How should sperm antibody tests be used clinically?

Human sperm protein encyclopedia and alloantigen index: mining novel allo-antigens using sera from ASA-positive infertile patients and vasectomized men

Anti-sperm antibodies (ASA) are an important cause of immunological infertility. The objective of this study was to identify immunodominant sperm antigens recognized by anti-sperm antibodies (ASA) in serum samples of infertile men, women and vasectomized men. High-resolution two-dimensional gel electrophoresis was employed to separate human sperm proteins using isoelectric focusing (IEF) or nonequilibrium pH gradient electrophoresis (NEPHGE), followed by PAGE and Western blotting. Serum samples from five infertile male and five infertile female subjects that contained ASA as assayed by the immunobead binding test (IBT), were analyzed by Western blotting using NEPHGE gels followed by enhanced chemiluminescence (ECL) to identify the basic sperm antigens reactive to the sera. Serum samples from five fertile male and five fertile female subjects that were ASA-negative by IBT were used as controls. Serum samples from six vasectomized men collected before vasectomy and at different time intervals until 6 months after vasectomy were analyzed by Western blotting using IEF gels. The ECL blots were analyzed to compare immunoreactivity between serum samples from fertile and infertile subjects and identify antigens unique to sera of the infertile subjects. Similarly, immunoreactivity between serum samples from pre- and post-vasectomy was compared to identify antigens unique to sera collected following vasectomy. Five allo-antigenic basic protein spots were recognized by sera from infertile males but not from fertile subjects. Five sperm iso-antigenic basic spots were recognized by infertile female subjects. Two among six of the vasectomized men's sera showed a difference in the Western blot profile 6 months after vasectomy, recognizing at least one new protein spot in each case when compared to pre-vasectomy sera. The acrosomal protein SP-10 was identified as an alloantigen recognized by a post-vasectomy serum. Molecular identities of the known allo- and iso-antigens identified in this study and in previous studies from this laboratory are reviewed and discussed.

Radial spoke protein 44 (human meichroacidin) is an axonemal alloantigen of sperm and cilia

To identify novel sperm alloantigens relevant to immune infertility, sera from infertile men containing antisperm antibodies (ASA) were employed on 2-D immunoblots of human sperm proteins. An immunoreactive protein spot (MW: 44 kDa, pI: 4.5) was microsequenced and the related cDNA was cloned yielding a 309 amino acid sequence corresponding to a gene currently annotated in Genbank as TSGA2 homolog (mouse) to signify 'testis specific gene A2'. In Genbank the protein deduced from this gene is currently named human meichroacidin, an orthologue of meichroacidin previously identified in mouse spermatocytes. Human TSGA2 mapped to chromosome 21q22.3. Human meichroacidin (hMCA) contained a single potential tyrosine phosphorylation site and five casein kinase phosporylation motifs. The N-terminus contained a Membrane Occupation Recognition Nexus (MORN) motif found in the lipid kinase-phosphatidylinositol 4-phosphate 5-kinase (PIP5K) family and junctophilins. However hMCA lacked the characteristic kinase homology domain of PIP5K. Northern blot analysis revealed 1.5 kb hMCA transcripts in testis and trachea with lower levels in thyroid and spinal cord. A semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) analysis demonstrated occurrence of the mRNA messages in all the ciliated tissues tested with highest levels of messages in testis and trachea. Western blot analysis showed the presence of hMCA protein in brain, thyroid and trachea at the identical mass, 44 kDa, as in human testis. However, this immunoreactive pattern differed from that of sperm in which a 38 kDa form was also evident suggesting that hMCA undergoes proteolytic processing. In human testis, hMCA localized to the tails of developing spermatids and did not localize to the nucleus of either spermatocytes or spermatids. EM immunocytochemistry localized hMCA within the radial spokes of the axonemal complex of the sperm flagellum, and immunofluorescence studies revealed h-meichroacidin in the cilia of epithelial cells in the trachea and ependyma. Bioinformatic identification of orthologues of meichroacidin in several lower organisms including ciliates and flagellates suggest the protein plays a role in flagellar motility across phyla. We propose the term radial spoke protein 44 as an accurate designation, preferable to human meichroacidin because it denotes the restricted localization of the protein to the radial spokes of the axonemes of both sperm and cilia. Further, since the human gene is expressed in brain, thyroid, trachea and lung in addition to testis, we suggest that the gene name be changed from TSGA2 [testis specific gene A2] to radial spoke protein 44 [RSP44].

Contraceptive vaccines targeting sperm

Overpopulation is a global problem of significant magnitude, with grave implications for the future. Development of new contraceptives is necessary, as existing forms of birth control are unavailable, impractical and/or too expensive for many individuals due to sociological, financial or educational limitations. Immunocontraception and, in particular, the targeting of antibodies to sperm-specific antigens implicated in sperm-egg binding and fertilisation offers an attractive approach to control fertility. Sperm-specific antibodies may impair fertility by inhibiting sperm motility, by reducing penetration of the cervical mucus by sperm, or by interfering in sperm capacitation or the acrosome reaction; alternatively, antisperm antibodies may invoke the complement cascade, resulting in sperm lysis. The antibodies raised against sperm-specific antigens have proved to be extremely effective at reducing sperm-egg interactions in vitro; fertility trials in subhuman primates will eventually be needed to prove the effectiveness of the sperm antigens in terms of contraceptive efficacy before trials in humans can be justified. In addition, existing and emerging strategies (such as sperm proteomics, the determination of molecular and structural details of sperm proteins, and the modelling of protein-ligand interactions using X-ray and/or NMR structures to name a few) are expected to provide the experimental foundation for the design of small molecule inhibitors with antifertility effects. The technology underpinning vaccine development is constantly being developed and the introduction of DNA/RNA vaccines is certain to impact upon the field of immunocontraception.

Semen characteristics: Advancement in andrological assessment

Progress in diagnosis of infertility, has been dramatically increased during the past decades with changes occurring in virtually all aspects of infertility research, thus providing innovative diagnostic testing and sophisticated instrumentation for improved management and treatment of infertility. There are about 50% of infertile couples who are suffering because of male infertility. Semen examination is a basic investigation for these infertile couples. It not only reveals the quantity and quality of sperm but also the quality of the seminal plasma, which is essential for normal sperm function. In this review, the recent advancement in investigation procedures has been analyzed which are very important in clinical practice to (a) evaluate the sperm fertilizing ability (Acrosin, aniline blue, HOS), (b) characterization of male accessory sex glands secretions (Fructose, alpha-glucosidase, PSA) and (c) the management of azoospermic patients. It is believed that use of such diagnostic procedures will facilitate wide selection of patients for whom an effective therapy might be then possible.

A comparison of the sperm mixed-agglutination reaction test with the peroxidase-labelled protein A test for detecting antisperm antibodies in infertile men with varicocele

OBJECTIVE

To compare the sperm mixed-agglutination reaction (sMAR) with the peroxidase-labelled protein A method (POPA) in infertile patients with varicocele.

PATIENTS, SUBJECTS AND METHODS

The study comprised 30 men with a history of varicocele-associated infertility and 30 fertile men (control group). Antisperm antibodies against spermatozoa in the semen and against progenitor spermatozoa in testicular tissue were detected using the two methods.

RESULTS

The tests were positive in 15 (50%) of patients with both the sMAR and the POPA methods, while no autoantibodies were detected in the control group. There were no significant differences between the methods. The sensitivity and specificity of both tests was approximately 93%, with no significant difference between them (P>0. 05).

CONCLUSION

Both methods may be used for detecting sperm autoantibodies in infertile patients with varicocele.

Human sperm proteome: immunodominant sperm surface antigens identified with sera from infertile men and women

The objective of this study was to identify those immunodominant sperm antigens recognized by antisperm antibodies (ASA) in the serum samples of infertile men and women. High-resolution two-dimensional gel electrophoresis was employed to separate human sperm proteins using isoelectric focusing or nonequilibrium pH gradient electrophoresis, followed by PAGE. Serum samples from 15 infertile male subjects and 6 infertile female subjects that contained ASA as assayed by the immunobead binding test (IBT) were analyzed by Western blotting followed by enhanced chemiluminescence (ECL). Serum samples from 10 fertile subjects (5 males and 5 females) that were ASA negative by IBT were used as controls. The ECL blots were analyzed by computer scanning to compare the immunoreactivity between serum samples from fertile and infertile subjects and to identify the antigens unique to the sera of the infertile subjects; 98 sperm auto- and iso-antigenic protein spots were recognized by sera from infertile males and females but not from fertile subjects. Based on vectorial labeling with 125I at the sperm surface, a subset of 6 auto- and iso-antigens was identified as possibly relevant to antibody-mediated infertility.

Seminal fluid antisperm antibodies measured by direct flow cytometry do not correlate with those measured by indirect flow cytometry, the indirect immunobead test, and the indirect mixed antiglobulin reaction

OBJECTIVE

To compare the direct flow cytometric (FCM) measurement of sperm-bound antibodies with the indirect FCM measurement of unbound antisperm antibodies in seminal plasma of the same ejaculates. To compare the FCM measurements with the indirect mixed antiglobulin reaction (MAR) and the indirect immunobead test (IBT) performed on the same seminal plasmas.

SETTING

University hospital-based infertility service.

PATIENTS

Eleven infertile men with a positive immunoglobulin (Ig) G direct MAR test and antibody positivity on the direct FCM measurements. Four control patients with a negative IgG-direct MAR test.

MAIN OUTCOME MEASURES

The proportion of spermatozoa positive for IgG and IgA antibodies as measured by various tests.

RESULTS

The direct and indirect FCM measurements for sperm-bound antibodies from seminal plasma did not correlate with each other. In general, IgG antibodies were not detectable by indirect FCM whereas IgA were detected in lower proportions than by direct FCM measurements. Weak correlation was observed between the indirect FCM, indirect MAR, and indirect IBT measurements.

CONCLUSION

Nearly all of the IgG and some of the IgA antisperm antibodies in seminal fluid bind to spermatozoa. Thus, indirect tests to measure antisperm antibodies from seminal plasma are likely to miss the presence of antisperm IgG antibodies while detecting some cases of IgA antibodies.

Risk factors for antisperm antibodies in infertile men

PROBLEM

The prevalence of anti-sperm antibodies (ASAs) in the general population is 0 to 2%; the prevalence in infertile men is much higher at 7 to 26%. However, the role of ASAs in male infertility remains controversial to date. Although several risk factors for ASA development have been defined (such as testicular torsion, varicocele, cryptorchidism, vasectomy, and genital tract infection), there are no specific indications for ASA testing.

METHOD

In order to examine if a single parameter exists identifying patients with elevated ASA titers, serum ASA testing was performed with an enzyme-linked immunosorbent assay (ELISA) in 226 consecutive male patients. The new assay, synchron ELISA (Synelisa) used in our study represents a new type of ELISA without fixation of the sperm surface antigens by formaldehyde or glutaraldehyde. Therefore, the quantitative assay is highly sensitive and reproducible since the structure of sperm surface antigens is not altered by the fixation process.

CONCLUSIONS

The prevalence of ASAs in this population was 14%, while the prevalence of the control group was 2.5%. Of all factors analyzed only a history of vasectomy, an acute epididymitis, and an abnormal result in the bovine mucus penetration test was associated with elevated ASA titers (P < .001). In addition, we could demonstrate a time related formation of ASAs in men after vasectomy.

Comparison of flow cytometric measurement of seminal antisperm antibodies with the mixed antiglobulin reaction and the serum tray agglutination test

OBJECTIVE

To compare the mixed antiglobulin reaction (MAR) and the serum tray agglutination test (TAT) with the flow cytometric (FCM) measurement of sperm antibodies. To evaluate by FCM the correlation in sperm antibody parameters between paired semen ejaculates obtained 2 to 4 weeks apart and the effect of washing on sperm antibody levels.

SETTING

University-based infertility clinic.

PATIENTS

The TAT and FCM were done on 81 patients with a positive immunoglobulin (Ig)G-MAR test. The correlation of sperm antibody parameters between paired semen samples was done in 16 men. A few samples were used to study the effect of washing on sperm antibody parameters.

MAIN OUTCOME MEASURES

The proportion of spermatozoa positive for IgG and IgA antibodies as well as the number of antibody molecules per spermatozoa measured by FCM.

RESULTS

In general, the degree of MAR positivity but not that of the TAT correlated with the sperm antibody load. With reference to FCM the MAR test had an 1% false positive rate, whereas the serum TAT had a 25% false negative rate. Correlation between FCM measurements of paired semen samples was good. Washing the spermatozoa once removed the loosely bound antibodies; further washes were not useful.

CONCLUSION

Flow cytometry is a reliable technique that correlates with the MAR test. In patients with a strongly positive MAR, FCM is useful to identify patients with a low sperm antibody load. It is speculated that patients with a low sperm antibody load may respond better to IVF treatment.

Risk factors for male partner antisperm antibodies

The role of antisperm antibodies in human infertility remains controversial. Indications for antisperm antibody testing of male partners of infertile marriages have been based upon anecdotal reports and studies using outdated assays. In an effort to define the indications for antisperm antibody testing of the male partner, the immunobead assay for antisperm antibodies was performed upon 100 consecutive men referred for evaluation of male factor infertility. The prevalence of antisperm antibodies in this patient population was 18% and only 9% when patients with a history of vasectomy were excluded. Of all the factors analyzed, only a history of vasectomy and sperm agglutination on semen analysis were predictive of antisperm antibody status (p < 0.001). Use of the aforementioned parameters as an indication for antisperm antibody testing would have resulted in a sensitivity of 94%, specificity 73% and negative predictive value 98% in this patient population. The only way to identify all patients with significant levels of antisperm antibody activity (sensitivity 100%) would have been to test every patient.

Comparison of the indirect immunobead, radiolabeled, and immunofluorescence assays for immunoglobulin G serum antibodies to human sperm

The relative sensitivities of the indirect immunobead test, the indirect flo cytometric immunofluorescence assay, and an indirect radiolabeled antiglobulin assay were compared. Eighteen immunobead test positive sera and 18 negative sera were used as the standard for the other two assays. Of the 18 positive sera, 14 (77%) and 5 (27%) were positive in the immunofluorescence assay and the radiolabeled antiglobulin assay, respectively. Four (22%) of the low titer immunobead test positive sera were negative by both the immunofluorescence assay and the radiolabeled antiglobulin assay. However, there was a significant positive correlation between the results of the immunofluorescence assay and the radiolabeled antiglobulin assay (r = 0.73) and between the results of the radiolabeled antiglobulin assay and the titer of the immunobead test (r = 0.82). The use of an unselected sperm population in the radiolabeled antiglobulin assay and the classical indirect immunofluorescence method using methanol-fixed sperm gave false-positive results in the radiolabeled antiglobulin assay and the immunofluorescence assay. These results suggested that immunoglobulin G antisperm antibody positive sera may be reactive both to sperm surface and internalized sperm antigens.

Association of antisperm antibodies with chronic nonbacterial prostatitis

Antisperm antibodies are significant in male factor infertility. The prevalence of antisperm antibodies in the infertile population is approximately 10 percent, and it is not cost-effective to test for these antibodies in every male partner of an infertile marriage. Earlier studies have demonstrated a higher prevalence of antisperm antibodies among men with a history of bacterial prostatitis or urethritis. Because of this established association, we measured the prevalence of serum antisperm antibodies, using a gel agglutination assay, in 28 men with chronic nonbacterial prostatitis and in age-matched control group of 69 men without a history of prostatitis. The prevalence was 25 percent (test subjects) and 7.2 percent (controls) (p less than 0.05). This finding indicates that nonbacterial prostatitis is a risk factor for the presence of serum antisperm antibodies and that subfertile men with a history of nonbacterial prostatitis should be tested for these antibodies.

Evaluation and treatment of a male factor component to unexplained infertility

The standard semen analysis frequently fails to identify subfertile males even when findings are normal and conversely often fails to identify fertile males with subnormal semen analyses. This has created the need to produce other tests of sperm physiology that will better distinguish a fertile from a subfertile specimen. Understanding more about the nature of the sperm defect should lead to the establishment of more specific and effective therapies. Until that time, it would still be reasonable to try some of the available empirical therapies even though they may work merely by a placebo mechanism.

SpermCheck: a simplified screening assay for immunological infertility

SpermCheck (Bio-Rad Laboratories, Hercules, CA), a new screening test for regional surface antibodies on motile sperm, uses monodispersed latex microspheres of uniform size as a vehicle to link rabbit antihuman immunoglobulins (IgA, IgG, IgM) and provides both negative and positive control sera, as well as sufficient buffer for sperm preparation in ambient CO2 atmosphere. When compared with reference data available for the immunobead test (IBT), the direct protocol (semen) for SpermCheck yielded 94.4% sensitivity with 100% specificity; the indirect protocol (serum) provided a sensitivity of 100% with 94.7% specificity. The microspheres of SpermCheck maintain a nearly uniform concentration per volume, with none to negligible clumping. The greater difference between the optical densities of latex and cytoplasm allows use of a light microscope for the rapid assessment of the percent of regional binding rather than the phase-contrast microscope required for the IBT. SpermCheck eliminates many difficulties encountered with the IBT, making SpermCheck a convenient screening assay for use in the physician's office.

Clinical evaluation of the enzyme-linked immunosorbent assay (ELISA) kit for antisperm antibodies

A commercially available enzyme-linked immunosorbent assay (ELISA) kit for the detection of antisperm antibodies in serum was compared with standard sperm immobilization test (SIT) with the use of sera from 83 infertile women and 29 control individuals. For the ELISA, 24% of the infertile patients and 10% of the controls showed positive results, whereas 15% of the patients and none of the control were positive in the SIT. Parallel tests carried out on the same sera indicated that these methods detect a different, though often overlapping, spectrum of antibody activity. The presence and number of motile sperm in cervical mucus during postcoital tests were found to be related to the results of the SIT. On the other hand, the ELISA did not appear to be related to the quality of postcoital tests. These data indicate that care must be employed to interpret the results of this ELISA kit for the detection of antisperm antibodies.