1
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Sanchez NDRR, Ritagliati C, Kopf GS, Kretschmer S, Buck J, Levin LR. The uniqueness of on-demand male contraception. Mol Aspects Med 2024; 97:101281. [PMID: 38805792 PMCID: PMC11167369 DOI: 10.1016/j.mam.2024.101281] [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: 04/23/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024]
Abstract
Because nearly half of pregnancies worldwide are unintended, available contraceptive methods are inadequate. Moreover, due to the striking imbalance between contraceptive options available for men compared to the myriad of options available to women, there is an urgent need for new methods of contraception for men. This review summarizes ongoing efforts to develop male contraceptives highlighting the unique aspects particular to on-demand male contraception, where a man takes a contraceptive only when and as often as needed.
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Affiliation(s)
| | - Carla Ritagliati
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Jochen Buck
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA.
| | - Lonny R Levin
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
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2
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Lee KH, Hwang JY. Ca 2+ homeostasis and male fertility: a target for a new male contraceptive system. Anim Cells Syst (Seoul) 2024; 28:171-183. [PMID: 38686363 PMCID: PMC11057403 DOI: 10.1080/19768354.2024.2345647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
Ca2+ is a key secondary messenger that determines sperm motility patterns. Mammalian sperm undergo capacitation, a process to acquire fertilizing ability, in the female reproductive tract. Capacitated sperm change their flagellar waveform to develop hyperactivated motility, which is crucial for successful sperm navigation to the eggs and fertilization. The sperm-specific channel, CATSPER, and an ATPase transporter, PMCA4, serve as major paths for Ca2+ influx and efflux, respectively, in sperm. The ionic paths coordinate Ca2+ homeostasis in the sperm, and their loss-of-function impairs sperm motility, to cause male infertility. In this review, we summarize the physiological significance of these two Ca2+ gates and suggest their potential applications in novel male contraceptives.
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Affiliation(s)
- Kyung-Ha Lee
- Department of Molecular Biology, Pusan National University, Busan, South Korea
- Institute of Systems Biology, Pusan National University, Busan, South Korea
| | - Jae Yeon Hwang
- Department of Molecular Biology, Pusan National University, Busan, South Korea
- Institute of Systems Biology, Pusan National University, Busan, South Korea
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3
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Nickels L, Yan W. Nonhormonal Male Contraceptive Development-Strategies for Progress. Pharmacol Rev 2023; 76:37-48. [PMID: 38101934 PMCID: PMC10759220 DOI: 10.1124/pharmrev.122.000787] [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: 11/21/2022] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Despite the widely demonstrated public health benefits of contraception, limited contraceptive options are available for men, placing both the contraceptive burden and opportunity solely on women. This review outlines the need for an increased focus on male contraceptive development and highlights several related topics, including the perspectives of women and men on male contraceptives, historical challenges, and reasons behind the persistent delays in male contraceptive development. It also discusses the importance of serendipitous observations in drug discovery and the limitations of depleting sperm or spermatogenic cells as a contraceptive approach. It further provides an overview of ongoing research and development on novel methods, with a goal to offer insights into the multifaceted aspects of nonhormonal male contraceptive development, addressing its implications for the health of men and women. SIGNIFICANCE STATEMENT: Despite well over half a century of effort in developing male contraceptives, there are no approved male contraceptive drugs on the market. This review aims to present strategies for progress in nonhormonal male contraception based on lessons learned from history, with the hope of expediting development and bringing a male contraceptive drug closer to reality.
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Affiliation(s)
- Logan Nickels
- Male Contraceptive Initiative, Durham, North Carolina (L.N.); The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California (W.Y.); and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (W.Y.)
| | - Wei Yan
- Male Contraceptive Initiative, Durham, North Carolina (L.N.); The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California (W.Y.); and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (W.Y.)
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4
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Nand KN, Jordan TB, Yuan X, Basore DA, Zagorevski D, Clarke C, Werner G, Hwang JY, Wang H, Chung JJ, McKenna A, Jarvis MD, Singh G, Bystroff C. Bacterial production of recombinant contraceptive vaccine antigen from CatSper displayed on a human papilloma virus-like particle. Vaccine 2023; 41:6791-6801. [PMID: 37833124 DOI: 10.1016/j.vaccine.2023.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023]
Abstract
CatSper is a voltage dependent calcium ion channel present in the principal piece of sperm tail. It plays a crucial role in sperm hyperactivated motility and so in fertilization. Extracellular loops of mouse sperm CatSper were used to develop a vaccine to achieve protection from pregnancy. These loops were inserted at one of the three hypervariable regions of Human Papilloma Virus (HPV) capsid protein (L1). Recombinant vaccines were expressed in E.coli as inclusion body (IB), purified, refolded and assembled into virus-like particles (VLP) in vitro, and adsorbed on alum. Four vaccine candidates were tested in Balb/C mice. All the constructs proved immunogenic, one showed contraceptive efficacy. This recombinant contraceptive vaccine is a non-hormonal intervention and is expected to give long-acting protection from undesired pregnancies.
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Affiliation(s)
- K N Nand
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - T B Jordan
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - X Yuan
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - D A Basore
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States; Department of Health and Natural Science, Mercy University, Dobbs Ferry, NY, United States
| | - D Zagorevski
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - C Clarke
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - G Werner
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States
| | - J Y Hwang
- Dept of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, United States
| | - H Wang
- Dept of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, United States
| | - J-J Chung
- Dept of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, United States; Department of Gynecology and Obstetrics, Yale University School of Medicine, New Haven, CT, United States
| | - A McKenna
- Bioresearch Core, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - M D Jarvis
- Bioresearch Core, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - G Singh
- Bioresearch Core, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - C Bystroff
- Dept of Biological Sciences, Rensselaer Polytechnic Institute, Troy NY, United States.
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5
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Sheridan T, Gómez-Torres P, Vera Cruz G, Martínez-Pérez GZ. A global grounded theory exploration of investigators' perspectives on male hormonal contraceptive development and acceptability. Glob Public Health 2022; 17:3760-3772. [PMID: 35901059 DOI: 10.1080/17441692.2022.2102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
While best practices have been proposed on how to engage men in family planning (FP), the limited options of male hormonal contraceptives (MHC) are a barrier to reaching men as clients of FP programs. The lack of alternative MHC is preventing the global health community from providing holistic reproductive healthcare. A qualitative grounded theory study was conducted in 2020 to explore MHC experts' perceptions around the development and theoretical acceptability of MHCs. Individual in-depth interviews were conducted with 15 key informants. The informants cited evidence that there is a demand for MHC. The inability to access this data by the pharmaceutical industry was acknowledged. Many informants expressed concern of the possibility for MHC to increase male power in a predominantly patriarchal world. To most informants, at least for the initial introduction of MHC, fertility sharing is something that will largely happen among couples alone rather than individually. There is proven demand among women and men for MHC, however industries may still be reluctant to invest. Effort is needed by the sexual and reproductive health and rights community to include male engagement in FP and to advocate for the development and use of MHC as a tool for women's empowerment.
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Affiliation(s)
- Taylor Sheridan
- The Barcelona Institute for Global Health Foundation (ISGlobal), Barcelona, Spain
| | - Piedad Gómez-Torres
- Department of Physiatrics and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Germano Vera Cruz
- Department of Psychology, UR 7273 CRP-CPO, University of Picardie Jules Verne, Amiens, France
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6
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Kadiyska T, Tourtourikov I, Dabchev K, Madzharova D, Tincheva S, Spandidos DA, Zoumpourlis V. Role of testis‑specific serine kinase 1B in undiagnosed male infertility. Mol Med Rep 2022; 25:204. [PMID: 35485285 PMCID: PMC9073834 DOI: 10.3892/mmr.2022.12720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Male infertility is a global problem affecting a considerable part of the male population. Current guidelines and practices aimed at diagnosing the cause of this problem still have low diagnostic yield. As novel candidate genes for infertility emerge, their functional role needs to be investigated in patient populations. The present study aimed to investigate testis-specific serine kinase 1B (TSSK1B), which was discovered in a previously diagnosed patient. Sanger sequencing of the coding regions and exon borders of TSSK1B was performed in a cohort of 100 male Bulgarian patients with unresolved infertility causes. Missense mutations were discovered in 10% of patients and were associated with clinical data on sperm dysmorphology. Two previously unreported mutations were discovered, p.3D>N and p.52F>L. All mutations were scored via in silico predictors and protein modelling using AlphaFold2. The present findings indicated an association between TSSK1B mutations and asthenoteratozoospermia, with further missense mutations in patients with azoospermia and teratozoospermia. Mutations in TSSK1B may be a cause of undiagnosed cases of male infertility and should be considered when molecular diagnostics are warranted.
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Affiliation(s)
- Tanya Kadiyska
- Department of Physiology and Pathophysiology, Medical University, 1413 Sofia, Bulgaria
| | | | | | | | - Savina Tincheva
- Genetic Medico‑Diagnostic Laboratory 'Genica', 1612 Sofia, Bulgaria
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion 71003, Greece
| | - Vassilis Zoumpourlis
- Biomedical Applications Unit, Institute of Chemical Biology, National Hellenic Research Foundation, 11635 Athens, Greece
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7
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ChoGlueck C. Still no pill for men? Double standards & demarcating values in biomedical research. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2022; 91:66-76. [PMID: 34879317 DOI: 10.1016/j.shpsa.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 06/13/2023]
Abstract
Double standards are widespread throughout biomedicine, especially in research on reproductive health. One of the clearest cases of double standards involves the feminine gendering of reproductive responsibility for contraception and the continued lack of highly effective, reversible methods for cisgender men. While the biomedical establishment accepts diversity and inclusion as important social values for clinical trials, their continued use of inequitable standards undermines their ability to challenge unfair social hierarchies by developing male contraception. Thus, the gender/sex bias present in contraceptive research raises the "New Demarcation Problem": If we accept that values can and will play important roles in science, how can we nevertheless distinguish positive influences of values from more corrosive bias? I argue that biomedical researchers ought to aim their clinical trials at equity and utilize methodologies that actually achieve that aim. More specifically, I contend that we can avoid the problem of double standards by gender/sex in contraceptive research by utilizing more equitable standards. My demarcation strategy captures dynamic interplay between values and their effects, with direct policy implications for institutions conducting, funding, and evaluating clinical trials. For male contraceptive trials, this involves shifting risk assessment from an individual model to a shared model for sexual partners.
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Affiliation(s)
- Christopher ChoGlueck
- Department of Communication, Liberal Arts, and Social Sciences (CLASS), New Mexico Institute of Mining and Technology (New Mexico Tech), 215 Finch Hall, 801 Leroy Place, Socorro, 87801, New Mexico, USA.
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8
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Hook C, Hardee K, Shand T, Jordan S, Greene ME. A long way to go: engagement of men and boys in country family planning commitments and implementation plans. Gates Open Res 2021; 5:85. [PMID: 34136752 PMCID: PMC8187813 DOI: 10.12688/gatesopenres.13230.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: To reach global goals related to women and girls’ access to modern family planning (FP) and gender equality, evidence shows that it is critical to understand and account for the role of men and boys as users of reproductive health services, as partners for millions of women & girls around the world, and as advocates in their communities. Under the Family Planning 2020 (FP2020) partnership, countries were encouraged to develop costed implementation plans and action plans in an effort to provide 120 million additional women and girls with contraception. As FP2020 becomes FP2030, reviewing these previously-developed strategies helps understand the extent to which countries considered the engagement of men as an important aspect of their family planning portfolios. Methods: We conducted textual analysis on commitments and implementation plans related to achieving FP2020 commitments in six countries in Africa and one in Asia to determine the extent to which male engagement was incorporated into country or subnational family planning goals, with particular focus on FP policy, program, and financial commitments. Results: Some of the documents analyzed included robust plans for including male engagement in their efforts to expand access to FP. The strongest aspects of male engagement programming were those that sought to engage men as advocates for women’s access to and use of FP services, and improve their knowledge and attitudes related to contraception and reproduction. The weakest aspects were engaging men as users of services and, vitally, tackling underlying gender norms which hamper men’s and women’s health-seeking behaviors and attitudes. Conclusions: Developing FP programs that target men and boys as people deserving of reproductive health services, as partners with women in building their families, and as social activists in their communities, will complement and strengthen existing FP programs as well as promote broader goals related to gender equality.
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Affiliation(s)
| | - Karen Hardee
- What Works Association, Washington, DC, 20036, USA
| | - Tim Shand
- ShandClarke Consulting Ltd, London, UK
| | - Sandra Jordan
- Public Health Consultant, Washington, DC, 20036, USA
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9
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Hook C, Hardee K, Shand T, Jordan S, Greene ME. A long way to go: engagement of men and boys in country family planning commitments and implementation plans. Gates Open Res 2021; 5:85. [PMID: 34136752 DOI: 10.12688/gatesopenres.13230.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Evidence shows that, to reach global goals related to women and girls' access to modern family planning (FP) and gender equality, it is critical to understand and account for the role of men and boys as users of reproductive health services, as partners for millions of women & girls around the world, and as advocates in their communities. Under the Family Planning 2020 (FP2020) partnership, countries were encouraged to develop costed implementation plans and action plans in an effort to provide 120 million additional women and girls with contraception. As FP2020 becomes FP2030, reviewing these previously-developed strategies helps understand the extent to which countries considered the engagement of men as an important aspect of their family planning portfolios. Methods: We conducted textual analysis on commitments and implementation plans related to achieving FP2020 commitments in seven countries in Africa and one in Asia to determine the extent to which male engagement was incorporated into country or subnational family planning goals, with particular focus on FP policy, program, and financial commitments. Results: Some of the documents analyzed included robust plans for including male engagement in their efforts to expand access to FP. The strongest aspects of male engagement programming were those that sought to engage men as advocates for women's access to and use of FP services, and improve men's knowledge and attitudes related to contraception and reproduction. The weakest aspects were engaging men as users of services and, vitally, tackling underlying gender norms which hamper men's and women's health-seeking behaviors and attitudes. Conclusions: Developing FP programs that target men and boys as people deserving of reproductive health services, as partners with women in building their families, and as social activists in their communities, will complement and strengthen existing FP programs as well as promote broader goals related to gender equality.
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Affiliation(s)
| | - Karen Hardee
- What Works Association, Washington, DC, 20036, USA
| | - Tim Shand
- ShandClarke Consulting Ltd, London, UK
| | - Sandra Jordan
- Public Health Consultant, Washington, DC, 20036, USA
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10
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Latack KR, Yuen F, Wang C, Nguyen BT. Online community queries on hormonal male contraception: An analysis of the Reddit "Ask Me Anything" experience. Contraception 2021; 104:159-164. [PMID: 33617839 DOI: 10.1016/j.contraception.2021.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Reddit is one of the most popular websites in the United States because of its user-driven aggregation and community-based curation of online content. We describe the use and impact of Reddit's Ask Me Anything platform, for public engagement and education about developments in hormonal male contraception (HMC). METHODS We analyzed the content from and user engagement with 2 Reddit Ask Me Anything events that answered user queries about HMC in June 2018 and March 2019. Clinical trial investigators provided real-time responses throughout the events. We examined the 25 most popular posts from each event, analyzing content for salient themes via an inductive approach. To quantify event impact, we examined Google Trends data and subsequent traffic to the investigator website. RESULTS Over 18,000 registered Reddit users interacted with each of the 2 Ask Me Anything events, with each generating over 1600 comments. The most popular posts of each Ask Me Anything event expressed interest in off-target effects associated with the use of HMCs. Additional themes included queries about previous and ongoing clinical trials, HMC physiology, and market analyses and projections of public willingness to use HMCs. The events coincided with a spike in both Google searches for "male birth control" and first-time visits to the study's website where users could express interest in participating in clinical trials. CONCLUSION Reddit Ask Me Anything events conducted by HMC investigators revealed wide public interest in HMCs. The events prompted further searches for more information on male contraception, while driving traffic to the investigator website for trial recruitment purposes. IMPLICATIONS Reddit Ask Me Anything events are a popular, cost-free online platform for publicly responding to a range of HMC-related queries, while providing investigators with insight into stakeholder priorities and preoccupations.
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Affiliation(s)
- Kyle R Latack
- University of Southern California, Department of Obstetrics and Gynecology, Section of Family Planning, Los Angeles, CA, United States
| | - Fiona Yuen
- Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Christina Wang
- Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Brian T Nguyen
- University of Southern California, Department of Obstetrics and Gynecology, Section of Family Planning, Los Angeles, CA, United States.
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11
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Syeda SS, Sánchez G, McDermott JP, Hong KH, Blanco G, Georg GI. The Na+ and K+ transport system of sperm (ATP1A4) is essential for male fertility and an attractive target for male contraception†. Biol Reprod 2020; 103:343-356. [PMID: 32588885 PMCID: PMC7401355 DOI: 10.1093/biolre/ioaa093] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/19/2020] [Indexed: 01/07/2023] Open
Abstract
One of the mechanisms that cells have developed to fulfil their specialized tasks is to express different molecular variants of a particular protein that has unique functional properties. Na,K-ATPase (NKA), the ion transport mechanism that maintains the transmembrane Na+ and K+ concentrations across the plasma membrane of cells, is one of such protein systems that shows high molecular and functional heterogeneity. Four different isoforms of the NKA catalytic subunit are expressed in mammalian cells (NKAα1, NKAα2, NKAα3, and NKAα4). NKAα4 (ATP1A4) is the isoform with the most restricted pattern of expression, being solely produced in male germ cells of the testis. NKAα4 is abundant in spermatozoa, where it is required for sperm motility and hyperactivation. This review discusses the expression, functional properties, mechanism of action of NKAα4 in sperm physiology, and its role in male fertility. In addition, we describe the use of NKAα4 as a target for male contraception and a potential approach to pharmacologically block its ion transport function to interfere with male fertility.
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Affiliation(s)
- Shameem Sultana Syeda
- Department of Medicinal Chemistry, College of Pharmacy, Institute for Therapeutics Discovery and Development, University of Minnesota, Minneapolis, MN 55414, USA
| | - Gladis Sánchez
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jeffrey P McDermott
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kwon Ho Hong
- Department of Medicinal Chemistry, College of Pharmacy, Institute for Therapeutics Discovery and Development, University of Minnesota, Minneapolis, MN 55414, USA
| | - Gustavo Blanco
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Gunda I Georg
- Department of Medicinal Chemistry, College of Pharmacy, Institute for Therapeutics Discovery and Development, University of Minnesota, Minneapolis, MN 55414, USA
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12
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Yuen F, Nguyen BT, Swerdloff RS, Wang C. Continuing the search for a hormonal male contraceptive. Best Pract Res Clin Obstet Gynaecol 2020; 66:83-94. [PMID: 32197832 PMCID: PMC7375909 DOI: 10.1016/j.bpobgyn.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
Abstract
This chapter discusses the mechanisms of action of hormonal male contraception, which suppresses the hypothalamic-pituitary-testis axis. When the intratesticular concentration of testosterone is subsequently suppressed to adequately low concentrations, spermatogenesis is arrested. Androgens are a necessary hormonal male contraceptive component because they not only suppress the hypothalamic-pituitary-testis axis, but also provide the male hormone necessary to maintain peripheral androgen functions. Past studies using testosterone alone and testosterone combined with progestins demonstrated contraceptive efficacy in the female partner at rates similar to combined hormonal female methods. Newer hormonal male contraceptive formulations and the alternative routes of administration are discussed, along with potential barriers, challenges, and opportunities for hormonal male contraceptive development. Novel methods that are safe, effective, reversible, user-friendly, and coitus-independent are intrinsic to equitably meet the various needs and limitations of an increasingly diverse population.
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Affiliation(s)
- Fiona Yuen
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA.
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90007, USA.
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA.
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13
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Khourdaji I, Zillioux J, Eisenfrats K, Foley D, Smith R. The future of male contraception: a fertile ground. Transl Androl Urol 2018; 7:S220-S235. [PMID: 29928620 PMCID: PMC5989114 DOI: 10.21037/tau.2018.03.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The continued and rapid expansion of the Earth’s population mandates the need for safe and effective measures of contraception. While a plethora of options exist for women, methods of contraception for the male partner are limited to condoms and vasectomy. The sequela of this discrepancy has led to the family planning burden falling disproportionately on the female partner. For the past several decades, extensive research has been undertaken exploring the feasibility of hormonal male contraception. This proposed method of contraception has focused on suppressing spermatogenesis by exploiting the hypothalamic-pituitary-gonadal (HPG) axis. Beginning with proof of concept studies in the early nineties, administration of testosterone in healthy male subjects has been shown to be an efficacious method of inducing sterility. Owing to ethnic differences in spermatogenesis suppression and the comparatively low rate of azoospermia in Caucasian men with androgen-only regimens, investigators have explored the addition of progestins to further enhance the efficacy of hormonal contraception. Though studies have revealed promise with androgen-progestin regimens, the lack of long-term studies has precluded the development of a marketable product. Recently, more research has been directed towards identifying non-hormonal alternatives to male contraception. These non-hormonal options have ranged from the development of devices facilitating reversible occlusion of the vas deferens lumen to medications disrupting various pathways in the process of spermatogenesis. Underlying the development of hormonal and non-hormonal strategies is the shared enthusiasm men and women have towards these male directed methods. The willingness of couples to pursue these alternatives combined with the global need to reduce the psychological and socioeconomic implications of unintended pregnancy ensures that research will continue to bring this goal to fruition.
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Affiliation(s)
- Iyad Khourdaji
- Department of Urology, University of Virginia Healthcare System, Charlottesville, VA, USA
| | - Jacqueline Zillioux
- Department of Urology, University of Virginia Healthcare System, Charlottesville, VA, USA
| | | | - Daniel Foley
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ryan Smith
- Department of Urology, University of Virginia Healthcare System, Charlottesville, VA, USA.,Contraline, Inc., Charlottesville, VA, USA.,University of Virginia School of Medicine, Charlottesville, VA, USA
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14
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Syeda SS, Sánchez G, Hong KH, Hawkinson JE, Georg GI, Blanco G. Design, Synthesis, and in Vitro and in Vivo Evaluation of Ouabain Analogues as Potent and Selective Na,K-ATPase α4 Isoform Inhibitors for Male Contraception. J Med Chem 2018; 61:1800-1820. [PMID: 29291372 PMCID: PMC5846083 DOI: 10.1021/acs.jmedchem.7b00925] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
![]()
Na,K-ATPase α4 is a testis-specific
plasma membrane Na+ and K+ transporter expressed
in sperm flagellum.
Deletion of Na,K-ATPase α4 in male mice results in complete
infertility, making it an attractive target for male contraception.
Na,K-ATPase α4 is characterized by a high affinity for the cardiac
glycoside ouabain. With the goal of discovering selective inhibitors
of the Na,K-ATPase α4 and of sperm function, ouabain derivatives
were modified at the glycone (C3) and the lactone (C17) domains. Ouabagenin
analogue 25, carrying a benzyltriazole moiety at C17,
is a picomolar inhibitor of Na,K-ATPase α4, with an outstanding
α4 isoform selectivity profile. Moreover, compound 25 decreased sperm motility in vitro and in vivo and affected sperm
membrane potential, intracellular Ca2+, pH, and hypermotility.
These results proved that the new ouabagenin triazole analogue is
an effective and selective inhibitor of Na,K-ATPase α4 and sperm
function.
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Affiliation(s)
- Shameem Sultana Syeda
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy , University of Minnesota , Minneapolis , Minnesota 55414 , United States
| | - Gladis Sánchez
- Department of Molecular and Integrative Physiology , University of Kansas Medical Center , Kansas City , Kansas 66160 , United States
| | - Kwon Ho Hong
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy , University of Minnesota , Minneapolis , Minnesota 55414 , United States
| | - Jon E Hawkinson
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy , University of Minnesota , Minneapolis , Minnesota 55414 , United States
| | - Gunda I Georg
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy , University of Minnesota , Minneapolis , Minnesota 55414 , United States
| | - Gustavo Blanco
- Department of Molecular and Integrative Physiology , University of Kansas Medical Center , Kansas City , Kansas 66160 , United States
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15
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Waller D, Bolick D, Lissner E, Premanandan C, Gamerman G. Reversibility of Vasalgel™ male contraceptive in a rabbit model. Basic Clin Androl 2017; 27:8. [PMID: 28417005 PMCID: PMC5381074 DOI: 10.1186/s12610-017-0051-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/01/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Development of a non-hormonal long-acting reversible contraceptive for men could have a significant impact on reducing unintended pregnancies. Vasalgel™ is a high molecular weight polymer consisting of styrene-alt-maleic acid (SMA) dissolved in dimethyl sulfoxide being developed as a reversible male contraceptive device. It forms a hydrogel when implanted into the vasa deferentia, which prevents the passage of sperm. Previous studies in the rabbit have proven its efficacy, durability and rapid onset. This study evaluates the capacity to restore sperm concentrations in ejaculates after a reversal procedure. METHODS Sodium bicarbonate was injected into the vasa deferentia after fourteen months of azoospermia following the injection of two device variations (Vasalgel 100 and Vasalgel 80). Semen samples were then collected for six months and sperm characteristics were compared to baseline levels. Samples of vasa deferentia were obtained for histological examination. RESULTS Spermatozoa were present in all subject ejaculates after the reversal procedure. Sperm concentration and sperm motility were similar to baseline levels after reversal, while sperm forward progression was significantly lower and normal acrosomes were not observed. Forward progression percentages increased linearly during six months of semen collection, however, normal acrosomes were not observed at the conclusion of the study. Histologically, several vasa deferentia were clear of the device and contained an intact epithelial lining. A smaller proportion of tissues contained residual test material. A secondary intraluminal inflammatory response was seen occasionally in the tissues containing residual material. There was no difference between the two device variations for studied parameters. CONCLUSIONS Vasalgel's prevention of sperm transport for 14 months was reversed through an intravasal injection of sodium bicarbonate. Post-reversal sperm concentrations and motility returned to baseline levels during the six-month follow up. Residual material in the vas lumen or compromised epididymal and vas deferens function may be resulting in reduced forward progression and loss of acrosomes during transit through the vas. Reduced forward progression and the lack of normal acrosomes strongly suggest impaired sperm function.
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Affiliation(s)
- Donald Waller
- Prelabs, LLC, 33 W Chicago Ave., Oak Park, IL 60302 USA
| | - David Bolick
- Seraphim Life Sciences Consulting, LLC, 2158 Bonaventure Drive, Suite 101, Vienna, VA 22181 USA
| | - Elaine Lissner
- Parsemus Foundation, PO Box 2246, Berkeley, CA 94702 USA
| | - Christopher Premanandan
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, 1925 Coffey Road, Columbus, OH 43215 USA
| | - Gary Gamerman
- Seraphim Life Sciences Consulting, LLC, 2158 Bonaventure Drive, Suite 101, Vienna, VA 22181 USA
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16
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Hardee K, Croce-Galis M, Gay J. Are men well served by family planning programs? Reprod Health 2017; 14:14. [PMID: 28115004 PMCID: PMC5260026 DOI: 10.1186/s12978-017-0278-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/04/2017] [Indexed: 11/24/2022] Open
Abstract
Although the range of contraceptives includes methods for men, namely condoms, vasectomy and withdrawal that men use directly, and the Standard Days Method (SDM) that requires their participation, family planning programming has primarily focused on women. What is known about reaching men as contraceptive users? This paper draws from a review of 47 interventions that reached men and proposes 10 key considerations for strengthening programming for men as contraceptive users. A review of programming shows that men and boys are not particularly well served by programs. Most programs operate from the perspective that women are contraceptive users and that men should support their partners, with insufficient attention to reaching men as contraceptive users in their own right. The notion that family planning is women’s business only is outdated. There is sufficient evidence demonstrating men’s desire for information and services, as well as men’s positive response to existing programming to warrant further programming for men as FP users. The key considerations focus on getting information and services where men and boys need it; addressing gender norms that affect men’s attitudes and use while respecting women’s autonomy; reaching adolescent boys; including men as users in policies and guidelines; scaling up successful programming; filling gaps with implementation research and monitoring & evaluation; and creating more contraceptive options for men.
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Affiliation(s)
- Karen Hardee
- Population Council, 4301 Connecticut Ave NW, Ste. 280, Washington, DC, 20008, USA.
| | | | - Jill Gay
- What Works Association, 54 Mills St, Morristown, New Jersey, 07960, USA
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17
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Chung SSW, Wang X, Wolgemuth DJ. Prolonged Oral Administration of a Pan-Retinoic Acid Receptor Antagonist Inhibits Spermatogenesis in Mice With a Rapid Recovery and Changes in the Expression of Influx and Efflux Transporters. Endocrinology 2016; 157:1601-12. [PMID: 26812157 PMCID: PMC4816726 DOI: 10.1210/en.2015-1675] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We have previously shown that oral administration of a pan-retinoic acid receptor antagonist in mice daily at 2.5 mg/kg for 4 weeks reversibly inhibited spermatogenesis, with no detectable side effects. To elucidate the lowest dose and the longest dosing regimen that inhibits spermatogenesis but results in complete restoration of fertility upon cessation of administration of the drug, we examined the effects of daily doses as low as 1.0 mg/kg with dosing periods of 4, 8, and 16 weeks. We observed 100% sterility in all regimens, with restoration of fertility upon cessation of the drug treatment even for as long as 16 weeks. There was no change in testosterone levels in these males and the progeny examined from 2 of the recovered males were healthy and fertile, with normal testicular weight and testicular histology. Strikingly, a more rapid recovery, as assessed by mating studies, was observed at the lower dose and longer dosing periods. Insight into possible mechanisms underlying this rapid recovery was obtained at 2 levels. First, histological examination revealed that spermatogenesis was not as severely disrupted at the lower dose and with the longer treatment regimens. Second, gene expression analysis revealed that the more rapid recovery may involve the interplay of ATP-binding cassette efflux and solute carrier influx transporters in the testes.
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Affiliation(s)
- Sanny S W Chung
- Departments of Genetics and Development (S.S.W.C., X.W., D.J.W.) and Obstetrics and Gynecology (D.J.W.), The Institute of Human Nutrition (D.J.W.), and The Herbert Irving Comprehensive Cancer Center (D.J.W.), Columbia University Medical Center, New York, New York 10032
| | - Xiangyuan Wang
- Departments of Genetics and Development (S.S.W.C., X.W., D.J.W.) and Obstetrics and Gynecology (D.J.W.), The Institute of Human Nutrition (D.J.W.), and The Herbert Irving Comprehensive Cancer Center (D.J.W.), Columbia University Medical Center, New York, New York 10032
| | - Debra J Wolgemuth
- Departments of Genetics and Development (S.S.W.C., X.W., D.J.W.) and Obstetrics and Gynecology (D.J.W.), The Institute of Human Nutrition (D.J.W.), and The Herbert Irving Comprehensive Cancer Center (D.J.W.), Columbia University Medical Center, New York, New York 10032
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18
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Waller D, Bolick D, Lissner E, Premanandan C, Gamerman G. Azoospermia in rabbits following an intravas injection of Vasalgel ™. Basic Clin Androl 2016; 26:6. [PMID: 27030808 PMCID: PMC4812607 DOI: 10.1186/s12610-016-0033-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vasectomy is currently the only long-acting contraceptive option available for men, despite increasing demand and potentially significant positive impacts on human health of additional male contraceptive options. Vasalgel ™ is a high molecular weight hydrogel polymer being developed as a non-hormonal long-acting reversible male contraceptive. Vasalgel consists of styrene-alt-maleic acid dissolved in dimethyl sulfoxide, which is distinct from styrene-alt-maleic anhydride materials previously studied. METHODS The goal of the study was to determine the contraceptive efficacy of two test articles with different levels of styrene maleic acid (100 %, and 80 % acid/20 % anhydride). The test articles were injected bilaterally in the vasa deferentia of mature male rabbits. Post-implantation analyses of semen parameters were completed over a 12 month period and compared to baseline measures of sperm concentration, motility and forward progression. RESULTS Both test articles were effective in blocking the passage of spermatozoa through the vasa deferentia in the 12 subjects completing the study. A significant decrease in sperm concentration occurred following implantation of the test material, with no measurable sperm concentration except for a few samples in one animal that were markedly oligospermic. Vasalgel produced a rapid onset of azoospermia, with no sperm in semen samples collected as early as 29-36 days post-implantation, and was durable over a 12 month period. CONCLUSION This study indicated that Vasalgel is an effective non-hormonal long-acting male contraceptive in a rabbit model.
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Affiliation(s)
- Donald Waller
- />Prelabs, LLC Inc., 33 W Chicago Ave., Oak Park, IL 60302 USA
| | - David Bolick
- />Seraphim Life Sciences Consulting, LLC, 2158 Bonaventure Drive, Suite 101, Vienna, VA 22181 USA
| | - Elaine Lissner
- />Parsemus Foundation, PO Box 2246, Berkeley, CA 94702 USA
| | - Christopher Premanandan
- />Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, 1925 Coffey Road, Columbus, OH 43215 USA
| | - Gary Gamerman
- />Seraphim Life Sciences Consulting, LLC, 2158 Bonaventure Drive, Suite 101, Vienna, VA 22181 USA
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19
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Abstract
Hormonal male contraception clinical trials began in the 1970s. The method is based on the use of exogenous testosterone alone or in combination with a progestin to suppress the endogenous production of testosterone and spermatogenesis. Studies using testosterone alone showed that the method was very effective with few adverse effects. Addition of a progestin increases the rate and extent of suppression of spermatogenesis. Common adverse effects include acne, injection site pain, mood change including depression, and changes in libido that are usually mild and rarely lead to discontinuation. Current development includes long-acting injectables and transdermal gels and novel androgens that may have both androgenic and progestational activities. Surveys showed that over 50 % of men will accept a new male method and female partners will trust their partner to take oral “male pills.” Partnership between government, nongovernment agencies, academia, and industry may generate adequate interest and collaboration to develop and market the first male hormonal contraception.
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20
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Roth MY, Page ST, Bremner WJ. Male hormonal contraception: looking back and moving forward. Andrology 2015; 4:4-12. [PMID: 26453296 DOI: 10.1111/andr.12110] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/11/2015] [Accepted: 08/26/2015] [Indexed: 11/26/2022]
Abstract
Despite numerous contraceptive options available to women, approximately half of all pregnancies in the United States and worldwide are unplanned. Women and men support the development of reversible male contraception strategies, but none have been brought to market. Herein we review the physiologic basis for male hormonal contraception, the history of male hormonal contraception development, currents agents in development as well as the potential risks and benefits of male hormonal contraception for men.
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Affiliation(s)
- M Y Roth
- Department of Medicine and Center for Research in Reproduction and Contraception, University of Washington, Seattle, WA, USA
| | - S T Page
- Department of Medicine and Center for Research in Reproduction and Contraception, University of Washington, Seattle, WA, USA
| | - W J Bremner
- Department of Medicine and Center for Research in Reproduction and Contraception, University of Washington, Seattle, WA, USA
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21
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Plana O. Male Contraception: Research, New Methods, and Implications for Marginalized Populations. Am J Mens Health 2015. [PMID: 26206159 DOI: 10.1177/1557988315596361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The majority of research on contraception has focused on manipulating the female reproductive system. Recent studies have identified novel contraceptives for males, including hormonal- and nonhormonal-based therapeutics. Although these new contraceptives are still undergoing clinical trials, their development and potential future use in society necessitate serious consideration of their implications for reproductive health. Through my analysis of the research conducted on male contraception over time and the current therapeutics available, it is clear that male contraception has the potential to shift societal gender dynamics and provide males with greater control over their own reproduction. This article also identifies the implications of these novel contraceptives for marginalized populations, especially men of color and men of lower socioeconomic positions. To overcome barriers to contraception among these populations, public policy efforts are needed in order to motivate the development of programs that facilitate coverage of these new male contraceptives by health plans and to increase their availability to underserved communities. Health care providers will be responsible for educating patients about these novel male contraception options and the need to continue using existing methods (e.g., condoms) in order to prevent sexually transmitted infections. This article analyzes the research conducted on male contraception and identifies the implications of these novel therapeutics for marginalized groups of men in the United States to identify the interventions that will be necessary to help ensure that all men have access to these promising scientific innovations.
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22
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Zhou B, Wang P, Zhang K, Jin FS, Li YF, Zhang J, Sun ZY. Reduction of fertility in male mice immunised with pSG.SS.C3d3.YL.Bin1b recombinant vaccine. EUR J CONTRACEP REPR 2015; 20:372-8. [DOI: 10.3109/13625187.2015.1021771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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23
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Serfaty D. A plea for male contraception. EUR J CONTRACEP REPR 2015; 20:75-6. [PMID: 25738315 DOI: 10.3109/13625187.2015.1020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- David Serfaty
- ICMC Coordinator, Hôpital Saint-Louis , Paris , France
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24
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Nguyen BT, Shih G, Turok DK. Putting the man in contraceptive mandate. Contraception 2013; 89:3-5. [PMID: 24210279 DOI: 10.1016/j.contraception.2013.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/28/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Box L466, Portland, OR 97239, USA.
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25
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Abstract
Human spermatozoa are highly complex specialized cells designed to survive a long and perilous journey from the site of insemination to the upper reaches of the female reproductive tract where fertilization occurs. During this journey, these cells have to run the gauntlet laid down by the female immune system and time their physiological maturation so that as soon as an egg appears in the Fallopian tube, they are equipped to recognize this cell and participate in a remarkable cascade of cellular interactions culminating in fertilization. Despite their high level of specialization, human spermatozoa are notoriously inadequate and appear to be major contributors to the poor fertility that characterizes our species. Defective spermatozoa are also known to have a major impact on the progress of pregnancy and the health trajectory of the offspring, resulting in paternally mediated increases in miscarriage rate and a range of diseases in the progeny, including dominant genetic diseases and cancer. The causes of defective sperm function are complex and involve both genetic and environmental impacts, as well as paternal age. Where genetic factors are involved, there is a concern that the widespread use of assisted conception technologies will serve to enhance the retention of poor fertility genes in the population such that the more we use assisted reproductive technologies in one generation the more we shall need them in the next. These observations may have important implications for the health and well-being of children and for the provision of reproductive healthcare services for future generations.
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