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Mohammadi A, Bashiri Z, Rafiei S, Asgari H, Shabani R, Hosseini S, Koruji M. Testicular niche repair after gonadotoxic treatments: Current knowledge and future directions. Biol Cell 2024; 116:e2300123. [PMID: 38470182 DOI: 10.1111/boc.202300123] [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: 12/05/2023] [Accepted: 01/25/2024] [Indexed: 03/13/2024]
Abstract
The testicular niche, which includes the germ cells, somatic cells, and extracellular matrix, plays a crucial role in maintaining the proper functions of the testis. Gonadotoxic treatments, such as chemotherapy and radiation therapy, have significantly improved the survival rates of cancer patients but have also been shown to have adverse effects on the testicular microenvironment. Therefore, repairing the testicular niche after gonadotoxic treatments is essential to restore its function. In recent years, several approaches, such as stem cell transplantation, gene therapy, growth factor therapy, and pharmacological interventions have been proposed as potential therapeutic strategies to repair the testicular niche. This comprehensive review aims to provide an overview of the current understanding of testis damage and repair mechanisms. We will cover a range of topics, including the mechanism of gonadotoxic action, repair mechanisms, and treatment approaches. Overall, this review highlights the importance of repairing the testicular niche after gonadotoxic treatments and identifies potential avenues for future research to improve the outcomes for cancer survivors.
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Affiliation(s)
- Amirhossein Mohammadi
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Bashiri
- Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Endometrium and Endometriosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Omid Fertility & Infertility Clinic, Hamedan, Iran
| | - Sara Rafiei
- Department of Botany and Plant Sciences, Faculty of Biological Sciences, Alzahra University, Tehran, Iran
| | - Hamidreza Asgari
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ronak Shabani
- Reproductive Sciences and Technology Research Center, Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - SeyedJamal Hosseini
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
- Department of Pharmaceutical Biomaterials and Medical Biomaterials Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Koruji
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Raffo M, Di Naro A, Napolitano L, Aveta A, Cilio S, Pandolfo SD, Manfredi C, Lonati C, Suardi NR. Testicular Cancer Treatments and Sexuality: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:586. [PMID: 38674232 PMCID: PMC11051825 DOI: 10.3390/medicina60040586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
The incidence of testicular cancer (TC) has been rapidly increasing over the past years. Diagnosis and early treatment have shown good oncological control, guaranteeing the patient different treatment approaches according to histology and tumor stage. Currently, physicians usually prioritize oncological outcomes over sexual outcomes and quality of life, considering as a first aim the overall survival of the patients; however, differently from other neoplasms, quality of life is still strongly affected among TC patients, and sexual outcomes are frequently compromised after each TC treatment. Several studies have suggested that each treatment approach may be associated with sexual dysfunctions, including erectile dysfunction, ejaculatory disorders, fertility issues, and hormonal changes. Since testicular cancer patients are more frequently young men, the subject of this work is substantial and should be analyzed in detail to help specialists in the management of this disease. The aim of the current narrative review is to generally describe every treatment for TC, including surgery, chemotherapy, radiotherapy, and retroperitoneal lymph node dissection, and to establish which sexual dysfunction may be specifically associated with each therapy.
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Affiliation(s)
- Massimiliano Raffo
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Angelo Di Naro
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
| | - Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Achille Aveta
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Simone Cilio
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University, 80138 Naples, Italy;
| | - Chiara Lonati
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
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Farnetani G, Vannucci M, Fino MG, Cioppi F, Rosta V, Palma M, Tamburrino L, Vinci S, Casamonti E, Degl'Innocenti S, Spinelli M, Abrardo C, Marchiani S, Lotti F, Muratori M, Riera-Escamilla A, Krausz C. Severe sperm DNA fragmentation may persist for up to 3 years after cytotoxic therapy in patients affected by Hodgkin lymphoma and non-Hodgkin lymphoma. Hum Reprod 2024; 39:496-503. [PMID: 38177083 DOI: 10.1093/humrep/dead269] [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: 10/03/2023] [Revised: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
STUDY QUESTION Does sperm DNA recover from damage in all men after 2 years from the end of cytotoxic treatments? SUMMARY ANSWER The current indication of 2 years waiting time for seeking natural pregnancy after cytotoxic treatment may not be adequate for all men, since severe sperm DNA damage is present in a proportion of subjects even after this timeframe. WHAT IS KNOWN ALREADY Data in the literature on sperm DNA fragmentation (SDF) in lymphoma patients after cytotoxic treatments are scarce. The largest longitudinal study evaluated paired pre- and post-therapy (up to 24 months) semen samples from 34 patients while one study performed a longer follow-up (36 months) in 10 patients. The median/mean SDF values >24 months after therapy did not show significant differences but the studies did not explore the proportion of patients with severe DNA damage and the analysis was done on frozen-thawed samples. STUDY DESIGN, SIZE, DURATION In this study, 53 Hodgkin lymphoma (HL) and 25 non-Hodgkin lymphoma (NHL) post-pubertal patients were included over a recruitment period of 10 years (2012-2022). Among them, 18 subjects provided paired semen samples for SDF analysis at the three time points. SDF was evaluated in patients before (T0) and after 2 (T2) and 3 years (T3) from the end of, cytotoxic treatments (chemotherapy alone or in combination with radiotherapy). A cohort of 79 healthy, fertile, and normozoospermic men >18 years old served as controls (recruited between 2016 and 2019). PARTICIPANTS/MATERIALS, SETTING, METHODS SDF was evaluated on fresh semen samples (i.e. spermatozoa potentially involved in natural conception) from patients and controls using TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) assay coupled with flow cytometry. SDF median values were compared between groups: (i) HL and NHL patients versus controls at the three time points; (ii) HL versus NHL patients at baseline; and (iii) patients at T0 versus T2 and T3. Severe DNA damage (SDD) was defined for SDF levels above the 95th percentile of controls (50%) and the proportion of patients with SDD at all time points was established. MAIN RESULTS AND THE ROLE OF CHANCE At T0, patients displayed higher median SDF than controls, reaching statistical significance in the NHL group: 40.5% [IQR: 31.3-52.6%] versus 28% [IQR: 22-38%], P < 0.05. Comparing SDF pre-treatment to that post-treatment, HL patients exhibited similar median values at the three time points, whereas NHL showed significantly lower values at T3 compared to T0: 29.2% [IQR: 22-38%] versus 40.5% [IQR: 31.3-52.6%], P < 0.05. The proportion with SDD in the entire cohort at T2 was 11.6% and 13.3% among HL and NHL patients, respectively. At T3, only one in 16 NHL patients presented SDD. LIMITATIONS, REASONS FOR CAUTION TUNEL assay requires at least 5 million spermatozoa to be performed; hence, severe oligozoospermic men were not included in the study. Although our cohort represents the largest one in the literature, the relatively small number of patients does not allow us to establish precisely the frequency of SDD at T2 which in our study reached 11-13% of patients. WIDER IMPLICATIONS OF THE FINDINGS Our data provide further insights into the long-term effects of cytotoxic treatments on the sperm genome. The persistent severe DNA damage after 2 years post-treatment observed in some patients suggests that there is an interindividual variation in restoring DNA integrity. We propose the use of SDF as a biomarker to monitor the treatment-induced genotoxic effects on sperm DNA in order to better personalize pre-conceptional counseling on whether to use fresh or cryopreserved spermatozoa. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by grants from the Istituto Toscano Tumori (ITT), Fondazione Ente Cassa di Risparmio di Firenze, the European Commission-Reproductive Biology Early Research Training (REPROTRAIN). C.K., G.F., V.R., and A.R.-E. belong to COST Action CA20119 (ANDRONET) which is supported by the European Cooperation in Science and Technology (www.cost.eu). The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Ginevra Farnetani
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Matteo Vannucci
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Maria Grazia Fino
- Andrology, Female Endocrinology and Gender Incongruence Unit, University Hospital Careggi (AOUC), Florence, Italy
| | - Francesca Cioppi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Viktoria Rosta
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Department of Gynecologic Oncology, Hungarian National Institute of Oncology, Budapest, Hungary
| | - Manuela Palma
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Lara Tamburrino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Serena Vinci
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Elena Casamonti
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Selene Degl'Innocenti
- Andrology, Female Endocrinology and Gender Incongruence Unit, University Hospital Careggi (AOUC), Florence, Italy
| | - Matilde Spinelli
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Department of Andrology, Fundació Puigvert, Universitat Autonoma de Barcelona, Instituto de Investigaciones Biomedicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Chiara Abrardo
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sara Marchiani
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesco Lotti
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Andrology, Female Endocrinology and Gender Incongruence Unit, University Hospital Careggi (AOUC), Florence, Italy
| | - Monica Muratori
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Antoni Riera-Escamilla
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Department of Andrology, Fundació Puigvert, Universitat Autonoma de Barcelona, Instituto de Investigaciones Biomedicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Csilla Krausz
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Andrology, Female Endocrinology and Gender Incongruence Unit, University Hospital Careggi (AOUC), Florence, Italy
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Zheng Y, Li DM, Li FP, Jiang XH, Yang L, Qu R, Bai HZ, Zhao GC, Tian K. Case report: remedial microdissection testicular sperm extraction after onco-microdissection testicular sperm extraction failure. Medicine (Baltimore) 2024; 103:e37201. [PMID: 38394502 DOI: 10.1097/md.0000000000037201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Testicular cancer (TC) mostly occurs in men aged 14 to 44. Studies have shown that TC seriously damages male fertility, and 6% to 24% of patients with TC were even found to suffer from azoospermia when they are diagnosed. At present, some studies have pointed out that onco-microdissection testicular sperm extraction (mTESE) can extract sperm from tumor testicles. However, there are almost no reports on remedial measures after onco-mTESE failure. Given the valuable opportunity for fertility preservation in patients with TC and azoospermia, it is necessary to provide effective remedial methods for patients with failed onco-mTESE. METHODS Two young men, who were diagnosed with TC and also found to have azoospermia, tried onco-mTESE while undergoing radical orchiectomy for fertility preservation. However, sperm extraction failed in both patients. Subsequently, the isolated testicular tissue of the patient in case 1 suffered from TC again, and the patient in case 2 was scheduled to receive multiple cycles of gonadotoxic chemotherapy. Because both had a plan to have a birth in the future, we performed remedial mTESE. RESULTS Sperm was successfully extracted from both patients. The patient recovered well, without complications. The patient couple in case 1 underwent 1 intracytoplasmic sperm injection (ICSI) cycle but did not achieve clinical pregnancy. CONCLUSIONS There is still an opportunity to extract sperm successfully using onco-mTESE, despite the difficulty of fertility preservation in TC patients with azoospermia. If sperm extraction from the tumor testis fails, implementing remedial mTESE as early as possible would likely preserve the last chance of fertility for these patients.
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Affiliation(s)
- Yi Zheng
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Ding-Ming Li
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Fu-Ping Li
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Xiao-Hui Jiang
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Luo Yang
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| | - Rui Qu
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| | - Heng-Zhou Bai
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Gui-Cheng Zhao
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Kun Tian
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
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Neyroud AS, Rolland AD, Lecuyer G, Evrard B, Alary N, Dejucq-Rainsford N, Bujan L, Ravel C, Chalmel F. Sperm DNA methylation dynamics after chemotherapy: a longitudinal study of a patient with testicular germ cell tumor treatment. Andrology 2024; 12:396-409. [PMID: 37354024 DOI: 10.1111/andr.13485] [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: 01/10/2023] [Revised: 05/26/2023] [Accepted: 06/19/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND An important issue for young men affected by testicular germ cell tumor (TGCT) is how TGCT and its treatment will affect, transiently or permanently, their future reproductive health. Previous studies have reported that xenobiotics can induce changes on human sperm epigenome and have the potential to promote epigenetic alterations in the offspring. OBJECTIVES Here, we report the first longitudinal DNA methylation profiling of frozen sperm from a TGCT patient before and up to 2 years after a bleomycin, etoposide, and cisplatin (BEP) chemotherapy. MATERIALS AND METHODS A TGCT was diagnosed in a 30-year-old patient. A cryopreservation of spermatozoa was proposed before adjuvant BEP treatment. Semen samples were collected before and after chemotherapy at 6, 9, 12, and 24 months. The DNA methylation status was determined by RRBS to detect DNA differentially methylated regions (DMRs). RESULTS The analysis revealed that among the 74 DMRs showing modified methylation status 6 months after therapy, 17 remained altered 24 months after treatment. We next associated DMRs with differentially methylated genes (DMGs), which were subsequently intersected with loci known to be important or expressed during early development. DISCUSSION AND CONCLUSION The consequences of the cancer treatment on the sperm epigenome during the recovery periods are topical issues of increasing significance as epigenetic modifications to the paternal genome may have deleterious effects on the offspring. The altered methylated status of these DMGs important for early development might modify their expression pattern and thus affect their function during key stages of embryogenesis, potentially leading to developmental disorders or miscarriages.
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Affiliation(s)
- Anne-Sophie Neyroud
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
- CHU de Rennes, Département de Gynécologie Obstétrique Reproduction-CECOS, Rennes, France
| | - Antoine Dominique Rolland
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Gwendoline Lecuyer
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Bertrand Evrard
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Nathan Alary
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Nathalie Dejucq-Rainsford
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Louis Bujan
- Développement Embryonnaire, Fertilité, Environnement (DEFE), UMR Inserm 1203 Université Toulouse 3 et Montpellier, Toulouse, France
- CECOS, Groupe d'activité de médecine de la reproduction, Hôpital Paule de Viguier, CHU Toulouse, Toulouse, France
| | - Célia Ravel
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
- CHU de Rennes, Département de Gynécologie Obstétrique Reproduction-CECOS, Rennes, France
| | - Frédéric Chalmel
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
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Sarian G, Chalas C, Le Teuff G, Fayech C, Dumas A, Demoor-Goldschmidt C, Fresneau B. Post-treatment sperm cryopreservation practices in childhood and young adult cancer survivors. Reprod Biomed Online 2024; 48:103573. [PMID: 38113762 DOI: 10.1016/j.rbmo.2023.103573] [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: 05/22/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 12/21/2023]
Abstract
RESEARCH QUESTION What are current practices of post-treatment fertility preservation in male childhood cancer survivors (CCS) who have not benefitted from pre-therapeutic fertility preservation in France and other European countries? DESIGN A survey was conducted of all fertility preservation centres in France (n = 30) and European fertility specialists (n = 9) in five European countries. Eight clinical cases and 40 questions were included to assess the effect of age at diagnosis, type of treatment (alkylating-agents, orchidectomy, testicular radiotherapy) and sperm parameters on the probability of a post-treatment fertility preservation proposal. Demographic characteristics of the responding practitioner were also collected. RESULTS Post-treatment sperm cryopreservation was proposed by 100% of fertility specialists in cases of severe oligoasthenoteratozoospermia, 77-88% in cases of moderate oligoasthenoteratozoospermia and in 65-77% in cases of sperm motility and vitality impairment. In cases of normal sperm parameters, 27-54% of fertility specialists would propose post-treatment sperm cryopreservation. These results did not differ significantly according to the type of treatment received or to responder-related factors. Practices of European specialists were also guided by sperm parameter results; 44-67% of specialists responding that they would propose sperm cryopreservation in cases of moderate to severe sperm parameter alterations. CONCLUSION Post-treatment semen analysis could be widely proposed to CCS who have not benefitted from pre-therapeutic fertility preservation. Post-treatment fertility preservation could be proposed in cases of persistent moderate to severe sperm parameter alterations. Guidelines would be important to homogenize practices and to encourage oncologists to refer CCS for fertility assessments.
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Affiliation(s)
| | - Céline Chalas
- Hospital Cochin, University of Paris-Cite, Department of Reproductive Biology-CECOS, Paris, France; Fédération française des CECOS, Toulouse, France
| | - Gwénaël Le Teuff
- Gustave Roussy, Paris-Saclay University, Department of Biostatistics and Epidemiology, Villejuif, F-94805, France
| | - Chiraz Fayech
- Gustave Roussy, Paris-Saclay University, Department of Children and Adolescents Oncology, Villejuif, F-94805, France
| | - Agnès Dumas
- University of Paris-Cite, ECEVE UMR 1123, F-75010 Paris, France; Inserm, Center for Research in Epidemiology and Public Health, U 1018, Epidemiology of Radiation, Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- Inserm, Center for Research in Epidemiology and Public Health, U 1018, Epidemiology of Radiation, Villejuif, France; University Hospital of Angers, Department of Pediatric Oncology and Hematology, Angers, France; Centre François Baclesse, Department of Radiotherapy and Protontherapy, Caen, France; Centre François Baclesse, Department of Supportive Care, Caen, France
| | - Brice Fresneau
- Gustave Roussy, Paris-Saclay University, Department of Children and Adolescents Oncology, Villejuif, F-94805, France; Inserm, Center for Research in Epidemiology and Public Health, U 1018, Epidemiology of Radiation, Villejuif, France.
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van der Meer DJ, Karim-Kos HE, Elzevier HW, Dinkelman-Smit M, Kerst JM, Atema V, Lehmann V, Husson O, van der Graaf WTA. The increasing burden of testicular seminomas and non-seminomas in adolescents and young adults (AYAs): incidence, treatment, disease-specific survival and mortality trends in the Netherlands between 1989 and 2019. ESMO Open 2024; 9:102231. [PMID: 38244349 PMCID: PMC10937200 DOI: 10.1016/j.esmoop.2023.102231] [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: 08/21/2023] [Revised: 11/11/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Testicular cancer incidence among adolescents and young adults (AYAs, aged 18-39 years at diagnosis) is increasing worldwide and most patients will survive the initial disease. Still, detailed epidemiological information about testicular cancer among AYAs is scarce. This study aimed to provide a detailed overview of testicular cancer trends in incidence, treatment, long-term relative survival and mortality by histological subtype among AYAs diagnosed in the Netherlands between 1989 and 2019. MATERIALS AND METHODS Data of all malignant testicular cancers (ICD-code C62) were extracted from the Netherlands Cancer Registry. Mortality data were retrieved from Statistics Netherlands. European age-standardized incidence and mortality rates with average annual percentage change statistics and relative survival estimates up to 20 years of follow-up were calculated. RESULTS A total of 12 528 testicular cancers were diagnosed between 1989 and 2019. Comparing 1989-1999 to 2010-2019, the incidence increased from 4.4 to 11.4 for seminomas and from 5.7 to 11.1 per 100 000 person-years for non-seminomas. Rising trends were most prominent for localized disease. Radiotherapy use in localized testicular seminomas declined from 78% in 1989-1993 to 5% in 2015-2019. Meanwhile, there was a slight increase in chemotherapy use. Most AYAs with localized seminomas and non-seminomas received active surveillance only (>80%). Overall, relative survival estimates remained well above 90% even at 20 years of follow-up for both seminomas and non-seminomas. Mortality rates declined from 0.5 to 0.4 per 100 000 person-years between 1989-1999 and 2010-2019. CONCLUSIONS The incidence of seminoma and non-seminoma testicular cancers significantly increased in AYAs in the Netherlands between 1989 and 2019. There was a shift towards less-aggressive treatment regimens without negative survival effects. Relative survival estimates remained well above 90% at 20 years of follow-up in most cases. Testicular cancer mortality was already low, but has improved further over time, which makes survivorship care an important issue for these young adults.
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Affiliation(s)
- D J van der Meer
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam.
| | - H E Karim-Kos
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht
| | - H W Elzevier
- Department of Urology and Medical Decision Making, Leiden University Medical Centre, Leiden
| | - M Dinkelman-Smit
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam
| | - J M Kerst
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - V Atema
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht
| | - V Lehmann
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam; Cancer Center Amsterdam (CCA), Amsterdam
| | - O Husson
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam; Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam
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8
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Lu X, Luo Y, Nie X, Zhang B, Wang X, Li R, Liu G, Zhou Q, Liu Z, Fan L, Hotaling JM, Zhang Z, Bo H, Guo J. Single-cell multi-omics analysis of human testicular germ cell tumor reveals its molecular features and microenvironment. Nat Commun 2023; 14:8462. [PMID: 38123589 PMCID: PMC10733385 DOI: 10.1038/s41467-023-44305-9] [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: 04/06/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Seminoma is the most common malignant solid tumor in 14 to 44 year-old men. However, its molecular features and tumor microenvironment (TME) is largely unexplored. Here, we perform a series of studies via genomics profiling (single cell multi-omics and spatial transcriptomics) and functional examination using seminoma samples and a seminoma cell line. We identify key gene expression programs share between seminoma and primordial germ cells, and further characterize the functions of TFAP2C in promoting tumor invasion and migration. We also identify 15 immune cell subtypes in TME, and find that subtypes with exhaustion features were located closer to the tumor region through combined spatial transcriptome analysis. Furthermore, we identify key pathways and genes that may facilitate seminoma disseminating beyond the seminiferous tubules. These findings advance our knowledge of seminoma tumorigenesis and produce a multi-omics atlas of in situ human seminoma microenvironment, which could help discover potential therapy targets for seminoma.
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Affiliation(s)
- Xiaojian Lu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yanwei Luo
- Department of Blood Transfusion, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xichen Nie
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Bailing Zhang
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xiaoyan Wang
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
| | - Ran Li
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
| | - Guangmin Liu
- NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Qianyin Zhou
- NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Zhizhong Liu
- NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Liqing Fan
- NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, China
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Zhe Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China.
- Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China.
| | - Hao Bo
- NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China.
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, China.
| | - Jingtao Guo
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China.
- University of Chinese Academy of Sciences, Beijing, China.
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9
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Prades S, Jos SL, Saïas-Magnan J, Bujan L, Eustache F, Blagosklonov O, Lechevallier E, Brugnon F, Loup-Cabaniols V, Bosquet D, Prades M, Ducrocq B, Chalas C, Giscard-d'Estaing S, Mayeur A, Koscinsky I, Schmitt F, Papaxanthos-Roche A, Teletin M, Thibault E, Beauvillard D, Mirallie S, Delepine B, Benhaim A, May-Panloup P, Veau S, Frapsauce C, Fauque P, Costello R, Rives N, Metzler-Guillemain C, Perrin J. Efficient pathway for men fertility preservation in testicular cancer or lymphoma: a cross-sectional study of national 2018 data. Basic Clin Androl 2023; 33:35. [PMID: 38082221 PMCID: PMC10714657 DOI: 10.1186/s12610-023-00209-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/29/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND In 15-49 years-old men, the main cancers are testicular cancer (TC) and lymphomas (L): freezing of ejaculated sperm is primarily used for male fertility preservation (FP) before cancer treatment. Our objective was to analyze the French FP rate in 15-49 years-old men diagnosed with TC or L in 2018. We designed a national descriptive cross-sectional study of sperm banking rate in men with a diagnosis of TC, Hodgkin L (HL) or non-Hodgkin L (NHL). From the French National Cancer Institute (INCa) 2018 data, we extracted the estimated incidence of TC and L in metropolitan France. From the 2018 activity report of CECOS network (Centers for Study and Banking of Eggs and Sperm), we extracted the number of men with TC or L who banked ejaculated sperm. We estimated the proportion of 15-49 years-old men diagnosed with TC or L who banked sperm. RESULTS Among 15-49 years-old men, INCa estimated 38,048 new cancer diagnoses in metropolitan France in 2018: 2,630 TC and 3,913 L (943 HL and 2,970 NHL). The CECOS network provided data from 26/27 metropolitan centers (96% response rate): 1,079 sperm banking for men with TC, 375 for HL and 211 for NHL. We estimated that the 2018 sperm banking rate in France was 41% for TC, 40% for HL, and 7% for NHL. CONCLUSIONS To our knowledge, our paper is the first cross-sectional study with multicenter and national data analyzing FP rate in cancer men: it suggests an efficient pathway for men to FP before cancer treatment, compared to previously published studies. Although sperm banking rate in 15-49 years-old men could definitely be improved, further studies should evaluate the information given to patients before gonadotoxic treatments, the factors associated with the absence of sperm banking and whether this lack of referral induces a loss of chance for these men.
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Affiliation(s)
- Ségolène Prades
- CECOS/Laboratory of Reproductive Biology, La Conception University Hospital, 13385, Marseille, France
| | - Sarah-Lyne Jos
- CECOS/Laboratory of Reproductive Biology, La Conception University Hospital, 13385, Marseille, France
| | - Jacqueline Saïas-Magnan
- CECOS/Laboratory of Reproductive Biology, La Conception University Hospital, 13385, Marseille, France
| | - Louis Bujan
- DEFE (Développement Embryonnaire, Fertilité, Environnement) INSERM, Universités Montpellier Et Toulouse 3, CECOS Hôpital Paule de Viguier, CHU de Toulouse, 1202, Toulouse, France
| | - Florence Eustache
- CECOS, Site Jean Verdier, Hôpitaux Universitaires Paris Seine-Saint-Denis, Bondy, France
- Genomics, Epigenetics and Physiopathology of Reproduction, Institut Cochin, Inserm U1016, Paris, France
| | - Oxana Blagosklonov
- Service de Biologie Et Medecine de La Reproduction, Cryobiologie-CECOS, CHRU Jean Minjoz, Besançon, France
| | - Eric Lechevallier
- Service d'Urologie et Transplantation Rénale, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Florence Brugnon
- 1240 IMOST, INSERM, Clermont Ferrand, France
- Service AMP CECOS, CHU Clermont Ferrand, Clermont Ferrand, France
| | - Vanessa Loup-Cabaniols
- CECOS Languedoc Roussillon, MONTPELLIER Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Dorian Bosquet
- Service de Médecine Et Biologie de la Reproduction - CECOS-CHU Amiens Picardie - Site Sud, Amiens, France
| | - Marie Prades
- Service de Biologie de La Reproduction-CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, 75020, PARIS, France
| | - Bérengère Ducrocq
- Institut de Biologie de la Reproduction - CECOS Hôpital Calmette, CHU de Lille, Lille, France
| | - Céline Chalas
- Laboratoire de Biologie de la Reproduction-CECOS, Assistance Publique-Hôpitaux de Paris.Centre Université Paris-Cité, GHU Cochin, Paris, France
| | - Sandrine Giscard-d'Estaing
- Biologie de La Reproduction, U1208, Hospices Civil de Lyon, HFME, Inserm, Bron, France
- Faculté de Médecine Lyon Sud, Université Claude Bernard, Oullins, France
| | - Anne Mayeur
- Reproductive Biology Department, CECOS, Paris-Saclay University, Antoine-Béclère Hospital, APHP, Clamart, France
| | - Isabelle Koscinsky
- NGERE (Nutrition Génétique Et Exposition Aux Risques Environnementaux) INSERM 1256 Université de Lorraine, 10 Avenue de La Forêt de Haye, 54505, Vandoeuvre Les Nancy, France
- Laboratoire de Biologie de La Reproduction, Hôpital Saint Joseph 26 Boulevard de Louvain, 13008, Marseille, France
| | - Françoise Schmitt
- CECOS ALSACE Mulhouse Groupe Hospitalier, de La Région de Mulhouse Et Sud Alsace, Mulhouse, France
| | | | - Marius Teletin
- Institut de Génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), Université́ de Strasbourg, France-LBDR-CECOS, Hôpitaux Universitaires de Strasbourg (HUS), , Strasbourg, France
| | - Emmanuelle Thibault
- Laboratoire de Biologie de la Reproduction - CECOS Hôpital L'Archet 2 - CHU de Nice, Nice, France
| | | | - Sophie Mirallie
- Service de Médecine Et Biologie de La Reproduction, CHU Nantes, France
| | - Béatrice Delepine
- Service de Biologie de La Reproduction Reims - Pôle de Biologie Médicale Et Pathologie, Reims, France
| | - Annie Benhaim
- Service de Biologie de La Reproduction Coordinatrice Clinico-Biologique du Centre d'AMP du CHU de Caen Pôle de Biologie-CHU, Caen, France
| | - Pascale May-Panloup
- Biologie de La Reproduction, Centre Hospitalier Universitaire & Univ Angers, INSERM, CNRS, MITOVASC, Equipe MitoLab, SFR ICAT, 49000, Angers, France
| | - Ségolène Veau
- Service de Biologie de La Reproduction-CECOS, CHU Rennes - Hôpital Sud, Rennes, France
| | - Cynthia Frapsauce
- Service de Médecine Et de Biologie de La Reproduction-CECOS, CHRU Bretonneau, Tours, France
| | - Patricia Fauque
- Burgundy University, INSERM 1231, Dijon, France
- Dijon University Hospital, Biology of Reproduction-CECOS Laboratory, Dijon, France
| | - Régis Costello
- Service d'Hématologie Et Thérapie Cellulaire, Hôpital La Conception, Assistance Publique Des Hôpitaux de Marseille, 147 Boulevard Baille, 13005, Marseille, France
| | - Nathalie Rives
- NorDiC UMR 1239, team "Adrenal and Gonadal Pathophysiology", Biology of Reproduction-CECOS Laboratory, Univ Rouen Normandie, Inserm, Rouen University Hospital, Rouen, France
| | - Catherine Metzler-Guillemain
- CECOS/Laboratory of Reproductive Biology, La Conception University Hospital, 13385, Marseille, France
- Aix Marseille Univ, INSERM, MMG, UMR_S1251, Marseille, France
| | - Jeanne Perrin
- CECOS/Laboratory of Reproductive Biology, La Conception University Hospital, 13385, Marseille, France.
- Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, Marseille, France.
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10
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Feraille A, Liard A, Rives N, Bubenheim M, Barbotin AL, Giscard d'Estaing S, Mirallié S, Ancelle A, Roux C, Brugnon F, Daudin M, Schneider P, Dumont L, Rondanino C. Impact of low- or moderate-risk gonadotoxic chemotherapy prior to testicular tissue freezing on spermatogonia quantity in human (pre)pubertal testicular tissue. Hum Reprod 2023; 38:2105-2118. [PMID: 37674325 DOI: 10.1093/humrep/dead161] [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: 12/28/2022] [Revised: 06/20/2023] [Indexed: 09/08/2023] Open
Abstract
STUDY QUESTION What is the impact of low- or moderate-risk gonadotoxic chemotherapy received prior to testicular tissue freezing (TTF), and of the cancer itself, on spermatogonia quantity in testicular tissue from (pre)pubertal boys? SUMMARY ANSWER Vincristine, when associated with alkylating agents, has an additional adverse effect on spermatogonia quantity, while carboplatin has no individual contribution to spermatogonia quantity, in testicular tissue of (pre)pubertal boys, when compared to patients who have received non-alkylating chemotherapy. WHAT IS KNOWN ALREADY The improved survival rates after cancer treatment necessitate the inclusion of fertility preservation procedures as part of the comprehensive care for patients, taking into consideration their age. Sperm cryopreservation is an established procedure in post-pubertal males while the TTF proposed for (pre)pubertal boys remains experimental. Several studies exploring testicular tissue of (pre)pubertal boys after TTF have examined the tubular fertility index (TFI, percentage of seminiferous tubule cross-sections containing spermatogonia) and the number of spermatogonia per seminiferous tubule cross-section (S/T). All studies have demonstrated that TFI and S/T always decrease after the introduction of chemotherapeutic agents, especially those which carry high gonadotoxic risks such as alkylating agents. STUDY DESIGN, SIZE, DURATION Testicular tissue samples from 79 (pre)pubertal boys diagnosed with cancer (from 6 months to 16 years of age) were cryopreserved between May 2009 and June 2014. Their medical diagnoses and previous chemotherapy exposures were recorded. We examined histological sections of (pre)pubertal testicular tissue to elucidate whether the chemotherapy or the primary diagnosis affects mainly TFI and S/T. PARTICIPANTS/MATERIALS, SETTING, METHODS (Pre)pubertal boys with cancer diagnosis who had been offered TTF prior to conditioning treatment for hematopoietic stem cell transplantation were included in the study. All the patients had previously received chemotherapy with low- or moderate-risk for future fertility. We have selected patients for whom the information on the chemotherapy received was complete. The quantity of spermatogonia and quality of testicular tissue were assessed by both morphological and immunohistochemical analyses. MAIN RESULTS AND THE ROLE OF CHANCE A significant reduction in the number of spermatogonia was observed in boys treated with alkylating agents. The mean S/T values in boys exposed to alkylating agents were significantly lower compared to boys exposed to non-alkylating agents (P = 0.018). In contrast, no difference was observed for patients treated with carboplatin as the sole administered alkylating agent compared to the group of patients exposed to non-alkylating agents. We observed an increase of S/T with age in the group of patients who did not receive any alkylating agent and a decrease of S/T with age when patients received alkylating agents included in the cyclophosphamide equivalent dose (CED) formula (r = 0.6166, P = 0.0434; r = -0.3759, P = 0.0036, respectively). The TFI and S/T decreased further in the group of patients who received vincristine in combination with alkylating agents (decrease of 22.4%, P = 0.0049 and P < 0.0001, respectively), but in this group the CED was also increased significantly (P < 0.0001). Multivariate analysis, after CED adjustment, showed the persistence of a decrease in TFI correlated with vincristine administration (P = 0.02). LIMITATIONS, REASONS FOR CAUTION This is a descriptive study of testicular tissues obtained from (pre)pubertal boys who were at risk of infertility. The study population is quite heterogeneous, with a small number of patients in each sub-group. Our results are based on comparisons between patients receiving alkylating agents compared to patients receiving non-alkylating agents rather than chemotherapy-naive patients. The French national guidelines for fertility preservation in cancer patients recommend TTF before highly gonadotoxic treatment. Therefore, all the patients had received low- or moderate-risk gonadotoxic chemotherapy before TTF. Access to testicular tissue samples from chemotherapy-naive patients with comparable histological types of cancer was not possible. The functionality of spermatogonia and somatic cells could not be tested by transplantation or in vitro maturation due to limited sample sizes. WIDER IMPLICATIONS OF THE FINDINGS This study summarizes the spermatogonial quantity of (pre)pubertal boys prior to TTF. We confirmed a negative correlation between the cumulative exposure to alkylating agents and spermatogonial quantity. In addition, the synergistic use of vincristine in combination with alkylating agents showed a cumulative deleterious effect on the TFI. For patients for whom fertility preservation is indicated, TTF should be proposed for chemotherapy with a predicted CED above 4000 mg/m2. However, the data obtained from vincristine and carboplatin use should be confirmed in a subsequent study including more patients. STUDY FUNDING/COMPETING INTEREST(S) This study had financial support from a French national research grant PHRC No. 2008/071/HP obtained by the French Institute of Cancer and the French Healthcare Organization. The sponsors played no role in the study. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Aurélie Feraille
- Biology of Reproduction-CECOS Laboratory, Univ Rouen Normandie, Inserm U1239, NorDIC, Team "Adrenal and Gonadal Pathophysiology", Rouen University Hospital, Rouen, France
| | - Agnès Liard
- Department of Child Surgery, Univ Rouen Normandie, Rouen University Hospital, Rouen, France
| | - Nathalie Rives
- Biology of Reproduction-CECOS Laboratory, Univ Rouen Normandie, Inserm U1239, NorDIC, Team "Adrenal and Gonadal Pathophysiology", Rouen University Hospital, Rouen, France
| | | | - Anne-Laure Barbotin
- Institut de Biologie de la Reproduction-Spermiologie-CECOS de Lille, CHU de Lille, Lille, France
| | | | - Sophie Mirallié
- Laboratoire de Biologie de la Reproduction-CECOS de Nantes, CHU de Nantes, Nantes, France
| | - Amélie Ancelle
- Laboratoire de Biologie de la Reproduction-CECOS de Caen, CHU de Caen, Caen, France
| | - Christophe Roux
- Laboratoire de Biologie de la Reproduction-CECOS de Besançon, CHU de Besançon, Besançon, France
| | - Florence Brugnon
- Laboratoire de Biologie de la Reproduction-CECOS d'Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Myriam Daudin
- CECOS Midi-Pyrénées, University Hospital of Toulouse, Hôpital Paule de Viguier, Toulouse, France
| | - Pascale Schneider
- Department of Pediatric Hematology and Oncology, Univ Rouen Normandie, Rouen University Hospital, Rouen, France
| | - Ludovic Dumont
- Biology of Reproduction-CECOS Laboratory, Univ Rouen Normandie, Inserm U1239, NorDIC, Team "Adrenal and Gonadal Pathophysiology", Rouen University Hospital, Rouen, France
| | - Christine Rondanino
- Biology of Reproduction-CECOS Laboratory, Univ Rouen Normandie, Inserm U1239, NorDIC, Team "Adrenal and Gonadal Pathophysiology", Rouen University Hospital, Rouen, France
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11
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Farnetani G, Fino MG, Cioppi F, Riera-Escamilla A, Tamburrino L, Vannucci M, Rosta V, Vinci S, Casamonti E, Turki L, Degl'Innocenti S, Spinelli M, Marchiani S, Lotti F, Muratori M, Krausz C. Long-term effect of cytotoxic treatments on sperm DNA fragmentation in patients affected by testicular germ cell tumor. Andrology 2023; 11:1653-1661. [PMID: 36932666 DOI: 10.1111/andr.13429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Testicular germ cell tumor is the most frequent neoplasia in men of reproductive age, with a 5-year survival rate of 95%. Antineoplastic treatments induce sperm DNA fragmentation, especially within the first year post-therapy. Data in the literature are heterogeneous concerning longer follow-up periods, and the large majority is limited to 2 years. OBJECTIVE To define the timing for the recovery of sperm DNA damage and the proportion of patients with severe DNA damage at 2 and 3 years from the end of therapy. MATERIALS AND METHODS Sperm DNA fragmentation was evaluated in 115 testicular germ cell tumor patients using terminal deoxynucleotidyl transferase dUTP nick end labeling assay coupled with flow cytometry before (T0 ) and 2 (T2 ) and 3 (T3 ) years post-treatment. Patients were divided based on the type of treatment: carboplatin, bleomycin-etoposide-cisplatin, and radiotherapy. For 24 patients, paired sperm DNA fragmentation data were available at all time-points (T0 -T2 -T3 ). Seventy-nine cancer-free, fertile normozoospermic men served as controls. Severe DNA damage was defined as the 95th percentile in controls (sperm DNA fragmentation = 50%). RESULTS Comparing patients versus controls, we observed: (i) no differences at T0 and T3 and (ii) significantly higher sperm DNA fragmentation levels (p < 0.05) at T2 in all treatment groups. Comparing pre- and post-therapy in the 115 patients, the median sperm DNA fragmentation values were higher in all groups at T2 , reaching significance (p < 0.05) only in the carboplatin group. While the median sperm DNA fragmentation values were also higher in the strictly paired cohort at T2 , about 50% of patients returned to baseline. The proportion of severe DNA damage in the entire cohort was 23.4% and 4.8% of patients at T2 and T3 , respectively. DISCUSSION Currently, testicular germ cell tumor patients are advised to wait 2 years post-therapy before seeking natural pregnancy. Our results suggest that this period may not be sufficient for all patients. CONCLUSION The analysis of sperm DNA fragmentation may represent a useful biomarker for pre-conception counseling following cancer treatment.
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Affiliation(s)
- Ginevra Farnetani
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Francesca Cioppi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antoni Riera-Escamilla
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Department of Andrology, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Catalonia, Spain
| | - Lara Tamburrino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matteo Vannucci
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- University Hospital Careggi (AOUC), Florence, Italy
| | - Viktoria Rosta
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Serena Vinci
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Elena Casamonti
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Leila Turki
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Matilde Spinelli
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sara Marchiani
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesco Lotti
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- University Hospital Careggi (AOUC), Florence, Italy
| | - Monica Muratori
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Csilla Krausz
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- University Hospital Careggi (AOUC), Florence, Italy
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12
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Gulino G, Distante A, Akhundov A, Bassi PF. Male infertility and urological tumors: Pathogenesis and therapeutical implications. Urologia 2023; 90:622-630. [PMID: 37491831 PMCID: PMC10623618 DOI: 10.1177/03915603221146147] [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: 01/31/2021] [Accepted: 02/22/2022] [Indexed: 07/27/2023]
Abstract
Most genitourinary tract cancers have a negative impact on male fertility. Although testicular cancers have the worst impact, other tumors such as prostate, bladder, and penis are diagnosed early and treated in relatively younger patients in which couple fertility can be an important concern. The purpose of this review is to highlight both the pathogenetic mechanisms of damage to male fertility in the context of the main urological cancers and the methods of preserving male fertility in an oncological setting, in light of the most recent scientific evidence. A systematic review of available literature was carried out on the main scientific search engines, such as PubMed, Clinicaltrials.Gov, and Google scholar. Three hundred twenty-five relevant articles on this subject were identified, 98 of which were selected being the most relevant to the purpose of this review. There is a strong evidence in literature that all of the genitourinary oncological therapies have a deep negative impact on male fertility: orchiectomy, partial orchiectomy, retroperitoneal lymphadenectomy (RPLND), radical cystectomy, prostatectomy, penectomy, as well as radiotherapy, chemotherapy, and hormonal androgen suppression. Preservation of fertility is possible and includes cryopreservation, hormonal manipulation with GnRH analogs before chemotherapy, androgen replacement. Germ cell auto transplantation is an intriguing strategy with future perspectives. Careful evaluation of male fertility must be a key point before treating genitourinary tumors, taking into account patients' age and couples' perspectives. Informed consent should provide adequate information to the patient about the current state of his fertility and about the balance between risks and benefits in oncological terms. Standard approaches to genitourinary tumors should include a multidisciplinary team with urologists, oncologists, radiotherapists, psycho-sexologists, andrologists, gynecologists, and reproductive endocrinologists.
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Affiliation(s)
- G Gulino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A Distante
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A Akhundov
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - PF Bassi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Xu R, Shen S, Wang D, Ye J, Song S, Wang Z, Yue Z. The role of HIF-1α-mediated autophagy in ionizing radiation-induced testicular injury. J Mol Histol 2023; 54:439-451. [PMID: 37728670 DOI: 10.1007/s10735-023-10153-6] [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: 10/10/2022] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Testis, as a key organ for maintaining male fertility, are extremely sensitive to ionizing radiation (IR). IR-induced testicular dysfunction and infertility are common adverse effects of radiation therapy in patients with pelvic cancer. To study the phenotype and mechanism of IR-induced testicular injury, the mice were irradiated with different radiation doses (0, 2 and 5 Gy) below the semi-lethal dose for one month. Our present results showed that testicular weight and the serum testosterone levels significantly decreased with the structural injury of the testis in an IR dose-dependent manner, indicating that IR caused not only the structural damage of the testis, but also the functional damage. Further analysis by TUNEL staining and Western blotting found that IR induced the apoptosis in a dose-dependent manner as indicated by increased expressions of cleaved caspase3, p53 and Bax on Day 15 after IR treatment. Combined with significantly increased oxidative stress, these results indicated that IR-induced testicular damage may be a long-term, progressively aggravated process, accompanied by apoptosis. Given the role of autophagy in apoptosis, the present study also detected and analyzed the localization and expressions of autophagy-related proteins LC-3I/II, beclin1, p62 and Atg12 in testicular cells, and found that LC-3II, beclin1 and Atg12 expressions significantly increased in the testicular cells of mice irradiated with 2 Gy and 5 Gy, while p62 expression significantly decreased with 5 Gy, implying autophagy was involved in the apoptosis of testicular cells induced by IR. Furthermore, the expressions of HIF-1α and BNIP3 were significantly enhanced in the testis cells of mice irradiated with 2 Gy and 5 Gy, suggesting the potential role of HIF-1α/BNIP3-mediated autophagy in the apoptosis of testicular cells induced by IR. Taken together, our findings demonstrated that HIF-1α/BNIP3-mediated autophagy not only plays a protective effect on the testicular cells of mice irradiated with 2 Gy, but also induces the apoptosis of the testicular cells of mice irradiated with 5 Gy, indicating the double effects on apoptosis, which will help us further understanding the molecular mechanisms of IR-induced testicular injury, and will facilitate us further studies on testicular radioprotection.
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Affiliation(s)
- Renfeng Xu
- Key Laboratory of Optoelectronic Science and Technology for Medicine of Ministry of Education, Provincial Key Laboratory for Developmental Biology and Neurosciences, College of Life Sciences, Fujian Normal University, Fuzhou, 350007, China
- Department of Cell Biology and Medical Genetics, Carson International Cancer Center, Guangdong Key Laboratory for Genome Stability and Disease Prevention, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Siting Shen
- Department of Cell Biology and Medical Genetics, Carson International Cancer Center, Guangdong Key Laboratory for Genome Stability and Disease Prevention, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Defan Wang
- Fujian Provincial Key Laboratory of Reproductive Health Research, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Jianqing Ye
- Key Laboratory of Optoelectronic Science and Technology for Medicine of Ministry of Education, Provincial Key Laboratory for Developmental Biology and Neurosciences, College of Life Sciences, Fujian Normal University, Fuzhou, 350007, China
| | - Shiting Song
- Department of Cell Biology and Medical Genetics, Carson International Cancer Center, Guangdong Key Laboratory for Genome Stability and Disease Prevention, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Zhengchao Wang
- Key Laboratory of Optoelectronic Science and Technology for Medicine of Ministry of Education, Provincial Key Laboratory for Developmental Biology and Neurosciences, College of Life Sciences, Fujian Normal University, Fuzhou, 350007, China.
| | - Zhicao Yue
- Department of Cell Biology and Medical Genetics, Carson International Cancer Center, Guangdong Key Laboratory for Genome Stability and Disease Prevention, Shenzhen University School of Medicine, Shenzhen, 518060, China.
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Cipriani S, Ricci E, Chiaffarino F, Esposito G, Dalmartello M, La Vecchia C, Negri E, Parazzini F. Trend of change of sperm count and concentration over the last two decades: A systematic review and meta-regression analysis. Andrology 2023; 11:997-1008. [PMID: 36709405 DOI: 10.1111/andr.13396] [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: 04/05/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Since the 1970s, several studies found that sperm concentration (SC) and total sperm count (TSC) constantly worsened over time, mainly in high-income countries. OBJECTIVES To evaluate whether the decreasing trend in sperm count is continuing in Western European countries and USA, we performed a systematic review and meta-regression analysis. MATERIALS AND METHODS Embase and Pubmed/Medline were searched papers published in English in the 2000-2020 period limiting the search to data collected in the USA and Western European countries. RESULTS We identified 62 articles and pooled information on 24,196 men (range 10-2,523), collected from 1993 to 2018. Considering all the studies, random-effects meta-regression analyses showed no significant trend for SC (slope per year -0.07 mil/mL, p-value = 0.86). Negative trends of SC were detected in Scandinavian countries (slope per year -1.11 mil/mL, 95% CI: -2.40 to +0.19; p-value = 0.09), but the findings were statistically not significant. No significant trends of SC were detected in Central Europe (slope per year +0.23, 95% CI -2.51 to +2.96; p-value = 0.87), the USA (slope per year +1.08, 95% CI -0.42 to +2.57; p-value = 0.16), and Southern Europe (slope per year +0.19, 95% CI -0.99 to +1.37; p-value = 0.75). We have analyzed separately findings from studies including sperm donors, fertile men, young unselected men (unselected men, study mean age < 25 years) and unselected men (unselected men, study mean age ≥ 25 years). No significant trends of SC were observed among sperm donors (slope per year -2.80, 95% CI -6.76 to +1.17; p-value 0.16), unselected men (slope per year -0.23, 95% CI -1.58 to +1.12; p-value 0.73), young unselected men (slope per year -0.49, 95% CI -1.76 to +0.79; p-value 0.45), fertile men (slope per year +0.29, 95% CI -1.09 to +1.67; p-value 0.68). DISCUSSION AND CONCLUSION The results of this analysis show no significant trends in SC, in USA, and selected Western European countries.
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Affiliation(s)
- Sonia Cipriani
- Gynaecology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Ricci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Chiaffarino
- Gynaecology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Esposito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michela Dalmartello
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eva Negri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Plotton I, Renault L, Lapoirie M, Lejeune H. Chemotherapies and male infertility. ANNALES D'ENDOCRINOLOGIE 2023; 84:481-482. [PMID: 37453790 DOI: 10.1016/j.ando.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Ingrid Plotton
- Service de biochimie et biologie moléculaire, centre de biologie et de pathologie Est, hospices civils de Lyon, Bron, France; Service de médecine de la reproduction, hôpital Femme-mère-enfant, hospices civils de Lyon, Bron, France; Université Claude-Bernard Lyon 1, Lyon, France; Inserm U1208, 18, avenue Doyen-Lépine, 69675 Bron cedex, France.
| | - Lucie Renault
- Service de médecine de la reproduction, hôpital Femme-mère-enfant, hospices civils de Lyon, Bron, France; Université Claude-Bernard Lyon 1, Lyon, France; Inserm U1208, 18, avenue Doyen-Lépine, 69675 Bron cedex, France
| | - Marion Lapoirie
- Service de médecine de la reproduction, hôpital Femme-mère-enfant, hospices civils de Lyon, Bron, France
| | - Hervé Lejeune
- Service de médecine de la reproduction, hôpital Femme-mère-enfant, hospices civils de Lyon, Bron, France; Université Claude-Bernard Lyon 1, Lyon, France; Inserm U1208, 18, avenue Doyen-Lépine, 69675 Bron cedex, France
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Himpe J, Lammerant S, Van den Bergh L, Lapeire L, De Roo C. The Impact of Systemic Oncological Treatments on the Fertility of Adolescents and Young Adults-A Systematic Review. Life (Basel) 2023; 13:life13051209. [PMID: 37240854 DOI: 10.3390/life13051209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Over the past decades, advancements in oncological treatments have led to major improvements in survival. Particularly for adolescents and young adults (AYAs), fertility is an important concern in cancer survivorship. The purpose of the review is to provide physicians with a practical overview of the current knowledge about the impact of systemic oncological treatments on the fertility of female and male AYAs. METHODS A systematic review was performed based on relevant articles obtained from 4 databases up until 31 December 2022. RESULTS The mechanisms of gonadotoxicity and the concurrent risk is described for the following categories: chemotherapy, targeted therapy and immunotherapy. For the category "chemotherapy", the specific effects and risks are listed for the different classes and individual chemotherapeutics. In the category "targeted therapy", a distinction was made between tyrosine kinase inhibitors (TKIs) and monoclonal antibodies. Information concerning immunotherapy is scarce. CONCLUSIONS The effects of chemotherapy on fertility are well investigated, but even in this category, results can be conflicting. Insufficient data are available on the fertility effects of targeted therapy and immunotherapy to draw definitive conclusions. More research is needed for these therapies and their evolving role in treating cancers in AYAs. It would be useful to include fertility endpoints in clinical trials that evaluate new and existing oncological treatments.
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Affiliation(s)
- Justine Himpe
- Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Sander Lammerant
- Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Lore Van den Bergh
- Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Lore Lapeire
- Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
- AYA Research Centre and Hub (ARCH), Ghent University, 9000 Ghent, Belgium
| | - Chloë De Roo
- AYA Research Centre and Hub (ARCH), Ghent University, 9000 Ghent, Belgium
- Department of Reproductive Medicine, Ghent University Hospital, 9000 Ghent, Belgium
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Rohozneanu EF, Deac C, Căinap CI. A Systematic Review Investigating the Difference between 1 Cycle versus 2 Cycles of Adjuvant Chemotherapy in Stage I Testicular Germ Cell Cancers. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:916. [PMID: 37241148 PMCID: PMC10223662 DOI: 10.3390/medicina59050916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
Standard care for stage I testicular germ cell cancers (seminomatous-STC or non-seminomatous-NSTC) is orchiectomy followed by active surveillance, 1 or 2 cycles of adjuvant chemotherapy, surgery or radiotherapy. The decision on the adjuvant therapeutic approach is guided by the associated risk factors of the patient and the potential related toxicity of the treatment. Currently, there is no consensus regarding the optimal number of adjuvant chemotherapy cycles. Although in terms of overall survival, there is no proven inconsistency regarding the number of cycles of adjuvant chemotherapy, and the rate of relapse may vary.
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Affiliation(s)
- Emanuiela Florentina Rohozneanu
- Department of Oncology, The Oncology Institute “Prof. Dr. Ion Chiricuţă” Cluj-Napoca, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
- Department of Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ciprian Deac
- Department of Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Călin Ioan Căinap
- Department of Oncology, The Oncology Institute “Prof. Dr. Ion Chiricuţă” Cluj-Napoca, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
- Department of Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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18
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Yumura Y, Takeshima T, Komeya M, Karibe J, Kuroda S, Saito T. Long-Term Fertility Function Sequelae in Young Male Cancer Survivors. World J Mens Health 2023; 41:255-271. [PMID: 36593712 PMCID: PMC10042651 DOI: 10.5534/wjmh.220102] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 01/03/2023] Open
Abstract
With advances in cancer treatment, such as cytotoxic chemotherapy and radiotherapy, grave new sequelae of treatment have emerged for young cancer survivors. One sequela that cannot be overlooked is male infertility, with reportedly 15% to 30% of cancer survivors losing their fertility potential. Cytotoxic therapy influences spermatogenesis at least temporarily, and in some cases, permanently. The degree of spermatogenesis impairment depends on the combination of drugs used, their cumulative dose, and the level of radiation. The American Society of Clinical Oncology has created an index to classify the risks to fertility based on treatment. Medical professionals currently use this risk classification in fertility preservation (FP) programs. FP programs are currently being promoted to prevent spermatogenesis failure resulting from cancer treatment. For patients who are able to ejaculate and whose semen contains sperm, the semen (sperm) is cryopreserved. Moreover, for patients who lack the ability to ejaculate, those with azoospermia or severe oligozoospermia, and those who have not attained puberty (i.e., spermatogenesis has not begun), testicular biopsy is performed to collect the sperm or germ cells and cryopreserve them. This method of culturing germ cells to differentiate the sperm has been successful in some animal models, but not in humans. FP has recently gained popularity; however, some oncologists and medical professionals involved in cancer treatment still lack adequate knowledge of these procedures. This hinders the dissemination of information to patients and the execution of FP. Information sharing and collaboration between reproductive medicine specialists and oncologists is extremely important for the development of FP. In Japan, the network of clinics and hospitals that support FP is expanding across prefectures.
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Affiliation(s)
- Yasushi Yumura
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
| | - Teppei Takeshima
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Mitsuru Komeya
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Jurii Karibe
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shinnosuke Kuroda
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Tomoki Saito
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
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19
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Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Jolles M, Pinotti R, Swan SH. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update 2023; 29:157-176. [PMID: 36377604 DOI: 10.1093/humupd/dmac035] [Citation(s) in RCA: 139] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Numerous studies have reported declines in semen quality and other markers of male reproductive health. Our previous meta-analysis reported a significant decrease in sperm concentration (SC) and total sperm count (TSC) among men from North America-Europe-Australia (NEA) based on studies published during 1981-2013. At that time, there were too few studies with data from South/Central America-Asia-Africa (SAA) to reliably estimate trends among men from these continents. OBJECTIVE AND RATIONALE The aim of this study was to examine trends in sperm count among men from all continents. The broader implications of a global decline in sperm count, the knowledge gaps left unfilled by our prior analysis and the controversies surrounding this issue warranted an up-to-date meta-analysis. SEARCH METHODS We searched PubMed/MEDLINE and EMBASE to identify studies of human SC and TSC published during 2014-2019. After review of 2936 abstracts and 868 full articles, 44 estimates of SC and TSC from 38 studies met the protocol criteria. Data were extracted on semen parameters (SC, TSC, semen volume), collection year and covariates. Combining these new data with data from our previous meta-analysis, the current meta-analysis includes results from 223 studies, yielding 288 estimates based on semen samples collected 1973-2018. Slopes of SC and TSC were estimated as functions of sample collection year using simple linear regression as well as weighted meta-regression. The latter models were adjusted for predetermined covariates and examined for modification by fertility status (unselected by fertility versus fertile), and by two groups of continents: NEA and SAA. These analyses were repeated for data collected post-2000. Multiple sensitivity analyses were conducted to examine assumptions, including linearity. OUTCOMES Overall, SC declined appreciably between 1973 and 2018 (slope in the simple linear model: -0.87 million/ml/year, 95% CI: -0.89 to -0.86; P < 0.001). In an adjusted meta-regression model, which included two interaction terms [time × fertility group (P = 0.012) and time × continents (P = 0.058)], declines were seen among unselected men from NEA (-1.27; -1.78 to -0.77; P < 0.001) and unselected men from SAA (-0.65; -1.29 to -0.01; P = 0.045) and fertile men from NEA (-0.50; -1.00 to -0.01; P = 0.046). Among unselected men from all continents, the mean SC declined by 51.6% between 1973 and 2018 (-1.17: -1.66 to -0.68; P < 0.001). The slope for SC among unselected men was steeper in a model restricted to post-2000 data (-1.73: -3.23 to -0.24; P = 0.024) and the percent decline per year doubled, increasing from 1.16% post-1972 to 2.64% post-2000. Results were similar for TSC, with a 62.3% overall decline among unselected men (-4.70 million/year; -6.56 to -2.83; P < 0.001) in the adjusted meta-regression model. All results changed only minimally in multiple sensitivity analyses. WIDER IMPLICATIONS This analysis is the first to report a decline in sperm count among unselected men from South/Central America-Asia-Africa, in contrast to our previous meta-analysis that was underpowered to examine those continents. Furthermore, data suggest that this world-wide decline is continuing in the 21st century at an accelerated pace. Research on the causes of this continuing decline and actions to prevent further disruption of male reproductive health are urgently needed.
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Affiliation(s)
- Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Niels Jørgensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine and Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), Murcia, Spain
| | - Dan Weksler-Derri
- Clalit Health Services, Kiryat Ono, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Maya Jolles
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Pinotti
- Gustave L. and Janet W. Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Chan D, Oros Klein K, Riera-Escamilla A, Krausz C, O’Flaherty C, Chan P, Robaire B, Trasler JM. Sperm DNA methylome abnormalities occur both pre- and post-treatment in men with Hodgkin disease and testicular cancer. Clin Epigenetics 2023; 15:5. [PMID: 36611168 PMCID: PMC9826600 DOI: 10.1186/s13148-022-01417-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Combination chemotherapy has contributed to increased survival from Hodgkin disease (HD) and testicular cancer (TC). However, questions concerning the quality of spermatozoa after treatment have arisen. While studies have shown evidence of DNA damage and aneuploidy in spermatozoa years following anticancer treatment, the sperm epigenome has received little attention. Our objectives here were to determine the impact of HD and TC, as well as their treatments, on sperm DNA methylation. Semen samples were collected from community controls (CC) and from men undergoing treatment for HD or TC, both before initiation of chemotherapy and at multiple times post-treatment. Sperm DNA methylation was assessed using genome-wide and locus-specific approaches. RESULTS Imprinted gene methylation was not affected in the sperm of HD or TC men, before or after treatment. Prior to treatment, using Illumina HumanMethylation450 BeadChip (450 K) arrays, a subset of 500 probes was able to distinguish sperm samples from TC, HD and CC subjects; differences between groups persisted post-treatment. Comparing altered sperm methylation between HD or TC patients versus CC men, twice as many sites were affected in TC versus HD men; for both groups, the most affected CpGs were hypomethylated. For TC patients, the promoter region of GDF2 contained the largest region of differential methylation. To assess alterations in DNA methylation over time/post-chemotherapy, serial samples from individual patients were compared. With restriction landmark genome scanning and 450 K array analyses, some patients who underwent chemotherapy showed increased alterations in DNA methylation, up to 2 to 3 years post-treatment, when compared to the CC cohort. Similarly, a higher-resolution human sperm-specific assay that includes assessment of environmentally sensitive regions, or "dynamic sites," also demonstrated persistently altered sperm DNA methylation in cancer patients post-treatment and suggested preferential susceptibility of "dynamic" CpG sites. CONCLUSIONS Distinct sperm DNA methylation signatures were present pre-treatment in men with HD and TC and may help explain increases in birth defects reported in recent clinical studies. Epigenetic defects in spermatozoa of some cancer survivors were evident even up to 2 years post-treatment. Abnormalities in the sperm epigenome both pre- and post-chemotherapy may contribute to detrimental effects on future reproductive health.
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Affiliation(s)
- Donovan Chan
- grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Centre, 1001 Décarie Boul. Block E, Montréal, QC Canada
| | - Kathleen Oros Klein
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC Canada
| | - Antoni Riera-Escamilla
- grid.7080.f0000 0001 2296 0625Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Catalonia Spain
| | - Csilla Krausz
- grid.7080.f0000 0001 2296 0625Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Catalonia Spain ,grid.8404.80000 0004 1757 2304Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Cristian O’Flaherty
- grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Centre, 1001 Décarie Boul. Block E, Montréal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Surgery, McGill University, Montréal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Pharmacology and Therapeutics, McGill University, Montréal, QC Canada
| | - Peter Chan
- grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Centre, 1001 Décarie Boul. Block E, Montréal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Urology, McGill University, Montréal, QC Canada
| | - Bernard Robaire
- grid.14709.3b0000 0004 1936 8649Department of Pharmacology and Therapeutics, McGill University, Montréal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Obstetrics and Gynecology, McGill University, Montréal, QC Canada
| | - Jacquetta M. Trasler
- grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Centre, 1001 Décarie Boul. Block E, Montréal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Pharmacology and Therapeutics, McGill University, Montréal, QC Canada ,grid.14709.3b0000 0004 1936 8649Departments of Pediatrics and Human Genetics, McGill University, Montréal, QC Canada
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21
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Rives N, Courbière B, Almont T, Kassab D, Berger C, Grynberg M, Papaxanthos A, Decanter C, Elefant E, Dhedin N, Barraud-Lange V, Béranger MC, Demoor-Goldschmidt C, Frédérique N, Bergère M, Gabrel L, Duperray M, Vermel C, Hoog-Labouret N, Pibarot M, Provansal M, Quéro L, Lejeune H, Methorst C, Saias J, Véronique-Baudin J, Giscard d'Estaing S, Farsi F, Poirot C, Huyghe É. What should be done in terms of fertility preservation for patients with cancer? The French 2021 guidelines. Eur J Cancer 2022; 173:146-166. [PMID: 35932626 DOI: 10.1016/j.ejca.2022.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
AIM To provide practice guidelines about fertility preservation (FP) in oncology. METHODS We selected 400 articles after a PubMed review of the literature (1987-2019). RECOMMENDATIONS Any child, adolescent and adult of reproductive age should be informed about the risk of treatment gonadotoxicity. In women, systematically proposed FP counselling between 15 and 38 years of age in case of treatment including bifunctional alkylating agents, above 6 g/m2 cyclophosphamide equivalent dose (CED), and for radiation doses on the ovaries ≥3 Gy. For postmenarchal patients, oocyte cryopreservation after ovarian stimulation is the first-line FP technique. Ovarian tissue cryopreservation should be discussed as a first-line approach in case of treatment with a high gonadotoxic risk, when chemotherapy has already started and in urgent cases. Ovarian transposition is to be discussed prior to pelvic radiotherapy involving a high risk of premature ovarian failure. For prepubertal girls, ovarian tissue cryopreservation should be proposed in the case of treatment with a high gonadotoxic risk. In pubertal males, sperm cryopreservation must be systematically offered to any male who is to undergo cancer treatment, regardless of toxicity. Testicular tissue cryopreservation must be proposed in males unable to cryopreserve sperm who are to undergo a treatment with intermediate or severe risk of gonadotoxicity. In prepubertal boys, testicular tissue preservation is: - recommended for chemotherapy with a CED ≥7500 mg/m2 or radiotherapy ≥3 Gy on both testicles. - proposed for chemotherapy with a CED ≥5.000 mg/m2 or radiotherapy ≥2 Gy. If several possible strategies, the ultimate choice is made by the patient.
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Affiliation(s)
- Nathalie Rives
- Normandie Univ, UNIROUEN, Team "Adrenal and Gonadal Physiopathology" Inserm U1239 Nordic, Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, France
| | - Blandine Courbière
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Thierry Almont
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Diana Kassab
- Methodology Unit, Association Française d'Urologie, Paris, Ile-de-France, France
| | - Claire Berger
- Department of Pediatric Hematology and Oncology, University-Hospital of Saint-Etienne, Hospital, Nord Saint-Etienne cedex 02, France 42055; Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne, 15 rue Ambroise Paré, Saint-Etienne cedex 02, France 42023
| | - Michaël Grynberg
- Reproductive Medicine and Fertility Department, Hôpital Antoine-Beclère, Clamart, Île-de-France, France
| | - Aline Papaxanthos
- Reproductive Medicine and Biology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Christine Decanter
- Medically Assisted Procreation and Fertility Preservation Department, Centre Hospitalier Régional Universitaire de Lille, Lille, Hauts-de-France, France
| | - Elisabeth Elefant
- Reference Center for Teratogenic Agents, Hôpital Armand-Trousseau Centre de Référence sur les Agents Tératogènes, Paris, Île-de-France, France
| | - Nathalie Dhedin
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Virginie Barraud-Lange
- Reproductive Medicine and Biology Department, Hôpital Cochin, Paris, Île-de-France, France
| | | | | | - Nicollet Frédérique
- Information and Promotion Department, Association Laurette Fugain, Paris, France
| | - Marianne Bergère
- Human Reproduction, Embryology and Genetics Directorate, Agence de la biomédecine, La Plaine Saint-Denis, France
| | - Lydie Gabrel
- Good Practices Unit - Guidelines and Medicines Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Marianne Duperray
- Guidelines and Drug Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Christine Vermel
- Expertise Quality and Compliance Mission - Communication and Information Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Natalie Hoog-Labouret
- Research and Innovation, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Michèle Pibarot
- OncoPaca-Corse Regional Cancer Network, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Magali Provansal
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Laurent Quéro
- Cancerology and Radiotherapy Department, Hôpital Saint Louis, AP-HP, Paris, France
| | - Hervé Lejeune
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Charlotte Methorst
- Reproductive Medicine and Biology Department, Centre Hospitalier des Quatre Villes - Site de Saint-Cloud, Saint-Cloud, France
| | - Jacqueline Saias
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Jacqueline Véronique-Baudin
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Sandrine Giscard d'Estaing
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Fadila Farsi
- Regional Cancer Network, Réseau Espace Santé Cancer, Lyon, Rhône-Alpes, France
| | - Catherine Poirot
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Éric Huyghe
- Urology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, Université Toulouse 3 Paul Sabatier, Toulouse, France.
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22
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Pening D, Constant M, Bruynbroeck M, Delbaere A, Demeestere I. Impact of cancer on cryopreserved sperm quality and fertility: A cohort study. Health Sci Rep 2022; 5:e726. [PMID: 35873394 PMCID: PMC9297376 DOI: 10.1002/hsr2.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- David Pening
- Department of Obstetrics and Gynecology, Fertility Clinic CUB—Erasme Hospital Brussels Belgium
- Research Laboratory on Human Reproduction Erasme Campus Université Libre de Bruxelles Brussels Belgium
| | - Marnie Constant
- Department of Obstetrics and Gynecology, Fertility Clinic CUB—Erasme Hospital Brussels Belgium
| | - Manon Bruynbroeck
- Fertility Clinic, IVF Laboratory CUB—Erasme Hospital Brussels Belgium
| | - Anne Delbaere
- Department of Obstetrics and Gynecology, Fertility Clinic CUB—Erasme Hospital Brussels Belgium
| | - I. Demeestere
- Research Laboratory on Human Reproduction Erasme Campus Université Libre de Bruxelles Brussels Belgium
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Ferlin A, Calogero AE, Krausz C, Lombardo F, Paoli D, Rago R, Scarica C, Simoni M, Foresta C, Rochira V, Sbardella E, Francavilla S, Corona G. Management of male factor infertility: position statement from the Italian Society of Andrology and Sexual Medicine (SIAMS) : Endorsing Organization: Italian Society of Embryology, Reproduction, and Research (SIERR). J Endocrinol Invest 2022; 45:1085-1113. [PMID: 35075609 DOI: 10.1007/s40618-022-01741-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Infertility affects 15-20% of couples and male factors are present in about half of the cases. For many aspects related to the diagnostic and therapeutic approach of male factor infertility, there is no general consensus, and the clinical approach is not uniform. METHODS In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), endorsed by the Italian Society of Embryology, Reproduction, and Research (SIERR), we propose evidence-based recommendations for the diagnosis, treatment, and management of male factor infertility to improve patient and couple care. RESULTS Components of the initial evaluation should include at minimum medical history, physical examination, and semen analysis. Semen microbiological examination, endocrine assessment, and imaging are suggested in most men and recommended when specific risk factors for infertility exist or first-step analyses showed abnormalities. Full examination including genetic tests, testicular cytology/histology, or additional tests on sperm is clinically oriented and based on the results of previous investigations. For treatment purposes, the identification of the specific cause and the pathogenetic mechanism is advisable. At least, distinguishing pre-testicular, testicular, and post-testicular forms is essential. Treatment should be couple-oriented, including lifestyle modifications, etiologic therapies, empirical treatments, and ART on the basis of best evidence and with a gradual approach. CONCLUSION These Guidelines are based on two principal aspects: they are couple-oriented and place high value in assessing, preventing, and treating risk factors for infertility. These Guidelines also highlighted that male infertility and in particular testicular function might be a mirror of general health of a man.
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Affiliation(s)
- A Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Via Giustiniani 2, 35121, Padua, Italy.
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - C Krausz
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - F Lombardo
- Department of Experimental Medicine, Laboratory of Seminology-Sperm Bank "Loredana Gandini", University of Rome "La Sapienza", Rome, Italy
| | - D Paoli
- Department of Experimental Medicine, Laboratory of Seminology-Sperm Bank "Loredana Gandini", University of Rome "La Sapienza", Rome, Italy
| | - R Rago
- Department of Gender, Parenting, Child and Adolescent Medicine, Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Rome, Italy
| | - C Scarica
- European Hospital, Centre for Reproductive Medicine, Rome, Italy
| | - M Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - C Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Via Giustiniani 2, 35121, Padua, Italy
| | - V Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Sbardella
- Department of Experimental Medicine, University of Rome "La Sapienza", Rome, Italy
| | - S Francavilla
- Department of Life, Health and Environmental Sciences, Unit of Andrology, University of L'Aquila, L'Aquila, Italy
| | - G Corona
- Medical Department, Endocrinology Unit, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
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24
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Bimbatti D, Lai E, Pierantoni F, Maruzzo M, Msaki A, De Toni C, Dionese M, Feltrin A, Basso U, Zagonel V. Patient Reported Outcomes, Paternity, Relationship, and Fertility in Testicular Cancer Survivors: Results from a Prospective Observational Single Institution Trial. Patient Prefer Adherence 2022; 16:3393-3403. [PMID: 36582267 PMCID: PMC9793790 DOI: 10.2147/ppa.s381812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/29/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Testicular cancer (TC) is the most common solid tumor in young adults. 95% of patients are cured, but they may experience late adverse effects (anxiety, fear of recurrence, and sexual dysfunction) with an impact on daily life. We attempted to assess Patient Reported Outcomes (PROMs), long-term sexual disorders, and difficulties in achieving fatherhood in a cohort of TC survivors, as well as their possible correlation with previous cancer treatments. METHODS Different questionnaires, such as the Impact of Cancer (IOC) and the Body Image Scale (BIS), were used to investigate the distinct areas of the PROMs. International Index of Erectile Function (IIEF15) and the Premature Ejaculation Diagnostic Tool (PEDT) focused on sexuality and fertility. Patients were prospectively recruited between February 2020 and February 2022. RESULTS 144 participants completed all the questionnaires. Results showed a good QoL, a moderate fear of TC recurrence, a good satisfaction with their personal body image, low incidence of premature ejaculation and erectile dysfunction. 19.5% of patients who had a testicular implant reported general dissatisfaction. Only 18% of patients had unsuccessfully attempted fatherhood, while the majority had not yet tried, and 23.4% succeeded. A low percentage of patients used procedures assisted reproduction and adoption. CONCLUSION This trial supports the use of various questionnaires as a multifactorial tool capable of investigating all the aspects of long-term cancer survivorship. The assessment of medical and psychosocial sequelae is an essential part of patient care and is important for the development of a comprehensive care plan for TC survivors.
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Affiliation(s)
- Davide Bimbatti
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
- Correspondence: Davide Bimbatti, Oncology 1 Unit, Istituto Oncologico Veneto, IOV - IRCCS, via Gattamelata 64, Padova, 35128, Italy, Email
| | - Eleonora Lai
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Francesco Pierantoni
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
- Oncology 3 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Marco Maruzzo
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Aichi Msaki
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Chiara De Toni
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Michele Dionese
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Alessandra Feltrin
- Hospital Psychology Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Umberto Basso
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
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Yumura Y, Takeshima T, Komeya M, Kuroda S, Saito T, Karibe J. Fertility and sexual dysfunction in young male cancer survivors. Reprod Med Biol 2022; 21:e12481. [PMID: 35949642 PMCID: PMC9356720 DOI: 10.1002/rmb2.12481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Newly emerging serious post‐treatment complications among young male cancer survivors involve fertility and sexual function, preventing them from pursuing a normal family life. Methods We studied and summarized published studies that assess the relationship between cancer treatments and reduced spermatogenesis or sexual dysfunction. Main findings Infertility often occurs because of anticancer therapies that impair spermatogenesis. While some patients postremission functionally recover fertility, others experience a decreased sperm count and azoospermia. Fertility‐preserving modalities are currently being promoted worldwide to preserve spermatogenesis following cancer therapy. Patients who can ejaculate and have sperm in their semen should cryopreserve semen. However, for patients who have never ejaculated before puberty or in whom spermatogenesis has not been established, testis biopsy is performed to collect and preserve sperm or germ cells. Fertility preservation is gaining popularity and requires continuous information dissemination to oncologists and cancer treatment professionals. Furthermore, male sexual dysfunction predominantly involves erectile dysfunction and ejaculation disorder. Conclusion Although preventive and therapeutic methods for these disorders have been established within urology, patients and medical professionals in other fields remain uninformed of these advances. Therefore, dissemination of information regarding fertility preservation techniques should be accelerated.
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Affiliation(s)
- Yasushi Yumura
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| | - Teppei Takeshima
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| | - Mitsuru Komeya
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| | - Shinnosuke Kuroda
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| | - Tomoki Saito
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| | - Jurii Karibe
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
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Blecher GA, Chung E, Katz D, Kim SHK, Bailie J. Onco-Testicular Sperm Extraction (oncoTESE): A Contemporary Concept Review and Report of Australian Sperm Retrieval Rates and Fertility Outcomes. Urology 2021; 160:109-116. [PMID: 34813838 DOI: 10.1016/j.urology.2021.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess sperm retrieval rates of Onco-Testicular Sperm Extraction (oncoTESE) in men with testicular tumors and coexisting severe spermatogenic impairment. METHODS Multi-centre Australian wide retrospective review of oncoTESE procedures performed within the last 10 years. Patients were postpubertal adults having a testicular tumor requiring orchidectomy, with severe oligozoospermia or nonobstructive azoospermia. Ipsilateral testicular sperm extraction was performed following radical inguinal orchidectomy. A contralateral micro-testicular sperm extraction was performed if no sperm or insufficient amounts were initially achieved. Surgical sperm retrieval rates, live birth rates and post operative serum testosterone were recorded. RESULTS Four surgeons compiled a total 13 patients. The mean age was 34.9 years. Seven of 13 were germ cell tumor (GCT), 4 of 13 had non-GCT and 2 of 13 contained benign lesions. Twelve of 13 patients were azoospermic and 1 was severely oligozoospermic. Sperm was found in 6 of 7 GCT patients; 3 of 7 were found in the ipsilateral testis whilst the remaining 4 underwent contralateral micro-testicular sperm extraction; sperm was retrieved in 3 of 4. The respective mean pre and post orchidectomy testosterone was 12.0 vs 14.1nmol/L (GCT cohort). Cryopreserved sperm has been used in assisted reproduction in 2 of 13 patients, with median follow up of 38.7 months. Including use of both cryopreserved and fresh sperm, 6 pregnancies were achieved, including 5 healthy live births and 1 miscarriage. CONCLUSION OncoTESE appears feasible, with acceptable sperm retrieval and subsequent live birth rates, following assisted reproduction. Despite significant underutilisation in the Australian population, oncoTESE should be considered in the management for TC patients with severe oligozoospermia, or nonobstructive azoospermia.
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Affiliation(s)
- Gideon Adam Blecher
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia; Department of Urology, Alfred Health, Melbourne, Victoria, Australia; Department of Urology, Monash Health, Melbourne, Victoria, Australia.
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia; AndroUrology Centre, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
| | - Darren Katz
- Department of Urology, Western Health, Melbourne, Victoria, Australia; Men's Health, Melbourne, Victoria, Australia
| | - Shannon Hee Kyung Kim
- IVF Australia, Sydney, New South Wales, Australia; Macquaire University, Macquarie school of medicine, Sydney, New South Wales, Australia
| | - John Bailie
- Department of Urology, Monash Health, Melbourne, Victoria, Australia
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27
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Faja F, Finocchi F, Carlini T, Rizzo F, Pallotti F, Spaziani M, Balercia G, Lenzi A, Paoli D, Lombardo F. PDE11A gene polymorphism in testicular cancer: sperm parameters and hormonal profile. J Endocrinol Invest 2021; 44:2273-2284. [PMID: 33661511 PMCID: PMC8421290 DOI: 10.1007/s40618-021-01534-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/11/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Testicular germ cell tumours (TGCTs) is the most common malignancy among young adult males. The etiology is multifactorial and both environmental and genetic factors play an important role in the origin and development of TGCT. Genetic susceptibility may result from the interaction of multiple common and low-penetrance genetic variants and one of the main candidate genes is PDE11A. Many PDE11A polymorphisms were found responsible for a reduced PDE activity in TGCT patients, who often also display impaired hormone and sperm profile. The aim of this study was to investigate testicular function and PDE11A sequence in testicular cancer cases. METHODS Semen analysis was performed in 116 patients with unilateral and bilateral sporadic TGCTs and in 120 cancer-free controls. We also investigated hormone profile and PDE11A polymorphisms using peripheral blood samples. RESULTS Our data revealed that TGCT patients showed lower testosterone levels, higher gonadotropins levels and worse semen quality than controls, although the mean and the medians of sperm parameters are within the reference limits. PDE11A sequencing detected ten polymorphisms not yet associated with TGCTs before. Among these, G223A in homozygosity and A288G in heterozygosity were significantly associated with a lower risk of testicular tumour and they displayed a positive correlation with total sperm number. CONCLUSIONS Our findings highlight the key role of PDE11A in testis and suggest the presence of an underlying complex and fine molecular mechanism which controls testis-specific gene expression and susceptibility to testicular cancer.
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Affiliation(s)
- F. Faja
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - F. Finocchi
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - T. Carlini
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - F. Rizzo
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - F. Pallotti
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - M. Spaziani
- Hormone Laboratory, Department of Experimental Medicine - Medical Pathophysiology Section, “Sapienza” University of Rome, Rome, Italy
| | - G. Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - A. Lenzi
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - D. Paoli
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - F. Lombardo
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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28
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Gezer A, Karadag-Sari E. The role of amifostine in preventing radiotherapy induced testicular tissue damage in rats. Biotech Histochem 2021; 97:215-221. [PMID: 34058938 DOI: 10.1080/10520295.2021.1933178] [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: 10/21/2022] Open
Abstract
The germinal epithelium of the adult testis is susceptible to radiation induced damage. Amifostine is a drug used to prevent the side effects of radiotherapy (RT) and chemotherapy. We investigated the protective role of amifostine against RT induced damage to rat testis using the TUNEL assay. We used adult male rats divided equally into four groups: untreated control group; amifostine group, 200 mg/kg amifostine/day for 3 days; RT-saline group, 2 Gy/day local irradiation of testes for 3 days; RT-amifostine group, 2 Gy/day local irradiation of testes for 3 days plus 200 mg/kg amifostine 30 min before each irradiation. Four weeks after treatment, rats were sacrificed for histological examination and apoptosis was assessed using the TUNEL method. The TUNEL staining density was obtained by evaluating separate seminiferous tubules selected randomly from each section using the stereological fractionator method. Apoptosis in the seminiferous tubules in the control group and amifostine groups were evaluated as spontaneous. Frequent apoptosis was observed in the RT-saline group; a statistically significant difference was observed between the RT treated and untreated groups. Administration of amifostine 30 min before RT protected the testicular germ cells against apoptosis.
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Affiliation(s)
- Arzu Gezer
- Vocational School of Health Services, Ataturk University, Erzurum, Turkey
| | - Ebru Karadag-Sari
- Histology Department, Faculty of Veterinary Medicine, Kafkas University, Kars, Turkey
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29
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Xavier R, de Carvalho RC, Fraietta R. Semen quality from patients affected by seminomatous and non-seminomatous testicular tumor. Int Braz J Urol 2021; 47:495-502. [PMID: 32459453 PMCID: PMC7993976 DOI: 10.1590/s1677-5538.ibju.2021.99.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/10/2020] [Indexed: 02/03/2023] Open
Abstract
Testicular cancer is considered a rare disease affecting approximately 1% to 2% of the male population. This neoplasm has a cure rate of over 95%; as a result, a major concern is the future of fertility of carriers from this disease. There are several histological subtypes of testicular tumors; however, the Testicular Germ Cell Tumors (TGCTs), comprising both seminoma and non-seminoma tumors, are considered the main subtypes of testicular neoplasms. TGCT are characterized by being a solid tumor that mostly affects young men aged between 15 and 40 years old. While TGCT subtypes may have an invasive potential, seminoma subtype does not affect other cells rather than germ cells, while non-seminomas have more invasive properties and can achieve somatic cells; thus, having a more aggressive nature. This research intends to review the literature regarding information about sperm parameters, correlating the data found in those studies to the subfertility and infertility of patients with TCGTs. Furthermore, it will also correlate the data to the non-seminoma and seminoma histological subtypes from pre- and post-cancer therapy. PubMed databases were used. Searched keywords included: seminoma AND non-seminoma; male infertility; germ cell tumor; chemotherapy AND radiotherapy. Only articles published in English were considered. Current studies demonstrate that both TGCT subtypes promote deleterious effects on semen quality resulting in decreased sperm concentration, declined sperm total motility and an increase in the morphology alterations. However, findings suggest that the non-seminoma subtype effects are more pronounced and deleterious. More studies will be necessary to clarify the behavior of seminoma and non-seminoma tumors implicating the reproductive health of male patients.
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Affiliation(s)
- Rosana Xavier
- Departamento de Cirurgia, Divisão de Urologia, Universidade Federal de São Paulo - UNIFESP São Paulo, SP, Brasil
| | - Renata Cristina de Carvalho
- Departamento de Cirurgia, Divisão de Urologia, Universidade Federal de São Paulo - UNIFESP São Paulo, SP, Brasil
| | - Renato Fraietta
- Departamento de Cirurgia, Divisão de Urologia, Universidade Federal de São Paulo - UNIFESP São Paulo, SP, Brasil
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30
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Hellesnes R, Myklebust TÅ, Bremnes RM, Karlsdottir Á, Kvammen Ø, Negaard HFS, Tandstad T, Wilsgaard T, Fosså SD, Haugnes HS. Metachronous Contralateral Testicular Cancer in the Cisplatin Era: A Population-Based Cohort Study. J Clin Oncol 2020; 39:308-318. [PMID: 33356420 DOI: 10.1200/jco.20.02713] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE It is hypothesized that cisplatin-based chemotherapy (CBCT) reduces the occurrence of metachronous contralateral (second) germ cell testicular cancer (TC). However, studies including treatment details are lacking. The aim of this study was to assess the second TC risk, emphasizing the impact of previous TC treatment. PATIENTS AND METHODS Based on the Cancer Registry of Norway, 5,620 men were diagnosed with first TC between 1980 and 2009. Treatment data regarding TC were retrieved from medical records. Cumulative incidences of second TC were estimated, and standardized incidence ratios were calculated. The effect of treatment intensity was investigated using Cox proportional hazard regression. RESULTS Median follow-up was 18.0 years, during which 218 men were diagnosed with a second TC after median 6.2 years. Overall, the 20-year crude cumulative incidence was 4.0% (95% CI, 3.5 to 4.6), with lower incidence after chemotherapy (CT) (3.2%; 95% CI, 2.5 to 4.0) than after surgery only (5.4%; 95% CI, 4.2 to 6.8). The second TC incidence was also lower for those age ≥ 30 years (2.8%; 95% CI, 2.3 to 3.4) at first TC diagnosis than those age < 30 years (6.0%; 95% CI, 5.0 to 7.1). Overall, the second TC risk was 13-fold higher compared with the risk of developing TC in the general male population (standardized incidence ratio, 13.1; 95% CI, 11.5 to 15.0). With surgery only as reference, treatment with CT significantly reduced the second TC risk (hazard ratio [HR], 0.55). For each additional CBCT cycle administered, the second TC risk decreased significantly after three, four, and more than four cycles (HRs, 0.53, 0.41, and 0.21, respectively). CONCLUSION Age at first TC diagnosis and treatment intensity influenced the second TC risk, with significantly reduced risks after more than two CBCT cycles.
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Affiliation(s)
- Ragnhild Hellesnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Roy M Bremnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Ása Karlsdottir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Øivind Kvammen
- Department of Oncology, Ålesund Hospital, Ålesund, Norway
| | | | - Torgrim Tandstad
- The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Sophie D Fosså
- Department of Registration, Cancer Registry of Norway, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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31
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Kruseová J, Černíková J, Zámečníková M, Hřivnová L, Koloušková S, Čepelová M, Kabíčková E, Čapek V, Lukš A, Eckschlager T. Semen analysis and treatment risk factors in long-term survivors of childhood cancer. Andrologia 2020; 53:e13853. [PMID: 33070396 DOI: 10.1111/and.13853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/07/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to compare semen quality (sperm density, progressive motility and spermia) between long-term childhood cancer survivors and a control group of males. The second objective was to correlate the semen analysis of the survivors with cancer treatment and endocrine status. The semen quality of 143 survivors (median age, 23.6 years) was compared to 200 men (median age, 27.9 years) who had not been diagnosed with cancer. The cancer-related risk factors and gonadotrophin levels were compared. Overall, 65% of the survivors had abnormal semen analysis compared to 26.5% of the controls (p < 0.0001). Survivors with nonaspermia had lower sperm density than the controls (p < 0.001). Other observed correlations were not significant. Survivors who were treated with alkylating agents were more likely to have abnormal semen analysis (p < 0.008). Follicle-stimulating hormone and luteinising hormone levels were significantly elevated (p < 0.0001) in survivors with abnormal semen analysis. The semen quality parameters, except for low sperm density, did not differ in survivors with nonaspermia compared to the controls. The risk factors included treatment with alkylating agents. Elevated gonadotrophin levels correlated with abnormal semen analysis. All cancer survivors should be made aware of the possibility of suffering from cancer treatment-related infertility.
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Affiliation(s)
- Jarmila Kruseová
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jelena Černíková
- Centre for Reproductive Genetics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Marina Zámečníková
- Centre for Reproductive Genetics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Lucie Hřivnová
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Stanislava Koloušková
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Michaela Čepelová
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Edita Kabíčková
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Václav Čapek
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Aleš Lukš
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Tomáš Eckschlager
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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32
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Gerstl B, Bertoldo MJ, Sullivan E, Volckmar X, Kerr A, Wand H, Ives A, Albalawi O, Anazodo A. Fatherhood Following Treatment for Testicular Cancer: A Systematic Review and Meta-Analyses. J Adolesc Young Adult Oncol 2020; 9:341-353. [DOI: 10.1089/jayao.2019.0164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brigitte Gerstl
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
- Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia
| | - Michael J. Bertoldo
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Elizabeth Sullivan
- Faculty Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Xanthie Volckmar
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Aidan Kerr
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Handan Wand
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Angela Ives
- Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Crawley, Australia
| | - Olayan Albalawi
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Statistics, Science College, Tabuk University, Tabuk, Saudi Arabia
| | - Antoinette Anazodo
- Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Nelune Comprehensive Cancer Center, Prince of Wales Hospital, Sydney, Australia
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33
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Liu Z, Cao K, Liao Z, Chen Y, Lei X, Wei Q, Liu C, Sun X, Yang Y, Cai J, Gao F. Monophosphoryl lipid A alleviated radiation-induced testicular injury through TLR4-dependent exosomes. J Cell Mol Med 2020; 24:3917-3930. [PMID: 32135028 PMCID: PMC7171420 DOI: 10.1111/jcmm.14978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/08/2019] [Accepted: 10/26/2019] [Indexed: 01/02/2023] Open
Abstract
Radiation protection on male testis is an important task for ionizing radiation-related workers or people who receive radiotherapy for tumours near the testicle. In recent years, Toll-like receptors (TLRs), especially TLR4, have been widely studied as a radiation protection target. In this study, we detected that a low-toxicity TLR4 agonist monophosphoryl lipid A (MPLA) produced obvious radiation protection effects on mice testis. We found that MPLA effectively alleviated testis structure damage and cell apoptosis induced by ionizing radiation (IR). However, as the expression abundance differs a lot in distinct cells and tissues, MPLA seemed not to directly activate TLR4 singling pathway in mice testis. Here, we demonstrated a brand new mechanism for MPLA producing radiation protection effects on testis. We observed a significant activation of TLR4 pathway in macrophages after MPLA stimulation and identified significant changes in macrophage-derived exosomes protein expression. We proved that after MPLA treatment, macrophage-derived exosomes played an important role in testis radiation protection, and specially, G-CSF and MIP-2 in exosomes are the core molecules in this protection effect.
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Affiliation(s)
- Zhe Liu
- Department of Radiation Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Kun Cao
- Department of Radiation Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China.,Department of Naval Aeromedicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Zebin Liao
- Department of Radiation Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Yuanyuan Chen
- Department of Radiation Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Xiao Lei
- Department of Radiation Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Qun Wei
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong Liu
- Department of Radiation Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Xuejun Sun
- Department of Radiation Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China.,Department of Naval Aeromedicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Yanyong Yang
- Department of Radiation Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Jianming Cai
- Department of Radiation Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Fu Gao
- Department of Radiation Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
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34
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Delessard M, Saulnier J, Rives A, Dumont L, Rondanino C, Rives N. Exposure to Chemotherapy During Childhood or Adulthood and Consequences on Spermatogenesis and Male Fertility. Int J Mol Sci 2020; 21:ijms21041454. [PMID: 32093393 PMCID: PMC7073108 DOI: 10.3390/ijms21041454] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 01/23/2023] Open
Abstract
Over the last decade, the number of cancer survivors has increased thanks to progress in diagnosis and treatment. Cancer treatments are often accompanied by adverse side effects depending on the age of the patient, the type of cancer, the treatment regimen, and the doses. The testicular tissue is very sensitive to chemotherapy and radiotherapy. This review will summarize the epidemiological and experimental data concerning the consequences of exposure to chemotherapy during the prepubertal period or adulthood on spermatogenic progression, sperm production, sperm nuclear quality, and the health of the offspring. Studies concerning the gonadotoxicity of anticancer drugs in adult survivors of childhood cancer are still limited compared with those concerning the effects of chemotherapy exposure during adulthood. In humans, it is difficult to evaluate exactly the toxicity of chemotherapeutic agents because cancer treatments often combine chemotherapy and radiotherapy. Thus, it is important to undertake experimental studies in animal models in order to define the mechanism involved in the drug gonadotoxicity and to assess the effects of their administration alone or in combination on immature and mature testis. These data will help to better inform cancer patients after recovery about the risks of chemotherapy for their future fertility and to propose fertility preservation options.
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35
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Parekh NV, Lundy SD, Vij SC. Fertility considerations in men with testicular cancer. Transl Androl Urol 2020; 9:S14-S23. [PMID: 32055481 DOI: 10.21037/tau.2019.08.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The modern approach to cancer management has evolved into a multidisciplinary initiative focused not only on cancer specific and overall survival, but also patient quality of life and survivorship. Future fertility is often a major concern for young patients undergoing cancer therapy. Fertility preservation has emerged as a viable but significantly underutilized option. Patients and families should be aware of the varying effects of antineoplastic therapy on their future fertility to allow for an informed decision regarding their fertility preservation options. In this review we discuss the epidemiology, pathophysiology, and management of fertility in the setting of testicular cancer diagnosis and treatment.
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Affiliation(s)
- Neel V Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Scott D Lundy
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah C Vij
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
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36
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Takami H, Fukushima S, Aoki K, Satomi K, Narumi K, Hama N, Matsushita Y, Fukuoka K, Yamasaki K, Nakamura T, Mukasa A, Saito N, Suzuki T, Yanagisawa T, Nakamura H, Sugiyama K, Tamura K, Maehara T, Nakada M, Nonaka M, Asai A, Yokogami K, Takeshima H, Iuchi T, Kanemura Y, Kobayashi K, Nagane M, Kurozumi K, Yoshimoto K, Matsuda M, Matsumura A, Hirose Y, Tokuyama T, Kumabe T, Ueki K, Narita Y, Shibui S, Totoki Y, Shibata T, Nakazato Y, Nishikawa R, Matsutani M, Ichimura K. Intratumoural immune cell landscape in germinoma reveals multipotent lineages and exhibits prognostic significance. Neuropathol Appl Neurobiol 2019; 46:111-124. [PMID: 31179566 DOI: 10.1111/nan.12570] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/03/2019] [Indexed: 12/13/2022]
Abstract
AIMS Alterations in microenvironments are a hallmark of cancer, and these alterations in germinomas are of particular significance. Germinoma, the most common subtype of central nervous system germ cell tumours, often exhibits massive immune cell infiltration intermingled with tumour cells. The role of these immune cells in germinoma, however, remains unknown. METHODS We investigated the cellular constituents of immune microenvironments and their clinical impacts on prognosis in 100 germinoma cases. RESULTS Patients with germinomas lower in tumour cell content (i.e. higher immune cell infiltration) had a significantly longer progression-free survival time than those with higher tumour cell contents (P = 0.03). Transcriptome analyses and RNA in-situ hybridization indicated that infiltrating immune cells comprised a wide variety of cell types, including lymphocytes and myelocyte-lineage cells. High expression of CD4 was significantly associated with good prognosis, whereas elevated nitric oxide synthase 2 was associated with poor prognosis. PD1 (PDCD1) was expressed by immune cells present in most germinomas (93.8%), and PD-L1 (CD274) expression was found in tumour cells in the majority of germinomas examined (73.5%). CONCLUSIONS The collective data strongly suggest that infiltrating immune cells play an important role in predicting treatment response. Further investigation should lead to additional categorization of germinoma to safely reduce treatment intensity depending on tumour/immune cell balance and to develop possible future immunotherapies.
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Affiliation(s)
- H Takami
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.,Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - S Fukushima
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - K Aoki
- Division of Gene and Immune Medicine, National Cancer Center Research Institute, Tokyo, Japan
| | - K Satomi
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.,Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - K Narumi
- Division of Gene and Immune Medicine, National Cancer Center Research Institute, Tokyo, Japan
| | - N Hama
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Y Matsushita
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.,Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - K Fukuoka
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.,Division of Pediatric Neuro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - K Yamasaki
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.,Department of Pediatrics, Osaka City General Hospital, Osaka, Japan
| | - T Nakamura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.,Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - A Mukasa
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - N Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - T Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - T Yanagisawa
- Division of Pediatric Neuro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - H Nakamura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Neurosurgery, Kurume University, Fukuoka, Japan
| | - K Sugiyama
- Department of Neurosurgery, Faculty of Medicine, Hiroshima University, Hiroshima, Japan
| | - K Tamura
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Maehara
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - M Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - M Nonaka
- Department of Neurosurgery, Kansai Medical University Hospital, Osaka, Japan
| | - A Asai
- Department of Neurosurgery, Kansai Medical University Hospital, Osaka, Japan
| | - K Yokogami
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - H Takeshima
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - T Iuchi
- Department of Neurosurgery, Chiba Cancer Center, Chiba, Japan
| | - Y Kanemura
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka, Japan.,Department of Biomedical Research and Innovation, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - K Kobayashi
- Department of Neurosurgery, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - M Nagane
- Department of Neurosurgery, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - K Kurozumi
- Department of Neurological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - K Yoshimoto
- Department of Neurosurgery, Kyusyu University Hospital, Fukuoka, Japan
| | - M Matsuda
- Department of Neurosurgery, University of Tsukuba Hospital, Ibaraki, Japan
| | - A Matsumura
- Department of Neurosurgery, University of Tsukuba Hospital, Ibaraki, Japan
| | - Y Hirose
- Department of Neurosurgery, Fujita Health University Hospital, Aichi, Japan
| | - T Tokuyama
- Department of Neurosurgery, Hamamatsu University Hospital, Shizuoka, Japan
| | - T Kumabe
- Department of Neurosurgery, Kitasato University, Kanagawa, Japan
| | - K Ueki
- Department of Neurosurgery, Dokkyo Medical Univeristy, Tochigi, Japan
| | - Y Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - S Shibui
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Y Totoki
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - T Shibata
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Y Nakazato
- Department of Pathology, Hidaka Hospital, Gunma, Japan
| | - R Nishikawa
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - M Matsutani
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - K Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
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37
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Boussada M, Ali RB, Chahbi A, Abdelkarim M, Fradj MKB, Dziri C, Bokri K, Akacha AB, El May MV. A new Thiocyanoacetamide protects rat sperm cells from Doxorubicin-triggered cytotoxicity whereas Selenium shows low efficacy: In vitro approach. Toxicol In Vitro 2019; 61:104587. [PMID: 31271807 DOI: 10.1016/j.tiv.2019.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/29/2019] [Accepted: 06/29/2019] [Indexed: 11/26/2022]
Abstract
Doxorubicin (DOX) exhibits a wide-ranging spectrum of antitumor activities which maintain its clinical use despite its devastating impact on highly proliferating cells. The present work was designed to develop a new approach which aims to protect male germ cells from DOX cytotoxicity. Thus, an assessment of the protective potential of a new thioamide analog (thiocyanoacetamide; TA) compared to selenium (Se) was performed in rat sperms exposed to DOX in vitro. Oxygen consumption rate (OCR) was measured after exposure to three different doses (0.5, 1, 1.5 and 2 μM) of DOX, Se or TA, and the suitable concentrations were selected for further studies afterwards. Motility, OCR in a time-dependent manner, glucose extracellular concentration and lipid peroxidation (LPO) were measured. Fatty acid (FA) content was assessed by gas chromatography (GC-FID). Cell death, superoxide anion (O2-), mitochondrial membrane potential (MMP), and DNA damage were evaluated by flow cytometry. TA association with DOX increased OCR and glucose uptake, improved cell survival and decreased DNA damage. The co-administration of DOX with Se increased OCR, significantly prevented O2- overproduction, and decreased LPO. Collected data brought new insights regarding this transformed TA, which showed better efficiency than Se in reducing DOX cytotoxic stress in sperms.
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Affiliation(s)
- Marwa Boussada
- UR17/ES/13 Laboratory of Histology and Embryology, Faculty of Medicine of Tunis, University of Tunis El Manar (UTM), Jabbari Jebel Lakhdar Street 15, 1007 Tunis, Tunisia.
| | - Ridha Ben Ali
- UR17/ES/13 Laboratory of Histology and Embryology, Faculty of Medicine of Tunis, University of Tunis El Manar (UTM), Jabbari Jebel Lakhdar Street 15, 1007 Tunis, Tunisia; Unity of Experimental Medicine, Faculty of Medicine of Tunis, University of Tunis El Manar (UTM), Jabbari Jebel Lakhdar Street 15, 1007 Tunis, Tunisia
| | - Ahlem Chahbi
- Laboratory of Hematology, Faculty of Medicine of Tunis, University of Tunis El Manar (UTM), Jabbari Jebel Lakhdar Street 15, 1007 Tunis, Tunisia.
| | - Mohamed Abdelkarim
- Laboratory of Hematology, Faculty of Medicine of Tunis, University of Tunis El Manar (UTM), Jabbari Jebel Lakhdar Street 15, 1007 Tunis, Tunisia
| | - Mohamed Kacem Ben Fradj
- UR05/08-08, LR99/ES/11, Department of Biochemistry, Rabta Hospital, University of Tunis El Manar (UTM), Jabbari Jebel Lakhdar Street 15, 1007 Tunis, Tunisia
| | - Chadli Dziri
- Unity of Experimental Medicine, Faculty of Medicine of Tunis, University of Tunis El Manar (UTM), Jabbari Jebel Lakhdar Street 15, 1007 Tunis, Tunisia
| | - Khouloud Bokri
- Laboratory of Organic Synthesis and Heterocyclic Chemistry Department, Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Tunis, Tunisia
| | - Azaiez Ben Akacha
- Laboratory of Organic Synthesis and Heterocyclic Chemistry Department, Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Tunis, Tunisia
| | - Michèle Véronique El May
- UR17/ES/13 Laboratory of Histology and Embryology, Faculty of Medicine of Tunis, University of Tunis El Manar (UTM), Jabbari Jebel Lakhdar Street 15, 1007 Tunis, Tunisia
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38
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Poorvu PD, Frazier AL, Feraco AM, Manley PE, Ginsburg ES, Laufer MR, LaCasce AS, Diller LR, Partridge AH. Cancer Treatment-Related Infertility: A Critical Review of the Evidence. JNCI Cancer Spectr 2019; 3:pkz008. [PMID: 31360893 PMCID: PMC6649805 DOI: 10.1093/jncics/pkz008] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/08/2019] [Accepted: 03/12/2019] [Indexed: 12/15/2022] Open
Abstract
Cancer treatments may compromise the fertility of children, adolescents, and young adults, and treatment-related infertility represents an important survivorship issue that should be addressed at diagnosis and in follow-up to ensure optimal decision-making, including consideration of pursuing fertility preservation. Risk of infertility varies substantially with patient and treatment factors. The ability to accurately assess fertility risk for many patients is hampered by limitations of the current literature, including heterogeneity in patient populations, treatments, and outcome measures. In this article, we review and synthesize the available data to estimate fertility risks from modern cancer treatments for both children and adult cancer survivors to enable clinicians to counsel patients about future fertility.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ann H Partridge
- Correspondence to: Ann H. Partridge, MD, MPH, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215-5450 (e-mail: .)
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39
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Shankara-Narayana N, Di Pierro I, Fennell C, Ly LP, Bacha F, Vrga L, Savkovic S, Turner L, Jayadev V, Conway AJ, Handelsman DJ. Sperm cryopreservation prior to gonadotoxic treatment: experience of a single academic centre over 4 decades. Hum Reprod 2019; 34:795-803. [DOI: 10.1093/humrep/dez026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/23/2019] [Indexed: 01/19/2023] Open
Affiliation(s)
- Nandini Shankara-Narayana
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
- ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Irene Di Pierro
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
| | - Carolyn Fennell
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
| | - Lam P Ly
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
- ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Fay Bacha
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
| | - Ljubica Vrga
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
| | - Sasha Savkovic
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
| | - Leo Turner
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
| | - Veena Jayadev
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
| | - Ann J Conway
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
- ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - David J Handelsman
- Andrology Department, Concord Hospital, Hospital Road, Concord Hospital, New South Wales, Australia
- ANZAC Research Institute, University of Sydney, Sydney, Australia
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Weibring K, Nord C, Ståhl O, Eberhard J, Sandberg K, Johansson H, Arver S, Giwercman A, Cohn-Cedermark G. Sperm count in Swedish clinical stage I testicular cancer patients following adjuvant treatment. Ann Oncol 2019; 30:604-611. [PMID: 30798330 DOI: 10.1093/annonc/mdz017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Little is known regarding sperm production following adjuvant treatment in testicular cancer (TC) clinical stage I (CS I) patients. PATIENTS AND METHODS A total of 182 TC patients aged 18-50 years were prospectively included during 2001-2006 at any given time within 5 years of orchiectomy. Semen samples were delivered postorchiectomy but before further treatment, 6, 12, 24, 36 and 60 months (T0-T60) after completed therapy. Total sperm number (TSN) and sperm concentration (SC) were used as measurements of testicular function. Four groups according to treatment modality were identified; Radiotherapy; To a total dose of 25.2 Gy to the infradiaphragmal paraaortic and ipsilateral iliac lymph nodes (RT, N = 70), one cycle of adjuvant BEP (bleomycin, etoposide, cisplatin, 5 day regimen) (BEP, N = 62), one cycle of adjuvant carboplatin AUC 7 (Carbo, N = 22), and patients managed by surveillance (SURV, N = 28). RESULTS In the cross-sectional analysis, a significant but transient drop in mean TSN and mean SC (T0-T60) was seen at T6 after radiotherapy. Apart from a significant increase in mean SC at T12 compared with baseline, no significant differences were observed in the other treatment groups. In 119 patients delivering 3 or more samples, values in TSN and SC were rather stable over time. Azoospermic patients (N = 11) were observed in most treatment groups except for in the BEP group. During follow-up, one azoospermic patient belonging to the Carbo group became normospermic. CONCLUSIONS No clinically significant long-term effect on TSN or SC associated with adjuvant treatment in TC CSI patients was found. However, as patients may have low sperm counts before orchiectomy as well as after adjuvant treatment, we offer sperm banking before orchiectomy as assisted reproductive measures may be necessary regardless of treatment given.
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Affiliation(s)
- K Weibring
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm.
| | - C Nord
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund
| | - J Eberhard
- Department of Oncology, Skane University Hospital, Lund
| | - K Sandberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - H Johansson
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - S Arver
- Department of Medicine/Huddinge, Karolinska Institute, Stockholm; Centre for Andrology and Sexual Medicine, Karolinska University Hospital, Stockholm
| | - A Giwercman
- Department of Translational Medicine, Lund University, Malmo, Sweden
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
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Fowler KE, Mandawala AA, Griffin DK. The role of chromosome segregation and nuclear organisation in human subfertility. Biochem Soc Trans 2019; 47:425-432. [DOI: 10.1042/bst20180231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Abstract
Spermatogenesis is central to successful sexual reproduction, producing large numbers of haploid motile male gametes. Throughout this process, a series of equational and reductional chromosome segregation precedes radical repackaging of the haploid genome. Faithful chromosome segregation is thus crucial, as is an ordered spatio-temporal ‘dance’ of packing a large amount of chromatin into a very small space. Ergo, when the process goes wrong, this is associated with an improper chromosome number, nuclear position and/or chromatin damage in the sperm head. Generally, screening for overall DNA damage is relatively commonplace in clinics, but aneuploidy assessment is less so and nuclear organisation studies form the basis of academic research. Several studies have focussed on the role of chromosome segregation, nuclear organisation and analysis of sperm morphometry in human subfertility observing significant alterations in some cases, especially of the sex chromosomes. Importantly, sperm DNA damage has been associated with infertility and both extrinsic (e.g. lifestyle) and intrinsic (e.g. reactive oxygen species levels) factors, and while some DNA-strand breaks are repaired, unexpected breaks can cause differential chromatin packaging and further breakage. A ‘healthy’ sperm nucleus (with the right number of chromosomes, nuclear organisation and minimal DNA damage) is thus an essential part of reproduction. The purpose of this review is to summarise state of the art in the fields of sperm aneuploidy assessment, nuclear organisation and DNA damage studies.
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Affiliation(s)
- Katie E. Fowler
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, U.K
| | - Anjali A. Mandawala
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, U.K
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Beaud H, Tremblay AR, Chan PTK, Delbes G. Sperm DNA Damage in Cancer Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1166:189-203. [PMID: 31301053 DOI: 10.1007/978-3-030-21664-1_11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fertility is a growing healthcare issue for a rising number of cancer survivors. In men, cancer itself and its treatment can negatively affect spermatogenesis by targeting the dividing spermatogonia and their cellular environment, ultimately leading to a reduction of testicular germ cells and sperm count. Experimental data and prospective longitudinal studies have shown that sperm production can recover after cancer treatment. But despite this, yet unpredictable, recovery in sperm production, cancer survivors are more at risk to produce sperm with aneuploidy, DNA damage, abnormal chromatin structure, and epigenetic defects even 2 years post-treatment. Sperm DNA alteration is of clinical concern, as these patients may father children or seek assisted reproduction technologies (ART) using gametes with damaged genome that could result in adverse progeny outcomes. Interestingly, large cohort studies revealed lower birth rate but no significant impact on the health of the children born from male cancer survivors (naturally or using ART). Nevertheless, a better understanding of how cocktail of chemotherapy and new anticancer agents affect spermatogenesis and sperm quality is needed to reduce side effects. Moreover, developing new fertility preservation strategies is essential as sperm cryopreservation before treatment is currently the only option but does not apply for prepubertal/young postpubertal patients.
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Affiliation(s)
- Hermance Beaud
- Institut national de la recherche scientifique, Centre INRS - Institut Armand-Frappier, QC, Canada
| | - Amelie R Tremblay
- Institut national de la recherche scientifique, Centre INRS - Institut Armand-Frappier, QC, Canada
| | - Peter T K Chan
- Division of Urology, McGill University Health Center, QC, Canada
| | - Geraldine Delbes
- Institut national de la recherche scientifique, Centre INRS - Institut Armand-Frappier, QC, Canada.
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Sperm DNA Fragmentation: Mechanisms of Origin. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1166:75-85. [DOI: 10.1007/978-3-030-21664-1_5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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44
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Walschaerts M, Bujan L, Chouquet C, Rossi V, Juillard JC, Thonneau P. Sperm cryopreservation incidence in men with testicular cancer: towards a stabilization in testicular cancer incidence? Results from the CECOS network. Basic Clin Androl 2018; 28:11. [PMID: 30123508 PMCID: PMC6091093 DOI: 10.1186/s12610-018-0075-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/26/2018] [Indexed: 11/16/2022] Open
Abstract
Background Testicular cancer (TC) represents 1% of all new male cancer cases but remains the most frequent cancer in adolescents and young adults in industrialized countries. In this study, we assessed time trends in use of sperm cryopreservation by men with TC from 1990 to 2013 in France. Methods We collected data from patients diagnosed with TC who underwent sperm cryopreservation in the French national network of sperm banks. Trends in the incidence of sperm cryopreservation were estimated through two statistical models: the commonly used Poisson regression model and the Verhulst model. Results Between 1990 and 2013, the overall incidence of sperm cryopreservation rose from 1.73 to 5.57 per 100,000 person-years. Poisson regression predicted an incidence of 9 per 100,000 [95% CI = 8.66–9.34] in 2020. However, since 2005, the observed sperm cryopreservation rate seems to be attenuating. The Verhulst model predicted an incidence of 6 per 100,000 after 2020. Conclusions Limitations include the impossibility of analyzing age-standardized incidence. Based on the Verhulst model, results suggest that it is still relevant to follow up TC incidence and sperm cryopreservation in order to confirm or refute the potential decrease already observed in this disease.
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Affiliation(s)
- Marie Walschaerts
- Université de Toulouse, UPS, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), TSA 70034, 31059 Toulouse Cedex 9, France
| | - Louis Bujan
- Université de Toulouse, UPS, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), TSA 70034, 31059 Toulouse Cedex 9, France.,2CECOS Groupe d'Activité de Médecine de la Reproduction, CHU Toulouse, Toulouse, France
| | - Cécile Chouquet
- 3Institut de Mathématiques de Toulouse, Laboratoire de Statistique et Probabilités, CNRS (UMR 5219), Paul Sabatier Université, Toulouse, France
| | - Valentine Rossi
- Université de Toulouse, UPS, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), TSA 70034, 31059 Toulouse Cedex 9, France
| | | | - Patrick Thonneau
- Université de Toulouse, UPS, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), TSA 70034, 31059 Toulouse Cedex 9, France
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Moody JA, Ahmed K, Yap T, Minhas S, Shabbir M. Fertility managment in testicular cancer: the need to establish a standardized and evidence-based patient-centric pathway. BJU Int 2018; 123:160-172. [DOI: 10.1111/bju.14455] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jemma A. Moody
- GKT School of Medical Education; King's College London; London UK
- College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
| | - Kamran Ahmed
- GKT School of Medical Education; King's College London; London UK
- Department of Urology; Guy's Hospital; London UK
| | - Tet Yap
- Department of Urology; Guy's Hospital; London UK
| | - Suks Minhas
- Imperial College Healthcare; NHS Trust; London UK
| | - Majid Shabbir
- GKT School of Medical Education; King's College London; London UK
- Department of Urology; Guy's Hospital; London UK
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Cebi Sen C, Yumusak N, Atilgan HI, Sadic M, Koca G, Korkmaz M. Effect of Amifostine on Sperm DNA Fragmentation and Testes after Radioiodine Treatment. J Vet Res 2018; 61:509-515. [PMID: 29978117 PMCID: PMC5937352 DOI: 10.1515/jvetres-2017-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/04/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction Radioactive iodine (RAI) is commonly used for the treatment of hyperthyroidism caused by Graves’ disease or thyroid nodules. However, information available on the impact of RAI therapy on male gonadal function is scarce. This study aimed to determine any possible damage to testicular tissue and sperm quality caused by RAI therapy, and the radioprotective effect of amifostine against such damage. Material and Methods In total, 36 rats were randomly allocated to three groups, including a control group, RAI group (111 MBq Iodine-131), and RAI + amifostine group (111 MBq Iodine-131 and a single dose of 200 mg/kg amifostine). Blood and epididymal sperm samples were taken for hormone analyses and the evaluation of spermatological parameters. The TUNEL assay and haematoxylin-eosin were used to stain testicular tissue samples to detect histological changes and apoptosis. Results The groups differed insignificantly for the testicular mass index and spermatozoa concentration. However, spermatozoa motility and percentage of viable spermatozoa were higher in the RAI + amifostine group, compared to the RAI group. Sperm DNA fragmentation and the index of apoptotic germ cells significantly decreased in the amifostine group, in comparison to the radioiodine group. While the testosterone levels showed no significant change, the follicle stimulating hormone (FSH) levels significantly decreased in the RAI + amifostine group. Conclusion All histopathological parameters and some spermatological parameters showed that RAI therapy caused statistically significant damage of testicular tissue and this damage was reduced by amifostine.
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Affiliation(s)
- Cigdem Cebi Sen
- Department of Reproduction and Artificial Insemination, 63200Sanliurfa, Turkey
| | - Nihat Yumusak
- Department of Pathology, Faculty of Veterinary Medicine, Harran University, 63200Sanliurfa, Turkey
| | - Hasan Ikbal Atilgan
- Department of Nuclear Medicine, Kahramanmaras Necip Fazil City Hospital, 46000Kahramanmaras, Turkey
| | - Murat Sadic
- Department of Nuclear Medicine, Ankara Training and Research Hospital, University of Health Sciences, 06100Ankara, Turkey
| | - Gokhan Koca
- Department of Nuclear Medicine, Ankara Training and Research Hospital, University of Health Sciences, 06100Ankara, Turkey
| | - Meliha Korkmaz
- Department of Nuclear Medicine, Ankara Training and Research Hospital, University of Health Sciences, 06100Ankara, Turkey
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García-Rodríguez FJ, Martínez-Fernández C, Brena D, Kukhtar D, Serrat X, Nadal E, Boxem M, Honnen S, Miranda-Vizuete A, Villanueva A, Cerón J. Genetic and cellular sensitivity of Caenorhabditis elegans to the chemotherapeutic agent cisplatin. Dis Model Mech 2018; 11:dmm.033506. [PMID: 29752286 PMCID: PMC6031354 DOI: 10.1242/dmm.033506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/10/2018] [Indexed: 12/13/2022] Open
Abstract
Cisplatin and derivatives are commonly used as chemotherapeutic agents. Although the cytotoxic action of cisplatin on cancer cells is very efficient, clinical oncologists need to deal with two major difficulties, namely the onset of resistance to the drug and the cytotoxic effect in patients. Here, we used Caenorhabditis elegans to investigate factors influencing the response to cisplatin in multicellular organisms. In this hermaphroditic model organism, we observed that sperm failure is a major cause of cisplatin-induced infertility. RNA sequencing data indicate that cisplatin triggers a systemic stress response, in which DAF-16/FOXO and SKN-1/NRF2, two conserved transcription factors, are key regulators. We determined that inhibition of the DNA damage-induced apoptotic pathway does not confer cisplatin protection to the animal. However, mutants for the pro-apoptotic BH3-only gene ced-13 are sensitive to cisplatin, suggesting a protective role of the intrinsic apoptotic pathway. Finally, we demonstrated that our system can also be used to identify mutations providing resistance to cisplatin and therefore potential biomarkers of innate cisplatin-refractory patients. We show that mutants for the redox regulator trxr-1, ortholog of the mammalian thioredoxin reductase 1 TRXR1, display cisplatin resistance. By CRISPR/Cas9, we determined that such resistance relies on the presence of the single selenocysteine residue in TRXR-1. This article has an associated First Person interview with the first author of the paper. Summary:Caenorhabditiselegans is a valuable model to identify genetic factors influencing the animal response to the widely used chemotherapeutic agent cisplatin.
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Affiliation(s)
- Francisco Javier García-Rodríguez
- Modeling human diseases in C. elegans. Genes, Diseases and Therapies Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.,Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, 08908 Barcelona, Spain
| | - Carmen Martínez-Fernández
- Modeling human diseases in C. elegans. Genes, Diseases and Therapies Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - David Brena
- Modeling human diseases in C. elegans. Genes, Diseases and Therapies Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Dmytro Kukhtar
- Modeling human diseases in C. elegans. Genes, Diseases and Therapies Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Xènia Serrat
- Modeling human diseases in C. elegans. Genes, Diseases and Therapies Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Ernest Nadal
- Thoracic Oncology Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Mike Boxem
- Division of Developmental Biology, Department of Biology, Faculty of Science, Utrecht University, 3584 CH Utrecht, The Netherlands
| | - Sebastian Honnen
- Heinrich Heine University Düsseldorf, Medical Faculty, Institute of Toxicology, D-40225 Düsseldorf, Germany
| | - Antonio Miranda-Vizuete
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, E-41013 Sevilla, Spain
| | - Alberto Villanueva
- Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, 08908 Barcelona, Spain
| | - Julián Cerón
- Modeling human diseases in C. elegans. Genes, Diseases and Therapies Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
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49
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Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Mindlis I, Pinotti R, Swan SH. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update 2018; 23:646-659. [PMID: 28981654 DOI: 10.1093/humupd/dmx022] [Citation(s) in RCA: 712] [Impact Index Per Article: 118.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/28/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Reported declines in sperm counts remain controversial today and recent trends are unknown. A definitive meta-analysis is critical given the predictive value of sperm count for fertility, morbidity and mortality. OBJECTIVE AND RATIONALE To provide a systematic review and meta-regression analysis of recent trends in sperm counts as measured by sperm concentration (SC) and total sperm count (TSC), and their modification by fertility and geographic group. SEARCH METHODS PubMed/MEDLINE and EMBASE were searched for English language studies of human SC published in 1981-2013. Following a predefined protocol 7518 abstracts were screened and 2510 full articles reporting primary data on SC were reviewed. A total of 244 estimates of SC and TSC from 185 studies of 42 935 men who provided semen samples in 1973-2011 were extracted for meta-regression analysis, as well as information on years of sample collection and covariates [fertility group ('Unselected by fertility' versus 'Fertile'), geographic group ('Western', including North America, Europe Australia and New Zealand versus 'Other', including South America, Asia and Africa), age, ejaculation abstinence time, semen collection method, method of measuring SC and semen volume, exclusion criteria and indicators of completeness of covariate data]. The slopes of SC and TSC were estimated as functions of sample collection year using both simple linear regression and weighted meta-regression models and the latter were adjusted for pre-determined covariates and modification by fertility and geographic group. Assumptions were examined using multiple sensitivity analyses and nonlinear models. OUTCOMES SC declined significantly between 1973 and 2011 (slope in unadjusted simple regression models -0.70 million/ml/year; 95% CI: -0.72 to -0.69; P < 0.001; slope in adjusted meta-regression models = -0.64; -1.06 to -0.22; P = 0.003). The slopes in the meta-regression model were modified by fertility (P for interaction = 0.064) and geographic group (P for interaction = 0.027). There was a significant decline in SC between 1973 and 2011 among Unselected Western (-1.38; -2.02 to -0.74; P < 0.001) and among Fertile Western (-0.68; -1.31 to -0.05; P = 0.033), while no significant trends were seen among Unselected Other and Fertile Other. Among Unselected Western studies, the mean SC declined, on average, 1.4% per year with an overall decline of 52.4% between 1973 and 2011. Trends for TSC and SC were similar, with a steep decline among Unselected Western (-5.33 million/year, -7.56 to -3.11; P < 0.001), corresponding to an average decline in mean TSC of 1.6% per year and overall decline of 59.3%. Results changed minimally in multiple sensitivity analyses, and there was no statistical support for the use of a nonlinear model. In a model restricted to data post-1995, the slope both for SC and TSC among Unselected Western was similar to that for the entire period (-2.06 million/ml, -3.38 to -0.74; P = 0.004 and -8.12 million, -13.73 to -2.51, P = 0.006, respectively). WIDER IMPLICATIONS This comprehensive meta-regression analysis reports a significant decline in sperm counts (as measured by SC and TSC) between 1973 and 2011, driven by a 50-60% decline among men unselected by fertility from North America, Europe, Australia and New Zealand. Because of the significant public health implications of these results, research on the causes of this continuing decline is urgently needed.
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Affiliation(s)
- Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, the Hebrew University Center of Excellence in Agriculture and Environmental Health, Ein Kerem Campus, PO BOX 12272, Jerusalem 9110202, Israel.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Niels Jørgensen
- University Department of Growth and Reproduction, University of Copenhagen, Rigshospitalet, CopenhagenDK-2100, Denmark
| | - Anderson Martino-Andrade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,Department of Physiology, Federal University of Parana, Curitiba 81531-980, Brazil
| | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine and Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), Murcia30100, Spain
| | - Dan Weksler-Derri
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva6676814, Israel
| | - Irina Mindlis
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY10029, USA
| | - Rachel Pinotti
- Gustave L. and Janet W. Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY10029, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY10029, USA
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Abstract
There were an estimated 8720 new cases of testicular cancer (TC) in the United States in 2016. The cause of the disease is complex, with several environmental and genetic risk factors. Although rare, the incidence has been steadily increasing. Fortunately, substantial advances in treatment have occurred over the last few decades, making TC one of the most curable malignancies. However, because TC typically occurs in younger men, considerations of the treatment impact on fertility, quality of life, and long-term toxicity are paramount; an individualized approach must be taken with patients based on their clinical and pathologic findings.
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Affiliation(s)
- Zachary L Smith
- Section of Urology, Department of Surgery, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA.
| | - Ryan P Werntz
- Section of Urology, Department of Surgery, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
| | - Scott E Eggener
- Section of Urology, Department of Surgery, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
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