Spem2, a novel testis-enriched gene, is required for spermiogenesis and fertilization in mice.

Spermiogenesis is considered to be crucial for the production of haploid spermatozoa with normal morphology, structure and function, but the mechanisms underlying this process remain largely unclear. Here, we demonstrate that SPEM family member 2 (Spem2), as a novel testis-enriched gene, is essential for spermiogenesis and male fertility. Spem2 is predominantly expressed in the haploid male germ cells and is highly conserved across mammals. Mice deficient for Spem2 develop male infertility associated with spermiogenesis impairment. Specifically, the insufficient sperm individualization, failure of excess cytoplasm shedding, and defects in acrosome formation are evident in Spem2-null sperm. Sperm counts and motility are also significantly reduced compared to controls. In vivo fertilization assays have shown that Spem2-null sperm are unable to fertilize oocytes, possibly due to their impaired ability to migrate from the uterus into the oviduct. However, the infertility of Spem2-/- males cannot be rescued by in vitro fertilization, suggesting that defective sperm-egg interaction may also be a contributing factor. Furthermore, SPEM2 is detected to interact with ZPBP, PRSS21, PRSS54, PRSS55, ADAM2 and ADAM3 and is also required for their processing and maturation in epididymal sperm. Our findings establish SPEM2 as an essential regulator of spermiogenesis and fertilization in mice, possibly in mammals including humans. Understanding the molecular role of SPEM2 could provide new insights into future therapeutic treatment of human male infertility and development of non-hormonal male contraceptives.

In vivo CRISPR screens reveal Serpinb9 and Adam2 as regulators of immune therapy response in lung cancer.

How the genetic landscape governs a tumor's response to immunotherapy remains poorly understood. To assess the immune-modulatory capabilities of 573 genes associated with altered cytotoxicity in human cancers, here we perform CRISPR/Cas9 screens directly in mouse lung cancer models. We recover the known immune evasion factors Stat1 and Serpinb9 and identify the cancer testis antigen Adam2 as an immune modulator, whose expression is induced by KrasG12D and further elevated by immunotherapy. Using loss- and gain-of-function experiments, we show that ADAM2 functions as an oncogene by restraining interferon and TNF cytokine signaling causing reduced presentation of tumor-associated antigens. ADAM2 also restricts expression of the immune checkpoint inhibitors PDL1, LAG3, TIGIT and TIM3 in the tumor microenvironment, which might explain why ex vivo expanded and adoptively transferred cytotoxic T-cells show enhanced cytotoxic efficacy in ADAM2 overexpressing tumors. Together, direct in vivo CRISPR/Cas9 screens can uncover genetic alterations that control responses to immunotherapies.

ADAM12 promotes gemcitabine resistance by activating EGFR signaling pathway and induces EMT in bladder cancer

Background Gemcitabine (GEM)-based chemotherapy regimens is widely used in bladder cancer (BC) patients. However, GEM resistance may occur and result in treatment failure and disease progression. A disintegrin and metalloprotease 12 (ADAM12) plays a critical role in many cancers. However, the role of ADAM12 in GEM resistance of BC remains unclear. Methods We analyzed the relationship between ADAM12 expression and tumor characteristics using the data downloaded from The Cancer Genome Atlas (TCGA) database and Gene Expression Omnibus (GEO) database. Then, we established GEM resistant BC cell lines and used quantitative real-time PCR, western blot, cell counting kit-8, immunohistochemistry, and xenograft mouse model to investigate the role of ADAM12 in GEM resistance. Results In general, ADAM12 was found to be upregulated in GEM resistant BC cells. ADAM12 knockdown increased the chemosensitivity of BC cells. We further proved that ADAM12 could promote GEM resistance by activating the epidermal growth factor receptor (EGFR) signaling pathway in BC. Furthermore, the epithelial–mesenchymal transition (EMT) phenotype was observed in GEM resistant BC cells. ADAM12 induced EMT process and promotes tumor progression in BC. Conclusion Our findings suggested that ADAM12 was a key gene for GEM resistance and positively correlated with malignancy of BC. It might serve as a novel and valuable therapeutic target for BC (AU)

Is there a relationship between infertility and fertilin β protein distribution? / ¿Existe relación entre la infertilidad y la distribución de la proteína fertilin β?

Introduction: Fertilin β is a sperm surface protein that can mediate sperm-egg membrane interaction. This study was conducted to determine whether the expression of fertilin β after intrauterine insemination (IUI) in donors with normal parameters after standard semen analysis is related to low success rate or failure of fertilization. Methods: We examined the sperm of 30 male donors who have normal as controls, oligozoospermia, and unexplained infertility as the clinically indication for IUI. Fertilin β has been labeled with the ADAM2 antibody by indirect immunofluorescence (IF) assay. To evaluate the reproducibility of the test, we selected four sperm samples scale of 0 to +++ according to the distribution of fluorescence label. Results: The results were highly correlated with the corrected total cell fluorescence (CTCF) (Rp=0.9972, P<0.05). We suggest that the relationship between infertility and fertilin β may be due to the distribution of this protein on the sperm surface. Male partners of couples with unexplained infertility showed a low distribution of fertilin β by a decrease of the fluorescence signal in the IF labeling (scale of +++ by 7.4±10.32%, P<0.0001, ±SD). Discussion: Abnormal fertilin β function may be a potential mechanism that could lead to fertilization failure. (AU)

Introducción: La fertilinβ es una proteína de la superficie del esperma que puede mediar entre la interacción del espermatozoide y la membrana del óvulo. Este estudio se realizó para determinar si la expresión de fertilinβ después de la inseminación intrauterina (IIU) en donantes con parámetros normales después del análisis estándar de semen está relacionada con una baja tasa de éxito o fracaso de la fertilización. Métodos: Examinamos los espermatozoides de 30 donantes masculinos que tenían controles normales, oligozoospermia e infertilidad inexplicable como indicación clínica de IIU. La fertilinβ ha sido etiquetada con el anticuerpo ADAM2 mediante un ensayo de inmunofluorescencia indirecta (IF). Para evaluar la reproducibilidad de la prueba, seleccionamos cuatro muestras de esperma en una escala de 0 a +++ según la distribución de la etiqueta de fluorescencia. Resultados: Los resultados estuvieron altamente correlacionados con la fluorescencia celular total corregida (Rp=0,9972, p<0,05). Sugerimos que la relación entre la infertilidad y la fertilinβ puede deberse a la distribución de esta proteína en la superficie del esperma. Los compañeros masculinos de parejas con infertilidad inexplicable mostraron una baja distribución de fertilinβ por una disminución de la señal de fluorescencia en el etiquetado IF (escala de +++ en 7,4 ±10,32%, p<0,0001, ±DE). Conclusión: La función anormal de la fertilinβ puede ser un mecanismo potencial que podría conducir al fracaso de la fertilización. (AU)

Is there a relationship between infertility and fertilin ß protein distribution?

INTRODUCTION: Fertilin ß is a sperm surface protein that can mediate sperm-egg membrane interaction. This study was conducted to determine whether the expression of fertilin ß after intrauterine insemination (IUI) in donors with normal parameters after standard semen analysis is related to low success rate or failure of fertilization. METHODS: We examined the sperm of 30 male donors who have normal as controls, oligozoospermia, and unexplained infertility as the clinically indication for IUI. Fertilin ß has been labeled with the ADAM2 antibody by indirect immunofluorescence (IF) assay. To evaluate the reproducibility of the test, we selected four sperm samples scale of 0 to +++ according to the distribution of fluorescence label. RESULTS: The results were highly correlated with the corrected total cell fluorescence (CTCF) (Rp=0.9972, P<0.05). We suggest that the relationship between infertility and fertilin ß may be due to the distribution of this protein on the sperm surface. Male partners of couples with unexplained infertility showed a low distribution of fertilin ß by a decrease of the fluorescence signal in the IF labeling (scale of +++ by 7.4±10.32%, P<0.0001, ±SD). DISCUSSION: Abnormal fertilin ß function may be a potential mechanism that could lead to fertilization failure.

A fertilin-derived peptide improves in vitro maturation and ploidy of human oocytes.

OBJECTIVE: To analyze the effect of a cyclic fertilin-derived peptide (cFEE) on in vitro maturation of human oocytes. DESIGN: Randomized study. SETTING: Fertility center in an academic hospital. PATIENT(S): Not applicable. INTERVENTION(S): Human immature germinal vesicle-stage oocytes (n = 1,629) donated for research according to French bioethics laws were randomly allocated to groups treated with 1 or 100 µM of cFEE or to a control group. They were incubated at 37 °C in 6% CO2 and 5% O2, and their maturation was assessed using time-lapse microscopy over 24 hours. In vitro maturated metaphase II oocytes were analyzed for chromosomal content using microarray comparative genomic hybridization, and their transcriptomes were analyzed using Affymetrix Clariom D microarrays. MAIN OUTCOME MEASURE(S): The percentage of oocytes undergoing maturation in vitro was observed. Aneuploidy and euploidy were assessed for all chromosomes, and differential gene expression was analyzed in oocytes treated with cFEE compared with the control to obtain insights into its mechanism of action. RESULT(S): cFEE significantly increased the percentage of oocytes that matured in vitro and improved euploidy in meiosis II oocytes by the up-regulation of FMN1 and FLNA genes, both of which encode proteins involved in spindle structure. CONCLUSION(S): cFEE improves human oocyte maturation in vitro and reduces aneuploidy. It may prove useful for treating oocytes before fertilization in assisted reproductive technology and for in vitro maturation in fertility preservation programs to improve oocyte quality and the chances for infertile couples to conceive.

Cyclic fertilin-derived peptide stimulates in vitro human embryo development.

OBJECTIVE: To study the cyclic fertilin peptide effects on preimplantation human embryogenesis. Cyclic fertilin peptide reproduces the structure of the binding site of the sperm Fertilin ß (also named A Disintegrin and Metalloprotease 2: ADAM2) disintegrin domain. It binds to the oocyte membrane and increases sperm-oocyte fusion index in human and fertilization rate in mouse, providing healthy pups. It also improves human oocyte maturation and chromosome segregation in meiosis I and binds to human embryo blastomeres, suggesting that it has a membrane receptor. DESIGN: Thawed human embryos at the 3 to 4 cells stage were randomly included in a dose-response study with cyclic fertilin peptide. Inner cell mass (ICM), trophectoderm (TE), and total cell numbers were evaluated in top- and good-quality blastocysts. SETTING: The study was performed in an academic hospital and research laboratory. PATIENT(S): Human embryos donated for research. This project was approved by the French "Agence de la Biomédecine." INTERVENTION(S): Immunofluorescence and tissue-specific gene expression analysis, using Clariom D microarrays, were performed to study its mechanism of action. MAIN OUTCOME MEASURE(S): Cyclic fertilin peptide improves blastocyst formation by almost 20%, the concentration of 1 µM being the lowest most efficient concentration. It significantly increases twice the TE cell number, without modifying the ICM. It increases the in vitro hatching rate from 14% to 45%. RESULT(S): Cyclic fertilin peptide stimulates TE growth. In the ICM, it induces transcriptional activation of intracellular protein and vesicle-mediated transport. CONCLUSION(S): Cyclic fertilin peptide dramatically improves human embryo development potential. It could be used to supplement culture medium and improve the in vitro human embryo development. Starting supplementation immediately after fertilization, instead of day 2, could significantly upgrade assisted reproductive technology outcome.

Sperm preparedness and adaptation to osmotic and pH stressors relate to functional competence of sperm in Bos taurus.

The adaptive ability of sperm in the female reproductive tract micromilieu signifies the successful fertilization process. The study aimed to analyze the preparedness of sperm to the prevailing osmotic and pH stressors in the female reproductive tract. Fresh bovine sperm were incubated in 290 (isosmotic-control), 355 (hyperosmotic-uterus and oviduct), and 420 (hyperosmotic-control) mOsm/kg and each with pH of 6.8 (uterus) and 7.4 (oviduct). During incubation, the changes in sperm functional attributes were studied. Sperm kinematics and head area decreased significantly (p < 0.05) immediately upon exposure to hyperosmotic stress at both pH. Proportion of sperm capacitated (%) in 355 mOsm/kg at 1 and 2 h of incubation were significantly (p < 0.05) higher than those in 290 mOsm media. The magnitude and duration of recovery of sperm progressive motility in 355 mOsm with pH 7.4 was correlated with the ejaculate rejection rate (R2 = 0.7). Using this information, the bulls were divided into good (n = 5) and poor (n = 5) osmo-adapters. The osmo-responsive genes such as NFAT5, HSP90AB1, SLC9C1, ADAM1B and GAPDH were upregulated (p < 0.05) in the sperm of good osmo-adapters. The study suggests that sperm are prepared for the osmotic and pH challenges in the female reproductive tract and the osmoadaptive ability is associated with ejaculate quality in bulls.

Immunolocalization of Fertilin ß, IZUMO1, and P34H in Ram Spermatozoa.

According to various reports, current methods of sperm freezing destroy the integrity of the sperm plasma membrane and acrosome. This study aimed to determine the changes in the existence and location of three proteins, namely fertilin ß, IZUMO1, and P34H, in ram spermatozoa. By using frozen-thawed spermatozoa, ejaculated fresh spermatozoa, and testicular and epididymal spermatozoa (obtained from caput, corpus, and caudal regions), the localizations of the mentioned proteins were performed using signal labeling with indirect immunofluorescence, and the quantification of these proteins was compared using Western blot analyses. Moreover, protein localization and signal labeling in fresh and frozen-thawed spermatozoa subjected to in vitro capacitation and acrosome reaction were compared. Using chlortetracycline (CTC) staining, as expected, it was detected that after incubating for 4 hours under capacitating conditions related to the control sample (0 hour), capacitated and acrosome-reacted sperm were increased (p < 0.001). Frozen-thawed samples had a lower density and expression than the ejaculate samples. Expression was not obtained, except for IZUMO1, from samples that underwent in vitro capacitation/acrosome reactions. Expression of IZUMO1 was seen as an increasing band formation from the equatorial region through the acrosome, after in vitro capacitation. However, after the acrosome reaction, the band formation was only on the equatorial region. Region-specific differences of proteins at the kDa level were obtained using Western blot analysis and possible isoforms specific to ram spermatozoa or proteins with similar epitopes were expressed. Considering the changes in surface proteins in frozen-thawed sperm, it is suggested that fertilin ß and P34H can be used as fertility or freezability markers.

Normal fertility in male mice lacking ADAM32 with testis-specific expression.

The a disintegrin and metalloprotease (ADAM) family proteins comprise a group of membrane-anchored proteins. ADAM32 is expressed specifically in testis and is closely related phylogenetically to ADAM2 and ADAM3, which are known to be critical for fertilization in mice. To assess the biological role of ADAM32, we analyzed Adam32-mutant mice. We found that male mice lacking ADAM32 have normal fertility, testicular integrity, and sperm characteristics. ADAM32 was found to exist at lower levels than ADAM2 and ADAM3 in wild-type testis and sperm, respectively. The present study demonstrates that ADAM32 is dispensable for fertility and appears to be functionally unrelated to ADAM2 and ADAM3 in mice.

Assessing the potential of HSPA2 and ADAM2 as two biomarkers for human sperm selection.

Selection of the best sperm, with the least defects, is a critical factor in the success of ART especially in male factor infertility. This study assessed the potential Heat shock protein (HSPA2) and metallopeptidase domain2 (ADAM2) biomarkers for sperm selection. Sperm were obtained from 72 asthenoteratozoospermic and 42 normospermic ejaculates. The semen characteristic, DNA fragmentation (DFI), chromatin maturation index (CMI), ADAM2 and HSPA2 levels on sperm, and their correlation with embryo quality were assessed in both groups. Results showed the significant reduction in HSPA2 and ADAM2 in asthenoteratozoospermic compared to normazoospermic ejaculates regarding the cut-off value of 14 and 13% for these two biomarkers. The specificity of HSPA2 and ADAM2 separately, and the combination of these two biomarkers, were 95.2, 90.5 and 93.5%, respectively, for sperm from normozoospermic ejaculates. However, they were 48.6, 50.0 and 54.5% for asthenoteratozoospermic ones. A significant correlation was observed with HSPA2, ADAM2 and a combination of these two biomarkers with CMI, DFI and embryo quality. Although a combination of these two biomarkers have the potential to be a good choice for selecting sperm with the lowest level of chromatin damage, it seems that selection according to HSPA2 has priority over ADAM2 or a combination of the two.

Effects of sperm proteins on fertilization in the female reproductive tract.

Mammalian fertilization that culminates by fusion of the male and female gametes is intricately regulated within the female reproductive tract. To become competent to fertilize an egg, the mammalian spermatozoa that enter the female reproductive tract must undergo a series of physiological changes, including hyperactivation, and capacitation. For reaching full competency, the acrosome, a specialized membrane-bound organelle that covers the anterior part of the sperm head, must undergo an acrosome reaction. For becoming competent to bind an ovum, and to penetrate the zona pellucida and cumulus, many sperm proteins are released in the course of the acrosome reaction. Ultimately, the acrosome binds to the oolemma and fusion of sperm and egg occurs. In this review, we outline current understanding of the roles and effects of some essential sperm proteins and their functions during fertilization in the female reproductive tract.

Effects of ADAM2 silencing on isoflurane-induced cognitive dysfunction via the P13K/Akt signaling pathway in immature rats.

Volatile anesthetics, including isoflurane, have been reported to have negative effects on cognitive dysfunction characterized by cognitive deficits following anesthesia. The aim of the current study was to investigate the effects involved with disintegrin and metallopeptidase domain 2 (ADAM2) silencing on isoflurane-induced cognitive dysfunction via the P13 K/Akt signaling pathway in immature rats. One week old healthy Sprague-Dawley (SD) rats were recruited and administered isoflurane anesthesia. The rats were then subjected to shADAM2 or wortmannin (PI3K/Akt signaling pathway inhibitor) to identify the effects of ADAM2 and the PI3K/Akt signaling pathway on the cognitive function of rats. Morris water maze and passive-avoidance tests were performed to examine the cognitive function of the rats. TUNEL staining was conducted to detect neuronal apoptosis in the hippocampal CA1 region. The obtained experimental results demonstrated that isoflurane anesthesia led to increased escape latency, reaction time, number of errors and TUNEL-positive neurons, along with a decreased latency time. In response to treatment with shADAM2, escape latency, reaction time, number of errors and TUNEL-positive cells were all noted to have decreased, in addition to elevated latency time, while contrasting trends were observed in regard to treatment with wortmannin. Taken together, the key findings of the present study revealed that shADAM2 activated the PI3K/Akt signaling pathway, resulting in elevated expressions of PI3K and Akt. Our study ultimately identified that ADAM2 silencing alleviates isoflurane-induced cognitive dysfunction by activating the P13 K/Akt signaling pathway in immature rats.

Romiplostim para púrpura trombocitopênica idiopática (PTI) crônica e refratária em alto risco de sangramento / Romiplostim for chronic idiopathic thrombocytopenic purpura (ITP) and refractory at high risk of bleeding

INTRODUÇÃO: A púrpura trombocitopênica idiopática crônica (PTI), atualmente denominada trombocitopenia imune primária (TIP) é uma doença autoimune adquirida, de causa desconhecida, caracterizada predominantemente pela presença isolada de trombocitopenia (baixas contagens de plaquetas). Fisiologicamente, observa-se a destruição aumentada das plaquetas causada por autoanticorpos contra os antígenos das plaquetas e por linfócitos T citotóxicos, associada a uma produção prejudicada de plaquetas pela medula óssea. Não existe exame laboratorial específico para o diagnóstico de PTI, sendo feito diagnóstico por exclusão: presença de trombocitopenia isolada, sem alterações nas outras séries do hemograma e no esfregaço de sangue periférico; e a exclusão de outras causas de trombocitopenia. O tratamento é recomendado apenas para pacientes com trombocitopenia grave (plaquetas < 20 x 109 /L) ou àqueles com sangramentos associados à trombocitopenia (plaquetas < 50 x 109 /L) e tem como objetivo controlar precocemente os sintomas, diminuir o risco de sangramento e causar menos impacto na qualidade de vida. Os agonistas do receptor de trombopoietina (TPO) aumentam a produção de plaquetas estimulando o receptor de TPO em pessoas com ITP crônica. Segundo o Protocolo Clínico e Diretrizes Terapêuticas - púrpura trombocitopênica idiopática (PCDT - PTI) do Ministério da Saúde, de 2013, as práticas de tratamento atuais para pacientes adultos com PTI crônica devem ter a seguinte abordagem: corticosteroides, imunoglobulina humana intravenosa, esplenectomia, azatioprina, ciclofosfamida, danazol e vincristina. TECNOLOGIA: Romiplostim (Nplate®). PERGUNTA: O romiplostim é seguro, eficaz e custo-efetivo em pacientes com PTI crônica, esplenectomizados, refratários e em alto risco de sangramento, quando comparado ao tratamento atual disponível no SUS? EVIDÊNCIAS CIENTÍFICAS: Baseada em dois ensaios clínicos randomizados e uma revisão sistemática da Cochrane (2011) com 6 ensaios clínicos randomizados (ECR) que avaliaram a eficácia e segurança dos agonistas do receptor de TPO em pacientes com PTI crônica. O ECR realizado por Bussel et. al. (2006) demostrou que o romiplostim causa um aumento significativo na contagem de plaquetas quando comparado ao placebo (RR= 3,00; IC95% 0,54 - 16,77), achado que foi corroborado pelo estudo de Kuter et. al. (2008) que encontrou taxas de duração da resposta plaquetária significativamente maiores (RR= 16,88; IC95% 1,06 - 268,42) e melhora significativa na taxa de resposta plaquetária global (RR= 34,28; IC95% 2,20 ­ 533,41), quando comparado o romiplostim com o placebo. A revisão sistemática confirmou esse achado, visto que, na análise combinada o uso de agonistas do receptor de TPO (romiplostim e eltrombopague) apresentou melhora significativa nas taxas de resposta plaquetária global comparado ao placebo (RR= 4,06; IC95% 2,93 - 5,63; valor de p< 0,00001) e ao tratamento padrão (RR= 1,81; IC95% 1,37 - 2,37; valor de p< 0,0001) , e maiores taxas de duração da resposta no número de plaquetas, com significância estatística, comparado ao placebo (RR= 14,16; IC95% 2,91 - 69,01; valor de p=0,001). Apesar desse aumento significativo na contagem de plaquetas, a RS demonstrou que não houve diferença significativa para incidência de eventos hemorrágicos importantes (classificados como graves, com risco de morte ou fatais) na PTI crônica quando comparado com placebo (RR= 0,48; IC95% 0,19 - 1,16; valor de p=0,10) ou tratamento padrão (RR= 0,49; IC95% 0,15 - 1,63; valor de p=0,24), resultado também encontrado no estudo de Kuter et. al. (2008) comparado com o placebo (RR= 0,50; IC95% 0,14 - 1,80). Nenhum dos estudos incluiu sobrevida global como desfecho, portanto, não foi possível avaliar se o romiplostim ajuda a prolongar a vida dos pacientes. Embora faltem estudos de longo prazo, a RS demonstrou que os agonistas do receptor de TPO são bem tolerados, apresentando o total de efeitos adversos semelhantes ao do grupo placebo (RR= 1,04; IC95% 0,95 - 1,15; valor de p=0,35). No que se refere ao total de eventos adversos graves, os 3 estudos não encontraram diferença significativa entre o romiplostim comparado ao placebo (RR= 0,12, IC 95% 0,01 - 1,00) (Bussel, 2006), (RR= 0,94, IC 95% 0,48 - 1,85) (Kuter, 2008) e (RR= 0,92; IC95% 0,61 - 1,38; valor de p= 0,68) (Zeng, 2011), entretanto a RS demonstrou uma redução significativa entre o romiplostim e o tratamento padrão (RR= 0,61; IC95% 0,40 - 0,92; valor de p=0,02). Não existe evidência suficiente para afirmar a eficácia do romiplostim na PTI crônica, sendo necessários mais estudos para explorar o papel desse medicamento no tratamento da PTI crônica de forma mais completa. AVALIAÇÃO ECONÔMICA: O demandante realizou avaliação de custo-utilidade, com modelo de Markov, com ciclo de 4 semanas, em um horizonte temporal de até o fim da vida, na perspectiva do SUS. Foram definidos os seguintes parâmetros: população de pacientes esplenectomizados, com PTI crônica, recebendo um tratamento a partir de segunda linha, com contagem de plaqueta (CP) < 20x109/L; possibilidade de 3 estados de saúde abrangentes (Plaquetas ≥ 50×109/L; Plaquetas < 50×109/L; Morto); comparação entre romiplostim e a terapia de regaste usada nos pacientes em observação e sem tratamento (imunoglobulina intravenosa - IVig); resposta ao tratamento (CP > 50x109/L); eficácia de cada tratamento (probabilidade de resposta inicial ao tratamento; tempo médio à resposta (CP > 50x109/L); tempo até a falha do tratamento (CP < 50x109/L durante 4 semanas consecutivas)); e desfechos primários (custos incrementais incorridos e os anos de vida ajustados por qualidade (QALYs) ganhos a partir da introdução do romiplostim). Os custos foram avaliados em Reais (R$) com base nos anos 2016 e 2017, extraídos do banco de dados SIGTAP do Ministério da Saúde (MS), lista de preço de medicamentos publicada pela Câmara de Regulação do Mercado de Medicamentos e parecer de especialistas locais. O custo do tratamento para cada intervenção incluiu: custos de compra dos medicamentos, administração de testes laboratoriais e monitoramento. Taxa de desconto de 5% para efetividade e custos. A razão de custo-efetividade incremental (RCEI) foi de R$ - 121.213,45 /QALY, mostrando que o tratamento da PTI com o romiplostim quando comparado com o grupo de pacientes em observação e sem tratamento é uma estratégia custo-efetiva (dominante). Foram realizadas análises de sensibilidade determinista e probabilística cujos resultados demonstraram que a RCEI foi robusta, visto que a estratégia de tratamento com o romiplostim continuou dominante, mesmo com a variação dos valores dos parâmetros utilizados no modelo. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: Foi estimada considerando duas possibilidades de prevalência de PTI, uma de "baixa prevalência" e outra de "alta prevalência", e dois panoramas de difusão da tecnologia, um conservador e outro otimista, totalizando a possibilidade de 4 diferentes cenários. Como resultado, o demandante encontrou que, durante 5 anos, em todos os quatro cenários, a incorporação do romiplostim resultaria em economias de R$ 49.386.749 a R$ 196.521.197 no cenário de "alta prevalência" e de R$ 49.725.986 a R$ 79.164.764 no cenário de "baixa prevalência". Na análise de sensibilidade unilateral, a incorporação do romiplostim permaneceu resultando em economias, mesmo com a variação dos valores dos dois parâmetros direcionadores do modelo. MONITORAMENTO DO HORIZONTE TECNOLÓGICO: Há tecnologias em fase de desenvolvimento clínico para tratamento de púrpura trombocitopênica idiopática. Porém, essas novas tecnologias ainda não tiveram seu registro aprovado pela Anvisa para a indicação clínica pesquisada. RECOMENDAÇÃO PRELIMINAR DA CONITEC: Os membros do Plenário presentes em sua 65ª reunião ordinária, no dia 04 de abril de 2018, indicaram que o tema seja submetido à Consulta Pública com recomendação preliminar a não incorporação no SUS do romiplostim para PTI crônica e refratária em alto risco de sangramento. Considerou-se que apesar do aumento significativo na contagem de plaquetas, a evidência atualmente disponível não foi suficiente para afirmar que o romiplostim reduz significativamente a incidência de eventos hemorrágicos importantes, comparado ao placebo e ao tratamento padrão e que os estudos econômicos apresentaram fragilidades, sobretudo, devido ao comparador utilizado. CONSULTA PÚBLICA: Foram recebidas 7 contribuições técnico-científicas e 14 contribuições de experiência ou opinião, sendo que todas discordaram totalmente da recomendação preliminar da CONITEC. De maneira geral, as contribuições apresentarem oito artigos e alguns comentários acerca: do PCDT vigente, do desfecho avaliado e da população alvo, entretanto não acrescentaram e nem mudaram os aspectos anteriormente discutidos e apresentados no relatório inicial da CONITEC. Assim, a CONITEC entendeu que não houve argumentação suficiente para alterar sua recomendação preliminar. RECOMENDAÇÃO FINAL: Os membros da CONITEC em 08/11/2018 deliberaram por unanimidade recomendar a não incorporação do romiplostim para tratamento de púrpura trombocitopênica idiopática, ao SUS. Foi assinado o Registro de Deliberação nº 393/2018. DECISÃO: Não incorporar o romiplostim para púrpura trombocitopênica idiopática (PTI) crônica e refratária em alto risco de sangramento, no âmbito do Sistema Único de Saúde - SUS. Dada pela Portaria nº 69, publicada no DOU nº 238, seção 1, página 71, em 11 de dezembro de 2018.

Identification of differentially expressed microRNAs in knee anterior cruciate ligament tissues surgically removed from patients with osteoarthritis.

The degradation of cruciate ligaments is frequently observed in degenerative joint diseases, such as osteo-arthritis (OA). The present study aimed to identify the differentially expressed microRNAs (miRNAs or miRs) in knee anterior cruciate ligament (ACL) tissues derived from patients with OA and in health subjects (non-OA). By using Affymetrix miRNA 4.0 microarrays, a total of 22 miRNAs (including let-7f-5p, miR-26b-5p and miR-146a-5p) were found to be upregulated, while 17 (including miR-18a-3p, miR-138-5p and miR-485-3p) were downregulated in the osteoarthritic ACL tissues (fold change ≥2, P-value <0.05). The expression levels of 12 miRNAs were validated by quantitative PCR, and the corresponding results revealed an excellent correlation with the microarray data (R2=0.889). Genes (such as a disintegrin and metalloproteinase domain with thrombospondin type-1 motifs, bone morphogenetic protein-2, runt related transcription factor-2, collagen-1A1 and 2, interleukin-6 and transforming growth factor-ß) involved in cartilage development and remodeling, collagen biosynthesis and degradation, inflammatory response and extracellular matrix homeostasis were predicted as potential targets of the dysregulated miRNAs. Moreover, a large set of putative genes were enriched in OA pathogenesis­associated pathways (such as mitogen-activated protein kinase and vascular endothelial growth factor signaling pathway). Collectively, the data from our study provides novel insight into the ligament injury-related miRNA dysregulation in patients with OA.

Low levels of PRSS37 protein in sperm are associated with many cases of unexplained male infertility.

PRSS37, a putative trypsin-like serine protease, is highly conserved during mammalian evolution as revealed by multiple sequence alignment. Mice deficient for Prss37 gene exhibit male infertility, but their mating behavior, spermatogenesis, sperm morphology, and motility remain unaffected, similar to a situation called unexplained male infertility (UMI) in men (human being). Here, we demonstrated that PRSS37 is restrictively expressed in human testis, where it is mainly located in the elongating and elongated spermatids during spermiogenesis as shown by immunohistochemical analysis of normal human testicular sections. In mature sperm, PRSS37 appears in the acrosome region and diminishes during acrosome reaction. Further examination reveals that PRSS37 contents in sperm from patients with UMI are dramatically lower than those in sperm from men with proven fertility or from sperm donors. Sperm with low PRSS37 contents exhibit abnormal activation of the proacrosin/acrosin system and premature proteolysis of ADAM2, which may impair the functional competence of human sperm in vivo However, the in vitro fertilization outcomes of sperm with low PRSS37 contents are not affected. Together, these data implicate an important role of PRSS37 for male fertility. PRSS37 can be used as a potential molecular biomarker for evaluating sperm fertilization capability in vivo but not in vitro.

Characterization of Mammalian ADAM2 and Its Absence from Human Sperm.

The members of the ADAM (a disintegrin and metalloprotease) family are membrane-anchored multi-domain proteins that play prominent roles in male reproduction. ADAM2, which was one of the first identified ADAMs, is the best studied ADAM in reproduction. In the male germ cells of mice, ADAM2 and other ADAMs form complexes that contribute to sperm-sperm adhesion, sperm-egg interactions, and the migration of sperm in the female reproductive tract. Here, we generated specific antibodies against mouse and human ADAM2, and investigated various features of ADAM2 in mice, monkeys and humans. We found that the cytoplasmic domain of ADAM2 might enable the differential association of this protein with other ADAMs in mice. Western blot analysis with the anti-human ADAM2 antibodies showed that ADAM2 is present in the testis and sperm of monkeys. Monkey ADAM2 was found to associate with chaperone proteins in testis. In humans, we identified ADAM2 as a 100-kDa protein in the testis, but failed to detect it in sperm. This is surprising given the results in mice and monkeys, but it is consistent with the failure of ADAM2 identification in the previous proteomic analyses of human sperm. These findings suggest that the reproductive functions of ADAM2 differ between humans and mice. Our protein analysis showed the presence of potential ADAM2 complexes involving yet-unknown proteins in human testis. Taken together, our results provide new information regarding the characteristics of ADAM2 in mammalian species, including humans.

D-penicillamine prevents ram sperm agglutination by reducing the disulphide bonds of a copper-binding sperm protein.

Head-to-head agglutination of ram spermatozoa is induced by dilution in the Tyrode's capacitation medium with albumin, lactate and pyruvate (TALP) and ameliorated by the addition of the thiol d-penicillamine (PEN). To better understand the association and disassociation of ram spermatozoa, we investigated the mechanism of action of PEN in perturbing sperm agglutination. PEN acts as a chelator of heavy metals, an antioxidant and a reducing agent. Chelation is not the main mechanism of action, as the broad-spectrum chelator ethylenediaminetetraacetic acid and the copper-specific chelator bathocuproinedisulfonic acid were inferior anti-agglutination agents compared with PEN. Oxidative stress is also an unlikely mechanism of sperm association, as PEN was significantly more effective in ameliorating agglutination than the antioxidants superoxide dismutase, ascorbic acid, α-tocopherol and catalase. Only the reducing agents cysteine and DL-dithiothreitol displayed similar levels of non-agglutinated spermatozoa at 0 h compared with PEN but were less effective after 3 h of incubation (37 °C). The addition of 10 µM Cu(2+) to 250 µM PEN + TALP caused a rapid reversion of the motile sperm population from a non-agglutinated state to an agglutinated state. Other heavy metals (cobalt, iron, manganese and zinc) did not provoke such a strong response. Together, these results indicate that PEN prevents sperm association by the reduction of disulphide bonds on a sperm membrane protein that binds copper. ADAM proteins are possible candidates, as targeted inhibition of the metalloproteinase domain significantly increased the percentage of motile, non-agglutinated spermatozoa (52.0% ± 7.8) compared with TALP alone (10.6% ± 6.1).

Mechanisms Underlying Testicular Damage and Dysfunction in Mice With Partial IGF-1 Deficiency and the Effectiveness of IGF-1 Replacement Therapy.

OBJECTIVE: To determine whether insulin-like growth factor (IGF-1) deficiency can cause testicular damage and to examine changes of the testicular morphology and testicular function-related gene expression caused by IGF-1 deficiency. Therefore, this study aims to determine the benefits of low doses of IGF-1 and to explore the mechanisms underlying the IGF-1 replacement therapy. MATERIALS AND METHODS: A murine model of IGF-1 deficiency was used to avoid any factor that could contribute to testicular damage. Testicular weight, score of histopathological damage, and gene expressions were studied in 3 experimental groups of mice: controls (wild-type Igf1(+/+)), heterozygous Igf1(+/-) with partial IGF-1 deficiency, and heterozygous Igf1(+/-) treated with IGF-1. RESULTS: Results show that the partial IGF-1 deficiency induced testicular damage and altered expression of genes involved in IGF-1 and growth hormone signaling and regulation, testicular hormonal function, extracellular matrix establishment and its regulation, angiogenesis, fibrogenesis, inflammation, and cytoprotection. In addition, proteins involved in tight junction expression were found to be reduced. However, low doses of IGF-1 restored the testicular damage and most of these parameters. CONCLUSION: IGF-1 deficiency caused the damage of the blood-testis barrier and testicular structure and induced the abnormal testicular function-related gene expressions. However, low doses of IGF-1 constitute an effective replacement therapy that restores the described testicular damage. Data herein show that (1) cytoprotective activities of IGF-1 seem to be mediated by heat shock proteins and that (2) connective tissue growth factor could play a relevant role together with IGF-1 in the extracellular matrix establishment.

Lack of ADAM2, CALR3 and SAGE1 Cancer/Testis Antigen Expression in Lung and Breast Cancer.

Immunotherapy is emerging as a supplement to conventional cancer treatment, and identifying antigen targets for specific types of cancer is critical to optimizing therapeutic efficacy. Cancer/testis antigens are highly promising targets for immunotherapy due to their cancer-specific expression and antigenic properties, but the expression patterns of most of the more than 200 identified cancer/testis antigens in various cancers remain largely uncharacterized. In this study, we investigated the expression of the cancer/testis antigens ADAM2, CALR3 and SAGE1 in lung and breast cancer, the two most frequent human cancers, with the purpose of providing novel therapeutic targets for these diseases. We used a set of previously uncharacterized antibodies against the cancer/testis antigens ADAM2, CALR3 and SAGE1 to investigate their expression in a large panel of normal tissues as well as breast and lung cancers. Staining for the well-characterized MAGE-A proteins was included for comparison. Immunohistochemical staining confirmed previous mRNA analysis demonstrating that ADAM2, CALR3 and SAGE1 proteins are confined to testis in normal individuals. Negative tissues included plancenta, which express many other CT antigens, such as MAGE-A proteins. Surprisingly, we detected no ADAM2, CALR3 and SAGE1 in the 67 lung cancers (mainly non-small lung cancer) and 189 breast cancers, while MAGE-A proteins were present in 15% and 7-16% of these tumor types, respectively. Treatment with DNA methyltransferase inhibitors has been proposed as an attractive strategy to increase the expression of cancer/testis antigens in tumors before immunotargeting; however, neither ADAM2, CALR3 nor SAGE1 could be significantly induced in lung and breast cancer cell lines using this strategy. Our results suggest that ADAM2, CALR3 and SAGE1 cancer/testis antigens are not promising targets for immunotherapy of breast and lung cancer.