1
|
Li Q, Lan QY, Zhu WB, Fan LQ, Huang C. Fertility preservation in adult male patients with cancer: a systematic review and meta-analysis. Hum Reprod Open 2024; 2024:hoae006. [PMID: 38389980 PMCID: PMC10882264 DOI: 10.1093/hropen/hoae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/09/2024] [Indexed: 02/24/2024] Open
Abstract
STUDY QUESTION Does sperm cryopreservation serve as a feasible and effective method for preserving fertility in adult male patients with cancer? SUMMARY ANSWER Sperm cryopreservation is an effective fertility preservation method and may benefit patients with cancer. WHAT IS KNOWN ALREADY Sperm cryopreservation is the only way to efficiently preserve male fertility. It is an important procedure in ART. Recently, due to remarkable advances in cancer treatment, an increasing number of studies have reported the outcomes of sperm cryopreservation in patients with cancer. STUDY DESIGN SIZE DURATION We conducted an extensive literature search for relevant studies published through to 31 December 2021, in the following databases: CENTRAL, CNKI, Cochrane Systematic Reviews, EMBASE, MEDLINE, PUBMED, and Web of Science. The search terms used were '(cryopreservation OR freeze OR freezing OR banking OR cryostorage OR storage) AND (sperm OR semen OR spermatozoon) AND (cancer OR tumor OR malignancy OR neoplasm)'. PARTICIPANTS/MATERIALS SETTING METHODS We included all studies that reported offering or attempting to cryopreserve sperm before or during cancer treatment in male patients considered at risk of treatment-related fertility impairment. We evaluated the eligibility of all data in each study. The major exclusion criteria were as follows: non-cancer patients; pediatric and adolescent cancer patients; not reporting the use of cryopreserved sperm; use of fresh semen for ART; not reporting the number of patients with cancer offered sperm cryopreservation or attempting to do so before or during treatment; using an experimental fertility preservation technique such as preservation of testicular tissue or spermatogonial stem cells; duplicate data; abstracts, case report, comments, reviews, or editorials; insufficient data reported. The quality of the included studies was assessed using the Newcastle-Ottawa scale and the Methodological Index for Non-Randomized Studies. MAIN RESULTS AND THE ROLE OF CHANCE This meta-analysis included 69 non-randomized studies, with 32 234 patients referred for sperm analysis and 23 178 patients cryopreserving at least one sperm sample. The pooled failed-to-cryopreserve rate was 10% (95% CI, 8-12%), and the sperm disposal and sperm use rates were 23% (95% CI, 16-30%) and 9% (95% CI, 8-10%), respectively. The pregnancy, miscarriage, and delivery rates were 28% (95% CI, 22-33%), 13% (95% CI, 10-17%), and 20% (95% CI, 15-25%), respectively. Subgroup analysis showed higher pregnancy and delivery rates, as well as a lower failed-to-cryopreserve rate, in recent studies compared to those released a decade ago. The studies from Asia reported higher sperm disposal and pregnancy rates than in other continents. Our analysis showed clinical pregnancy rates per cycle of 34% (27-41%), 24% (14-35%), and 9% (5-15%) and delivery rates per cycle of 23% (17-30%), 18% (11-26%), and 5% (1-9%) for ICSI, IVF, and IUI, respectively. LIMITATIONS REASONS FOR CAUTION As with all meta-analyses, some limitations should be considered. The first limitation of our study is that the data span 36 years. During this time, the World Health Organization has revised its sperm analysis standards, and other important changes have been made. There is also a limitation in that the outcome does not analyze the correlation between the type of cancer and sperm quality. Many of the earlier studies were limited by small sample sizes and a lack of control groups. Furthermore, almost all studies did not consider the severity of the disease, which could potentially have a substantial impact on the results. Consequently, further research should evaluate the effect of the type of cancer and, in particular, the severity of the condition on sperm quality in order to draw more precise conclusions. Similarly, it is inappropriate that most studies failed to differentiate between patients with different types of tumors and instead drew generalized conclusions that are presumed to apply to all patients with cancer. In the present analysis, we did not have in-depth information on patients' disease, and although extensive efforts were made to conduct a thorough systematic review and meta-analysis of the outcomes for patients with various types of tumors, the results must be acknowledged as being subject to bias. However, the use of average results obtained in each study, without the patient-level data, might also represent a source of bias. WIDER IMPLICATIONS OF THE FINDINGS Sperm cryopreservation is an effective fertility preservation method and may benefit patients with cancer. The observed utilization rate of frozen sperm at 9% may underestimate the actual usage, as the short follow-up period is inadequate for obtaining comprehensive data on the use of frozen sperm in young cancer survivors. ART plays an important role in fertility preservation and the achievement of pregnancy, with this meta-analysis showing that ICSI delivers better clinical outcomes than IVF or IUI in patients with cancer undergoing fertility preservation. STUDY FUNDING/COMPETING INTERESTS This work was supported by the National Natural Science Foundation of China (grant no. 82001634, 81960550), and the China Postdoctoral Science Foundation (2019M661521). There are no competing interests to declare. REGISTRATION NUMBER CRID 42022314460.
Collapse
Affiliation(s)
- Qing Li
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Qiong-Yu Lan
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Wen-Bing Zhu
- Human Sperm Bank, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China
- The Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, Hunan, People's Republic of China
| | - Li-Qing Fan
- Human Sperm Bank, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China
- The Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, Hunan, People's Republic of China
| | - Chuan Huang
- Human Sperm Bank, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, People's Republic of China
- The Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha, Hunan, People's Republic of China
| |
Collapse
|
2
|
Vesztergom D, Takács T, Bíró K, Polgár C, Krádi A, Varga S, Novák Z, Kopa Z. [Fertility preservation of adult and prepubertal male cancer patients]. Orv Hetil 2023; 164:2016-2023. [PMID: 38142451 DOI: 10.1556/650.2023.32953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 12/26/2023]
Abstract
Bár a fiúgyermekeket, illetve a fertilis korú férfiakat érintő daganatos
megbetegedések száma világszerte emelkedik, az onkológiai kezelések
eredményessége folyamatosan javul. Ennek következtében jelentősen
felértékelődött a terápiát követő életminőség, és ezen belül, kiemelten, a
nemzőképesség megőrzése. Magyarországon még nem áll rendelkezésre egységes
fertilitásprezervációs szakmai irányelv, betegirányítási rendszer és dedikált
infrastruktúra. A szerzők áttekintik a legfrissebb, irányadó nemzetközi és hazai
szakirodalmi adatokat, és elemzik az érintett szakterületeken szerzett hazai
tapasztalatokat. Ezek ismeretében írnak a fiúgyermekek és a fertilis korú
férfiak onkológiai kezelésének fertilitási kockázatairól, a számukra elérhető
nemzőképességi prezervációs módszerekről, külön kitérve a prae-, illetve
peripubertas-korú fiúkra, valamint a heredaganatok esetén alkalmazható
eljárásokra. Eredményeik multidiszciplináris szemléletet tükröző ismertetése
szakmai ajánlás alapját képezheti. Pubertas utáni életkorú férfiaknál a
fertilitás megőrzésének leghatékonyabb módja az onkológiai kezelést megelőző
spermium-mélyfagyasztás, melyet ejakulációs képtelenség esetén asszisztált
ejakulációs technikák vagy sebészi spermiumnyerés egészíthet ki. Adolescens korú
férfiaknál is lehet spermium-mélyfagyasztás, de ez a mintaadás miatt sokszor
nehézségbe ütközik. Ilyen esetekben, illetve prae- vagy peripubertaskorban
(ejakuláció hiányában) műtéti úton nyert hímivarsejtek vagy spermatogenetikus
őssejtek krioprezervációja végezhető. A spermatogenetikus őssejtek
vonatkozásában a későbbi felhasználás lehetőségei jelenleg experimentális
jellegűek. Speciális megközelítést igényelnek a heredaganatos páciensek.
Megállapításaik alapján egyértelműen szükséges egy egységes szakmai irányelv
szerint, az andrológiai és onkológiai team szoros együttműködésén alapuló
fertilitásprezervációs rendszer kialakítása, amelyhez a megfelelő hely
biztosítása, a humánerőforrás képzése mellett az infrastrukturális,
finanszírozási és jogi környezet megteremtése is szükséges. Tekintve, hogy
hazánkban az onkológiai kezelésre szoruló fiúgyermekek és fertilis korú férfiak
nemzőképesség-megőrzésének mértéke elmarad az ideálistól, egyéni és társadalmi
szempontból is kiemelten fontos, hogy a legkorszerűbb eljárásokhoz az érintett
betegek megfelelő helyen és módon hozzáférjenek. Orv Hetil. 2023; 164(51):
2016–2023.
Collapse
Affiliation(s)
- Dóra Vesztergom
- 1 Országos Kórházi Főigazgatóság, Humán Reprodukciós Igazgatóság Budapest Magyarország
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Klinikai Orvostudományi Doktori Iskola Szeged Magyarország
- 6 Semmelweis Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Klinika, Asszisztált Reprodukciós Centrum Budapest Magyarország
| | - Tamás Takács
- 6 Semmelweis Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Klinika, Asszisztált Reprodukciós Centrum Budapest Magyarország
| | | | - Csaba Polgár
- 4 Országos Onkológiai Intézet Budapest Magyarország
- 7 Semmelweis Egyetem, Általános Orvostudományi Kar, Onkológiai Tanszék Budapest Magyarország
| | - Anna Krádi
- 1 Országos Kórházi Főigazgatóság, Humán Reprodukciós Igazgatóság Budapest Magyarország
| | - Szilvia Varga
- 5 Országos Onkológiai Intézet, Sugárterápiás Központ Budapest Magyarország
| | - Zoltán Novák
- 2 Országos Onkológiai Intézet, Nőgyógyászati Osztály Budapest Magyarország
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Klinikai Orvostudományi Doktori Iskola Szeged Magyarország
| | - Zsolt Kopa
- 8 Semmelweis Egyetem, Általános Orvostudományi Kar, Urológiai Klinika, Andrológiai Centrum 1082 Budapest, Korányi S. u. 2. Magyarország
| |
Collapse
|
3
|
Younis N, Caldeira-Brant AL, Chu T, Abdalla S, Orwig KE. Human immature testicular tissue organ culture: a step towards fertility preservation and restoration. Front Endocrinol (Lausanne) 2023; 14:1242263. [PMID: 37701899 PMCID: PMC10494240 DOI: 10.3389/fendo.2023.1242263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
Background Cryopreservation of immature testicular tissue (ITT) is currently the only option to preserve fertility of prepubertal patients. Autologous transplantation of ITT may not be safe or appropriate for all patients. Therefore, methods to mature ITT ex vivo are needed. Objectives Aim to investigate the feasibility of inducing in vitro spermatogenesis from ITT cryopreserved for pediatric patients prior to initiation of gonadotoxic therapy. Materials and methods Cryopreserved-thawed ITT from prepubertal and peripubertal patients were cultured for 7, 16, and 32 days in medium with no hormones or supplemented with 5 IU/L FSH, 1 IU/L hCG, or 5IU/L FSH+1 IU/L hCG. Samples were evaluated histologically to assess tissue integrity, and immunofluorescence staining was performed to identify VASA (DDX4)+ germ cells, UCHL1+ spermatogonia, SYCP3+ spermatocytes, CREM+ spermatids, SOX9+ Sertoli cells. Proliferation (KI67) and apoptosis (CASPASE3) of germ cells and Sertoli cells were also analyzed. Sertoli and Leydig cell maturation was evaluated by AR and INSL3 expression as well as expression of the blood testis barrier protein, CLAUDIN11, and testosterone secretion in the culture medium. Results Integrity of seminiferous tubules, VASA+ germ cells and SOX9+ Sertoli cells were maintained up to 32 days. The number of VASA+ germ cells was consistently higher in the peripubertal groups. UCHL1+ undifferentiated spermatogonia and SOX9+ Sertoli cell proliferation was confirmed in most samples. SYCP3+ primary spermatocytes began to appear by day 16 in both age groups. Sertoli cell maturation was demonstrated by AR expression but the expression of CLAUDIN11 was disorganized. Presence of mature and functional Leydig cells was verified by INSL3 expression and secretion of testosterone. Gonadotropin treatments did not consistently impact the number or proliferation of germ cells or somatic cells, but FSH was necessary to increase testosterone secretion over time in prepubertal samples. Conclusion ITT were maintained in organotypic culture for up to 32 days and spermatogonia differentiated to produce primary spermatocytes in both pre- and peripubertal age groups. However, complete spermatogenesis was not observed in either group.
Collapse
Affiliation(s)
- Nagham Younis
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Biological Sciences, School of Science, University of Jordan, Amman, Jordan
| | - Andre L. Caldeira-Brant
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tianjiao Chu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Shtaywy Abdalla
- Department of Biological Sciences, School of Science, University of Jordan, Amman, Jordan
| | - Kyle E. Orwig
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| |
Collapse
|
4
|
Khaleel B, Lunenfeld E, Kapelushnik J, Huleihel M. Effect of Granulocyte Colony-Stimulating Factor on the Development of Spermatogenesis in the Adulthood of Juvenile AML Mice Model Treated with Cytarabine. Int J Mol Sci 2023; 24:12229. [PMID: 37569605 PMCID: PMC10419160 DOI: 10.3390/ijms241512229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Pediatric acute myeloid leukemia (AML) generally occurs de novo. The treatment of AML includes cytarabine (CYT) and other medications. The granulocyte-colony stimulating factor (GCSF) is used in the clinic in cases of neutropenia after chemotherapies. We show that the administration of GCSF in combination with CYT in AML-diagnosed mice (AML+CYT+GCSF) extended the survival of mice for additional 20 days. However, including GCSF in all treatment modalities does not affect the testis' weight or the histology of the seminiferous tubules (STs). We show that GCSF does not affect normal ST histology from AML-, CYT-, or (AML+CYT)-treated groups compared to the relevant treated group without GCSF 2, 4, and 5 weeks post-injection. However, when comparing the percentages of normal STs between the AML+CYT+GCSF-treated groups and those without GCSF, we observe an increase of 17%-42% in STs at 4 weeks and 5.5 weeks post-injection. Additionally, we show that the injection of GCSF into the normal, AML-alone, or CYT-alone groups, or in combination with AML, significantly decreases the percentage of STs with apoptotic cells compared to the relevant groups without GCSF and to the CT (untreated mice) only 2 weeks post-injection. We also show that injection of GCSF into the CT group increases the examined spermatogonial marker PLZF within 2 weeks post-injection. However, GCSF does not affect the count of meiotic cells (CREM) but decreases the post-meiotic cells (ACROSIN) within 4 weeks post-injection. Furthermore, GCSF not only extends the survival of the AML+CYT-treated group, but it also leads to the generation of sperm (1.2 ± 0.04 × 106/mL) at 5.5 weeks post-injection. In addition, we demonstrate that the injection of GCSF into the CT group increases the RNA expression level of IL-10 but not IL-6 compared to CT 2 weeks post-treatment. However, the injection of GCSF into the AML-treated group reverses the expression levels of both IL-10 and IL-6 to normal levels compared to CT 2 weeks post-injection. Thus, we suggest that the addition of GCSF to the regimen of AML after CYT may assist in the development of future therapeutic strategies to preserve male fertility in AML prepubertal patients.
Collapse
Affiliation(s)
- Bara’ah Khaleel
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel;
- The Center of Advanced Research and Education in Reproduction (CARER), Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel;
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Eitan Lunenfeld
- Adelson School of Medicine, Ariel University, Ariel 4076414, Israel;
| | - Joseph Kapelushnik
- The Center of Advanced Research and Education in Reproduction (CARER), Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel;
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
- Department of Pediatric Oncology and Hematology, Soroka Medical Center, Beer-Sheva, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Mahmoud Huleihel
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel;
- The Center of Advanced Research and Education in Reproduction (CARER), Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel;
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| |
Collapse
|
5
|
Braye A, Delgouffe E, van der Werff Ten Bosch J, Gies I, Ferster A, Goossens E. Gonadal development and function after immature testicular tissue banking as part of high-risk gonadotoxic treatment. Pediatr Blood Cancer 2023:e30370. [PMID: 37150973 DOI: 10.1002/pbc.30370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Experimental fertility preservation programs have been started to safeguard the future fertility of prepubertal and pubertal males requiring high-risk gonadotoxic treatment protocols. However, long-term follow-up studies evaluating the effects on their gonadal development and function related to the testicular biopsy procedure are rather limited. DESIGN This two-center follow-up study (between 2002 and 2020) evaluated the gonadal development and function of a cohort of 59 prepubertal and pubertal males who have been offered immature testicular tissue banking (TTB) prior to conventional high-risk chemo- and/or radiotherapy (HR-C/R) or conditioning therapy before hematopoietic stem cell transplantation (CT-HSCT). The aim is to investigate the long-term impact of the testicular biopsy procedure and the high-risk gonadotoxic treatment. Testicular growth and the reproductive hormones luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), and inhibin B (INHB) were analyzed after treatment completion, and compared between males accepting TTB and those refusing TTB (control) as well as between HR-C/R and CT-HSCT treatment protocols. RESULTS Of the 59 prepubertal and pubertal males included, 25 were treated by HR-C/R and 34 required CT-HSCT. TTB was accepted for 39 males and refused for 20 males. Most patients were prepubertal at diagnosis (85%), at TTB (79%), and at treatment completion (76%), and pubertal or postpubertal at their last follow-up visit (66%). After 5.0 (1.0-13.0) years post treatment, most patients show normal testicular volumes (83%) and normal LH (89%), FSH (87%), T (87%), and INHB (79%) serum levels. The testicular biopsy procedure did not have an effect on testicular growth, LH, FSH, T, and INHB. Significantly more small postpubertal testicular volumes (p = .0278) and low INHB serum levels (p = .0130) were recorded after CT-HSCT, especially after myeloablative conditioning. CONCLUSION The clinical follow-up data demonstrate no effect related to the biopsy procedure, but a substantial risk for impaired gonadal development after high-risk gonadotoxic treatment, in particular myeloablative CT-HSCT. Longer follow-up studies with a larger study population are needed to confirm these preliminary findings.
Collapse
Affiliation(s)
- Aude Braye
- Department of Reproduction, Genetics and Regenerative Medicine (RGRG), Biology of the Testis (BITE), Vrije Universiteit Brussel (VUB), Laarbeeklaan, Brussels, Belgium
| | - Emily Delgouffe
- Department of Reproduction, Genetics and Regenerative Medicine (RGRG), Biology of the Testis (BITE), Vrije Universiteit Brussel (VUB), Laarbeeklaan, Brussels, Belgium
| | - Jutte van der Werff Ten Bosch
- Department of Pediatrics, Division of Pediatric Oncology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan, Brussels, Belgium
| | - Inge Gies
- Department of Pediatrics, Division of Pediatric Endocrinology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan, Brussels, Belgium
| | - Alina Ferster
- Department of Hemato-Oncology, Université Libre de Bruxelles (ULB), Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Jean Joseph Crocqlaan, Brussels, Belgium
| | - Ellen Goossens
- Department of Reproduction, Genetics and Regenerative Medicine (RGRG), Biology of the Testis (BITE), Vrije Universiteit Brussel (VUB), Laarbeeklaan, Brussels, Belgium
| |
Collapse
|
6
|
AbuMadighem A, Shuchat S, Lunenfeld E, Yossifon G, Huleihel M. Testis on a chip - a microfluidic 3-dimensional culture system for the development of spermatogenesis in-vitro. Biofabrication 2022; 14. [PMID: 35334473 DOI: 10.1088/1758-5090/ac6126] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/25/2022] [Indexed: 11/12/2022]
Abstract
This research presents a novel Testis-on-a Chip- platform. Testicular cells are enzymatically isolated from the seminiferous tubules of sexually immature mice, seeded in a methylcellulose gel and cultured in a microfluidic chip. The unique design sandwiches the soft methylcellulose between stiffer agar support gels. The cells develop into organoids continuing to proliferate and differentiate. After seven weeks of culture the cells have over 95% viability. Confocal microscopy of the developed organoids reveals a structure containing the various stages of spermatogenesis up to and including meiosis II: premeiotic, meiotic and post-meiotic germ cells. The organoid structure also contains the supporting Sertoli and peritubular cells. The responsiveness of the system to the addition of testosterone and retinoic acid to the culture medium during the experiment are also investigated. As a benchmark, the Testis-on-a-Chip is compared to a conventional three-dimensional methylcellulose cell culture in a well plate. Analysis via FACS (Fluorescence-activated cell sorting) shows more haploid cells in the chip as compared to the plates. Immunofluorescence staining after seven weeks of culture shows more differentiated cells in the chip as compared to the well plate. This demonstrates the feasibility of our platform as well as its advantages. This research opens new horizons for the study and realization of spermatogenesis in-vitro. It can also enable the implementation of microfluidic technologies in future therapeutic strategies for pre pubertal male fertility preservation and adults with maturation arrest. Lastly, it can serve as a platform for drug and toxin testing.
Collapse
Affiliation(s)
- Ali AbuMadighem
- Ben-Gurion University of the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Southern, 84105, ISRAEL
| | - Sholom Shuchat
- Technion Israel Institute of Technology, Faculty of Mechanical Engineering, Haifa, Haifa, 3200003, ISRAEL
| | - Eitan Lunenfeld
- Ben-Gurion University of the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Beer-Sheva, Southern, 84105, ISRAEL
| | - Gilad Yossifon
- Technion Israel Institute of Technology, Faculty of Mechanical Engineering, Haifa, Haifa, 3200003, ISRAEL
| | - Mahmoud Huleihel
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer-Sheva, 84105, ISRAEL
| |
Collapse
|
7
|
Abstract
Cryptorchidism is associated with infertility in adulthood. Early orchiopexy is suggested to reduce the risk. Information is lacking on the potential link between infant germ cell maturation and the risk of future infertility. The objective of the study was to evaluate age-related germ cell development in cryptorchidism. Immunostaining for markers of germ cell development (octamer-binding transcription factor 3/4 [OCT3/4], placental alkaline phosphatase [PLAP], KIT proto-oncogene [C-KIT], podoplanin [D2-40], Lin-28 homolog A [LIN28], and G antigen 7 [GAGE-7]) was performed in testicular biopsies from 40 cryptorchid boys aged 4-35 months. Germ cell numbers and distributions were evaluated in cross sections of seminiferous tubules, with and without immunostaining. OCT3/4, D2-40, and LIN28 were generally expressed in the early stages of germ cell development, as shown by positive expression in germ cells in the central region of seminiferous tubules. In contrast, PLAP and GAGE-7 were expressed in both central and peripheral parts of the tubules in the early stages of development and expressed mainly in a peripheral position with advancing age. Germ cell maturation was delayed in this study population as compared with that observed in our previous study on germ cell markers in a healthy population. The number of GAGE-7-positive germ cells per tubular cross section obtained by immunostaining was significantly higher than that obtained by standard hematoxylin and eosin staining. Double immunostaining revealed heterogeneity in germ cell development in cryptorchid testes. These results shed light on the pathophysiology of germ cell development in boys with cryptorchidism.
Collapse
Affiliation(s)
- Li-Hua Dong
- Laboratory of Reproductive Biology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - Simone Hildorf
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - Kolja Kvist
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - Dina Cortes
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark.,Department of Pediatrics, Copenhagen University Hospital Hvidovre, Copenhagen 2650, Denmark
| | - Jørgen Thorup
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark.,Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| |
Collapse
|
8
|
Durairajanayagam D, Agarwal A, Baskaran S, Vij S. Afterword: An update on clinical utility and diagnostic value of various andrological techniques. Andrologia 2021; 53:e13819. [PMID: 33620116 DOI: 10.1111/and.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Kampus Sungai Buloh, Selangor, Malaysia
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Vij
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
9
|
Abstract
Fertility preservation is the process of saving gametes, embryos, gonadal tissues and/or gonadal cells for individuals who are at risk of infertility due to disease, medical treatments, age, genetics, or other circumstances. Adult patients have the options to preserve eggs, sperm, or embryos that can be used in the future to produce biologically related offspring with assisted reproductive technologies. These options are not available to all adults or to children who are not yet producing mature eggs or sperm. Gonadal cells/tissues have been frozen for several thousands of those patients worldwide with anticipation that new reproductive technologies will be available in the future. Therefore, the fertility preservation medical and research communities are obligated to responsibly develop next-generation reproductive technologies and translate them into clinical practice. We briefly describe standard options to preserve and restore fertility, but the emphasis of this review is on experimental options, including an assessment of readiness for translation to the human fertility clinic.
Collapse
Affiliation(s)
- Chatchanan Doungkamchan
- Molecular Genetics and Developmental Biology Graduate Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kyle E Orwig
- Molecular Genetics and Developmental Biology Graduate Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| |
Collapse
|
10
|
Funke M, Yang Y, Lahtinen A, Benninghoven-Frey K, Kliesch S, Neuhaus N, Stukenborg JB, Jahnukainen K. Z-scores for comparative analyses of spermatogonial numbers throughout human development. Fertil Steril 2021; 116:713-20. [PMID: 33975728 DOI: 10.1016/j.fertnstert.2021.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To normalize age-dependent effects on standardized measures of spermatogonial quantity such as the number of spermatogonia per tubular cross-section (S/T) or fertility index. DESIGN Published quantitative histologic data on human spermatogonial numbers were used to create Z-scores for reference means and tested on archived testicular tissue samples. SETTING Retrospective cohort study. PATIENT(S) The sample cohort comprised testicular samples from 24 boys with cancer diagnosis and 10 with Klinefelter syndrome, as part of the fertility preservation programs NORDFERTIL and Androprotect, as well as archived histologic samples from 35 prepubertal boys with acute lymphoblastic leukemia and 20 testicular biobank samples. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Z-score values for S/T and fertility index on the basis of morphology and germ cell-specific markers (MAGEA4 and/or DDX4) were calculated, and the impact of cancer therapy exposure and genetic disorders on Z-score values was evaluated. RESULT(S) The Z-scores for S/T values in the nontreated samples (-2.08 ± 2.20, n = 28) and samples treated with nonalkylating agents (-1.90 ± 2.60, n = 25) were comparable within ±3 standard deviations of the reference mean value but differed significantly from samples exposed to alkylating agents (-12.14 ± 9.20, n = 22) and from patients with Klinefelter syndrome (-11.56 ± 4.89, n = 8). The Z-scores for S/T were correlated with increasing cumulative exposure to alkylating agents (r = -0.7020). CONCLUSION(S) The Z-score values for S/T allow for the quantification of genetic and cancer treatment-related effects on testicular tissue stored for fertility preservation, facilitating their use for patient counseling.
Collapse
|
11
|
Findeklee S, Kasoha M, Radosa J, Radosa M, Haj Hamoud B, Sima R. WOMEN AND MEN WITH CANCER AND A FUTURE DESIRE FOR CHILDREN - WHAT SHOULD CLINICIANS CONSIDER IN COVID-19 PANDEMIC TIMES? Acta Endocrinol (Buchar) 2021; 17:234-240. [PMID: 34925573 PMCID: PMC8665243 DOI: 10.4183/aeb.2021.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The topic of fertility preservation has been gaining increasing importance since the beginning of this century. The reasons for this development are the advances in oncological therapy over the past few decades, with cure rates of approximately over 90%, and the fact that starting families is increasingly postponed in later periods of life in industrialized countries. Since March 2020 the whole medical and non-medical world experiences a pandemic due to Covid-19 (coronavirus disease 2019) which has never been seen before. This created a plenty of challenges for both, the patients and healthcare providers. This review article presents the fertility-protective methods currently available for women and men suffering from cancer with their clinical approach, value, advantages and disadvantages. Besides, it focuses on the changes and special considerations which have to be taken into account during pandemic times including preventive measures as well as the patient's access to the fertility preserving options. In conclusion every premenopausal woman and every man with incomplete family planning suffering from cancer should be counselled about the existing fertility preserving techniques before commencing cancer therapy.
Collapse
Affiliation(s)
- S. Findeklee
- Kinderwunschzentrum Niederrhein Mönchengladbach/Krefeld - Reproductive Medicine, Mönchengladbach, North Rhine-Westphalia, Germany
| | - M. Kasoha
- Saarland University Hospital Department of Gynaecology Obstetrics and Reproductive Medicine - Gynaecology, Obstetrics and Reproductive Medicine, Homburg, Saarland, Germany
| | - J.C. Radosa
- Saarland University Hospital Department of Gynaecology Obstetrics and Reproductive Medicine - Gynaecology, Obstetrics and Reproductive Medicine, Homburg, Saarland, Germany
| | - M.P. Radosa
- Klinikum Bremen-Nord gGmbH - Gynaecology and Obstetrics, Bremen, Germany
| | - B. Haj Hamoud
- Saarland University Hospital Department of Gynaecology Obstetrics and Reproductive Medicine - Gynaecology, Obstetrics and Reproductive Medicine, Homburg, Saarland, Germany
| | - R.M. Sima
- “Carol Davila” University of Medicine and Pharmacy - Gynaecology and Obstetrics, Bucharest, Romania
| |
Collapse
|
12
|
Huleihel M, Lunenfeld E. Approaches and Technologies in Male Fertility Preservation. Int J Mol Sci 2020; 21:E5471. [PMID: 32751826 DOI: 10.3390/ijms21155471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Male fertility preservation is required when treatment with an aggressive chemo-/-radiotherapy, which may lead to irreversible sterility. Due to new and efficient protocols of cancer treatments, surviving rates are more than 80%. Thus, these patients are looking forward to family life and fathering their own biological children after treatments. Whereas adult men can cryopreserve their sperm for future use in assistance reproductive technologies (ART), this is not an option in prepubertal boys who cannot produce sperm at this age. In this review, we summarize the different technologies for male fertility preservation with emphasize on prepubertal, which have already been examined and/or demonstrated in vivo and/or in vitro using animal models and, in some cases, using human tissues. We discuss the limitation of these technologies for use in human fertility preservation. This update review can assist physicians and patients who are scheduled for aggressive chemo-/radiotherapy, specifically prepubertal males and their parents who need to know about the risks of the treatment on their future fertility and the possible present option of fertility preservation.
Collapse
|
13
|
Abstract
Spermatogenesis is the process of the proliferation and differentiation of spermatogonial stem cells (SSCs) to generate sperm. Leukemia patients show impairment in some of the endocrine hormones that are involved in spermatogenesis. They also show a decrease in semen parameters before and after thawing of cryopreserved samples compared to a control. The mechanisms behind these effects have not yet been described. This review summarizes the effect of leukemia on semen parameters from adult patients and highlights feasible suggested mechanisms that may affect impairment of spermatogenesis in these patients. We suggest the possible involvement of leukemia in disturbing hormones involved in spermatogenesis, and the imbalance in testicular paracrine/autocrine factors involved in the formation of SSC niches that control their proliferation and differentiation. Understanding the mechanisms of leukemia in the impairment of spermatogenesis may lead to the development of novel therapeutic strategies mainly for prepubertal boys who do not yet produce sperm.
Collapse
Affiliation(s)
- Yulia Michailov
- a The Shraga Segal Dept. of Microbiology, Immunology, and Genetics , Ben-Gurion University of the Negev , Beer-Sheva , Israel.,b The Center of Advanced Research and Education in Reproduction (CARER) , Ben-Gurion University of the Negev , Beer-Sheva , Israel.,c Faculty of Health Sciences , Ben-Gurion University of the Negev , Beer-Sheva , Israel.,d IVF Unit , Barzilai Medical Center , Ashkelon , Israel
| | - Eitan Lunenfeld
- b The Center of Advanced Research and Education in Reproduction (CARER) , Ben-Gurion University of the Negev , Beer-Sheva , Israel.,c Faculty of Health Sciences , Ben-Gurion University of the Negev , Beer-Sheva , Israel.,e Department of Obstetrics and Gynaecology , Soroka Medical Center , Beer-Sheva , Israel
| | - Joseph Kapelushnik
- b The Center of Advanced Research and Education in Reproduction (CARER) , Ben-Gurion University of the Negev , Beer-Sheva , Israel.,c Faculty of Health Sciences , Ben-Gurion University of the Negev , Beer-Sheva , Israel.,f Department of Pediatric Oncology and Department of Hematology , Soroka Medical Center , Beer-Sheva , Israel
| | - Mahmoud Huleihel
- a The Shraga Segal Dept. of Microbiology, Immunology, and Genetics , Ben-Gurion University of the Negev , Beer-Sheva , Israel.,b The Center of Advanced Research and Education in Reproduction (CARER) , Ben-Gurion University of the Negev , Beer-Sheva , Israel.,c Faculty of Health Sciences , Ben-Gurion University of the Negev , Beer-Sheva , Israel.,g The National Institute for Biotechnology in the Negev , Beer-Sheva , Israel
| |
Collapse
|
14
|
Gat I, Maghen L, Filice M, Wyse B, Zohni K, Jarvi K, Lo KC, Gauthier Fisher A, Librach C. Optimal culture conditions are critical for efficient expansion of human testicular somatic and germ cells in vitro. Fertil Steril 2017; 107:595-605.e7. [PMID: 28259258 DOI: 10.1016/j.fertnstert.2016.12.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To optimize culture conditions for human testicular somatic cells (TSCs) and spermatogonial stem cells. DESIGN Basic science study. SETTING Urology clinic and stem cell research laboratory. PATIENT(S) Eight human testicular samples. INTERVENTIONS(S) Testicular tissues were processed by mechanical and enzymatic digestion. Cell suspensions were subjected to differential plating (DP) after which floating cells (representing germ cells) were removed and attached cells (representing TSCs) were cultured for 2 passages (P0-P1) in StemPro-34- or DMEM-F12-based medium. Germ cell cultures were established in both media for 12 days. MAIN OUTCOME MEASURE(S) TSC cultures: proliferation doubling time (PDT), fluorescence-activated cell sorting for CD90, next-generation sequencing for 89 RNA transcripts, immunocytochemistry for TSC and germ cell markers, and conditioned media analysis; germ cell cultures: number of aggregates. RESULT(S) TSCs had significantly prolonged PDT in DMEM-F12 versus StemPro-34 (319.6 ± 275.8 h and 110.5 ± 68.3 h, respectively). The proportion of CD90-positive cells increased after P1 in StemPro-34 and DMEM-F12 (90.1 ± 10.8% and 76.5 ± 17.4%, respectively) versus after DP (66.3 ± 7%). Samples from both media after P1 clustered closely in the principle components analysis map whereas those after DP did not. After P1 in either medium, CD90-positive cells expressed TSC markers only, and fibroblast growth factor 2 and bone morphogenetic protein 4 were detected in conditioned medium. A higher number of germ cell aggregates formed in DMEM-F12 (59 ± 39 vs. 28 ± 17, respectively). CONCLUSION(S) Use of DMEM-F12 reduces TSC proliferation while preserving their unique characteristics, leading to improved germ cell aggregates formation compared with StemPro-34, the standard basal medium used in the majority of previous reports.
Collapse
Affiliation(s)
- Itai Gat
- Create Fertility Centre, Toronto, Ontario, Canada; Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel; Sackler school of medicine, Tel Aviv university, Tel Aviv, Israel
| | - Leila Maghen
- Create Fertility Centre, Toronto, Ontario, Canada
| | | | - Brandon Wyse
- Create Fertility Centre, Toronto, Ontario, Canada
| | - Khaled Zohni
- Create Fertility Centre, Toronto, Ontario, Canada; Department of Reproductive Health and Family Planning, National Research Center, Cairo, Egypt
| | - Keith Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kirk C Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Clifford Librach
- Create Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Women's College Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
15
|
Medrano JV, Rombaut C, Simon C, Pellicer A, Goossens E. Human spermatogonial stem cells display limited proliferation in vitro under mouse spermatogonial stem cell culture conditions. Fertil Steril 2016; 106:1539-1549.e8. [PMID: 27490045 DOI: 10.1016/j.fertnstert.2016.07.1065] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/17/2016] [Accepted: 07/11/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To study the ability of human spermatogonial stem cells (hSSCs) to proliferate in vitro under mouse spermatogonial stem cell (mSSC) culture conditions. DESIGN Experimental basic science study. SETTING Reproductive biology laboratory. PATIENT(S) Cryopreserved testicular tissue with normal spermatogenesis obtained from three donors subjected to orchiectomy due to a prostate cancer treatment. INTERVENTION(S) Testicular cells used to create in vitro cell cultures corresponding to the following groups: [1] unsorted human testicular cells, [2] differentially plated human testicular cells, and [3] cells enriched with major histocompatibility complex class 1 (HLA-)/epithelial cell surface antigen (EPCAM+) in coculture with inactivated testicular feeders from the same patient. MAIN OUTCOME MEASURE(S) Analyses and characterization including immunocytochemistry and quantitative reverse-transcription polymerase chain reaction for somatic and germ cell markers, testosterone and inhibin B quantification, and TUNEL assay. RESULT(S) Putative hSSCs appeared in singlets, doublets, or small groups of up to four cells in vitro only when testicular cells were cultured in StemPro-34 medium supplemented with glial cell line-derived neurotrophic factor (GDNF), leukemia inhibitory factor (LIF), basic fibroblast growth factor (bFGF), and epidermal growth factor (EGF). Fluorescence-activated cell sorting with HLA-/EPCAM+ resulted in an enrichment of 27% VASA+/UTF1+ hSSCs, compared to 13% in unsorted controls. Coculture of sorted cells with inactivated testicular feeders gave rise to an average density of 112 hSSCs/cm2 after 2 weeks in vitro compared with unsorted cells (61 hSSCs/cm2) and differentially plated cells (49 hSSCS/cm2). However, putative hSSCs rarely stained positive for the proliferation marker Ki67, and their presence was reduced to the point of almost disappearing after 4 weeks in vitro. CONCLUSION(S) We found that hSSCs show limited proliferation in vitro under mSSC culture conditions. Coculture of HLA-/EPCAM+ sorted cells with testicular feeders improved the germ cell/somatic cell ratio.
Collapse
|