IMMUNOHISTOCHEMICAL AND ULTRASTRUCTURAL STUDY OF PROGRAMMED CELL DEATH IN TESTES WITH VARICOCELES
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Accelerated apoptcsis may be a significant factor in pathophysiology of many male infertility states with abnormal spermatogenesis. Objective: To study programmed cell death in testicular tissue of patients with varicoceles r.,nd evaluate it: possible role in associated impaired spermatogenic activity. Design: lmmunohistochemical staining for paraffin-embedded testis biopsy specimens and ultra-structural study by electron microscope as a controlled prospective study. Setting: Andrology clinic unit, Histology and electron microscope laboratory. Petit_ •1(s): twenty-nine men with varicoceles (23 infertile & 6 fertile) and 7 controls. Intervention(s): After clinical and ultrasonographic evaluation, apoptosis was detected in tesicular biopsy specimens using terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling (TUNEL) method and confirmed by electron microscope. Main Outcome Measure(s): Apoptotic indices in different histological patterns associated with varicocele, Johnsen's testicular biopsy scores and testicular sizes. Result(s): The occurrence of apoptosis was not confined to a particular germ cell population but comprised all types of germ cells and was not observed in Sertoli cells. The mean apoptotic indices of both fertile and infertile varicocele groups (4.55% & 6.29% respectively) were significantly higher than control group (2.71%) [P<0.05]. However, the level of increase was variable according to the associated histopathological patterns. There were nonsignificant correlations of apoptotic index with biopsy score, testicular size and grades of varicocele. Conclusion(s): apoptosis is increased in the testes of fertile and infertile patients with varicocele & may be implicated in associated spermatogenic dysfunction. This will guide future work towards possible mechanisms involved in disturbed regulation of apoptosis as a key mediator of abnormal human sperm production and for future gene therapy in male infertility.