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Are There Associations between Seminal Plasma Advanced Oxidation Protein Products and Selected Redox-Associated Biochemical Parameters in Infertile Male Patients? A Preliminary Report. Cells 2022; 11:cells11223667. [PMID: 36429095 PMCID: PMC9688436 DOI: 10.3390/cells11223667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/05/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Oxidative stress (OS) is one of the reasons for male infertility. Seminal plasma contains a multitude of enzymes and ions which influence OS and thus may affect male fertility. The aim of the study was to check for associations between seminal plasma advanced oxidation protein products (AOPP) concentrations and levels of selected biochemical parameters (total protein, iron, uric acid, magnesium, calcium) in infertile men, and establish whether they are associated with sperm disorders. Seminal plasma AOPP, as well as total protein, iron, uric acid, calcium, and magnesium concentrations, were determined for the following patient groups: normozoospermic (N; n = 33), teratozoospermic (T; n = 30), asthenoteratozoospermic (AT; n = 18), and oligoasthenoteratozoospermic (OAT; n = 28). AOPP concentrations were significantly higher in N and T groups in comparison to AT and OAT groups. Total protein concentrations were significantly lower in the T group in comparison to the AT and OAT groups, whereas iron concentrations significantly decreased in the OAT group in comparison to the T and N patients. AOPP differentiates AT patients from men with other sperm disorders. Our results suggest that asthenozoospermia may be connected with total protein levels. Insufficient iron levels may reflect a decrease in sperm count.
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The Association between Clusterin Sialylation Degree and Levels of Oxidative–Antioxidant Balance Markers in Seminal Plasmas and Blood Sera of Male Partners with Abnormal Sperm Parameters. Int J Mol Sci 2022; 23:ijms231810598. [PMID: 36142505 PMCID: PMC9501354 DOI: 10.3390/ijms231810598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
Nearly 30% of infertility cases are caused by male factor. This study aimed at checking the associations between the sialylation degree of glycoprotein clusterin (CLU) and levels of oxidative–antioxidant balance markers in infertile men. Using lectin-ELISA with biotinylated lectins specific to α2,6-linked (Sambucus nigra agglutinin, SNA) and α2,3-linked (Maackia amurensis agglutinin, MAA) sialic acid (SA), the CLU sialylation in 132 seminal plasmas (SP) and 91 blood sera (BS) were analyzed. Oxidative–antioxidant status was measured by determining Sirtuin-3 (SIRT3), Sirtuin-5 (SIRT5), total antioxidant status (TAS), and ferric reducing antioxidant power (FRAP) levels. We indicate that multiple sperm disorders are associated with decreased expression of MAA-reactive SA in SP. Decreased SP SIRT3 concentrations may be associated with teratozoospermia and oligoasthenoteratozoospermia. ROC curve and cluster analysis revealed that SP relative reactivity of CLU glycans with MAA, the value of MAA/SNA ratio, and SIRT3 and SIRT5 concentrations may constitute an additional set of markers differentiating infertile oligoasthenoteratozoospermic patients (OAT) from normozoospermic (N), asthenoteratozoospermic (AT) and teratozoospermic (T). The multinomial logistic regression analysis confirmed the potential utility of SIRT3 determinations for differentiation between N and OAT groups as well as between N and T groups for SIRT3 and SIRT5. For BS, based on ROC curve and cluster analysis, relative reactivities of CLU glycans with SNA, MAA, SIRT3 and FRAP concentrations may be useful in the differentiation of normozoospermic patients from those with sperm disorders. The multinomial logistic regression analysis showed that the SNA relative reactivity with CLU glycans significantly differentiated the N group from AT, OAT and T groups, and FRAP concentrations significantly differed between N and AT groups, which additionally confirms the potential utility of these biomarkers in the differentiation of infertile patients with abnormal sperm parameters. The knowledge about associations between examined parameters may also influence future research aimed at seeking new male infertility therapies.
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Asgari R, Mansouri K, Abdolmaleki A, Bakhtiari M. Association of matrix metalloproteinases with male reproductive functions; with focus on MMP2, 7, and 9. Meta Gene 2021. [DOI: 10.1016/j.mgene.2021.100906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hamutoğlu R, Bulut HE, Kaloğlu C, Önder O, Dağdeviren T, Aydemir MN, Korkmaz EM. The regulation of trophoblast invasion and decidual reaction by matrix metalloproteinase-2, metalloproteinase-7, and metalloproteinase-9 expressions in the rat endometrium. Reprod Med Biol 2020; 19:385-397. [PMID: 33071641 PMCID: PMC7542015 DOI: 10.1002/rmb2.12342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE We aimed to evaluate how matrix metalloproteinases (MMPs) regulate the trophoblast invasion and placentation. METHODS Female rats were divided into the estrous cycle and early pregnancy day groups. Obtained uterine tissues and implantation sites were processed for immunofluorescence and real-time PCR examinations. RESULTS The mRNA expression of MMP-7 was higher than MMP-2 and MMP-9. Immunofluorescence findings confirmed that MMP-2, MMP-7, and MMP-9 were localized in the endometrial stroma, while MMP-7 was high in glandular and lining epithelial cells throughout the entire estrous cycle. However, their immunolocalizations and mRNA expressions were dramatically changed with the early pregnancy days. The MMP-7 reached very strong immunostaining in the giant trophoblast cells (GTCs), and the cytoplasm of mature and differentiating decidual cells, whereas MMP-2 and MMP-9 were mostly seen in the primary decidual zone (PDZ), GTCs, and the endothelium of blood vessels. CONCLUSIONS All three MMPs seemed likely to be a key mediator of trophoblast invasion into the decidual region as well as angiogenesis during the placentation process. Due to the strong and wide expression of MMP-7 in the mature decidua, it could be suggested that MMP-7 is important for decidual ECM remodeling and it might be used as a new marker of decidual reaction.
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Affiliation(s)
- Rasim Hamutoğlu
- Department of Histology and EmbryologyFaculty of MedicineCumhuriyet UniversitySivasTurkey
| | - Hüseyin Eray Bulut
- Department of Histology and EmbryologyFaculty of MedicineCumhuriyet UniversitySivasTurkey
| | - Celal Kaloğlu
- Department of Histology and EmbryologyFaculty of MedicineCumhuriyet UniversitySivasTurkey
- Cumhuriyet University Assisted Reproduction Technology (ART) CenterSivasTurkey
| | - Ozan Önder
- Department of Histology and EmbryologyFaculty of MedicineCumhuriyet UniversitySivasTurkey
| | - Tuğba Dağdeviren
- Department of Histology and EmbryologyFaculty of MedicineCumhuriyet UniversitySivasTurkey
| | - Merve Nur Aydemir
- Department of Molecular Biology and GeneticsFaculty of ScienceCumhuriyet UniversitySivasTurkey
| | - Ertan Mahir Korkmaz
- Department of Molecular Biology and GeneticsFaculty of ScienceCumhuriyet UniversitySivasTurkey
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Janiszewska E, Kratz EM. Could the glycosylation analysis of seminal plasma clusterin become a novel male infertility biomarker? Mol Reprod Dev 2020; 87:515-524. [PMID: 32222009 DOI: 10.1002/mrd.23340] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 11/06/2022]
Abstract
Male infertility is becoming a rapidly growing problem around the world, mainly in the highly developed countries. Seminal proteome composition seems to be one of the crucial factors of the proper course of fertilization - clusterin (CLU) is among the most important ones. CLU, as one of the crucial seminal plasma glycoproteins, plays a very important role in sperm capacitation and immune tolerance in the female reproductive tract. CLU is also known as a sensitive marker of oxidative stress. It has six n-glycosylation sites and also exhibits chaperone activity. An analysis of changes in the profile and degree of CLU glycosylation may shed some new light on the molecular mechanisms of the fertilization process and may be used as an additional diagnostic marker of male fertility. This study constitutes a review of the recently available literature concerning human seminal CLU, including changes in its glycosylation, analyzed in the context of human reproduction.
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Affiliation(s)
- Ewa Janiszewska
- Department of Laboratory Diagnostics, Division of Laboratory Diagnostics, Faculty of Pharmacy, Wroclaw, Poland
| | - Ewa Maria Kratz
- Department of Laboratory Diagnostics, Division of Laboratory Diagnostics, Faculty of Pharmacy, Wroclaw, Poland
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Elmi A, Zannoni A, Govoni N, Bertocchi M, Forni M, Ventrella D, Bacci ML. Uncovering the Physiological Mechanisms Underlying the Roe Deer ( Capreolus capreolus) Testicular Cycle: Analyses of Gelatinases and VEGF Patterns and Correlation with Testes Weight and Testosterone. Animals (Basel) 2020; 10:ani10030444. [PMID: 32155893 PMCID: PMC7143327 DOI: 10.3390/ani10030444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/25/2022] Open
Abstract
Simple Summary The roe deer (Capreolus capreolus) is a wild, small ruminant common in Europe and Asia with a peculiar reproductive cycle. The adult male shows a complete suspension of spermatozoa production during the winter that start again in spring with the peak of sexual activity in summer (July–August). The physiological mechanism underlying such a cycle is yet to be clarified. The work aimed at the analysis of some molecules, like gelatinases (MMP) and vascular growth factor, physiologically involved in tissue remodeling, in roe deer samples collected before (June–July) and after (August–September) the rutting period. Samples were provided by hunters of the Bologna Apennines area (Italy) according to the regional hunting plan. The result showed a post-rut reduction of testicular weight and testosterone, indicative of testes involution, correlated with an increase in pro-MMP2, the latent gelatinase capable of sustaining spermatogenesis once activated. It can be assumed that gelatinases are involved in the testicular cycle and start accumulating after the rutting period to be then activated in preparation of the next reproductive season inducing spermatozoa development and migration. Future studies on this pathway during all seasonal testicular cycles will provide more information about the interesting reproductive physiology of roe deer. Abstract The roe deer (Capreolus capreolus) represents a spontaneous model of testicular inactivation: During winter, bucks show a suspension of spermatogenesis that starts again in spring and peaks during the breeding season (July–August). The underlying mechanisms to the regulation of the cyclic testicular changes are still not fully clear but seem to be imputable to the spermatogenic cell line since other testicular cell populations remain stable without apoptotic phenomena. The aim of the study was to investigate apoptosis, gelatinases (MMP2 and 9), their inhibiting factors (TIMP 1-2), and two isoforms of vascular endothelial growth factor (VEGF121 and 165) with its receptors (VEGFR1-2) in testes collected during pre- and post-rut periods, and to correlate them with testicular weight (TW) and testosterone (TEST). Testes from 18 adult sexually mature bucks were collected in Bologna Apennines (Italy). Samples were weighed and parenchyma collected. Radioimmunoassay, real-time PCR, and zymography were performed. The results showed a post-rut decrease in TW and TEST and an increase in proMMP2, also highlighting a correlation between the gelatinases and the testicular functionality. The VEGF pattern did not show modifications nor correlation with TW and TEST. Overall, gelatinases and their inhibitors, described herein for the first time in roe deer testes, seem to play an important role in the testicular cycle.
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The Potential Role of Seminal Plasma in the Fertilization Outcomes. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5397804. [PMID: 31531356 PMCID: PMC6720062 DOI: 10.1155/2019/5397804] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 07/21/2019] [Indexed: 01/26/2023]
Abstract
For human infertility both male and female factors may be equally important. Searching for molecular biomarkers of male infertility, neglected for decades, and the attempts to explain regulatory mechanisms of fertilization become thus extremely important. Apart from examination of the structure and function of male gametes, also the possible importance of seminal plasma components should be considered. In this article we discuss data that indicate for the substantial significance of active seminal plasma components for conception and achievement of healthy pregnancy. Seminal plasma impact on the storage and cryopreservation of human and animal sperm and regulatory role of glycodelin on human sperm capacitation as well as hypothesized course of female immune response to allogenic sperm and conceptus has been discussed. The possible involvement of carbohydrates in molecular mechanism of fetoembryonic defense has been also mentioned.
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Belardin LB, Antoniassi MP, Camargo M, Intasqui P, Fraietta R, Bertolla RP. Semen levels of matrix metalloproteinase (MMP) and tissue inhibitor of metallorproteinases (TIMP) protein families members in men with high and low sperm DNA fragmentation. Sci Rep 2019; 9:903. [PMID: 30696858 PMCID: PMC6351682 DOI: 10.1038/s41598-018-37122-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/23/2018] [Indexed: 12/20/2022] Open
Abstract
Matrix Metalloproteinases (MMPs) and their regulators – Tissue Inhibitors of Matrix Metalloproteinases (TIMPs) – participate in extracellular matrix remodeling, fibrosis, and semen liquefaction, as well as to inflammatory activity. Seminal plasma has been shown to contain MMPs (MMP-2 and MMP-9) and TIMPs (TIMP-1 and TIMP-2). Also, a link between MMPs gene expression and excessive reactive oxygen species (ROS) has been established. In semen, ROS are associated with altered sperm function and increased DNA fragmentation. In this study, it is hypothesized that seminal MMPs and TIMPs levels are associated with sperm DNA fragmentation due to the fact that MMPs have been associated with semen quality. We also hypothesized that these proteins could predict DNA fragmentation status in sperm. Therefore, this study set out to verify if sperm DNA fragmentation levels relate to seminal levels of members of the MMP and TIMP protein families. The High sperm DNA fragmentation group presented lower seminal plasma levels of MMP-2, MMP-7, TIMP-1, TIMP-2 and TIMP-4 when compared to Low sperm DNA fragmentation group. Also, samples in the high sperm DNA fragmentation group presented higher acrosome integrity and lower mitochondrial activity levels when compared to low sperm DNA fragmentation samples. In the logistic regression analysis, MMP-2, MMP-7, and TIMP-4 classified samples as low and high sperm DNA fragmentation, with an overall model fit of 74.5%. Results from this study may demonstrate a specific inflammatory mechanism in samples with high sperm DNA fragmentation. This, in turn, can lead to the development of new studies regarding this mechanism and, in the future, create an opportunity to treat these patients for sperm DNA fragmentation by treating inflammatory seminal activity.
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Affiliation(s)
| | | | - Mariana Camargo
- Department of Surgery, Division of Urology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paula Intasqui
- Department of Surgery, Division of Urology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato Fraietta
- Department of Surgery, Division of Urology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ricardo Pimenta Bertolla
- Department of Surgery, Division of Urology, Universidade Federal de São Paulo, São Paulo, Brazil. .,Hospital São Paulo, São Paulo, Brazil.
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Kerns K, Zigo M, Sutovsky P. Zinc: A Necessary Ion for Mammalian Sperm Fertilization Competency. Int J Mol Sci 2018; 19:E4097. [PMID: 30567310 PMCID: PMC6321397 DOI: 10.3390/ijms19124097] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022] Open
Abstract
The importance of zinc for male fertility only emerged recently, being propelled in part by consumer interest in nutritional supplements containing ionic trace minerals. Here, we review the properties, biological roles and cellular mechanisms that are relevant to zinc function in the male reproductive system, survey available peer-reviewed data on nutritional zinc supplementation for fertility improvement in livestock animals and infertility therapy in men, and discuss the recently discovered signaling pathways involving zinc in sperm maturation and fertilization. Emphasis is on the zinc-interacting sperm proteome and its involvement in the regulation of sperm structure and function, from spermatogenesis and epididymal sperm maturation to sperm interactions with the female reproductive tract, capacitation, fertilization, and embryo development. Merits of dietary zinc supplementation and zinc inclusion into semen processing media are considered with livestock artificial insemination (AI) and human assisted reproductive therapy (ART) in mind. Collectively, the currently available data underline the importance of zinc ions for male fertility, which could be harnessed to improve human reproductive health and reproductive efficiency in agriculturally important livestock species. Further research will advance the field of sperm and fertilization biology, provide new research tools, and ultimately optimize semen processing procedures for human infertility therapy and livestock AI.
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Affiliation(s)
- Karl Kerns
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211-5300, USA.
| | - Michal Zigo
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211-5300, USA.
| | - Peter Sutovsky
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211-5300, USA.
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO 65211-5300, USA.
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Roshankhah S, Mansouri K, Bakhtiari M, Salahshoor MR, Asgari R. Synergistic effects of TIMP2-418G/C and MMP9-1562C/T variants on the male infertility risk. Mol Biol Rep 2018; 46:861-866. [PMID: 30515695 DOI: 10.1007/s11033-018-4541-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/28/2018] [Indexed: 11/26/2022]
Abstract
Matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) involve in the degradation of the extracellular matrix (ECM) that imbalances their activity and may lead to various diseases. The present study aims to evaluate the association between MMP9-1562C/T and TIMP2-418G/C variants and synergistic effects of both variants on male infertility in an Iranian population. We analyzed these polymorphisms in 101 infertile men and 106 fertile men as a control group using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Based on the obtained results, no considerable association was observed in MMP9-1562C/T polymorphism frequency between infertile men and controls while frequencies of TIMP2-418G/C variant were significantly different in infertile and control groups (P = 0.028). Men with CC, GC and CC + GC genotypes for TIMP2-418G/C polymorphism had an increased risk of infertility compared to men with GG genotype [OR = 1.85, 95% CI (0.917-3.734, P = 0.086), OR = 1.94, 95% CI (1.098-3.437, P = 0.023) and OR = 2.053 95% CI (1.179-3.577, P = 0.011), respectively]. Also, in the presence of both TIMP2-418C and MMP9-1562T alleles the male infertility risk was significantly increased (P = 0.032). The current study suggests that the variation of TIMP2 gene and its interaction with MMP9 gene might be associated with male infertility. However, to confirm these findings, further studies are required in different ethnicities and with a larger sample size.
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Affiliation(s)
- Shiva Roshankhah
- Fertility and Sterility Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Mansouri
- Medical Biology Research Center (MBRC), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mitra Bakhtiari
- Fertility and Sterility Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Reza Salahshoor
- Fertility and Sterility Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rezvan Asgari
- Medical Biology Research Center (MBRC), Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Roychoudhury S, Sharma R, Sikka S, Agarwal A. Diagnostic application of total antioxidant capacity in seminal plasma to assess oxidative stress in male factor infertility. J Assist Reprod Genet 2016; 33:627-635. [PMID: 26941096 DOI: 10.1007/s10815-016-0677-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/11/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study was undertaken in order to establish a new reference value for the total antioxidant capacity (TAC) in seminal plasma as a predictor of fertility. This study also aims to propose a detailed protocol for the TAC assay including calculation of assay results and assessment of sensitivity and specificity over possible cutoff values in infertile men and controls with proven and unproven fertility. METHODS Seminal plasma from 279 infertile patients and 46 normal healthy men referred to a male infertility testing laboratory were tested to measure TAC by a colorimetric assay kit. Receiver operating characteristics (ROC) curves were generated to establish cutoff values, sensitivity, and specificity, and the distribution of cutoff values in controls and infertile patients was calculated. RESULTS Infertile patients showed significantly lower levels (mean ± SEM) of total antioxidants (micromolar Trolox equivalents) in their seminal plasma (1863.84 ± 27.16 μM) compared to those from fertile men (2013 ± 56.04 μM, P = 0.019). A preferred cutoff TAC value of 1947 μM could facilitate better diagnosis of oxidative stress (OS) in men with male factor infertility. At this threshold, the specificity of TAC assay was 63.0 % and the sensitivity 59.5 % with a positive predictive value of 90.7 % and a negative predictive value of 20.4 %. CONCLUSIONS Our results establish a new diagnostic cutoff TAC value of 1947 μM in seminal plasma to distinguish prevalence of OS in infertile patients compared to healthy men. This study provides a robust reference value of seminal plasma TAC that may provide an important diagnostic tool to the physicians for managing OS and male factor infertility in such patients.
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Affiliation(s)
- Shubhadeep Roychoudhury
- American Center for Reproductive Medicine, Cleveland Clinic, 10681 Carnegie Avenue, Desk X11, Cleveland, OH, 44195, USA
- Department of Life Science and Bioinformatics, Assam University, Silchar, 788011, India
| | - Rakesh Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, 10681 Carnegie Avenue, Desk X11, Cleveland, OH, 44195, USA
| | - Suresh Sikka
- Tulane University Health Sciences Center, New Orleans, LA, 70112-2699, USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, 10681 Carnegie Avenue, Desk X11, Cleveland, OH, 44195, USA.
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