTFDB. Through the feature extraction methods, including genomic difference analysis, Lasso, Boruta, SVM-RFE, and logistic regression, ETV2, TBX2, and ZNF689 were ultimately screened and then were included in the random forest (RF) diagnosis model. The RF model displayed high predictive power in the training (F-measure = 1) and two external validation (n = 31, F-measure = 0.902; n = 20, F-measure = 0.941) cohorts. The seminal plasma and testicular biopsy samples of 20 control and 20 NOA patients were collected from the local hospital, and the expression levels of ETV2, TBX2, and ZNF689 were measured via RT-qPCR and immunohistochemistry. The RF model could also distinguish the NOA samples in the local cohort (F-measure = 0.741). Single-cell RNA sequencing analysis, which was based on the 432 testicular cell samples from an NOA patient, showed that ETV2, TBX2, and ZNF689 were all significantly associated with spermatogenesis. In all, a 3-TF random forest diagnosis model was successfully established, providing novel insights into the latent mechanisms of NOA.
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Yu C, Zhou C, Lin F, Zhang W, Wang X, Hu L, Lu R. Analysis of the Growth and Development of Children Born with ICSI of Epididymal and Testicular Spermatozoa: A Propensity Matching Study. Curr Pharm Des 2023; 29:2668-2678. [PMID: 37929741 DOI: 10.2174/0113816128264448231022201641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The study aimed to evaluate whether singleton live births (at 0, 1, 6, 12, and 24 months) following intracytoplasmic sperm injection (ICSI) using sperm of different origins (ejaculated or non-ejaculated sperm) are associated with the growth and development of children born. METHODS This was a retrospective cohort study conducted at a single center from January 2016 to December 2019. Follow-up data of the children were obtained from the Jiangsu Province Maternal and Child database. A total of 350 singleton live births after fresh embryo transfer (ET) with ICSI were included. Based on the origin of the sperm, the patients were divided into two groups: the ejaculated group (n = 310) and the non-ejaculated group (n = 40). Propensity score matching was used to control for multiple baseline covariates, resulting in 80 singleton live births (ejaculated sperm) matched to 40 singleton live births (non-ejaculated). The non-ejaculated group was further divided into two subgroups: the PESA group (n = 23) and the TESA group (n = 17). The primary outcome of the study was the growth and development of children. Secondary outcomes included the 2PN rate, high-cleavage embryo rate, blastocyst formation rate, and others. RESULTS After matching parental age, BMI, occupation, and maternal serum AMH level, there was no significant difference found in the growth and development of children between the non-ejaculated and ejaculated group or the PESA group and TESA group, respectively. However, the 2PN rate and the blastocyst formation rate were higher in the ejaculated group compared to the non-ejaculated group (91.02 and 85.45, P = 0.002) and (67.37 and 56.06, P = 0.019), respectively. The high-quality cleavage embryo rate was also higher in the TESA group compared to the PESA group (85.06 and 65.63, P = 0.001). CONCLUSION This study suggests that there are no significant differences in the growth and development of children born following ICSI using sperm of different origins (ejaculated or non-ejaculated). For nonobstructive azoospermia (OA) patients, sperm derived from the testis may be more effective than derived from the epididymis. However, due to the limited sample size of the non-ejaculated group in this study, further investigations with larger sample sizes are needed to validate these findings.
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Affiliation(s)
- Chunmei Yu
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Jiangsu, Changzhou, China
| | - Chao Zhou
- Reproduction Medical Center, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Feng Lin
- Department of Wuqia County People Hospital, The Xinjiang Uygur Autonomous Region, China
| | - Wanchao Zhang
- Department of Wuqia County People Hospital, The Xinjiang Uygur Autonomous Region, China
| | - Xiaoyu Wang
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Jiangsu, Changzhou, China
| | - Lingmin Hu
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Jiangsu, Changzhou, China
| | - Renjie Lu
- Changzhou Medical Center, Changzhou Third People's Hospital, Nanjing Medical University, Jiangsu, China
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Cai H, Cao X, Qin D, Liu Y, Liu Y, Hua J, Peng S. Gut microbiota supports male reproduction via nutrition, immunity, and signaling. Front Microbiol 2022; 13:977574. [PMID: 36060736 PMCID: PMC9434149 DOI: 10.3389/fmicb.2022.977574] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 12/12/2022] Open
Abstract
Gut microbiota (GM) is a major component of the gastrointestinal tract. Growing evidence suggests that it has various effects on many distal organs including the male reproductive system in mammals. GM and testis form the gut-testis axis involving the production of key molecules through microbial metabolism or de novo synthesis. These molecules have nutrition, immunity, and hormone-related functions and promote the male reproductive system via the circulatory system. GM helps maintain the integral structure of testes and regulates testicular immunity to protect the spermatogenic environment. Factors damaging GM negatively impact male reproductive function, however, the related mechanism is unknown. Also, the correlation between GM and testis remains to be yet investigated. This review discusses the complex influence of GM on the male reproductive system highlighting the impact on male fertility.
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Affiliation(s)
- Hui Cai
- Shaanxi Centre of Stem Cells Engineering and Technology, College of Veterinary Medicine, Northwest A&F University, Shaanxi, China
| | - Xuanhong Cao
- Shaanxi Centre of Stem Cells Engineering and Technology, College of Veterinary Medicine, Northwest A&F University, Shaanxi, China
| | - Dezhe Qin
- State Key Laboratory for Molecular and Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Yundie Liu
- Shaanxi Centre of Stem Cells Engineering and Technology, College of Veterinary Medicine, Northwest A&F University, Shaanxi, China
| | - Yang Liu
- Shaanxi Centre of Stem Cells Engineering and Technology, College of Veterinary Medicine, Northwest A&F University, Shaanxi, China
| | - Jinlian Hua
- Shaanxi Centre of Stem Cells Engineering and Technology, College of Veterinary Medicine, Northwest A&F University, Shaanxi, China
| | - Sha Peng
- Shaanxi Centre of Stem Cells Engineering and Technology, College of Veterinary Medicine, Northwest A&F University, Shaanxi, China
- *Correspondence: Sha Peng,
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Zhang Z, Zhang Y, Zhang N. Clinical outcome of microsurgical vasoepididymostomy versus epididymal or testicular sperm retrieval combined with intracytoplasmic sperm injection in obstructive azoospermia males. Andrologia 2022; 54:e14458. [PMID: 35688176 DOI: 10.1111/and.14458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/20/2022] [Accepted: 03/09/2022] [Indexed: 01/10/2023] Open
Abstract
This purpose of the retrospective study was to compare the clinical outcome of microsurgical vasoepididymostomy (MVE) and sperm retrieval combined with intracytoplasmic sperm injection (ICSI) in the treatment of males with obstructive azoospermia. From February 2018 to December 2019, a total of 69 males with obstructive azoospermia underwent MVE while 351 males with obstructive azoospermia in their first ICSI cycles were enrolled. Patients in the MVE group achieved higher pregnancy rate and births delivered rate than those in ICSI group (pregnancy rate, 44.6% vs. 27.6% for MVE and ICSI, respectively; delivery rate, 38.5% versus 25.8% for MVE and ICSI, respectively). Besides, lower female age (<35 vs. ≥35 years old, OR 1.15, 95% CI = 1.08-1.21), higher sperm concentration and forward motility after MVE((sperm concentration, OR (95% CI) = 1.12 (1.08-1.23), sperm forward motility, OR (95% CI) = 1.10 (1.06-1.20)) were associated with higher probability of pregnancy. Based on these data, it has been found that MVE is the prior option for males with obstructive azoospermia suitable for the surgery, other than direct subjected to ICSI. More high quality studies are needed in the future due to the non-randomized design and the relative small size of this study.
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Affiliation(s)
- Zheng Zhang
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Yong Zhang
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Nan Zhang
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
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Wu X, Zhou L, Shi J, Cheng CY, Sun F. Multiomics analysis of male infertility. Biol Reprod 2022; 107:118-134. [PMID: 35639635 DOI: 10.1093/biolre/ioac109] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/12/2022] [Accepted: 05/17/2022] [Indexed: 11/14/2022] Open
Abstract
Infertility affects 8-12% of couples globally, and the male factor is a primary cause in approximately 50% of couples. Male infertility is a multifactorial reproductive disorder, which can be caused by paracrine and autocrine factors, hormones, genes, and epigenetic changes. Recent studies in rodents and most notably in humans using multiomics approach have yielded important insights into understanding the biology of spermatogenesis. Nonetheless, the etiology and pathogenesis of male infertility are still largely unknown. In this review, we summarized and critically evaluated findings based on the use of advanced technologies to compare normal and obstructive azoospermia (OA) versus non-obstructive azoospermia (NOA) men, including whole-genome bisulfite sequencing (WGBS), single cell RNA-seq (scRNA-seq), whole exome sequencing (WES), and ATAC-seq. It is obvious that the multiomics approach is the method of choice for basic research and clinical studies including clinical diagnosis of male infertility.
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Affiliation(s)
- Xiaolong Wu
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.,Institute of Reproductive Medicine, Nantong University School of Medicine, Nantong, Jiangsu 226001, China
| | - Liwei Zhou
- Institute of Reproductive Medicine, Nantong University School of Medicine, Nantong, Jiangsu 226001, China
| | - Jie Shi
- Institute of Reproductive Medicine, Nantong University School of Medicine, Nantong, Jiangsu 226001, China
| | - C Yan Cheng
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.,Institute of Reproductive Medicine, Nantong University School of Medicine, Nantong, Jiangsu 226001, China
| | - Fei Sun
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.,Institute of Reproductive Medicine, Nantong University School of Medicine, Nantong, Jiangsu 226001, China
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Tang D, Li K, Lv M, Xu C, Geng H, Wang C, Cheng H, He X, Zhang Y, Cao Y. Altered mRNAs Profiles in the Testis of Patients With "Secondary Idiopathic Non-Obstructive Azoospermia". Front Cell Dev Biol 2022; 10:824596. [PMID: 35646930 PMCID: PMC9133692 DOI: 10.3389/fcell.2022.824596] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Non-obstructive azoospermia (NOA) is the most severe form of male infertility. Currently, known causative factors, including congenital and several acquired causes only account for approximately 30% of NOA cases. The causes for NOA remain unclear for most patients, which is known as idiopathic (iNOA). However, whether iNOA is due to congenital defects or acquired abnormalities is a confusing problem due to the delayed diagnosis of this frustrating condition until the childbearing age. Therefore, we collected several cases with "secondary idiopathic NOA" and detected the altered mRNAs profiles in the testicular tissues to explore the possible molecular basis. Materials and Methods: In this study, several patients with a previous history of natural pregnancy with their partners before, who were diagnosed as iNOA based on the outcomes of routine semen analysis and multiple testis biopsies now, were enrolled. Some known risk factors and genetic factors were excluded. Therefore, we defined this phenotype as "secondary idiopathic NOA." To explore the possible molecular basis of this disease, we performed mRNA expression analysis through next-generation sequencing on three cases and other three patients with obstructive azoospermia as controls. Bioinformatics analyses were conducted to assess differentially expressed genes and possible biological mechanisms involved in the disease. Quantitative real-time reverse transcription polymerase chain reaction assays were applied to confirm the results in several selected mRNAs involved in stages and metabolism of Sertoli cells. Results: A series of mRNAs were found to be altered in testicular tissues between patients with "secondary idiopathic NOA" and controls, including 6,028 downregulated and 3,402 upregulated mRNAs. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genome (KEGG) analyses revealed a range of GO and KEGG terms, such as cellular process involved in reproduction, protein degradation, and absorption. Conclusion: The present study introduces a novel classification called "secondary idiopathic NOA." We provide a global view of the altered mRNAs involved in spermatogenetic failure in these cases. Regarding the limited samples, further studies should be taken to understand this new classification.
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Affiliation(s)
- Dongdong Tang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Kuokuo Li
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Mingrong Lv
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Chuan Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hao Geng
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chao Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huiru Cheng
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Xiaojin He
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Yan Zhang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, WuHan, China
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
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