Diverse spermatogenic defects in humans caused by Y chromosome deletions encompassing a novel RNA-binding protein gene.

We have detected deletions of portions of the Y chromosome long arm in 12 of 89 men with azoospermia (no sperm in semen). No Y deletions were detected in their male relatives or in 90 other fertile males. The 12 deletions overlap, defining a region likely to contain one or more genes required for spermatogenesis (the Azoospermia Factor, AZF). Deletion of the AZF region is associated with highly variable testicular defects, ranging from complete absence of germ cells to spermatogenic arrest with occasional production of condensed spermatids. We find no evidence of YRRM genes, recently proposed as AZF candidates, in the AZF region. The region contains a single-copy gene, DAZ (Deleted in AZoospermia), which is transcribed in the adult testis and appears to encode an RNA binding protein. The possibility that DAZ is AZF should now be explored.

The DAZ gene cluster on the human Y chromosome arose from an autosomal gene that was transposed, repeatedly amplified and pruned.

It is widely believed that most or all Y-chromosomal genes were once shared with the X chromosome. The DAZ gene is a candidate for the human Y-chromosomal Azoospermia Factor (AZF). We report multiple copies of DAZ (> 99% identical in DNA sequence) clustered in the AZF region and a functional DAZ homologue (DAZH) on human chromosome 3. The entire gene family appears to be expressed in germ cells. Sequence analysis indicates that the Y-chromosomal DAZ cluster arose during primate evolution by (i) transposing the autosomal gene to the Y, (ii) amplifying and pruning exons within the transposed gene and (iii) amplifying the modified gene. These results challenge prevailing views of sex chromosome evolution, suggesting that acquisition of autosomal fertility genes is an important process in Y chromosome evolution.

Structure and function of ribosomal protein S4 genes on the human and mouse sex chromosomes.

The human sex-linked genes RPS4X and RPS4Y encode distinct isoforms of ribosomal protein S4. Insufficient expression of S4 may play a role in the development of Turner syndrome, the complex human phenotype associated with monosomy X. In mice, the S4 protein is encoded by an X-linked gene, Rps4, and is identical to human S4X; there is no mouse Y homolog. We report here the organization of the human RPS4X and RPS4Y and mouse Rps4 genes. Each gene comprises seven exons; the positions of introns are conserved. The 5' flanking sequences of human RPS4X and mouse Rps4 are very similar, while RPS4Y diverges shortly upstream of the transcription start site. In chickens, S4 is encoded by a single gene that is not sex linked. The chicken protein differs from human S4X by four amino acid substitutions, all within a region encoded by a single exon. Three of the four substitutions are also present in human S4Y, suggesting that the chicken S4 gene may have arisen by recombination between S4X- and S4Y-like sequences. Using isoform-specific antisera, we determined that human S4X and S4Y are both present in translationally active ribosomes. S4Y is about 10 to 15% as abundant as S4X in ribosomes from normal male placental tissue and 46,XY cultured cells. In 49,XYYYY cells, S4Y is about half as abundant as S4X. In 49,XXXXY cells, S4Y is barely detectable. These results bear on the hypothesized role of S4 deficiency in Turner syndrome.

Prevalence of neurosyphilis at Government Rajaji Hospital, Madurai, India.

Forty patients (34 males and 6 females) with neurological complaints/manifestations and with a past history of multiple sexual partners attending the Government Rajaji Hospital, Madurai, India between April 1992 and October 1992 were investigated for neurosyphilis. Metabolic disorders, hypertension, ischaemic heart disease, arrhythmias and trauma were excluded. Seven males (17.5%) were found to have neurosyphilis. The youngest was 26 years old and the oldest was 47. All were married and of low socioeconomic background. Meningovascular syphilis was the predominant presentation (6:1). Associated cardiovascular involvement was noticed in one of the cases. There was no associated HIV infection in these cases. The incidence is higher than previous reports from this centre.

A pilot study on the clinical efficacy of Solanum xanthocarpum and Solanum trilobatum in bronchial asthma.

Solanum xanthocarpum and Solanum trilobatum are widely used to treat respiratory diseases in southern Indian traditional medicine (Siddha). A pilot study was undertaken to investigate the clinical efficacy and safety of a single dose of the above herbs in mild to moderate bronchial asthma. The respiratory functions (FVC, FEV1, PEFR and FEF25-75%) were assessed by using a spirometer prior to and 2 h after oral administration of 300 mg powder of whole plant of either S. xanthocarpum or S. trilobatum. Standard bronchodilator drugs, salbutamol (4 mg) and deriphylline (200 mg) were used for comparison. Treatment with either S. xanthocarpum or S. trilobatum significantly improved the various parameters of pulmonary function in asthmatic subjects. However, the effect was less when compared to that of deriphylline or salbutamol. No untoward effects were reported during the study. The results of the present study confirm the traditional claim for the usefulness of these herbs in bronchial asthma. More detailed studies are required to investigate the mechanism of action and therapeutic utility of S. xanthocarpum and S. trilobatum.

Adrenal cortical function and reserve in lepromatous leprosy.

22 chronic Lepromatous Leprosy patients of over 10 years duration, 17 non-reactional and 5 in reactional state who have not taken steroids as part of treatment were selected for the study. Serum cortisol was estimated by Radio-immuno-assay. Samples for basal values were collected at 8.00 A.M. Stimulated values were estimated in samples collected 8 hours after ACTH gel 40 units IM or 2 hours after 0.15 unit/kg BW Plain Insulin I.V. Basal cortisol values are: Normal controls 123.06 +/- 57.33 ng/ml. Non-reactional: 100.47 +/- 30.33 ng/ml; Reactional 141.4 +/- 43.15 ng/ml. Stimulated values are: Normal controls: 207.6 +/- 72.57 ng/ml. Non-reactional: 175.33 +/- 57.07 ng/ml, Reactional: 230 +/- 40.92 ng/ml. Basal serum cortisol in the non-reactional state is slightly lower than in normals but not statistically significant (P greater than 0.1). The basal cortisol in reactional subjects is slightly higher than in normals but not significant statistically (P greater than 0.05). The percentage rise over the basal value after stimulation test is found to be significantly low in both the reactional and non reactional states (P greater than 0.05) and also there is no statistically significant difference between these two groups (p greater than 0.5). Hence it is concluded that the Adrenal cortical reserve is low both in the non-reactional and reactional states of Lepromatous Leprosy.

Further studies on the clinical efficacy of Solanum xanthocarpum and Solanum trilobatum in bronchial asthma.

The clinical efficacy of two herbs S. xanthocarpum and S. trilobatum in a dose of 300 mg tds for 3 days was investigated in mild to moderate bronchial asthma. Their effect was compared with standard bronchodilator drugs, salbutamol (4 mg) and deriphylline (200 mg). The respiratory function was assessed by measuring the peak expiratory flow rate (PEFR) using a mini peak flow meter. In addition, improvement in lung function was assessed by physical examination (rhonchi and crepitation) and other symptoms such as cough, breathlessness and sputum. S. xanthocarpum and S. trilobatum produced a progressive improvement in the ventilatory function of asthmatic individuals over 3 days. The scores for rhonchi, cough, breathlessness and sputum were decreased by these drug treatments. The improvement in PEFR and the reduction in other symptom scores clearly indicate a bronchodilator effect, a decrease of oedema and secretions in the airway lumen. The response to these herbs can be considered to be equivalent to that of deriphylline but less than salbutamol. No untoward effects were reported during the study. The present study further confirms the traditional use of these herbs in bronchial asthma.

Severe oligozoospermia resulting from deletions of azoospermia factor gene on Y chromosome.

BACKGROUND: About 13% of cases of non-obstructive azoospermia are caused by deletion of the azoospermia factor (AZF), a gene or gene complex normally located on the long arm of the Y chromosome. Oligozoospermia is far more common than azoospermia, but little is known about genetic causes. We investigated whether severe oligozoospermia is caused by AZF deletions and, if so, whether those deletions are present in mature spermatozoa. METHODS: By PCR, we tested leucocyte DNA, from 35 men who presented at infertility clinics and who had severe oligozoospermia, for the presence of 118 DNA landmarks scattered across the Y chromosome. In the two men in whom Y-chromosome deletions in leucocyte DNA were detected, we also tested leucocyte DNA from the individuals' fathers, and in one man we tested sperm DNA. FINDINGS: In two men with ejaculate sperm counts of 40 000-100 000 per mL, we detected Y-chromosome deletions in leucocyte DNA similar in location to those previously reported in azoospermic individuals. No Y-chromosome deletions were detected in the fathers of the two men. For one of the two men, sperm DNA was tested, and it showed the same Y-chromosome deletion seen in leucocytes. INTERPRETATION: The Y-chromosome deletions in these two men are de-novo mutations, and are therefore the cause of their severe oligozoospermia. Not only is the absence of AZF compatible with spermatogenesis, albeit at reduced rate, but also the resultant sperm bear the mutant Y chromosome. Because intracytoplasmic sperm injection is increasingly used as a means of circumventing oligozoospermia, AZF deletions could be transmitted by this practice, and would probably result in infertile sons. In cases of severe oligozoospermia, it may be appropriate to offer Y-DNA testing and genetic counselling before starting assisted reproductive procedures.

Distal lateral ventricular atrium: reevaluation of normal range.

PURPOSE: To reassess the mean size of the lateral cerebral ventricular atrium in the fetus. MATERIALS AND METHODS: Measurements were obtained from axial ultrasound (US) images of 500 fetuses by using the standard criteria, and they were reviewed for consistency. Eleven fetuses had ventricular atrial measurements of 10 mm or more, and they were also followed up. Postnatal evaluation consisted of US examinations of the head in three patients and clinical examination of all 11 patients. RESULTS: The mean size of the ventricular atrium was 6.6 mm with a standard deviation (SD) of 1.4 mm. However, the mean plus 2.5 SD would yield an upper normal limit of 10.1 mm. Findings at the postnatal examinations of the 11 fetuses with isolated lateral ventriculomegaly (three with measurements of 13 mm or less and eight with measurements at 10 mm) were normal. CONCLUSION: Use of 10 mm (mean from this study plus 2.5 SD) as the upper limit of normal for the ventricular atrial measurement should be continued. Measurements of 10 mm or above should prompt a careful search for associated fetal abnormalities and consideration of amniocentesis.

Y chromosome deletions in azoospermic and severely oligozoospermic men undergoing intracytoplasmic sperm injection after testicular sperm extraction.

Y chromosome deletions encompassing the AZFc region have been reported in 13% of azoospermic men and 7% of severely oligozoospermic men. We examined the impact of these Y deletions on the severity of testicular defects in 51 azoospermic men undergoing intracytoplasmic sperm injection (ICSI) after testicular sperm extraction (TESE) and 30 men with severe oligozoospermia undergoing ICSI after ejaculation of spermatozoa. In addition, five azoospermic patients shown previously to have Y chromosome deletions underwent histological evaluation of their previously obtained testis biopsy specimens. A further 27 azoospermic men underwent TESE-ICSI, but not Y chromosome DNA testing. Ten of 51 azoospermic men (20%) who underwent TESE-ICSI and Y-DNA testing were found to be deleted for portions of the Y chromosome AZFc region. Of these 10, five had spermatozoa retrievable from the testis, and in two cases the wives became pregnant. Of the 41 azoospermic men with no Y chromosome deletion, 22 (54%) had spermatozoa retrievable from the testis, and in 12 cases (29%) the wives became pregnant. Four of 30 (13%) severely oligozoospermic patients were found to be deleted for AZFc and in three (75%) of these pregnancy was achieved. The other 26 severely oligozoospermic couples who had no AZFc deletions underwent ICSI, and 12 (46%) have an ongoing or delivered pregnancy. The embryo implantation rate was not significantly different for azoospermic (22%), oligozoospermic (16%), Y-deleted (14%) or Y-intact (18%) men. Of the total of 19 infertile men who had Y chromosome deletions, 14 had deletions within Y chromosome intervals 6D-6F, in the AZFc region. Twelve of those 14 had some spermatozoa (however few in number) in the ejaculate or testis. Five of the Y-deleted men had deletions that extended more proximally on the Y chromosome, and in none of these could any spermatozoa be observed in either ejaculate or testis. These results support the concept that, in azoospermic or oligozoospermic men with Y chromosome deletions limited to intervals 6D-6F (AZFc), there are generally very small numbers of testicular or ejaculated spermatozoa. Larger Y deletions, including and extending beyond the AZFc region and encompassing more Y genes, tend to be associated with a total absence of testicular spermatozoa. In those cases where spermatozoa were retrieved, the presence of Y deletions had no obvious impact on fertilization or pregnancy rate.

Adnexal masses: comparison of specificity of endovaginal US and pelvic MR imaging.

In a prospective study, 32 women with suspected pelvic masses at physical examination underwent both endovaginal ultrasound (US) and magnetic resonance (MR) imaging to compare their ability in diagnosis of adnexal masses. Criteria for the diagnosis of various types of adnexal masses with MR imaging and endovaginal US were prospectively defined, and the ability of either modality to allow a specific diagnosis was assessed. For each modality, measures of sensitivity, specificity, and accuracy were obtained. Results indicated higher diagnostic capability of endovaginal US for simple cysts (five of five), hemorrhagic cysts (eight of nine), endometriomas (nine of 14), and ovarian carcinomas (three of three). MR imaging demonstrated higher diagnostic capability for dermoids (three of three). MR imaging and endovaginal US showed equal diagnostic capability for pedunculated fibroids (two of two). For all masses, observers, and observations, the overall sensitivity of endovaginal US was 76% versus 49% for MR imaging, and the overall accuracy of endovaginal US was 83% versus 70% for MR imaging. The authors suggest that endovaginal US is a better modality than MR imaging for the assessment of suspected pelvic masses.

Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis.

PURPOSE: To determine which magnetic resonance (MR) imaging features are most predictive of extracapsular extension of prostate carcinoma. MATERIALS AND METHODS: In 77 patients who had stage pT2 or pT3 prostate carcinoma, MR images were retrospectively reviewed by three readers with varying experience in interpretation of endorectal coil images of the prostate gland. MR imaging features assessed were broad tumor contact, smooth capsular bulge, irregular bulge, obliteration of the rectoprostatic angle, and asymmetry of the neurovascular bundle. Multivariate logistic regression analysis was performed to determine the relative value of each MR imaging feature. RESULTS: At multivariate analysis, obliteration of the rectoprostatic angle and asymmetry of the neurovascular bundle were most predictive of extracapsular extension, with a specificity of up to 95% and sensitivity of 38%. Poor-quality images reduced accuracy for all readers. The most experienced reader demonstrated overall accuracy of 77% in determination of extracapsular extension. CONCLUSION: Obliteration of the rectoprostatic angle and asymmetry of the neurovascular bundle were most indicative of extracapsular extension. Reader experience plays an important role in the ability to interpret prostate MR images and is an important contributor to interobserver variability.

Azoospermic men with deletion of the DAZ gene cluster are capable of completing spermatogenesis: fertilization, normal embryonic development and pregnancy occur when retrieved testicular spermatozoa are used for intracytoplasmic sperm injection.

Some men with non-obstructive azoospermia harbour fully formed spermatozoa within their testicular tissue that can be used to achieve pregnancy via intracytoplasmic sperm injection (ICSI). Recently, Reijo et al. (1995) provided compelling evidence that the DAZ gene cluster is a strong candidate for one of the elusive azoospermia factors (AZF) located on the long arm of the Y chromosome. The DAZ gene cluster is deleted in 13% of azoospermic men and a small percentage of severely oligozoospermic men. Vertical transmission from father to son of AZF region deletions has also been described. Presumably these fathers were oligozoospermic. This led us to ask whether the azoospermic male with deletions of the AZF/DAZ region can also complete minimal spermatogenesis and whether any spermatozoa found could participate in fertilization, embryo development and pregnancy. Three out of six (50%) of the azoospermic men with AZF/DAZ deletions had spermatozoa identified within their harvested testicular tissue. When these spermatozoa were used for ICSI, fertilization occurred in 36% of injected oocytes. This compared favourably with testicular spermatozoa retrieved from non-obstructive azoospermic men without AZF/DAZ gene deletions. In one case, a twin conception resulted, which represents the first term pregnancy reported using spermatozoa from an AZF/DAZ deleted azoospermic male. Therefore it is necessary to take the possibility of transmission of infertility or sterility to our patients' offspring seriously when utilizing today's reproductive technologies, as spermatogenesis in men with AZF/DAZ deletions is by no means an exceptional occurrence.

Reconstructing hominid Y evolution: X-homologous block, created by X-Y transposition, was disrupted by Yp inversion through LINE-LINE recombination.

The human X and Y chromosomes share many blocks of similar DNA sequence. We conducted mapping and nucleotide sequencing studies of extensive, multi-megabase homologies between Yp and Xq21, which do not recombine during male meiosis. We confirmed and built upon previous evidence that a Yp inversion had occurred during evolution: a single contiguous segment of Xq21 is homologous to two non-contiguous segments of Yp. We precisely defined and sequenced the inversion breakpoints, obtaining evidence that the inversion was mediated by recombination between LINE-1 elements in otherwise non-homologous regions. This inversion appears to have followed a single transposition of an approximately 4 Mb segment from the X to the Y chromosome. These events jointly account for the present arrangement of Yp-Xq21 homologous sequences. Based on Southern blotting studies of primates and of humans drawn from diverse populations, we conclude that both the X-Y transposition and the subsequent, LINE-mediated Yp inversion occurred after the divergence of hominid and chimp lineages but before the radiation of extant human populations. This evolutionary scenario is consistent with our finding of 99.3 +/- 0.2% nucleotide identity between the X and Y chromosomes within the transposed region, which suggests that the transposition occurred approximately 3-4 million years ago, near the time of emergence of Homo . Comparative sequencing of the entire human X and Y chromosomes may reveal a succession of transpositions, inversions and other rearrangements underlying the complex pattern of sequence similarities between the present-day sex chromosomes. With the possible exception of cubitus valgus, phenotypic features of Turner syndrome are absent in individuals monosomic for Yp-Xq21 homologous sequences, suggesting that most of the critical 'Turner genes' are found elsewhere on the X and Y chromosomes.

Four DAZ genes in two clusters found in the AZFc region of the human Y chromosome.

The DAZ genes are candidate fertility factors that lie within the human Y chromosome's AZFc region, whose deletion is a common cause of spermatogenic failure. The number of DAZ genes has been difficult to determine, in part because the nucleotide sequences of the DAZ genes are nearly identical. Here, fluorescence in situ hybridization and characterization of BAC clones revealed four full-length DAZ genes on the human Y chromosome. They exist in two clusters, each comprising an inverted pair of DAZ genes (3' <-- 5'::5' --> 3'). Analysis of genomic sequences and testicular transcripts suggested that three or four DAZ genes are translated. Each gene contains at least seven tandem copies of a previously described, 2.4-kb repeat unit that encodes 24 amino acids. In addition, two DAZ genes contain tandem copies of a 10.8-kb repeat unit that encodes the RNA-binding domain, which appears to be multimerized in some DAZ proteins. Combining our present results with previous studies, we can reconstruct several steps in the evolution of the DAZ genes on the Y chromosome. In the ancestral Y-chromosomal DAZ gene, amplification of both intragenic repeats began before the human and cynomolgus (Old World) monkey lineages diverged. During subsequent evolution, an inverted duplication of this modified gene occurred. Finally, the resulting two-gene cluster was duplicated, generating the two-cluster/four-gene arrangement found on modern human Y chromosomes.