Expression of claudin‑11 in a rat model of varicocele and its effects on the blood‑testis barrier

Correlation Between Semen Quality and Bilateral Scrotal Skin Temperature Shown in the Chronological Results of Two Patients With Left-Sided Varicocele

Scrotal skin temperature (SST) reflects intratesticular temperature, the elevation of which has adverse effects on bilateral spermatogenesis. The present study evaluated the effects of bilateral heat stress on the semen quality of two patients with a left-sided varicocele using chronological SST measurements. Scrotal skin temperature in two patients with a left-sided varicocele was determined using a thermal imaging camera (FLIR C2, FLIR Systems, Wilsonville, OR, USA). Case 1 was a single man seeking preconception care and diagnosed with a painful Grade 2 varicocele. The value for left side SST-right side SST (ΔSST) decreased from 3.2°C to -1.2°C along with the exacerbation of the varicocele from Grade 2 to 3. A varicocelectomy was performed because of the worsening of semen quality. Case 2 was an infertile man with a painful Grade 1 varicocele. The initial ΔSST of 2.4°C was temporarily reduced to 0.6°C, followed by recovery to 2.6°C along with a clear improvement in spermatogram results. To the best of our knowledge, the present chronological findings are the first to show that bilateral elevation of intratesticular temperature in a patient with a left-sided varicocele is substantially related to the deterioration of spermatogenesis.

Varicocele and testicular cord torsion: immune testicular microenvironment imbalance

The main functions of the testis, steroidogenesis and spermatogenesis, depend on the endocrine axis and systemic and local tolerance mechanisms. Infectious or non-infectious diseases may disturb testicular immune regulation causing infertility. Literature has illustrated that bacterial and viral infections lead to autoimmune infertility: either sperm antibodies or autoimmune epidydimo-orchitis. However, little is known about the association between non-infectious testicular pathologic diseases and autoimmunity. Here we review the novel aspect of varicocele and testicular cord torsion pathology linked to inflammation and discuss how immune factors could contribute to or modulate autoimmunity in ipsi- and contralateral testis.

Varicocele associated male infertility: cellular and molecular perspectives of pathophysiology

BACKGROUND

Varicocele is a common risk factor associated with reduced male fertility potential. The current understanding of varicocele pathophysiology does not completely explain the clinical manifestation of infertility. The present treatment options such as antioxidant supplementation and varicocelectomy only helps ∼35% of men to achieve spontaneous pregnancy.

OBJECTIVE

This review aims to summarize the available knowledge on cellular and molecular alterations implicated to varicocele associated male infertility and also highlights the new knowledge generated by 'Omics' technologies.

MATERIALS AND METHODS

PubMed, MEDLINE, Cochrane and Google Scholar databases are searched using different combinations of keywords (varicocele, infertile/fertile men with varicocele, cellular changes, molecular mechanisms, proteome, epigenome, transcriptome and metabolome). A total of 229 relevant human and animal studies published till 2021 were included in this review.

RESULTS

Current understanding advocates oxidative stress (OS) as a major contributory factor to the varicocele associated male infertility. Excessive OS causes alteration in testicular microenvironment and sperm DNA fragmentation which further contributes to infertility. Molecular and omics studies have identified several promising biomarkers such as AAMP, SPINT1, MKI67 (genetic markers), sperm quality and function related protein markers, global sperm DNA methylation level (epigenetic marker), Hspa2, Protamine, Gadd7, Dynlt1 and Beclin1 (mRNA markers), PRDX2, HSPA, APOA2, YKL40 (seminal protein markers), total choline and PHGDH (metabolic markers).

DISCUSSION

Mature spermatozoa harbours a plethora of molecular information in form of proteome, epigenome and transcriptome; which could provide very important clues regarding pathophysiology of varicocele associated infertility. Recent molecular and omics studies in infertile men with varicocele have identified several promising biomarkers. Upon further validation with larger and well-defined studies, some of these biomarkers could aid in varicocele management.

CONCLUSION

The present evidences suggest inclusion of OS and sperm DNA fragmentation tests could be useful to the diagnostic workup for men with varicocele. Furthermore, including precise molecular markers may assist in diagnostics and prognostics of varicocele associated male infertility. This article is protected by copyright. All rights reserved.

Bibliometric and visual analysis of blood-testis barrier research

Background: Extensive research on the blood-testis barrier has been undertaken in recent years. However, no systematic bibliometric study has been conducted on this subject. Our research aimed to identify the hotspots and frontiers of blood-testis barrier research and to serve as a guide for future scientific research and decision-making in the field.

Methods: Studies on the blood-testis barrier were found in the Web of Science Core Collection. VOSviewer, CiteSpace, and Microsoft Excel were used to conduct the bibliometric and visual analyses.

Results: We found 942 blood-testis barrier studies published in English between 1992 and 2022. The number of annual publications and citations increased significantly between 2011 and 2022, notably in the United States. China and the United States, the US Population Council, Endocrinology, and Cheng C. Yan were the most productive countries, institution, journal, and author, respectively. The study keywords indicated that blood-testis barrier research involves a variety of compositional features (tight junctions, cytoskeleton, adherens junctions), cell types (Sertoli cells, germ cells, Leydig cells, stem cells), reproductive toxicity (cadmium, nanoparticles, bisphenol-a), and relevant mechanisms (spermatogenesis, apoptosis, oxidative stress, dynamics, inflammation, immune privilege).

Conclusion: The composition and molecular processes of the blood-testis barrier as well as the blood-testis barrier in male infertility patients are the primary research hotspots in this field. In addition, future research will likely focus on treatment and the development of novel medications that target signal pathways in oxidative stress and apoptosis to preserve the blood-testis barrier. Further studies must extend to clinical diagnosis and therapy.

Varicoceles in Men With Non-obstructive Azoospermia: The Dilemma to Operate or Not

The knowledge on male reproduction is constantly expanding, especially in treating infertility due to non-obstructive azoospermia (NOA). Varicocele is occasionally diagnosed in a subpopulation of males with NOA. Varicocele repair in NOA-men may contribute to the reappearance of spermatozoa in semen. However, spontaneous pregnancies are observed in only a small percentage of NOA-men post-varicocelectomy. Additionally, it has been reported that the repair of varicocele in NOA-men (before the performance of sperm retrieval techniques) may increase the testicular sperm recovery rate. In addition, it increases the pregnancy rate in intracytoplasmic sperm injection (ICSI) programs in NOA-men without spermatozoa in the semen post-varicocelectomy. In addition, to the improvement in Sertoli cellular secretory function, varicocelectomy may increase the secretory function of Leydig cells, which subsequently results in improved androgen production, raising the probability to negate the need for testosterone replacement therapy in cases of late-onset hypogonadism. On the other hand, the benefit of varicocelectomy in patients with NOA is still debatable. The current review study aims to provide a critical and extensive review of varicocele repair in males with NOA. This study additionally focuses on the impact of varicocele repair on sperm retrieval rates and its influence on the ICSI outcomes for those couples who remain negative for spermatozoa in their semen samples post-varicocelectomy.

Varicocele-Mediated Male Infertility: From the Perspective of Testicular Immunity and Inflammation

Background

Varicocele (VC) is present in 35 - 40% of men with infertility. However, current surgical and antioxidant treatments are not completely effective. In addition to oxidative stress, it is likely that other factors such as testicular immune microenvironment disorder contribute to irreversible testicular. Evidence suggests that VC is associated with anti-sperm antibodies (ASAs), spermatogenesis and testosterone secretion abnormalities, and testicular cytokine production. Moreover, inhibition of inflammation can alleviate VC-mediated pathogenesis. The normal function of the testis depends on its immune tolerance mechanism. Testicular immune regulation is complex, and many infectious or non-infectious diseases may damage this precision system.

Results

The testicular immune microenvironment is composed of common immune cells and other cells involved in testicular immunity. The former includes testicular macrophages, T cells, dendritic cells (DCs), and mast cells, whereas the latter include Leydig cells and Sertoli cells (SCs). In animal models and in patients with VC, most studies have revealed an abnormal increase in the levels of ASAs and pro-inflammatory cytokines such as interleukin (IL)-1 and tumor necrosis factor (TNF)-alpha in the seminal plasma, testicular tissue, and even peripheral blood. It is also involved in the activation of potential inflammatory pathways, such as the nucleotide-binding oligomerization domain-like receptor family pyrin domain containing (NLRP)-3 pathway. Finally, the development of VC-mediated infertility (VMI) may be facilitated by abnormal permeability of proteins, such as claudin-11, that constitute the blood-testis barrier (BTB).

Conclusions

The testicular immune response, including the production of ASAs and inflammatory factors, activation of inflammatory pathways, and destruction of the BTB may be involved in the pathogenesis of VMI it is necessary to further explore how patient outcomes can be improved through immunotherapy.

Blood-Testis Barrier and Sperm Delayed in the Cauda Epididymis of the Reproductively Regressed Syrian Hamsters

The Syrian (golden) hamsters are seasonal breeders whose reproductive functions are active in summer and inactive in winter. In experimental facility mimicking winter climate, short photoperiod (SP) induces gonadal regression. The blood-testis barrier (BTB) of the sexually involuted animals have been reported to be permeable, allowing developing germ cells to be engulfed or sloughed off the epithelium of the seminiferous tubules. The expressions of genes related to the tight junction composing of BTB were investigated in the reproductive active and inactive testes. Claudin-11, occludin, and junctional adhesion molecule (JAM) were definitely expressed in the active testes but not discernably detected in the inactive testes. And spermatozoa (sperm) were observed in the whole lengths of epididymides in the active testes. They were witnessed in only cauda region of the epididymides but not in caput and corpus regions in animals with the inactive testes. The results imply that the disorganization of BTB is associated with the testicular regression. The developing germ cells are swallowed into the Sertoli cells or travel into the lumen, as supported by the presence of the sperm delayed in the last region of the epididymis. These outcomes suggest that both apoptosis and desquamation are the processes that eliminate the germ cells during the regressing stage in the Syrian hamsters.

Claudins: New Players in Human Fertility and Reproductive System Cancers

Claudins are major integral proteins of tight junctions (TJs), the apical cell-cell adhesions that enable maintaining polarity of epithelial cells, their differentiation, and cell signaling. A number of studies have indicated that claudins might play a crucial role in both physiology and pathogenesis. Their tissue-specific expression was originally linked to the development of different types of cancer and triggered a hope to use them as diagnostic or prognostic markers. However, it seems that their expression is more complex than that, and undoubtedly, claudins participate in one of the most important molecular events in cells. This review summarizes the recent research evaluating the role of claudins in fertility and the most common endocrine-dependent cancers in the reproductive system and highlights the crucial role of claudins both in human fertility and the most common cancers.

Sertoli Cell Alterations in Peripubertal Varicocelized Rats: Evidence of Primary Damage on Spermatogenesis

Idiopathic varicocele is closely associated with male infertility or subfertility. Sertoli cell is a very important regulator of spermatogenesis. We investigated the morphofunctional alterations in the Sertoli cell and its possible involvement in the establishment of testicular primary lesion in experimental left-sided varicocele, induced from peripuberty. Twenty-five male peripubertal rats (44 days postpartum [dpp]) were distributed into two groups: control (C) and varicocele (V). Experimental left varicocele was induced in rats through the partial ligature of the left renal vein. Euthanasia was performed at 100 dpp. Testicular histopathology and testosterone plasmatic level were evaluated. Transferrin and vimentin proteins were, respectively, used as immunomarkers of Sertoli cell function and structure. Significant reductions in vimentin and transferrin expressions were noticed in androgen-dependent stages (VII and VIII) of the seminiferous epithelium cycle in V rats; testosterone plasmatic level was also reduced. Bilateral testicular histopathological alterations were found in V rats, mainly massive germ cell desquamation. The histological damage and changes in protein expressions occurred bilaterally. The relevant impairment of the functional and structural characteristics of the Sertoli cell, together with the typical massive germ cell desquamation, indicates that Sertoli cell changes can primarily contribute to the significant testicular dysfunction associated with varicocele.

Multiple signaling pathways in Sertoli cells: recent findings in spermatogenesis

The functions of Sertoli cells in spermatogenesis have attracted much more attention recently. Normal spermatogenesis depends on Sertoli cells, mainly due to their influence on nutrient supply, maintenance of cell junctions, and support for germ cells' mitosis and meiosis. Accumulating evidence in the past decade has highlighted the dominant functions of the MAPK, AMPK, and TGF-β/Smad signaling pathways during spermatogenesis. Among these pathways, the MAPK signaling pathway regulates dynamics of tight junctions and adherens junctions, proliferation and meiosis of germ cells, proliferation and lactate production of Sertoli cells; the AMPK and the TGF-β/Smad signaling pathways both affect dynamics of tight junctions and adherens junctions, as well as the proliferation of Sertoli cells. The AMPK signaling pathway also regulates lactate supply. These signaling pathways combine to form a complex regulatory network for spermatogenesis. In testicular tumors or infertile patients, the activities of these signaling pathways in Sertoli cells are abnormal. Clarifying the mechanisms of signaling pathways in Sertoli cells on spermatogenesis provides new insights into the physiological functions of Sertoli cells in male reproduction, and also serves as a pre-requisite to identify potential therapeutic targets in abnormal spermatogenesis including testicular tumor and male infertility.