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Graziani A, Grande G, Martin M, Ferraioli G, Colonnello E, Iafrate M, Dal Moro F, Ferlin A. Chronic Prostatitis/Chronic Pain Pelvic Syndrome and Male Infertility. Life (Basel) 2023; 13:1700. [PMID: 37629557 PMCID: PMC10455764 DOI: 10.3390/life13081700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/29/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is defined as urologic pain or discomfort in the pelvic region, associated with urinary symptoms and/or sexual dysfunction, lasting for at least 3 of the previous 6 months. The rate of symptoms related to prostatitis has a mean prevalence of 8-8.2%. CP/CPPS is most frequent in men younger than 50 years, among whom it is the most common urologic diagnosis. In the last decades, many studies have been published on CP/CPPS and its association with male infertility. The pathophysiologic relation between CP/CPPS and male infertility involves several aspects, which are not well studied yet. A reduction in semen parameters has been demonstrated in patients with CP/CPPS, and several mechanisms have been proposed to represent putative pathophysiological links between CP/CPPS and infertility, including male accessory gland inflammation, metabolic syndrome, inflammatory bowel disease, HPV co-infection and autoimmunity. In light of this evidence, a multidisciplinary approach is advocated for patients with known CP/CPPS, and particular attention is needed for male patients of infertile couples in order to evaluate male accessory glands correctly. In addition, it is advisable that future studies dealing with the treatment of CP/CPPS take into consideration all the different pathophysiological aspects implicated.
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Affiliation(s)
- Andrea Graziani
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, 35122 Padova, Italy
| | - Giuseppe Grande
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, 35122 Padova, Italy
| | - Michel Martin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, 35122 Padova, Italy
| | - Giordana Ferraioli
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy
| | - Elena Colonnello
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Chair of Endocrinology and Medical Sexology (ENDOSEX), University of Tor Vergata, 00133 Rome, Italy
| | - Massimo Iafrate
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, 35122 Padova, Italy
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2
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Magistro G, Wagenlehner FME, Pilatz A. [Chronic prostatitis/chronic pelvic pain syndrome]. Urologie 2023:10.1007/s00120-023-02089-2. [PMID: 37120786 DOI: 10.1007/s00120-023-02089-2] [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] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 05/01/2023]
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is defined as chronic pain or discomfort in the pelvic region for at least 3 of the past 6 months. It is variably associated with lower urinary tract symptoms, psychosocial consequences, and sexual dysfunction. Specific test systems or biomarkers for a definitive diagnosis are still not available. The purposes of the basic diagnostic assessment are to determine the individual spectrum of symptoms and to rule out differential diagnoses of pelvic pain. Patient-reported outcome measures (PROMs) like the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) are valuable instruments for the initial diagnostic assessment and to evaluate treatment response. Classification systems like UPOINTS (urinary, psychosocial, organ specific, infection, neurologic/systemic, tenderness of skeletal muscles, sexual dysfunction) are valuable tools to determine the individual spectrum of symptoms, to guide the adapted diagnostic assessment, and to identify relevant targets for a multimodal and tailored treatment. Close urological monitoring of CP/CPPS patients is usually necessary, especially to minimize the unwarranted use of antibiotics in the case of undulating complaints.
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Affiliation(s)
- G Magistro
- Urologische Klinik, Asklepios Westklinikum Hamburg, Suurheid 20, 22559, Hamburg, Deutschland.
| | - F M E Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Giessen, Gießen, Deutschland
| | - A Pilatz
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Giessen, Gießen, Deutschland
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Schneider L, Dansranjav T, Neumann E, Yan H, Pilatz A, Schuppe HC, Wagenlehner F, Schagdarsurengin U. Post-prostatic-massage urine exosomes of men with chronic prostatitis/chronic pelvic pain syndrome carry prostate-cancer-typical microRNAs and activate proto-oncogenes. Mol Oncol 2023; 17:445-468. [PMID: 36321189 PMCID: PMC9980307 DOI: 10.1002/1878-0261.13329] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has a high prevalence of up to 15% and accounts for 90-95% of prostatitis diagnoses, and yet its etiopathogenesis and link to prostate cancer (PCa) are still unclear. Here, we investigated microRNAs in exosomes isolated from blood and post-prostatic-massage urine of CP/CPPS type IIIb patients and healthy men. THP-1 monocytes (human leukemia monocytic cell line) were treated with exosomes and subjected to mRNA arrays "Cancer Inflammation and Immunity Crosstalk" and "Transcription Factors." Using The Cancer Genome Atlas, the expression of CP/CPPS-associated microRNAs was analyzed in PCa and normal prostate tissue. In silico functional studies were carried out to explore the disease ontology of CP/CPPS. In CP/CPPS, urine exosomes exhibited significant upregulation of eight PCa-specific microRNAs (e.g., hsa-miR-501, hsa-miR-20a, and hsa-miR-106), whose target genes were significantly enriched for GO terms, hallmark gene sets, and pathways specific for carcinogenesis. In THP-1 monocytes, CP/CPPS-derived urine exosomes induced upregulation of PCa-associated proinflammatory genes (e.g., CCR2 and TLR2) and proto-oncogene transcription factors (e.g., MYB and JUNB). In contrast, CP/CPPS-derived blood exosomes exhibited molecular properties similar to those of healthy men. Thus, CP/CPPS exhibits molecular changes that constitute a risk for PCa and should be considered in the development of PCa biomarkers and cancer screening programs.
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Affiliation(s)
- Laura Schneider
- 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
| | - Temuujin Dansranjav
- Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Germany
| | - Elena Neumann
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University of Giessen, Bad Nauheim, Germany
| | - Hang Yan
- 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
| | - Adrian Pilatz
- 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
| | - 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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Cai T, Alidjanov J, Palagin I, Medina-Polo J, Nickel JC, Wagenlehner FME. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): look to the future. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00645-7. [PMID: 36631538 DOI: 10.1038/s41391-023-00645-7] [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] [Received: 09/10/2022] [Revised: 10/12/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Jakhongir Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Ivan Palagin
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Smolensk, Russia
| | - José Medina-Polo
- Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Curtis Nickel
- Department of Urology, Queen's University School of Medicine, Kingston, ON, Canada
| | - Florian M E Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
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Moryousef J, Blankstein U, Curtis Nickel J, Krakowsky Y, Gilron I, Jarvi K. Overview of seminal fluid biomarkers for the evaluation of chronic prostatitis: a scoping review. Prostate Cancer Prostatic Dis 2022; 25:627-40. [PMID: 34845305 DOI: 10.1038/s41391-021-00472-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a very common and difficult condition to evaluate, as it is a clinical diagnosis, without a measurable diagnostic "gold standard". The aim of this scoping review is to synthesize all the available data for seminal fluid biomarkers used to assess patients with CP/CPPS. METHODS A systematic search to identify all relevant publications was conducted on October 22, 2020 across five databases: Ovid Medline, Ovid EMBASE, PubMed, CCRT, and the CINAHL. Two independent authors screened all articles and extracted relevant data. RESULTS A total of 27 articles met the eligibility criteria. A majority of studies were case-control (15), with 6 observational cohorts and 6 comparative interventional studies. The total number of pooled patients included 585 patients with CP/CPPS (unspecified subtype), 371 patients with inflammatory CP/CPPS, 387 patients with non-inflammatory CP/CPPS, 354 patients with chronic bacterial prostatitis, and 432 healthy controls. Inflammatory seminal biomarkers were the most frequently studied, with IL6, IL8, TNFα and IL1β being the most promising candidates. CONCLUSIONS There are a number of very promising seminal biomarkers to help categorize and monitor therapies in CP/CPPS. Large multicentre studies using a shared protocol for measuring seminal biomarkers with the primary intention of biomarker validation are needed prior to clinical implementation. Identification of biomarker(s) will facilitate the etiological categorization of patients with chronic prostatitis and provide an objective framework to tailor specific therapies according to the biomarker family.
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Chen Q, Feng J, Liu Z, An D, Li Y, Zhou S, Weng Z. Research trends of prostatitis over past 20 years: A bibliometric analysis. Andrologia 2021; 53:e14206. [PMID: 34365673 DOI: 10.1111/and.14206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022] Open
Abstract
In the past two decades, thousands of documents in the field of prostatitis have been published. This bibliometric analysis aimed to assess the characteristics, hotspots and frontiers trend of global scientific output on prostatitis. With the trend of moderate growth, altogether 2,423 papers were reviewed. The leading role of the United States in global prostatitis research was obvious, while China had developed rapidly in recent years. Queen's University and JOURNAL OF UROLOGY were the most prolific affiliation and journal respectively. Nickel, J. C made the greatest contribution to the field of prostatitis. Five hotspots have been confirmed: (a) male infertility associated with prostatitis and the molecular mechanisms; (b) diagnosis and treatment of prostatitis; (c) inflammation, pain and bladder irritation symptoms; (d) relationship between chronic prostatitis/chronic pelvic pain syndrome, benign prostatic hyperplasia and prostate cancer; (e) epidemiology, complications of prostatitis and improvement of acupuncture. This bibliometric analysis reveals that the international cooperation was becoming more and more close. Hotspot analysis shows that the molecular mechanism of prostatitis will be a hotspot in the future, mainly focussing on inflammatory immunity and oxidative stress.
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Affiliation(s)
- Qi Chen
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiaming Feng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhidan Liu
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dongyang An
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yadan Li
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaohu Zhou
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiwei Weng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
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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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Abstract
Chronic prostatitis (CP, or chronic pelvic pain syndrome, CPPS) is defined as chronic pain or discomfort in the pelvic region for at least 3 of the past 6 months, often accompanied by lower urinary tract symptoms, psychosocial impairments and sexual dysfunction. Currently, no biomarkers or clinical test procedures for a definitive diagnosis are available. The main objectives for the diagnostic assessment are to exclude differential diagnoses of pelvic pain and to determine the individual symptom profile of the patient. The UPOINTS classification identifies the individual clinical profile of the patient, provides guidance for the necessary diagnostic steps and is the foundation for a tailored multimodal, symptom-oriented and personalized treatment concept. Regular follow-up controls are needed to monitor the treatment response with the option to modify if necessary.
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Elieh Ali Komi D, Shafaghat F, Haidl G. Significance of mast cells in spermatogenesis, implantation, pregnancy, and abortion: Cross talk and molecular mechanisms. Am J Reprod Immunol 2020; 83:e13228. [PMID: 32053232 DOI: 10.1111/aji.13228] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 10/29/2019] [Revised: 01/07/2020] [Accepted: 02/03/2020] [Indexed: 12/19/2022] Open
Abstract
Both subsets of MCs including MCTC (tryptase-positive, chymase-positive) and MCT (tryptase-positive, chymase-negative) are present in the testis and epididymis. Increased number of MCs, higher levels of MC-released tryptase in testis and seminal plasma of males with fertility problems, and promoting sperm motility in individuals with oligozoospermia after using MC blockers provide evidence that MCs may play a role in male infertility/subfertility disturbances. MC-released tryptase and histamine contribute to the fibrosis and may disrupt spermatogenesis. MCs not only influence the process of spermatogenesis but also have effects on the function of other testis-residing cells. MC-derived histamine may influence the steroidogenesis of Leydig cells by acting through H1R and H2R receptors. Additionally, the interaction between MC-released ATP and P2X receptors expressed on the peritubular cells may induce the production of the pro-inflammatory mediators by peritubular cells. Further investigations showed that MCs may be involved in the pathology of female infertility during implantation, pregnancy, and abortion. In the uterus, MCT subtype is abundant in myometrium and adjacent basal layer while MCTC subtype is distributed in all layers. MCs in response to hormones mainly estradiol and progesterone become activated and release a wide range of mediators including histamine, VEGF, proteases, and metalloproteinases (MMPs) that have a role in different stages of pregnancy. An increasing influx of MCs to the cervix during the pregnancy occurs that helps to the physiologic cervical ripening. While MMPs degrade the extracellular matrix (ECM), VEGF modulates neovascularization and histamine influences the embryo implantation. MC-derived histamine may have a positive effect during implantation due to its participation in tissue remodeling. MC proteases including tryptase and chymase activate the precursors of MMP2 and MMP9 to mediate ECM degradation during the physiologic menstrual cycle. There is a line of evidence that MCs have a role in abortion by releasing TNF-α.
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Affiliation(s)
- Daniel Elieh Ali Komi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Immunology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzaneh Shafaghat
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Immunology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Gerhard Haidl
- Andrology Unit, Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
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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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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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