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Kranz J, Bartoletti R, Bruyère F, Cai T, Geerlings S, Köves B, Schubert S, Pilatz A, Veeratterapillay R, Wagenlehner FME, Bausch K, Devlies W, Horváth J, Leitner L, Mantica G, Mezei T, Smith EJ, Bonkat G. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Eur Urol 2024:S0302-2838(24)02263-2. [PMID: 38714379 DOI: 10.1016/j.eururo.2024.03.035] [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: 03/12/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Urological infections significantly impact the wellbeing and quality of life of individuals owing to their widespread occurrence and diverse clinical manifestations. The objective of the guidelines panel was to provide evidence-based guidance on the diagnosis, treatment, and prevention of urinary tract infections (UTIs) and male accessory-gland infections, while addressing crucial public health aspects related to infection control and antimicrobial stewardship. METHODS For the 2024 guidelines on urological infections, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS Key recommendations emphasise the importance of a thorough medical history and physical examination for patients with urological infections. The guidelines stress the role of antimicrobial stewardship to combat the rising threat of antimicrobial resistance, providing recommendations for antibiotic selection, dosing, and duration on the basis of the latest evidence. CONCLUSIONS AND CLINICAL IMPLICATIONS This overview of the 2024 EAU guidelines offers valuable insights into managing urological infections and are designed for effective integration into clinical practice. PATIENT SUMMARY The European Association of Urology has issued an updated guideline on urological infections. The guidelines provide recommendations for diagnosis, treatment, and prevention, with a particular focus on minimising antibiotic use because of the increasing global threat of antimicrobial resistance.
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Affiliation(s)
- Jennifer Kranz
- Department of Urology and Pediatric Urology, RWTH Aachen University, Aachen, Germany; Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle, Germany.
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Franck Bruyère
- Department of Urology, CHRU Bretonneau, Tours, France; Université Francois Rabelais, PRES Centre Val de Loire, Tours, France
| | - Tommaso Cai
- Department of Urology, Santa Chiara, Regional Hospital, Trento, Italy
| | - Suzanne Geerlings
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bela Köves
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Sören Schubert
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Kathrin Bausch
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Wout Devlies
- Department of Urology, UZ Leuven, Leuven, Belgium
| | - József Horváth
- BKMK SZTE ÁOK Okt. Kh. Urológiai Osztálya, Kecskemét, Hungary
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Tunde Mezei
- Department of Urology, Telemark Hospital, Skien, Norway
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Gernot Bonkat
- alta Uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry, University of Basel, Basel, Switzerland
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Andrade AD, Almeida PGC, Mariani NAP, Santos NCM, Camargo IA, Martini PV, Kushima H, Ai D, Avellar MCW, Meinhardt A, Pleuger C, Silva EJR. Regional modulation of toll-like receptor signaling pathway genes in acute epididymitis in mice. Andrology 2024. [PMID: 38497291 DOI: 10.1111/andr.13630] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Region-specific immune environments in the epididymis influence the immune responses to uropathogenic Escherichia coli (UPEC) infection, a relevant cause of epididymitis in men. Toll-like receptors (TLRs) are essential to orchestrate immune responses against bacterial infections. The epididymis displays region-specific inflammatory responses to bacterial-derived TLR agonists, such as lipopolysaccharide (LPS; TLR4 agonist) and lipoteichoic acid (LTA; TLR2/TLR6 agonist), suggesting that TLR-associated signaling pathways could influence the magnitude of inflammatory responses in epididymitis. OBJECTIVES To investigate the expression and regulation of key genes associated with TLR4 and TLR2/TLR6 signaling pathways during epididymitis induced by UPEC, LPS, and LTA in mice. MATERIAL AND METHODS Epididymitis was induced in mice using UPEC, ultrapure LPS, or LTA, injected into the interstitial space of the initial segment or the lumen of the vas deferens close to the cauda epididymidis. Samples were harvested after 1, 5, and 10 days for UPEC-treated animals and 6 and 24 h for LPS-/LTA-treated animals. Ex vivo epididymitis was induced by incubating epididymal regions from naive mice with LPS or LTA. RT-qPCR and Western blot assays were conducted. RESULTS UPEC infection up-regulated Tlr2, Tlr4, and Tlr6 transcripts and their associated signaling molecules Cd14, Ticam1, and Traf6 in the cauda epididymidis but not in the initial segment. In these epididymal regions, LPS and LTA differentially modulated Tlr2, Tlr4, Tlr6, Cd14, Myd88, Ticam1, Traf3, and Traf6 expression levels. NFKB and AP1 activation was required for LPS- and LTA-induced up-regulation of TLR-associated signaling transcripts in the cauda epididymidis and initial segment, respectively. CONCLUSION The dynamic modulation of TLR4 and TLR2/TLR6 signaling pathways gene expression during epididymitis indicates bacterial-derived antigens elicit an increased tissue sensitivity to combat microbial infection in a spatial manner in the epididymis. Differential activation of TLR-associated signaling pathways may contribute to fine-tuning inflammatory responses along the epididymis.
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Affiliation(s)
- Alexandre D Andrade
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Priscila G C Almeida
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Noemia A P Mariani
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Natalia C M Santos
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Isabela A Camargo
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Poliana V Martini
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Helio Kushima
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Dingding Ai
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Maria Christina W Avellar
- Department of Pharmacology, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Andreas Meinhardt
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany
- Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
- Centre of Reproductive Health, Hudson Institute of Medical Research, Clayton, Australia
| | - Christiane Pleuger
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany
- Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Erick J R Silva
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University, Botucatu, São Paulo, Brazil
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Yang C, Li J, Liu JC, Zeng Q, Yeung WSB, Chiu PCN, Duan YG. Alterations of small non-coding RNA in the spermatozoa of mice with paternal experimental autoimmune epididymo-orchitis are associated with metabolic dysfunction in offspring. Andrology 2023. [PMID: 38127116 DOI: 10.1111/andr.13579] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Infection and inflammation of the genital tract are major potentially treatable factors contributing to male infertility. The profile of small non-coding RNA (sncRNAs) in spermatozoa can be altered by environmental exposures and inflammatory conditions. OBJECTIVES Experimental autoimmune epididymo-orchitis (EAEO) is a well-established model of autoimmune-induced chronic testicular and epididymal inflammation. This model investigates the effect of chronic inflammation on sperm sncRNA profiles and offspring phenotypes. MATERIALS AND METHODS Regarding the EAEO model, mice were immunized with testis homogenates thrice. Subsequently, flow cytometry and histological analyses were conducted on EAEO mice. Next-generation sequencing was used to profile small RNA of spermatozoa from the caput, corpus, and cauda epididymis. We performed a comprehensive integrative analysis of sperm sncRNAs and chronic epididymitis and identified their molecular signatures. The metabolic functions of the first-generation (F1) offspring were evaluated using a glucose tolerance test (GTT). RESULTS Body weight and metabolic function were significantly altered in F1 offspring from EAEO sperm donors. The analysis of cauda sperm sncRNA profiles revealed that the proportions of miRNAs and tsRNAs increased and decreased, respectively, after autoimmunization. Three differentially expressed miRNAs and seven differentially expressed tsRNAs were significantly correlated with F1 metabolic dysfunction. The expression patterns of miRNAs and tsRNAs in mice partially overlapped with those observed in the spermatozoa from human patients with chronic epididymitis. DISCUSSION AND CONCLUSIONS We revealed that autoimmune epididymo-orchitis alters sncRNA profiles in mouse spermatozoa. Offspring from mice with autoimmune orchitis develop metabolic disorders. A comprehensive analysis of human and mouse inflammation data revealed an association between alterations in the miRNA and tsRNA profiles of epididymal spermatozoa and offspring phenotypes.
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Affiliation(s)
- Chen Yang
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Jianlin Li
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynecology, Li Kai Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Jin-Chuan Liu
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynecology, Li Kai Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Qunxiong Zeng
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynecology, Li Kai Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - William Shu-Biu Yeung
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynecology, Li Kai Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Philip Chi-Ngong Chiu
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynecology, Li Kai Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Yong-Gang Duan
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
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McArthur M, Patel M. A pictorial review of genitourinary infections and inflammations. Clin Imaging 2023; 104:110013. [PMID: 37918136 DOI: 10.1016/j.clinimag.2023.110013] [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: 08/22/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Various infectious and inflammatory diseases affect the genitourinary system. This paper provides a review of multiple common and uncommon infectious and inflammatory conditions affecting the genitourinary system and some associated complications. These include acute infectious cystitis, emphysematous cystitis, acute pyelonephritis, emphysematous pyelonephritis, renal and perinephric abscesses, pyonephrosis, xanthogranulomatous pyelonephritis, epididymo-orchitis, vasitis, prostatitis, pelvic inflammatory disease, renal hydatid infection, renal tuberculosis, actinomycosis, Erdheim-Chester Disease, IgG4-Related Kidney Disease, urethritis and urethral strictures, ureteritis cystica, and genitourinary fistulas. Radiologists should be aware of these diseases' complications and management. Uncommon conditions must be considered when evaluating the genitourinary system.
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Affiliation(s)
- Mark McArthur
- University of California, Los Angeles, United States.
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Wang Z, Qiu M, Gao X, Zhang L. Testicular ischemia secondary to acute epididymitis: A case report. Medicine (Baltimore) 2023; 102:e33843. [PMID: 37335700 DOI: 10.1097/md.0000000000033843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
RATIONALE Rare side effects of acute epididymitis include testicular infarction and ischemia. Distinguishing them from testicular torsion is challenging, both clinically and radiologically. However, only a few such cases have been reported to date. PATIENT CONCERNS A 12-year-old child presented with persistent right testicular pain for 3 days. It developed after trauma and was accompanied by gradual swelling and enlargement of the right scrotum, with nausea and vomiting. Scrotal color Doppler ultrasonography demonstrated right epididymitis, right scrotal wall swelling, and right testicular torsion. Routine blood tests revealed leukocyte and neutrophil counts were both above normal. DIAGNOSIS Scrotal exploration revealed edema and adhesions in all layers of the scrotal wall. The right testicle was pale. The patient was diagnosed with testicular ischemia secondary to acute epididymitis. INTERVENTIONS The patient underwent simultaneous lower spermatic cord sheath dissection and decompression, testicular sheath reversal, and right testicular fixation. OUTCOMES Blood flow to the testicles gradually recovered after decompression, as did the color. Postoperatively, the patient's scrotal swelling and pain improved significantly. LESSONS Despite the rarity of this condition, it is a potentially serious consequence of epididymitis and should be considered when patients experience sudden scrotal pain.
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Affiliation(s)
- Zhichao Wang
- Department of Urology, Jinan Central Hospital, Shandong University, Jinan, Shandong Province, China
| | - Mengzhen Qiu
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Xinghua Gao
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Longyang Zhang
- Department of Urology, Jinan Central Hospital, Shandong University, Jinan, Shandong Province, China
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Lv D, Zhao M, Ni J, Liu W, Ren Y, Zhu D, Hu J. NGF regulates sertoli cell growth and prevents LPS-induced junction protein damage via PI3K/AKT/NFκB signaling. Theriogenology 2023; 195:138-148. [DOI: 10.1016/j.theriogenology.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
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Barrachina F, Ottino K, Tu LJ, Soberman RJ, Brown D, Breton S, Battistone MA. CX3CR1 deficiency leads to impairment of immune surveillance in the epididymis. Cell Mol Life Sci 2022; 80:15. [PMID: 36550225 PMCID: PMC9948740 DOI: 10.1007/s00018-022-04664-w] [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: 08/16/2022] [Revised: 11/09/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Mononuclear phagocytes (MPs) play an active role in the immunological homeostasis of the urogenital tract. In the epididymis, a finely tuned balance between tolerance to antigenic sperm and immune activation is required to maintain epididymal function while protecting sperm against pathogens and stressors. We previously characterized a subset of resident MPs that express the CX3CR1 receptor, emphasizing their role in antigen sampling and processing during sperm maturation and storage in the murine epididymis. Bacteria-associated epididymitis is the most common cause of intrascrotal inflammation and frequently leads to reproductive complications. Here, we examined whether the lack of functional CX3CR1 in homozygous mice (CX3CR1EGFP/EGFP, KO) alters the ability of MPs to initiate immune responses during epididymitis induced by LPS intravasal-epididymal injection. Confocal microscopy revealed that CX3CR1-deficient MPs located in the initial segments of the epididymis displayed fewer luminal-reaching membrane projections and impaired antigen capture activity. Moreover, flow cytometry showed a reduction of epididymal KO MPs with a monocytic phenotype under physiological conditions. In contrast, flow cytometry revealed an increase in the abundance of MPs with a monocytic signature in the distal epididymal segments after an LPS challenge. This was accompanied by the accumulation of CD103+ cells in the interstitium, and the prevention or attenuation of epithelial damage in the KO epididymis during epididymitis. Additionally, CX3CR1 deletion induced downregulation of Gja1 (connexin 43) expression in KO MPs. Together, our study provides evidence that MPs are gatekeepers of the immunological blood-epididymis barrier and reveal the role of the CX3CR1 receptor in epididymal mucosal homeostasis by inducing MP luminal protrusions and by regulating the monocyte population in the epididymis at steady state as well as upon infection. We also uncover the interaction between MPs and CD103+ dendritic cells, presumably through connexin 43, that enhance immune responses during epididymitis. Our study may lead to new diagnostics and therapies for male infertility and epididymitis by identifying immune mechanisms in the epididymis.
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Affiliation(s)
- F Barrachina
- Program in Membrane Biology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - K Ottino
- Program in Membrane Biology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - L J Tu
- Program in Membrane Biology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - R J Soberman
- Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - D Brown
- Program in Membrane Biology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - S Breton
- Centre Hospitalier Universitaire de Québec-Research Center, Department of Obstetrics, Gynecology, and Reproduction, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - M A Battistone
- Program in Membrane Biology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
- Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
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Shi X, Zhao H, Kang Y, Dong X, Yu C, Xie Q, Duan Y, Liao A, Huang D. The Role of Mononuclear Phagocytes in the Testes and Epididymis. Int J Mol Sci 2022; 24. [PMID: 36613494 DOI: 10.3390/ijms24010053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
The mononuclear phagocytic system (MPS) is the primary innate immune cell group in male reproductive tissues, maintaining the balance of pro-inflammatory and immune tolerance. This article aims to outline the role of mononuclear macrophages in the immune balance of the testes and epididymis, and to understand the inner immune regulation mechanism. A review of pertinent publications was performed using the PubMed and Google Scholar databases on all articles published prior to January 2021. Search terms were based on the following keywords: 'MPS', 'mononuclear phagocytes', 'testes', 'epididymis', 'macrophage', 'Mφ', 'dendritic cell', 'DC', 'TLR', 'immune', 'inflammation', and 'polarization'. Additionally, reference lists of primary and review articles were reviewed for other publications of relevance. This review concluded that MPS exhibits a precise balance in the male reproductive system. In the testes, MPS cells are mainly suppressed subtypes (M2 and cDC2) under physiological conditions, which maintain the local immune tolerance. Under pathological conditions, MPS cells will transform into M1 and cDC1, producing various cytokines, and will activate T cell specific immunity as defense to foreign pathogens or self-antigens. In the epididymis, MPS cells vary in the different segments, which express immune tolerance in the caput and pro-inflammatory condition in the cauda. Collectively, MPS is the control point for maintaining the immune tolerance of the testes and epididymis as well as for eliminating pathogens.
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Pleuger C, Ai D, Hoppe ML, Winter LT, Bohnert D, Karl D, Guenther S, Epelman S, Kantores C, Fijak M, Ravens S, Middendorff R, Mayer JU, Loveland KL, Hedger M, Bhushan S, Meinhardt A. The regional distribution of resident immune cells shapes distinct immunological environments along the murine epididymis. eLife 2022; 11:82193. [PMID: 36515584 DOI: 10.7554/elife.82193] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 07/26/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
The epididymis functions as transition zone for post-testicular sperm maturation and storage and faces contrasting immunological challenges, i.e. tolerance towards spermatozoa vs. reactivity against pathogens. Thus, normal organ function and integrity relies heavily on a tightly controlled immune balance. Previous studies described inflammation-associated tissue damage solely in the distal regions (corpus, cauda), but not in the proximal regions (initial segment, caput). To understand the observed region-specific immunity along the epididymal duct, we have used an acute bacterial epididymitis mouse model and analyzed the disease progression. Whole transcriptome analysis using RNAseq 10 days post infection showed a pro-inflammatory environment within the cauda, while the caput exhibited only minor transcriptional changes. High-dimensional flow cytometry analyses revealed drastic changes in the immune cell composition upon infection with uropathogenic Escherichia coli. A massive influx of neutrophils and monocytes was observed exclusively in distal regions and was associated with bacterial appearance and tissue alterations. In order to clarify the reasons for the region-specific differences in the intensity of immune responses, we investigated the heterogeneity of resident immune cell populations under physiological conditions by scRNASeq analysis of extravascular CD45+ cells. Twelve distinct immune cell subsets were identified, displaying substantial differences in distribution along the epididymis as further assessed by flow cytometry and immunofluorescence staining. Macrophages constituted the majority of resident immune cells and were further separated in distinct subgroups based on their transcriptional profile, tissue location and monocyte-dependence. Crucially, the proximal and distal regions showed striking differences in their immunological landscapes. These findings indicate that resident immune cells are strategically positioned along the epididymal duct, potentially providing different immunological environments required for addressing the contrasting immunological challenges and thus, preserving tissue integrity and organ function.
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Affiliation(s)
- Christiane Pleuger
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Dingding Ai
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Minea L Hoppe
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Laura T Winter
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Daniel Bohnert
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Dominik Karl
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Stefan Guenther
- ECCPS Bioinformatics and Deep Sequencing Platform, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Slava Epelman
- Ted Rogers Center of Heart Research, Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Crystal Kantores
- Ted Rogers Center of Heart Research, Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Monika Fijak
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Sarina Ravens
- Institute of Immunology, Hannover Medical School, Hanover, Germany
| | - Ralf Middendorff
- Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany.,Institute of Anatomy and Cell Biology, Unit of Signal Transduction, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Johannes U Mayer
- Department of Dermatology and Allergology, Philipps-University of Marburg, Marburg, Germany
| | - Kate L Loveland
- Centre of Reproductive Health, Hudson Institute of Medical Research, Clayton, Australia.,Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, Australia
| | - Mark Hedger
- Centre of Reproductive Health, Hudson Institute of Medical Research, Clayton, Australia.,Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, Australia
| | - Sudhanshu Bhushan
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Andreas Meinhardt
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Center of Reproductive Medicine, Justus-Liebig-University of Giessen, Giessen, Germany.,Centre of Reproductive Health, Hudson Institute of Medical Research, Clayton, Australia
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Li Y, Zhu J, Zhao X, Sun Y, Xu F, Xu S, Shang X. Oral Lycopene Administration Attenuates Inflammation and Oxidative Stress by Regulating Plasma Lipids in Rats with Lipopolysaccharide-Induced Epididymitis. J Inflamm Res 2022; 15:6517-6531. [PMCID: PMC9719710 DOI: 10.2147/jir.s380785] [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: 07/12/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Epididymitis histological alterations and related long-term reproductive issues cannot be cured by antibiotics alone. Few studies have been done on the effect of lycopene on epididymitis, despite the fact that it is an efficient antioxidant. The objective of this study was to assess the impact of lycopene on Lipopolysaccharide (LPS)-induced epididymis and lipid metabolism. Methods Thirty-one 260–290g rats were separated into the blank control group (n=10), the oil-control group (n=10), the single intraperitoneal injection of 5 mg/kg LPS (n=5), and the continuous intragastric of 5 mg/kg lycopene (n=6). The animals were euthanized after four weeks, and blood and the epididymis were removed for analysis. Results Lycopene significantly decreased IL-1α, IL-1β, TNF-α, MCP-1, IL-6 and lipid peroxidation product Malondialdehyde in serum and epididymis. It significantly increased the epididymis’s antioxidant enzyme and total antioxidant capacity. According to LC-MS plasma lipidomics, lycopene increased phosphatidylcholine, lysophosphatidylcholine, decreased phosphatidylethanolamine, triacylglycerol, and diacylglycerol levels, changed the composition of lipids, altered metabolic pathways, and these changes were related to the mechanism of anti-inflammatory and oxidative stress. 20 lipids, including PC (20:5e) and LPC (14:0), were identified through additional Spearman correlation analysis as being related to cytokines and oxidation indices. They served as possible lipid markers that may be utilized to gauge the severity of inflammation. Conclusion Lycopene has anti-inflammatory and antioxidant properties that improve histopathological and functional damage in LPS-induced epididymitis and is an alternate supplement for treating epididymitis. Lipidomics provide new perspectives on the possible mechanism of lycopene in protecting against LPS-induced epididymitis by integrating lipid metabolism and inflammation.
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Affiliation(s)
- Yu Li
- Department of Urology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, People’s Republic of China
| | - Jinde Zhu
- Department of Urology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, People’s Republic of China
| | - Xiaodong Zhao
- Department of Urology, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yi Sun
- Department of Urology, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, People’s Republic of China,Department of Pathology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Feng Xu
- Department of Urology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, People’s Republic of China,Department of Urology, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Song Xu
- Department of Urology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, People’s Republic of China,Department of Urology, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Xuejun Shang
- Department of Urology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, People’s Republic of China,Department of Urology, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, People’s Republic of China,Correspondence: Xuejun Shang, Department of Urology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, No. 305 East Zhongshan Road, Nanjing, 210002, People’s Republic of China, Tel +8613813905418, Email
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11
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Myers C, Hastert MC, Cornwall GA. Host defense functions of the epididymal amyloid matrix. Mol Hum Reprod 2022; 28:6823549. [PMID: 36367296 PMCID: PMC9709822 DOI: 10.1093/molehr/gaac038] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
The epididymal lumen is an immunologically distinct environment. It maintains tolerance for the naturally antigenic spermatozoa to allow their maturation into functional cells while simultaneously defending against pathogens that can ascend the male tract and cause infertility. We previously demonstrated that a nonpathological amyloid matrix that includes several cystatin-related epididymal spermatogenic (CRES) subgroup family members is distributed throughout the mouse epididymal lumen but its function was unknown. Here, we reveal a role for the epididymal amyloid matrix in host defense and demonstrate that the CRES amyloids and CD-1 mouse epididymal amyloid matrix exhibit potent antimicrobial activity against bacterial strains that commonly cause epididymal infections in men. We show the CRES and epididymal amyloids use several defense mechanisms including bacterial trapping, disruption of bacterial membranes and promotion of unique bacterial ghost-like structures. Remarkably, these antimicrobial actions varied depending on the bacterial strain indicating CRES amyloids and the epididymal amyloids elicit strain-specific host defense responses. We also demonstrate that the CRES monomer and immature assemblies of the epididymal amyloid transitioned into advanced structures in the presence of bacteria, suggesting their amyloid-forming/shape-shifting properties allows for a rapid reaction to a pathogen and provides an inherent plasticity in their host defense response. Together, our studies reveal new mechanistic insight into how the male reproductive tract defends against pathogens. Future studies using a mouse model for human epididymitis are needed to establish the epididymal amyloid responses to pathogens in vivo. Broadly, our studies provide an example of why nature has maintained the amyloid fold throughout evolution.
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Affiliation(s)
- Caitlyn Myers
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Gail A Cornwall
- Correspondence address. Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; E-mail:
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12
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Magistro G, Stief CG, Wagenlehner FME, Pilatz A. [Urinary diversion for acute epididymitis : Transurethral or suprapubic catheter?]. Urologe A 2022; 61:609-613. [PMID: 35486147 DOI: 10.1007/s00120-022-01834-3] [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] [Accepted: 04/07/2022] [Indexed: 11/26/2022]
Abstract
Acute infective epididymitis is the most common cause for scrotal pain in adults. The severe course of the disease requires immediate antimicrobial management, comprised antibiotic treatment and supportive measures. Patients with chronic indwelling catheters and developing epididymitis show a more severe clinical course compared to patients without a catheter. Although it is common clinical practice to place a catheter for the treatment of a systemic infectious condition of the genitourinary tract, there is only limited evidence of support due to the absence of clinical trials.
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Affiliation(s)
- G Magistro
- Urologische Klinik und Poliklinik der Universität München, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland.
| | - C G Stief
- Urologische Klinik und Poliklinik der Universität München, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - F M E Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Adrian Pilatz
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
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13
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Khastgir J. Advances in the antibiotic management of epididymitis. Expert Opin Pharmacother 2022; 23:1103-1113. [PMID: 35380486 DOI: 10.1080/14656566.2022.2062228] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Acute epididymitis is commonly encountered and typically presents acutely within a wide clinical spectrum. Most cases of acute epididymitis are caused by bacterial infection, most often by sexually transmitted organisms and urinary pathogens. Current treatment regimens remain empirical, although recent advances using modern diagnostic techniques support a change in the management paradigm. AREAS COVERED The choice of the initial antibiotic regimen is empirical and based on the most likely causative pathogen, whether sexually transmitted, enteric or other. Adherence of clinical practice remains short of available guidance, which may be improved by thorough clinical and microbiologic assessment, supported by a knowledge of the commonly associated pathogenic organisms, and the appropriate choice of tests required for their identification. Use of advanced microbiology techniques and studies of current practice provide new insights that have challenged traditional management paradigms. The authors discuss these points in and provide their expert perspectives on its treatment and future developments. EXPERT OPINION Relatively sparse direct trial data exists on antimicrobial treatments for acute epididymitis. Much of the presently available guidance is derived from previous guidance recommendations, knowledge of antimicrobial activities of specific agents, and treatment outcomes in uncomplicated infections. Identification of specific pathogens and prescribing accuracy is dependent on the extent to which cases are investigated and is therefore variable.
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Affiliation(s)
- Jay Khastgir
- Princess of Wales Hospital, Cwm Taff Bro Morgannwg NHS University Health Board & Swansea University School of Medicine, Swansea
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14
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Hasan H, Bhushan S, Fijak M, Meinhardt A. Mechanism of Inflammatory Associated Impairment of Sperm Function, Spermatogenesis and Steroidogenesis. Front Endocrinol (Lausanne) 2022; 13:897029. [PMID: 35574022 PMCID: PMC9096214 DOI: 10.3389/fendo.2022.897029] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Infection and inflammation are relevant entities of male reproductive disorders that can lead to sub-/infertility. Associated damage of the testis of affected men and in rodent models include leukocytic infiltration, edema formation, fibrosis, germ cell loss and reduced androgen levels. Negative effects on spermatogenesis are thought to be elicited by oxidative stress sustained mostly by increased levels of ROS and pro-inflammatory cytokines. Under normal conditions these cytokines have physiological functions. However, increased levels as seen in inflammation and infection, but also in obesity and cancer are harmful for germ cells and impair steroidogenesis. As a summary, there is mounting evidence that the activation of inflammatory pathways is a rather common feature in various forms of male testicular disorders that extends beyond established infectious/inflammatory cues. This mini review will focus on relevant entities and the mechanisms of how a dysbalance of local testicular factors contributes to disturbances of spermatogenesis and steroidogenesis.
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Affiliation(s)
| | | | - Monika Fijak
- *Correspondence: Andreas Meinhardt, ; Monika Fijak,
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15
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Heinhold M, Eder E. [55/m-Right-sided testicular pain : Preparation for the medical specialist examination: part 12]. Urologe A 2021; 61:29-32. [PMID: 34586454 DOI: 10.1007/s00120-021-01648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Maximiliane Heinhold
- Klinik für Urologie, Klinikum Ingolstadt GmbH, Krumenauerstraße 25, 85049, Ingolstadt, Deutschland
| | - Elisabeth Eder
- Klinik für Urologie, Klinikum Ingolstadt GmbH, Krumenauerstraße 25, 85049, Ingolstadt, Deutschland.
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16
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 674] [Impact Index Per Article: 224.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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17
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Berg E, Houska P, Nesheim N, Schuppe HC, Pilatz A, Fijak M, Manthey M, Steger K, Wagenlehner F, Schagdarsurengin U. Chronic Prostatitis/Chronic Pelvic Pain Syndrome Leads to Impaired Semen Parameters, Increased Sperm DNA Fragmentation and Unfavorable Changes of Sperm Protamine mRNA Ratio. Int J Mol Sci 2021; 22:7854. [PMID: 34360620 DOI: 10.3390/ijms22157854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/09/2021] [Accepted: 07/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a frequent disease affecting men of every age and accounting for a great number of consultations at urology departments. Previous studies suggested a negative impact of CP/CPPS on fertility. As increasing attention has been attributed to additional aspects, such as sperm DNA integrity and sperm protein alterations, besides the WHO standard semen analysis when assessing male fertility, in this prospective study, we aimed to further characterize the fertility status in CP/CPPS patients with a focus on these parameters. METHODS Sperm DNA fragmentation measured by sperm chromatin structure assay (SCSA) and protamine 1 to protamine 2 mRNA ratio assessed by RT-qPCR were analyzed along with conventional ejaculate parameters and inflammatory markers in 41 CP/CPPS patients and 22 healthy volunteers. RESULTS We found significant differences between the groups concerning multiple conventional ejaculate parameters. A significant increase in sperm DNA fragmentation was shown in CP/CPPS patients with association to other sperm parameters. The majority of CP/CPPS patients exhibited protamine mRNA ratios out of the range of regular fertility. CONCLUSIONS This is a pioneering study with a strong practical orientation revealing that CP/CPPS leads to increased sperm DNA damage and changes in sperm protamine levels, emphasizing an unfavorable impact of CP/CPPS on fertility.
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18
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Magistro G, Pilatz A, Schneede P, Schneidewind L, Wagenlehner F. [Viral infections in urology]. Urologe A 2021; 60:1150-8. [PMID: 34228144 DOI: 10.1007/s00120-021-01589-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 06/09/2021] [Indexed: 11/25/2022]
Abstract
Einleitung Die COVID-19-Pandemie („coronavirus disease 2019“) hat eindrucksvoll gezeigt, dass Infektionskrankheiten enorme Auswirkungen auf das Gesundheitswesen und darüber hinaus haben können. In der Urologie spielen Viren bei spezifischen Entitäten eine Rolle, wo sich der Urologe mit Viruserkrankungen beschäftigen muss. Methodik Diese Übersichtsarbeit hat zum Ziel in der Urologie relevante Virusinfektionen zu beschreiben und insbesondere die Impfprävention hervorzuheben. Es erfolgte eine selektive Literaturrecherche zu den Themen „COVID und Urologie“, „Urogenitale Virusinfektionen“, „Virale urologische Infektionen in der Transplantationsmedizin“ sowie „Impfprävention von Viruserkrankungen“. Ergebnisse Coronaviren sind Viren, die bereits 2‑mal lokale Epidemien verursacht haben (SARS- [„severe acute respiratory syndrome“] und MERS-Epidemie [„middle east respiratory syndrome“]). Die Tatsache, dass die SARS-CoV-2-Erkrankung („severe acute respiratory syndrome coronavirus 2“) auch ohne Symptome ansteckend ist, hat im Wesentlichen zu der raschen Ausbreitung und weltweiten Pandemie geführt. Eine Vielzahl von Viren, die auch eine Virämie induzieren können, wurde im Ejakulat nachgewiesen und wird damit mit einer etwaigen urogenitalen Infektion in Verbindung gebracht. Hierzu zählen u. a. das Mumps‑, Coxsackie-Viren oder Enteroviren. Es wurde auch gezeigt, dass auch eine Zika-Virusinfektion sexuell über die Spermien als Carrier übertragen werden kann. Somit spielen Viren auch eine wichtige Rolle in der Reproduktion. Bei der Nierentransplantation sind Urologen häufig mit viralen Infektionen konfrontiert. Die effektivste Waffe gegenüber Viren stellt die Impfprävention dar. Schlussfolgerung Äthiopathogenetisch ist der Urogenitaltrakt im Rahmen einer Virämie oder über eine Reaktivierung durch eine Immunsuppression am häufigsten mitbetroffen. Therapeutisch kommt der Immunmodulation sowie der Impfprophylaxe eine führende Rolle zu.
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19
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Khanmohammad KR, Khalili MB, Sadeh M, Talebi AR, Astani A, Shams A, Zare F. The effect of lipopolysaccharide from uropathogenic Escherichia coli on the immune system, testis tissue, and spermatozoa of BALB/c mice. Clin Exp Reprod Med 2021; 48:105-110. [PMID: 34024084 PMCID: PMC8176160 DOI: 10.5653/cerm.2020.03888] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/19/2020] [Indexed: 01/14/2023] Open
Abstract
Objective Uropathogenic Escherichia coli is known to cause urinary tract infections, and the endotoxin (lipopolysaccharide [LPS]) of this bacterium may cause deficiencies of sperm quality and morphology. In the present study, the effects of LPS on mouse sperm were studied, and the levels of interleukin (IL)-17A and possible changes in testis tissue were evaluated. Methods LPS of uropathogenic E. coli was extracted using the methanol-chloroform method, followed confirmation using sodium dodecyl sulfate-polyacrylamide electrophoresis. Purified LPS (100 µg/kg) or phosphate-buffered saline was injected intraperitoneally into BALB/c mice for 7 days consecutively in the test and control groups, mice were sacrificed on days 3, 7, and 42 after the first injection. Blood was tested for levels of IL-17A using the enzyme-linked immunosorbent assay method. Testis tissue and sperm were collected from each mouse and were studied according to standard protocols. Results The mean sperm count and motility significantly decreased (p=0.03) at 3, 7, and 42 days after the injections. The level of IL-17A in the test groups increased, but not significantly (p=0.8, p=0.11, and p=0.15, respectively). Microscopic studies showed no obvious changes in the morphology of the testis tissue; however, significant changes were observed in the cellular parenchyma on day 42. Conclusion LPS can stimulate the immune system to produce proinflammatory cytokines, resulting in an immune response in the testis and ultimately leading to deficiency in sperm parameters and testis tissue damage. In addition, the presence of LPS could significantly impair sperm parameters, as shown by the finding of decreased motility.
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Affiliation(s)
- Khadije Rezai Khanmohammad
- Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Bagher Khalili
- Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Maryam Sadeh
- Department of Laboratory Sciences, Faculty of Paramedical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Reza Talebi
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Akram Astani
- Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Shams
- Department of Immunology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fateme Zare
- Reproductive Immunology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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20
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Chirwa M, Davies O, Castelino S, Mpenge M, Nyatsanza F, Sethi G, Shabbir M, Rayment M. United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020. Int J STD AIDS 2021; 32:884-895. [PMID: 34009058 DOI: 10.1177/09564624211003761] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis has been updated in 2020. It offers advice on diagnostic tests, treatment and health promotion principles in the effective management of epididymo-orchitis. Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination. First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline. Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility. Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms (e.g. negative microscopy for gram-negative intracellular diplococci or no risk factors for gonorrhoea identified). Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin). If enteric pathogens are a likely cause (e.g. older patient, not sexually active, recent instrumentation, men who practice insertive anal intercourse, men with known abnormalities of the urinary tract or a positive urine dipstick for leucocytes and nitrites), ofloxacin and levofloxacin are recommended. A clinical care pathway has been produced to simplify the management of epididymo-orchitis. A patient information leaflet has been developed.
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Affiliation(s)
- Mimie Chirwa
- Genitourinary Medicine, 9762Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
| | - Olubanke Davies
- Genitourinary Medicine, Epsom & St Helier University Hospitals NHS Trust, London, UK
| | - Sheena Castelino
- Genitourinary Medicine, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Mbiye Mpenge
- Consultant Microbiologist, Weston Area Health NHS Trust, Weston-super-Mare, Somerset, UK
| | - Farai Nyatsanza
- Genitourinary Medicine, Cambridge Community Services NHS Trust, Cambridgeshire, UK
| | - Gulshan Sethi
- Genitourinary Medicine, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Majid Shabbir
- Urologist, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Michael Rayment
- Genitourinary Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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21
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Wang M, Yang Y, Cansever D, Wang Y, Kantores C, Messiaen S, Moison D, Livera G, Chakarov S, Weinberger T, Stremmel C, Fijak M, Klein B, Pleuger C, Lian Z, Ma W, Liu Q, Klee K, Händler K, Ulas T, Schlitzer A, Schultze JL, Becher B, Greter M, Liu Z, Ginhoux F, Epelman S, Schulz C, Meinhardt A, Bhushan S. Two populations of self-maintaining monocyte-independent macrophages exist in adult epididymis and testis. Proc Natl Acad Sci U S A 2021; 118:e2013686117. [PMID: 33372158 DOI: 10.1073/pnas.2013686117] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Macrophages are the principal immune cells of the epididymis and testis, but their origins, heterogeneity, development, and maintenance are not well understood. Here, we describe distinct populations of epididymal and testicular macrophages that display an organ-specific cellular identity. Combining in vivo fate-mapping, chimeric and parabiotic mouse models with in-depth cellular analyses, we found that CD64hiMHCIIlo and CD64loMHCIIhi macrophage populations of epididymis and testis arise sequentially from yolk sac erythro-myeloid progenitors, embryonic hematopoiesis, and nascent neonatal monocytes. While monocytes were the major developmental source of both epididymal and testicular macrophages, both populations self-maintain in the steady-state independent of bone marrow hematopoietic precursors. However, after radiation-induced macrophage ablation or during infection, bone marrow-derived circulating monocytes are recruited to the epididymis and testis, giving rise to inflammatory macrophages that promote tissue damage. These results define the layered ontogeny, maintenance and inflammatory response of macrophage populations in the male reproductive organs.
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22
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Abolghasemi S, Alizadeh M, Hashemi A, Tehrani S. Etiology and Clinical Features of Epididymo-orchitis: A Single-center Study in Tehran, Iran. Infect Disord Drug Targets 2021; 21:142-145. [PMID: 32067623 DOI: 10.2174/1871526520666200218115400] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 11/22/2022]
Abstract
CDATA[Introduction: Epididymo-orchitis is a common urological disease among men. Little is known about the clinical and epidemiological aspects of the disease in Iran. Thus, the present study was aimed at investigating the etiology, clinical sequelae and risk factors of patients with epididymo- orchitis in Tehran, Iran. METHODS Patients presenting with epididymo-orchitis were prospectively analyzed in order to study the etiology and pattern of the disease. Bacteriological, molecular and serological tests were undertaken to look for Chlamydia trachomatis, Neisseria gonorrhoeae, Brucella spp., Mycoplasma spp, and other bacteria. RESULTS Fifty patients with epididymo-orchitis were evaluated according to their clinical symptoms, duration of symptoms, physical examination, and laboratory studies. The mean age of the patients was 53 years. Fever, dysuria, pain in the flanks, urinary frequency and discharges occurred in 58.0%, 50.0%, 50.0%, 28.0% and 6.0%, respectively. Bacterial pathogen was identified in 26% (13/50) of patients by urine culture. Escherichia coli was the etiological agent in 11/13 patients (84.6%). Two out of 50 patients (4.0%) were also positive for Chlamydia trachomatis. Two samples were serologically positive for Brucella spp. High Mean age, fever, urinary frequency, history of the underlying disease and history of urinary tract infections were found to have a significant association with the positive bacteriologic urine culture (P<0.05). CONCLUSIONS The most common clinical manifestations were fever, dysuria, and abdominal pain. E. coli and C. trachomatis were the major causative agents. The use of a set of diagnostic approaches including clinical symptoms, urine culture and more precise techniques such as PCR should be taken into consideration for the definitive diagnosis.
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Affiliation(s)
- Sara Abolghasemi
- Labbafinejad Clinical Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Alizadeh
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Departmenet of Microbiology, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabnam Tehrani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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23
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Lu Y, Liu M, Tursi NJ, Yan B, Cao X, Che Q, Yang N, Dong X. Uropathogenic Escherichia coli Infection Compromises the Blood-Testis Barrier by Disturbing mTORC1-mTORC2 Balance. Front Immunol 2021; 12:582858. [PMID: 33679734 PMCID: PMC7933507 DOI: 10.3389/fimmu.2021.582858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/19/2021] [Indexed: 01/05/2023] Open
Abstract
The structural and functional destruction of the blood-testis barrier (BTB) following uropathogenic E. coli (UPEC) infection may be a critical component of the pathologic progress of orchitis. Recent findings indicate that the mammalian target of the rapamycin (mTOR)-signaling pathway is implicated in the regulation of BTB assembly and restructuring. To explore the mechanisms underlying BTB damage induced by UPEC infection, we analyzed BTB integrity and the involvement of the mTOR-signaling pathway using in vivo and in vitro UPEC-infection models. We initially confirmed that soluble virulent factors secreted from UPEC trigger a stress response in Sertoli cells and disturb adjacent cell junctions via down-regulation of junctional proteins, including occludin, zonula occludens-1 (ZO-1), F-actin, connexin-43 (CX-43), β-catenin, and N-cadherin. The BTB was ultimately disrupted in UPEC-infected rat testes, and blood samples from UPEC-induced orchitis in these animals were positive for anti-sperm antibodies. Furthermore, we herein also demonstrated that mTOR complex 1 (mTORC1) over-activation and mTORC2 suppression contributed to the disturbance in the balance between BTB "opening" and "closing." More importantly, rapamycin (a specific mTORC1 inhibitor) significantly restored the expression of cell-junction proteins and exerted a protective effect on the BTB during UPEC infection. We further confirmed that short-term treatment with rapamycin did not aggravate spermatogenic degeneration in infected rats. Collectively, this study showed an association between abnormal activation of the mTOR-signaling pathway and BTB impairment during UPEC-induced orchitis, which may provide new insights into a potential treatment strategy for testicular infection.
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Affiliation(s)
- Yongning Lu
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Miao Liu
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nicholas J. Tursi
- Department of Biology, University of Pennsylvania, Philadelphia, PA, United States
| | - Bin Yan
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiang Cao
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Che
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nianqin Yang
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xi Dong
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
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24
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Zhang Z, Wang M, Zhang Y, Zhang Y, Bartkuhn M, Markmann M, Hossain H, Chakraborty T, Hake SB, Jia Z, Meinhardt A, Bhushan S. Uropathogenic Escherichia coli Virulence Factor α-Hemolysin Reduces Histone Acetylation to Inhibit Expression of Proinflammatory Cytokine Genes. J Infect Dis 2021; 223:1040-1051. [PMID: 33453118 DOI: 10.1093/infdis/jiab018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/03/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
Urinary tract infections are common and costly diseases affecting millions of people. Uropathogenic Escherichia coli (UPEC) is a primary cause of these infections and has developed multiple strategies to avoid the host immune response. Here, we dissected the molecular mechanisms underpinning UPEC inhibition of inflammatory cytokine in vitro and in vivo. We found that UPEC infection simulates nuclear factor-κB activation but does not result in transcription of cytokine genes. Instead, UPEC-mediated suppression of the metabolic enzyme ATP citrate lyase results in decreased acetyl-CoA levels, leading to reduced H3K9 histone acetylation in the promotor region of CXCL8. These effects were dependent on the UPEC virulence factor α-hemolysin and were reversed by exogenous acetate. In a murine cystitis model, prior acetate supplementation rapidly resolved UPEC-elicited immune responses and improved tissue recovery. Thus, upon infection, UPEC rearranges host cell metabolism to induce chromatin remodeling processes that subvert expression of host innate immune response genes.
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Affiliation(s)
- Zhengguo Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Ming Wang
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University of Giessen, Giessen, Germany.,Medical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yiming Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Marek Bartkuhn
- Institute for Genetics, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Melanie Markmann
- Institute of Medical Microbiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Hamid Hossain
- Klinikum St Marien Amberg, Amberg and Kliniken Nordoberpfalz AG, Weiden, Germany
| | - Trinad Chakraborty
- Institute of Medical Microbiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Sandra B Hake
- Institute for Genetics, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Zhankui Jia
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Andreas Meinhardt
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Sudhanshu Bhushan
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Justus-Liebig-University of Giessen, Giessen, Germany
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25
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Pleuger C, Silva EJR, Pilatz A, Bhushan S, Meinhardt A. Differential Immune Response to Infection and Acute Inflammation Along the Epididymis. Front Immunol 2020; 11:599594. [PMID: 33329594 PMCID: PMC7729520 DOI: 10.3389/fimmu.2020.599594] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022] Open
Abstract
The epididymis is a tubular structure connecting the vas deferens to the testis. This organ consists of three main regions—caput, corpus, and cauda—that face opposing immunological tasks. A means of combating invading pathogens is required in the distally located cauda, where there is a risk of ascending bacterial infections originating from the urethra. Meanwhile, immune tolerance is necessary at the caput, where spermatozoa with immunogenic neo-antigens originate from the testis. Consistently, when challenged with live bacteria or inflammatory stimuli, the cauda elicits a much stronger immune response and inflammatory-inflicted damage than the caput. At the cellular level, a role for diverse and strategically positioned mononuclear phagocytes is emerging. At the mechanistic level, differential expression of immunoprotective and immunomodulatory mediators has been detected between the three main regions of the epididymis. In this review, we summarize the current state of knowledge about region-specific immunological characteristics and unveil possible underlying mechanisms on cellular and molecular levels. Improved understanding of the different immunological microenvironments is the basis for an improved therapy and counseling of patients with epididymal infections.
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Affiliation(s)
- Christiane Pleuger
- Institute of Anatomy and Cell Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Centre of Reproductive Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Erick José Ramo Silva
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, Brazil
| | - Adrian Pilatz
- Hessian Centre of Reproductive Medicine, Justus-Liebig-University Giessen, Giessen, Germany.,Department of Urology, Pediatric Urology and Andrology, University Hospital, Justus-Liebig-University Giessen, Giessen, Germany
| | - Sudhanshu Bhushan
- Institute of Anatomy and Cell Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Centre of Reproductive Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Andreas Meinhardt
- Institute of Anatomy and Cell Biology, Justus-Liebig-University Giessen, Giessen, Germany.,Hessian Centre of Reproductive Medicine, Justus-Liebig-University Giessen, Giessen, Germany
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26
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Andrade AD, Almeida PGC, Mariani NAP, Freitas GA, Kushima H, Filadelpho AL, Spadella MA, Avellar MCW, Silva EJR. Lipopolysaccharide-induced epididymitis modifies the transcriptional profile of Wfdc genes in mice†. Biol Reprod 2020; 104:144-158. [PMID: 33034631 DOI: 10.1093/biolre/ioaa189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Whey-acidic protein four-disulfide core domain (WFDC) genes display putative roles in innate immunity and fertility. In mice, a locus on chromosome 2 contains 5 and 11 Wfdc genes in its centromeric and telomeric subloci, respectively. Although Wfdc genes are highly expressed in the epididymis, their contributions to epididymal function remain elusive. Here, we investigated whether Wfdc genes are regulated in response to lipopolysaccharide (LPS)-induced epididymitis, an inflammatory condition that impairs male fertility. We induced epididymitis in mice via (i) interstitial LPS injection into epididymal initial segment and (ii) intravasal LPS injection into the vas deferens towards cauda epididymis. Interstitial and intravasal LPS induced a differential upregulation of inflammatory mediators (interleukin 1 beta, interleukin 6, tumor necrosis factor, interferon gamma, and interleukin 10) in the initial segment and cauda epididymis within 72 h post-treatment. These changes were accompanied by a time-dependent endotoxin clearance from the epididymis. In the initial segment, interstitial LPS upregulated all centromeric (Slpi, Wfdc5, Wfdc12, Wfdc15a, and Wfdc15b) and five telomeric (Wfdc2, Wfdc3, Wfdc6b, Wfdc10, and Wfdc13) Wfdc transcripts at 24 and 72 h. In the cauda epididymis, intravasal LPS upregulated Wfdc5 and Wfdc2 transcripts at 24 h, followed by a downregulation of Wfdc15b and three telomeric (Wfdc6a, Wfdc11, and Wfdc16) gene transcripts at 72 h. Pharmacological inhibition of nuclear factor kappa B activation prevented LPS-induced upregulation of centromeric and telomeric Wfdc genes depending on the epididymal region. We show that LPS-induced inflammation differentially regulated the Wfdc locus in the proximal and distal epididymis, indicating region-specific roles for the Wfdc family in innate immune responses during epididymitis.
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Affiliation(s)
- Alexandre D Andrade
- Department of Biophysics and Pharmacology, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | - Priscila G C Almeida
- Department of Biophysics and Pharmacology, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | - Noemia A P Mariani
- Department of Biophysics and Pharmacology, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | - Geanne A Freitas
- Department of Pharmacology, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Hélio Kushima
- Department of Biophysics and Pharmacology, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | - André L Filadelpho
- Department of Structural and Functional Biology, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | | | - Maria Christina W Avellar
- Department of Pharmacology, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Erick J R Silva
- Department of Biophysics and Pharmacology, Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
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27
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Zhao H, Yu C, He C, Mei C, Liao A, Huang D. The Immune Characteristics of the Epididymis and the Immune Pathway of the Epididymitis Caused by Different Pathogens. Front Immunol 2020; 11:2115. [PMID: 33117332 PMCID: PMC7561410 DOI: 10.3389/fimmu.2020.02115] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/05/2020] [Indexed: 01/26/2023] Open
Abstract
The epididymis is an important male accessory sex organ where sperm motility and fertilization ability develop. When spermatozoa carrying foreign antigens enter the epididymis, the epididymis shows "immune privilege" to tolerate them. It is well-known that a tolerogenic environment exists in the caput epididymis, while pro-inflammatory circumstances prefer the cauda epididymis. This meticulously regulated immune environment not only protects spermatozoa from autoimmunity but also defends spermatozoa against pathogenic damage. Epididymitis is one of the common causes of male infertility. Up to 40% of patients suffer from permanent oligospermia or azoospermia. This is related to the immune characteristics of the epididymis itself. Moreover, epididymitis induced by different pathogenic microbial infections has different characteristics. This article elaborates on the distribution and immune response characteristics of epididymis immune cells, the role of epididymis epithelial cells (EECs), and the epididymis defense against different pathogenic infections (such as uropathogenic Escherichia coli, Chlamydia trachomatis, and viruses to provide therapeutic approaches for epididymitis and its subsequent fertility problems.
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Affiliation(s)
- Hu Zhao
- Department of Human Anatomy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Caiqian Yu
- Department of Human Anatomy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunyu He
- Institute of Reproduction Health Research, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunlei Mei
- Institute of Reproduction Health Research, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Aihua Liao
- Institute of Reproduction Health Research, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Donghui Huang
- Institute of Reproduction Health Research, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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28
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Devlies W, Seghers M, Dilen K. Case report on secondary testicular necrosis due to fulminant epididymitis: ultrasonographic evaluation and diagnosis. BMC Urol 2020; 20:115. [PMID: 32753033 PMCID: PMC7404914 DOI: 10.1186/s12894-020-00655-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scrotal pain is a common complaint in the clinical practice, with many underlying causes. Infectious causes, like epididymitis, are frequently encountered in the work-up of scrotal pain. The presentation of epididymitis is mostly mild, yet major complications can occur. CASE PRESENTATION We present a 35-year-old male presenting with scrotal pain and swelling of the testicle. Epididymitis with testicular necrosis was diagnosed using repeated doppler ultrasonography measurements. An orchiectomy was performed which showed a hemorrhagic process with affected spermatic cord. Funiculitis together with epididymal swelling can impede testicular blood flow, with testicular necrosis possibly resulting in orchiectomy. This is the first case that proved funiculitis to co-exist in loss of colour doppler on pathological evaluation. CONCLUSIONS In order to reduce major complications, medical therapy should be promptly initiated when there is a suspicion of epididymitis.
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Affiliation(s)
- Wout Devlies
- Faculty of Medicine, KU Leuven, Leuven, Belgium. .,Department of Urology, Regional hospital St. Franciskus, Heusden-Zolder, Belgium.
| | - Mattias Seghers
- Department of Radiology, Regional hospital St. Franciskus, Heusden-Zolder, Belgium
| | - Kurt Dilen
- Department of Urology, Regional hospital St. Franciskus, Heusden-Zolder, Belgium
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29
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Klein B, Pant S, Bhushan S, Kautz J, Rudat C, Kispert A, Pilatz A, Wijayarathna R, Middendorff R, Loveland KL, Hedger MP, Meinhardt A. Dexamethasone improves therapeutic outcomes in a preclinical bacterial epididymitis mouse model. Hum Reprod 2020; 34:1195-1205. [PMID: 31211847 DOI: 10.1093/humrep/dez073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/25/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Can dexamethasone improve infertility-related cauda epididymidal tissue damage caused by bacterial epididymitis? SUMMARY ANSWER Dexamethasone in addition to anti-microbial treatment effectively reduces long-term deleterious epididymal tissue damage by dampening the host's adaptive immune response. WHAT IS KNOWN ALREADY Despite effective anti-microbial treatment, ~40% of patients with epididymitis experience subsequent sub- or infertility. An epididymitis mouse model has shown that the host immune response is mainly responsible for the magnitude of epididymal tissue damage that is fundamentally causative of the subsequent fertility issues. STUDY DESIGN, SIZE, DURATION Bacterial epididymitis was induced in male mice by using uropathogenic Escherichia coli (UPEC). From Day 3 after infection onwards, mice were treated with daily doses of levofloxacin (20 mg/kg, total n = 12 mice), dexamethasone (0.5 mg/kg, total n = 9) or both in combination (total n = 11) for seven consecutive days. Control animals were left untreated, i.e. given no interventional treatment following UPEC infection (total n = 11). Half of the animals from each group were killed either at 10 or 31 days post-infection. PARTICIPANTS/MATERIALS, SETTING, METHODS A mouse model of induced bacterial epididymitis was applied to adult male C57BL/6J mice. At the respective endpoints (10 or 31 days post-infection), epididymides were collected. Effectiveness of antibiotic treatment was assessed by plating of epididymal homogenates onto lysogeny broth agar plates. Overall tissue morphology and the degree and nature of tissue damage were assessed histologically. Quantitative RT-PCR was used to assess local cytokine transcript levels. Blood was drawn and serum analysed for systemic IgG and IgM levels by ELISA. In addition, correlation analyses of clinical data and serum-analyses of IgG and IgM levels in patients with epididymitis were performed. MAIN RESULTS AND THE ROLE OF CHANCE The addition of dexamethasone to the standard anti-microbial treatment did not further worsen epididymal tissue integrity. In fact, an obviously dampened immune response and reduced tissue reaction/damage was observed at both 10 and 31 days post-infection following combined treatment. More specifically, epididymal duct continuity was preserved, enabling sperm transit. In contrast, in untreated or antibiotic-treated animals, damage of the epididymal duct and duct constrictions were observed, associated with a lack of cauda spermatozoa. In line with the bacteriostatic/bactericidal effect of levofloxacin (alone as well as in combination), local cytokine transcript levels were significantly and similarly reduced in animals treated with levofloxacin alone (P < 0.01) or in combination with dexamethasone (P < 0.05) compared to UPEC-infected untreated animals. Interestingly, the addition of dexamethasone to the anti-microbial treatment induced a unique dampening effect on adaptive immunity, since systemic IgG and IgM levels as well as the pan-T cell marker CD3 were reduced at both 10 and 31 days post-infection. LIMITATIONS, REASONS FOR CAUTION Breeding studies to address the fertility-protecting effect of the combined treatment were not possible in the experimental animals because the vas deferens was ligated (model specific). WIDER IMPLICATIONS OF THE FINDINGS Whereas innate immunity is necessary and involved in acute bacterial clearance, adaptive immunity seems to be responsible for long-term, subclinical immunological activities that may negatively affect the pathogenesis of bacterial epididymitis even after effective bacterial eradication. These effects can be reduced in mice by the additional treatment with dexamethasone. This immunological characteristic of bacterial epididymitis shows similarities to the Jarisch-Herxheimer reaction known from other types of bacterial infection. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by grants from the Deutsche Forschungsgemeinschaft, Monash University and the Medical Faculty of Justus-Liebig University to the International Research Training Group on 'Molecular pathogenesis of male reproductive disorders' (GRK 1871). R.W., K.L.L. and M.P.H. were supported by grants from the National Health and Medical Research Council of Australia (ID1079646, ID1081987, ID1020269 and ID1063843) and by the Victorian Government's Operational Infrastructure Support Program. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER No clinical trial involved.
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Affiliation(s)
- Britta Klein
- Institute of Anatomy and Cell Biology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Swapnila Pant
- Institute of Anatomy and Cell Biology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Sudhanshu Bhushan
- Institute of Anatomy and Cell Biology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Julia Kautz
- Institute of Anatomy and Cell Biology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Carsten Rudat
- Institute for Molecular Biology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Andreas Kispert
- Institute for Molecular Biology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Germany
| | - Rukmali Wijayarathna
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Ralf Middendorff
- Institute of Anatomy and Cell Biology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Kate L Loveland
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia.,School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Mark P Hedger
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Andreas Meinhardt
- Institute of Anatomy and Cell Biology, Justus-Liebig University of Giessen, Giessen, Germany.,Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia
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30
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Zambrano F, Schulz M, Pilatz A, Wagenlehner F, Schuppe HC, Conejeros I, Uribe P, Taubert A, Sánchez R, Hermosilla C. Increase of leucocyte-derived extracellular traps (ETs) in semen samples from human acute epididymitis patients-a pilot study. J Assist Reprod Genet 2020; 37:2223-2231. [PMID: 32651678 DOI: 10.1007/s10815-020-01883-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/01/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To study the effector mechanism against pathogens of polymorphonuclear neutrophils (PMN) and macrophages, called ETosis, involving the release of extracellular traps (ETs) in patients with acute epididymitis. To assess the different ET phenotypes present in semen samples and to identify correlations between ETosis and clinical parameters. MATERIALS AND METHODS Samples from patients diagnosed with acute epididymitis were examined and compared with samples from uninfected controls. Biochemical analyses of seminal fluid included determination of peroxidase, α-glucosidase, fructose, and elastase levels. ETosis in semen was determined through presence of citrullinated histones, global histones, and extracellular DNA. Different ETosis phenotypes such as spread ETs, aggregated ETs, and diffuse ETs were identified by co-localisation of extruded DNA with myeloperoxidase and global histones. Anti-CD15+ and anti-CD68+ antibodies were used to identify different cell lines. RESULTS Revealed a high number of ETs compared with the control group. The mean number of CD15+PMN and CD68+ macrophages was higher in the acute epididymitis group. ETosis increase in ejaculates correlated with clinical parameters such as enhancement of elastase concentrations and diminution of fructose in the semen. CONCLUSIONS This work shows for the first time the presence of ETs and their components in semen from patients with acute epididymitis. The presence of infections is an important factor for induction of ETs in semen. Furthermore, the presence of ETosis in ejaculates is suggestive of developing infectious processes and might possibly have a diagnostic value.
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Affiliation(s)
- Fabiola Zambrano
- Laboratory in Reproductive Medicine and Molecular Endocrinology, Center of Excellence in Translational Medicine-Scientific and Technological Bioresource Nucleus (CEMT - BIOREN), Universidad de La Frontera, Avenida Alemania, 0458, Temuco, Chile.,Department of Preclinical Sciences, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Mabel Schulz
- Laboratory in Reproductive Medicine and Molecular Endocrinology, Center of Excellence in Translational Medicine-Scientific and Technological Bioresource Nucleus (CEMT - BIOREN), Universidad de La Frontera, Avenida Alemania, 0458, Temuco, Chile.,Department of Preclinical Sciences, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Ivan Conejeros
- Institute of Parasitology, Justus Liebig University Giessen, Giessen, Germany
| | - Pamela Uribe
- Laboratory in Reproductive Medicine and Molecular Endocrinology, Center of Excellence in Translational Medicine-Scientific and Technological Bioresource Nucleus (CEMT - BIOREN), Universidad de La Frontera, Avenida Alemania, 0458, Temuco, Chile
| | - Anja Taubert
- Institute of Parasitology, Justus Liebig University Giessen, Giessen, Germany
| | - Raúl Sánchez
- Laboratory in Reproductive Medicine and Molecular Endocrinology, Center of Excellence in Translational Medicine-Scientific and Technological Bioresource Nucleus (CEMT - BIOREN), Universidad de La Frontera, Avenida Alemania, 0458, Temuco, Chile. .,Department of Preclinical Sciences, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile.
| | - Carlos Hermosilla
- Institute of Parasitology, Justus Liebig University Giessen, Giessen, Germany
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31
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Wijayarathna R, Pasalic A, Nicolas N, Biniwale S, Ravinthiran R, Genovese R, Muir JA, Loveland KL, Meinhardt A, Fijak M, Hedger MP. Region-specific immune responses to autoimmune epididymitis in the murine reproductive tract. Cell Tissue Res 2020; 381:351-360. [PMID: 32383098 DOI: 10.1007/s00441-020-03215-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/28/2019] [Accepted: 04/04/2020] [Indexed: 12/11/2022]
Abstract
Epididymitis is a common pathology of the male reproductive tract, potentially leading to infertility. Studies on bacterial epididymitis indicate that the cauda epididymis is more susceptible to inflammatory damage than the caput. These regional differences in immunoregulation are further investigated using an experimental autoimmune epididymo-orchitis model. Adult mice were immunized against testicular antigens and tissues were collected at 30 and 50 days following the first immunization. Epididymitis developed progressively; 70% of the mice developed disease at 30 days after the initial immunization and 93% at 50 days. Epididymitis was characterized by epithelial damage, immune cell infiltrates and fibrosis in the cauda, with minimal changes in the corpus, while the caput was unaffected. The incidence of epididymitis was greater than that of orchitis but similar to vasitis. The severity of epididymitis was positively correlated with the orchitis severity. Expression of key genes implicated in epididymal immunoregulation, inflammation and fibrosis, such as Ido1, Tnf, Tgfb1, Ccl2, Il1b, Il10, Cx3cl1 and Col1a1, was unchanged in the caput but increased in proportion to damage severity in the cauda at 50 days. Activin receptor mRNA expression in the cauda was negatively correlated with disease severity. These data suggest that the cauda is highly susceptible to inflammatory damage following an autoimmune challenge but the caput is minimally affected. This may be because the cauda is required to combat ascending infections through a robust inflammatory response, while the caput provides a more tolerogenic environment in order to protect the auto-antigenic sperm released from the testis.
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Affiliation(s)
- Rukmali Wijayarathna
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia. .,Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
| | - Alen Pasalic
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Nour Nicolas
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Institute of Anatomy and Cell Biology, Justus-Liebig University Giessen, Giessen, Germany
| | - Sneha Biniwale
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Rama Ravinthiran
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Rosemary Genovese
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Julie A Muir
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Kate L Loveland
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Andreas Meinhardt
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Institute of Anatomy and Cell Biology, Justus-Liebig University Giessen, Giessen, Germany
| | - Monika Fijak
- Institute of Anatomy and Cell Biology, Justus-Liebig University Giessen, Giessen, Germany
| | - Mark P Hedger
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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32
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Fünfstück R, Hoyme U, Naber K, Pilatz A, Schubert S, Wagenlehner F. Calculated parenteral initial treatment of bacterial infections: Infections of the kidneys and the genito-urinary tract. GMS Infect Dis 2020; 8:Doc12. [PMID: 32373437 PMCID: PMC7186803 DOI: 10.3205/id000056] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This is the eighth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter deals with the treatment of more severe infections of the kidney and the urogenital tract, including urosepsis. Recommendations for empiric and targeted antibacterial treatment are given.
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Affiliation(s)
- Reinhard Fünfstück
- Klinik für Innere Medizin, Sophien- und Hufeland-Klinikum gGmbH Weimar, Germany
| | - Udo Hoyme
- Klinik für Gynäkologie und Geburtshilfe St. Georg Klinikum Eisenach, Germany
| | - Kurt Naber
- Urologische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Adrian Pilatz
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität Giessen, Germany
| | - Sören Schubert
- Max von Pettenkofer-Institut, Medizinische Fakultät, Ludwig Maximilians-Universität München, Munich, Germany
| | - Florian Wagenlehner
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität Giessen, Germany
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33
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Pilatz A, Kilb J, Kaplan H, Fietz D, Hossain H, Schüttler CG, Diemer T, Bergmann M, Domann E, Weidner W, Wagenlehner F, Schuppe HC. High prevalence of urogenital infection/inflammation in patients with azoospermia does not impede surgical sperm retrieval. Andrologia 2019; 51:e13401. [PMID: 31456226 PMCID: PMC7147116 DOI: 10.1111/and.13401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 01/12/2023] Open
Abstract
Considering infection/inflammation to be an important risk factor in male infertility, the aim of this study was to make a comprehensive evaluation of the prevalence of urogenital tract infection/inflammation and its potential impact on sperm retrieval in azoospermic patients. In this prospective study, 71 patients with azoospermia were subjected to an extensive andrological workup including comprehensive microbiological diagnostics (2-glass test, semen, testicular swab and testicular tissue analysis) and testicular biopsy/testicular sperm extraction (TESE). Medical history suggested urogenital tract infection/inflammation in 7% of patients, 11% harboured STIs, 14% showed significant bacteriospermia, 15% had seminal inflammation, 17% fulfilled the MAGI definition, and 27% had relevant pathogens. At the testicular level, 1 patient had a swab positive for bacteria, no viruses were detected, tissue specimens never indicated pathogens, whereas histopathology revealed focal immune cell infiltrates in 23% of samples. Testicular sperm retrieval rate was 100% in obstructive and 46% in nonobstructive azoospermia. None of the infection/inflammation-related variables was associated with the success of sperm retrieval or inflammatory lesions in the testis. The high prevalence of urogenital infection/inflammation among azoospermic men underpins their role as significant aetiologic factors in male infertility. However, this observation does not refer to the chances of sperm retrieval at the time of surgery/TESE.
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Affiliation(s)
- Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany.,Hessian Centre of Reproductive Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Jill Kilb
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Huelya Kaplan
- Department of Trauma, Hand and Reconstructive Surgery, Justus Liebig University Giessen, Giessen, Germany
| | - Daniela Fietz
- Hessian Centre of Reproductive Medicine, Justus Liebig University Giessen, Giessen, Germany.,Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University Giessen, Giessen, Germany
| | - Hamid Hossain
- Institute for Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany.,Institute for Laboratory Medicine and Microbiology, Klinikum St. Marien Amberg, Amberg, Germany
| | - Christian G Schüttler
- Institute for Medical Virology, National Reference Laboratory (NRZ) for HBV and HDV, Justus Liebig University Giessen, Giessen, Germany
| | - Thorsten Diemer
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany.,Hessian Centre of Reproductive Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Martin Bergmann
- Hessian Centre of Reproductive Medicine, Justus Liebig University Giessen, Giessen, Germany.,Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University Giessen, Giessen, Germany
| | - Eugen Domann
- Institute for Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany.,Hessian Centre of Reproductive Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany.,Hessian Centre of Reproductive Medicine, Justus Liebig University Giessen, Giessen, Germany
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34
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Schulz M, Zambrano F, Schuppe HC, Wagenlehner F, Taubert A, Gaertner U, Sánchez R, Hermosilla C. Monocyte-derived extracellular trap (MET) formation induces aggregation and affects motility of human spermatozoa in vitro. Syst Biol Reprod Med 2019; 65:357-366. [PMID: 31208212 DOI: 10.1080/19396368.2019.1624873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The presence of bacteria and/or leukocytes can alter semen quality resulting in low sperm quality and infertility. Inflammation or infection increases the numbers of PMN or macrophages/monocytes in male genital tract. Release of extracellular traps (ETs) by leukocytes has been recognized as a novel mechanism of early host innate immunity, in response to invasive pathogens. This is the first work that evaluated the mechanism of triggered ETs in monocytes co-incubated with spermatozoa or bacteria and the effect on sperm function. Selected spermatozoa and human monocytes isolated from peripheral blood were obtained by healthy donors. Two experimental models were developed, one aseptic (non-infectious) incubating spermatozoa and monocytes, and septic models (infectious) incubating spermatozoa with monocytes and uropathogenic Escherichia coli (E. coli). ETs of monocytes (METs) (DNA, global histone and citrullinated histones) were visualized by scanning electron microscopy (SEM) and immunofluorescence analyses. Progressive motility was performed at 0, 10, 30, 60, and 180 min after co-incubation with CASA system. SEM- and immunofluorescence-analyses revealed human spermatozoa alone or in the presence of E. coli as strong inducers METs. In aseptic model, the motility decreased to 65.2 ± 3.5% at 10 min of incubation and 29.3 ± 3.3% at 30 min (p < 0.001). In septic model, motility decreased to 44.5 ± 5.9% (10 min) and 12.7 ± 2.2% (30 min) (p < 0.001). MET-derived small spermatozoa aggregations were observed in both models. METs might physically block spermatozoa and decrease motility after a brief contact. This may impair male fertility, especially in patients with genital tract infections or chronic inflammation. Abbreviations: PMN: polymorphonuclear; ETs: extracellular traps; E. coli: Escherichia coli; METs: ETs of monocytes; SEM: scanning electron microscopy; NE: neutrophil elastase; MPO: myeloperoxidase; MAGI: male accessory gland infection; PBMC: peripheral blood mononuclear cells; RT: room temperature; CFU: colony forming units; CASA: computer-aided sperm analysis; H4Cit3: histone H4 citrullinated 3.
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Affiliation(s)
- Mabel Schulz
- Laboratory of Reproductive Medicine and Molecular Endocrinology, Center for Translational Medicine (CEMT-BIOREN), Faculty of Medicine, Universidad de La Frontera , Temuco , Chile.,Doctoral Program in Morphological Sciences, Faculty of Medicine, Universidad de La Frontera , Temuco , Chile.,Institute of Parasitology, Biomedical Research Center Seltersberg (BFS), Justus Liebig University Giessen , Giessen , Germany
| | - Fabiola Zambrano
- Laboratory of Reproductive Medicine and Molecular Endocrinology, Center for Translational Medicine (CEMT-BIOREN), Faculty of Medicine, Universidad de La Frontera , Temuco , Chile.,Department of Preclinical Science, Faculty of Medicine, Universidad de La Frontera , Temuco , Chile
| | - Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen , Giessen , Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen , Giessen , Germany
| | - Anja Taubert
- Institute of Parasitology, Biomedical Research Center Seltersberg (BFS), Justus Liebig University Giessen , Giessen , Germany
| | - Ulrich Gaertner
- Institute of Anatomy and Cell Biology, Justus Liebig University Giessen , Giessen , Germany
| | - Rául Sánchez
- Laboratory of Reproductive Medicine and Molecular Endocrinology, Center for Translational Medicine (CEMT-BIOREN), Faculty of Medicine, Universidad de La Frontera , Temuco , Chile.,Department of Preclinical Science, Faculty of Medicine, Universidad de La Frontera , Temuco , Chile
| | - Carlos Hermosilla
- Institute of Parasitology, Biomedical Research Center Seltersberg (BFS), Justus Liebig University Giessen , Giessen , Germany
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35
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Avellar MCW, Ribeiro CM, Dias-da-Silva MR, Silva EJR. In search of new paradigms for epididymal health and disease: innate immunity, inflammatory mediators, and steroid hormones. Andrology 2019; 7:690-702. [PMID: 31207127 DOI: 10.1111/andr.12654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/30/2018] [Revised: 04/22/2019] [Accepted: 04/29/2019] [Indexed: 02/07/2023]
Abstract
The primary job of the epididymis is to mature and protect the luminally transiting spermatozoa. Mounting evidence is showing that innate immune components [including Toll-like receptors (TLRs) and antimicrobial proteins, among which are β-defensins] and inflammatory mediators, under the primary influence of androgens, participate in the cellular and molecular processes that define this tissue. Here, we present an overview of the contributions of these signaling pathway components during epididymal homeostasis and discuss the hypotheses as to their involvement in epididymitis, the most common urological inflammatory condition in men, frequently impairing their fertility. Drawing primarily from rodent models, we also focus on how the distribution and functional expression of innate immune components are differentially regulated in the prenatal developing epididymis, providing new insights into the disruption of these signaling pathways throughout the lifespan. Male infertility is caused by a variety of conditions, such as congenital malformations, genetic and endocrine disorders, exposure to environmental toxicants, and inflammatory/infectious conditions. More than one-third of infertile men with an idiopathic condition cannot currently be adequately diagnosed. Thinking about the innate immunity and inflammation context of the epididymis may provide new insights and directions as to how these systems contribute to male fertility, as well as also uncover urological and andrological outcomes that may aid clinicians in diagnosing and preventing epididymal pathologies.
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Affiliation(s)
- M C W Avellar
- Department of Pharmacology, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - C M Ribeiro
- Department of Pharmacology, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - M R Dias-da-Silva
- Department of Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - E J R Silva
- Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista 'Júlio de Mesquita Filho', Botucatu, SP, Brazil
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36
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Song SH, Shim JY, Sung S, Her YS, Oh M, Shin DH, Lee J, Baek J, Lee WS, Kim DS. Delayed recovery of a patient with obstructive azoospermia and a history of acute epididymitis. Clin Exp Reprod Med 2019; 46:95-98. [PMID: 31181877 PMCID: PMC6572663 DOI: 10.5653/cerm.2019.46.2.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/02/2019] [Indexed: 11/06/2022] Open
Abstract
Obstructive azoospermia caused by acute epididymitis is usually permanent, and microsurgical vasoepididymostomy is the only reconstructive treatment option. There have been no reports of delayed recovery of sperm count after over 1 year in a patient with obstructive azoospermia related to history of acute epididymitis. We present a young male patient who had azoospermia and a history of acute epididymitis who experienced delayed recovery, with complete restoration of sperm production and the ability to conceive naturally.
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Affiliation(s)
- Seung-Hun Song
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Jeong Yun Shim
- Department of Pathology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Suye Sung
- Department of Andrology Lab, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Young Sun Her
- Department of Andrology Lab, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Mihee Oh
- Department of Andrology Lab, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dong Hyuk Shin
- Department of Andrology Lab, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Jinil Lee
- Department of Andrology Lab, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Jeoungwon Baek
- Department of Andrology Lab, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dong Suk Kim
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
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37
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Lei Y, Yang J, Li Y, Yu X, Deng S, Xue C, Zheng W, Shang J, Xue Y. Traditional Chinese medicine on treating epididymitis: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e15975. [PMID: 31192937 PMCID: PMC6587607 DOI: 10.1097/md.0000000000015975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Epididymitis is a common disease in nonspecific infections of the male reproductive system according to the clinical incidence of acute epididymitis and chronic epididymitis. Many clinical trials have proven that Chinese medicine has a significant effect in the treatment of epididymitis. In this systematic review, we aim to evaluate the effectiveness and safety of traditional Chinese medicine (TCM) for epididymitis. METHODS We will search for PubMed, Cochrane Library, AMED, Embase, WorldSciNet, Nature, Science online, China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of epididymitis. ETHICS AND DISSEMINATION This systematic review will evaluate the efficacy and safety of TCM for treating epididymitis. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.Registration number: PROSPERO CRD42019130569.
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Affiliation(s)
- Yi Lei
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Jie Yang
- Beijing Fengtai Maternal & Child Health Hospital
| | - Yongqiang Li
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Xudong Yu
- Department of Andrology, Dongzhimen Hospital, Dongcheng District, Beijing, China
| | - Sheng Deng
- Department of Andrology, Dongzhimen Hospital, Dongcheng District, Beijing, China
| | - Chaohui Xue
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Wei Zheng
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Jianwei Shang
- Department of Andrology, Dongzhimen Hospital, Dongcheng District, Beijing, China
| | - Yahui Xue
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
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38
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Abstract
Orchitis can be acutely symptomatic or chronically asymptomatic. Among the acute forms is the rarer isolated orchitis, which is of viral origin in most cases as well as the more frequent secondary orchitis, which is usually the result of an ascending bacterial epididymitis. In addition, sterile forms of orchitis are also seen in patients with systemic autoimmune comorbidities. Chronic asymptomatic orchitis is the term used to describe cellular immune infiltrates in the testes, which are observed in approximately 25% of cases of azoospermia during testicular biopsy. The etiopathogenesis of these infiltrates is largely unknown with postinfection and primary pathogen-independent autoimmune reactions being discussed. Animal experimental models of orchitis may be helpful to investigate the immunological mechanisms involved as well as the therapeutic possibilities.
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Affiliation(s)
- A Pilatz
- Klinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
| | - M Fijak
- Institut für Anatomie und Zellbiologie, Justus-Liebig-Universität, Gießen, Deutschland
| | - F Wagenlehner
- Klinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - H-C Schuppe
- Klinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
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39
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Abstract
The management of female stress urinary incontinence (SUI) has come under scrutiny in recent years following growing reports of mesh-related complications. Patients require thorough evaluation and management as part of a multidisciplinary team, and extensive counselling about the surgical treatment options is imperative. There is no clear consensus on the optimal management of the complex group of patients with mesh-related complications or recurrent SUI. We present two cases of female SUI to highlight the key factors to be considered when managing these patients. Level of evidence: Level 5.
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Affiliation(s)
- Néha Sihra
- Department of Urology, St George’s Hospital, London, UK
| | - Magda Kujawa
- Department of Urology, Stockport NHS Foundation Trust, Stepping Hill Hospital, UK
| | - Eskinder Solomon
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| | | | - Arun Sahai
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| | - Sachin Malde
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
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40
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Abstract
BACKGROUND Epididymitis is a common disease in non-specific infections of the male reproductive system. According to the clinical incidence of acute epididymitis and chronic epididymitis, which is more common in chronic epididymitis. There are many clinical trials confirmed that acupuncture treatment can relieve pain and improve symptoms of epididymitis to some extent. In this systematic review, we aim to evaluate the effectiveness and safety of acupuncture for epididymitis. METHODS AND ANALYSIS We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of epididymitis. ETHICS AND DISSEMINATION This systematic review will evaluate the efficacy and safety of acupuncture for epididymitis. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process trial. REGISTRATION NUMBER PROSPERO CRD42018111348.
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Affiliation(s)
- Jisheng Wang
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital
| | - Liang Han
- Department of Andrology, Fangshan Hospital, Beijing University of Chinese Medicine, Fangshan District
| | - Binghao Bao
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital
| | - Xudong Yu
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital
| | - Kaige Zhang
- Graduate School of Beijing University of Chinese Medicine
- Department of Encephalopathy, Dongzhimen Hospital, Beijing, China
| | - Hengheng Dai
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital
| | - Xiao Li
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital
| | - Bin Wang
- Department of Andrology, Dongzhimen Hospital
| | - Haisong Li
- Department of Andrology, Dongzhimen Hospital
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41
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Louette A, Krahn J, Caine V, Ha S, Lau TTY, Singh AE. Treatment of Acute Epididymitis: A Systematic Review and Discussion of the Implications for Treatment Based on Etiology. Sex Transm Dis 2018; 45:e104-8. [DOI: 10.1097/olq.0000000000000901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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42
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Pilatz A, Veeratterapillay R, Köves B, Cai T, Bartoletti R, Wagenlehner F, Bruyère F, Geerlings S, Bonkat G, Pradere B. Update on Strategies to Reduce Infectious Complications After Prostate Biopsy. Eur Urol Focus 2018; 5:20-28. [PMID: 30503175 DOI: 10.1016/j.euf.2018.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 07/12/2018] [Revised: 11/04/2018] [Accepted: 11/19/2018] [Indexed: 11/24/2022]
Abstract
CONTEXT Prostate biopsy is one of the most performed procedures in urology. As a diagnostic procedure it should be of low risk. However, morbidity following prostate biopsy is common due to infectious complications. OBJECTIVE To describe how to reduce infectious complications following prostate biopsy. We report on antibiotic and technical interventions to reduce infectious complications. EVIDENCE ACQUISITION The data presented are based on a narrative review. Search in PubMed and Medline was performed until May 2018 with a focus on randomised controlled trials and meta-analyses. Articles were reviewed for data on symptomatic infections, hospitalisation, and adverse events. EVIDENCE SYNTHESIS Antibiotic prophylaxis is the standard of care. However, the duration of antibiotic preemptive treatment is still under debate. The use of augmented antibiotic prophylaxis as well as targeted antibiotic prophylaxis might be of potential value, but evidence is currently limited. Moreover, no antibiotic class was shown to be clearly superior to another. The evaluation of the technical aspects during prostate biopsy reveals that rectal preparation with povidone-iodine is clearly effective to reduce infectious complications. Transperineal biopsy has a potential benefit to reduce infectious complications, but powerful randomised controlled studies are missing. Finally, the number of biopsy cores, the application of periprostatic nerve block, or the use of a cleansing enema has no impact on prostate biopsy in terms of infectious complications. CONCLUSIONS The available data only suggest that rectal preparation with povidone-iodine as well as antibiotic prophylaxis is of significant advantage to reduce infectious complications following prostate biopsy. The augmented and targeted antibiotic prophylaxis shows some potential, but need further validation. PATIENT SUMMARY In this review we evaluate the best management strategy to prevent infectious complications following prostate biopsy. We show that antibiotic prophylaxis is essential for prostate biopsy and that rectal preparation with povidone-iodine is mandatory.
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Affiliation(s)
- Adrian Pilatz
- Department of Urology, Paediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | | | - Bela Köves
- South-Pest Teaching Hospital, Department of Urology, Budapest, Hungary
| | - Tommaso Cai
- Santa Chiara Regional Hospital, Department of Urology, Trento, Italy
| | - Riccardo Bartoletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Florian Wagenlehner
- Department of Urology, Paediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Franck Bruyère
- Academic Department of Urology, CHRU Tours, François Rabelais University, Tours, France
| | - Suzanne Geerlings
- Division of Infectious Diseases, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Gernot Bonkat
- alta uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry (COB), University of Basel, Basel, Switzerland
| | - Benjamin Pradere
- Academic Department of Urology, CHRU Tours, François Rabelais University, Tours, France.
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Haidl G, Haidl F, Allam JP, Schuppe HC. Therapeutic options in male genital tract inflammation. Andrologia 2018; 51:e13207. [DOI: 10.1111/and.13207] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/25/2018] [Accepted: 10/15/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Gerhard Haidl
- Andrology Unit, Department of Dermatology and Allergy; University Hospital Bonn; Bonn Germany
| | - Friederike Haidl
- Department of Urology; University Hospital Cologne; Cologne Germany
| | - Jean-Pierre Allam
- Andrology Unit, Department of Dermatology and Allergy; University Hospital Bonn; Bonn Germany
| | - Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University; Giessen Germany
- Hessian Centre of Reproductive Medicine; Justus Liebig University; Giessen Germany
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Abstract
Introduction Although more often recognized as a culprit in female urinary tract infection, coagulase-negative staphylococci (CoNS) can cause severe genitourinary infections in men. While positive blood cultures with CoNS are usually thought to be contaminants, in the setting of a severe genito-urinary infection they can represent true infection. Case presentation We present the case of a 70-year-old male without a central venous catheter or urinary catheter who developed Staphylococcus haemolyticus bloodstream infection secondary to epididymo-orchitis. Conclusion This case highlights the importance of prompt recognition of serious CoNS infections, including bacteraemia, in the setting of CoNS genitourinary tract infections.
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Affiliation(s)
- Christina Pindar
- Case Western Reserve, University School of Medicine, Cleveland, OH 44106, USA
| | - Roberto A Viau
- Case Western Reserve, University School of Medicine, Cleveland, OH 44106, USA.,Department of Medicine, Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA
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Fijak M, Pilatz A, Hedger MP, Nicolas N, Bhushan S, Michel V, Tung KSK, Schuppe HC, Meinhardt A. Infectious, inflammatory and 'autoimmune' male factor infertility: how do rodent models inform clinical practice? Hum Reprod Update 2018; 24:416-441. [PMID: 29648649 PMCID: PMC6016649 DOI: 10.1093/humupd/dmy009] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/02/2018] [Accepted: 03/10/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infection and inflammation of the reproductive tract are significant causes of male factor infertility. Ascending infections caused by sexually transmitted bacteria or urinary tract pathogens represent the most frequent aetiology of epididymo-orchitis, but viral, haematogenous dissemination is also a contributory factor. Limitations in adequate diagnosis and therapy reflect an obvious need for further understanding of human epididymal and testicular immunopathologies and their contribution to infertility. A major obstacle for advancing our knowledge is the limited access to suitable tissue samples. Similarly, the key events in the inflammatory or autoimmune pathologies affecting human male fertility are poorly amenable to close examination. Moreover, the disease processes generally have occurred long before the patient attends the clinic for fertility assessment. In this regard, data obtained from experimental animal models and respective comparative analyses have shown promise to overcome these restrictions in humans. OBJECTIVE AND RATIONALE This narrative review will focus on male fertility disturbances caused by infection and inflammation, and the usefulness of the most frequently applied animal models to study these conditions. SEARCH METHODS An extensive search in Medline database was performed without restrictions until January 2018 using the following search terms: 'infection' and/or 'inflammation' and 'testis' and/or 'epididymis', 'infection' and/or 'inflammation' and 'male genital tract', 'male infertility', 'orchitis', 'epididymitis', 'experimental autoimmune' and 'orchitis' or 'epididymitis' or 'epididymo-orchitis', antisperm antibodies', 'vasectomy'. In addition to that, reference lists of primary and review articles were reviewed for additional publications independently by each author. Selected articles were verified by each two separate authors and discrepancies discussed within the team. OUTCOMES There is clear evidence that models mimicking testicular and/or epididymal inflammation and infection have been instructive in a better understanding of the mechanisms of disease initiation and progression. In this regard, rodent models of acute bacterial epididymitis best reflect the clinical situation in terms of mimicking the infection pathway, pathogens selected and the damage, such as fibrotic transformation, observed. Similarly, animal models of acute testicular and epididymal inflammation using lipopolysaccharides show impairment of reproduction, endocrine function and histological tissue architecture, also seen in men. Autoimmune responses can be studied in models of experimental autoimmune orchitis (EAO) and vasectomy. In particular, the early stages of EAO development showing inflammatory responses in the form of peritubular lymphocytic infiltrates, thickening of the lamina propria of affected tubules, production of autoantibodies against testicular antigens or secretion of pro-inflammatory mediators, replicate observations in testicular sperm extraction samples of patients with 'mixed atrophy' of spermatogenesis. Vasectomy, in the form of sperm antibodies and chronic inflammation, can also be studied in animal models, providing valuable insights into the human response. WIDER IMPLICATIONS This is the first comprehensive review of rodent models of both infectious and autoimmune disease of testis/epididymis, and their clinical implications, i.e. their importance in understanding male infertility related to infectious and non-infectious/autoimmune disease of the reproductive organs.
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Affiliation(s)
- Monika Fijak
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Aulweg 123, Giessen, Germany
| | - Adrian Pilatz
- Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Germany
| | - Mark P Hedger
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, Australia
| | - Nour Nicolas
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Aulweg 123, Giessen, Germany
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, Australia
| | - Sudhanshu Bhushan
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Aulweg 123, Giessen, Germany
| | - Vera Michel
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Aulweg 123, Giessen, Germany
| | - Kenneth S K Tung
- Departments of Pathology and Microbiology, Beirne Carter Center for Immunology Research, University of Virginia, 345 Crispell Drive, Charlottesville, VA, USA
| | - Hans-Christian Schuppe
- Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Germany
| | - Andreas Meinhardt
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Aulweg 123, Giessen, Germany
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, Australia
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Nesheim N, Ellem S, Dansranjavin T, Hagenkötter C, Berg E, Schambeck R, Schuppe HC, Pilatz A, Risbridger G, Weidner W, Wagenlehner F, Schagdarsurengin U. Elevated seminal plasma estradiol and epigenetic inactivation of ESR1 and ESR2 is associated with CP/CPPS. Oncotarget 2018; 9:19623-19639. [PMID: 29731970 PMCID: PMC5929413 DOI: 10.18632/oncotarget.24714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/24/2018] [Indexed: 12/15/2022] Open
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is associated with urinary tract symptoms and hormonal imbalances amongst others. The heterogeneous clinical presentation, unexplored molecular background and lack of prostate biopsies complicate therapy. Here, using liquid biopsies, we performed a comprehensive translational study on men diagnosed with CP/CPPS type III (n= 50; median age 39.8, range 23-65) and age-matched controls (n= 61; median age 36.8, range 20-69), considering biochemical parameters of blood and ejaculates, and epigenetic regulation of the estrogen receptor genes (ESR1 and ESR2) in leukocytes isolated from blood (systemic regulation) and in somatic cells isolated from ejaculates (local regulation). We found elevated 17β-estradiol (E2) levels in seminal plasma, but not in blood plasma, that was significantly associated with CP/CPPS and impaired urinary tract symptoms. In ejaculated somatic cells of CP/CPPS patients we found that ESR1 and ESR2 were both significantly higher methylated in CpG-promoters and expressionally down-regulated in comparison to controls. Mast cells are reported to contribute to CP/CPPS and are estrogen responsive. Consistent with this, we found that E2 -treatment of human mast cell lines (HMC-1 and LAD2) resulted in altered cytokine and chemokine expression. Interestingly, in HMC-1 cells, possessing epigenetically inactivated ESR1 and ESR2, E2 -treatment led to a reduced transcription of a number of inflammatory genes. Overall, these data suggest that elevated local E2 levels associate with an epigenetic down-regulation of the estrogen receptors and have a prominent role in CP/CPPS. Investigating E2 levels in semen could therefore serve as a promising biomarker to select patients for estrogen targeted therapy.
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Affiliation(s)
- Nils Nesheim
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
- Working Group Epigenetics of the Urogenital System, Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Stuart Ellem
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Temuujin Dansranjavin
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Christina Hagenkötter
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
- Working Group Epigenetics of the Urogenital System, Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Elena Berg
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
- Working Group Epigenetics of the Urogenital System, Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Rupert Schambeck
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
- Working Group Epigenetics of the Urogenital System, Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Hans-Christian Schuppe
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Adrian Pilatz
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Gail Risbridger
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Wolfgang Weidner
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Florian Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Undraga Schagdarsurengin
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
- Working Group Epigenetics of the Urogenital System, Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
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Lei T, Moos S, Klug J, Aslani F, Bhushan S, Wahle E, Fröhlich S, Meinhardt A, Fijak M. Galectin-1 enhances TNFα-induced inflammatory responses in Sertoli cells through activation of MAPK signalling. Sci Rep 2018; 8:3741. [PMID: 29487346 PMCID: PMC5829165 DOI: 10.1038/s41598-018-22135-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/19/2018] [Indexed: 01/21/2023] Open
Abstract
Galectin-1 (Gal-1) is a pleiotropic lectin involved in the modulation of immune responses. Using a model of rat experimental autoimmune orchitis (EAO), we investigated the role of Gal-1 in testicular inflammation. EAO is characterized by leukocytic infiltrates in the interstitium, damage of spermatogenesis and production of inflammatory mediators like TNFα and MCP1 causing infertility. In normal rat testis Gal-1 was mainly expressed in Sertoli cells and germ cells. In the inflamed testis, Gal-1 expression was significantly downregulated most likely due to germ cell loss. Analyses of lectin binding and expression of glucosaminyl- and sialyltransferases indicated that the glycan composition on the cell surface of Sertoli and peritubular cells becomes less favourable for Gal-1 binding under inflammatory conditions. In primary Sertoli cells Gal-1 expression was found to be upregulated after TNFα challenge. Pretreatment with Gal-1 synergistically and specifically enhanced TNFα-induced expression of MCP1, IL-1α, IL-6 and TNFα in Sertoli cells. Combined stimulation of Sertoli cells with Gal-1 and TNFα enhanced the phosphorylation of MAP kinases as compared to TNFα or Gal-1 alone. Taken together, our data show that Gal-1 modulates inflammatory responses in Sertoli cells by enhancing the pro-inflammatory activity of TNFα via stimulation of MAPK signalling.
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Affiliation(s)
- Tao Lei
- Department of Anatomy and Cell Biology, Justus-Liebig University, Giessen, Germany
| | - Sven Moos
- Department of Anatomy and Cell Biology, Justus-Liebig University, Giessen, Germany
| | - Jörg Klug
- Department of Anatomy and Cell Biology, Justus-Liebig University, Giessen, Germany
| | - Ferial Aslani
- Department of Anatomy and Cell Biology, Justus-Liebig University, Giessen, Germany
| | - Sudhanshu Bhushan
- Department of Anatomy and Cell Biology, Justus-Liebig University, Giessen, Germany
| | - Eva Wahle
- Department of Anatomy and Cell Biology, Justus-Liebig University, Giessen, Germany
| | - Suada Fröhlich
- Department of Anatomy and Cell Biology, Justus-Liebig University, Giessen, Germany
| | - Andreas Meinhardt
- Department of Anatomy and Cell Biology, Justus-Liebig University, Giessen, Germany
| | - Monika Fijak
- Department of Anatomy and Cell Biology, Justus-Liebig University, Giessen, Germany.
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Ryan L, Daly P, Cullen I, Doyle M. Epididymo-orchitis caused by enteric organisms in men > 35 years old: beyond fluoroquinolones. Eur J Clin Microbiol Infect Dis 2018; 37:1001-1008. [PMID: 29450767 DOI: 10.1007/s10096-018-3212-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/08/2018] [Indexed: 11/26/2022]
Abstract
Epididymo-orchitis is a common urological condition in men of all ages, causing a unilateral or bilateral swelling of the epididymis and/or testis. It is frequently caused by sexually transmitted infections, Chlamydia trachomatis and Neisseria gonorrheae, as well as common enteric organisms implicated in urinary tract infections. Men over 35 years old may develop epididymo-orchitis associated with enteric organisms, often associated with functional bladder outlet problems such as benign prostatic hyperplasia or urethral stricture disease. Fluoroquinolones, especially ciprofloxacin, have long been the mainstay of treatment for these infections; however, rising resistance to ciprofloxacin in E. coli isolates in Europe and the USA means that there is an unprecedented necessity for alternative antimicrobials with adequate penetration into genital tissues (epididymis and testes) to allow appropriate and comprehensive treatment of epididymo-orchitis in this group of patients.
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Affiliation(s)
- Laura Ryan
- Department of Clinical Microbiology, University Hospital Waterford, Waterford, Ireland.
| | - Padraig Daly
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | - Ivor Cullen
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | - Maeve Doyle
- Department of Clinical Microbiology, University Hospital Waterford, Waterford, Ireland
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Silva EJR, Ribeiro CM, Mirim AFM, Silva AAS, Romano RM, Hallak J, Avellar MCW. Lipopolysaccharide and lipotheicoic acid differentially modulate epididymal cytokine and chemokine profiles and sperm parameters in experimental acute epididymitis. Sci Rep 2018; 8:103. [PMID: 29311626 PMCID: PMC5758752 DOI: 10.1038/s41598-017-17944-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/28/2017] [Indexed: 11/09/2022] Open
Abstract
Bacterial infections are the most prevalent etiological factors of epididymitis, a commonly diagnosed inflammatory disease in the investigation of male infertility factors. The influence of early pathogenic mechanisms at play during bacterial epididymitis on reproductive outcomes is little understood. We report here that experimental epididymitis induced in rats by Gram-negative (LPS) and Gram-positive (LTA) bacterial products resulted in differential patterns of acute inflammation in the cauda epididymis. LPS elicited a strong inflammatory reaction, as reflected by upregulation of levels of mRNA for seven inflammatory mediators (Il1b, Tnf, Il6, Ifng, Il10, Nos2 and Nfkbia), and tissue concentration of six cytokines/chemokines (IL1A, IL1B, IL6, IL10, CXCL2 and CCL2) within the first 24 h post-treatment. Conversely, LTA induced downregulation of one (Nfkbia) and upregulation of six (Il1b, Il6, Nos2, Il4 Il10 and Ptgs1) inflammatory gene transcripts, whereas increased the tissue concentration of three cytokines/chemokines (IL10, CXCL2 and CCL2). The stronger acute inflammatory response induced by LPS correlated with a reduction of epididymal sperm count and transit time that occurred at 1, 7, and 15 days post-treatment. Our study provides evidence that early epididymal inflammatory signaling events to bacterial activators of innate immunity may contribute to the detrimental effects of epididymitis upon male fertility.
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Affiliation(s)
- Erick J R Silva
- Section of Experimental Endocrinology, Department of Pharmacology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, 04044-020, Brazil.
- Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, 18618-869, Brazil.
| | - Camilla M Ribeiro
- Section of Experimental Endocrinology, Department of Pharmacology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, 04044-020, Brazil
| | - André F M Mirim
- Section of Experimental Endocrinology, Department of Pharmacology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, 04044-020, Brazil
| | - Alan A S Silva
- Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, 18618-869, Brazil
| | - Renata M Romano
- Section of Experimental Endocrinology, Department of Pharmacology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, 04044-020, Brazil
- Department of Pharmacy, State University of Centro-Oeste, Guarapuava, PR, 85040-080, Brazil
| | - Jorge Hallak
- Androscience, Science and Innovation Center in Andrology, São Paulo, SP, 03178-200, Brazil
- Reproductive Toxicology Unity, Department of Pathology and Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, 01246-903, Brazil
| | - Maria Christina W Avellar
- Section of Experimental Endocrinology, Department of Pharmacology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP, 04044-020, Brazil.
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50
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Schuppe HC, Pilatz A, Hossain H, Diemer T, Wagenlehner F, Weidner W. Urogenital Infection as a Risk Factor for Male Infertility. Dtsch Arztebl Int 2017; 114:339-346. [PMID: 28597829 PMCID: PMC5470348 DOI: 10.3238/arztebl.2017.0339] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 07/13/2015] [Accepted: 03/13/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Infections of the genital tract are considered common causes of male fertility disorders, with a prevalence of 6-10%. Most of the affected men are asymptomatic. The diagnostic evaluation is based mainly on laboratory testing. Inconsistent diagnostic criteria have been applied to date, and this may explain the controversial debate about the role of infection and inflammation in the genital tract as a cause of infertility. The risk of an irreversible fertility disorder should not be underestimated. METHODS This review is based on pertinent publications retrieved by a selective literature search in PubMed, including guidelines from Germany and abroad and systematic review articles. RESULTS The main causes of inflammatory disease of the male genital tract are ascending sexually transmitted infections (STIs) and uropathogens. Chronic prostatitis has no more than a limited influence on ejaculate variables. By contrast, approximately 10% of men who have had acute epididymitis develop persistent azoospermia thereafter, and 30% have oligozoospermia. Obstruction of the excurrent ducts can ensue, as can post-infectious disturbances of spermatogenesis. The differential diagnostic evaluation includes the determination of testicular volumes, hormone concentrations, and ejaculate variables. Epidemiological data are lacking with regard to infertility after primary orchitis of infectious origin; however, up to 25% of testicular biopsies obtained from infertile men reveal focal inflammatory reactions. Multiple studies have suggested a deleterious effect of leukocytes and inflammatory mediators on sperm para - meters. On the other hand, the clinical significance of bacteriospermia remains unclear. CONCLUSION Any suspicion of an infectious or inflammatory disease in the male genital tract should prompt a systematic diagnostic evaluation and appropriate treatment. For patients with obstructive azoospermia, the etiology and site of the obstruction determine the surgical approach to be taken. In the near future, the elucidation of underlying pathophysiological mechanisms and the identification of suitable biomarkers may enable new strategies for conservative treatment.
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Affiliation(s)
- Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
| | - Hamid Hossain
- Institute of Medical Microbiology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
| | - Thorsten Diemer
- Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
- Institute of Medical Microbiology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
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