Immunoglobulin class and regional specificity of antispermatozoal autoantibodies blocking cervical mucus penetration by human spermatozoa

Value of serum antisperm antibodies in diagnosing obstructive azoospermia

PURPOSE

The requisite presence of active spermatogenesis for antisperm antibody production may be useful in identifying obstructive azoospermia. The diagnostic performance of serum antisperm antibody was evaluated as a test for obstructive azoospermia.

MATERIALS AND METHODS

A total of 484 men with male infertility who had undergone antisperm antibody testing were evaluated. Demographic data, patient history, and followup were recorded. Obstruction was confirmed by surgical exploration. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated to quantify diagnostic performance. ROC curves were calculated and compared.

RESULTS

Of 484 men 272 possessed documented obstruction of the vas or epididymis and 212 had documented infertility without azoospermia. The obstructed group had significantly increased antisperm antibody levels compared to the nonobstructed group. IgG, IgA, and IgM were analyzed as diagnostic tests for obstruction. The AUC for IgG, IgA and IgM ROC curves was 0.92, 0.85 and 0.67, respectively. The AUC for serum IgG against sperm tails was 0.92, 0.87 against sperm heads and 0.79 against sperm midpieces. IgG demonstrated the highest sensitivity (85%) with a specificity of 97% (chi-square test p <0.01). IgA possessed the highest specificity (99%), positive predictive value (99%) and positive likelihood ratio (70.0).

CONCLUSIONS

The presence of serum antisperm antibody was highly accurate in predicting obstructive azoospermia, particularly after vasectomy. It can obviate the need for testis biopsy, the current but more invasive and costly gold standard of detection. This allows the surgeon to proceed directly to surgical reconstruction or sperm retrieval after a simple blood test.

Antisperm antibodies and conception

Sperm have been known to be antigenic for more than a century. There is a strong body of evidence that in humans and in other species at least some antibodies that bind to sperm antigens can cause infertility. Therefore, these antibodies are of interest today for two practical reasons. Firstly, the association of the antibodies with infertility means that they must be detected and then the couples treated appropriately. Secondly, because these antibodies can induce infertility they have the potential to be developed for contraceptive purposes in humans and also for the control of feral animal populations.

Basis, diagnosis and treatment of immunological infertility in men

Sperm-reactive antibodies (SpAb) are found attached to sperm, or present in serum or seminal fluid, in approximately 6% of men presenting with infertility. Data supports their pathophysiological role in some cases by the interference with sperm motility and/or sperm-egg interaction. The occurrence of SpAbs may follow disruption of either the cellular barrier separating sperm antigens from the immune system (e.g. testis trauma or obstruction to sperm outflow), or to dysregulation of normal immunosuppressive activities within the male reproductive tract. The epididymis is likely to be the key site of antibody generation, especially in the setting of obstruction. Detection methods are all based on the detection of Ig isotypes rather than specific antibody-antigen interactions, which limits their usefulness. Treatment options in the past (immunosuppression, intrauterine insemination, conventional in vitro fertilization) have been superceded by intracytoplasmic sperm injection (ICSI) which appears to circumvent all adverse effects of male SpAbs.

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.

Antisperm antibodies: etiology, pathogenesis, diagnosis, and treatment

OBJECTIVE

To critically review the English-language literature and describe the current diagnosis, prevalence, etiology, and treatment of antisperm antibodies (ASA).

DESIGN

A comprehensive literature search of the English-language literature published between 1966 and December 1997 was performed on MEDLINE. Articles were also located via bibliographies of published works.

RESULT(S)

Data were excerpted from articles identified by MEDLINE search. The diagnosis, prevalence, etiology, and treatment of ASA are described.

CONCLUSION(S)

There is sufficient evidence that ASA impair fertility in couples with unexplained infertility. A number of different methodologies are available, which may be used in their detection. However, in many cases, test interpretation is subjective. Although there is not enough evidence to support systemic treatment for ASA, application of a variety of assisted reproductive technologies improves outcome.

Expression of the human antigen SPAG2 in the testis and localization to the outer dense fibers in spermatozoa

ABSTRACT Antisperm antibodies (ASAs) have been implicated in some instances of infertility. To characterize sperm antigens relevant to immunologic and immunocontraceptive development, SPAG2 (sperm-associated antigen 2) was identified by screening a human testis cDNA library with human sera positive for ASAs. Subsequently, two isoforms, SPAG2-1 and SPAG2-2, were identified in testis and placenta libraries, respectively. In the current study, Southern analysis of human genomic DNA with a probe common to the two SPAG2 isoforms indicated a single SPAG2 gene; therefore, alternative splicing is a likely mechanism for production of variant mRNAs. In situ hybridization of human testis sections demonstrated the expression of SPAG2 in primary spermatocytes, with decreased or arrested expression in postmeiotic cells. Immunofluorescence of Triton X-100-extracted spermatozoa with an anti-SPAG2 peptide antiserum indicate that SPAG2 is an intracellular component of the sperm flagellum. Electron microscopy refined this localization to the outer dense fibers (ODFs), structural filaments associated with the mammalian sperm axoneme. The ODFs have been reported to be composed of keratin-like intermediate filament proteins. However, SPAG2 does not exhibit the molecular characteristics of such proteins, nor does SPAG2 demonstrate sequence homology with previously characterized ODF proteins. Therefore, SPAG2 represents a novel protein of human sperm ODFs. Characterization of SPAG2 will further our understanding of ODF function in normal sperm motility and of flagellar abnormalities that lead to male infertility.

Efficacy of intracytoplasmic sperm injection (ICSI) treatment in the immunological infertile patients

PROBLEM

To evaluate the efficacy of intracytoplasmic sperm injection (ICSI) treatment in the immunological infertile patients.

METHODS

The subjects were 60 cycles of 44 immunological infertile patients and these clinical data were analysed, retrospectively. They were classified into female and male immunological infertility group and were treated with conventional IVF, ICSI, and half-ICSI.

RESULTS

The fertilization rate of ICSI (60.3%) and half-ICSI (60.7%) cycles were significantly (P < 0.01) higher than conventional IVF (42.6%) cycles. In the male immunological infertility group, fertilization rate was significantly (P < 0.01) higher in ICSI (60.7%) and half-ICSI (66.7%) cycles than in conventional IVF (27.4%) cycles and clinical pregnancy rate was higher in ICSI (54.5%) and half ICSI (33.3%) than in conventional IVF (25.0%) cycles.

CONCLUSIONS

We suggest that ICSI treatment is highly effective method to improve fertilization and pregnancy rate in IVF-ET program of male immunological infertility.

Autoimmunogenicity of the human sperm protein Sp17 in vasectomized men and identification of linear B cell epitopes

OBJECTIVE

To assess whether human sera positive for antisperm antibodies have detectable levels of Sp17 autoantibodies and to determine the linear B cell epitopes to which these are raised for both native and recombinant Sp17.

DESIGN

Enzyme-linked immunoaborbent assays were performed against recombinant HSp17 on 15 serum samples from prevasovasostomy and postvasovasostomy patients. Positive sera then were used in mimotope analyses to determine HSp17 immunodominant linear B cell epitopes. These were compared with the linear B cell epitopes of recombinant HSp17.

SETTING

University research laboratory.

PATIENT(S)

Fifteen vasectomized or vasovasostomized men.

MAIN OUTCOME MEASURE(S)

Serum antibody reactivity to human Sp17.

RESULT(S)

Sera from vasectomized and vasovasostomized men exhibit Sp17 antibodies raised predominantly to two immunodominant linear B cell epitopes (amino acids 4 to 19 and amino acids 118 to 127), which differed from those of recombinant HSp17 (amino acids 52 to 79 and amino acids 124 to 136).

CONCLUSION(S)

The results show that Sp17 is an antigen to which vasectomized men raise autoantibodies. Two linear B cell epitopes predominate in native Sp17 and these differ from (but overlap with) those of the bacterially expressed recombinant protein.

The role of antisperm antibodies in infertility

OBJECTIVE

To discuss the role of antisperm antibodies (Ab) in infertility, including proposed mechanisms of antisperm Ab formation, assays for their detection, and treatments for immune-mediated infertility.

DESIGN

Major studies in the published literature and data from The University of Texas Southwestern Medical Center, Division of Reproductive Endocrinology. Reports were reviewed that investigated the development and impact of alloimmunity and autoimmunity to spermatozoa in men and alloimmunity in women and the current methods of treatment for resultant subfertility.

RESULTS

The exposure of spermatozoal antigens to the mucosal and systemic immune systems results in development of immunity to a multiplicity of spermatozoal epitopes. The evaluation of studies that examine the role of antisperm Ab in infertility is complicated by the lack of standardization of antisperm Ab assays and the difficulty in identifying those epitopes for antisperm Ab binding that are responsible for subfertility. Sperm-associated antisperm Ab and antisperm Ab in cervical mucus (CM) reduce sperm mobility and may also impair sperm-ovum interaction. The clinical significance of serum antisperm Ab in both men and women, however, is controversial. Current therapy for antisperm Ab associated infertility is empiric and largely unproven.

CONCLUSIONS

Antisperm Ab on the sperm surface and in CM are implicated in the pathogenesis of a subset of patients with infertility. Further studies that determine the clinically relevant sites of antisperm Ab interaction will aid in directing the treatment of subfertility mediated by antisperm Ab.

Effect of sperm-associated antibodies on the dynamics of sperm movement and on the acrosome reaction of human spermatozoa

Anti-sperm antibodies were eluted from the sperm cell fraction of autoimmune human ejaculates and transferred onto normal motile spermatozoa. The movement and the acrosomal status of these antibody-coated spermatozoa were evaluated after incubation in a capacitating medium. The amplitude of lateral head displacement (ALH) and the straight line velocity (VSL) were analyzed using an HTM automated motility analyser. Acrosomal loss was monitored by an FITC-conjugated lectin binding technique. During the 6-h incubation in BWW-BSA medium, antibody-free and antibody-coated spermatozoa exhibited significant changes of ALH and VSL distribution that evolved differently in the two populations. The dynamics of sperm movement in control spermatozoa were apparently modified by the presence of antibodies on the sperm membrane. The low percentage of spontaneous acrosomal loss obtained in control populations, even after 20 h of incubation, was not modified by the presence of antibodies on spermatozoa. However, the same antibodies decreased the acrosomal loss induced by a calcium ionophore after 3 h of incubation in capacitating conditions. These results suggest that sperm capacitation and acrosome reaction, considered as essential for successful fertilization, can be altered by antisperm antibodies present on human ejaculated spermatozoa.