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Chereshnev VA, Pichugova SV, Beikin YB, Chereshneva MV, Iukhta AI, Stroev YI, Churilov LP. Pathogenesis of Autoimmune Male Infertility: Juxtacrine, Paracrine, and Endocrine Dysregulation. PATHOPHYSIOLOGY 2021; 28:471-488. [PMID: 35366245 PMCID: PMC8830464 DOI: 10.3390/pathophysiology28040030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022] Open
Abstract
According to global data, there is a male reproductive potential decrease. Pathogenesis of male infertility is often associated with autoimmunity towards sperm antigens essential for fertilization. Antisperm autoantibodies (ASAs) have immobilizing and cytotoxic properties, impairing spermatogenesis, causing sperm agglutination, altering spermatozoa motility and acrosomal reaction, and thus preventing ovum fertilization. Infertility diagnosis requires a mandatory check for the ASAs. The concept of the blood-testis barrier is currently re-formulated, with an emphasis on informational paracrine and juxtacrine effects, rather than simple anatomical separation. The etiology of male infertility includes both autoimmune and non-autoimmune diseases but equally develops through autoimmune links of pathogenesis. Varicocele commonly leads to infertility due to testicular ischemic damage, venous stasis, local hyperthermia, and hypoandrogenism. However, varicocelectomy can alter the blood-testis barrier, facilitating ASAs production as well. There are contradictory data on the role of ASAs in the pathogenesis of varicocele-related infertility. Infection and inflammation both promote ASAs production due to "danger concept" mechanisms and because of antigen mimicry. Systemic pro-autoimmune influences like hyperprolactinemia, hypoandrogenism, and hypothyroidism also facilitate ASAs production. The diagnostic value of various ASAs has not yet been clearly attributed, and their cut-levels have not been determined in sera nor in ejaculate. The assessment of the autoimmunity role in the pathogenesis of male infertility is ambiguous, so the purpose of this review is to show the effects of ASAs on the pathogenesis of male infertility.
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Affiliation(s)
- Valeriy A. Chereshnev
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (V.A.C.); (S.V.P.); (M.V.C.)
| | - Svetlana V. Pichugova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (V.A.C.); (S.V.P.); (M.V.C.)
- State Autonomous Healthcare Institution of the Sverdlovsk Region “Clinical and Diagnostic Center” (GAUZ SO “CDC” Clinical Diagnostic Center), 620144 Yekaterinburg, Russia;
| | - Yakov B. Beikin
- State Autonomous Healthcare Institution of the Sverdlovsk Region “Clinical and Diagnostic Center” (GAUZ SO “CDC” Clinical Diagnostic Center), 620144 Yekaterinburg, Russia;
| | - Margarita V. Chereshneva
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (V.A.C.); (S.V.P.); (M.V.C.)
| | - Angelina I. Iukhta
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199304 Saint Petersburg, Russia; (Y.I.S.); (L.P.C.)
| | - Yuri I. Stroev
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199304 Saint Petersburg, Russia; (Y.I.S.); (L.P.C.)
| | - Leonid P. Churilov
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199304 Saint Petersburg, Russia; (Y.I.S.); (L.P.C.)
- Saint Petersburg Research Institute of Phthisiopulmonology, 191036 Saint Petersburg, Russia
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Kbirou A, Jandou I, Adnane E, Mohammed E, Moataz A, Mohammed D, Debbagh A, Aboutaieb R. Profil épidémiologique et clinique de l’infertilité masculine : étude observationnelle transversale descriptive et analytique. SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression. LANCET GLOBAL HEALTH 2020; 7:e1197-e1225. [PMID: 31402004 DOI: 10.1016/s2214-109x(19)30279-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/12/2019] [Accepted: 05/30/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. METHODS We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of between-study heterogeneity were determined using meta-regression. FINDINGS We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3·0% (95% CI 2·3-3·8) in general populations, 2·8% (1·0-5·2) in intermediate-risk populations, 13·2% (7·2-20·7) in female sex workers, 11·3% (9·0-13·7) in infertility clinic attendees, 12·4% (7·9-17·7) in women with miscarriage, 12·4% (9·4-15·7) in symptomatic women, and 17·4% (12·5-22·8) in symptomatic men. Pooled prevalence of current rectal infection was 7·7% (4·2-12·0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29·0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018. INTERPRETATION C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region. FUNDING National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation).
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Frikh M, Mrimar N, Kasouati J, Hamzaoui A, Maleb A, Lemnouer A, Choukairi O, Barkiyou M, El Ouennass M. [Prevalence and role of IgG anti-Chlamydia trachomatis in a population of infertile men in Morocco]. Prog Urol 2019; 29:612-618. [PMID: 31473105 DOI: 10.1016/j.purol.2019.08.261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 06/03/2019] [Accepted: 08/06/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Infertility is a global public health problem that affects 15% of couples of childbearing age. Male infertility is involved in 20 to 50% of cases. These figures are sharply increasing around the world. Several factors may be responsible for this infertility with especially hormonal, genetic, toxic or infectious factors. The latter are dominated mainly by Chlamydia infection. Among the most serious complications of this infection are infertility related to urethritis, epididymitis and irreversible total azoospermia in men and tubal obstructions and ectopic pregnancies in women. STUDY OBJECTIVE To determine the prevalence of IgG anti-Chlamydia trachomatis in men consulting for infertility and the association between previous contact with this bacterium and the impairment of sperm quality and sperm function. MATERIAL AND METHODS Prospective study over 26months of 143 patients referred to the service for infertility assessment of the couple. Demographic data, primary or secondary character of infertility, risk factors (tobacco, inguinal hernia, varicocele and history of urogenital infections), semen parameters (volume, mobility, pH, vitality and morphological abnormalities) were studied as well as the determination of the anti-C. trachomatis IgG titer. The prevalence of Chlamydia infection and the association of the infection and alteration of the various parameters of the semen were analyzed. RESULTS The average age of patients was 38.5±8.55. Infertility was primary in 72% of patients. Among the patients, 54.5% had an abnormal spermogram. Chlamydia IgG antibodies were positive in 37.1% of patients whose 58.5% had abnormal spermogram. Analysis of sperm parameters of patients with and without IgG C. trachomatis showed an altered vitality in Chlamydia positive patients with an OR at 2.41, P=0.02, (95% CI: 1.15-5.06). CONCLUSION The prevalence of Chlamydia infection is high in infertile male. C. trachomatis IgG antibodies may be associated with an alteration of spermatozoa vitality without significant impairment of other semen parameters. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- M Frikh
- Service de bactériologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et pharmacie, université Mohammed V, avenue des FAR, Hay Riad, 10100 Rabat, Maroc.
| | - N Mrimar
- Service de bactériologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et pharmacie, université Mohammed V, avenue des FAR, Hay Riad, 10100 Rabat, Maroc.
| | - J Kasouati
- Service d'hygiène et de médecine de collectivité, hôpital militaire d'instruction Mohamed V Rabat, université Mohammed V, Rabat, Maroc.
| | - A Hamzaoui
- Service de bactériologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et pharmacie, université Mohammed V, avenue des FAR, Hay Riad, 10100 Rabat, Maroc.
| | - A Maleb
- Faculté de médecine, université Mohammed Premier, Oujda, Maroc.
| | - A Lemnouer
- Service de bactériologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et pharmacie, université Mohammed V, avenue des FAR, Hay Riad, 10100 Rabat, Maroc.
| | - O Choukairi
- Laboratoire d'histo-embryologie et cytogénétique, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc.
| | - M Barkiyou
- Laboratoire d'histo-embryologie et cytogénétique, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc.
| | - M El Ouennass
- Service de bactériologie, hôpital militaire d'instruction Mohammed V, faculté de médecine et pharmacie, université Mohammed V, avenue des FAR, Hay Riad, 10100 Rabat, Maroc. elouennassm.@yahoo.fr
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Dehghan Marvast L, Aflatoonian A, Talebi AR, Eley A, Pacey AA. Relationship between Chlamydia trachomatis and Mycoplasma genitalium infection and pregnancy rate and outcome in Iranian infertile couples. Andrologia 2016; 49. [PMID: 28032361 DOI: 10.1111/and.12747] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 11/30/2022] Open
Abstract
The study was performed to investigate the prevalence of Chlamydia trachomatis and Mycoplasma genitalium in a population of infertile couples from Iran and how this relates to tubal factor infertility, pregnancy rate and outcome of pregnancy. Blood, semen and first-void urine samples were obtained from 250 infertile couples and 250 fertile women as a control. Infertile couples were followed up after 24 months to determine diagnosis, referral for assisted conception, any pregnancy and pregnancy outcome. Data were analysed with regard to the results of (i) serological analysis for specific antibodies to C. trachomatis in serum; (ii) the presence of C. trachomatis and M. genitaliumDNA in first-void urine; and (iii) in a semen sample of the male partner. Prevalence of C. trachomatis in our study population was comparable to other studies using similar methods and test specimens. No evidence of M. genitalium infection was found. Detection of C. trachomatis in one partner rarely correlated with infection in the other. The risk of tubal factor infertility and the probability of pregnancy and pregnancy outcome were unrelated to the results of serological tests for C. trachomatis antibodies or the presence of C. trachomatisDNA in first-void urine of both partners and in a semen sample provided by the male.
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Affiliation(s)
- L Dehghan Marvast
- Department of Human Metabolism, Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield, UK
| | - A Aflatoonian
- Research and Clinical Centre for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - A R Talebi
- Research and Clinical Centre for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - A Eley
- Department of Infection and Immunity, University of Sheffield, Sheffield, UK
| | - A A Pacey
- Department of Human Metabolism, Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield, UK
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Recurrent miscarriages, innate immunity, and autoimmune reaction to chlamydial 60-kDa heat shock protein--is there an association? Fertil Steril 2014; 101:1675-80. [PMID: 24680363 DOI: 10.1016/j.fertnstert.2014.02.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 02/13/2014] [Accepted: 02/20/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate a potential association of immunity to the Chlamydia trachomatis 60kDa heat shock protein (ChlamHSP60) and recurrent miscarriages. DESIGN Prospective study. SETTING Outpatient miscarriage clinic of a university-based hospital. PATIENT(S) 120 asymptomatic women with a history of recurrent miscarriages. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Determination of serum immunoglobulin G (IgG) antibodies (Ab) to ChlamHSP60 and human HSP60 and, in parallel, mannose-binding lectin (MBL) and the total hemolytic complement (CH50); medical history and clinical examination, including multiple relevant laboratory determinants. RESULT(S) ChlamHSP60 Ab were detected in 24 (20%) of 120 patients. Antibodies to human HSP60 were found in 19 (15.8%) of 120 patients, and more frequently in individuals who tested positive for ChlamHSP60. ChlamHSP60 were statistically significantly associated with antichlamydial IgG Ab. However, antibodies to ChlamHSP60 were not related to medical history, the number of abortions, or the time frame of fetal loss. ChlamHSP60 antibodies were not associated with the relevant variables of the coagulation cascade, a panel of autoimmune parameters including thyroid autoimmunity, deficiencies of the complement system (low MBL), or with antibodies to common infectious diseases. No statistically significant differences were was found when comparing the prevalence of ChlamHSP60 Ab in the study group with recurrent miscarriages and 90 controls (women attending for an annual pelvic examination). CONCLUSION(S) Immunity to ChlamHSP60 does not play a major role in the etiology of recurrent miscarriages.
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Eggert-Kruse W, Batschulat K, Demirakca T, Strowitzki T. Male immunity to the chlamydial 60 kDa heat shock protein (HSP 60) - associated with semen quality? Andrologia 2014; 47:66-76. [DOI: 10.1111/and.12224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- W. Eggert-Kruse
- Department of Gynecological Endocrinology and Reproductive Medicine; Women's Hospital; University of Heidelberg; Heidelberg Germany
| | - K. Batschulat
- Department of Gynecological Endocrinology and Reproductive Medicine; Women's Hospital; University of Heidelberg; Heidelberg Germany
| | - T. Demirakca
- Department of Gynecological Endocrinology and Reproductive Medicine; Women's Hospital; University of Heidelberg; Heidelberg Germany
| | - T. Strowitzki
- Department of Gynecological Endocrinology and Reproductive Medicine; Women's Hospital; University of Heidelberg; Heidelberg Germany
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Spetz AL, Chiodi F. Reduction of HIV-1 load in semen during follow-up study of RV144 vaccine trial boosts interest for novel correlates of immune protection in genital mucosa. J Infect Dis 2012; 207:1189-92. [PMID: 22829649 DOI: 10.1093/infdis/jis477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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The utility and cost of Chlamydia trachomatis and Neisseria gonorrhoeae screening of a male infertility population. Fertil Steril 2012; 97:299-305. [DOI: 10.1016/j.fertnstert.2011.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 11/13/2011] [Accepted: 11/17/2011] [Indexed: 11/19/2022]
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Antichlamydial antibodies, human fertility, and pregnancy wastage. Infect Dis Obstet Gynecol 2011; 2011:525182. [PMID: 21949601 PMCID: PMC3178110 DOI: 10.1155/2011/525182] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 06/21/2011] [Indexed: 11/17/2022] Open
Abstract
Genital infections with Chlamydia trachomatis (C. trachomatis) continue to be a worldwide epidemic. Immune response to chlamydia is important to both clearance of the disease and disease pathogenesis. Interindividual responses and current chlamydial control programs will have enormous effects on this disease and its control strategies. Humoral immune response to C. trachomatis occurs in humans and persistent antibody levels appear to be most directly correlated with more severe and longstanding disease and with reinfection. There is a close correlation between the presence of antichlamydial antibodies in females and tubal factor infertility; the closest associations have been found for antibodies against chlamydial heat shock proteins. The latter antibodies have also been shown to be useful among infertile patients with prior ectopic pregnancy, and their presence has been correlated with poor IVF outcomes, including early pregnancy loss. We review the existing literature on chlamydial antibody testing in infertile patients and present an algorithm for such testing in the infertile couple.
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Re: Eggert-Kruse et al.: Are chlamydial lipopolysaccharide-directed antibodies in seminal plasma or serum clinically significant during investigation of male infertility? (Urology 2011;77:1101-1106). Urology 2011; 78:723; author reply 723-4. [PMID: 21884923 DOI: 10.1016/j.urology.2011.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 03/28/2011] [Accepted: 04/08/2011] [Indexed: 11/22/2022]
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Reply by the Authors. Urology 2011. [DOI: 10.1016/j.urology.2011.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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