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Rey RA, Grinspon RP. Anti-Müllerian hormone, testicular descent and cryptorchidism. Front Endocrinol (Lausanne) 2024; 15:1361032. [PMID: 38501100 PMCID: PMC10944898 DOI: 10.3389/fendo.2024.1361032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
Anti-Müllerian hormone (AMH) is a Sertoli cell-secreted glycoprotein involved in male fetal sex differentiation: it provokes the regression of Müllerian ducts, which otherwise give rise to the Fallopian tubes, the uterus and the upper part of the vagina. In the first trimester of fetal life, AMH is expressed independently of gonadotropins, whereas from the second trimester onwards AMH testicular production is stimulated by FSH and oestrogens; at puberty, AMH expression is inhibited by androgens. AMH has also been suggested to participate in testicular descent during fetal life, but its role remains unclear. Serum AMH is a well-recognized biomarker of testicular function from birth to the first stages of puberty. Especially in boys with nonpalpable gonads, serum AMH is the most useful marker of the existence of testicular tissue. In boys with cryptorchidism, serum AMH levels reflect the mass of functional Sertoli cells: they are lower in patients with bilateral than in those with unilateral cryptorchidism. Interestingly, serum AMH increases after testis relocation to the scrotum, suggesting that the ectopic position result in testicular dysfunction, which may be at least partially reversible. In boys with cryptorchidism associated with micropenis, low AMH and FSH are indicative of central hypogonadism, and serum AMH is a good marker of effective FSH treatment. In patients with cryptorchidism in the context of disorders of sex development, low serum AMH is suggestive of gonadal dysgenesis, whereas normal or high AMH is found in patients with isolated androgen synthesis defects or with androgen insensitivity. In syndromic disorders, assessment of serum AMH has shown that Sertoli cell function is preserved in boys with Klinefelter syndrome until mid-puberty, while it is affected in patients with Noonan, Prader-Willi or Down syndromes.
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Affiliation(s)
- Rodolfo A. Rey
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Biología Celular, Histología, Embriología y Genética, Buenos Aires, Argentina
- Instituto de Investigaciones Biomédicas, Santa Fe, Argentina
| | - Romina P. Grinspon
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
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Stachowiak M, Nowacka-Woszuk J, Szabelska-Beresewicz A, Zyprych-Walczak J, Krzeminska P, Sosinski O, Nowak T, Switonski M. A massive alteration of gene expression in undescended testicles of dogs and the association of KAT6A variants with cryptorchidism. Proc Natl Acad Sci U S A 2024; 121:e2312724121. [PMID: 38315849 PMCID: PMC10873591 DOI: 10.1073/pnas.2312724121] [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: 07/28/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024] Open
Abstract
Cryptorchidism is the most common form of disorder of sex development in male dogs, but its hereditary predisposition is poorly elucidated. The gonadal transcriptome of nine unilaterally cryptorchid dogs and seven control dogs was analyzed using RNA-seq. Comparison between the scrotal and inguinal gonads of unilateral cryptorchid dogs revealed 8,028 differentially expressed genes (DEGs) (3,377 up-regulated and 4,651 down-regulated). A similar number of DEGs (7,619) was found by comparing the undescended testicles with the descended testicles of the control dogs. The methylation status of the selected DEGs was also analyzed, with three out of nine studied DEGs showing altered patterns. Bioinformatic analysis of the cDNA sequences revealed 20,366 SNP variants, six of which showed significant differences in allelic counts between cryptorchid and control dogs. Validation studies in larger cohorts of cryptorchid (n = 122) and control (n = 173) dogs showed that the TT genotype (rs850666472, p.Ala1230Val) and the AA genotype in 3'UTR (16:23716202G>A) in KATA6, responsible for acetylation of lysine 9 in histone H3, are associated with cryptorchidism (P = 0.0383). Both the transcript level of KAT6A and H3K9 acetylation were lower in undescended testes, and additionally, the acetylation depended on the genotypes in exon 17 and the 3'UTR. Our study showed that the massive alteration of the transcriptome in undescended testicles is not caused by germinal DNA variants in DEG regulatory sequences but is partly associated with an aberrant DNA methylation and H3K9 acetylation patterns. Moreover, variants of KAT6A can be considered markers associated with the risk of this disorder.
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Affiliation(s)
- Monika Stachowiak
- Department of Genetics and Animal Breeding, Poznan University of Life Sciences, 60-637Poznan, Poland
| | - Joanna Nowacka-Woszuk
- Department of Genetics and Animal Breeding, Poznan University of Life Sciences, 60-637Poznan, Poland
| | - Alicja Szabelska-Beresewicz
- Department of Mathematical and Statistical Methods, Poznan University of Life Sciences, 60-637Poznan, Poland
| | - Joanna Zyprych-Walczak
- Department of Mathematical and Statistical Methods, Poznan University of Life Sciences, 60-637Poznan, Poland
| | - Paulina Krzeminska
- Department of Genetics and Animal Breeding, Poznan University of Life Sciences, 60-637Poznan, Poland
- Department of Ribonucleoprotein Biochemistry, Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704Poznan, Poland
| | - Oskar Sosinski
- Department of Genetics and Animal Breeding, Poznan University of Life Sciences, 60-637Poznan, Poland
| | - Tomasz Nowak
- Department of Genetics and Animal Breeding, Poznan University of Life Sciences, 60-637Poznan, Poland
| | - Marek Switonski
- Department of Genetics and Animal Breeding, Poznan University of Life Sciences, 60-637Poznan, Poland
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3
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Lucas-Herald AK, Alkanhal KI, Caney E, Malik I, Alimussina M, McNeilly JD, Bradnock T, Lee B, Steven M, Flett M, O’Toole S, McGowan R, Faisal Ahmed S. Gonadal Function in Boys with Bilateral Undescended Testes. J Endocr Soc 2024; 8:bvad153. [PMID: 38205164 PMCID: PMC10777671 DOI: 10.1210/jendso/bvad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Indexed: 01/12/2024] Open
Abstract
Background Bilateral undescended testes (BUDT) may be a marker of an underlying condition that affects sex development or maturation. Aims To describe the extent of gonadal dysfunction in cases of BUDT who had systematic endocrine and genetic evaluation at a single tertiary pediatric center. Methods A retrospective review was conducted of all boys with BUDT who had endocrine evaluation between 2008 and 2021 at the Royal Hospital for Children, Glasgow (RHCG). Continuous variables were analyzed using Mann-Whitney U and non-continuous variables using Fisher's exact, via Graphpad Prism v 8.0. Multivariable logistic regression was used to identify any associations between groups. A P < .05 was considered statistically significant. Results A total of 243 bilateral orchidopexies were performed at RHCG between 2008 and 2021. Of these 130 (53%) boys were seen by the endocrine team. The median (range) age at first orchidopexy was 1 year (0.2, 18.0) with 16 (12%) requiring re-do orchidopexy. The median External Masculinization Score of the group was 10 (2, 11) with 33 (25%) having additional genital features. Of the 130 boys, 71 (55%) had extragenital anomalies. Of the 70 who were tested, a genetic abnormality was detected in 38 (54%), most commonly a chromosomal variant in 16 (40%). Of the 100 who were tested, endocrine dysfunction was identified in 38 (38%). Conclusion Genetic findings and evidence of gonadal dysfunction are common in boys who are investigated secondary to presentation with BUDT. Endocrine and genetic evaluation should be part of routine clinical management of all cases of BUDT.
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Affiliation(s)
- Angela K Lucas-Herald
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Khalid I Alkanhal
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
- Obesity and Endocrine Metabolism Center, King Fahad Medical City, 58046 Riyady 11525, Saudi Arabia
| | - Emma Caney
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Iman Malik
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Malika Alimussina
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Jane D McNeilly
- Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Timothy Bradnock
- Department of General Paediatric Surgery, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Boma Lee
- Department of Paediatric Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Mairi Steven
- Department of Paediatric Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Martyn Flett
- Department of Paediatric Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Stuart O’Toole
- Department of Paediatric Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Ruth McGowan
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
- West of Scotland Centre for Genomic Medicine, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
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Renault L, Labrune E, Giscard d’Estaing S, Cuzin B, Lapoirie M, Benchaib M, Lornage J, Soignon G, de Souza A, Dijoud F, Fraison E, Pral-Chatillon L, Bordes A, Sanlaville D, Schluth–Bolard C, Salle B, Ecochard R, Lejeune H, Plotton I. Delaying testicular sperm extraction in 47,XXY Klinefelter patients does not impair the sperm retrieval rate, and AMH levels are higher when TESE is positive. Hum Reprod 2022; 37:2518-2531. [PMID: 36112034 PMCID: PMC9627253 DOI: 10.1093/humrep/deac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION Should testicular sperm extraction (TESE) in non-mosaic 47,XXY Klinefelter syndrome (KS) patients be performed soon after puberty or could it be delayed until adulthood? SUMMARY ANSWER The difference in sperm retrieval rate (SRR) in TESE was not significant between the 'Young' (15-22 years old) cohort and the 'Adult' (23-43 years old) cohort of non-mosaic KS patients recruited prospectively in parallel. WHAT IS KNOWN ALREADY Several studies have tried to define predictive factors for TESE outcome in non-mosaic KS patients, with very heterogeneous results. Some authors have found that age was a pejorative factor and recommended performing TESE soon after puberty. To date, no predictive factors have been unanimously recognized to guide clinicians in deciding to perform TESE in azoospermic KS patients. STUDY DESIGN, SIZE, DURATION Two cohorts (Young: 15-22 years old; Adult: 23-43 years old) were included prospectively in parallel. A total of 157 non-mosaic 47,XXY KS patients were included between 2010 and 2020 in the reproductive medicine department of the University Hospital of Lyon, France. However 31 patients gave up before TESE, four had cryptozoospermia and three did not have a valid hormone assessment; these were excluded from this study. PARTICIPANTS/MATERIALS, SETTING, METHODS Data for 119 patients (61 Young and 58 Adult) were analyzed. All of these patients had clinical, hormonal and seminal evaluation before conventional TESE (c-TESE). MAIN RESULTS AND THE ROLE OF CHANCE The global SRR was 45.4%. SRRs were not significantly different between the two age groups: Young SRR=49.2%, Adult SRR = 41.4%; P = 0.393. Anti-Müllerian hormone (AMH) and inhibin B were significantly higher in the Young group (AMH: P = 0.001, Inhibin B: P < 0.001), and also higher in patients with a positive TESE than in those with a negative TESE (AMH: P = 0.001, Inhibin B: P = 0.036). The other factors did not differ between age groups or according to TESE outcome. AMH had a better predictive value than inhibin B. SRRs were significantly higher in the upper quartile of AMH plasma levels than in the lower quartile (or in cases with AMH plasma level below the quantification limit): 67.7% versus 28.9% in the whole population (P = 0.001), 60% versus 20% in the Young group (P = 0.025) and 71.4% versus 33.3% in the Adult group (P = 0.018). LIMITATIONS, REASONS FOR CAUTION c-TESE was performed in the whole study; we cannot rule out the possibility of different results if microsurgical TESE had been performed. Because of the limited sensitivity of inhibin B and AMH assays, a large number of patients had values lower than the quantification limits, preventing the definition a threshold below which negative TESE can be predicted. WIDER IMPLICATIONS OF THE FINDINGS In contrast to some studies, age did not appear as a pejorative factor when comparing patients 15-22 and 23-44 years of age. Improved accuracy of inhibin B and AMH assays in the future might still allow discrimination of patients with persistent foci of spermatogenesis and guide clinician decision-making and patient information. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by a grant from the French Ministry of Health D50621 (Programme Hospitalier de Recherche Clinical Régional 2008). The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER NCT01918280.
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Affiliation(s)
- 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, Bron Cedex, France
| | - Elsa Labrune
- 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, Bron Cedex, France
| | - Sandrine Giscard d’Estaing
- 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, Bron Cedex, France
| | - Beatrice Cuzin
- Service d’Urologie et de Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Marion Lapoirie
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Mehdi Benchaib
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Jacqueline Lornage
- 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, Bron Cedex, France
| | - Gaëlle Soignon
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - André de Souza
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Frédérique Dijoud
- Université Claude Bernard Lyon 1, Lyon, France
- Inserm U1208, Bron Cedex, France
- Laboratoire d’Anatomopathologie, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Bron, France
| | - Eloïse Fraison
- 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, Bron Cedex, France
| | - Laurence Pral-Chatillon
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Agnès Bordes
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Damien Sanlaville
- Université Claude Bernard Lyon 1, Lyon, France
- Service de Génétique, Laboratoire de Cytogénétique Constitutionnelle, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
- Lyon Neuroscience Research Center, GENDEV Team, CNRS UMR 5292, INSERM U1028, UCBL1, Bron, France
| | - Caroline Schluth–Bolard
- Université Claude Bernard Lyon 1, Lyon, France
- Service de Génétique, Laboratoire de Cytogénétique Constitutionnelle, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
- Lyon Neuroscience Research Center, GENDEV Team, CNRS UMR 5292, INSERM U1028, UCBL1, Bron, France
| | - Bruno Salle
- 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, Bron Cedex, France
| | - René Ecochard
- Université Claude Bernard Lyon 1, Lyon, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, 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, Bron Cedex, France
| | - Ingrid Plotton
- 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, Bron Cedex, France
- Service de Biochimie et Biologie Moléculaire, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
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Hernández-Jardón N, Rojas-Castañeda JC, Landero-Huerta D, Reyes-Cruz E, Reynoso-Robles R, Juárez-Mosqueda MDL, Medrano A, Reyes-Delgado F, Vigueras-Villaseñor RM. Cryptorchidism: The dog as a study model. Front Vet Sci 2022; 9:935307. [PMID: 36176705 PMCID: PMC9514118 DOI: 10.3389/fvets.2022.935307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022] Open
Abstract
Cryptorchidism (CO) or undescended testicle is an abnormality of male gonadal development that can generate long-term repercussions in men, such as infertility and germ cell neoplasia in situ (GCNIS). The origin of these alterations in humans is not completely clear, due to the absence of an animal model with similar testicular development as in humans with CO. This work intends to describe the testicular histological development of dogs with congenital CO, and determine whether the species could adequately serve as a study model for this pathology in humans. The study was carried out with 36 dogs, equally distributed in two groups: healthy control (CTRL) and CO groups. The contralateral testis to the undescended one in CO group of the animals was considered and analyzed. Each group was subdivided in three stages of development: (1) peripubertal stage (6–8 months), (2) young adult (9–48 months) and (3) senile (49–130 months). Histological development, the presence of cells with gonocyte morphology, cell proliferation, testicular lipoperoxidation and hormonal concentrations of testosterone, estradiol, FSH and LH were evaluated and described. In the cryptorchid testes, the first histological alterations appeared from the first stage of development and were maintained until the senile stage. A pronounced testicular lipoperoxidation occurred only in the second stage of development. The histological alterations due to CO were markedly evident in the young adult stage. Testosterone concentrations witnessed a decrease starting from in the second stage and kept on until the last stage. The contralateral testes of the CO animals showed alterations that positioned them between the control and CO testes. Testicular development of dogs with CO is similar to that of humans. The results of the study suggest that this species could serve as a suitable model for the study of CO in humans.
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Affiliation(s)
- Norma Hernández-Jardón
- Programa Doctorado en Ciencias de la Producción y de la Salud Animal, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Julio César Rojas-Castañeda
- Laboratorio de Biología de la Reproducción, Instituto Nacional de Pediatría, SS, Mexico City, Mexico
- Julio César Rojas-Castañeda
| | - Daniel Landero-Huerta
- Laboratorio de Biología de la Reproducción, Instituto Nacional de Pediatría, SS, Mexico City, Mexico
| | - Estefanía Reyes-Cruz
- Programa Doctorado en Ciencias de la Producción y de la Salud Animal, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rafael Reynoso-Robles
- Laboratorio de Morfología Celular y Tisular, Instituto Nacional de Pediatría, SS, Mexico City, Mexico
| | - María del Lourdes Juárez-Mosqueda
- Departamento de Morfología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alfredo Medrano
- Laboratorio de Reproducción Animal, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán Izcalli, Mexico
| | - Fausto Reyes-Delgado
- Banfield Pet Hospital-Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rosa María Vigueras-Villaseñor
- Laboratorio de Biología de la Reproducción, Instituto Nacional de Pediatría, SS, Mexico City, Mexico
- *Correspondence: Rosa María Vigueras-Villaseñor
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Hildorf SE. Clinical aspects of histological and hormonal parameters in boys with cryptorchidism: Thesis for PhD degree. APMIS 2022; 130 Suppl 143:1-58. [PMID: 35822689 PMCID: PMC9542020 DOI: 10.1111/apm.13247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Simone Engmann Hildorf
- Department of Pediatric Surgery and Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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7
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Kanakatti Shankar R, Dowlut-McElroy T, Dauber A, Gomez-Lobo V. Clinical Utility of Anti-Mullerian Hormone in Pediatrics. J Clin Endocrinol Metab 2022; 107:309-323. [PMID: 34537849 PMCID: PMC8764360 DOI: 10.1210/clinem/dgab687] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT Anti-Mullerian hormone (AMH) was originally described in the context of sexual differentiation in the male fetus but has gained prominence now as a marker of ovarian reserve and fertility in females. In this mini-review, we offer an updated synopsis on AMH and its clinical utility in pediatric patients. DESIGN AND RESULTS A systematic search was undertaken for studies related to the physiology of AMH, normative data, and clinical role in pediatrics. In males, AMH, secreted by Sertoli cells, is found at high levels prenatally and throughout childhood and declines with progression through puberty to overlap with levels in females. Thus, serum AMH has clinical utility as a marker of testicular tissue in males with differences in sexual development and cryptorchidism and in the evaluation of persistent Mullerian duct syndrome. In females, serum AMH has been used as a predictive marker of ovarian reserve and fertility, but prepubertal and adolescent AMH assessments need to be interpreted cautiously. AMH is also a marker of tumor burden, progression, and recurrence in germ cell tumors of the ovary. CONCLUSIONS AMH has widespread clinical diagnostic utility in pediatrics but interpretation is often challenging and should be undertaken in the context of not only age and sex but also developmental and pubertal stage of the child. Nonstandardized assays necessitate the need for assay-specific normative data. The recognition of the role of AMH beyond gonadal development and maturation may usher in novel diagnostic and therapeutic applications that would further expand its utility in pediatric care.
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Affiliation(s)
- Roopa Kanakatti Shankar
- Division of Endocrinology, Children’s National Hospital, Washington DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Correspondence: Roopa Kanakatti Shankar, MBBS, MS, George Washington University School of Medicine, Endocrinologist, Children’s National Hospital, 111 Michigan Ave NW, Washington DC, 20010, USA.
| | - Tazim Dowlut-McElroy
- Pediatric and Adolescent Gynecology Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Andrew Dauber
- Division of Endocrinology, Children’s National Hospital, Washington DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Veronica Gomez-Lobo
- Pediatric and Adolescent Gynecology Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
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8
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Yuan L, Wang H, Yang H, Chen S, Yang D, Zhang Y. Expression of the NSE,SP,NFH and DβH in normal and cryptorchid testes of Bactrian camel. Anim Reprod 2022; 19:e20210087. [PMID: 35154438 PMCID: PMC8827324 DOI: 10.1590/1984-3143-ar2021-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/17/2021] [Indexed: 11/21/2022] Open
Abstract
Neuroendocrine substances play essential roles in regulating the normal physiological functions of testicles. The purpose of this study is to explore the localization and effects of four neuroendocrine markers (NSE, SP, NFH and DβH) in normal and cryptorchid testes of Bactrian camels using western blotting, transmission electron microscopy, immunohistochemistry, and immunofluorescence methods. The results showed that cryptorchidism caused a reduction in layers of spermatogenic epithelium and decreased glycogen positivity in the basement membrane. The ultrastructure revealed that macrophages were always found around the Leydig cells, crowded with swelling mitochondria in cryptorchidism. Expression of NSE in the Leydig cells of cryptorchidism was significantly weakened compared to that in the normal group(p<0.01). We found that SP was always distributed along the nerve fibers in normal testes and was expressed in the Leydig cells of cryptorchidism. However, expression of NFH in the cryptorchidic tissue was strongly positive in the spermatogenic epithelium, with limited expression in Leydig cells and no expression in peritubular myoid cells. Therefore, the expression of DβH in the Sertoli cells was comparatively strong in both the normal and cryptorchidism groups. NFH and DβH expression was significantly increased in the cryptorchidism group compared with the normal group (p<0.01). These findings indicated that the underdeveloped seminiferous epithelium and pathological changes in cryptorchid tissue in Bactrian camels were potentially related to a disorder in glycoprotein metabolism. Our results suggest that NSE and SP could help judge the pathological changes of cryptorchidism. The present study provides the first evidence at the protein level for the existence of NFH and DβH in Sertoli and Leydig cells in Bactrian camel cryptorchidism and provides a more in-depth understanding of neuroendocrine regulation is crucial for animal cryptorchidism.
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Affiliation(s)
| | - Hua Wang
- Gansu Agricultural University, China
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Rey RA. Biomarcadores de hipogonadismo masculino en la infancia y la adolescencia. ADVANCES IN LABORATORY MEDICINE 2020; 1:20190043. [PMCID: PMC10158747 DOI: 10.1515/almed-2019-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/19/2020] [Indexed: 06/28/2023]
Abstract
El eje hipotálamo-hipófiso-testicular es activo en la vida fetal y durante los primeros meses de la vida posnatal: la hipófisis secreta hormona luteinizante (LH) y folículo-estimulante (FSH), mientras que el testículo produce testosterona y factor insulino-símil 3 (INSL3) en las células de Leydig y hormona anti-Mülleriana (AMH) e inhibina B en las células de Sertoli. En la infancia, los niveles séricos de gonadotrofinas, testosterona y factor INSL3 disminuyen a valores prácticamente indetectables, pero los de AMH e inhibina B permanecen altos. En la pubertad, se reactivan las gonadotrofinas y la producción de testosterona e INSL3, aumenta la inhibina y disminuye la AMH, como signo de maduración de la célula de Sertoli. Sobre la base del conocimiento de la fisiología del desarrollo del eje, es posible utilizar clínicamente estos biomarcadores para interpretar la fisiopatología y diagnosticar las diferentes formas de hipogonadismo que pueden presentarse en la infancia y la adolescencia.
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Affiliation(s)
- Rodolfo A. Rey
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET-FEI- División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo, 1330, C1425EFD, Buenos Aires, Argentina
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10
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Rey RA. Biomarkers of male hypogonadism in childhood and adolescence. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200024. [PMID: 37363780 PMCID: PMC10159267 DOI: 10.1515/almed-2020-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/19/2020] [Indexed: 06/28/2023]
Abstract
Objectives The objective of this review was to characterize the use of biomarkers of male hypogonadism in childhood and adolescence. Contents The hypothalamic-pituitary-gonadal (HPG) axis is active during fetal life and over the first months of postnatal life. The pituitary gland secretes follicle stimulating hormone (FSH) and luteinizing hormone (LH), whereas the testes induce Leydig cells to produce testosterone and insulin-like factor 3 (INSL), and drive Sertoli cells to secrete anti-Müllerian hormone (AMH) and inhibin B. During childhood, serum levels of gonadotropins, testosterone and insulin-like 3 (INSL3) decline to undetectable levels, whereas levels of AMH and inhibin B remain high. During puberty, the production of gonadotropins, testosterone, and INSL3 is reactivated, inhibin B increases, and AMH decreases as a sign of Sertoli cell maturation. Summary and outlook Based on our knowledge of the developmental physiology of the HPG axis, these biomarkers can be used in clinical practice to interpret the physiopathology of hypogonadism. Additionally, these markers can have diagnostic value in different forms of hypogonadism that may appear during childhood and adolescence.
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Affiliation(s)
- Rodolfo A. Rey
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET-FEI- División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, C1425EFD, Buenos Aires, Argentina
- Departamento de Histología, Biología Celular, Embriología y Genética, Facultad de Medicina, Universidad de Buenos Aires, C1121ABG, Buenos Aires, Argentina
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11
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Davis SM, Bloy L, Roberts TP, Kowal K, Alston A, Tahsin A, Truxon A, Ross JL. Testicular function in boys with 47,XYY and relationship to phenotype. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2020; 184:371-385. [PMID: 32544298 PMCID: PMC7413633 DOI: 10.1002/ajmg.c.31790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022]
Abstract
An additional Y chromosome occurs in ~1 in 1,000 males, resulting in the karyotype 47,XYY. The phenotype includes tall stature, hypotonia, neuropsychiatric comorbidities, and an increased risk of infertility in adulthood. Little is known about testicular function in childhood and adolescence in 47,XYY. This cross-sectional study aimed to assess testicular function serum biomarkers, including total testosterone, inhibin B, and anti-mullerian hormone (AMH), in 82 boys with XYY (11.3 ± 3.8 years) compared with 66 male controls (11.6 ± 3.8 years). The association of testicular hormones with physical features, neuropsychological phenotype, and magnetoencephalography (MEG) was assessed with multiple linear regression models. Results indicate males with XYY have significantly lower inhibin B (median 84 pg/ml vs. 109 pg/ml, p = .004) and higher AMH (median 41 ng/ml vs. 29 ng/ml, p = .011); however, testosterone, testicular volume, and stretched penile length were not different from controls. In the exploratory analysis of relationships between hormone concentrations and phenotypic assessments, higher inhibin B concentrations were positively correlated with lower BMI and better cognitive, academic, and behavioral outcomes in the XYY group. Testosterone concentrations were positively associated with better behavioral outcomes in boys with XYY. Higher testosterone and inhibin B concentrations were also associated with shorter auditory latencies measured using magnetoencephalography (MEG) in XYY. With a few exceptions, testicular hormones were not associated with phenotypic outcomes in controls. In conclusion, there is evidence of subtle impaired testicular function in boys with XYY and a newly described relationship between measures of testicular function and some aspects of the XYY phenotype.
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Affiliation(s)
- Shanlee M Davis
- eXtraordinarY Kids Clinic and Research Program, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Luke Bloy
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Timothy P.L. Roberts
- Lurie Family Foundations MEG Imaging Center, Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Karen Kowal
- eXtraordinarY Kids Clinic, DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Amanda Alston
- eXtraordinarY Kids Clinic, DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Aysha Tahsin
- eXtraordinarY Kids Clinic, DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Alyssa Truxon
- eXtraordinarY Kids Clinic, DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Judith L Ross
- eXtraordinarY Kids Clinic, DuPont Hospital for Children, Wilmington, Delaware, USA
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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12
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Grinspon RP, Freire AV, Rey RA. Hypogonadism in Pediatric Health: Adult Medicine Concepts Fail. Trends Endocrinol Metab 2019; 30:879-890. [PMID: 31471249 DOI: 10.1016/j.tem.2019.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/19/2019] [Accepted: 08/06/2019] [Indexed: 02/03/2023]
Abstract
The classical definition of hypogonadism, used in adult medicine, as gonadal failure resulting in deficient steroid and gamete production, and its classification into hypergonadotropic and hypogonadotropic refer to primary gonadal and hypothalamic-pituitary disorders respectively and may lead to under- or misdiagnosis in pediatrics. Indeed, in children with primary gonadal failure, gonadotropin levels may be within the reference range for age. Conversely, since gonadotropins and steroids are normally low during childhood, it may prove impossible to show the existence of a hypogonadotropic state before pubertal age. Anti-Müllerian hormone (AMH) and inhibin B arise as more adequate biomarkers to assess gonadal function and increase the possibility of making an earlier diagnosis of hypogonadism in children, which may positively impact on timely management.
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Affiliation(s)
- Romina P Grinspon
- Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330 - C1425EFD Buenos Aires, Argentina
| | - Analía V Freire
- Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330 - C1425EFD Buenos Aires, Argentina
| | - Rodolfo A Rey
- Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330 - C1425EFD Buenos Aires, Argentina.
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13
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Zhao N, Lu XL, Li JT, Zhang JM. Treatment of idiopathic oligozoospermia with combined human chorionic gonadotropin/human menopausal gonadotrophin: A randomised, double-blinded, placebo-controlled clinical study. Andrologia 2019; 51:e13271. [PMID: 30891813 DOI: 10.1111/and.13271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/13/2019] [Accepted: 02/26/2019] [Indexed: 01/26/2023] Open
Abstract
To evaluate whether hCG/hMG therapy has beneficial effects on idiopathic oligozoospermia in Chinese infertility population. The patients were randomly divided into the treatment group receiving hCG/hMG for 3 months and the placebo group receiving placebo for 3 months. Semen and biochemical analysis was performed, and DNA fragmentation as well as spermatid concentration was evaluated. Administration of hCG/hMG for 3 months could significantly improve sperm concentration, rate of forward motile spermatozoa, total motile sperm count, the percentage of sperm with normal morphology and the rate of spontaneous pregnancy in medium- and higher-level inhibin B group respectively. Moreover, in medium- and higher-level inhibin B group, sperm DNA fragmentation index and spermatid concentration were significantly declined respectively at the end of treatment. However, there were no significant differences in lower-level inhibin B group before and after treatment in term of seminal parameters, DNA fragmentation and spermatid concentration. HCG/hMG therapy for 3 months has a beneficial effect on a part of male with idiopathic oligozoospermia, and the efficacy of hCG/hMG therapy is associated with the inhibin B level.
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Affiliation(s)
- Nan Zhao
- Department of Andrology, People's Hospital of Liaocheng City, Liaocheng City, China
| | - Xi-Lan Lu
- Center for Reproductive Medicine, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Jun-Tao Li
- Center for Reproductive Medicine, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
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14
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Hildorf S, Dong L, Thorup J, Clasen-Linde E, Yding Andersen C, Cortes D. Sertoli Cell Number Correlates with Serum Inhibin B in Infant Cryptorchid Boys. Sex Dev 2019; 13:74-82. [DOI: 10.1159/000497374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/26/2022] Open
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Kuiri-Hänninen T, Koskenniemi J, Dunkel L, Toppari J, Sankilampi U. Postnatal Testicular Activity in Healthy Boys and Boys With Cryptorchidism. Front Endocrinol (Lausanne) 2019; 10:489. [PMID: 31396156 PMCID: PMC6663997 DOI: 10.3389/fendo.2019.00489] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/04/2019] [Indexed: 01/25/2023] Open
Abstract
Cryptorchidism, or undescended testis, is a well-known risk factor for testicular cancer and impaired semen quality in adulthood, conditions which have their origins in early fetal and postnatal life. In human pregnancy, the interplay of testicular and placental hormones as well as local regulatory factors and control by the hypothalamic-pituitary (HP) axis, lead to testicular descent by term. The normal masculine development may be disrupted by environmental factors or genetic defects and result in undescended testes. Minipuberty refers to the postnatal re-activation of the HP-testicular (T) axis after birth. During the first weeks of life, gonadotropin levels increase, followed by activation and proliferation of testicular Leydig, Sertoli and germ cells. Consequent rise in testosterone levels results in penile growth during the first months of life. Testicular size increases and testicular descent continues until three to five months of age. Insufficient HPT axis activation (e.g., hypogonadotropic hypogonadism) is often associated with undescended testis and therefore minipuberty is considered an important phase in the normal male reproductive development. Minipuberty provides a unique window of opportunity for the early evaluation of HPT axis function during early infancy. For cryptorchid boys, hormonal evaluation during minipuberty may give a hint of the underlying etiology and aid in the evaluation of the later risk of HPT axis dysfunction and impaired fertility. The aim of this review is to summarize the current knowledge of the role of minipuberty in testicular development and descent.
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Affiliation(s)
- Tanja Kuiri-Hänninen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
- *Correspondence: Tanja Kuiri-Hänninen
| | - Jaakko Koskenniemi
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Leo Dunkel
- Barts and the London, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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16
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Rodprasert W, Virtanen HE, Mäkelä JA, Toppari J. Hypogonadism and Cryptorchidism. Front Endocrinol (Lausanne) 2019; 10:906. [PMID: 32010061 PMCID: PMC6974459 DOI: 10.3389/fendo.2019.00906] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023] Open
Abstract
Congenital cryptorchidism (undescended testis) is one of the most common congenital urogenital malformations in boys. Prevalence of cryptorchidism at birth among boys born with normal birth weight ranges from 1.8 to 8.4%. Cryptorchidism is associated with a risk of low semen quality and an increased risk of testicular germ cell tumors. Testicular hormones, androgens and insulin-like peptide 3 (INSL3), have an essential role in the process of testicular descent from intra-abdominal position into the scrotum in fetal life. This explains the increased prevalence of cryptorchidism among boys with diseases or syndromes associated with congenitally decreased secretion or action of androgens, such as patients with congenital hypogonadism and partial androgen insensitivity syndrome. There is evidence to support that cryptorchidism is associated with decreased testicular hormone production later in life. It has been shown that cryptorchidism impairs long-term Sertoli cell function, but may also affect Leydig cells. Germ cell loss taking place in the cryptorchid testis is proportional to the duration of the condition, and therefore early orchiopexy to bring the testis into the scrotum is the standard treatment. However, the evidence for benefits of early orchiopexy for testicular endocrine function is controversial. The hormonal treatments using human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) to induce testicular descent have low success rates, and therefore they are not recommended by the current guidelines for management of cryptorchidism. However, more research is needed to assess the effects of hormonal treatments during infancy on future male reproductive health.
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Affiliation(s)
- Wiwat Rodprasert
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
- *Correspondence: Wiwat Rodprasert
| | - Helena E. Virtanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
| | - Juho-Antti Mäkelä
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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17
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Wang Y, Wei Y, Tang X, Liu B, Shen L, Long C, Lin T, He D, Wu S, Wei G. Association between androgen receptor polymorphic CAG and GGC repeat lengths and cryptorchidism: A meta-analysis of case-control studies. J Pediatr Urol 2018; 14:432.e1-432.e9. [PMID: 29914823 DOI: 10.1016/j.jpurol.2018.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/21/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Previous studies have revealed the relationship between androgen receptor (AR) CAG and/or GGC polymorphisms and risk of cryptorchidism, yet the results have been elusive and controversial. AIM To determine whether AR polymorphic CAG and/or GGC repeats are related to cryptorchidism. STUDY DESIGN The relevant studies were obtained from PubMed, Embase, China National Knowledge Infrastructure, and Wanfang. The pooled odds ratios with 95% confidence intervals (CIs) were used to assess the strength of associations. Subgroup analyses were performed based on ethnicity and source of controls. Moreover, Begg's funnel plots and Egger's linear regression test were conducted to determine publication bias. RESULTS Eight case-control studies containing 321 patients and 784 normal controls were included. There was a significant association between longer CAG repeats and cryptorchidism risk (weighted mean difference (WMD) = 0.62; 95% CIs 0.06, 1.18; P = 0.031). Moreover, there was a significant association between the longer GGC repeats and cryptorchidism risk (WMD = 0.87; 95% CIs 0.04, 1.74; P = 0.040). There was significant association between the longer CAG repeats and bilateral cryptorchidism (WMD = 0.88; 95% CIs -0.18, 1.94; P = 0.011), while there was no significant association between the longer CAG repeats and unilateral cryptorchidism (WMD = -0.09; 95% CIs -0.50, 0.31; P = 0.554). There were significant associations between the longer GGC repeats and unilateral cryptorchidism (WMD = 0.88; 95% CIs -0.30, 2.05; P = 0.005) and bilateral cryptorchidism (WMD = 1.35; 95% CIs -0.52, 3.21; P = 0.000). Stratifying analysis revealed an association between longer CAG/GGC repeats and cryptorchidism in Caucasian populations from Europe (WMD = 0.73; 95% CIs 0.00, 1.46; P = 0.017), while there was no association with Asian populations. DISCUSSION This meta-analysis found that CAG/GGC repeats in the AR gene were longer in cryptorchidism patients compared to controls. Both the longer CAG repeats and GGC repeats in the AR gene were associated with cryptorchidism risk. The longer CAG repeats were associated with bilateral cryptorchidism, whereas the longer GGC repeats were associated with unilateral and bilateral cryptorchidism. Stratifying analysis revealed an association between longer CAG/GGC repeats and cryptorchidism in Caucasian populations from Europe, while there was no association between longer CAG/GGC repeats and cryptorchidism in Asian populations. CONCLUSION The CAG/GGC repeats in the AR gene were longer in cryptorchidism than in controls. Longer CAG repeats may play a role in determining bilateral cryptorchidism, and longer GGC repeats may play a role in determining unilateral and bilateral cryptorchidism. These observations were more applicable to Caucasian populations.
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Affiliation(s)
- Y Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children's Urogenital Development and Tissue Engineering, China
| | - Y Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children's Urogenital Development and Tissue Engineering, China
| | - X Tang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children's Urogenital Development and Tissue Engineering, China
| | - B Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, China
| | - L Shen
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China
| | - C Long
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, China
| | - T Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, China
| | - D He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, China
| | - S Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children's Urogenital Development and Tissue Engineering, China; Ministry of Education Key Laboratory of Child Development and Disorders, China.
| | - G Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children's Urogenital Development and Tissue Engineering, China; Ministry of Education Key Laboratory of Child Development and Disorders, China
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Esposito S, Cofini M, Rigante D, Leonardi A, Lucchetti L, Cipolla C, Lanciotti L, Penta L. Inhibin B in healthy and cryptorchid boys. Ital J Pediatr 2018; 44:81. [PMID: 30012176 PMCID: PMC6048859 DOI: 10.1186/s13052-018-0523-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cryptorchidism, the most common male genital abnormality observed in paediatrics, might often be associated with long-term functional consequences and can even reoccur after a successful orchidopexy. Serum markers that identify cryptorchid boys with gonadal dysfunction early should be useful in a decision-making process. Inhibin B, produced during all of childhood but altered in cryptorchid subjects, appears strictly related to Sertoli cells, and its levels directly reflect the status of the testis germinative epithelium. Unfortunately, its precise roles in bilateral and unilateral cryptorchidism are still debated and being unravelled. Herein, we report the most current knowledge about inhibin B in both healthy boys and those with cryptorchidism to discuss and clarify its potential clinical applications. Discussion Inhibin B represents a simple and repeatable serum marker and it seems to well asses the presence and function of the testicular tissue. Testicular tissue in prepubertal age is largely made up of Sertoli cells; inhibin B, coming from working Sertoli cells, allows to indirectly evaluate their function. Besides, inhibin B is produced throughout childhood, even before puberty, in contrast with central hormones, and it is not influenced by androgens during puberty, in contrast with other testicular hormones. Although further studies are needed, low levels of inhibin B have been related with low testicular score and/or with consistent alterations of testicular parameters at histological examination. This means that inhibin B could be an indirect marker of testicular functions that could even replace testicular biopsies, but current data are inconsistent to confirm this potential role of inhibin B in cryptorchidism. Conclusion Inhibin B represents an effective candidate for early identification of testicular dysfunction after orchidopexy for cryptorchidism. Unfortunately, current data cannot exactly clarify the real role of inhibin B as a predictor of future testicular function in cryptorchidism and future long-term follow-up studies, with repeated inhibin B checks both in cryptorchid and in formerly cryptorchid children and adolescents, will permit to assess if previous normal levels of inhibin B would match with future normal pubertal development and fertility potential.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy.
| | - Marta Cofini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alberto Leonardi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Laura Lucchetti
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Clelia Cipolla
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Lucia Lanciotti
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Laura Penta
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
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Lu XL, Liu JJ, Li JT, Yang QA, Zhang JM. Melatonin therapy adds extra benefit to varicecelectomy in terms of sperm parameters, hormonal profile and total antioxidant capacity: A placebo-controlled, double-blind trial. Andrologia 2018; 50:e13033. [PMID: 29740842 DOI: 10.1111/and.13033] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- X.-L. Lu
- Department of Reproductive Medicine; Jinan Central Hospital affiliated to Shandong University; Jinan China
| | - J.-J. Liu
- Hospital affiliated to Institute of Traditional Chinese Medicine & Materia Medica of Shandong Province; Jinan China
| | - J.-T. Li
- Department of Reproductive Medicine; Jinan Central Hospital affiliated to Shandong University; Jinan China
| | - Q.-A. Yang
- School of Nursing; Shandong Xiehe University; Jinan China
| | - J.-M. Zhang
- School of Nursing; Shandong Xiehe University; Jinan China
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20
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Gegenschatz-Schmid K, Verkauskas G, Demougin P, Bilius V, Dasevicius D, Stadler MB, Hadziselimovic F. Curative GnRHa treatment has an unexpected repressive effect on Sertoli cell specific genes. Basic Clin Androl 2018; 28:2. [PMID: 29456864 PMCID: PMC5806254 DOI: 10.1186/s12610-018-0067-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/23/2018] [Indexed: 12/27/2022] Open
Abstract
Background Follicle stimulating hormone and testosterone stimulate Sertoli cells to support germ cell function and differentiation. During mini-puberty, when gonadotropin (GnRH) stimulates increases in plasma luteinizing hormone (LH) and testosterone levels, gonocytes are transformed into Ad spermatogonia. In cryptorchidism, impaired gonadotropin secretion during mini-puberty results in insufficient LH and testosterone secretion, impaired gonocyte transition to Ad spermatogonia, and perturbed Sertoli cell proliferation. Treatment with a gonadotropin-releasing hormone agonist (GnRHa/Buserelin) induced gonocytes to differentiate into Ad spermatogonia and rescued fertility. The present study evaluated the impact of low LH secretion on Sertoli cell function by comparing differential gene expression data between testes with low LH that lacked Ad spermatogonia (Ad-) and testes that completed mini-puberty (Ad+). Furthermore, we analyzed changes in the transcription of selected Sertoli cell specific genes in response to GnRHa treatment. Results Ad- testes showed reduced expression of nine out of 40 selected Sertoli cell specific genes compared to Ad+ testes. GnRHa treatment repressed most of the Sertoli cell specific genes, including the inhibins, but it increased the expression of genes that regulate apoptosis (FASLG) and proliferation (GDNF). Conclusions Impaired-minipuberty with decreased LH and testosterone levels affected Ad and Sertoli cell development through positive and negative regulation of morphoregulatory and apoptotic genes. GnRHa treatment had a repressive effect on most Sertoli cell specific genes, which suggested that Sertoli cells underwent a cellular rearrangement. We propose that gonadotropin-dependent increases in FASLG and GDNF expression drove Sertoli cell proliferation and germ cell self-renewal and supported the transition of gonocytes to Ad spermatogonia, independent of inhibins.
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Affiliation(s)
| | - Gilvydas Verkauskas
- 2Children's Surgery Centre, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
| | - Philippe Demougin
- 3Biozentrum, Life Sciences Training Facility, University of Basel, 4001 Basel, Switzerland
| | - Vytautas Bilius
- 2Children's Surgery Centre, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
| | - Darius Dasevicius
- 4Institute for Pathology, National Centre of Pathology, Affiliate of Vilnius University Hospital Santariskiu Klinikos, 08406 Vilnius, Lithuania
| | - Michael B Stadler
- 5Friedrich Miescher Institute for Biomedical Research, 4058 Basel, Switzerland.,6Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Faruk Hadziselimovic
- Cryptorchidism Research Institute, Kindermedizinisches Zentrum Liestal, 4410 Liestal, Switzerland
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Grinspon RP, Gottlieb S, Bedecarrás P, Rey RA. Anti-Müllerian Hormone and Testicular Function in Prepubertal Boys With Cryptorchidism. Front Endocrinol (Lausanne) 2018; 9:182. [PMID: 29922225 PMCID: PMC5996917 DOI: 10.3389/fendo.2018.00182] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/04/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The functional capacity of the testes in prepubertal boys with cryptorchidism before treatment has received very little attention. The assessment of testicular function at diagnosis could be helpful in the understanding of the pathophysiology of cryptorchidism and in the evaluation of the effect of treatment. Anti-Müllerian hormone is a well-accepted Sertoli cell biomarker to evaluate testicular function during childhood without the need for stimulation tests. OBJECTIVE The aim of the study was to assess testicular function in prepubertal children with cryptorchidism before orchiopexy, by determining serum anti-Müllerian hormone (AMH). We also evaluated serum gonadotropins and testosterone and looked for associations between testicular function and the clinical characteristics of cryptorchidism. MATERIALS AND METHODS We performed a retrospective, cross-sectional, analytical study at a tertiary pediatric public hospital. All clinical charts of patients admitted at the outpatient clinic, and recorded in our database with the diagnosis of cryptorchidism, were eligible. The main outcome measure of the study was the serum concentration of AMH. Secondary outcome measures were serum LH, FSH, and testosterone. For comparison, serum hormone levels from a normal population of 179 apparently normal prepubertal boys were used. RESULTS Out of 1,557 patients eligible in our database, 186 with bilateral and 124 with unilateral cryptorchidism were selected using a randomization software. Median AMH standard deviation score was below 0 in both the bilaterally and the unilaterally cryptorchid groups, indicating that testicular function was overall decreased in patients with cryptorchidism. Serum AMH was significantly lower in boys with bilateral cryptorchidism as compared with controls and unilaterally cryptorchid patients between 6 months and 1.9 years and between 2 and 8.9 years of age. Serum AMH below the normal range reflected testicular dysfunction in 9.5-36.5% of patients according to the age group in bilaterally cryptorchid boys and 6.3-16.7% in unilaterally cryptorchid boys. FSH was elevated in 8.1% and LH in 9.1% of boys with bilateral cryptorchidism, most of whom were anorchid. In patients with present testes, gonadotropins were only mildly elevated in less than 5% of the cases. Basal testosterone was mildly decreased in patients younger than 6 months old, and uninformative during childhood. CONCLUSION Prepubertal boys with cryptorchidism, especially those with bilaterally undescended gonads, have decreased AMH production. Although serum AMH may fall within the normal range, there is a considerable prevalence of testicular dysfunction during childhood in this frequent condition.
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Affiliation(s)
- Romina P. Grinspon
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Silvia Gottlieb
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Patricia Bedecarrás
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Rodolfo A. Rey
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
- Departamento de Histología, Biología Celular, Embriología y Genética, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- *Correspondence: Rodolfo A. Rey,
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22
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Hadziselimovic F. On the descent of the epididymo-testicular unit, cryptorchidism, and prevention of infertility. Basic Clin Androl 2017; 27:21. [PMID: 29163975 PMCID: PMC5686796 DOI: 10.1186/s12610-017-0065-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/27/2017] [Indexed: 12/22/2022] Open
Abstract
This comprehensive review provides in-depth coverage of progress made in understanding the molecular mechanisms underlying cryptorchidism, a frequent pathology first described in about 1786 by John Hunter. The first part focuses on the physiology, embryology, and histology of epididymo-testicular descent. In the last 20 years epididymo-testicular descent has become the victim of schematic drawings with an unjustified rejection of valid histological data. This part also includes discussion on the roles of gonadotropin-releasing hormone, fibroblast growth factors, Müllerian inhibiting substance, androgens, inhibin B, and insulin-like 3 in epididymo-testicular descent. The second part addresses the etiology and histology of cryptorchidism as well as the importance of mini-puberty for normal fertility development. A critical view is presented on current clinical guidelines that recommend early orchidopexy alone as the best possible treatment. Finally, by combining classical physiological information and the output of cutting-edge genomics data into a complete picture the importance of hormonal treatment in preventing cryptorchidism-induced infertility is underscored.
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Affiliation(s)
- Faruk Hadziselimovic
- Cryptorchidism Research Institute, Kindermedizinisches Zentrum Liestal, Liestal, Switzerland
- Pediatrics at the University of Basel and Director of Cryptorchidism Research Institfigute, Kindermedizinisches Zentrum, Bahnhofplatz 11, 4410 Liestal, Switzerland
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