Functional status of the Sertoli cell in azoospermic men
2003; Elsevier BV; Volume: 79; Issue: 1 Linguagem: Inglês
10.1016/s0015-0282(02)04544-2
ISSN1556-5653
AutoresR. Anniballo, F. Ubaldi, Jan Tesařík, Pietro Micheli, Laura Rienzi, Ermanno Greco, M Sorrentino,
Tópico(s)Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
ResumoThe article by Bar-Shira Maymon et al. (1Bar-Shira Maymon B. Yogev L. Paz G. Kleiman S. Schreiber L. Botchan A. et al.Sertoli cell maturation in men with azoospermia of different etiologies.Fertil Steril. 2002; 77: 904-909Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar) is noteworthy in attempting to differentiate the Sertoli cell functional status between normal and pathological biopsies. Once this was a task of diagnostic histology that was based on morphological appearance alone. A noxa patogena, by altering the tubular membrane and Sertoli cell functionality, alters the Sertoli cell germ cells’ interrelationship, provoking ailment and impairment of the germ-cell line and finally compromising fertility. This mechanism has not yet been clarified fully, but there is a sufficient body of evidence to indicate that Sertoli cell functionality, and its evaluation, is of crucial importance in azoospermia cases, where the likelihood of finding spermatozoa for testicular sperm extraction–intracytoplasmic sperm injection programs proves low. Therefore, in general, this immunological tool (2Steger K. Rey R. Kleish S. Louis F. Schleiger G. Bergman M. Immunohistochemical detection of immature Sertoli cell markers in testicular tissue of infertile adult men a preliminary study.Int J Androl. 1996; 19: 122-128Crossref PubMed Scopus (100) Google Scholar) could be of great use in diagnosing pictures when histology on its own cannot (3Anniballo R. Ubaldi F. Cobellis L. Sorrentino M. Rienzi L. Greco E. et al.Criteria predicting the absence of spermatozoa in the Sertoli cell-only syndrome can be used to improve success rate of sperm retrieval.Hum Reprod. 2000; 15: 2269-2277Crossref PubMed Scopus (71) Google Scholar). However, some observations need to be made on the article to further the understanding and the potential uses of this tool. 1.In the paper, only three groups of azoospermia are considered (mixed atrophy, A; spermatocyte arrest, B; and obstructive azoospermia, C). In each, the rate of chromosome pairing in spermatocytes also has been observed to ensure that group B azoospermia is really due to a germ-line defect (4Egozcue J. Templado C. Vidal F. Navarro J. Morer-Fargas F. Marina S. Meiotic studies in a series of 1100 infertile and sterile males.Hum Genet. 1983; 65: 85-88Crossref PubMed Scopus (122) Google Scholar). Strangely, no cases of fibrosclerosis, germ cell aplasia, Klinefelter syndrome, immature testis, or hypospermatogenesis (5Levin H.S. Testicular biopsy in the study of male infertility. Its current usefulness, histologic techniques, and prospects for the future.Hum Pathol. 1979; 10: 569-584Abstract Full Text PDF PubMed Scopus (109) Google Scholar) that could have revealed more convincing results on Sertoli cell functionality were included.2.In group A, mixed atrophy microphotographs (wherein spermatogenesis is lost and the cellular appearance is of only Sertoli cell syndrome show (Fig. 1, microphoto B) only a little part of a Sertoli cell only syndrome (SCO) tubule. In this small part of the tubule, the cytokeratin 18 (CK18) immunoreactive expression of the Sertoli cell cannot be entirely evaluated. There is no other immunolabeling reactivity shown, for example, of more compromised Sertoli cell syndrome (such as those aligned along the tubular membrane of highly impaired tubules with thickening of the basal membrane, or oedema, and tubular regression into ghost tubules), where the anti-Müllerian (AMH) and CK18 expression should be revealed more clearly.3.Bar-Shira Maymon et al. imply that AMH or CK18 can be singularly expressed, or coexpressed, with vimentin. This is only true because the process is probably sequential. Indeed it is difficult to interpret the actual status of the Sertoli cell’s impairment and the moment at which the Sertoli cell stops secreting vimentin and begins to revive the production of AMH and CK18. The sole expressions of AMH or CK18 from Sertoli cell syndrome are unable to provide a reliable cutoff point because the level of their impairment, in our experience, varies from one Sertoli cell to another as well as from one tubule to another. Often, on the same slide and perhaps in the same tubule, the morphological appearance of the Sertoli cell and its AMH or CK18 immunolabeling expression is ambiguous; therefore, histological and lab tests are needed (3Anniballo R. Ubaldi F. Cobellis L. Sorrentino M. Rienzi L. Greco E. et al.Criteria predicting the absence of spermatozoa in the Sertoli cell-only syndrome can be used to improve success rate of sperm retrieval.Hum Reprod. 2000; 15: 2269-2277Crossref PubMed Scopus (71) Google Scholar).4.A correlation should have been sought between the morphological status of the Sertoli cells (and the tubule to which they belong), and their immunolabeling expression for vimentin, AMH, and CK18.In any case, this work is noteworthy because it aims to examine and differentiate the Sertoli cell functionality in pathological pictures. Therefore, it is a welcome aid in this field: its future contribution to a better understanding of azoospermia cases, particularly nonobstructive azoospermia cases, seems promising. The article by Bar-Shira Maymon et al. (1Bar-Shira Maymon B. Yogev L. Paz G. Kleiman S. Schreiber L. Botchan A. et al.Sertoli cell maturation in men with azoospermia of different etiologies.Fertil Steril. 2002; 77: 904-909Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar) is noteworthy in attempting to differentiate the Sertoli cell functional status between normal and pathological biopsies. Once this was a task of diagnostic histology that was based on morphological appearance alone. A noxa patogena, by altering the tubular membrane and Sertoli cell functionality, alters the Sertoli cell germ cells’ interrelationship, provoking ailment and impairment of the germ-cell line and finally compromising fertility. This mechanism has not yet been clarified fully, but there is a sufficient body of evidence to indicate that Sertoli cell functionality, and its evaluation, is of crucial importance in azoospermia cases, where the likelihood of finding spermatozoa for testicular sperm extraction–intracytoplasmic sperm injection programs proves low. Therefore, in general, this immunological tool (2Steger K. Rey R. Kleish S. Louis F. Schleiger G. Bergman M. Immunohistochemical detection of immature Sertoli cell markers in testicular tissue of infertile adult men a preliminary study.Int J Androl. 1996; 19: 122-128Crossref PubMed Scopus (100) Google Scholar) could be of great use in diagnosing pictures when histology on its own cannot (3Anniballo R. Ubaldi F. Cobellis L. Sorrentino M. Rienzi L. Greco E. et al.Criteria predicting the absence of spermatozoa in the Sertoli cell-only syndrome can be used to improve success rate of sperm retrieval.Hum Reprod. 2000; 15: 2269-2277Crossref PubMed Scopus (71) Google Scholar). However, some observations need to be made on the article to further the understanding and the potential uses of this tool. 1.In the paper, only three groups of azoospermia are considered (mixed atrophy, A; spermatocyte arrest, B; and obstructive azoospermia, C). In each, the rate of chromosome pairing in spermatocytes also has been observed to ensure that group B azoospermia is really due to a germ-line defect (4Egozcue J. Templado C. Vidal F. Navarro J. Morer-Fargas F. Marina S. Meiotic studies in a series of 1100 infertile and sterile males.Hum Genet. 1983; 65: 85-88Crossref PubMed Scopus (122) Google Scholar). Strangely, no cases of fibrosclerosis, germ cell aplasia, Klinefelter syndrome, immature testis, or hypospermatogenesis (5Levin H.S. Testicular biopsy in the study of male infertility. Its current usefulness, histologic techniques, and prospects for the future.Hum Pathol. 1979; 10: 569-584Abstract Full Text PDF PubMed Scopus (109) Google Scholar) that could have revealed more convincing results on Sertoli cell functionality were included.2.In group A, mixed atrophy microphotographs (wherein spermatogenesis is lost and the cellular appearance is of only Sertoli cell syndrome show (Fig. 1, microphoto B) only a little part of a Sertoli cell only syndrome (SCO) tubule. In this small part of the tubule, the cytokeratin 18 (CK18) immunoreactive expression of the Sertoli cell cannot be entirely evaluated. There is no other immunolabeling reactivity shown, for example, of more compromised Sertoli cell syndrome (such as those aligned along the tubular membrane of highly impaired tubules with thickening of the basal membrane, or oedema, and tubular regression into ghost tubules), where the anti-Müllerian (AMH) and CK18 expression should be revealed more clearly.3.Bar-Shira Maymon et al. imply that AMH or CK18 can be singularly expressed, or coexpressed, with vimentin. This is only true because the process is probably sequential. Indeed it is difficult to interpret the actual status of the Sertoli cell’s impairment and the moment at which the Sertoli cell stops secreting vimentin and begins to revive the production of AMH and CK18. The sole expressions of AMH or CK18 from Sertoli cell syndrome are unable to provide a reliable cutoff point because the level of their impairment, in our experience, varies from one Sertoli cell to another as well as from one tubule to another. Often, on the same slide and perhaps in the same tubule, the morphological appearance of the Sertoli cell and its AMH or CK18 immunolabeling expression is ambiguous; therefore, histological and lab tests are needed (3Anniballo R. Ubaldi F. Cobellis L. Sorrentino M. Rienzi L. Greco E. et al.Criteria predicting the absence of spermatozoa in the Sertoli cell-only syndrome can be used to improve success rate of sperm retrieval.Hum Reprod. 2000; 15: 2269-2277Crossref PubMed Scopus (71) Google Scholar).4.A correlation should have been sought between the morphological status of the Sertoli cells (and the tubule to which they belong), and their immunolabeling expression for vimentin, AMH, and CK18. In any case, this work is noteworthy because it aims to examine and differentiate the Sertoli cell functionality in pathological pictures. Therefore, it is a welcome aid in this field: its future contribution to a better understanding of azoospermia cases, particularly nonobstructive azoospermia cases, seems promising. Functional status of the Sertolic cell in azoospermic men: Reply of the authorsFertility and SterilityVol. 79Issue 1Preview Full-Text PDF
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