Introduction and acknowledgements
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Biomedical subjects
Publications and source records attributed to M Sousa.
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Men with non-obstructive azoospermia exhibit different histopathologic syndromes in the testicle biopsy, varying from aplasia, Sertoli cell only syndrome, maturation arrest and hypoplasia. The genetic basis of these syndromes is discussed. We present the diagnostic testicle biopsies performed on 160 consecutive non-obstructive azoospermic patients, and these results were correlated with the findings after multiple bilateral treatment testicle biopsy. Each syndrome had to be reevaluated as for the presence of at least one focus of spermatogenesis up to the primary spermatocyte, round spermatid, elongating spermatid, elongated spermatid, or spermatozoa stages. The clinical outcome using donor sperm-IVF, spermatid or sperm intracytoplasmic injection is thereafter presented. A new prognosis based on the findings of this large clinical series coupled to results obtained with Y chromosome molecular screening is offered. Alternative treatments to donor sperm for men without spermatids are discussed.
A sperm cytosolic factor is responsible for oocyte activation at fertilization in mammals. The molecular identity of this factor is not yet known, although a sperm phospholipase Cgamma (PLCgamma) is a potential candidate. In this study, cation-exchange chromatography with a Heparin column was used for the fractionation of porcine sperm cytosolic extracts. Oocyte activation potential of the resulting fractions was tested and active fractions were subjected to Western blot analysis using antibodies specific to PLCgamma1. PLCgamma1 was detected in fractions other than those supporting oocyte activation (Ca(2+)-release and pronuclear formation). The active Heparin fraction was then purified on a Mono Q anion-exchange column. One of the resulting fractions still contained Ca(2+)-releasing activity, but pronuclear formation did not occur. We conclude that sperm PLCgamma1 is not involved in oocyte activation and that Ca(2+)-release and pronuclear formation requires multiple factors from sperm cytosol.
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In Scrobicularia plana testis, a nuclear acid phosphatase (ACPase) activity was detected in mid and late spermatids with the improved Gomori-chloride procedure. Lead deposits were first observed in mid spermatids at focal points over condensed chromatin strands, increasing in density as chromatin further condensated. In late spermiogenesis, lead deposits became concentrated between chromatin aggregates, and after total DNA compaction were transfered to the nuclear periphery and then shed into the cytoplasm. The specificity of the nuclear ACPase was tested against different pH values (3.9, 7.2, 7.8, 9.0), substrates (TPP, IDP, TMP, p-NCS, ATP, GTP, AMP, ADP, AMP-PNP) and inhibitors (NaF, levamisole, Zn, vanadate, theophylline). To further specify the nature of this nuclear ACPase, other enzymes were comparatively studied at their optimal pH values and at pH 5.0: nucleoside-diphosphatase, thiamin-pyrophosphatase, inorganic trimetaphosphatase, lysosomal arylsulfatases A and B, ATPase, GTPase, 5'-nucleotidase, adenylate kinase, and adenylate cyclase. Several other controls were introduced to exclude artefactual deposits induced by lead ions and tissue molecules. The results showed that the enzyme has an optimal pH at 5.0, a high specific affinity for beta-GP, and is inhibited by NaF, which suggests that it behaves as a type B-ACPase, and all controls demonstrated the specificity of the enzymic activity. Because lead deposits were specifically and temporally associated with spermatid chromatin condensation, when DNA and RNA synthesis, histones, phosphoproteins and RNA molecules strongly decrease, it is possible to suggest that the nuclear ACPase could be associated with DNA processing during chromatin compaction or involved in the hydrolysis of 2' and 3' nucleotides resulting from nuclear RNase action during RNA degradation.
We report a case of tuberculous arthritis of the hip in a 22 year old male patient, treated with arthrotomy and antituberculous antibiotic therapy for 9 months; the joint deteriorated and 2 years later he underwent uncemented total hip arthroplasty. He received antibiotic therapy for 3 months preoperatively and for 6 months postoperatively. At 5 year follow-up there was no evidence of recurrent infection.
Fertilization and pregnancy outcomes of 50 round spermatid injection (ROSI) and 20 elongated spermatid injection (ELSI) treatment cycles are related to various characteristics of the cycles, with particular reference to spermatid developmental stage as assessed by using a classification scheme adapted to this purpose. Although this classification includes eight stages, a complete block was mostly detected at the earliest stage (Sa1) or at the latest stages (Sd1 and Sd2). Thus, spermiogenesis was blocked at Sa1 stage in 50 cases (71%), at Sd1 stage in eight cases (11%) and at Sd2 stage in 10 cases (14%). Only in two cases (3%) was spermiogenesis blocked at an intermediate stage (Sb2). Globally, fertilization rates were higher for ELSI than for ROSI. No pregnancy was achieved in the ROSI cycles, whereas nine pregnancies resulted from the ELSI cycles. Two of them (both with Sd2 spermatids) ended in a first trimester spontaneous abortion. Of the seven ongoing pregnancies, five are singleton (two with Sd1 spermatids, two with Sd2 spermatids, and one after a mixed transfer after injection of Sa2 and Sd1 spermatids) and two are twin (one with Sd1 and the other with Sd2 spermatids). No pregnancy was achieved in the two cycles with Sb2 spermatids. One of the two twin pregnancies has already resulted in the birth of two healthy children.
In an attempt to determine whether co-culture could promote sperm maturation, three patients with non-obstructive azoospermia, two with maturation arrest at the level of primary spermatocytes and one patient with <1% tubules showing complete spermatogenesis, and one patient with total globozoospermia, gave consent to experimentally co-culture round spermatids retrieved from the testicle on Vero cell monolayers. In all azoospermic patients elongating spermatids could be obtained from round spermatids. In one case of maturation arrest, of 37 round spermatids co-cultured for up to 5 days, 30% developed flagella, 46% matured to elongating and 19% to elongated spermatids, with one mature spermatozoon also obtained (3%). In the same patient, primary cultures of three round spermatids with flagella enabled development of one further mature spermatozoon. In the case with total globozoospermia, of six round spermatids co-cultured for up to 5 days, one mature spermatozoon was obtained, with a flagellum and normal head morphology. These preliminary findings suggest that it may be possible to overcome the round spermatid block, and even the triggering of morphological abnormalities arising at the spermiogenic level, by in-vitro maturation under special environmental conditions.
Complete remission induced by all-trans retinoic acid (ATRA) in acute promyelocytic leukemia is short lived, and several consolidation chemotherapy courses usually are given to reduce the relapse rate. To assess the value of short-term intensive consolidation, 38 patients with newly diagnosed acute promyelocytic leukemia entered a prospective study in which induction therapy with ATRA immediately was followed by a single course of mitoxantrone plus high-dose cytarabine (3 g/m2 every 12 hours, days 1-4), with no further treatment. Complete remission was achieved in 31 patients (81.6%) after a median time of 49 days of ATRA (to which chemotherapy was added at entry in 10 patients with leukocytosis). Thirty patients received the planned consolidation course. After a median follow-up of 36 months, four of these patients have relapsed and 24 are still in first complete remission, for an estimated disease-free survival of 75% at 60 months. The authors conclude that this single course consolidation of ATRA-induced remission provides excellent long-term control of acute promyelocytic leukemia.
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We present nine cases of spermatid intracytoplasmic injection for the treatment of non-obstructive azoospermia. In eight cases, no elongated spermatids or spermatozoa were found in previous spermiograms or testicular biopsies. In these patients, treatment was performed using ejaculated (n = 6) and testicular (n = 2) retrieved round spermatids (Sa type). In cases where ejaculated round spermatids were used, they were isolated on the day before oocyte retrieval and left in culture for 24 h before intracytoplasmic sperm injection (ICSI). No pregnancy was obtained in either group, although culturing seemed to increase the fertilization rate. In one other case, elongated spermatids were observed in the previous spermiogram and thus a normal ICSI procedure was scheduled. However, on the day of oocyte retrieval, no spermatids could be recovered from fresh sequential ejaculates, and a testicular open biopsy was then performed. Both round and elongated spermatids were found in the testicular tissue, but only the more mature germinal cells (Sb2) were injected. From this case, a normal pregnancy was obtained which resulted in the birth by Caesarean section at 37 weeks of gestation of a normal healthy baby girl, weighing 2700 g.
The feasibility of achieving viable embryos, developing to term after transfer into the uterus, by fertilizing oocytes with spermatids has been demonstrated both in animal studies and in preliminary human clinical trials. Here we review the current clinical indications of spermatid conception and discuss the predictable success rates associated with each of these indications. Potential health hazards relating to the use of spermatids for conception are updated taking into account the risk of abnormal or incomplete epigenetic modifications of newly discovered human imprinted genes. We also add new experimental data showing the occurrence of spermatids in patients lacking spermatozoa and demonstrating that round spermatids recovered from patients with complete spermiogenesis failure (no elongated spermatids or spermatozoa ever detected in the patient's history) are often deficient in the factor(s) responsible for oocyte activation. The possible consequences of this deficiency for the occurrence of abnormal fertilization patterns and for the impairment of further preimplantation and post-implantation development are discussed. It is concluded that the development of diagnostic tests to assess the intrinsic quality of spermatids, with regard to their ability to act as gametes, is urgently needed as part of pre-treatment diagnosis before infertile couples are included in a spermatid conception programme. Centres wishing to use spermatids in human assisted reproduction should also be prepared to offer adequate diagnostic methods to control genomic imprinting abnormalities in the progeny.
A proliferative activity study analysing morphometric and quantitative aspects of nucleolar organizer regions (NORs) and proliferating cell nuclear antigen (PCNA) expression was conducted in 10 cases of peripheral ossifying fibroma (POF) and 10 cases of ossifying fibroma (OF). For NOR identification, the silver staining technique (AgNOR technique) was used. PCNA expression was determined by immunohistochemical staining using the PC10 antibody. The AgNOR analysis for the two lesions showed a profile characteristic of benign lesions. OF showed higher AgNOR number and PCNA expression than POF. Our results suggest increased proliferative activity in OF compared with POF.
The impact on occult leukemia of GM-CSF as a sensitizing agent has not been studied. We treated 41 adult patients with de novo acute myeloid leukemia, 25 of whom achieved complete remission and were given 1 to 3 post-remission courses, each course including GM-CSF begun 4 days prior to chemotherapy and given until day 3. After a median follow-up of 32 months, the probability of remaining in continuous complete remission was 17% at 46 months. GM-CSF in this setting was not associated with an improved outcome, arguing against a priming effect.
Although Malacostracan species represent an important alimentary human resource, the ultrastructure of oogenesis in P. kerathurus remains unknown. Previtellogenic oocytes of Penaeus kerathurus possess a large nucleus with several peripheral nucleoli. The endoplasmic reticulum (ER) is originated from expansions of the nuclear envelope (NE) and contains small dense granules, which are first formed inside the intermembranous space of the NE but are later exported to the ER lumen. Direct vesiculation from the NE and ER then give rise to the Golgi complexes. Small yolk vesicles appear to be mainly formed by vesiculation of the ER, but also receive materials from the Golgi complexes. They contain a fine fibrillar content which seems to originate from decondensation of the small dense granules. Small vesicles and small multivesicular bodies originated from the NE, ER and Golgi complexes, as also myelin figures directly shedded from the NE, fuse together to give origin to large multivesticular bodies (MVB). These organelles, which have an incomplete membrane and appear meshed within nuage materials, give origin, at a later stage, to lipid droplets that are thereafter extruded into the cytoplasm. Neighbouring oocytes exhibit intercellular bridges, the remaining of their surface being surrounded by a single layer of flattened follicular cells. These results show for the first time in Malacostraca the existence of oocyte intercellular bridges, that the ER and Golgi complexes arise from NE activity, that early yolk formation is endogenous and derives from the activity of the NE, ER and Golgi complexes, and that lipid droplets are products of intracellular membrane recycling activity occurring within large multivesicular bodies.
PURPOSE: We studied the influence of aging, hyaluronidase removal of the cumulus, and microinjection on the sperm binding potential of human oocytes under intact zona assay conditions to determine the safe use of unstored aged unfertilized ICSI oocytes on zona binding tests. Results were also compared with those for aged IVF oocytes under the same conditions. METHODS: To avoid the large variation in sperm binding scores, we compared the ratios of the number of sperm bound to nontreated versus to treated oocytes. Treated oocytes were those whose zonae were exposed to hyaluronidase, an agent that decreases sperm binding. Experimental groups were fresh oocytes, experimentally aged fresh oocytes, fresh oocytes whose cumulus was removed either mechanically or with hyaluronidase, aged ICSI oocytes, and aged IVF oocytes. RESULTS: Statistical analysis within and between groups showed that aging, previous insemination, cumulus removal by hyaluronidase, and microinjection did not affect the sperm binding potential of human oocytes. CONCLUSIONS: As the zona binding ability of fresh and unfertilized aged ICSI oocytes is similar, they can be used safely in zona assays.
OBJECTIVE: To report the birth of two healthy children after intracytoplasmic sperm injection (ICSI) with totally immotile spermatozoa recovered from the ejaculate. DESIGN: Retrospective case report. SETTING: University-based hospital. PATIENT(S): Four couples in whom spermatozoa recovered from the ejaculate were totally immotile but presented normal vitality scores. INTERVENTION(S): Therapeutical IVF-ET attempts coupled with ICSI. MAIN OUTCOME MEASURE(S): Fertilization and pregnancy results after ICSI. RESULTS: With random sperm injection, 19 of the 36 injected oocytes showed normal fertilization and cleavage. One of four patients had a twin pregnancy that resulted in birth of two healthy children. CONCLUSION(S): In cases in which totally immotile ejaculated sperm present normal vitality scores, normal clinical outcomes can be achieved by using the usual random sperm selection during conventional ICSI.
A rapid, simple and efficient method for selecting living spermatozoa for intracytoplasmic sperm injection (ICSI) in cases with total lack of sperm movement is described. The selection is based on a characteristic deformation of living spermatozoa exposed to hypo-osmotic conditions during short sequential exposures to modified culture medium and polyvinylpyrrolidone solution; the osmolarity of both of these solutions is reduced by one half by diluting them with an equal amount of water. The application of the sperm viability selection step in six ICSI treatment cycles with total absence of sperm movement resulted in a fertilization rate of 41.9% and the establishment of two ongoing clinical pregnancies. The method described for the selection of living spermatozoa makes it possible to reach acceptable fertilization rates and to obtain ongoing pregnancies by ICSI in cases with total lack of sperm movement. Because of its simplicity, this method can easily be improvised when the total lack of sperm movement is an unexpected finding made on the day of the planned ICSI.