Genomic testing for copy number and single nucleotide variants in spermatogenic failure

PURPOSE

To identify clinically significant genomic copy number (CNV) and single nucleotide variants (SNV) in males with unexplained spermatogenic failure (SPGF).

MATERIALS AND METHODS

Peripheral blood DNA from 97/102 study participants diagnosed with oligozoospermia, severe oligozoospermia, or non-obstructive azoospermia (NOA) was analyzed for CNVs via array comparative genomic hybridization (aCGH) and SNVs using whole-exome sequencing (WES).

RESULTS

Of the 2544 CNVs identified in individuals with SPGF, > 90% were small, ranging from 0.6 to 75 kb. Thirty, clinically relevant genomic aberrations, were detected in 28 patients (~ 29%). These included likely diagnostic CNVs in 3/41 NOA patients (~ 7%): 1 hemizygous, intragenic TEX11 deletion, 1 hemizygous DDX53 full gene deletion, and 1 homozygous, intragenic STK11 deletion. High-level mosaicism for X chromosome disomy (~ 10% 46,XY and ~ 90% 47,XXY) was also identified in 3 of 41 NOA patients who previously tested normal with conventional karyotyping. The remaining 24 CNVs detected were heterozygous, autosomal recessive carrier variants. Follow-up WES analysis confirmed 8 of 27 (30%) CNVs (X chromosome disomy excluded). WES analysis additionally identified 13 significant SNVs and/or indels in 9 patients (~ 9%) including X-linked AR, KAL1, and NR0B1 variants.

CONCLUSION

Using a combined genome-wide aCGH/WES approach, we identified pathogenic and likely pathogenic SNVs and CNVs in 15 patients (15%) with unexplained SPGF. This value equals the detection rate of conventional testing for aneuploidies and is considerably higher than the prevalence of Y chromosome microdeletions. Our results underscore the importance of comprehensive genomic analysis in emerging diagnostic testing of complex conditions like male infertility.

Reaching the "Hard-to-Reach" Sexual and Gender Diverse Communities for Population-Based Research in Cancer Prevention and Control: Methods for Online Survey Data Collection and Management

PURPOSE

Around 5% of United States (U.S.) population identifies as Sexual and Gender Diverse (SGD), yet there is limited research around cancer prevention among these populations. We present multi-pronged, low-cost, and systematic recruitment strategies used to reach SGD communities in New Mexico (NM), a state that is both largely rural and racially/ethnically classified as a "majority-minority" state.

METHODS

Our recruitment focused on using: (1) Every Door Direct Mail (EDDM) program, by the United States Postal Services (USPS); (2) Google and Facebook advertisements; (3) Organizational outreach via emails to publicly available SGD-friendly business contacts; (4) Personal outreach via flyers at clinical and community settings across NM. Guided by previous research, we provide detailed descriptions on using strategies to check for fraudulent and suspicious online responses, that ensure data integrity.

RESULTS

A total of 27,369 flyers were distributed through the EDDM program and 436,177 impressions were made through the Google and Facebook ads. We received a total of 6,920 responses on the eligibility survey. For the 5,037 eligible respondents, we received 3,120 (61.9%) complete responses. Of these, 13% (406/3120) were fraudulent/suspicious based on research-informed criteria and were removed. Final analysis included 2,534 respondents, of which the majority (59.9%) reported hearing about the study from social media. Of the respondents, 49.5% were between 31-40 years, 39.5% were Black, Hispanic, or American Indian/Alaskan Native, and 45.9% had an annual household income below $50,000. Over half (55.3%) were assigned male, 40.4% were assigned female, and 4.3% were assigned intersex at birth. Transgender respondents made up 10.6% (n=267) of the respondents. In terms of sexual orientation, 54.1% (n=1371) reported being gay or lesbian, 30% (n=749) bisexual, and 15.8% (n=401) queer. A total of 756 (29.8%) respondents reported receiving a cancer diagnosis and among screen-eligible respondents, 66.2% reported ever having a Pap, 78.6% reported ever having a mammogram, and 84.1% reported ever having a colonoscopy. Over half of eligible respondents (58.7%) reported receiving Human Papillomavirus vaccinations.

CONCLUSION

Study findings showcase effective strategies to reach communities, maximize data quality, and prevent the misrepresentation of data critical to improve health in SGD communities.

Reaching the "Hard-to-Reach" Sexual and Gender Diverse Communities for Population-Based Research in Cancer Prevention and Control: Methods for Online Survey Data Collection and Management

Purpose

Around 5% of United States (U.S.) population identifies as Sexual and Gender Diverse (SGD), yet there is limited research around cancer prevention among these populations. We present multi-pronged, low-cost, and systematic recruitment strategies used to reach SGD communities in New Mexico (NM), a state that is both largely rural and racially/ethnically classified as a "majority-minority" state.

Methods

Our recruitment focused on using: (1) Every Door Direct Mail (EDDM) program, by the United States Postal Services (USPS); (2) Google and Facebook advertisements; (3) Organizational outreach via emails to publicly available SGD-friendly business contacts; (4) Personal outreach via flyers at clinical and community settings across NM. Guided by previous research, we provide detailed descriptions on using strategies to check for fraudulent and suspicious online responses, that ensure data integrity.

Results

A total of 27,369 flyers were distributed through the EDDM program and 436,177 impressions were made through the Google and Facebook ads. We received a total of 6,920 responses on the eligibility survey. For the 5,037 eligible respondents, we received 3,120 (61.9%) complete responses. Of these, 13% (406/3120) were fraudulent/suspicious based on research-informed criteria and were removed. Final analysis included 2,534 respondents, of which the majority (59.9%) reported hearing about the study from social media. Of the respondents, 49.5% were between 31-40 years, 39.5% were Black, Hispanic, or American Indian/Alaskan Native, and 45.9% had an annual household income below $50,000. Over half (55.3%) were assigned male, 40.4% were assigned female, and 4.3% were assigned intersex at birth. Transgender respondents made up 10.6% (n=267) of the respondents. In terms of sexual orientation, 54.1% (n=1371) reported being gay or lesbian, 30% (n=749) bisexual, and 15.8% (n=401) queer. A total of 756 (29.8%) respondents reported receiving a cancer diagnosis and among screen-eligible respondents, 66.2% reported ever having a Pap, 78.6% reported ever having a mammogram, and 84.1% reported ever having a colonoscopy. Over half of eligible respondents (58.7%) reported receiving Human Papillomavirus vaccinations.

Conclusion

Study findings showcase effective strategies to reach communities, maximize data quality, and prevent the misrepresentation of data critical to improve health in SGD communities.

Examining differences based on gender and sexual orientation for cervical cancer screening and prevention behaviors

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Background: Population-based studies to examine cervical cancer screening (CCS) and prevention among sexual and gender diverse (SGD) individuals have been limited. We conducted a state-wide survey in New Mexico to examine differences in CCS and HPV vaccination uptake based on gender and sexual orientation. Methods: The survey was advertised using mailed flyers, social media, and targeted internet ads across the state. We received a total of 2534 responses, of which 797 respondents were CCS eligible (i.e., between 21-65 years old, had a cervix, and did not have a prior cervical cancer diagnosis) and provided information about CCS and were included in this analysis. Descriptive statistics were conducted using SAS 9.4. Results: Of the 797 respondents, 83% were 21 - 40 years old, 44% were white, 34% reported an annual household income below $50,000, 83% were employed, 81% had health insurance, and 73% reported having a primary care provider. Fourteen percent were transgender men or nonbinary, 86% were cisgender women, 34% were bisexual, 48% were lesbian, and 18% were queer. While there were no statistical differences in self-reported CCS based on gender identity, 31% of cisgender women and 25% of transgender men and nonbinary individuals reported never receiving a Pap test. The top reason for never receiving a Pap test among cisgender women was that their healthcare provider told them they did not need it (17%) and for transgender men and nonbinary individuals the top reasons were that they had an HPV vaccine (21%) or that it was too painful, unpleasant, or embarrassing (21%). There were significant statistical differences based on sexual orientation for receiving a Pap test (p < 0.001) and for being up to date on screening (Pap test in the past 3 years, a co-test, or primary HPV test in the past 5 years) (p = 0.03). Among lesbians, 39% reported never having a Pap test, compared with 17% of bisexuals and 30% of queer individuals. For lesbians, the top reason for not receiving a Pap test was not knowing that Pap tests existed (19%), while the top reason for both bisexual and queer individuals was that their healthcare provider told them they did not need it (17% and 19%, respectively). No significant differences were noted in HPV vaccination uptake among respondents. Conclusions: In order to address sexual orientation differences noted in our study, future research is needed to explore mechanisms through which these differences operate using community-based approaches. Additionally, educational interventions inclusive of different gender identities and sexual orientations are needed to improve motivations for screening uptake among SGD individuals. Finally, specific considerations for SGD individuals should be incorporated into screening recommendations and guidelines and clearly communicated to providers, further enabling them to make recommendations for these populations.

Abstract PO-080: Reaching the “hard to reach” sexual and gender diverse communities for population-based research in cancer prevention

Purpose Despite about 5% of the US population identifying as Sexual and Gender Diverse (SGD), there is limited research on cancer prevention and control disparities in this population. In New Mexico (NM), population-level data from the Department of Health show differences in cervical and breast cancer screening uptake based on sexual orientation, but these data do not document disparities based on gender identity and for other types of cancer, prompting us to assess cancer prevention practices among NM SGD communities. SGD communities have consistently been considered “hard to reach” and much of the extant SGD studies have been conducted in large urban cities. We present findings on how to implement innovative, multi-pronged, and systematic recruitment strategies to engage SGD communities in NM, a state that is both largely rural and racially classified as “majority-minority” state. Methods Our recruitment efforts focused on four strategies: (1) Every Door Direct Mail program (by the United States Postal Services) was used to mail flyers across targeted (based on residential areas, income below $30,000, and between ages 30-71) mailing routes across NM. (2) These routes were also targeted for study-related ads via Google, Twitter, and Facebook. (3) Email outreach was conducted with SGD-friendly businesses, state cancer coalitions, and the University of New Mexico Comprehensive Cancer Center's Office of Community Outreach and Engagement. (4) Flyers were displayed at clinical and community settings across NM. All flyers, ads, and emails contained QR codes for a pre-survey that determined eligibility for participation in the main survey (i.e. 21-80 years old, NM resident, member of SGD community). Questions on the online survey, provided in both English and Spanish, inquired about the participant's demographics, body organs, physical health, vaccination history, healthcare access, and cancer screening practices. Results A total of 27,369 flyers were distributed and 436,177 impressions were made on social media, resulting in 5,080 surveys from eligible participants. Approximately 68% heard about the study from social media, 17% from email, 16% through friends or family, and 12% from flyers. All eligible participants were then emailed three times and, in a few cases, mailed a survey. This resulted in 3,115 completed surveys. Half of respondents were between 31-40 years, 38% were Black, Hispanic, or American Indian/Alaskan Native, and 48% had an annual household income below $50,000. Eighteen percent identified as lesbian, 30% gay, 28% bisexual, and 18% queer, while 48% were cisgender men, 32% cisgender women, and 13% transgender. Approximately 44% reported residing in rural areas and responses were received from 172 unique NM zip codes. Conclusion To reach state-wide SGD communities and engage them in population-based research, innovative and systematic efforts are needed. Social media and postal flyers may provide successful recruitment opportunities with potential to use these methods for future public health interventions for these populations.

Citation Format: Prajakta Adsul, Karen Quezada, Katie Myers, Talya Jaffe, Bernard Tawfik, Emily Wu, Molly McClain, Shiraz Mishra, Miria Kano. Reaching the “hard to reach” sexual and gender diverse communities for population-based research in cancer prevention [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-080.

Diagnosis of postoperative urinary ascites using renal scintigraphy

Nuclear medicine biliary studies have been routinely used to identify bile leaks that occur after laparoscopic cholecystecomy. The use of a Tc-99m mercaptoacetyltriglycine (MAG3) renal scan to diagnose a case of urinary leakage that occurred after a laparoscopic-assisted colectomy is shown in this report. Laparoscopic surgery is widely used in place of conventional laparotomy to minimize recovery time and discomfort after surgery. The complication rate for laparoscopic colectomy has been reported as approximately 6% to 10%. In particular, ureteral leak has been reported in 2% of procedures. Ascites of unknown origin can become a diagnostic dilemma. We present a case of postoperative ascites of unknown origin that was successfully diagnosed as urinary leakage using renal scintigraphy.

Mouse autosomal homolog of DAZ, a candidate male sterility gene in humans, is expressed in male germ cells before and after puberty

Deletion of the Azoospermia Factor (AZF) region of the human Y chromosome results in spermatogenic failure. While the identity of the critical missing gene has yet to be established, a strong candidate is the putative RNA-binding protein DAZ (Deleted in Azoospermia). Here we describe the mouse homolog of DAZ. Unlike human DAZ, which is Y-linked, in mouse the Dazh (DAZ homolog) gene maps to chromosome 17. Nonetheless, the predicted amino acid sequences of the gene products are quite similar, especially in their RNP/RRM (putative RNA-binding) domains, and both genes are transcribed predominantly in testes; the mouse gene is transcribed at a lower level in ovaries. Dazh transcripts were not detected in testes of mice that lack germ cells. In testes of wildtype mice, Dazh transcription is detectable 1 day after birth (when the only germ cells are prospermatogonia), increases steadily as spermatogonial stem cells appear, plateaus as the first wave of spermatogenic cells enters meiosis (10 days after birth), and is sustained at this level thereafter. This unique pattern of expression suggests that Dazh participates in differentiation, proliferation, or maintenance of germ cell founder populations before, during, and after the pubertal onset of spermatogenesis. Such functions could readily account for the diverse spermatogenic defects observed in human males with AZF deletions.

Diverse spermatogenic defects in humans caused by Y chromosome deletions encompassing a novel RNA-binding protein gene

We have detected deletions of portions of the Y chromosome long arm in 12 of 89 men with azoospermia (no sperm in semen). No Y deletions were detected in their male relatives or in 90 other fertile males. The 12 deletions overlap, defining a region likely to contain one or more genes required for spermatogenesis (the Azoospermia Factor, AZF). Deletion of the AZF region is associated with highly variable testicular defects, ranging from complete absence of germ cells to spermatogenic arrest with occasional production of condensed spermatids. We find no evidence of YRRM genes, recently proposed as AZF candidates, in the AZF region. The region contains a single-copy gene, DAZ (Deleted in AZoospermia), which is transcribed in the adult testis and appears to encode an RNA binding protein. The possibility that DAZ is AZF should now be explored.

Genetic abnormalities and reproductive failure

Adequate male development and spermatogenesis involve a complex array of events, all prescribed by numerous gene products in an orderly temporal and spatial sequence. A single defect in any portion of these myriad steps may lead to total failure of testicular development or simply subtle spermatogenic deficiency. As emphasis continues to be placed upon elucidation of the molecular and genetic basis underlying clinical and phenotypic human failings, knowledge will slowly accumulate to explain these failings and, it is hoped, to suggest treatment strategies for some.

Pulsatile release of growth hormone and prolactin from the primate pituitary in vitro

Perifused anterior hemipituitaries from one male and 4 female monkeys released GH and PRL in a pulsatile pattern, with mean +/- SE interpulse intervals of 8.2 +/- 0.4 and 8.5 +/- 0.3 min, as determined by a cycle detection computer algorithm. Mean hormone concentrations in the perifusate fractions collected at 2-min intervals were 435 +/- 89 (GH) and 515 +/- 262 (PRL) ng/ml. Pulse amplitudes averaged 74 +/- 16 ng/ml for GH and 189 +/- 89 ng/ml for PRL. These findings suggest the presence of a high frequency pulsatile secretory mechanism within the primate pituitary.