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Li Y, Wu W, Xu W, Wang Y, Wan S, Chen W, Yang D, Zhang M, Wu X, Yang X, Du X, Wang C, Han M, Chen Y, Li N, Hua J. Eif2s3y alleviated LPS-induced damage to mouse testis and maintained spermatogenesis by negatively regulating Adamts5. Theriogenology 2023; 211:65-75. [PMID: 37586163 DOI: 10.1016/j.theriogenology.2023.08.003] [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: 04/12/2023] [Revised: 07/09/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023]
Abstract
Eif2s3y (eukaryotic translation initiation factor 2, subunit 3, structural gene Y-linked, Eif2s3y) is an essential gene for spermatogenesis. Early studies have shown that Eif2s3y can promote the proliferation of spermatogonial stem cells (SSCs) and can replace the Y chromosome together with sex-determining region Y (Sry) to transform SSCs into round spermatozoa. We injected lentiviral particles into the seminiferous tubules of mouse testes by sterile surgery surgically to establish overexpressing Eif2s3y testes. And then the mice were intraperitoneally injected with LPS to established the model of testis inflammation. Through RNA sequencing, qRT-PCR analysis, Western blot, co-culture etc., we found that Eif2s3y alleviated LPS-induced damage in mouse testes and maintained spermatogenesis. In testes with Eif2s3y overexpression, the seminiferous tubules were more regularly organized after exposure to LPS compared with the control. Eif2s3y performs its function by negatively regulating Adamts5 (a disintegrin and metalloproteinase containing a thrombospondin-1 motif), an extracellular matrix-degrading enzyme. ADAMTS5 shows a disruptive effect when the testis is exposed to LPS. Overexpression of Eif2s3y inhibited the TLR4/NFκB signaling pathway in the testis in response to LPS. Generally, our research shows that Eif2s3y protects the testis from LPS and maintains spermatogenesis by negatively regulating Adamts5.
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Affiliation(s)
- Yunxiang Li
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Wenping Wu
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Wenjing Xu
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Yuqi Wang
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Shicheng Wan
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Wenbo Chen
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Donghui Yang
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Mengfei Zhang
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Xiaojie Wu
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Xinchun Yang
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Xiaomin Du
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Congliang Wang
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Miao Han
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Yuguang Chen
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China
| | - Na Li
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China; Key Laboratory of Livestock Biology, Northwest A&F University, Yangling, Shaanxi, China.
| | - Jinlian Hua
- College of Veterinary Medicine/Shaanxi Centre of Stem Cells Engineering & Technology, Northwest Agriculture & Forestry University, Yangling, Shaanxi, China; Key Laboratory of Livestock Biology, Northwest A&F University, Yangling, Shaanxi, China.
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Reifarth L, Körber H, Packeiser EM, Goericke-Pesch S. Detection of spermatogonial stem cells in testicular tissue of dogs with chronic asymptomatic orchitis. Front Vet Sci 2023; 10:1205064. [PMID: 37396999 PMCID: PMC10311113 DOI: 10.3389/fvets.2023.1205064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Chronic asymptomatic idiopathic orchitis (CAO) is an important but neglected cause of acquired infertility due to non-obstructive azoospermia (NOA) in male dogs. The similarity of the pathophysiology in infertile dogs and men supports the dog's suitability as a possible animal model for studying human diseases causing disruption of spermatogenesis and evaluating the role of spermatogonial stem cells (SSCs) as a new therapeutic approach to restore or recover fertility in cases of CAO. To investigate the survival of resilient stem cells, the expression of the protein gene product (PGP9.5), deleted in azoospermia like (DAZL), foxo transcription factor 1 (FOXO1) and tyrosine-kinase receptor (C-Kit) were evaluated in healthy and CAO-affected canine testes. Our data confirmed the presence of all investigated germ cell markers at mRNA and protein levels. In addition, we postulate a specific expression pattern of FOXO1 and C-Kit in undifferentiated and differentiating spermatogonia, respectively, whereas DAZL and PGP9.5 expressions were confirmed in the entire spermatogonial population. Furthermore, this is the first study revealing a significant reduction of PGP9.5, DAZL, and FOXO1 in CAO at protein and/or gene expression level indicating a severe disruption of spermatogenesis. This means that chronic asymptomatic inflammatory changes in CAO testis are accompanied by a significant loss of SSCs. Notwithstanding, our data confirm the survival of putative stem cells with the potential of self-renewal and differentiation and lay the groundwork for further research into stem cell-based therapeutic options to reinitialize spermatogenesis in canine CAO-affected patients.
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Affiliation(s)
| | | | | | - Sandra Goericke-Pesch
- Reproductive Unit – Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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Ichikawa T, Shimojima Y, Nomura S, Kishida D, Shiozaki M, Tanimura J, Sekijima Y. Testicular vasculitis in eosinophilic granulomatosis with polyangiitis: a case-based review. Clin Rheumatol 2023; 42:293-299. [PMID: 36414864 DOI: 10.1007/s10067-022-06453-z] [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: 10/18/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
Testicular vasculitis (TV) develops when an organ is involved in systemic vasculitis. A 47-year-old man with eosinophilic granulomatosis with polyangiitis (EGPA) developed TV as the first clinical episode. The patient had bronchial asthma for 8 years and developed left testicular pain before developing arthralgia, abdominal involvement, and sensory polyneuropathy, which led to the diagnosis of EGPA. The induration of the affected testicle persisted even after initiating immunosuppressive therapy with corticosteroids and cyclophosphamide, raising concern for testicular neoplasm, while testicular pain and other symptoms resolved. The patient underwent inguinal orchiectomy, and a histology examination of the resected testicle revealed fibrinoid necrotizing vasculitis. Only three cases of biopsy-proven TV in patients with EGPA have been reported in our review of published English-language articles. Two of the three patients in the reviewed cases developed TV before being diagnosed with EGPA. Moreover, all patients underwent extirpation of the affected testicle, leading to a pathological diagnosis of TV. This report suggests that TV may develop and be the presenting condition in EGPA, although urogenital involvement is rare.
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Affiliation(s)
- Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Shun Nomura
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Masashi Shiozaki
- Department of Urology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Jun Tanimura
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
- Department of Neurology, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, 390-8510, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Abstract
PRACTICAL RELEVANCE An infertile tom used to be a relatively rare presentation in feline practice. However, as a result of breeding strategies targeting specific morphological/behavioural traits, and the influence of inbreeding (especially practised in rare breeds), among other factors, feline infertility has become a genuine clinical problem. Furthermore, increased interest among cat breeders and pet owners in diagnosing and treating an 'unsuccessful' tom (including using assisted reproductive techniques [ARTs]), has made such patients more commonplace in veterinary practice. CLINICAL CHALLENGES A definitive cause for male infertility is often difficult to identify. One of the biggest challenges is the lack of fertility-based reference values for semen quality and hormone levels. Moreover, the literature in this field is scant and many reproductive tract conditions described in other species have not been reported in cats. The establishment of diagnostic tools and algorithms is essential to facilitate a reliable assessment of fertility potential. GLOBAL IMPORTANCE There is a growing demand for appropriate veterinary care relating to feline reproduction. There is an expectation among breeders, particularly of pedigree cats of high breeding value, that the same options widely used for dogs (including ARTs) should also be available for cats. EQUIPMENT AND TECHNICAL SKILLS Equipment required for investigating male infertility includes a microscope and ultrasound machine; a blood analyser may also be useful, but samples can instead be sent to a laboratory. The skills required are often already performed by veterinarians; for example, catheterising the urethra, performing ultrasonography and blood sampling. EVIDENCE BASE There are some reports of fertility problems in male cats in the literature, but this area of feline reproduction is still relatively undeveloped. This review draws on the comprehensive knowledge developed and shared by specialists in this field, and is supported by the authors' own clinical experience.
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Affiliation(s)
- Sylwia Prochowska
- Department of Reproduction and Clinic of Farm Animals, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Wojciech Niżański
- Department of Reproduction and Clinic of Farm Animals, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
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Pröbstl C, Umbach A, Beineke A, Körber H, Goericke-Pesch S. Immune cell characterization in spontaneous autoimmune orchitis in dogs. Theriogenology 2022; 187:219-226. [DOI: 10.1016/j.theriogenology.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/07/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
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Goericke-Pesch S, Reifarth L, Behrens Mathiesen C, Schuler G, Umbach AK, Körber H. Chronic Immune-Mediated Orchitis Is the Major Cause of Acquired Non-obstructive Azoospermia in Dogs. Front Vet Sci 2022; 9:865967. [PMID: 35433905 PMCID: PMC9010537 DOI: 10.3389/fvets.2022.865967] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/21/2022] [Indexed: 12/26/2022] Open
Abstract
Azoospermia, the lack of spermatozoa in the ejaculate, is the most common finding in infertile but otherwise healthy male dogs and represents an increasing reproductive health issue in men, too. The diagnosis can be further classified as non-obstructive azoospermia and obstructive azoospermia due to an obstruction of the deferent ducts. Although non-obstructive azoospermia comprises more than half of azoospermic cases in men and is a common cause of infertility in the male dog, knowledge of the underlying etiology and pathophysiology is still strongly limited, and much uncertainty exists about the true incidence and possible treatment options. Therefore, this study aims to investigate and characterize infertile canine patients in detail by combining results of andrological examinations (clinical parameters, semen analysis, bacterial examination of semen, and Brucella canis serology), endocrine analysis (luteinizing hormone, testosterone, estradiol-17ß, and thyroid function), analysis of the alkaline phosphatase in seminal plasma, and histological assessment of testicular biopsies of 10 azoospermic dogs. Our results not only verify non-obstructive etiology for 9/10 cases of canine azoospermia but also further identified significant histopathological changes of the testicular tissue with severely disrupted spermatogenesis, including fibrotic remodeling, vacuolization, Sertoli-cell-only syndrome, tubular shadows, and an increase of the interstitial and vascular area. In addition, three dogs showed local and six dogs generalized immune-cell infiltration, indicating chronic immune-mediated orchitis. Only in one case (no. 1) that no immune cells were found, and obstructive azoospermia was suspected due to low alkaline phosphatase activity. Furthermore, the detection of anti-thyroideal antibodies in two dogs indicates an autoimmune thyroid disease and a correlation between the occurrence of thyroidal disorders and azoospermia. Our results confirm previous findings and contribute additional evidence suggesting that chronic immune-mediated orchitis is the major cause of infertility in dogs. Further studies should focus on uncovering underlying inflammatory processes behind spermatogenic failure in these cases and identify possible treatment options to (re-)initialize spermatogenesis.
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Affiliation(s)
- Sandra Goericke-Pesch
- Department of Veterinary Sciences, Section for Veterinary Reproduction and Obstetrics, Faculty of Health and Medical Sciences, University of Copenhagen, Tåstrup, Denmark
- Reproductive Unit – Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
- *Correspondence: Sandra Goericke-Pesch
| | - Larena Reifarth
- Reproductive Unit – Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Christina Behrens Mathiesen
- Department of Veterinary Sciences, Section for Veterinary Reproduction and Obstetrics, Faculty of Health and Medical Sciences, University of Copenhagen, Tåstrup, Denmark
| | - Gerhard Schuler
- Clinic for Obstetrics, Gynecology and Andrology of Large and Small Animals, Giessen, Germany
| | | | - Hanna Körber
- Department of Veterinary Sciences, Section for Veterinary Reproduction and Obstetrics, Faculty of Health and Medical Sciences, University of Copenhagen, Tåstrup, Denmark
- Reproductive Unit – Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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Chereshnev VA, Pichugova SV, Beikin YB, Chereshneva MV, Iukhta AI, Stroev YI, Churilov LP. Pathogenesis of Autoimmune Male Infertility: Juxtacrine, Paracrine, and Endocrine Dysregulation. PATHOPHYSIOLOGY 2021; 28:471-488. [PMID: 35366245 PMCID: PMC8830464 DOI: 10.3390/pathophysiology28040030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022] Open
Abstract
According to global data, there is a male reproductive potential decrease. Pathogenesis of male infertility is often associated with autoimmunity towards sperm antigens essential for fertilization. Antisperm autoantibodies (ASAs) have immobilizing and cytotoxic properties, impairing spermatogenesis, causing sperm agglutination, altering spermatozoa motility and acrosomal reaction, and thus preventing ovum fertilization. Infertility diagnosis requires a mandatory check for the ASAs. The concept of the blood–testis barrier is currently re-formulated, with an emphasis on informational paracrine and juxtacrine effects, rather than simple anatomical separation. The etiology of male infertility includes both autoimmune and non-autoimmune diseases but equally develops through autoimmune links of pathogenesis. Varicocele commonly leads to infertility due to testicular ischemic damage, venous stasis, local hyperthermia, and hypoandrogenism. However, varicocelectomy can alter the blood–testis barrier, facilitating ASAs production as well. There are contradictory data on the role of ASAs in the pathogenesis of varicocele-related infertility. Infection and inflammation both promote ASAs production due to “danger concept” mechanisms and because of antigen mimicry. Systemic pro-autoimmune influences like hyperprolactinemia, hypoandrogenism, and hypothyroidism also facilitate ASAs production. The diagnostic value of various ASAs has not yet been clearly attributed, and their cut-levels have not been determined in sera nor in ejaculate. The assessment of the autoimmunity role in the pathogenesis of male infertility is ambiguous, so the purpose of this review is to show the effects of ASAs on the pathogenesis of male infertility.
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Affiliation(s)
- Valeriy A. Chereshnev
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (V.A.C.); (S.V.P.); (M.V.C.)
| | - Svetlana V. Pichugova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (V.A.C.); (S.V.P.); (M.V.C.)
- State Autonomous Healthcare Institution of the Sverdlovsk Region “Clinical and Diagnostic Center” (GAUZ SO “CDC” Clinical Diagnostic Center), 620144 Yekaterinburg, Russia;
| | - Yakov B. Beikin
- State Autonomous Healthcare Institution of the Sverdlovsk Region “Clinical and Diagnostic Center” (GAUZ SO “CDC” Clinical Diagnostic Center), 620144 Yekaterinburg, Russia;
| | - Margarita V. Chereshneva
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (V.A.C.); (S.V.P.); (M.V.C.)
| | - Angelina I. Iukhta
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199304 Saint Petersburg, Russia; (Y.I.S.); (L.P.C.)
- Correspondence:
| | - Yuri I. Stroev
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199304 Saint Petersburg, Russia; (Y.I.S.); (L.P.C.)
| | - Leonid P. Churilov
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199304 Saint Petersburg, Russia; (Y.I.S.); (L.P.C.)
- Saint Petersburg Research Institute of Phthisiopulmonology, 191036 Saint Petersburg, Russia
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Qu N, Ogawa Y, Kuramasu M, Nagahori K, Sakabe K, Itoh M. Immunological microenvironment in the testis. Reprod Med Biol 2020; 19:24-31. [PMID: 31956282 PMCID: PMC6955586 DOI: 10.1002/rmb2.12293] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/17/2019] [Accepted: 07/27/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The testis is specific in that it produces haploid germ cells of which autoantigens newly appear long after the neonatal immune tolerance. Under normal condition, these autoantigens are protected by the blood-testis barrier formed by Sertoli cells. Thus, the testis is an immunologically privileged site where haploid cells are protected from autoimmune attack. METHODS The immunological microenvironment in the testis was experimentally investigated using mice and rats. MAIN FINDINGS Not only the blood-testis barrier but also various immuno-suppressive factors are involved in the immune-privileged testis. Indeed, germ cells transplanted into the xenogeneic seminiferous tubules could proliferate and differentiate with no aid of artificial immunosuppression. On the other hand, autoimmune orchitis could be experimentally produced by various methods of immunization with syngeneic or xenogeneic germ cell antigens. CONCLUSION Our results indicate that the testis is immunologically privileged but also immunologically fragile organ. Therefore, the dual nature is critical for immunoregulation of testicular function.
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Affiliation(s)
- Ning Qu
- Department of AnatomyTokyo Medical UniversityTokyoJapan
- Department of Anatomy, Division of Basic Medical ScienceTokai University School of MedicineKanagawaJapan
| | - Yuki Ogawa
- Department of AnatomyTokyo Medical UniversityTokyoJapan
| | | | | | - Kou Sakabe
- Department of Anatomy, Division of Basic Medical ScienceTokai University School of MedicineKanagawaJapan
| | - Masahiro Itoh
- Department of AnatomyTokyo Medical UniversityTokyoJapan
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Tiseo BC, Bonfá E, Borba EF, Munhoz GA, Wood GJA, Srougi M, Silva CA, Cocuzza M. Complete urological evaluation including sperm DNA fragmentation in male systemic lupus erythematosus patients. Lupus 2018; 28:59-65. [DOI: 10.1177/0961203318815764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To evaluate sperm DNA fragmentation analysis in non-azoospermic male systemic lupus erythematosus (SLE) patients. Methods Twenty-eight consecutive male SLE patients (American College of Rheumatology criteria) and 34 healthy controls were evaluated for demographic/exposures data, urological evaluation, hormone profile and sperm analysis (including sperm DNA fragmentation). Clinical features, disease activity/damage scores and treatment were also evaluated. Results The median age (33 (20–52) vs. 36.5 (25–54) years, P = 0.329) and frequency of varicocele (25% vs. 32%, P = 0.183) were similar in SLE patients and healthy controls. Sperm DNA fragmentation showed significantly higher levels of cells class III (44 (9–88) vs. 16.5 (0–80)%, P = 0.001) and cell class IV (10.5 (3–86) vs. 7 (0–36)%, P = 0.039) in SLE. The sperm DNA fragmentation index was also significantly higher in SLE patients (62 (31–97) vs. 25.5 (0–100)%, P < 0.001). Conventional sperm parameters (including sperm count, motility and morphology) were similar in both groups. In SLE patients no correlations were observed between sperm DNA fragmentation index and age, disease duration, Systemic Lupus Erythematosus Disease Activity Index 2000 and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index scores, and cumulative dose of prednisone, hydroxychloroquine, intravenous cyclophosphamide, methotrexate, azathioprine and mycophenolate mofetil ( P > 0.05). Further analysis of SLE patients treated with and without intravenous cyclophosphamide showed that total sperm motility was significantly lower in the former group (64% (15–83) vs. 72% (57–86), P = 0.024). The sperm DNA fragmentation index was alike in both groups (52.5 (31–95) vs. 67.5 (34–97)%, P = 0.185). Conclusions To our knowledge, this is the first demonstration that male non-azoospermic SLE patients have increased sperm DNA fragmentation without evident gonadal dysfunction. Intravenous cyclophosphamide does not seem to be a major determinant for this abnormality. Future prospective study is necessary to determine the impact of this alteration in these patients' fertility.
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Affiliation(s)
- BC Tiseo
- Discipline of Urology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - E. Bonfá
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - EF. Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - GA. Munhoz
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - GJA. Wood
- Discipline of Urology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - M. Srougi
- Discipline of Urology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - CA. Silva
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
- Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - M. Cocuzza
- Discipline of Urology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
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Buscatti IM, Abrão HM, Kozu K, Marques VLS, Gomes RC, Sallum AME, Silva CA. Characterization of scrotal involvement in children and adolescents with IgA vasculitis. Adv Rheumatol 2018; 58:38. [DOI: 10.1186/s42358-018-0039-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
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Buscatti I, Abrão H, Kozu K, Cunha R, Sallum A, Silva C. ENVOLVIMENTO ESCROTAL EM CRIANÇAS E ADOLESCENTES COM PÚRPURA DE HENOCH‐SCHÖNLEIN. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Farhat J, Farhat SCL, Braga ALF, Cocuzza M, Borba EF, Bonfá E, Silva CA. Ozone decreases sperm quality in systemic lupus erythematosus patients. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:212-9. [PMID: 27267639 DOI: 10.1016/j.rbre.2015.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 07/06/2015] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To investigate the deleterious effects of air pollutants exposure in the Sao Paulo metropolitan region on semen quality in systemic lupus erythematosus (SLE). METHODS A seven-years longitudinal repeated-measures panel study was performed at the Laboratory of Experimental Air Pollution and Rheumatology Division. Two semen samples from 28 post-pubertal SLE patients were analyzed. Daily concentrations of air pollutants exposure: PM10, SO2, NO2, ozone, CO, and meteorological variables were evaluated on 90 days before each semen collection dates using generalized estimating equation models. RESULTS Intravenous cyclophosphamide (IVCYC) and ozone had an association with a decrease in sperm quality of SLE patients. IVCYC was associated with decreases of 64.3 million of spermatozoa/mL (95% CI 39.01-89.65; p=0.0001) and 149.14 million of spermatozoa/ejaculate (95% CI 81.93-216.38; p=0.017). With regard to ozone, the most relevant adverse effects were observed from lags 80-88, when the exposure to an interquartile range increase in ozone 9-day moving average concentration led to decreases of 22.9 million of spermatozoa/mL (95% CI 5.8-40.0; p=0.009) and 70.5 million of spermatozoa/ejaculate (95% CI 12.3-128.7; p=0.016). Further analysis of 17 patients that never used IVCYC showed association between exposure to ozone (80-88 days) and decrease of 30.0 million of spermatozoa/mL (95% CI 7.0-53.0; p=0.011) and 79.0 million of spermatozoa/ejaculate (95% CI 2.1-155.9; p=0.044). CONCLUSION Ozone and IVCYC had a consistent adverse effect on semen quality of SLE patients during spermatogenesis. Minimizing exposure to air pollution should be taken into account, especially for patients with chronic systemic inflammatory diseases living in large cities.
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Affiliation(s)
- Juliana Farhat
- Group of Environmental Epidemiology Studies, Laboratory of Experimental Air Pollution, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Sylvia Costa Lima Farhat
- Group of Environmental Epidemiology Studies, Laboratory of Experimental Air Pollution, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alfésio Luís Ferreira Braga
- Group of Environmental Epidemiology Studies, Laboratory of Experimental Air Pollution, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil; Group of Environmental Exposure and Risk Assessment Studies, Post-Graduate Program in Public Health, Universidade Católica de Santos, Santos, SP, Brazil
| | - Marcello Cocuzza
- Division of Urology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Ferreira Borba
- Division of Rheumatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eloisa Bonfá
- Division of Rheumatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clovis Artur Silva
- Division of Rheumatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil; Unit of Pediatric Rheumatology, Instituto da Criança, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
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Verón GL, Molina RI, Tissera AD, Estofan GM, Marín-Briggiler CI, Vazquez-Levin MH. Incidence of Sperm Surface Autoantibodies and Relationship with Routine Semen Parameters and Sperm Kinematics. Am J Reprod Immunol 2016; 76:59-69. [PMID: 27139084 DOI: 10.1111/aji.12519] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 04/07/2016] [Indexed: 01/01/2023] Open
Abstract
PROBLEM Antisperm antibodies (ASA) are associated with male subfertility. However, results on sperm surface autoantibodies are controversial, the relationship between ASA and semen parameters (WHO, 2010) is unknown, and data on ASA and sperm kinematics are scarce. METHOD OF STUDY A retrospective study carried out in men undergoing routine semen analysis (WHO 2010), ASA evaluation (direct SpermMAR(™) (IgG) test), and computer-assisted sperm analysis (CASA). RESULTS A 2.6% and a 5.9% incidence of ASA-positive cases were found (cut-off 50% and 10%, respectively; n = 7492). ASA-positive samples had lower (P < 0.0001) sperm concentration, count, motility, and hypo-osmotic swelling (HOS) test score. HOS results did not correlate with sperm vitality in normozoospermic samples with high ASA levels. In unselected samples, ASA-positive samples (cut-off 50%) showed decreased sperm kinematics (VSL, VAP, LIN, ALH, STR, BCF, WOB), but in normozoospermic samples, ASA-positive and ASA-negative subgroups had similar CASA results. CONCLUSIONS ASA evaluation is highly relevant in full semen assessment.
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Affiliation(s)
- Gustavo Luis Verón
- Instituto de Biología y Medicina Experimental (IBYME; CONICET-FIBYME), Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | - Clara Isabel Marín-Briggiler
- Instituto de Biología y Medicina Experimental (IBYME; CONICET-FIBYME), Ciudad Autónoma de Buenos Aires, Argentina
| | - Mónica Hebe Vazquez-Levin
- Instituto de Biología y Medicina Experimental (IBYME; CONICET-FIBYME), Ciudad Autónoma de Buenos Aires, Argentina
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15
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Farhat J, Farhat SCL, Braga ALF, Cocuzza M, Borba EF, Bonfá E, Silva CA. O ozônio diminui a qualidade do sêmen em pacientes com lúpus eritematoso sistêmico. REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2015.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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16
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Donnelly CG, Cheong SH, Gilbert RO. Unilateral autoimmune orchitis with concurrent contralateral testicular atrophy in a two‐year‐old Newfoundland dog. VETERINARY RECORD CASE REPORTS 2016. [DOI: 10.1136/vetreccr-2015-000277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Callum George Donnelly
- Department of Clinical SciencesTheriogenology SectionCornell UniversityCollege of Veterinary MedicineIthacaNew YorkUSA
| | - Soon Hon Cheong
- Department of Clinical SciencesTheriogenology SectionCornell UniversityCollege of Veterinary MedicineIthacaNew YorkUSA
| | - Robert O Gilbert
- Department of Clinical SciencesTheriogenology SectionCornell UniversityCollege of Veterinary MedicineIthacaNew YorkUSA
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17
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Silva CA, Aikawa NE, Pereira RMR, Campos LMA. Management considerations for childhood-onset systemic lupus erythematosus patients and implications on therapy. Expert Rev Clin Immunol 2015; 12:301-13. [DOI: 10.1586/1744666x.2016.1123621] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Clovis Artur Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nadia Emi Aikawa
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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18
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Cytokines in the blood and semen of infertile patients. Cent Eur J Immunol 2015; 40:337-44. [PMID: 26648778 PMCID: PMC4655384 DOI: 10.5114/ceji.2015.54596] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/11/2015] [Indexed: 12/02/2022] Open
Abstract
Cytokines have been important mediators of the immunity and can be involved in numerous processes in the male genital tract including acting as immunomodulatory elements within the male gonad. The aims of this study were: 1) to detect pro- and anti-inflammatory cytokine levels in the control group and subgroups of infertile men; and 2) to set up the practical recommendations concerning determination of cytokine levels for the male infertility diagnosis. Observations were performed in a group of 82 men: healthy controls (n = 27) and infertile patients (n = 55). The male infertility group was further subdivided into patients with: varicocele (n = 22), idiopathic infertility (n = 13) and partners of couples with recurrent spontaneous abortion (RSA; n = 20). Semen analysis was determined following WHO criteria. The cytokine interleukin 1β (IL-1β), IL-6, IL-10, IL-18; tumor necrosis factor α (TNF-α), interferon g (IFN-g) and transforming growth factor β1 (TGF-β1) contents in serum and seminal plasma were determined by quantitative ELISA. An interesting marker of male infertility appears to be TGF-β1 (blood) significantly elevated in idiopathically infertile males and in the RSA group. Besides elevated TGF-β1 in a group of idiopathic infertility significantly elevated IL-10, IL-18, IFN-g (blood) and statistically decreased IL-1β while increased IFN-g were revealed in seminal plasma compared to healthy controls. We may postulate novel cytokine micropatterns for patients with different background of infertility. Therefore, circulating cytokines: IL-1β, IL-10, IL-18, TGF-β1, IFN-g and IL-1β, IFN-g and TGF-β1 in seminal plasma should be extended in evaluation of specific types of male infertility.
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20
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Fijak M, Zeller T, Huys T, Klug J, Wahle E, Linder M, Haidl G, Allam JP, Pilatz A, Weidner W, Schuppe HC, Meinhardt A. Autoantibodies against protein disulfide isomerase ER-60 are a diagnostic marker for low-grade testicular inflammation. Hum Reprod 2014; 29:2382-92. [DOI: 10.1093/humrep/deu226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Croy BA. Reproductive immunology issue one: cellular and molecular biology. Cell Mol Immunol 2014; 11:405-6. [PMID: 25066420 DOI: 10.1038/cmi.2014.64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 06/22/2014] [Indexed: 12/13/2022] Open
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22
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Park SJ, Suh JS, Lee JH, Lee JW, Kim SH, Han KH, Shin JI. Advances in our understanding of the pathogenesis of Henoch-Schönlein purpura and the implications for improving its diagnosis. Expert Rev Clin Immunol 2014; 9:1223-38. [PMID: 24215411 DOI: 10.1586/1744666x.2013.850028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Henoch-Schönlein purpura (HSP) is a leukocytoclastic vasculitis classically characterized by palpable purpura, arthritis, abdominal pain and renal disease. In this article, we summarize our current understanding of the pathogenesis of HSP and the implications for improving its diagnosis. Although the pathogenesis of HSP is not fully understood yet, exciting new information has emerged in recent years, leading to a better understanding of its pathogenesis. Here, we discuss genetic predisposition, immunoglobulins with a particular emphasis on IgA1, activated complements, cytokines and chemokines, abnormal coagulation and autoantibodies in the underlying pathogenic mechanisms. Finally, diagnostic criteria for HSP developed by institutions such as the American College of Rheumatology and the European League against Rheumatism/Paediatric Rheumatology European Society were proposed to improve early detection and diagnosis.
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Affiliation(s)
- Se Jin Park
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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23
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Diminished ovarian reserve in Behçet’s disease patients. Clin Rheumatol 2014; 34:179-83. [DOI: 10.1007/s10067-014-2680-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/05/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
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Abstract
The initiation and perpetuation of autoimmunity recognize numerous checkpoints, from the genomic susceptibility to the breakdown of tolerance. This latter phenomenon includes the loss of B cell anergy and T regulatory cell failure, as well as the production of autoantibodies and autoreactive T cells. These mechanisms ultimately lead to tissue injury via different mechanisms that span from the production of proinflammatory cytokines to the chemotaxis of immune cells to the target sites. The pathways to autoimmunity have been widely investigated over the past year and resulted in a number of articles in peer-reviewed journals that has increased by nearly 10 % compared to 2011. We herein follow on the attempt to provide a brief discussion of the majority of articles on autoimmune diseases that were published in the major immunology journals in the previous solar year. The selection is necessarily arbitrary and may thus not be seen as comprehensive but reflects current research trends. Indeed, 2012 articles were mostly dedicated to define new and old mechanisms with potential therapeutic implications in autoimmunity in general, though based on specific clinical conditions or animal models. As paradigmatic examples, the environmental influence on autoimmunity, Th17 changes modulating the autoimmune response, serum autoantibodies and B cell changes as biomarkers and therapeutic targets were major issues addressed by experimental articles in 2012. Further, a growing number of studies investigated the sex bias of autoimmunity and supported different working hypotheses to explain the female predominance, including sex chromosome changes and reproductive life factors. In conclusion, the resulting scenario illustrates that common factors may underlie different autoimmune diseases and this is well represented by the observed alterations in interferon-α and TGFβ or by the shared signaling pathways.
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Affiliation(s)
- Carlo Selmi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy,
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25
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Silva CA, Yamakami LYS, Aikawa NE, Araujo DB, Carvalho JF, Bonfá E. Autoimmune primary ovarian insufficiency. Autoimmun Rev 2014; 13:427-30. [PMID: 24418305 DOI: 10.1016/j.autrev.2014.01.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 12/30/2022]
Abstract
Primary ovarian insufficiency (POI) is defined as sustained amenorrhea, increased follicle-stimulating hormone and low estrogen levels, whereas diminished ovarian reserve (DOR) is characterized as regular menses and alterations of ovarian reserve tests. POI of autoimmune origin may be associated with adrenal autoimmunity, non-adrenal autoimmunity or isolated. This autoimmune disease is characterized by serum ovarian, adrenocortical or steroidogenic cell autoantibodies. POI of adrenal autoimmune origin is the most frequent type observed in 60-80% of patients. Clinically, amenorrhea is the hallmark of POI, however before menstruation stops completely, irregular cycles occur. Infertility, hot flushes, vaginal atrophy, and dyspareunia are also common. Autoimmune oophoritis is characterized by mononuclear inflammatory cell infiltrate in the theca cells of growing follicles, with early stage follicles without lymphocytic infiltration. This infiltrate includes plasma, B and T-cells. A novel classification criterion for autoimmune POI/DOR is proposed subdividing in three distinct categories (possible, probable and confirmed) according to autoantibodies, autoimmune disease and ovarian histology. Unfortunately, up to date guidelines for the treatment of autoimmune oophoritis are not available. Strategies to POI treatment include hormone replacement and infertility therapy. Assisted conception with donated oocytes has been proven to achieve pregnancy by intra cytoplasmic sperm injection in POI women.
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Affiliation(s)
- C A Silva
- Pediatric Rheumatology Unit, Department of Pediatric, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - L Y S Yamakami
- Division of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - N E Aikawa
- Pediatric Rheumatology Unit, Department of Pediatric, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - D B Araujo
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
| | - J F Carvalho
- Division of Rheumatology, Faculdade de Medicina da Universidade da Bahia, Bahia, Brazil
| | - E Bonfá
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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26
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de Oliveira GT, Martins SS, Deboni M, Picciarelli P, Campos LMA, Jesus AA, Koda YKL, Silva CA. Cutaneous vasculitis in ulcerative colitis mimicking Henoch-Schönlein purpura. J Crohns Colitis 2013; 7:e69-73. [PMID: 22626504 DOI: 10.1016/j.crohns.2012.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/13/2012] [Accepted: 05/01/2012] [Indexed: 02/08/2023]
Abstract
To the best of our knowledge, no cases of ulcerative colitis (UC) mimicking Henoch-Schönlein purpura (HSP) have been reported so far. During a 28-year period 5635 patients were followed up at our Pediatric Rheumatology Unit and 357 had HSP according to the European League Against Rheumatism, the Paediatric Rheumatology International Trials Organisation and the Paediatric Rheumatology European Society validated classification criteria. At the same period, 148 patients with IBD according to the European Society for Paediatric Gastroenterology, Hepatology and Nutrition criteria were followed up at the Pediatric Gastroenterology Unit in our University Hospital. Only two of them had vasculitis, as an extra intestinal manifestation of UC mimicking HSP, and fulfilled both disease criteria. A 2-year old girl had bloody diarrhoea, severe abdominal pain, arthritis in ankles, petechiae and palpable purpura not related to thrombocytopenia in lower limbs. A 5-year old boy had bloody diarrhoea, palpable purpura in buttocks, lower limbs, penis and scrotum associated with arthritis in knees, orchitis in right testicle and periarticular swelling in hands and feet. Their ileocolonoscopy showed diffuse mucosal erythema, oedema, friability and multiple irregular ulcers, and histopathological examination of colonic specimen revealed diffuse chronic mucosal inflammation, crypt distortion and crypt abscesses suggesting ulcerative colitis. There were no signs of intestinal vasculitis in both cases. In conclusion, this is the first study in a paediatric population that evidenced palpable purpura associated with UC mimicking HSP.
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Affiliation(s)
- Guilherme Trudes de Oliveira
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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27
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Testicular Sertoli cell function in ankylosing spondylitis. Clin Rheumatol 2013; 32:1075-9. [DOI: 10.1007/s10067-013-2215-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/23/2013] [Accepted: 02/07/2013] [Indexed: 10/27/2022]
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28
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Nukumizu LA, Saad CG, Ostensen M, Almeida BP, Cocuzza M, Gonçalves C, Saito O, Bonfá E, Silva CA. Gonadal function in male patients with ankylosing spondylitis. Scand J Rheumatol 2012; 41:476-81. [DOI: 10.3109/03009742.2012.688218] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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