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Farnetani G, Vannucci M, Fino MG, Cioppi F, Rosta V, Palma M, Tamburrino L, Vinci S, Casamonti E, Degl'Innocenti S, Spinelli M, Abrardo C, Marchiani S, Lotti F, Muratori M, Riera-Escamilla A, Krausz C. Severe sperm DNA fragmentation may persist for up to 3 years after cytotoxic therapy in patients affected by Hodgkin lymphoma and non-Hodgkin lymphoma. Hum Reprod 2024; 39:496-503. [PMID: 38177083 DOI: 10.1093/humrep/dead269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
STUDY QUESTION Does sperm DNA recover from damage in all men after 2 years from the end of cytotoxic treatments? SUMMARY ANSWER The current indication of 2 years waiting time for seeking natural pregnancy after cytotoxic treatment may not be adequate for all men, since severe sperm DNA damage is present in a proportion of subjects even after this timeframe. WHAT IS KNOWN ALREADY Data in the literature on sperm DNA fragmentation (SDF) in lymphoma patients after cytotoxic treatments are scarce. The largest longitudinal study evaluated paired pre- and post-therapy (up to 24 months) semen samples from 34 patients while one study performed a longer follow-up (36 months) in 10 patients. The median/mean SDF values >24 months after therapy did not show significant differences but the studies did not explore the proportion of patients with severe DNA damage and the analysis was done on frozen-thawed samples. STUDY DESIGN, SIZE, DURATION In this study, 53 Hodgkin lymphoma (HL) and 25 non-Hodgkin lymphoma (NHL) post-pubertal patients were included over a recruitment period of 10 years (2012-2022). Among them, 18 subjects provided paired semen samples for SDF analysis at the three time points. SDF was evaluated in patients before (T0) and after 2 (T2) and 3 years (T3) from the end of, cytotoxic treatments (chemotherapy alone or in combination with radiotherapy). A cohort of 79 healthy, fertile, and normozoospermic men >18 years old served as controls (recruited between 2016 and 2019). PARTICIPANTS/MATERIALS, SETTING, METHODS SDF was evaluated on fresh semen samples (i.e. spermatozoa potentially involved in natural conception) from patients and controls using TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) assay coupled with flow cytometry. SDF median values were compared between groups: (i) HL and NHL patients versus controls at the three time points; (ii) HL versus NHL patients at baseline; and (iii) patients at T0 versus T2 and T3. Severe DNA damage (SDD) was defined for SDF levels above the 95th percentile of controls (50%) and the proportion of patients with SDD at all time points was established. MAIN RESULTS AND THE ROLE OF CHANCE At T0, patients displayed higher median SDF than controls, reaching statistical significance in the NHL group: 40.5% [IQR: 31.3-52.6%] versus 28% [IQR: 22-38%], P < 0.05. Comparing SDF pre-treatment to that post-treatment, HL patients exhibited similar median values at the three time points, whereas NHL showed significantly lower values at T3 compared to T0: 29.2% [IQR: 22-38%] versus 40.5% [IQR: 31.3-52.6%], P < 0.05. The proportion with SDD in the entire cohort at T2 was 11.6% and 13.3% among HL and NHL patients, respectively. At T3, only one in 16 NHL patients presented SDD. LIMITATIONS, REASONS FOR CAUTION TUNEL assay requires at least 5 million spermatozoa to be performed; hence, severe oligozoospermic men were not included in the study. Although our cohort represents the largest one in the literature, the relatively small number of patients does not allow us to establish precisely the frequency of SDD at T2 which in our study reached 11-13% of patients. WIDER IMPLICATIONS OF THE FINDINGS Our data provide further insights into the long-term effects of cytotoxic treatments on the sperm genome. The persistent severe DNA damage after 2 years post-treatment observed in some patients suggests that there is an interindividual variation in restoring DNA integrity. We propose the use of SDF as a biomarker to monitor the treatment-induced genotoxic effects on sperm DNA in order to better personalize pre-conceptional counseling on whether to use fresh or cryopreserved spermatozoa. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by grants from the Istituto Toscano Tumori (ITT), Fondazione Ente Cassa di Risparmio di Firenze, the European Commission-Reproductive Biology Early Research Training (REPROTRAIN). C.K., G.F., V.R., and A.R.-E. belong to COST Action CA20119 (ANDRONET) which is supported by the European Cooperation in Science and Technology (www.cost.eu). The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Ginevra Farnetani
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Matteo Vannucci
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Maria Grazia Fino
- Andrology, Female Endocrinology and Gender Incongruence Unit, University Hospital Careggi (AOUC), Florence, Italy
| | - Francesca Cioppi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Viktoria Rosta
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Department of Gynecologic Oncology, Hungarian National Institute of Oncology, Budapest, Hungary
| | - Manuela Palma
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Lara Tamburrino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Serena Vinci
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Elena Casamonti
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Selene Degl'Innocenti
- Andrology, Female Endocrinology and Gender Incongruence Unit, University Hospital Careggi (AOUC), Florence, Italy
| | - Matilde Spinelli
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Department of Andrology, Fundació Puigvert, Universitat Autonoma de Barcelona, Instituto de Investigaciones Biomedicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Chiara Abrardo
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sara Marchiani
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesco Lotti
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Andrology, Female Endocrinology and Gender Incongruence Unit, University Hospital Careggi (AOUC), Florence, Italy
| | - Monica Muratori
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Antoni Riera-Escamilla
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Department of Andrology, Fundació Puigvert, Universitat Autonoma de Barcelona, Instituto de Investigaciones Biomedicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Csilla Krausz
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Andrology, Female Endocrinology and Gender Incongruence Unit, University Hospital Careggi (AOUC), Florence, Italy
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Calamai C, Ammar O, Rosta V, Farnetani G, Zimmitti S, Giovannelli L, Vignozzi L, Krausz C, Muratori M. Testicular and Haematological Cancer Induce Very High Levels of Sperm Oxidative Stress. Antioxidants (Basel) 2023; 12:1145. [PMID: 37371875 DOI: 10.3390/antiox12061145] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Cancer impairs spermatogenesis, whereas results on sperm DNA integrity are controversial and no data are available about sperm oxidative stress. In cancer patients, we detected sperm DNA fragmentation (sDF) and both viable (ROS production in viable sperm fraction/viable spermatozoa) and total (ROS production in viable sperm fraction/total spermatozoa) oxidative stress. We found that cancer (22.50 (17.00-26.75)%, n = 85) increased sDF with respect to the control groups in both normozoospermic subfertile patients (NSP) (12.75 (8.63-14.88)%, n = 52, p < 0.001) and in healthy donors (HD) (8.50 (7.00-14.00)%, n = 19, p < 0.001). The induction of viable oxidative stress (n = 96) with cancer was even higher: 36.60 (24.05-58.65)% versus 11.10 (8.63-14.90)% in NSP (p < 0.001) and 9.60 (8.00-14.03)% in HD (p < 0.001). Similar, albeit lower, differences were found for total oxidative stress. SDF sharply correlated to viable oxidative stress when we considered all subjects (cancer patients and controls) (r = 0.591, p < 0.001, n = 134), but no correlation was found when only cancer patients were studied (r = 0.200; p > 0.05, n = 63). In conclusion, cancer significantly increases sDF and sperm oxidative stress levels. Additional mechanisms to oxidative attack might be responsible for increased sDF in cancer patients. Because sperm oxidative stress might affect the outcomes of sperm cryopreservation, of cancer treatments and of sperm epigenoma, the detection of oxidative stress could be of help in managing the reproductive issues of cancer patients.
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Affiliation(s)
- Costanza Calamai
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
| | - Oumaima Ammar
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
| | - Viktoria Rosta
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
| | - Ginevra Farnetani
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
| | - Salvatore Zimmitti
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50139 Florence, Italy
| | - Lisa Giovannelli
- Department NEUROFARBA, University of Florence, 50139 Florence, Italy
| | - Linda Vignozzi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
- Andrology, Women's Endocrinology and Gender Incongruence Unit, AOU Careggi, 50139 Florence, Italy
| | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
- Andrology, Women's Endocrinology and Gender Incongruence Unit, AOU Careggi, 50139 Florence, Italy
| | - Monica Muratori
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
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Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Jolles M, Pinotti R, Swan SH. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update 2023; 29:157-176. [PMID: 36377604 DOI: 10.1093/humupd/dmac035] [Citation(s) in RCA: 151] [Impact Index Per Article: 151.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Numerous studies have reported declines in semen quality and other markers of male reproductive health. Our previous meta-analysis reported a significant decrease in sperm concentration (SC) and total sperm count (TSC) among men from North America-Europe-Australia (NEA) based on studies published during 1981-2013. At that time, there were too few studies with data from South/Central America-Asia-Africa (SAA) to reliably estimate trends among men from these continents. OBJECTIVE AND RATIONALE The aim of this study was to examine trends in sperm count among men from all continents. The broader implications of a global decline in sperm count, the knowledge gaps left unfilled by our prior analysis and the controversies surrounding this issue warranted an up-to-date meta-analysis. SEARCH METHODS We searched PubMed/MEDLINE and EMBASE to identify studies of human SC and TSC published during 2014-2019. After review of 2936 abstracts and 868 full articles, 44 estimates of SC and TSC from 38 studies met the protocol criteria. Data were extracted on semen parameters (SC, TSC, semen volume), collection year and covariates. Combining these new data with data from our previous meta-analysis, the current meta-analysis includes results from 223 studies, yielding 288 estimates based on semen samples collected 1973-2018. Slopes of SC and TSC were estimated as functions of sample collection year using simple linear regression as well as weighted meta-regression. The latter models were adjusted for predetermined covariates and examined for modification by fertility status (unselected by fertility versus fertile), and by two groups of continents: NEA and SAA. These analyses were repeated for data collected post-2000. Multiple sensitivity analyses were conducted to examine assumptions, including linearity. OUTCOMES Overall, SC declined appreciably between 1973 and 2018 (slope in the simple linear model: -0.87 million/ml/year, 95% CI: -0.89 to -0.86; P < 0.001). In an adjusted meta-regression model, which included two interaction terms [time × fertility group (P = 0.012) and time × continents (P = 0.058)], declines were seen among unselected men from NEA (-1.27; -1.78 to -0.77; P < 0.001) and unselected men from SAA (-0.65; -1.29 to -0.01; P = 0.045) and fertile men from NEA (-0.50; -1.00 to -0.01; P = 0.046). Among unselected men from all continents, the mean SC declined by 51.6% between 1973 and 2018 (-1.17: -1.66 to -0.68; P < 0.001). The slope for SC among unselected men was steeper in a model restricted to post-2000 data (-1.73: -3.23 to -0.24; P = 0.024) and the percent decline per year doubled, increasing from 1.16% post-1972 to 2.64% post-2000. Results were similar for TSC, with a 62.3% overall decline among unselected men (-4.70 million/year; -6.56 to -2.83; P < 0.001) in the adjusted meta-regression model. All results changed only minimally in multiple sensitivity analyses. WIDER IMPLICATIONS This analysis is the first to report a decline in sperm count among unselected men from South/Central America-Asia-Africa, in contrast to our previous meta-analysis that was underpowered to examine those continents. Furthermore, data suggest that this world-wide decline is continuing in the 21st century at an accelerated pace. Research on the causes of this continuing decline and actions to prevent further disruption of male reproductive health are urgently needed.
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Affiliation(s)
- Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Niels Jørgensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine and Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), Murcia, Spain
| | - Dan Weksler-Derri
- Clalit Health Services, Kiryat Ono, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Maya Jolles
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Pinotti
- Gustave L. and Janet W. Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Al-Jebari Y, Rylander L, Ståhl O, Giwercman A. Risk of Congenital Malformations in Children Born Before Paternal Cancer. JNCI Cancer Spectr 2019; 2:pky027. [PMID: 31360856 PMCID: PMC6649839 DOI: 10.1093/jncics/pky027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/04/2018] [Accepted: 05/08/2018] [Indexed: 11/12/2022] Open
Abstract
Background Increased risk of congenital malformations in children fathered by men treated for cancer might be due to mutagenicity of cancer therapies. Finding of increased malformation prevalence in offspring born before paternal cancer would indicate a treatment-independent mechanism. Methods Through national registries, we obtained data on singletons born in Sweden from 1994 to 2014 (n = 1 796 160) and their fathers and mothers (1 092 950/1 092 011). Men with cancer (n = 23 932) fathered 26 601 and 9926 children before and after cancer diagnosis, respectively. Associations between paternal cancer, diagnoses retrieved from the Swedish Cancer Register, and offspring malformations, based on Swedish Medical Birth Register data, were estimated by logistic regression. Results Children conceived before paternal cancer had a statistically significantly increased risk of all malformations (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.02 to 1.15, P = .016, 3.8% vs 3.4%) and major malformations (OR = 1.09, 95% CI = 1.01 to 1.18, P = .03, 2.4% vs 2.1%). Eye and central nervous system cancers were associated with the highest risk of all malformations (OR = 1.30, 95% CI = 1.04 to 1.61, P = .02, 4.5% vs 3.4%). A similar trend was seen for testicular cancer. The malformation rates among children conceived before and after paternal cancer diagnosis were similar. Conclusions The association between paternal cancer and risk of malformations in the offspring is not solely due to mutagenic effects of cancer therapy. The increase in prevalence of birth anomalies among children of fathers with malignancy might be due to cancer per se or a common underlying paternal factor, for example, genomic instability.
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Affiliation(s)
- Yahia Al-Jebari
- Molecular Reproductive Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden (YA AG)
| | - Lars Rylander
- Unit for Environmental Epidemiology, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden (LR)
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden (OS)
| | - Aleksander Giwercman
- Molecular Reproductive Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden (YA AG)
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5
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Sperm DNA Fragmentation: Mechanisms of Origin. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1166:75-85. [DOI: 10.1007/978-3-030-21664-1_5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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6
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Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Mindlis I, Pinotti R, Swan SH. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update 2018; 23:646-659. [PMID: 28981654 DOI: 10.1093/humupd/dmx022] [Citation(s) in RCA: 733] [Impact Index Per Article: 122.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/28/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Reported declines in sperm counts remain controversial today and recent trends are unknown. A definitive meta-analysis is critical given the predictive value of sperm count for fertility, morbidity and mortality. OBJECTIVE AND RATIONALE To provide a systematic review and meta-regression analysis of recent trends in sperm counts as measured by sperm concentration (SC) and total sperm count (TSC), and their modification by fertility and geographic group. SEARCH METHODS PubMed/MEDLINE and EMBASE were searched for English language studies of human SC published in 1981-2013. Following a predefined protocol 7518 abstracts were screened and 2510 full articles reporting primary data on SC were reviewed. A total of 244 estimates of SC and TSC from 185 studies of 42 935 men who provided semen samples in 1973-2011 were extracted for meta-regression analysis, as well as information on years of sample collection and covariates [fertility group ('Unselected by fertility' versus 'Fertile'), geographic group ('Western', including North America, Europe Australia and New Zealand versus 'Other', including South America, Asia and Africa), age, ejaculation abstinence time, semen collection method, method of measuring SC and semen volume, exclusion criteria and indicators of completeness of covariate data]. The slopes of SC and TSC were estimated as functions of sample collection year using both simple linear regression and weighted meta-regression models and the latter were adjusted for pre-determined covariates and modification by fertility and geographic group. Assumptions were examined using multiple sensitivity analyses and nonlinear models. OUTCOMES SC declined significantly between 1973 and 2011 (slope in unadjusted simple regression models -0.70 million/ml/year; 95% CI: -0.72 to -0.69; P < 0.001; slope in adjusted meta-regression models = -0.64; -1.06 to -0.22; P = 0.003). The slopes in the meta-regression model were modified by fertility (P for interaction = 0.064) and geographic group (P for interaction = 0.027). There was a significant decline in SC between 1973 and 2011 among Unselected Western (-1.38; -2.02 to -0.74; P < 0.001) and among Fertile Western (-0.68; -1.31 to -0.05; P = 0.033), while no significant trends were seen among Unselected Other and Fertile Other. Among Unselected Western studies, the mean SC declined, on average, 1.4% per year with an overall decline of 52.4% between 1973 and 2011. Trends for TSC and SC were similar, with a steep decline among Unselected Western (-5.33 million/year, -7.56 to -3.11; P < 0.001), corresponding to an average decline in mean TSC of 1.6% per year and overall decline of 59.3%. Results changed minimally in multiple sensitivity analyses, and there was no statistical support for the use of a nonlinear model. In a model restricted to data post-1995, the slope both for SC and TSC among Unselected Western was similar to that for the entire period (-2.06 million/ml, -3.38 to -0.74; P = 0.004 and -8.12 million, -13.73 to -2.51, P = 0.006, respectively). WIDER IMPLICATIONS This comprehensive meta-regression analysis reports a significant decline in sperm counts (as measured by SC and TSC) between 1973 and 2011, driven by a 50-60% decline among men unselected by fertility from North America, Europe, Australia and New Zealand. Because of the significant public health implications of these results, research on the causes of this continuing decline is urgently needed.
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Affiliation(s)
- Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, the Hebrew University Center of Excellence in Agriculture and Environmental Health, Ein Kerem Campus, PO BOX 12272, Jerusalem 9110202, Israel.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Niels Jørgensen
- University Department of Growth and Reproduction, University of Copenhagen, Rigshospitalet, CopenhagenDK-2100, Denmark
| | - Anderson Martino-Andrade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,Department of Physiology, Federal University of Parana, Curitiba 81531-980, Brazil
| | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine and Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), Murcia30100, Spain
| | - Dan Weksler-Derri
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva6676814, Israel
| | - Irina Mindlis
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY10029, USA
| | - Rachel Pinotti
- Gustave L. and Janet W. Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY10029, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY10029, USA
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Paoli D, Pallotti F, Lenzi A, Lombardo F. Fatherhood and Sperm DNA Damage in Testicular Cancer Patients. Front Endocrinol (Lausanne) 2018; 9:506. [PMID: 30271379 PMCID: PMC6146098 DOI: 10.3389/fendo.2018.00506] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023] Open
Abstract
Testicular cancer (TC) is one of the most treatable of all malignancies and the management of the quality of life of these patients is increasingly important, especially with regard to their sexuality and fertility. Survivors must overcome anxiety and fears about reduced fertility and possible pregnancy-related risks as well as health effects in offspring. There is thus a growing awareness of the need for reproductive counseling of cancer survivors. Studies found a high level of sperm DNA damage in TC patients in comparison with healthy, fertile controls, but no significant difference between these patients and infertile patients. Sperm DNA alterations due to cancer treatment persist from 2 to 5 years after the end of the treatment and may be influenced by both the type of therapy and the stage of the disease. Population studies reported a slightly reduced overall fertility of TC survivors and a more frequent use of ART than the general population, with a success rate of around 50%. Paternity after a diagnosis of cancer is an important issue and reproductive potential is becoming a major quality of life factor. Sperm chromatin instability associated with genome instability is the most important reproductive side effect related to the malignancy or its treatment. Studies investigating the magnitude of this damage could have a considerable translational importance in the management of cancer patients, as they could identify the time needed for the germ cell line to repair nuclear damage and thus produce gametes with a reduced risk for the offspring.
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8
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Kumar K, Lewis S, Vinci S, Riera-Escamilla A, Fino MG, Tamburrino L, Muratori M, Larsen P, Krausz C. Evaluation of sperm DNA quality in men presenting with testicular cancer and lymphoma using alkaline and neutral Comet assays. Andrology 2017; 6:230-235. [DOI: 10.1111/andr.12429] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/14/2017] [Accepted: 08/21/2017] [Indexed: 02/03/2023]
Affiliation(s)
- K. Kumar
- Centre for Public Health; Queen's University Belfast; Belfast Northern Ireland UK
| | - S. Lewis
- Centre for Public Health; Queen's University Belfast; Belfast Northern Ireland UK
| | - S. Vinci
- Sexual Medicine and Andrology Unit; Department of Clinical and Experimental Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - A. Riera-Escamilla
- Sexual Medicine and Andrology Unit; Department of Clinical and Experimental Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - M.-G. Fino
- Sexual Medicine and Andrology Unit; Department of Clinical and Experimental Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - L. Tamburrino
- Sexual Medicine and Andrology Unit; Department of Clinical and Experimental Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - M. Muratori
- Sexual Medicine and Andrology Unit; Department of Clinical and Experimental Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | | | - C. Krausz
- Sexual Medicine and Andrology Unit; Department of Clinical and Experimental Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
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9
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Vassilakopoulou M, Boostandoost E, Papaxoinis G, de La Motte Rouge T, Khayat D, Psyrri A. Anticancer treatment and fertility: Effect of therapeutic modalities on reproductive system and functions. Crit Rev Oncol Hematol 2015; 97:328-34. [PMID: 26481950 DOI: 10.1016/j.critrevonc.2015.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 06/27/2015] [Accepted: 08/04/2015] [Indexed: 11/16/2022] Open
Abstract
The significant improvement of cancer treatments entailed a longer life in cancer survivors and raised expectations for higher quality of life with minimized long-term toxicity. Infertility and gonadal dysfunction are adverse effects of anticancer therapy or may be related to specific tumors. In female cancer survivors, premature ovarian failure is common after antineoplastic treatments resulting in infertility and other morbidities related to oestrogen deficiency such as osteoporosis. In male cancer survivors, infertility and persistent a zoospermia is a more common long-term adverse effect than hypogonadism because germ cells are more sensitive to chemotherapy and radiotherapy than leydig cells. Gonadal toxicity and compromise of reproductive functions will be more efficiently prevented and treated if addressed before treatment initiation. This review focuses on these issues in young cancer survivors of childbearing age, where methods of protecting or restoring endocrine function and fertility need to be considered.
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Affiliation(s)
- Maria Vassilakopoulou
- Service d'Oncologie Médicale, Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital 75013 Paris, France; Service d'Oncologie Médicale, Hôpital Marc Jacquet, Melun, Seine et Marne, France.
| | - Erfaneh Boostandoost
- Service d'Oncologie Médicale, Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital 75013 Paris, France; Service d'Oncologie Médicale, Hôpital Marc Jacquet, Melun, Seine et Marne, France
| | - George Papaxoinis
- Oncology Unit, Second Department of Internal Medicine, Hippocration Hospital, University of Athens, 108V. Sophias, 11634, Greece
| | - Thibault de La Motte Rouge
- Institut Curie, Hôpital René Huguenin, Service d'Oncologie Médicale, 35 rue Dailly, Saint-Cloud, 92210, France
| | - David Khayat
- Service d'Oncologie Médicale, Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital 75013 Paris, France
| | - Amanda Psyrri
- Oncology Department, Attikon Hospital, University of Athens, 1 Rimini, 12462, Greece
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Paoli D, Gallo M, Rizzo F, Spanò M, Leter G, Lombardo F, Lenzi A, Gandini L. Testicular cancer and sperm DNA damage: short- and long-term effects of antineoplastic treatment. Andrology 2014; 3:122-8. [DOI: 10.1111/j.2047-2927.2014.00250.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 06/09/2014] [Accepted: 06/20/2014] [Indexed: 11/27/2022]
Affiliation(s)
- D. Paoli
- Laboratory of Seminology-Sperm Bank; Department of Experimental Medicine; University of Rome “La Sapienza”; Rome Italy
| | - M. Gallo
- Laboratory of Seminology-Sperm Bank; Department of Experimental Medicine; University of Rome “La Sapienza”; Rome Italy
| | - F. Rizzo
- Laboratory of Seminology-Sperm Bank; Department of Experimental Medicine; University of Rome “La Sapienza”; Rome Italy
| | - M. Spanò
- Laboratory of Toxicology; Unit of Radiation Biology and Human Health; ENEA Casaccia Research Centre; Rome Italy
| | - G. Leter
- Laboratory of Toxicology; Unit of Radiation Biology and Human Health; ENEA Casaccia Research Centre; Rome Italy
| | - F. Lombardo
- Laboratory of Seminology-Sperm Bank; Department of Experimental Medicine; University of Rome “La Sapienza”; Rome Italy
| | - A. Lenzi
- Laboratory of Seminology-Sperm Bank; Department of Experimental Medicine; University of Rome “La Sapienza”; Rome Italy
| | - L. Gandini
- Laboratory of Seminology-Sperm Bank; Department of Experimental Medicine; University of Rome “La Sapienza”; Rome Italy
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Bujan L, Walschaerts M, Brugnon F, Daudin M, Berthaut I, Auger J, Saias J, Szerman E, Moinard N, Rives N, Hennebicq S. Impact of lymphoma treatments on spermatogenesis and sperm deoxyribonucleic acid: a multicenter prospective study from the CECOS network. Fertil Steril 2014; 102:667-674.e3. [PMID: 25044088 DOI: 10.1016/j.fertnstert.2014.06.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/16/2014] [Accepted: 06/02/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine consequences of lymphoma treatments on sperm characteristics and sperm DNA, and to evaluate predictors of sperm recovery. DESIGN Multicenter prospective longitudinal study of patients analyzed before treatment and after 3, 6, 12, and 24 months. SETTING University hospitals. PATIENT(S) Seventy-five Hodgkin lymphoma and non-Hodgkin lymphoma patients and a control group of 257 fertile men. INTERVENTION(S) Semen analyses, and sperm DNA and chromatin assessments. MAIN OUTCOME MEASURE(S) Comparisons of sperm characteristics before and after treatment. RESULT(S) Patients already had altered sperm characteristics before lymphoma treatment, with no identified risk factor. Sperm count, total sperm count, motility, and vitality decreased after treatment, with lowest values at 3 and 6 months. Twelve months after treatment, mean sperm count recovered to pretreatment values after doxorubicin, bleomycin, vinblastine, darcarbacine (ABVD) or ABVD+radiotherapy, but not after doxorubicin, cyclophosphamide, vincristine, prednisone (CHOP) or mechlorethamine, oncovin, procarbazine, prednisone (MOPP) chemotherapies. It was noteworthy that 7% of patients remained azoospermic at 24 months. After 24 months, Kaplan-Meier estimates showed that more than 90% of patients will recover normal sperm count after ABVD or ABVD+radiotherapy vs. 61% for CHOP chemotherapies. In multivariate analyses including diagnosis and treatment protocol, only pretreatment total sperm count was related to recovery. Compared with a control group, lymphoma patients had higher sperm chromatin alterations and DNA fragmentation before any treatment. After treatment, DNA fragmentation assessed by TUNEL assay and sperm chromatin structure assay decreased from 3 and 6 months, respectively, while remaining higher than in the control group during follow-up. CONCLUSION(S) Lymphoma patients had altered sperm DNA and chromatin before treatment. Lymphoma treatment had damaging effects on spermatogenesis. These data on both the recovery period according to treatment modalities and the pre- and post-treatment chromatin status of sperm are useful tools for counseling patients wishing to conceive.
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Affiliation(s)
- Louis Bujan
- Université de Toulouse, University Paul Sabatier, Groupe de Recherche en Fertilité Humaine (Human Fertility Research Group) and CECOS, Toulouse, France; Fédération Française des CECOS, France, Paris.
| | - Marie Walschaerts
- Université de Toulouse, University Paul Sabatier, Groupe de Recherche en Fertilité Humaine (Human Fertility Research Group) and CECOS, Toulouse, France
| | - Florence Brugnon
- Fédération Française des CECOS, France, Paris; Assistance Médicale à la Procréation, CECOS, Universitary Hospital Estaing, and Laboratoire Génétique Reproduction et Développement, Université d'Auvergne, Faculté de Médecine, Clermont-Ferrand, France
| | - Myriam Daudin
- Université de Toulouse, University Paul Sabatier, Groupe de Recherche en Fertilité Humaine (Human Fertility Research Group) and CECOS, Toulouse, France; Fédération Française des CECOS, France, Paris
| | - Isabelle Berthaut
- Fédération Française des CECOS, France, Paris; Service d'Histologie, Biologie de la Reproduction-CECOS, Hôpital Tenon, Paris, France
| | - Jacques Auger
- Fédération Française des CECOS, France, Paris; Département d'Histologie-Embryologie, Biologie de la Reproduction-CECOS, Site Port-Royal, Paris Centre University Hospitals, Paris, France
| | - Jacqueline Saias
- Fédération Française des CECOS, France, Paris; Laboratoire de Biologie de la Reproduction-Cecos, Hôpital La Conception, Marseille, France
| | - Ethel Szerman
- Fédération Française des CECOS, France, Paris; Unité de Biologie de la Reproduction-CECOS, Pole de Biologie, Universitary Hospital Côte de Nacre, Caen, France
| | - Nathalie Moinard
- Université de Toulouse, University Paul Sabatier, Groupe de Recherche en Fertilité Humaine (Human Fertility Research Group) and CECOS, Toulouse, France; Fédération Française des CECOS, France, Paris
| | - Nathalie Rives
- Fédération Française des CECOS, France, Paris; CECOS Biologie de la Reproduction, Universitary Hospital Rouen, and Gamétogenèse et Qualité du Gamète research group, Université de Rouen, Rouen, France
| | - Sylvianne Hennebicq
- Fédération Française des CECOS, France, Paris; Laboratoire d'Aide à la Procréation-CECOS, Laboratoire AGe, Imagerie, Modélisation, Équipe Génétique-Infertilité-Thérapeutique, Faculté de Médecine de Grenoble, Grenoble, France
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Mitwally MFM. Fertility preservation and minimizing reproductive damage in cancer survivors. Expert Rev Anticancer Ther 2014; 7:989-1001. [PMID: 17627459 DOI: 10.1586/14737140.7.7.989] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Recent advances in oncology have helped in the survival and cure of increasing numbers of childhood cancer patients and those during their reproductive age period. This has increased the need to improve existing technology, and prompted the search for new technologies, to minimize the gonadotoxic effects of cancer treatment and preserve human fertility. Conservative surgical approaches for cancer treatment have been widely accepted following progress in early detection of cancer and accumulating long-term outcome safety data. Gonadal suppression to increase resistance to cancer treatment by gonadotropin analogues and sex hormones has been suggested. However, while this is unlikely to be effective in males, there is no general consensus on its success in the female. Fertility preservation options for both male and female patients include cryopreservation of embryos, gametes and gonads. While embryo cryopreservation is a well-established and successful technique, there are several obvious limitations. Gamete cryopreservation is very successful in males (sperm freezing) while still experimental in females (oocyte freezing), with growing evidence suggesting its potential success. Gonadal cryopreservation is still in its early stages of experimental development, both in males (testicular tissue cryopreservation and in vitro spermatogenesis) and female (ovarian tissue cryopreservation and in vitro follicular maturation).
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Diedrich K, Fauser B, Devroey P. Cancer and fertility: strategies to preserve fertility. Reprod Biomed Online 2011; 22:232-48. [DOI: 10.1016/j.rbmo.2010.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 09/07/2010] [Accepted: 11/02/2010] [Indexed: 11/26/2022]
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14
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Ståhl O, Boyd HA, Giwercman A, Lindholm M, Jensen A, Kjær SK, Anderson H, Cavallin-Ståhl E, Rylander L. Risk of birth abnormalities in the offspring of men with a history of cancer: a cohort study using Danish and Swedish national registries. J Natl Cancer Inst 2011; 103:398-406. [PMID: 21303994 PMCID: PMC3046951 DOI: 10.1093/jnci/djq550] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The potential mutagenic effects of cancer therapies and the growing number of young male cancer survivors have given rise to concern about the health of their offspring. Methods We identified all singleton children born alive in Denmark between 1994 and 2004 and in Sweden between 1994 and 2005 (n = 1 777 765). Of the 8670 children with a paternal history of cancer, 8162 were conceived naturally and 508 were conceived using assisted reproductive technologies (ARTs) (in vitro fertilization or intracytoplasmatic sperm injection). Of the 1 769 0795 children without a paternal history of cancer, 25 926 were conceived using ARTs. Associations between paternal history of cancer and risk of adverse birth outcomes of children conceived naturally or by ARTs were investigated using log-linear binomial models, yielding risk ratios (RRs) with 95% confidence intervals (CIs). All statistical tests were two-sided. Results The offspring of male cancer survivors were more likely to have major congenital abnormalities than the offspring of fathers with no history of cancer (RR = 1.17, 95% CI = 1.05 to 1.31, P = .0043, 3.7% vs 3.2%). However, the mode of conception (natural conception or ARTs) did not modify the association between paternal history of cancer and risk of congenital abnormalities (natural conception, RR = 1.17, 95% CI = 1.04 to 1.31; ARTs, RR = 1.22, 95% CI = 0.80 to 1.87, Pinteraction = .84). Conclusion We observed a statistically significant but modest increase in the risk of major congenital abnormalities among offspring of males with a history of cancer, independent of the mode of conception.
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Affiliation(s)
- Olof Ståhl
- Department of Clinical Sciences, Molecular Reproductive Medicine Research Unit, Lund University, Malmö, Sweden.
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15
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Smit M, van Casteren NJ, Wildhagen MF, Romijn JC, Dohle GR. Sperm DNA integrity in cancer patients before and after cytotoxic treatment. Hum Reprod 2010; 25:1877-83. [PMID: 20551071 DOI: 10.1093/humrep/deq104] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We assessed sperm DNA fragmentation index (DFI) in cancer patients before and after treatment to evaluate if sperm DNA integrity is compromised by cancer itself or its treatment. METHODS In a prospective study, DFI was assessed in 127 patients diagnosed with testicular germ cell tumours (TGCT), Hodgkin's lymphoma (HL), non-Hodgkin's lymphoma (NHL) and various malignancies. The severity of cancer and tumour markers at diagnosis was recorded. Follow-up DFI after treatment was available in 52 patients who were mostly less severely affected. RESULTS In patients diagnosed with TGCT, HL and various malignancies, pretreatment DFI levels were not significantly different from that of proven fertile controls, but in patients with NHL an increased DFI was found. An overall significant decrease in post-treatment DFI (13.2% range 5.0-70.5) compared with pretreatment values (17.1% range 5.1-66.6) was found (P = 0.040). In TGCT patients, post-treatment DFI was significantly higher in patients who were treated with radiotherapy (16.9% range 11.5-39.9) compared with that in patients treated with chemotherapy (CT) alone (10.9% range 5.5-39.9) (P = 0.037). In HL patients, the type of treatment or number of CT cycles was not associated with DFI. Overall, post-treatment DFI in cancer patients was not significantly different from that of proven fertile controls. CONCLUSIONS In this study, the presence of cancer does not seem to negatively affect the sperm DNA integrity in TGCT and HL patients; only NHL patients showed increased DFI at the time of diagnosis compared with healthy controls. Our results confirm previous reports that DFI decreases significantly following various anti-cancer treatments. In contrast, radiotherapy in TGCT patients is associated with an increase in DFI compared with CT treatment alone.
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Affiliation(s)
- M Smit
- Andrology Unit of the Department of Urology, Erasmus MC, 3000 CA Rotterdam, The Netherlands.
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16
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Saalu LC. The incriminating role of reactive oxygen species in idiopathic male infertility: an evidence based evaluation. Pak J Biol Sci 2010; 13:413-422. [PMID: 20973394 DOI: 10.3923/pjbs.2010.413.422] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The male factor is considered a major contributory factor to infertility. Apart from the conventional causes for male infertility such as varicocoele, cryptorchidism, infections, obstructive lesions, cystic fibrosis, trauma and tumours, a new and important cause has been identified as being responsible for the so-called idiopathic male infertility: oxidative stress. Oxidative Stress (OS) is a condition that occurs when the production of Reactive Oxygen Species (ROS) overwhelms the antioxidant defense produced against them. In male reproductive pathological conditions, the OS significantly impairs spermatogenesis and sperm function, which may lead to male infertility. Reactive Oxygen Species (ROS) known as free radicals are oxidizing agents generated as a result of metabolism of oxygen and have at least one unpaired electron that make them very reactive species. Spermatozoa generate Reactive Oxygen Species (ROS) in physiological amounts, which play a role in sperm functions during sperm capacitation, Acrosome Reaction (AR) and oocyte fusion, but they need to be controlled and their concentrations maintained at a level that is not deleterious to the cells. Administration of antioxidants in patients with 'male factor' infertility has begun to attract considerable interest. The main difficulty of such an approach is our incomplete understanding of the role of free radicals in normal and abnormal sperm function leading to male infertility. The purpose of the present review is to address the relationship between ROS and idiopathic male factor infertility.
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Affiliation(s)
- L C Saalu
- Department of Anatomy, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
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Said TM, Tellez S, Evenson DP, Del Valle AP. Assessment of sperm quality, DNA integrity and cryopreservation protocols in men diagnosed with testicular and systemic malignancies. Andrologia 2009; 41:377-82. [DOI: 10.1111/j.1439-0272.2009.00941.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Dhawan A, Bajpayee M, Parmar D. The Comet Assay: A Versatile Tool for Assessing DNA Damage. THE COMET ASSAY IN TOXICOLOGY 2009. [DOI: 10.1039/9781847559746-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Alok Dhawan
- Developmental Toxicology Division Indian Institute of Toxicology Research (Formerly Industrial Toxicology Research Centre) P.O. Box 80 M.G. Marg Lucknow 226 001 India
| | - Mahima Bajpayee
- Developmental Toxicology Division Indian Institute of Toxicology Research (Formerly Industrial Toxicology Research Centre) P.O. Box 80 M.G. Marg Lucknow 226 001 India
| | - Devendra Parmar
- Developmental Toxicology Division Indian Institute of Toxicology Research (Formerly Industrial Toxicology Research Centre) P.O. Box 80 M.G. Marg Lucknow 226 001 India
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Ståhl O, Eberhard J, Cavallin-Ståhl E, Jepson K, Friberg B, Tingsmark C, Spanò M, Giwercman A. Sperm DNA integrity in cancer patients: the effect of disease and treatment. ACTA ACUST UNITED AC 2008; 32:695-703. [DOI: 10.1111/j.1365-2605.2008.00933.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Dhawan A, Bajpayee M, Parmar D. Comet assay: a reliable tool for the assessment of DNA damage in different models. Cell Biol Toxicol 2008; 25:5-32. [PMID: 18427939 DOI: 10.1007/s10565-008-9072-z] [Citation(s) in RCA: 241] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 03/17/2008] [Indexed: 11/29/2022]
Abstract
New chemicals are being added each year to the existing burden of toxic substances in the environment. This has led to increased pollution of ecosystems as well as deterioration of the air, water, and soil quality. Excessive agricultural and industrial activities adversely affect biodiversity, threatening the survival of species in a particular habitat as well as posing disease risks to humans. Some of the chemicals, e.g., pesticides and heavy metals, may be genotoxic to the sentinel species and/or to non-target species, causing deleterious effects in somatic or germ cells. Test systems which help in hazard prediction and risk assessment are important to assess the genotoxic potential of chemicals before their release into the environment or commercial use as well as DNA damage in flora and fauna affected by contaminated/polluted habitats. The Comet assay has been widely accepted as a simple, sensitive, and rapid tool for assessing DNA damage and repair in individual eukaryotic as well as some prokaryotic cells, and has increasingly found application in diverse fields ranging from genetic toxicology to human epidemiology. This review is an attempt to comprehensively encase the use of Comet assay in different models from bacteria to man, employing diverse cell types to assess the DNA-damaging potential of chemicals and/or environmental conditions. Sentinel species are the first to be affected by adverse changes in their environment. Determination of DNA damage using the Comet assay in these indicator organisms would thus provide information about the genotoxic potential of their habitat at an early stage. This would allow for intervention strategies to be implemented for prevention or reduction of deleterious health effects in the sentinel species as well as in humans.
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Affiliation(s)
- Alok Dhawan
- Developmental Toxicology Division, Indian Institute of Toxicology Research (formerly Industrial Toxicology Research Centre), PO Box 80, M.G. Marg, Lucknow, 226 001, India.
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O'Flaherty C, Vaisheva F, Hales BF, Chan P, Robaire B. Characterization of sperm chromatin quality in testicular cancer and Hodgkin's lymphoma patients prior to chemotherapy. Hum Reprod 2008; 23:1044-52. [PMID: 18346994 DOI: 10.1093/humrep/den081] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although the incidences of testicular cancer and Hodgkin's lymphoma have increased in young men over the past decade, combination chemotherapy has improved survival. As fertility is of importance to these patients, characterization of sperm chromatin structure is needed. We assessed sperm chromatin in testicular cancer and Hodgkin's lymphoma patients prior to chemotherapy, in comparison with control community and idiopathic infertile volunteers. METHODS DNA damage was assessed with the sperm chromatin structure assay (SCSA), terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and comet assays; reactive thiols (SH) and DNA compaction were determined with the monobromobimane (mBBr) and chromomycin A3 (CMA3) assays, respectively. RESULTS Both testicular cancer (37%) and Hodgkin's lymphoma (81%) patients had normospermic samples with increased DNA damage, compared with controls. Cancer patients also had higher reactive thiols and CMA3 staining, indicating low DNA compaction. CONCLUSIONS Sperm DNA integrity and compaction were affected in testicular cancer and Hodgkin's lymphoma patients prior to chemotherapy. Although SCSA, TUNEL and comet assays all detected DNA damage, the latter was optimal for use in cancer patients. A combination of the comet assay with tests that evaluate sperm DNA compaction, such as flow cytometry-based CMA3 and mBBr assays, is a reliable strategy to characterize sperm chromatin quality in cancer patients at the time of sperm banking.
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Affiliation(s)
- C O'Flaherty
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec, Canada
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22
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Gonadal failure after treatment of hematologic malignancies: from recognition to management for health-care providers. ACTA ACUST UNITED AC 2008; 5:78-89. [DOI: 10.1038/ncponc1016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 08/14/2007] [Indexed: 11/08/2022]
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Baumgartner A, Cemeli E, Anderson D. The comet assay in male reproductive toxicology. Cell Biol Toxicol 2007; 25:81-98. [PMID: 17972149 DOI: 10.1007/s10565-007-9041-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 10/03/2007] [Indexed: 01/23/2023]
Abstract
Due to our lifestyle and the environment we live in, we are constantly confronted with genotoxic or potentially genotoxic compounds. These toxins can cause DNA damage to our cells, leading to an increase in mutations. Sometimes such mutations could give rise to cancer in somatic cells. However, when germ cells are affected, then the damage could also have an effect on the next and successive generations. A rapid, sensitive and reliable method to detect DNA damage and assess the integrity of the genome within single cells is that of the comet or single-cell gel electrophoresis assay. The present communication gives an overview of the use of the comet assay utilising sperm or testicular cells in reproductive toxicology. This includes consideration of damage assessed by protocol modification, cryopreservation vs the use of fresh sperm, viability and statistics. It further focuses on in vivo and in vitro comet assay studies with sperm and a comparison of this assay with other assays measuring germ cell genotoxicity. As most of the de novo structural aberrations occur in sperm and spermatogenesis is functional from puberty to old age, whereas female germ cells are more complicated to obtain, the examination of male germ cells seems to be an easier and logical choice for research and testing in reproductive toxicology. In addition, the importance of such an assay for the paternal impact of genetic damage in offspring is undisputed. As there is a growing interest in the evaluation of genotoxins in male germ cells, the comet assay allows in vitro and in vivo assessments of various environmental and lifestyle genotoxins to be reliably determined.
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Affiliation(s)
- A Baumgartner
- Division of Biomedical Sciences, University of Bradford, Richmond Road, Bradford, West Yorkshire BD7 1DP, UK
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Cocuzza M, Sikka SC, Athayde KS, Agarwal A. Clinical relevance of oxidative stress and sperm chromatin damage in male infertility: an evidence based analysis. Int Braz J Urol 2007; 33:603-21. [DOI: 10.1590/s1677-55382007000500002] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2007] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Suresh C. Sikka
- Reproductive Research Center; Glickman Urological and Kidney Institute; Cleveland Clinic; Tulane University Health Sciences Center, USA
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Edelstein A, Yavetz H, Kleiman SE, Botchan A, Hauser R, Paz G, Yogev L. Deoxyribonucleic acid-damaged sperm in cryopreserved-thawed specimens from cancer patients and healthy men. Fertil Steril 2007; 90:205-8. [PMID: 17658528 DOI: 10.1016/j.fertnstert.2007.05.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 05/29/2007] [Accepted: 05/29/2007] [Indexed: 11/21/2022]
Abstract
A similarity was found between the percentage of thawed, DNA-damaged spermatozoa in cancer patients and that in candidates to become sperm bank donors who had low sperm cryofreezability. Both groups were significantly different from the sperm bank donor group. It is suggested that the higher rate of DNA fragmentation in sperm from cancer patients compared with sperm bank donors is apparently a result of selecting donors by the level of sperm cryofreezability (i.e., high), rather than a direct effect of an existing malignancy.
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Affiliation(s)
- Avital Edelstein
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Gandini L, Sgrò P, Lombardo F, Paoli D, Culasso F, Toselli L, Tsamatropoulos P, Lenzi A. Effect of chemo- or radiotherapy on sperm parameters of testicular cancer patients. Hum Reprod 2006; 21:2882-9. [PMID: 16997940 DOI: 10.1093/humrep/del167] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aims of our study were to investigate the short- and long-term effects of chemo- or radiotherapy on spermatogenesis in patients with testicular cancer and to establish any correlation between pre-therapy sperm parameters, histotype and treatment type/intensity and the progress of spermatogenesis during the post-therapy period. METHODS We evaluated 166 patients affected by testicular cancer, who cryobanked about 1 month after the removal of the cancerous testis and before beginning chemo- (CH group; n = 71) or radiotherapy (RT group; n = 95). RESULTS For the CH group, there was a statistically significant decrease in sperm parameters, which was most significant 3 months after the end of chemotherapy. For the RT group, this decrease was most relevant 6 months after the end of radiotherapy. Two years after therapy, 3% of the CH group and 6% of the RT group remained azoospermic. To evaluate whether spermatogenesis recovery is a function of baseline semen quality, we divided each group into two subgroups by pre-therapy total sperm count (A, <40 x 10(6)/ejaculate; B, >or=40 x 10(6)/ejaculate). At t(24), subgroup A of both the CH and RT groups showed improved sperm parameters over the baseline, whereas subgroup B for both CH and RT groups showed a return of sperm parameters to those of baseline values. CONCLUSIONS In conclusion, the recovery of spermatogenesis after chemo- or radiotherapy in our group of testicular cancer patients was not a function of pre-therapy sperm parameter quality. Cryopreservation of sperm before performing such therapy is therefore imperative.
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Affiliation(s)
- Loredana Gandini
- Laboratory of Seminology and Immunology of Human Reproduction, Department of Medical Pathophysiology, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
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Ståhl O, Eberhard J, Jepson K, Spano M, Cwikiel M, Cavallin-Ståhl E, Giwercman A. Sperm DNA integrity in testicular cancer patients. Hum Reprod 2006; 21:3199-205. [PMID: 16931803 DOI: 10.1093/humrep/del292] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We evaluated the impact of testicular germ cell cancer (TGCC), its treatment and length of follow-up on sperm DNA integrity. METHODS In 96 TGCC patients, semen was collected at specific intervals until 5 years after treatment. Sperm DNA integrity was assessed by the sperm chromatin structure assay (SCSA, n = 193) and by the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL, n = 159) assay. Results were expressed as DNA fragmentation index (DFI). Controls comprised of 278 military conscripts. RESULTS Post-surgery testicular cancer (TC) patients did not differ from controls. Compared with pretreatment values, radiotherapy induced a transient increase in SCSA(DFI) (medians: 12 versus 19%; P = 0.03), normalizing after 3-5 years. One year or more after therapy, 5/13 (38%) of normozoospermic, irradiated patients had SCSA(DFI) >27% compared with 7% of normozoospermic controls (P = 0.002). More than two cycles of chemotherapy decreased DFI 3-5 years post-therapy (median SCSA(DFI): 12 versus 9.1%, P = 0.02; median TUNEL(DFI): 11 versus 7.5%, P = 0.03). CONCLUSION Irradiation increases sperm DNA damage 1-2 years after treatment, and 38% of irradiated patients with normozoospermia had high (>27%) DNA damage, which may affect the sperm-fertilizing ability. TC per se is not associated with an increase of DFI, and DFI is reduced by three or more cycles of chemotherapy.
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Affiliation(s)
- O Ståhl
- Department of Oncology, Lund University Hospital, Lund, Sweden.
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Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K, Beck LN, Brennan LV, Oktay K. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 2006; 24:2917-31. [PMID: 16651642 DOI: 10.1200/jco.2006.06.5888] [Citation(s) in RCA: 1307] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer. METHODS An expert panel and a writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature from 1987 to 2005 was performed, and included a search of online databases and consultation with content experts. RESULTS The literature review found many cohort studies, case series, and case reports, but relatively few randomized or definitive trials examining the success and impact of fertility preservation methods in people with cancer. Fertility preservation methods are used infrequently in people with cancer. RECOMMENDATIONS As part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists. Clinician judgment should be employed in the timing of raising this issue, but discussion at the earliest possible opportunity is encouraged. Sperm and embryo cryopreservation are considered standard practice and are widely available; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise. CONCLUSION Fertility preservation is often possible in people undergoing treatment for cancer. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during treatment planning.
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Spermon JR, Ramos L, Wetzels AMM, Sweep CGJ, Braat DDM, Kiemeney LALM, Witjes JA. Sperm integrity pre- and post-chemotherapy in men with testicular germ cell cancer. Hum Reprod 2006; 21:1781-6. [PMID: 16601009 DOI: 10.1093/humrep/del084] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While (partial) recovery of spermatogenesis, observed by means of standard semen analysis, has been seen in testicular cancer patients after chemotherapy with cisplatin, sperm genomic integrity and its implication for the patient's fertility are poorly understood. METHODS Semen and serum from 22 patients treated for testicular cancer were analysed pre- and post-chemotherapy. Besides routine semen analysis, sperm samples were evaluated by computerized karyometric image analysis (CKIA), chromomycin-A3 assay (CMA3, chromatin condensation) and TdT-mediated dUTP nick-end labelling assay (TUNEL, DNA damage). Serum FSH, LH and testosterone concentrations were measured. RESULTS Ejaculate volume decreased post-chemotherapy (P<0.05). External sperm characteristics (CKIA morphometry) and sperm counts did not deteriorate after chemotherapy. An improvement in DNA condensation was assessed after chemotherapy (37 versus 50% and 47.5 versus 63.7% for CMA3 and CKIA respectively; both P<0.005); yet a high percentage of TUNEL-positive sperm was found in the samples (21 versus 25% for pre- and post-chemotherapy samples respectively). These values were significantly higher than those of a convenience sample of normozoospermic males attending pre-IVF screening. Serum FSH and LH (IU/l) increased after chemotherapy compared with pretreatment levels (8.1 versus 16.7 and 4.5 vs 6.8; both P<0.05, respectively). CONCLUSIONS Despite the improvement in sperm chromatin packaging after chemotherapy, an abnormally high percentage of DNA-damaged sperm was found in these samples. As sperm quality does not reach normal levels after treatment, it remains difficult to outline the best strategy and guidance concerning fertility potential of testicular cancer patients.
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Affiliation(s)
- J R Spermon
- Department of Urology, Radboud University Nijmegen Medical Centre, The Netherlands.
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