曹宇,劉仲偉,孟昱時(shí),程波,邱學(xué)德,李志鵬,曹貴華,何進(jìn),和術(shù)臣
(1. 昆明醫(yī)科大學(xué)第二附屬醫(yī)院生殖醫(yī)學(xué)科,昆明 650101;2. 湖南中醫(yī)藥大學(xué)附屬寧鄉(xiāng)醫(yī)院泌尿外科,長(zhǎng)沙 410600;3. 滕州市中心人民醫(yī)院泌尿外科,滕州 277500;4. 昆明醫(yī)科大學(xué)第二附屬醫(yī)院男性科,昆明 650101;5. 昆明醫(yī)科大學(xué)第二附屬醫(yī)院泌尿外科,昆明 650101)
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卵泡刺激素和干細(xì)胞因子對(duì)大鼠非梗阻性無(wú)精子癥模型生精功能的影響
曹宇1,2,劉仲偉1,孟昱時(shí)1,程波3,邱學(xué)德4*,李志鵬5,曹貴華5,何進(jìn)5,和術(shù)臣5
(1. 昆明醫(yī)科大學(xué)第二附屬醫(yī)院生殖醫(yī)學(xué)科,昆明650101;2. 湖南中醫(yī)藥大學(xué)附屬寧鄉(xiāng)醫(yī)院泌尿外科,長(zhǎng)沙410600;3. 滕州市中心人民醫(yī)院泌尿外科,滕州277500;4. 昆明醫(yī)科大學(xué)第二附屬醫(yī)院男性科,昆明650101;5. 昆明醫(yī)科大學(xué)第二附屬醫(yī)院泌尿外科,昆明650101)
【摘要】目的探討卵泡刺激素(FSH)、干細(xì)胞因子(SCF)對(duì)Wistar大鼠非梗阻性無(wú)精子癥(NOA)動(dòng)物模型生精功能的影響。方法使用白消安15 mg/kg單次腹腔注射制作Wistar大鼠NOA動(dòng)物模型,抽樣檢查模型制造成功后。隨機(jī)抽取72只大鼠分為兩組:治療組給予大鼠后腿肌肉注射FSH 250 mU/次和SCF 150 ng/次,每3 d重復(fù)注射1次,共注射19次;對(duì)照組予以等量的生理鹽水行大鼠后腿肌肉注射。治療組和對(duì)照組均于用藥后19 d、38 d和57 d摘取一側(cè)睪丸制成石蠟病理切片,采用Johnsen法評(píng)價(jià)其生精功能;取一側(cè)附睪計(jì)數(shù)附睪尾精子數(shù),每組每次12只。結(jié)果治療組用藥19 d、38 d和57 d睪丸組織切片Johnsen評(píng)分均顯著高于對(duì)照組(P均<0.05);用藥后19 d 和38 d治療組睪丸內(nèi)曲細(xì)精管排列較對(duì)照組緊密、整齊;管腔內(nèi)各級(jí)生精細(xì)胞數(shù)量亦多于對(duì)照組;用藥后57 d治療組睪丸內(nèi)曲細(xì)精管與正常睪丸基本一致,而同期對(duì)照組內(nèi)有不少曲細(xì)精管局部呈現(xiàn)“空泡樣”結(jié)構(gòu)。用藥后19 d,兩組附睪內(nèi)均未見(jiàn)精子;用藥38 d時(shí)治療組附睪內(nèi)精子數(shù)[(77.55±55.18)個(gè)/ml]顯著高于對(duì)照組[(41.05±29.20)個(gè)/ml](P<0.05);用藥57 d時(shí)治療組附睪內(nèi)精子數(shù)[(122.13±80.67)個(gè)/ml]亦顯著高于對(duì)照組[(58.50±26.15)個(gè)/ml](P<0.05)。結(jié)論FSH聯(lián)合SCF肌注能夠促進(jìn)Wistar大鼠NOA模型生精功能的恢復(fù)。
【關(guān)鍵詞】非梗阻性無(wú)精子癥模型;卵泡刺激素;干細(xì)胞因子;生精功能
Effect of FSH and SCF on spermatogenesis of non-obstructive azoospermia in rat models
CAOYu1,2,LIUZhong-wei1,MENGYu-shi1,CHENGBo3,QIUXue-de4*,LIZhi-peng5,CAOGui-hua5,HEJin5,HEShu-chen5
1.DepartmentofReproductiveMedicine,the2ndAffiliatedHospitalofKunmingMedicalUniversity,Kunming650101
(JReprodMed2016,25(2):160-165)
非梗阻性無(wú)精子癥(NOA)因?yàn)榫褐腥狈?,臨床上一度缺少有效的治療方法,隨著人類(lèi)輔助生殖技術(shù)的誕生和快速發(fā)展,使得NOA患者的治療出現(xiàn)了突破性的進(jìn)展。然而對(duì)于那些睪丸內(nèi)無(wú)精子生成的NOA患者,目前臨床上仍然缺乏有效的治療手段。有研究報(bào)道FSH可以通過(guò)改善精子的超微結(jié)構(gòu)和精子線粒體DNA的聚合,提高精子質(zhì)量與濃度[1],干細(xì)胞因子(SCF)可促進(jìn)A型精原細(xì)胞DNA的合成[2],在原始生殖細(xì)胞和精原細(xì)胞的粘附、遷移、增殖和存活中也發(fā)揮著重要作用[3]。本研究利用白消安單次腹腔注射建立Wistar大鼠NOA動(dòng)物模型,并通過(guò)將FSH和SCF聯(lián)合注射于NOA模型,探討FSH和SCF對(duì)大鼠NOA模型生精功能的影響,現(xiàn)將結(jié)果報(bào)告如下。
材料與方法
1. 實(shí)驗(yàn)動(dòng)物:選用SPF級(jí)成年雄性Wistar大鼠150只,體重220~280 g[實(shí)驗(yàn)動(dòng)物生產(chǎn)許可證號(hào):SCXK(湘)2009-0012,實(shí)驗(yàn)動(dòng)物質(zhì)量合格證號(hào):HNACSDC20100520]。
2. 主要試劑及圖像分析系統(tǒng):Bouin's液,由昆明醫(yī)科大學(xué)病理科提供,使用前配制;FSH、SCF、白消安(Sigma,美國(guó));伊紅(The Coleman & Bell,美國(guó));蘇木素(上?;瘜W(xué)試劑);顯微攝影系統(tǒng)DM4000B、數(shù)碼相機(jī)DFC320、攝影軟件IM50(Leica,德國(guó));HPIA-2000高清晰度病理圖文分析系統(tǒng)(同濟(jì)大學(xué));病理切片的制作及觀察均由昆明醫(yī)科大學(xué)病理科錢(qián)忠義老師幫助完成。
1. 大鼠NOA模型的制作和檢測(cè):采血檢測(cè)成年雄性大鼠血清性激素水平,排除有內(nèi)分泌疾病者(該部分實(shí)驗(yàn)由昆明醫(yī)科大學(xué)第二附屬醫(yī)院檢驗(yàn)科陳江醫(yī)生協(xié)助完成)。對(duì)成年雄性大鼠予以白消安15 mg/kg單次腹腔注射[4],38 d后從存活的大鼠中,隨機(jī)抽取10只大鼠取一側(cè)睪丸和附睪作組織切片,以睪丸切片見(jiàn)不到精子細(xì)胞和精子,附睪切片內(nèi)見(jiàn)不到精子為標(biāo)準(zhǔn),并與正常大鼠的睪丸和附睪切片比較,檢驗(yàn)大鼠NOA模型是否成功。
2. 動(dòng)物模型分組和用藥方式:取72只NOA模型大鼠隨機(jī)分為兩組。治療組36只,于大鼠后腿肌肉注射 FSH 250 mU/次和SCF 150 ng/次,每3 d重復(fù)注射1次,共注射19次;對(duì)照組36只,給予同等體積的生理鹽水行大鼠后腿肌肉注射,次數(shù)與實(shí)驗(yàn)組相同。
3. 標(biāo)本采集:治療組和對(duì)照組均于用藥后19 d、38 d和57 d摘取一側(cè)睪丸制備石蠟切片;取一側(cè)附睪行計(jì)數(shù)附睪尾精子數(shù),完整剪下附睪尾,置于1 ml生理鹽水中剪碎組織,37℃水浴10 min后,用吸管吹出精子使之游離,離心后計(jì)數(shù)精子數(shù);每組每次12只。
4. 標(biāo)本觀測(cè)指標(biāo):切片制成后,每份標(biāo)本觀察25個(gè)垂直切面,Johnsen評(píng)分評(píng)價(jià)睪丸組織生精功能,其評(píng)價(jià)標(biāo)準(zhǔn)[5]為:完好的精子發(fā)生為10分;各級(jí)生精細(xì)胞存在但排列紊亂者為9 分;僅有少量精子(>10個(gè))者為 8分;無(wú)精子但有大量精子細(xì)胞者為7 分;無(wú)精子僅有少量精子細(xì)胞(5~10個(gè))者為6分;無(wú)精子但有較多精母細(xì)胞者為 5 分;無(wú)精子細(xì)胞僅有個(gè)別精母細(xì)胞(<5個(gè))者為 4 分;僅有精原細(xì)胞為 3 分;無(wú)生精細(xì)胞僅有支持細(xì)胞為2 分;管腔內(nèi)無(wú)細(xì)胞為1 分。另外,對(duì)附睪管內(nèi)精子數(shù)進(jìn)行計(jì)數(shù)。
結(jié)果
注射白消安38 d后,隨機(jī)抽取10只建模大鼠,取一側(cè)睪丸和附睪作組織切片,組織形態(tài)學(xué)顯示:建模大鼠睪丸萎陷,睪丸血供較差;附睪形態(tài)基本正常,顏色較晦暗。光鏡下可見(jiàn):睪丸生精小管萎縮,支持細(xì)胞數(shù)量減少,各級(jí)生精細(xì)胞基本消失,排列紊亂;生精小管腔隙擴(kuò)大,出現(xiàn)“空泡樣”改變。附睪管僅存附睪管上皮細(xì)胞,管腔內(nèi)見(jiàn)不到精子(圖1A、B)。認(rèn)為大鼠NOA模型建立成功。
A:睪丸 B:附睪圖1 建模大鼠睪丸、附睪切片 HE染色,×400
正常大鼠的睪丸切片內(nèi)可見(jiàn)形態(tài)正常的曲細(xì)精管,排列緊密,界線清晰;管腔內(nèi)各級(jí)生精細(xì)胞排列規(guī)整,可見(jiàn)大量形態(tài)正常的精子;支持細(xì)胞數(shù)量正常、形態(tài)飽滿(mǎn)。附睪管腔排列緊密,形態(tài)規(guī)整,上皮細(xì)胞呈單層有序排列,管腔內(nèi)可見(jiàn)大量的精子,且形態(tài)良好(圖2A、B)。
A:睪丸 B:附睪圖2 正常大鼠睪丸、附睪切片 HE染色,×400
用藥19 d后,與對(duì)照組比較,可見(jiàn)治療組睪丸切片內(nèi)曲細(xì)精管排列緊密,曲細(xì)精管間的血管較對(duì)照組多,血管管腔也較對(duì)照組大。曲細(xì)精管管腔內(nèi),各級(jí)生精細(xì)胞數(shù)量較對(duì)照組多,排列整齊,且細(xì)胞形態(tài)和飽滿(mǎn)程度與正常生精細(xì)胞基本一致。治療組內(nèi)的“空泡樣”結(jié)構(gòu)亦較對(duì)照組少(圖3 A、B)。
A:用藥19 d治療組;B:用藥19 d對(duì)照組; C:用藥38 d治療組;D:用藥38 d對(duì)照組; E:用藥57 d治療組;F:用藥57 d對(duì)照組圖3 不同用藥時(shí)間大鼠睪丸組織形態(tài)觀察 HE染色,×400
用藥38 d后,可見(jiàn)治療組睪丸切片內(nèi)曲細(xì)精管排列較對(duì)照組規(guī)則、整齊,管腔內(nèi)可見(jiàn)各級(jí)生精細(xì)胞排列規(guī)整,且各級(jí)細(xì)胞數(shù)量亦較對(duì)照組多;曲細(xì)精管間的血管較對(duì)照組多;支持細(xì)胞形態(tài)較飽滿(mǎn)。對(duì)照組內(nèi)可見(jiàn)少量“空泡樣”組織結(jié)構(gòu)(NOA模型成功后的結(jié)構(gòu)),而治療組幾乎沒(méi)有(圖3 C、D)。
用藥57 d后,治療組睪丸切片內(nèi)曲細(xì)精管排列規(guī)則、整齊,基本與正常睪丸組織一致;且可見(jiàn)較多血管,血管管腔大,提示局部血供較好。對(duì)照組內(nèi)則可見(jiàn)部分曲細(xì)精管及各級(jí)生精細(xì)胞恢復(fù),顯示出較明顯的各級(jí)生精細(xì)胞的層次結(jié)構(gòu),但仍有不少曲細(xì)精管局部呈現(xiàn)出“空泡樣”結(jié)構(gòu),甚至整個(gè)曲細(xì)精管內(nèi)找不到生精細(xì)胞;血管形態(tài)相對(duì)不明顯(圖3E、F)。
用藥后不同時(shí)間,治療組睪丸Johnsen評(píng)分均顯著高于對(duì)照組(P均<0.05);用藥后第19天,兩組附睪內(nèi)均未見(jiàn)精子,用藥后第38、57天,治療組附睪內(nèi)精子數(shù)顯著高于對(duì)照組(P均<0.05)(表1)。
表1 不同時(shí)間兩組睪丸Johnsen評(píng)分及
注:與對(duì)照組同一時(shí)間比較,*P<0.05
討論
自ICSI用于臨床以來(lái),幫助很多NOA患者獲得了生育。理論上只要獲得少量精子,NOA患者就可以通過(guò)ICSI獲得生育機(jī)會(huì)。然而,即使采用睪丸取精成功率最高的顯微切割睪丸精子抽吸術(shù),仍有近一半的NOA患者睪丸內(nèi)無(wú)法找到精子[7]。但也有學(xué)者研究發(fā)現(xiàn)NOA睪丸取精失敗者即使睪丸內(nèi)無(wú)精子,也多能在睪丸組織的局部發(fā)現(xiàn)殘存的各級(jí)生殖細(xì)胞[7-8]。
有研究報(bào)道,行生殖細(xì)胞體外成熟培養(yǎng)時(shí),在培養(yǎng)基中加入高濃度的FSH和睪酮(T),可提高精子分化生成的速度,表明增加激素濃度有利于激素與其受體有效結(jié)合,促進(jìn)精子生成與分化,且能有效抑制生精細(xì)胞的凋亡[9]。體外培養(yǎng)的研究結(jié)果提示NOA患者睪丸組織中殘存的生殖細(xì)胞是可以增殖分化的。
在激素對(duì)精子發(fā)生的調(diào)控過(guò)程中,支持細(xì)胞處于核心地位,其中FSH與生殖過(guò)程密切相關(guān),F(xiàn)SH是雄性精子發(fā)育以及支持細(xì)胞生長(zhǎng)的基礎(chǔ)[10]。FSH與支持細(xì)胞膜上的卵泡刺激素受體(FSHR)結(jié)合,激活環(huán)腺苷酸-蛋白激酶A(cAMP-PKA)、絲裂原活化蛋白激酶(MAPK)、鈣離子通道等信號(hào)通路,將來(lái)自FSH的信號(hào)轉(zhuǎn)化為生精細(xì)胞所需要的各種因子信號(hào),促進(jìn)生精過(guò)程[11-12]。有研究證實(shí),F(xiàn)SH不僅可以促進(jìn)早期生精細(xì)胞發(fā)育和精原細(xì)胞的分裂,還可以作用于間質(zhì)細(xì)胞,分泌雄激素結(jié)合蛋白,促進(jìn)精子生成;并通過(guò)改善精子超微結(jié)構(gòu)和精子線粒體DNA的聚合提高精子的濃度和活動(dòng)力[1,13]。Dorrington等[14]通過(guò)研究發(fā)現(xiàn),在大鼠嬰幼兒時(shí)期,注射FSH可以促進(jìn)睪丸支持細(xì)胞的有絲分裂。在動(dòng)物研究中發(fā)現(xiàn),注射FSH可以誘導(dǎo)未成熟小鼠精子發(fā)生,并促進(jìn)性早熟[15]。Jafarian等[16]通過(guò)將FSH和戊酸雌二醇注射于白消安制成的小鼠無(wú)精子癥模型,發(fā)現(xiàn)單獨(dú)注射FSH可促進(jìn)生精功能的恢復(fù)。
支持細(xì)胞還可以產(chǎn)生SCF,SCF是c-kit酪氨酸激酶受體的配體,是原始生殖細(xì)胞體外培養(yǎng)存活所必須,在睪丸發(fā)育過(guò)程中,其與原始生殖細(xì)胞、精原細(xì)胞的粘附、遷移、增殖和存活密切相關(guān),并刺激原始生殖細(xì)胞和A型精原細(xì)胞的DNA合成[17]。在成人睪丸中,支持細(xì)胞受到FSH刺激以后,c-kit受體可在除生殖干細(xì)胞以外的各級(jí)精原細(xì)胞中表達(dá);在體外培養(yǎng)中FSH可防止生殖細(xì)胞凋亡,隨著FSH刺激的增加,SCF水平相應(yīng)升高[3]。表明FSH可能通過(guò)SCF-c-kit通路發(fā)揮對(duì)生殖細(xì)胞的保護(hù)作用。在睪丸功能失調(diào)患者的體內(nèi)存在SCF/c-kit基因表達(dá)的缺陷,在生精障礙和無(wú)精子癥患者體內(nèi)生精細(xì)胞凋亡過(guò)程的增加也和SCF/c-kit表達(dá)的減少存在聯(lián)系[18]。Yan等[3]將曲細(xì)精管在有或無(wú)SCF刺激的條件下進(jìn)行體外培養(yǎng),通過(guò)DNA梯狀條帶和原位末端標(biāo)記染色測(cè)定細(xì)胞凋亡,發(fā)現(xiàn)SCF處理組較對(duì)照組細(xì)胞凋亡發(fā)生時(shí)間較晚,凋亡程度也較低;當(dāng)SCF缺乏時(shí),F(xiàn)SH對(duì)生殖細(xì)胞的保護(hù)作用隨之下降。在使用白消安制成的大鼠NOA模型中,睪丸組織內(nèi)SCF/c-kit的調(diào)節(jié)通路發(fā)生改變,使轉(zhuǎn)錄因子E2F處于無(wú)活性狀態(tài),不能正常啟動(dòng)增殖細(xì)胞核抗原基因的轉(zhuǎn)錄,并使G1期特定蛋白表達(dá)受到抑制,誘導(dǎo)生殖細(xì)胞的凋亡[19]。Plotton等[20]在一項(xiàng)研究中使用免疫組織化學(xué)的方法,比較49例正常生精、生精功能低下、生精阻滯、唯支持細(xì)胞綜合征患者睪丸組織中SCF的表達(dá)情況,發(fā)現(xiàn)生精功能低下、生精阻滯和唯支持細(xì)胞綜合征患者睪丸組織中SCF的表達(dá)較正常對(duì)照組降低。
綜上所述,本研究結(jié)果顯示FSH、SCF對(duì)NOA大鼠模型有較明顯的治療效果,能明顯改善生精功能,提示對(duì)于NOA患者,也許可以通過(guò)補(bǔ)充外源性的FSH和SCF,提高體內(nèi)FSH和SCF濃度,促進(jìn)生殖細(xì)胞分裂分化為精子,以期改善NOA患者助孕治療的結(jié)局。但本研究為動(dòng)物實(shí)驗(yàn),旨在提供一個(gè)研究思路,后期尚需要進(jìn)一步的研究和探討。
【參考文獻(xiàn)】
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[編輯:郭永]
關(guān)于出示刊出文稿獲基金資助及獲獎(jiǎng)證明的說(shuō)明
凡在我刊刊登的文稿,或刊登文稿所涉及的科研項(xiàng)目、課題、獲國(guó)家或部、省級(jí)各種基金資助及獲得科學(xué)技術(shù)成果獎(jiǎng)、科學(xué)技術(shù)進(jìn)步獎(jiǎng)?wù)?,?qǐng)將資助證明及獲獎(jiǎng)證書(shū)(復(fù)印件)寄至本刊編輯部,以便綜合整理。謝謝合作。
本刊編輯部
2.DepartmentofUrology,NingxiangHospitalAffiliatedtoHunanUniversityofChineseMedicine,Changsha410600
3.DepartmentofUrology,theCentralHospitalofTengzhou,Tengzhou277500
4.DepartmentofAndriatrics,the2ndAffiliatedHospitalofKunmingMedicalUniversity,Kunming650101
5.DepartmentofUrology,the2ndAffiliatedHospitalofKunmingMedicalUniversity,Kunming
650101
【Abstract】
Objective: To assessment the influence of FSH and stem cell factor (SCF) on the spermatogenic function in rat models of non-obstructive azoospermia.
Methods: The 72 rat models of non-obstructive azoospermia were prepared by injecting busulfan at a dose of 15 mg/kg into the abdominal cavity for each rat. The rat models were divided into two groups after successful establishment. The rats in treatment group were injected with 250 mU FSH and 150 ng SCF into hind leg muscle,every three days for 19 times. The rats in the control group were given equal amount of normal saline in the same way. The unilateral testis and epididymis of the rats were respectively obtained for morphological examination or sperm count on the 19th,38thand 57thday after administration. The spermatogenesis was evaluated by Johnsen score,and the sperm number in unilateral epididymis was accounted by CASA,twelve rats for each time.
Results: The Johnsen scores of the rats in the treatment group were significantly higher than those in the control group on the 19th,38thand 57thday after administration (P<0.05). The arrangements of seminiferous tubule of the treatment groups were more tightness than the control groups,and the number of spermatogenic cells at all stage in the lumen in the treatment groups were more than the control groups on the 19thor 38thday after administration. The morphology of seminiferous tubules in the treatment group was similar as normal testis,while that in the control groups showed "vacuole-like" structure on the 57thday after administration. There was no sperm in the epididymis tube in both of treatment and control group on the 19thday after administration. The sperm counts in the epididymis tube in treatment group on the 38thday after administration [(77.55±55.18)/ml] were significantly higher than those in the control group [(41.05±29.20)/ml] (P<0.05),and it was similar on the 57thday after administrating [(122.13±80.67)/ml vs. (58.50±26.15)/ml) (P<0.05).
Conclusions: FSH and SCF by injecting muscle can improve the spermatogenesis recovery of Wistar rat with non-obstructive azoospermia.
Key words:Non-obstructive azoospermia model;FSH;Stem cell factor;Spermatogenesis
【作者簡(jiǎn)介】曹宇,男,湖南長(zhǎng)沙人,碩士研究生,主治醫(yī)師,泌尿外科和男性不育專(zhuān)業(yè).(*通訊作者,Email:scottqiucn@126.com)
【基金項(xiàng)目】國(guó)家自然基金項(xiàng)目(30760250)
【收稿日期】2015-04-10;【修回日期】2015-06-20
DOI:10.3969/j.issn.1004-3845.2016.2.011