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Persaud Y, Leonard A, Rai P. Current and emerging drug treatment strategies to tackle sickle cell anemia. Expert Opin Emerg Drugs 2024:1-20. [PMID: 38988318 DOI: 10.1080/14728214.2024.2379260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/09/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Since its discovery in the early 1900s, sickle cell disease (SCD) has contributed significantly to the scientific understanding of hemoglobin and hemoglobinopathies. Despite this, now almost a century later, optimal medical management and even curative options remain limited. Encouragingly, in the last decade, there has been a push toward advancing the care for individuals with SCD and a diversifying interest in options to manage this disorder. AREAS COVERED Here, we review the current state of disease modifying therapies for SCD including fetal hemoglobin inducers, monoclonal antibodies, anti-inflammatory modulators, and enzyme activators. We also discuss current curative strategies with specific interest in transformative gene therapies. EXPERT OPINION SCD is a chronic, progressive disease that despite a century of clinical description, only now is seeing a growth and advance in therapeutic options to improve the lifespan and quality of life for individuals with SCD. We anticipate newly designed and even repurposed therapies that may work as a single agent or combination agents to tackle the progression of SCD. The vast majority of individuals living with SCD are unlikely to receive gene therapy, therefore improved disease management is critical even for those that may ultimately chose to pursue a potentially curative strategy.
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Affiliation(s)
- Yogindra Persaud
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alexis Leonard
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Parul Rai
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
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2
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Cilio S, Fallara G, Lupo Stanghellini MT, Ciceri F, Montorsi F, Lunghi F, Salonia A. Impact of Hydroxyurea to Treat Haematological Disorders on Male Fertility: Two Case Reports and a Systematic Review. World J Mens Health 2024; 42:531-542. [PMID: 38164027 PMCID: PMC11216956 DOI: 10.5534/wjmh.230069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE Hydroxyurea (HU) is a cytoreductive agent used as standard treatment option for sickle cell anaemia/disease (SCD), essential thrombocythemia (ET), and polycythaemia vera (PV). Despite its overall good safety profile, its use also in relatively young patients raises an interest on its potential impact on spermatogenesis. To perform a systematic review of all published articles investigating fertility in male patients affected by SCD, ET, and PV and treated with HU. Two paradigmatic case reports of patients affected by PV and ET, respectively, have been also reported. MATERIALS AND METHODS PubMed, EMBASE, and Cochrane databases were queried for all the published studies indexed up to November 15th, 2022. A combination of the following keywords was used: "hydroxyurea," "fertility," "male," "sperm," "sickle cell anaemia," "sickle cell disease," "essential thrombocythemia," "polycythaemia vera." RESULTS Of 48 articles identified, 8 studies, involving 161 patients, were eligible for inclusion. Overall, the number of spermatogonia per round cross section of seminiferous tubule were decreased in patients with SCD compared to healthy males. HU treatment was always associated with a worsening of semen parameters, even up to azoospermia. Notably, treatment discontinuation was associated with an improvement of semen parameters and a trend toward normalization in the case of PV and ET, with a less clear amelioration in men with SCD. In both our patients with either PV or ET, HU discontinuation was associated with a significant improvement of spermatogenesis with successful spontaneous pregnancies. CONCLUSIONS Published evidence do not consistently report normalization of spermatogenesis after HU discontinuation in SCD cases. Conversely, the literature almost consistently reported an improvement of semen parameters at the discontinuation of HU therapy in PV and ET cases. Our real-life two cases confirmed those findings. The willing of fatherhood and the need for effective fertility treatment warrant further research to improve work-up management in men with hematological disorders.
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Affiliation(s)
- Simone Cilio
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy.
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Palandri F, Branzanti F, Venturi M, Dedola A, Fontana G, Loffredo M, Patuelli A, Ottaviani E, Bersani M, Reta M, Addimanda O, Vicennati V, Vianelli N, Cavo M. Real-life use of ropeg-interferon α2b in polycythemia vera: patient selection and clinical outcomes. Ann Hematol 2024; 103:2347-2354. [PMID: 38771499 PMCID: PMC11224071 DOI: 10.1007/s00277-024-05809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
Ropeginterferon-alfa2b (ropegIFNα2b) is a long-acting IFN formulation with broad FDA/EMA approval as a therapy of polycythemia vera (PV) with no symptomatic splenomegaly. There is currently lack of information on the real-world patient selection, including the impact of local reimbursement policies, and drug management, particularly: type/timing of screening and follow-up tests; absolute/relative contraindications to therapy; ropegIFNα2b dose and combinations with hydroxyurea. As a sub-analysis of the PV-ARC retrospective study (NCT06134102), we here report our monocenter experience with ropegIFNα2b in the period from January 2021, corresponding to drug availability outside clinical trial, and December 2023. Among the 149 patients with EMA/FDA indication, only 55 (36.9%) met the local reimbursement criteria and 18 (12.1%) received ropegIFNα2b. Thanks to appropriate screening, relative/absolute contraindications to ropegIFNα2b were detected and managed in a multidisciplinary manner. Efficacy and safety of ropegIFNα2b was confirmed, with 3 cases of early molecular response. General use of low ropegIFNα2b dose, with frequent need for hydroxyurea combinations, was noted. This real-world experience suggests a significant impact of local regulations on drug prescription and the need for greater real-world data collection on ropegIFNα2b in PV patients. Also, it describes appropriate multidisciplinary screening and monitoring procedures during ropegIFNα2b therapy.
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Affiliation(s)
- Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.
| | - F Branzanti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy
| | - M Venturi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy
| | - A Dedola
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy
| | - G Fontana
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy
| | - M Loffredo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy
| | - A Patuelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy
| | - E Ottaviani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - M Bersani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - M Reta
- UO Interaziendale Medicina Interna ad Indirizzo Reumatologico AUSL BO-IRCCS AOUBO, Bologna, Italy
| | - O Addimanda
- UO Interaziendale Medicina Interna ad Indirizzo Reumatologico AUSL BO-IRCCS AOUBO, Bologna, Italy
| | - V Vicennati
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - N Vianelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - M Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy
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Sewaralthahab S, Alsubki LA, Alhrabi MS, Alsultan A. Effects of hydroxyurea on fertility in male and female sickle cell disease patients. A systemic review and meta-analysis. PLoS One 2024; 19:e0304241. [PMID: 38848387 PMCID: PMC11161076 DOI: 10.1371/journal.pone.0304241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Evidence supports the benefits of hydroxyurea (HU) in adults with sickle cell disease (SCD), but reservations remain due to long-term concerns of fertility. Retrospective analysis of clinical records of SCD patients (haemoglobin SS genotype) have identified gender-related differences in disease progression. This could inform risk stratification during SCD at diagnosis with the possibility to guide therapeutic decisions. METHODS This systemic review and meta-analysis evaluated fertility parameters in both children (aged ≥ 6 years) and adults with SCD receiving HU therapy. Studies were sourced from PubMed and EMBASE from inception to July 2023. A total of 160 potentially relevant articles were identified. RESULTS Four studies were included that evaluated the effects of HU on sperm parameters in males. A further 4 studies assessed anti-mullerian hormone (AMH) levels and ovarian reserves in females. Differences from baseline values were used to identify compromised fertility. Amongst males, HU treatment negatively impacted the concentration of spermatozoa (MD = -15.48 million/mL; 95% CI: [-20.69, -10.26]; p< 0.001), which continued following treatment cessation (MD = -20.09 million/mL; 95% CI: [-38.78, -1.40]; P = 0.04). HU treatment also led to lower total sperm counts (MD = -105.87 million; 95% CI: [-140.61, -71.13]; P< 0.001) which persisted after treatment (MD = -53.05 million; 95% CI: [-104.96, -1.14]; P = 0.05). Sperm volume, initial forward motility and morphology were unaffected by HU treatment. In females, HU treatment decreased the mean AMH levels 1.83 (95% CI [1.42, 2.56]. A total of 18.2.% patients treated with HU showed reduced ovarian reserves. INTERPRETATION & CONCLUSIONS This systemic review and meta-analysis suggest that the use of HU for SCD impacts seminal fluid parameters in males and can diminish AMH levels and ovarian reserves in females.
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Affiliation(s)
- Sarah Sewaralthahab
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Oncology Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Lujain A. Alsubki
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Maram S. Alhrabi
- Oncology Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Alsultan
- Oncology Center, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Elsabagh AA, Benkhadra M, Elmakaty I, Elsayed A, Elsayed B, Elmarasi M, Abutineh M, Qasem NM, Ali E, Yassin M. Male Fertility and Fatherhood in Chronic Myeloid Leukemia: Current Understanding and Future Perspectives. Cancers (Basel) 2024; 16:791. [PMID: 38398181 PMCID: PMC10886940 DOI: 10.3390/cancers16040791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 02/25/2024] Open
Abstract
Chronic myeloid leukemia (CML), while traditionally a disease of the elderly, has recently risen in incidence among younger patients. Hence, fertility concerns have emerged considering the disease process and treatments, especially with the current scarce and conflicting recommendations. This review explores the impact of CML treatments including the first-line tyrosine kinase inhibitors (TKIs) and other treatments on male fertility in chronic myeloid leukemia (CML) patients. The aim of this review was to compile the available evidence on male fertility to ultimately tailor treatment plans for male CML patients for whom fertility and future chances for conception pose a concern. The data available on the conventional and newer TKIs to address fertility concerns were reviewed, particularly the potential long- and short-term effects. Also, the possible side effects on subsequent generations were a crucial focus point of this review to reach a more comprehensive CML management approach. We found and compared the evidence on TKIs approved to treat CML. We also reported the effects of hydroxyurea, interferon, and transplantation, which are considered second-line treatments. Our findings suggest that these drugs might have an undiscovered effect on fertility. More research with larger sample sizes and longer follow-up periods is essential to solidify our understanding of these effects.
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Affiliation(s)
- Ahmed Adel Elsabagh
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar; (I.E.); (B.E.); (M.E.)
| | - Maria Benkhadra
- National Center for Cancer Care & Research, Hamad General Hospital, Doha P.O. Box 3050, Qatar;
| | - Ibrahim Elmakaty
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar; (I.E.); (B.E.); (M.E.)
| | - Abdelrahman Elsayed
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar; (I.E.); (B.E.); (M.E.)
| | - Basant Elsayed
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar; (I.E.); (B.E.); (M.E.)
| | - Mohamed Elmarasi
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar; (I.E.); (B.E.); (M.E.)
| | - Mohammad Abutineh
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha P.O. Box 3050, Qatar (N.M.Q.)
| | - Nabeel Mohammad Qasem
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha P.O. Box 3050, Qatar (N.M.Q.)
| | - Elrazi Ali
- One Brooklyn Health, Interfaith Medical Center, Brooklyn, NY 11213, USA;
| | - Mohamed Yassin
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha P.O. Box 3050, Qatar (N.M.Q.)
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Virgous C, Lyons L, Sakwe A, Nayyar T, Goodwin S, Hildreth J, Osteen K, Bruner-Tran K, Alawode O, Bourne P, Hills ER, Archibong AE. Resumption of Spermatogenesis and Fertility Post Withdrawal of Hydroxyurea Treatment. Int J Mol Sci 2023; 24:ijms24119374. [PMID: 37298325 DOI: 10.3390/ijms24119374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/11/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Hydroxyurea (HU), a drug for treating cancers of the blood and the management of sickle cell anemia, induces hypogonadism in males. However, the impact of HU on testicular architecture and function, as well as its effects on the resumption of male fertility following treatment withdrawal, remain poorly understood. We used adult male mice to determine whether HU-induced hypogonadism is reversible. Fertility indices of mice treated with HU daily for ~1 sperm cycle (2 months) were compared with those of their control counterparts. All indices of fertility were significantly reduced among mice treated with HU compared to controls. Interestingly, significant improvements in fertility indices were apparent after a 4-month withdrawal from HU treatment (testis weight: month 1 post-HU withdrawal (M1): HU, 0.09 ± 0.01 vs. control, 0.33 ± 0.03; M4: HU, 0.26 ± 0.03 vs. control, 0.37 ± 0.04 g); sperm motility (M1: HU,12 vs. 59; M4: HU, 45 vs. control, 61%; sperm density (M1: HU, 1.3 ± 0.3 vs. control, 15.7 ± 0.9; M4: HU, 8.1 ± 2.5 vs. control, 16.8 ± 1.9 million). Further, circulating testosterone increased in the 4th month following HU withdrawal and was comparable to that of controls. When a mating experiment was conducted, recovering males sired viable offspring with untreated females albeit at a lower rate than control males (p < 0.05); therefore, qualifying HU as a potential candidate for male contraception.
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Affiliation(s)
- Carlos Virgous
- Animal Care Facility, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37209, USA
| | - Letitia Lyons
- Department of Obstetrics and Gynecology, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37208, USA
| | - Amos Sakwe
- Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37208, USA
| | - Tultul Nayyar
- Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37208, USA
| | - Shawn Goodwin
- Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37208, USA
| | - James Hildreth
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37208, USA
| | - Kevin Osteen
- Women's Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Kaylon Bruner-Tran
- Women's Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Oluwatobi Alawode
- Department of Obstetrics and Gynecology, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37208, USA
| | - Phillip Bourne
- Department of Obstetrics and Gynecology, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37208, USA
| | - Edward Richard Hills
- Department of Obstetrics and Gynecology, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37208, USA
| | - Anthony E Archibong
- Department of Obstetrics and Gynecology, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37208, USA
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, 1005 D.B. Todd Blvd, Nashville, TN 37208, USA
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Masliukaite I, Ntemou E, Feijen EAM, van de Wetering M, Meissner A, Soufan AT, Repping S, Kremer LMC, Jahnukainen K, Goossens E, van Pelt AMM. Childhood cancer and hematological disorders negatively affect spermatogonial quantity at diagnosis: a retrospective study of a male fertility preservation cohort. Hum Reprod 2023; 38:359-370. [PMID: 36708005 PMCID: PMC9977127 DOI: 10.1093/humrep/dead004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/20/2022] [Indexed: 01/29/2023] Open
Abstract
STUDY QUESTION What is the impact of cancer or hematological disorders on germ cells in pediatric male patients? SUMMARY ANSWER Spermatogonial quantity is reduced in testes of prepubertal boys diagnosed with cancer or severe hematological disorder compared to healthy controls and this reduction is disease and age dependent: patients with central nervous system cancer (CNS tumors) and hematological disorders, as well as boys <7 years are the most affected. WHAT IS KNOWN ALREADY Fertility preservation in pediatric male patients is considered based on the gonadotoxicity of selected treatments. Although treatment effects on germ cells have been extensively investigated, limited data are available on the effect of the disease on the prepubertal male gonad. Of the few studies investigating the effects of cancer or hematologic disorders on testicular function and germ cell quantity in prepuberty, the results are inconsistent. However, recent studies suggested impairments before the initiation of known gonadotoxic therapy. Understanding which diseases and at what age affect the germ cell pool in pediatric patients before treatment is critical to optimize strategies and counseling for fertility preservation. STUDY DESIGN, SIZE, DURATION This multicenter retrospective cohort study included 101 boys aged <14 years with extra-cerebral cancer (solid tumors), CNS tumors, leukemia/lymphoma (blood cancer), or non-malignant hematological disorders, who were admitted for a fertility preservation programme between 2002 and 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS In addition to clinical data, we analyzed measurements of testicular volume and performed histological staining on testicular biopsies obtained before treatment, at cryopreservation, to evaluate number of spermatogonia per tubular cross-section, tubular fertility index, and the most advanced germ cell type prior to chemo-/radiotherapy. The controls were data simulations with summary statistics from original studies reporting healthy prepubertal boys' testes characteristics. MAIN RESULTS AND THE ROLE OF CHANCE Prepubertal patients with childhood cancer or hematological disorders were more likely to have significantly reduced spermatogonial quantity compared to healthy controls (48.5% versus 31.0% prevalence, respectively). The prevalence of patients with reduced spermatogonial quantity was highest in the CNS tumor (56.7%) and the hematological disorder (55.6%) groups, including patients with hydroxyurea pre-treated sickle cell disease (58.3%) and patients not exposed to hydroxyurea (50%). Disease also adversely impacted spermatogonial distribution and differentiation. Irrespective of disease, we observed the highest spermatogonial quantity reduction in patients <7 years of age. LIMITATIONS, REASONS FOR CAUTION For ethical reasons, we could not collect spermatogonial quantity data in healthy prepubertal boys as controls and thus deployed statistical simulation on data from literature. Also, our results should be interpreted considering low patient numbers per (sub)group. WIDER IMPLICATIONS OF THE FINDINGS Cancers, especially CNS tumors, and severe hematological disorders can affect spermatogonial quantity in prepubertal boys before treatment. Consequently, these patients may have a higher risk of depleted spermatogonia following therapies, resulting in persistent infertility. Therefore, patient counseling prior to disease treatment and timing of fertility preservation should not only be based on treatment regimes, but also on diagnoses and age. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by Marie Curie Initial Training Network (ITN) (EU-FP7-PEOPLE-2013-ITN) funded by European Commision grant no. 603568; ZonMW Translational Adult stem cell research (TAS) grant no. 116003002. No competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Ieva Masliukaite
- Reproductive Biology Laboratory, Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Elissavet Ntemou
- Biology of the Testis Lab, Department of Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | | | - Andreas Meissner
- Reproductive Biology Laboratory, Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alexandre T Soufan
- Reproductive Biology Laboratory, Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sjoerd Repping
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- The National Health Care Institute, Diemen, The Netherlands
| | - Leontien M C Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Kirsi Jahnukainen
- NORDFERTIL Research Lab Stockholm, Department of Women’s and Children’s Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- New Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ellen Goossens
- Biology of the Testis Lab, Department of Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ans M M van Pelt
- Reproductive Biology Laboratory, Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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8
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Hui EX, Huang X, Oon HH. Review of Dermatologic Medications and Impact on Male Fertility, Sexual Dysfunction and Teratogenicity. Andrology 2022; 10:1272-1285. [PMID: 35876714 DOI: 10.1111/andr.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/04/2022] [Accepted: 07/17/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dermatologic medications have been linked to issues with safety during pregnancy and lactation. Despite this, limited research, often with conflicting findings, has been published on the association between dermatologic medications, male infertility, sexual dysfunction, and teratogenicity following paternal exposure. OBJECTIVE This review seeks to provide evidence-based guidance for physicians who are prescribing dermatologic medications to male patients who are trying to conceive. METHODS Common medications used in the largest outpatient specialist dermatologic centre in Singapore were the focus of this review. A PubMed search using MeSH terms from inception to April 22, 2021, was conducted. A secondary search was conducted to include common non-dermatologic medications. Drug information from various online clinical resources and the Tenth Edition of Drugs in Pregnancy and Lactation were also used as a reference. RESULTS In this review of 234 studies, 131 medications were covered. A total of 34 medications were associated with male infertility and sexual dysfunction, while 16 medications were implicated with concerns of teratogenicity. DISCUSSION AND CONCLUSION Physicians are advised to discuss the potential impact on male fertility and teratogenicity with males who are trying to conceive, while taking into consideration the clinical efficacy and tolerability of these medications and alternative treatments. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Edward Xw Hui
- National Skin Centre, 1 Mandalay Rd, Singapore, 308205, Singapore
| | - Xiaoling Huang
- National Skin Centre, 1 Mandalay Rd, Singapore, 308205, Singapore
| | - Hazel H Oon
- National Skin Centre, 1 Mandalay Rd, Singapore, 308205, Singapore
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Ali EA, Abu-Tineh M, Rozi W, Ali B, Babiker A, Hailan Y, Al-Maharmeh Q, Maat Z, Ismail A, Yassin MA. The Outcome of Fatherhood in Patients With Philadelphia-Negative Myeloproliferative Neoplasms: A Single-Institution Experience. Cureus 2022; 14:e25953. [PMID: 35855233 PMCID: PMC9286008 DOI: 10.7759/cureus.25953] [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] [Accepted: 06/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Fertility is a highly complex subject; it involves more than one individual and has profound psychological and economic implications. Moreover, it is affected by several factors, including age, significant systemic illness in either partner, exposure to environmental toxins, medications, or radiation. In patients with malignancy, fertility is more complicated. Patients with a malignancy might have reduced fertility due to the disease, medication, and radiation. Besides the reduced fertility, there are more concerns regarding the subsequent effect of cancer treatment on their offspring and the possibility of having healthy children. There were many studies regarding fertility in patients with cancer; however, in male patients with Philadelphia-negative myeloproliferative neoplasms (MPNs), there are very limited data. Objectives In this study, we aim to see the outcome of fatherhood in male patients with Philadelphia-negative myeloproliferative neoplasms (MPNs), polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) whether on treatment or not. Methods A retrospective mixed-design study of male patients with Philadelphia-negative MPN was followed up in our institute (National Center for Cancer Care and Research (NCCCR)), Doha, Qatar, between January 1, 2008, and January 1, 2020. Patients were interviewed regarding fertility-related information. All included patients had a confirmed diagnosis of Philadelphia-negative MPN according to World Health Organization (WHO) 2008 or WHO 2016 criteria for MPN, aged more than 18 years old. Results A total of 124 male patients were interviewed, and only 20 patients met the inclusion criteria. The majority of the patients were lost to follow-up or could not be contacted, and 28.8% of the excluded patients had their families completed by the time of diagnosis. The treatment received included hydroxycarbamide (n=8), pegylated interferon 2 alpha (n=10), ruxolitinib (n=1), and phlebotomy (n=1). The mean duration of exposure to treatment before pregnancy was 4.7 years. The mode of delivery was normal vaginal delivery in 71.4% of the pregnancies. The total number of offspring was 30, and the total number of conceptions was 30. Conclusion Our data showed that most Philadelphia-negative MPN male patients on treatment had their offspring born normally with no serious complications, congenital anomalies, or reports of MPN-related cancers. Patients’ concerns regarding fertility should be addressed well to ensure a better quality of life.
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Nickel RS, Maher JY, Hsieh MH, Davis MF, Hsieh MM, Pecker LH. Fertility after Curative Therapy for Sickle Cell Disease: A Comprehensive Review to Guide Care. J Clin Med 2022; 11:2318. [PMID: 35566443 PMCID: PMC9105328 DOI: 10.3390/jcm11092318] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 12/30/2022] Open
Abstract
Curative therapy for sickle cell disease (SCD) currently requires gonadotoxic conditioning that can impair future fertility. Fertility outcomes after curative therapy are likely affected by pre-transplant ovarian reserve or semen analysis parameters that may already be abnormal from SCD-related damage or hydroxyurea treatment. Outcomes are also likely affected by the conditioning regimen. Conditioning with myeloablative busulfan and cyclophosphamide causes serious gonadotoxicity particularly among post-pubertal females. Reduced-intensity and non-myeloablative conditioning may be acutely less gonadotoxic, but more short and long-term fertility outcome data after these approaches is needed. Fertility preservation including oocyte/embryo, ovarian tissue, sperm, and experimental testicular tissue cryopreservation should be offered to patients with SCD pursing curative therapy. Regardless of HSCT outcome, longitudinal post-HSCT fertility care is required.
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Affiliation(s)
- Robert Sheppard Nickel
- Children’s National Hospital, Division of Hematology, Washington, DC 20001, USA;
- Children’s National Hospital, Division of Blood and Marrow Transplantation, Washington, DC 20001, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, DC 20001, USA;
| | - Jacqueline Y. Maher
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Pediatric and Adolescent Gynecology, National Institutes of Health, Bethesda, MD 20810, USA;
- Children’s National Hospital, Pediatric and Adolescent Gynecology Program, Washington, DC 20001, USA
| | - Michael H. Hsieh
- School of Medicine and Health Sciences, The George Washington University, Washington, DC 20001, USA;
- Children’s National Hospital, Division of Urology, Washington, DC 20001, USA
| | - Meghan F. Davis
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC 20001, USA;
| | - Matthew M. Hsieh
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20810, USA;
| | - Lydia H. Pecker
- Division of Hematology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 20810, USA
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11
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Li Z, Wang S, Gong C, Hu Y, Liu J, Wang W, Chen Y, Liao Q, He B, Huang Y, Luo Q, Zhao Y, Xiao Y. Effects of Environmental and Pathological Hypoxia on Male Fertility. Front Cell Dev Biol 2021; 9:725933. [PMID: 34589489 PMCID: PMC8473802 DOI: 10.3389/fcell.2021.725933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/23/2021] [Indexed: 12/28/2022] Open
Abstract
Male infertility is a widespread health problem affecting approximately 6%-8% of the male population, and hypoxia may be a causative factor. In mammals, two types of hypoxia are known, including environmental and pathological hypoxia. Studies looking at the effects of hypoxia on male infertility have linked both types of hypoxia to poor sperm quality and pregnancy outcomes. Hypoxia damages testicular seminiferous tubule directly, leading to the disorder of seminiferous epithelium and shedding of spermatogenic cells. Hypoxia can also disrupt the balance between oxidative phosphorylation and glycolysis of spermatogenic cells, resulting in impaired self-renewal and differentiation of spermatogonia, and failure of meiosis. In addition, hypoxia disrupts the secretion of reproductive hormones, causing spermatogenic arrest and erectile dysfunction. The possible mechanisms involved in hypoxia on male reproductive toxicity mainly include excessive ROS mediated oxidative stress, HIF-1α mediated germ cell apoptosis and proliferation inhibition, systematic inflammation and epigenetic changes. In this review, we discuss the correlations between hypoxia and male infertility based on epidemiological, clinical and animal studies and enumerate the hypoxic factors causing male infertility in detail. Demonstration of the causal association between hypoxia and male infertility will provide more options for the treatment of male infertility.
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Affiliation(s)
- Zhibin Li
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.,Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Sumin Wang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Chunli Gong
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yiyang Hu
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jiao Liu
- Department of Endoscope, The General Hospital of Shenyang Military Region, Liaoning, China
| | - Wei Wang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yang Chen
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qiushi Liao
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Bing He
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.,Department of Laboratory Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Yu Huang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qiang Luo
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yongbing Zhao
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yufeng Xiao
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Soliman AT, Alaaraj N, Yassin M. The Effects of Treatment with Blood Transfusion, Iron Chelation and Hydroxyurea on Puberty, Growth and Spermatogenesis in Sickle Cell Disease (SCD): A short update. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021386. [PMID: 34487059 PMCID: PMC8477091 DOI: 10.23750/abm.v92i4.11917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022]
Abstract
Sickle cell disease (SCD) is traditionally associated with growth failure and delayed puberty. Wasting and stunting are still prevalent in children and adolescents with SCD, especially in developing countries. In addition, sperm abnormalities are frequent in males with SCD, with high rates of low sperm density, low sperm counts, poor motility, and increased abnormal morphology. Severe anaemia, vaso-occlusive attacks with ischemic injury to different organs including the pituitary gland and testis, and nutritional factors are incriminated in the pathogenesis of defective growth, puberty, and spermatogenesis. There is great phenotypic variability among patients with SCD. The variability in the clinical severity of SCD can partly be explained by genetic modifiers, including HbF level and co-inheritance of α-thalassaemia. In the past, severe disease led to early mortality. Advancements in treatment have allowed patients with SCD to have a longer and better quality of life. For most patients, the mainstays of treatment are preventive and supportive. For those with severe SCD, three major therapeutic options are currently available: erythrocyte transfusion or exchange, hydroxyurea and hematopoietic stem cell transplantation. In this mini review the authors tried to recognize, delineate, and update knowledge on abnormalities due to SCD from those created by the use of different treatment modalities. (www.actabiomedica.it)
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Affiliation(s)
- Ashraf T Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar; Department of Hematology and Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Weill Cornell Medicine- Qatar (WCMCQ).
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Mohamed Yassin
- Department of Hematology and Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
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Lai ZS, Yeh TK, Chou YC, Hsu T, Lu CT, Kung FC, Hsieh MY, Lin CH, Chen CT, James Shen CK, Jiaang WT. Potent and orally active purine-based fetal hemoglobin inducers for treating β-thalassemia and sickle cell disease. Eur J Med Chem 2021; 209:112938. [PMID: 33109398 DOI: 10.1016/j.ejmech.2020.112938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/23/2020] [Accepted: 10/10/2020] [Indexed: 11/25/2022]
Abstract
Reactivation of fetal hemoglobin (HbF) expression by therapeutic agents has been suggested as an alternative treatment to modulate anemia and the related symptoms of severe β-thalassemia and sickle cell disease (SCD). Hydroxyurea (HU) is the first US FDA-approved HbF inducer for treating SCD. However, approximately 25% of the patients with SCD do not respond to HU. A previous study identified TN1 (1) as a small-molecule HbF inducer. However, this study found that the poor potency and oral bioavailability of compound 1 limits the development of this inducer for clinical use. To develop drug-like compounds, further structure-activity relationship studies on the purine-based structure of 1 were conducted. Herein, we report our discovery of a more potent inducer, compound 13a, that can efficiently induce γ-globin gene expression at non-cytotoxic concentrations. The molecular mechanism of 13a, for the regulation HbF expression, was also investigated. In addition, we demonstrated that oral administration of 13a can ameliorate anemia and the related symptoms in SCD mice. The results of this study suggest that 13a can be further developed as a novel agent for treating hemoglobinopathies, such as β-thalassemia and SCD.
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Affiliation(s)
- Zheng-Sheng Lai
- Institute of Molecular Biology, Academia Sinica, Taipei, 11529, Taiwan, ROC; Institute of Molecular Medicine, College of Medicine, National Taiwan University, No.7.Chung San South Road, Taipei, 10002, Taiwan, ROC
| | - Teng-Kuang Yeh
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, No. 35, Keyan Rd., Zhunan Town, Miaoli Country, 35053, Taiwan, ROC
| | - Yu-Chi Chou
- Biomedical Translation Research Center (BioTReC), Academia Sinica, Taipei, 11529, Taiwan, ROC
| | - Tsu Hsu
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, No. 35, Keyan Rd., Zhunan Town, Miaoli Country, 35053, Taiwan, ROC
| | - Cheng-Tai Lu
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, No. 35, Keyan Rd., Zhunan Town, Miaoli Country, 35053, Taiwan, ROC
| | - Fang-Chun Kung
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, No. 35, Keyan Rd., Zhunan Town, Miaoli Country, 35053, Taiwan, ROC
| | - Ming-Yen Hsieh
- Institute of Biological Chemistry, Academia Sinica, Taipei, 11529, Taiwan, ROC
| | - Chun-Hung Lin
- Institute of Biological Chemistry, Academia Sinica, Taipei, 11529, Taiwan, ROC
| | - Chiung-Tong Chen
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, No. 35, Keyan Rd., Zhunan Town, Miaoli Country, 35053, Taiwan, ROC
| | - Che-Kun James Shen
- Institute of Molecular Biology, Academia Sinica, Taipei, 11529, Taiwan, ROC
| | - Weir-Torn Jiaang
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, No. 35, Keyan Rd., Zhunan Town, Miaoli Country, 35053, Taiwan, ROC.
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14
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Ajayi AF, Akhigbe RE. The physiology of male reproduction: Impact of drugs and their abuse on male fertility. Andrologia 2020; 52:e13672. [DOI: 10.1111/and.13672] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ayodeji Folorunsho Ajayi
- Department of Physiology College of Medicine Ladoke Akintola University of Technology Ogbomoso Nigeria
| | - Roland Eghoghosoa Akhigbe
- Department of Physiology College of Medicine Ladoke Akintola University of Technology Ogbomoso Nigeria
- Reproductive Biology and Toxicology Research Laboratories Oasis of Grace Hospital Osogbo Nigeria
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15
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Effect of N(Epsilon)-(carboxymethyl)lysine on Laboratory Parameters and Its Association with β S Haplotype in Children with Sickle Cell Anemia. DISEASE MARKERS 2019; 2019:1580485. [PMID: 31636731 PMCID: PMC6766128 DOI: 10.1155/2019/1580485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/17/2019] [Indexed: 11/17/2022]
Abstract
The present study aimed to investigate the association of Nε-carboxymethyllysine (CML) with laboratory parameters and βS haplotypes in pediatric sickle cell anemia (SCA) patients with or without hydroxyurea (HU) therapy. We included 55 children with SCA (SCAtotal), where 27 were on HU treatment (SCA-HU+) and 28 without HU treatment (SCA-HU−). Laboratory characteristics were determined using electronic methods while CML was measured using competitive ELISA. βS haplotypes were determined by RFLP-PCR. Significant increases in MCV and MCH and significant decreases in leukocytes, eosinophils, basophils, atypical lymphocytes, lymphocytes, and monocytes were found in SCA-HU+ compared to SCA-HU−. SCA-HU+ presented significant reduction in aspartate transaminase and lactate dehydrogenase and increase in creatinine levels compared to SCA-HU−. CML levels were significantly higher in both SCA-HU+ and SCA-HU− compared to the healthy control. In addition, a negative correlation was found between CML and alanine transaminase in SCA-HU+ and SCAtotal (p < 0.01). A significant association was found between CML levels and βS haplotypes. The results suggest that CML has a role to play in SCA complications, independent of HU therapy.
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16
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Tohamy HG, Gad El-Karim DR, El-Sayed YS. Attenuation potentials of royal jelly against hydroxyurea-induced infertility through inhibiting oxidation and release of pro-inflammatory cytokines in male rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:21524-21534. [PMID: 31127524 DOI: 10.1007/s11356-019-05521-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/17/2019] [Indexed: 05/26/2023]
Abstract
Hydroxyurea (HDU), a class of antineoplastic drugs, has a powerful efficacy in the treatment of several types of malignancies. However, it has multiple adverse effects including reduced fertility, especially in males. Thus, 60 male albino rats were used to investigate the chemoprotective potentials of royal jelly on HDU-induced testicular damage. Animals were gastro-gavaged with HDU (225 or 450 mg kg-1 bw day-1) before royal jelly (100 mg kg-1 bw day-1) for 60 days. Blood samples and testicles were collected, and spermatozoon was obtained. In a dose-dependent manner, the sperm count, motility and liveability, and testosterone, GSH, and catalase concentrations were decreased in HDU groups, whereas MDA, FSH, LH, IL-6, and IFN-γ expression levels were increased. Germinal epithelium degeneration, germ cell sloughing, reduction in the number of luminal spermatozoa, interstitial congestion, and severe leukocyte infiltration besides no glandular secretion in most of the acini were identified. However, royal jelly intake in HDU-treated rats successfully improved sperm quality, hormonal and antioxidant status, and reproductive organ histoarchitecture. Thus, it could be concluded that royal jelly is endowed with antioxidative and anti-inflammatory activities and could be, therefore, used as an adjuvant remedy to improve HDU-induced male subfertility.
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Affiliation(s)
- Hossam G Tohamy
- Department of Pathology, Faculty of Veterinary Medicine, Alexandria University, Alexandria, Egypt
| | - Dina R Gad El-Karim
- Department of Clinical Pathology, Faculty of Veterinary Medicine, Alexandria University, Alexandria, Egypt
| | - Yasser S El-Sayed
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Damanhour University, Damanhour, 22511, Egypt.
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17
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New changes in pregnancy and lactation labelling: Review of dermatologic drugs. Int J Womens Dermatol 2019; 5:216-226. [PMID: 31700976 PMCID: PMC6831768 DOI: 10.1016/j.ijwd.2019.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 12/24/2022] Open
Abstract
Background The U.S. Food and Drug Administration has published new pregnancy and lactation labelling rules that set standards on the presentation of information with regard to drug usage during pregnancy and breastfeeding, as well as the effects on fertility. These guidelines became effective June 30, 2015, and classified the risks of using prescription drugs during pregnancy in three detailed subsections: Pregnancy, Lactation, and Females and Males of Reproductive Potential. These sections describe the risks within a real-world context of caring for these patients. Objective In this study, we reclassified and categorized drugs and treatments commonly used in dermatology according to these new guidelines. Methods We performed a search of the medical literature about the use of relevant prescription drugs during pregnancy and breastfeeding and their effect on fertility. The search included prospective and retrospective studies, review articles from PubMed-indexed journals (from inception to November 2018), U.S. Food and Drug Administration records, pregnancy exposure registries, relevant information and studies provided in drug labeling by companies, and updated pharmacologic texts and guidelines up to 2018. Results Topical immunomodulators, systemic immunomodulators (including biologics), systemic antipruritic agents, antimicrobials, as well as acne, hair, and cosmetic agents were included. We have made best attempts to review and consolidate existing and new data and include them in our guide. Conclusion This new narrative format facilitates prescribing by considering a variety of factors. One previously overlooked aspect was the impact on the reproductive potential of both male and female patients. Rather than depending on overly simplistic letter risk categories, dermatologists will now need to make prescribing decisions based on each patient and the information provided, which will allow for better decision making and patient care.
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Adverse effect of hydroxyurea on spermatogenesis in patients with sickle cell anemia after 6 months of treatment. Blood 2017; 130:2354-2356. [DOI: 10.1182/blood-2017-03-771857] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Huang AW, Muneyyirci-Delale O. Reproductive endocrine issues in men with sickle cell anemia. Andrology 2017; 5:679-690. [DOI: 10.1111/andr.12370] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 03/19/2017] [Accepted: 03/22/2017] [Indexed: 02/03/2023]
Affiliation(s)
- A. W. Huang
- Obstetrics and Gynecology; Rutgers New Jersey Medical School; Newark NY USA
| | - O. Muneyyirci-Delale
- Obstetrics and Gynecology; State University of New York Downstate Medical Center; Brooklyn NY USA
- Obstetrics and Gynecology; Kings County Hospital Center; Brooklyn NY USA
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Pule GD, Mowla S, Novitzky N, Wonkam A. Hydroxyurea down-regulates BCL11A, KLF-1 and MYB through miRNA-mediated actions to induce γ-globin expression: implications for new therapeutic approaches of sickle cell disease. Clin Transl Med 2016; 5:15. [PMID: 27056246 PMCID: PMC4824700 DOI: 10.1186/s40169-016-0092-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/29/2016] [Indexed: 12/29/2022] Open
Abstract
Background The major therapeutic benefit of hydroxyurea, the only FDA-approved pharmacologic treatment for sickle cell disease (SCD), is directly related to fetal hemoglobin (HbF) production that leads to significant reduction of morbidity and mortality. However, potential adverse effects such as infertility, susceptibility to infections, or teratogenic effect have been subject of concerns. Therefore, understanding HU molecular mechanisms of action, could lead to alternative therapeutic agents to increase HbF with less toxicity. This paper investigated whether HU-induced HbF could operate through post-transcriptional miRNAs regulation of BCL11A, KLF-1 and MYB, potent negative regulators of HbF. Both ex vivo differentiated primary erythroid cells from seven unrelated individuals, and K562 cells were treated with hydroxyurea (100 μM) and changes in BCL11A, KLF-1, GATA-1, MYB, β- and γ-globin gene expression were investigated. To explore potential mechanisms of post-transcriptional regulation, changes in expression of seven targeted miRNAs, previously associated with basal γ-globin expression were examined using miScript primer assays. In addition, K562 cells were transfected with miScript miRNA inhibitors/anti-miRNAs followed by Western Blot analysis to assess the effect on HbF protein levels. Direct interaction between miRNAs and the MYB 3′-untranslated region (UTR) was also investigated by a dual-luciferase reporter assays. Results Down-regulation of BCL11A and MYB was associated with a sevenfold increase in γ-globin expression in both primary and K562 cells (p < 0.003). Similarly, KLF-1 was down-regulated in both cell models, corresponding to the repressed expression of BCL11A and β-globin gene (p < 0.04). HU induced differential expression of all miRNAs in both cell models, particularly miR-15a, miR-16, miR-26b and miR-151-3p. An HU-induced miRNAs-mediated mechanism of HbF regulation was illustrated with the inhibition of miR-26b and -151-3p resulting in reduced HbF protein levels. There was direct interaction between miR-26b with the MYB 3′-untranslated region (UTR). Conclusions These experiments have shown the association between critical regulators of γ-globin expression (MYB, BCL11A and KLF-1) and specific miRNAs; in response to HU, and demonstrated a mechanism of HbF production through HU-induced miRNAs inhibition of MYB. The role of miRNAs-mediated post-transcriptional regulation of HbF provides potential targets for new treatments of SCD that may minimize alterations to the cellular transcriptome. Electronic supplementary material The online version of this article (doi:10.1186/s40169-016-0092-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gift Dineo Pule
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, Republic of South Africa
| | - Shaheen Mowla
- Division of Hematology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
| | - Nicolas Novitzky
- Division of Hematology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, Republic of South Africa.
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22
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Nkashama GM, Wakamb GKA, Mulangu AM, Nkashama GM, Kupa BK, Numbi OL. [From Hemoglobin SS to SF: interest of hydroxyurea in the management of sickle cell disease in two Congolese children and review of the literature]. Pan Afr Med J 2015; 21:124. [PMID: 26327961 PMCID: PMC4546726 DOI: 10.11604/pamj.2015.21.124.5784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/07/2015] [Indexed: 11/11/2022] Open
Abstract
La drépanocytose est une maladie grave par ses complications et par les difficultés liées à sa prise en charge, notamment en milieu sous-équipé. Les auteurs rapportent l'effet bénéfique de l'hydroxyurée dans la prise en charge de deux patients drépanocytaires, au prix cependant d'une surveillance hématologique rigoureuse. Une revue de la littérature étaye par ailleurs les modalités d'administration de ce médicament et les perspectives ultérieures d'un tel traitement dans la drépanocytose.
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Affiliation(s)
- Gayllord Mutoke Nkashama
- Université de Lubumbashi, BP 1825, Département de Pédiatrie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Gray Kanteng A Wakamb
- Université de Lubumbashi, BP 1825, Département de Pédiatrie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Augustin Mutombo Mulangu
- Université de Lubumbashi, BP 1825, Département de Pédiatrie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Georges Mutoke Nkashama
- Université de Lubumbashi, BP 1825, Département de Pédiatrie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Boniface Kabeya Kupa
- Université de Lubumbashi, BP 1825, Département de Pédiatrie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Oscar Luboya Numbi
- Université de Lubumbashi, BP 1825, Département de Pédiatrie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
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Pule GD, Mowla S, Novitzky N, Wiysonge CS, Wonkam A. A systematic review of known mechanisms of hydroxyurea-induced fetal hemoglobin for treatment of sickle cell disease. Expert Rev Hematol 2015; 8:669-79. [PMID: 26327494 DOI: 10.1586/17474086.2015.1078235] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To report on molecular mechanisms of fetal hemoglobin (HbF) induction by hydroxyurea (HU) for the treatment of sickle cell disease. STUDY DESIGN Systematic review. RESULTS Studies have provided consistent associations between genomic variations in HbF-promoting loci and variable HbF level in response to HU. Numerous signal transduction pathways have been implicated, through the identification of key genomic variants in BCL11A, HBS1L-MYB, SAR1 or XmnI polymorphism that predispose the response to the treatment, and signal transduction pathways that modulate γ-globin expression (cAMP/cGMP; Giα/c-Jun N-terminal kinase/Jun; methylation and miRNA). Three main molecular pathways have been reported: i) Epigenetic modifications, transcriptional events and signaling pathways involved in HU-mediated response, ii) Signaling pathways involving HU-mediated response and iii) Post-transcriptional pathways (regulation by miRNAs). CONCLUSIONS The complete picture of HU-mediated mechanisms of HbF production in Sickle Cell Disease remains elusive. Research on post-transcriptional mechanisms could lead to therapeutic targets that may minimize alterations to the cellular transcriptome.
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Affiliation(s)
- Gift D Pule
- a 1 Department of Medicine, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
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Elchuri SV, Williamson RS, Clark Brown R, Haight AE, Spencer JB, Buchanan I, Hassen-Schilling L, Brown MR, Mertens AC, Meacham LR. The effects of hydroxyurea and bone marrow transplant on Anti-Müllerian hormone (AMH) levels in females with sickle cell anemia. Blood Cells Mol Dis 2015; 55:56-61. [DOI: 10.1016/j.bcmd.2015.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/29/2015] [Indexed: 01/03/2023]
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25
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Dehury S, Purohit P, Patel S, Meher S, Kullu BK, Sahoo LK, Patel NK, Mohapatra AK, Das K, Patel DK. Low and fixed dose of hydroxyurea is effective and safe in patients with HbSβ(+) thalassemia with IVS1-5(G→C) mutation. Pediatr Blood Cancer 2015; 62:1017-23. [PMID: 25546091 DOI: 10.1002/pbc.25391] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/14/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite compelling evidence that hydroxyurea is safe and effective in sickle cell disease, it is prescribed sparingly due to several barriers like knowledge gaps in certain genotypes, apprehension about its safety and toxicity, and limited resources. We undertook this study to find out the efficacy and safety of HU in patients with HbSβ(+) -thalassemia with IVS1-5(G→C) mutation. PROCEDURE We registered 318 patients with HbSβ(+) -thalassemia with IVS1-5(G→C) mutation. Of these, 203 were enrolled for hydroxyurea treatment at a low and fixed dose of 10 mg/kg/day. One hundred four patients (Group-I: 37 children and Group-II: 67 adults) with ≥2 years of hydroxyurea treatment were studied. RESULTS The rate of vaso-occlusive crises, requirement of blood transfusion and rate of hospitalization reduced from 3 to 0.5, 1 to 0 and 1 to 0 in Group-I and 3 to 0, 1 to 0 and 0.5 to 0 in Group-II respectively after HU therapy (P < 0.0001). %HbF level, hemoglobin, MCV and MCH increased significantly, whereas HbS, WBC, platelet count, serum-bilirubin and LDH levels decreased significantly after HU therapy. It has been observed that along with fairly subtle hematological changes following HU therapy, there was a substantial clinical improvement occurred in these patients. Transient myelotoxicity was observed in 4.8%. There was minimal gonadal toxicity without affecting reproductive function. CONCLUSION In view of easy affordability, better acceptability, minimal toxicity, the need of infrequent monitoring and its potential effectiveness, low and fixed dose of hydroxyurea is suitable for treatment of patients with HbSβ(+) -thalassemia in resource poor setting.
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Affiliation(s)
- Snehadhini Dehury
- Sickle Cell Clinic and Molecular Biology Laboratory, Veer Surendra Sai Medical College, Burla, Sambalpur, Odisha, India
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Pharmacological Induction of Human Fetal Globin Gene in Hydroxyurea-Resistant Primary Adult Erythroid Cells. Mol Cell Biol 2015; 35:2541-53. [PMID: 25986606 DOI: 10.1128/mcb.00035-15] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/06/2015] [Indexed: 11/20/2022] Open
Abstract
Pharmacological induction of the fetal γ globin gene and the consequent formation of HbF (α2/γ2) in adult erythroid cells are one feasible therapeutic strategy for sickle cell disease (SCD) and severe β-thalassemias. Hydroxyurea (HU) is the current drug of choice for SCD, but serious side effects limit its clinical use. Moreover, 30 to 50% of patients are irresponsive to HU treatment. We have used high-throughput screening to identify benzo[de]benzo[4,5]imidazo[2,1-a]isoquinolin-7-one and its derivatives (compounds I to VI) as potent γ globin inducers. Of the compounds, I to V exert superior γ globin induction and have better therapeutic potential than HU, likely because of their activation of the p38 mitogen-activated protein kinase (MAPK) signaling pathway and modulation of expression levels and/or chromosome binding of γ globin gene regulators, including BCL11A, and chromatin structure over the γ globin promoter. Unlike sodium butyrate (NaB), the global levels of acetylated histones H3 and H4 are not changed by compound II treatment. Remarkably, compound II induces the γ globin gene in HU-resistant primary human adult erythroid cells, the p38 signaling pathway of which appears to be irresponsive to HU and NaB as well as compound II. This study provides a new framework for the development of new and superior compounds for treating SCD and severe β-thalassemias.
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Wu ZQ, Chen DL, Lin FH, Lin L, Shuai O, Wang JY, Qi LK, Zhang P. Effect of bajijiasu isolated from Morinda officinalis F. C. how on sexual function in male mice and its antioxidant protection of human sperm. JOURNAL OF ETHNOPHARMACOLOGY 2015; 164:283-92. [PMID: 25686781 DOI: 10.1016/j.jep.2015.02.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 02/05/2015] [Accepted: 02/08/2015] [Indexed: 05/19/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In recent years, the physiological aspects of human fertility have been seriously influenced by the interactions of genetic and environmental factors. Almost one in 20 males has been affected by male infertility, providing a great challenge and an opportunity to use natural compounds as alternatives to chemical drugs with comprehensive adverse effects. However, ample evidences are scanty to support the physiological mechanisms of natural compounds used to treat male infertility. In traditional Chinese medicine, Morinda officinalis F. C. How is widely used as a herb that invigorates the kidneys and supports yang, the original energy in the human body, to resist diseases and in treating male infertility. In this study, we evaluated whether bajijiasu isolated from the roots of M. officinalis F.C. How is a potential agent for the treatment of male infertility. MATERIALS AND METHOD In this study, both normal and kidney-yang-deficient mice were administered bajijiasu orally at different concentrations. To determine the pharmacological mechanism of bajijiasu, we observed the sexual behavior and genital organ coefficients, determined their serum hormone levels, analyzed their sperm quality parameters, and examined histopathological sections from them. We also used enzymatic assays to determine the effects of bajijiasu on superoxide dismutase, glutathione peroxidase, and malondialdehyde. Confocal micro-Raman spectroscopy was used to investigate the changes in the DNA of H2O2-damaged human sperm after treatment with bajijiasu in vitro. RESULTS Our results showed that bajijiasu enhanced the sexual behavior of both normal and kidney-yang-deficient mice. It also markedly increased the testosterone concentrations, reduced the levels of cortisol, improved the quality of the sperm, and counteracted the histopathological impairment induced by hydroxyurea in the kidney-yang-deficient mice. The enzymatic assay and Raman spectra showed that bajijiasu protects the DNA of sperm from damage by H2O2. CONCLUSION Bajijiasu is a potential androgen-like drug that modulates hormone levels to some extent without producing reproductive-organ lesions, enhances the sexual function of male mice, and protects the DNA of human sperm from H2O2 damage. Thus, bajijiasu is an active ingredient of M. officinalis F.C. How that improves the human reproductive capacity.
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Affiliation(s)
- Ze-Qing Wu
- College of Chinese Materia Medical, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, People׳s Republic of China
| | - Di-Ling Chen
- Guangdong Institute of Microbiology, Guangzhou 510070, People׳s Republic of China
| | - Fang-Hua Lin
- Department of Life Science, Huizhou University, Huizhou, Guangdong 516007, People׳s Republic of China
| | - Li Lin
- College of Chinese Materia Medical, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, People׳s Republic of China.
| | - Ou Shuai
- College of Chinese Materia Medical, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, People׳s Republic of China
| | - Jin-Yu Wang
- College of Chinese Materia Medical, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, People׳s Republic of China
| | - Long-Kai Qi
- College of Chinese Materia Medical, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, People׳s Republic of China
| | - Peng Zhang
- College of Chinese Materia Medical, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, People׳s Republic of China
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Abstract
As medical advances improve survival, reduce disease-related morbidity, and improve quality of life, reproductive issues will take higher priority in the sickle cell disease (SCD) community. A wide variety of topics are addressed in this chapter, including fertility, gonadal failure, erectile dysfunction, and menstrual issues in SCD. Etiologies of impaired male fertility are multifactorial and include hypogonadism, erectile dysfunction, sperm abnormalities, and complications of medical therapies. Much less is known about the prevalence and etiology of infertility in women with SCD. Other reproductive issues in women included in this review are pain and the menstrual cycle, contraception, and preconception counseling. Finally, long-term therapies for SCD and their impact on fertility are presented. Transfusional iron overload and gonadal failure are addressed, followed by options for fertility preservation after stem cell transplantation. Focus is placed on hydroxyurea therapy given its benefits and increasing use in SCD. The impact of this agent on spermatogenesis, azoospermia, and the developing fetus is discussed.
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Shaeer OKZM, Shaeer KZM, AbdelRahman IFS, El-Haddad MS, Selim OM. Priapism as a result of chronic myeloid leukemia: case report, pathology, and review of the literature. J Sex Med 2015; 12:827-34. [PMID: 25630365 DOI: 10.1111/jsm.12812] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Priapism is rare-presenting feature in male patients with chronic myeloid leukemia (CML). Several hypotheses for pathogenesis have been described. Management has been controversial; some authors described resolution following priapism-specific interventions, and others recommended addition of CML-specific therapy or even CML-specific therapy alone. AIM In this report, we describe presentation and management of a man with refractory priapism that was the first presenting manifestation of CML. We also report, for the first time, the pathology sections of the sinusoidal tissue in such cases. Literature is reviewed for similar cases and their outcome. METHODS A 21-year-old male patient presented with painful priapism that started 6 days earlier and failed aspiration-irrigation. CBC revealed marked leucocytosis. Oncology care diagnosed CML, and treatment with Imatinib was commenced with prior semen cryopreservation. Following remission, a penile prosthesis was implanted, assisted by optical corporotomy. Sinusoidal tissue biopsy was stained by hematoxylin/eosin (H&E) and CD34. MAIN OUTCOME MEASURES Pathology sections of cavernous tissue following CML-induced priapism. RESULTS The penile implant survived without complications. H&E examination of the sinusoidal tissue biopsy revealed leukemic infiltration associated with vascular endothelial damage. CD34 staining showed the mixed picture of leukemic infiltrates, intact vascular endothelium with lumena showing leukemic cells, alternating with destroyed vessels, and no vascular lumena and ruminants of endothelial cells. CONCLUSION Priapism can be the first manifestation of previously undetected CML. The pathological picture of sinusoidal tissue in such cases is presented. In the case at hand, a complete blood picture was helpful in early diagnosis of CML and early initiation of targeted chemotherapy along with the corporal irrigation/aspiration or shunt surgery. It is therefore recommended to have a CBC examined at presentation of any case of ischemic priapism of unknown etiology, early initiation of CML therapy along with aspiration/irrigation, preferably cryopreserving a semen sample before CML therapy.
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Tvrda E, Peer R, Sikka SC, Agarwal A. Iron and copper in male reproduction: a double-edged sword. J Assist Reprod Genet 2015; 32:3-16. [PMID: 25245929 PMCID: PMC4294866 DOI: 10.1007/s10815-014-0344-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/09/2014] [Indexed: 01/12/2023] Open
Abstract
Iron and copper are essential trace nutrients playing important roles in general health and fertility. However, both elements are highly toxic when accumulating in large quantities. Their direct or indirect impact on the structure and function of male gonads and gametes is not completely understood yet. Excess or deficiency of either element may lead to defective spermatogenesis, reduced libido, and oxidative damage to the testicular tissue and spermatozoa, ultimately leading to fertility impairment. This review will detail the complex information currently available on the dual roles iron and copper play in male reproduction.
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Affiliation(s)
- Eva Tvrda
- />Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH USA
- />Department of Animal Physiology, Slovak University of Agriculture, Nitra, Slovakia
| | - Rohan Peer
- />Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH USA
| | - Suresh C. Sikka
- />Department of Urology, Tulane University School of Medicine, New Orleans, LA USA
| | - Ashok Agarwal
- />Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH USA
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Smith-Whitley K. Reproductive issues in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:418-24. [PMID: 25696888 DOI: 10.1182/asheducation-2014.1.418] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
As medical advances improve survival, reduce disease-related morbidity, and improve quality of life, reproductive issues will take higher priority in the sickle cell disease (SCD) community. A wide variety of topics are addressed in this chapter, including fertility, gonadal failure, erectile dysfunction, and menstrual issues in SCD. Etiologies of impaired male fertility are multifactorial and include hypogonadism, erectile dysfunction, sperm abnormalities, and complications of medical therapies. Much less is known about the prevalence and etiology of infertility in women with SCD. Other reproductive issues in women included in this review are pain and the menstrual cycle, contraception, and preconception counseling. Finally, long-term therapies for SCD and their impact on fertility are presented. Transfusional iron overload and gonadal failure are addressed, followed by options for fertility preservation after stem cell transplantation. Focus is placed on hydroxyurea therapy given its benefits and increasing use in SCD. The impact of this agent on spermatogenesis, azoospermia, and the developing fetus is discussed.
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Affiliation(s)
- Kim Smith-Whitley
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA
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32
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DeBaun MR. Hydroxyurea therapy contributes to infertility in adult men with sickle cell disease: a review. Expert Rev Hematol 2014; 7:767-73. [PMID: 25242414 DOI: 10.1586/17474086.2014.959922] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hydroxyurea therapy, a chemotherapeutic agent, is the only US FDA approved therapy for the prevention of vaso-occlusive pain in sickle cell disease (SCD). The National Institutes of Health has sponsored two Phase III randomized, placebo-controlled trials, initially in adults, and subsequently in children with sickle cell anemia (SCA). Despite the overwhelming evidence that hydroxyurea therapy is beneficial to children and adults with SCA, individuals with SCA and their families express reservations about its use, in part because of the concerns about fertility, particularly in men. As adolescent boys with SCD are now expected to reach their reproductive years, a new concern is emerging about the role of hydroxyurea therapy as a barrier to their progeny. This review will systemically evaluate compromised fertility in men with SCD, and the evidence that hydroxyurea therapy is associated with further decreasing fertility in men with SCD.
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Affiliation(s)
- Michael R DeBaun
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry-Matthew Walker Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center 2200 Children's Way, Room 11206 DOT, Nashville, TN 37232-9000, USA
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Patel S, Purohit P, Mashon RS, Dehury S, Meher S, Sahoo S, Dash SS, Das K, Das P, Patel DK. The effect of hydroxyurea on compound heterozygotes for sickle cell-hemoglobin D-Punjab--a single centre experience in eastern India. Pediatr Blood Cancer 2014; 61:1341-6. [PMID: 24616059 DOI: 10.1002/pbc.25004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/29/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although hydroxyurea is the only effective agent for the treatment of sickle cell disease, published experience with this drug is limited to treatment of homozygous sickle cell anemia and HbS/β thalassemia. The role of hydroxyurea in the treatment of patients with HbSD-Punjab, a rare hemoglobinopathy with phenotypic expression similar to that of sickle cell anemia is unknown. PROCEDURE Over a period of 10 years, we followed 42 patients with HbSD-Punjab, of which 20 presented with severe clinical manifestations (≥3 episodes of VOC and/or ≥2 units of blood transfusion in the previous 12 months). These 20 patients were enrolled for treatment with hydroxyurea at a dose of 10 mg/kg/day and followed prospectively for a period of 24 months. RESULTS The frequency of VOC decreased significantly and none of them required blood transfusion while receiving hydroxyurea. The HbF, total hemoglobin, MCV, MCH, and MCHC levels increased significantly, whereas HbS, WBC, platelet count, total serum bilirubin, and LDH levels decreased significantly in all the patients. No short-term drug toxicity was observed. CONCLUSION This study describes the use of hydroxyurea therapy in patients with HbSD-Punjab. Low dose hydroxyurea (10 mg/kg/day) was found to be effective in reducing the clinical severity in patients with HbSD-Punjab without any short-term toxicity. In view of easy affordability amongst poor patients, widespread acceptability by patients and doctors, the need of infrequent monitoring and its potential effectiveness, low dose hydroxyurea is suitable for treatment of patients with HbSD-Punjab.
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Affiliation(s)
- Siris Patel
- Department Medicine, Veer Surendra Sai Medical College, Burla, Sambalpur, Odisha, India
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34
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Ramirez G, García-Sanchez R, Plaza S. [Management of patients with essential thrombocythemia]. Med Clin (Barc) 2013. [PMID: 23177312 DOI: 10.1016/j.medcli.2012.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Gemma Ramirez
- Servicio de Hematología y Hemoterapia, Hospital Virgen de la Victoria, Málaga, España
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35
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Patel DK, Mashon RS, Patel S, Das BS, Purohit P, Bishwal SC. Low dose hydroxyurea is effective in reducing the incidence of painful crisis and frequency of blood transfusion in sickle cell anemia patients from eastern India. Hemoglobin 2013; 36:409-20. [PMID: 22881992 DOI: 10.3109/03630269.2012.709897] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There are several questions pertaining to dosage, duration and potential long-term toxicity of hydroxyurea (HU) therapy. Use of HU is extremely limited in eastern India because of its high cost and apprehension of its toxicities. We undertook this study to assess the clinical, biochemical and hematological efficacy of minimal dose HU (10 mg/kg/day) in 118 sickle cell anemia patients (27 pediatric and 91 adults). The frequency of painful crises reduced significantly in 71.5 and 92.2% in pediatric and adult cases, respectively. Ninety-five percent of the patients became transfusion independent. The baseline Hb F, total hemoglobin (Hb), MCV, MCH and MCHC levels increased significantly, whereas the WBC, platelet count and total serum bilirubin values decreased significantly. This is the first study of minimal dose HU therapy in eastern India that showed impressive improvement in clinical and hematological parameters with minimal toxicity.
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Affiliation(s)
- Dilip K Patel
- Department of Medicine, Veer Surendra Sai Medical College, Burla, Orissa, India.
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Imatinib mesylate at therapeutic doses has no impact on folliculogenesis or spermatogenesis in a leukaemic mouse model. Leuk Res 2012; 36:271-4. [DOI: 10.1016/j.leukres.2011.09.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 09/11/2011] [Accepted: 09/22/2011] [Indexed: 11/23/2022]
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Karimi M, Zekavat OR, Haghpanah S, Javad P, Karamizadeh Z. Comparative study of hypogonadism in beta-thalassemia intermedia patients with and without hydroxyurea. Hematology 2012; 17:122-124. [DOI: 10.1179/102453312x13221316477778] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Mehran Karimi
- Hematology Research CenterShiraz University of Medical Science, Shiraz, Iran
| | - Omid R. Zekavat
- Hematology Research CenterShiraz University of Medical Science, Shiraz, Iran
| | - Sezaneh Haghpanah
- Hematology Research CenterShiraz University of Medical Science, Shiraz, Iran
| | - Parvin Javad
- Hematology Research CenterShiraz University of Medical Science, Shiraz, Iran
| | - Zohreh Karamizadeh
- Hematology Research CenterShiraz University of Medical Science, Shiraz, Iran
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Leader A, Lishner M, Michaeli J, Revel A. Fertility considerations and preservation in haemato-oncology patients undergoing treatment. Br J Haematol 2011; 153:291-308. [DOI: 10.1111/j.1365-2141.2011.08629.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Kovacic P. Hydroxyurea (therapeutics and mechanism): Metabolism, carbamoyl nitroso, nitroxyl, radicals, cell signaling and clinical applications. Med Hypotheses 2011; 76:24-31. [DOI: 10.1016/j.mehy.2010.08.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 08/03/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
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40
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Kalff A, Dowsing C, Grigg A. The impact of a regular erythrocytapheresis programme on the acute and chronic complications of sickle cell disease in adults. Br J Haematol 2010; 149:768-74. [DOI: 10.1111/j.1365-2141.2010.08150.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Abstract
Hydroxyurea therapy offers promise for ameliorating the clinical course of children with sickle cell disease (SCD). Hydroxyurea is a prototypic therapeutic option; it can be administered with minimal side effects, has a relatively wide therapeutic window, and has mechanisms of action that address pathophysiologic pathways of sickling, vaso-occlusion, hemolysis, and organ damage. There are limited data regarding hydroxyurea's ability to prevent or diminish organ dysfunction, and the long-term risks of hydroxyurea therapy remain incompletely defined. Although clinical trials are underway to address long-term issues, hydroxyurea remains an effective but underutilized therapy for SCD.
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Affiliation(s)
- Matthew M Heeney
- Department of Pediatrics, Harvard Medical School, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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42
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Wiles NM, Howard J. Role of hydroxycarbamide in prevention of complications in patients with sickle cell disease. Ther Clin Risk Manag 2009; 5:745-55. [PMID: 19816573 PMCID: PMC2754089 DOI: 10.2147/tcrm.s4769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Indexed: 11/23/2022] Open
Abstract
Sickle cell disease (SCD) is a genetically inherited condition caused by a point mutation in the beta globin gene. This results in the production of the abnormal hemoglobin, sickle hemoglobin (HbS). Hydroxycarbamide, is an antimetabolite/cytotoxic which works by inhibiting ribonucleotide reductase, blocking the synthesis of DNA and arresting cells in the S phase. In sickle cell anemia, it promotes fetal hemoglobin (HbF) synthesis, improves red cell hydration, decreases neutrophil and platelet count, modifies red cell endothelial cell interactions and acts as a nitric oxide donor. Trials have shown the clinical benefit of hydroxycarbamide in a subpopulation of adult patients with SCD, with a 44% reduction in the median annual rate of painful crises, a decrease in the incidence of acute chest syndrome and an estimated 40% reduction in overall mortality over a 9-year observational period. Its use in pediatrics has also been well established; trials have shown it is well tolerated and does not impair growth or development. In addition it decreases the number and duration of hospital attendences. A number of emerging uses of hydroxycarbamide currently are being investigated, such as stroke prevention.
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Affiliation(s)
- NM Wiles
- Department of Haematology, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - J Howard
- Department of Haematology, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Lukusa AK, Vermylen C, Vanabelle B, Curaba M, Brichard B, Chantrain C, Dupont S, Ferrant A, Wyns C. Bone marrow transplantation or hydroxyurea for sickle cell anemia: long-term effects on semen variables and hormone profiles. Pediatr Hematol Oncol 2009; 26:186-94. [PMID: 19437321 DOI: 10.1080/07357900902892780] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ten male subjects affected by sickle cell anemia (SCA) were studied to evaluate the long-term effects of therapies on their fertility. Their ages ranged from 18 to 34 years (median: 32 years). Four subjects were treated by hydroxyurea (HU) and 6 by hematopoietic stem cell transplantation (HSCT). The median follow-up after HU initiation and HSCT was 10.5 years (range: 8-15 years) and 15.5 years (range: 8-21 years), respectively. Three of the 6 in the HSCT group and two of the 4 in the HU group were azoospermic. One HSCT subject had normal semen and hormone variables, showing that normal fertility can occasionally be expected after transplantation in SCA. The remaining 4 patients (2 HSCT and 2 HU) were oligozoospermic. With regard to HU, semen impairment appears to be related to the duration of treatment. To draw general conclusions, further research with a large number of patients treated since childhood with HU or HSCT is warranted.
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Affiliation(s)
- Aimé Kazadi Lukusa
- Department of Pediatric Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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Adverse effects of a clinically relevant dose of hydroxyurea used for the treatment of sickle cell disease on male fertility endpoints. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:1124-44. [PMID: 19440437 PMCID: PMC2672375 DOI: 10.3390/ijerph6031124] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 03/10/2009] [Indexed: 11/17/2022]
Abstract
Two experiments were conducted to determine: 1) whether the adult male transgenic sickle cell mouse (Tg58 x Tg98; TSCM), exhibits the patterns of reproductive endpoints (hypogonadism) characteristic of men with sickle cell disease (SCD) and 2) whether hydroxyurea (HU) exacerbates this condition. In Experiment 1, blood samples were collected from adult age-matched TSCM and ICR mice (ICRM) (N = 10/group) for plasma testosterone measurements. Subsequently, mice were sacrificed, testes excised and weighed and stored spermatozoa recovered for the determination of sperm density, progressive motility and percentage of spermatozoa with normal morphology. In experiment 2, adult male TSCM were orally treated with 25 mg HU/kg body weight/day for 28 or 56 days. Control mice received the vehicle for HU (saline) as described above. At the end of the treatment periods, blood samples were collected for quantification of circulating testosterone. Subsequently, mice were sacrificed, testes and epididymides were recovered and weighed and one testis per mouse was subjected to histopathology. Stored spermatozoa were recovered for the determination of indices of sperm quality mentioned in Experiment 1. Testis weight, stored sperm density, progressive motility, percentage of spermatozoa with normal morphology and plasma testosterone concentrations of TSCM were significantly lower by 40, 65, 40, 69 and 66%, respectively than those of ICRM. These data indicate that adult TSCM used in this study suffered from hypogonadism, characteristically observed among adult male SCD patients. In Experiment 2, HU treatment significantly decreased testis weight on day 28, (0.09 +/- 0.004 g) that was further decreased on day 56 (0.06 +/- 0.003 g; treatment x time interaction) compared with controls (day 28, 0.15 +/- 0.01 g; day 56, 2, 0.16 +/- 0.01 g). Concomitant with a 52% shrinkage (P<0.001) in area of testes in 56 days of HU treatment, testes from HU-treated TSCM exhibited significant atrophic degeneration in the seminiferous tubules compared with controls. Furthermore, treated TSCM had only Sertoli cells and cell debris remaining in most of the seminiferous tubules in comparison with controls. Leydig cell prominence and hyperplasia were more evident (P<0.05) in the steroidogenic compartments of testes of HU-treated TSCM compared with controls. However, plasma testosterone concentrations were reduced by HU treatment (P<0.05; treatment x time interaction) compared with controls on the two time periods studied. Epididymides from HU-treated TSCM sustained a 25% shrinkage (P<0.05), along with 69 (P<0.005) and 95% reduction (P<0.005), in stored sperm density and sperm progressive motility (treatment x time interaction P<0.05), respectively on day 56 of treatment compared with controls. These data demonstrate that TSCM used in this study exhibited SCD-induced hypogonadism, thus authenticating their use for studying the effect of HU on male reproductive endpoints observed in SCD patients. Secondarily, our data show that HU treatment exacerbated the already SCD-induced hypogonadism to gonadal failure.
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Ware RE, Aygun B. Advances in the use of hydroxyurea. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2009; 2009:62-69. [PMID: 20008183 DOI: 10.1182/asheducation-2009.1.62] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Clinical experience with hydroxyurea for patients with sickle cell disease (SCD) has been accumulating for the past 25 years. The bulk of the current evidence suggests that hydroxyurea is well-tolerated, safe, and efficacious for most patients with SCD. Hydroxyurea has proven clinical efficacy for reducing acute vaso-occlusive events including pain episodes and acute chest syndrome. Salutary effects on hematological parameters include increases in fetal hemoglobin (HbF), hemoglobin, and MCV; also significant decreases occur in WBC, ANC, reticulocytes, LDH, and bilirubin. Treatment with hydroxyurea is usually considered for patients with recurrent vaso-occlusive events, but additional indications for treatment may include laboratory markers of disease severity and evidence of chronic organ dysfunction. Ten years ago, the US Food and Drug Administration approved hydroxyurea for adult patients with clinically severe SCD; however, its use in children remains off-label. Despite the large body of evidence regarding its efficacy and safety, hydroxyurea is currently prescribed only sparingly for patients with SCD and therefore has only limited effectiveness for this disorder; barriers to its use need to be identified and overcome.
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Affiliation(s)
- Russell E Ware
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
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Strouse JJ, Lanzkron S, Beach MC, Haywood C, Park H, Witkop C, Wilson RF, Bass EB, Segal JB. Hydroxyurea for sickle cell disease: a systematic review for efficacy and toxicity in children. Pediatrics 2008; 122:1332-42. [PMID: 19047254 DOI: 10.1542/peds.2008-0441] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Hydroxyurea is the only approved medication for the treatment of sickle cell disease in adults; there are no approved drugs for children. OBJECTIVE Our goal was to synthesize the published literature on the efficacy, effectiveness, and toxicity of hydroxyurea in children with sickle cell disease. METHODS Medline, Embase, TOXLine, and the Cumulative Index to Nursing and Allied Health Literature through June 2007 were used as data sources. We selected randomized trials, observational studies, and case reports (English language only) that evaluated the efficacy and toxicity of hydroxyurea in children with sickle cell disease. Two reviewers abstracted data sequentially on study design, patient characteristics, and outcomes and assessed study quality independently. RESULTS We included 26 articles describing 1 randomized, controlled trial, 22 observational studies (11 with overlapping participants), and 3 case reports. Almost all study participants had sickle cell anemia. Fetal hemoglobin levels increased from 5%-10% to 15%-20% on hydroxyurea. Hemoglobin concentration increased modestly (approximately 1 g/L) but significantly across studies. The rate of hospitalization decreased in the single randomized, controlled trial and 5 observational studies by 56% to 87%, whereas the frequency of pain crisis decreased in 3 of 4 pediatric studies. New and recurrent neurologic events were decreased in 3 observational studies of hydroxyurea compared with historical controls. Common adverse events were reversible mild-to-moderate neutropenia, mild thrombocytopenia, severe anemia, rash or nail changes (10%), and headache (5%). Severe adverse events were rare and not clearly attributable to hydroxyurea. CONCLUSIONS Hydroxyurea reduces hospitalization and increases total and fetal hemoglobin levels in children with severe sickle cell anemia. There was inadequate evidence to assess the efficacy of hydroxyurea in other groups. The small number of children in long-term studies limits conclusions about late toxicities.
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Affiliation(s)
- John J Strouse
- Department of Pediatrics, Johns Hopkins University School of Medicine, Division of Pediatric Hematology, 720 Rutland Ave, Ross 1125, Baltimore, MD 21205, USA.
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Abstract
BACKGROUND Hydroxyurea is the only approved drug for treatment of sickle cell disease. OBJECTIVE To synthesize the published literature on the efficacy, effectiveness, and toxicity of hydroxyurea when used in adults with sickle cell disease. DATA SOURCES MEDLINE, EMBASE, TOXLine, and CINAHL were searched through 30 June 2007. STUDY SELECTION Randomized trials, observational studies, and case reports evaluating efficacy and toxicity of hydroxyurea in adults with sickle cell disease, and toxicity studies of hydroxyurea in other conditions that were published in English. DATA EXTRACTION Paired reviewers abstracted data on study design, patient characteristics, and outcomes sequentially and did quality assessments independently. DATA SYNTHESIS In the single randomized trial, the hemoglobin level was higher in hydroxyurea recipients than placebo recipients after 2 years (difference, 6 g/L), as was fetal hemoglobin (absolute difference, 3.2%). The median number of painful crises was 44% lower than in the placebo group. The 12 observational studies that enrolled adults reported a relative increase in fetal hemoglobin of 4% to 20% and a relative reduction in crisis rates by 68% to 84%. Hospital admissions declined by 18% to 32%. The evidence suggests that hydroxyurea may impair spermatogenesis. Limited evidence indicates that hydroxyurea treatment in adults with sickle cell disease is not associated with leukemia. Likewise, limited evidence suggests that hydroxyurea and leg ulcers are not associated in patients with sickle cell disease, and evidence is insufficient to estimate the risk for skin neoplasms, although these outcomes can be attributed to hydroxyurea in other conditions. LIMITATION Only English-language articles were included, and some studies were of lower quality. CONCLUSION Hydroxyurea has demonstrated efficacy in adults with sickle cell disease. The paucity of long-term studies limits conclusions about toxicity.
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Lanzkron S, Strouse JJ, Wilson R, Beach MC, Haywood C, Park H, Witkop C, Bass EB, Segal JB. Systematic review: Hydroxyurea for the treatment of adults with sickle cell disease. Ann Intern Med 2008; 148:939-55. [PMID: 18458272 PMCID: PMC3256736 DOI: 10.7326/0003-4819-148-12-200806170-00221] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hydroxyurea is the only approved drug for treatment of sickle cell disease. OBJECTIVE To synthesize the published literature on the efficacy, effectiveness, and toxicity of hydroxyurea when used in adults with sickle cell disease. DATA SOURCES MEDLINE, EMBASE, TOXLine, and CINAHL were searched through 30 June 2007. STUDY SELECTION Randomized trials, observational studies, and case reports evaluating efficacy and toxicity of hydroxyurea in adults with sickle cell disease, and toxicity studies of hydroxyurea in other conditions that were published in English. DATA EXTRACTION Paired reviewers abstracted data on study design, patient characteristics, and outcomes sequentially and did quality assessments independently. DATA SYNTHESIS In the single randomized trial, the hemoglobin level was higher in hydroxyurea recipients than placebo recipients after 2 years (difference, 6 g/L), as was fetal hemoglobin (absolute difference, 3.2%). The median number of painful crises was 44% lower than in the placebo group. The 12 observational studies that enrolled adults reported a relative increase in fetal hemoglobin of 4% to 20% and a relative reduction in crisis rates by 68% to 84%. Hospital admissions declined by 18% to 32%. The evidence suggests that hydroxyurea may impair spermatogenesis. Limited evidence indicates that hydroxyurea treatment in adults with sickle cell disease is not associated with leukemia. Likewise, limited evidence suggests that hydroxyurea and leg ulcers are not associated in patients with sickle cell disease, and evidence is insufficient to estimate the risk for skin neoplasms, although these outcomes can be attributed to hydroxyurea in other conditions. LIMITATION Only English-language articles were included, and some studies were of lower quality. CONCLUSION Hydroxyurea has demonstrated efficacy in adults with sickle cell disease. The paucity of long-term studies limits conclusions about toxicity.
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Affiliation(s)
- Sophie Lanzkron
- School of Medicine ,Johns Hopkins University, 1830 East Monument Street, Suite 7300, Baltimore, MD 21205, USA
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