Analysis of the methylation pattern of six gene promoters in sperm of men with abnormal protamination

It has recently been shown that alteration of the methylation pattern of imprinted genes is associated with different types of male infertility. The objective of our study was to investigate the methylation pattern of selected gene promoters in sperm of patients with abnormal protamine replacement. The promoters of OCT4, SOX2, NANOG, HOXC11, miR-17and CREMwere analyzed using bisulfite sequencing and the percentage of DNA methylation was compared between patients with an abnormal protamine l/protamine 2 （P1/ P2） ratio and normozoospermic controls. No significant quantitative differences were found between groups of patients with either an abnormally high or low P1/P2 ratio compared to normal controls. However, two individual samples from infertile subjects （2/20, 10%） showed an altered methylation pattern for the CREMgene promoter that was not found in control samples. These two samples had a significantly higher （P〈0.05） promoter methylation （5.58 and 4.23%, respectively） compared to the control group （0.46%）. In conclusion, in our pilot study, extreme methylations defects were not seen broadly in severely infertile men. However, two patients exhibited altered methylation of the CREMgene, which may be either causative or a result of abnormal protmaine replacement.

Aberrant protamination in sperm correlates to anomalous nuclear and cytoplasmic architectures in infertile males with sperm dysmorphology

Aberrant sperm protamination is linked to sperm dysmorphology and nuclear chromatin condensation.Yet,its effects on sperm cytoplasmic maturation remain largely unexplored.The relationships of protamines,sperm morphology,DNA damage,and cytoplasmic remodeling were illustrated in this study to provide fresh perspectives on the mechanisms of male infertility.A total of 205 infertile males were allocated into 5 groups according to the percentage of spermatozoa exhibiting abnormal morphology within their samples.Sperm concentration,motility,abnormal sperm morphology,cytoplasmic droplets(CDs),and excess residual cytoplasm(ERC)were analyzed according to the World Health Organization manual(2010).Sperm nuclear vacuoles(NVs)were determined by propidium iodide(PI)staining.Sperm protamine expressions(P1 and P2)were detected by western blot.DNA damage was measured by acridine orange test(AOT)to calculate the proportion of sperm with single-strand DNA breaks(SSBs).Our data showed that sperm concentration and motility in infertile males significantly decreased with the severity of abnormal sperm morphology(both P<0.01).P1 level,P1/P2 ratio,and SSB rate increased with the severity of sperm dysmorphology,whilst the P2 level decreased(all P<O.01).NVs,CDs,and ERC were more common in males with sperm dysmorphology and positively correlated with the SSB rate(all P<O.01).The relationships between the SSB rate and the P1/P2 ratio were also significant(P<0.01).Aberrant protamination may cause sperm dysmorphology and compromise male fertility by impairing sperm's nucleus and cytoplasm maturation,with the P1/P2 ratio potentially serving as a valuable indicator of sperm quality and male fertility.

Chromatin condensation but not DNA integrity of pig sperm is greater in the sperm-rich fraction

Background Protamination and condensation of sperm chromatin as well as DNA integrity play an essential role during fertilization and embryo development.In some mammals,like pigs,ejaculates are emitted in three separate fractions:pre-sperm,sperm-rich(SRF)and post sperm-rich(PSRF).These fractions are known to vary in volume,sperm concentration and quality,as well as in the origin and composition of seminal plasma(SP),with differences being also observed within the SRF one.Yet,whether disparities in the DNA integrity and chromatin condensation and pro-tamination of their sperm exist has not been interrogated.Results This study determined chromatin protamination(Chromomycin A3 test,CMA_(3)),condensation(Dibromobi-mane test,DBB),and DNA integrity(Comet assay)in the pig sperm contained in the first 10 m L of the SRF(SRF-P1),the remaining portion of the sperm-rich fraction(SRF-P2),and the post sperm-rich fraction(PSRF).While chromatin protamination was found to be similar between the different ejaculate fractions(P>0.05),chromatin condensation was seen to be greater in SRF-P1 and SRF-P2 than in the PSRF(P=0.018 and P=0.004,respectively).Regarding DNA integrity,no differences between fractions were observed(P>0.05).As the SRF-P1 has the highest sperm concentra-tion and ejaculate fractions are known to differ in antioxidant composition,the oxidative stress index(OSi)in SP,calcu-lated as total oxidant activity divided by total antioxidant capacity,was tested and confirmed to be higher in the SRF-P1 than in SRF-P2 and PSRF(0.42±0.06 vs.0.23±0.09 and 0.08±0.00,respectively;P<0.01);this index,in addition,was observed to be correlated to the sperm concentration of each fraction(Rs=0.973;P<0.001).Conclusion While sperm DNA integrity was not found to differ between ejaculate fractions,SRF-P1 and SRF-P2 were observed to exhibit greater chromatin condensation than the PSRF.This could be related to the OSi of each fraction.

成人骨髓间质干细胞分化为神经元样细胞前后基因表达的研究

目的探讨成人骨髓间质干细胞(MSC)分化为神经元样细胞前后基因表达的变化。方法从成人骨髓分离MSC,培养扩增。用参芪液诱导hMSC分化为神经元,并用免疫组化法检测神经元烯醇化酶(NSE)、神经丝蛋白(NF)、胶质纤维酸性蛋白(GFAP)的表达来鉴定是否为神经元样细胞。采用半定量RTPCR方法检测10个基因(包括内胚层基因Ceruloplasmin;中胚层基因SM22;外胚层基因Amyloidprecursorprotein、syntaxin;生殖系基因protamine;神经元特异性基因NeuroD、NF、NSE、GFAP、Tau)在诱导分化前后的变化。结果hMSC经参芪液诱导后,可见神经元样细胞。免疫组化结果显示诱导出的神经元样细胞表达NSE、NF阳性,GFAP阴性。hMSC在分化前表达内胚层、中胚层、外胚层和生殖系基因,随着分化时间的延长,生殖系基因不表达,内胚层和中胚层基因表达减弱,外胚层基因表达基本不变。而在分化过程中外胚层基因和神经元特异性标记基因表达明显增强。结论hMSC分化为神经元样细胞的过程并不是简单的神经特异性基因的“开”和“关”,而是与神经细胞分化成熟过程中相关基因表达的量相关。

公山羊Protamine 1 mRNA表达特性及与精液品质相关性的研究

旨在研究雄性山羊主要繁殖器官中PRM1mRNA表达特性,分析精子PRM1mRNA表达与精液品质参数的相关性。本研究通过荧光定量PCR技术分析PRM1mRNA表达规律,利用免疫组化技术对睾丸中PRM1蛋白进行定位,并应用GraphPad Prism 5软件分析精子PRM1mRNA表达量与精液品质指标的相关性。结果显示,PRM1mRNA在睾丸中高度表达,其次是附睾,睾丸中PRM1mRNA表达量是附睾头的247倍,附睾头显著高于附睾体和尾(P<0.05),在剩余其他组织中微量表达。在周岁之前,睾丸中PRM1mRNA表达量随着月龄增加而增加,12月龄的表达量显著高于9月龄的表达量(P<0.05),9月龄表达量显著高于其他低月龄的表达量(P<0.05)。精子PRM1mRNA的表达量与精子活力(R2=0.586 0,P=0.000 5)、精子密度(R2=0.442 2,P=0.004 9)呈显著正相关。山羊PRM1在长形精子细胞和精子细胞中表达,睾丸其他生精细胞及间质细胞中无表达。山羊PRM1mRNA表达具有时空表达特性,PRM1mRNA表达量可以作为评价公羊繁殖力的指标。

Characterization of nucleohistone and nucleoprotamine components in the mature human sperm nucleus

Aim： To simultaneously determine the localization of histones and protamines within human sperm nuclei. Methods： Immunofluorescence of the core histones and protamines and fluorescence in situ hybridization of the telomere region of chromosome 16 was assessed in decondensed human sperm nuclei. Results： Immunofluorescent localization of histones, protamine 1 （PRM1） and protamine 2 （PRM2） along with fluorescence in situ hybridization localization of chromosome 16 telomeric sequences revealed a discrete distribution in sperm nuclei. Histones localized to the posterior ring region （i.e. the sperm nuclear annulus）, whereas PRM1 and PRM2 appeared to be dispersed throughout the entire nucleus. Conclusion： The co-localization of the human core sperm histones with the telomeric regions of chromosome 16 is consistent with the reorganization of specific non-protamine regions into a less compacted state.

Proteomics and the genetics of sperm chromatin condensation

Spermatogenesis involves extremely marked cellular, genetic and chromatin changes resulting in the generation of the highly specialized sperm cell. Proteomics allows the identification of the proteins that compose the spermatogenic cells and the study of their function. The recent developments in mass spectrometry （MS） have markedly increased the throughput to identify and to study the sperm proteins. Catalogs of thousands of testis and spermatozoan proteins in human and different model species are becoming available, setting up the basis for subsequent research, diagnostic applications and possibly the future development of specific treatments. The present review intends to summarize the key genetic and chromatin changes at the different stages of spermatogenesis and in the mature sperm cell and to comment on the presently available proteomic studies.

Comparative study of the effects of three semen preparation media on semen analysis,DNA damage and protamine deficiency,and the correlation between DNA integrity and sperm parameters

Semen samples collected from 28 male partners of infertile couples were divided into three equal aliquots and prepared with three selected media,such as PureSperm （Nidacon,Gothenburg,Sweden）,Sil-Select Plus^TM （Fertipro,Beemem,Belgium） and SpermGrad^TM（Vitrolife,Gothenburg,Sweden）. The differences in mean percentages of semen parameters were assessed by repeated measures analysis. Correlations of sperm DNA damage,as measured by terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） assay,and of protamine deficiency,as measured by chromomycin A3 （CMA3） staining with sperm parameters,were determined by Pearson＇s correlation. After preparation with all three media,sperm concentrations decreased （P〈0.05） while percentages of sperm with normal morphology increased （P〈0.05）. Percentages of sperm motility,rapid motility and progressive motile concentration （PMC） increased （P〈0.05） for each ofthese parameters,PureSperm preparation gave the best results （P〈0.05）. The percentage of DNA damage decreased in the PureSperm and Sil-Select Plus preparations （17.9% and 31.3%,respectively,P〈0.05） and increased in the SpermGrad preparation （56.3%,P〈0.05）. Protamine deficiency also decreased in all three kinds of media,59.3%,47.7% and 40.3% for PureSperm,Sil-Select Plus and SpermGrad preparations,respectively （P〈0.05）. The percentage of DNA-damaged sperm was negatively correlated with the percentages of sperm motility,rapid motility and PMC,but was positively correlated with static motility （P〈0.05）. This comparative study and correlation analysis revealed that PureSperm preparation yielded sperm with the best motility and the lowest percentage of protamine deficiency. The Sil-Select Plus preparation yielded sperm with the lowest amount of DNA damage. The SpermGrad preparation had a high percentage of sperm with normal morphology,but also had the highest percentage of sperm with DNA damage. Sperm DNA damage was correlated with percentages of sperm motility,rapid motility,static motility and PMC.

The Protamine-like DNA-binding Protein P6.9 Epigenetically Up-regulates Autographa californica Multiple Nucleopolyhedrovirus Gene Transcription in the Late Infection Phase

Protamines are a group of highly basic proteins first discovered in spermatozoon that allow for denser packaging of DNA than histones and will result in down-regulation of gene transcription^l~. It is well recognized that the Autographa californica multicapsid nucleopolyhedrovirus （AcMNPV） encodes P6.9, a protamine-like protein that forms the viral subnucleosome through binding to the viral genome[29]. Previous research demonstrates that P6.9 is essential for viral nucleocapsid assembly, while it has no influence on viral genome replication1311. In the present study, the role of P6.9 in viral gene transcription regulation is characterized. In contrast to protamines or other protamine-like proteins that usually down-regulate gene transcription, P6.9 appears to up-regulate viral gene transcription at 12-24 hours post infection （hpi）, whereas it is non-essential for the basal level of viral gene transcription. Fluorescence microscopy reveals the P6.9＇s co-localization with DNA is temporally and spatially synchronized with P6.9＇s impact on viral gene transcription, indicating the P6.9-DNA association contributes to transcription regulation. Chromatin fractionation assay further reveals an unexpected co-existence of P6.9 and host RNA polymerase II in the same transcriptionally active chromatin fraction at 24 hpi, which may probably contribute to viral gene transcription up-regulation in the late infection phase.

Basic peptide protamine exerts antimicrobial activity against periodontopathic bacteria——Growth inhibition of periodontopathic bacteria by protamine

Protamine was investigated for its antibacterial activity against the periodontal pathogens, Porphyromonas gingivalis, Prevotella intermedia and Aggregatibacter actinomycetemcomitans. We determined the minimum inhibitory concentrations of protamine and its hydrolysate and their bactericidal activity. Protamine inhibited the growth of all periodontopathic bacteria tested on agar plates. Protamine, which MIC was 6.3 × 10-7 g L-1, was most effective against P. gingivalis. The antibacterial effect of native protamine was higher than that of its hydrolysate. An ATP bioluminescence assay revealed that protamine showed bactericidal activity against P. gingivalis in a time-dependent manner. These results indicate that protamine could be candidate peptide for prevention of P. gingivalis infection.

Studies on Expression of P1 Protamine Gene in Rat and Mouse Testis

Protamine is a kind small, basic protein rich in arginine residues and found to be complexed with DNA in spermatozoa. We have cloned a 150 bp cDNA encoding the rat protamine (rP) by RT PCR technique. Dig labelled cDNA for rP was used for Northern blot analysis to study the expression of P1 protamine gene in rat and mouse. P1 protamine mRNA was detected only in rat testis, no hybridization signals were detected in rat brain and lever. In addition, the presence of P1 protamine mRNA was detected not only in rat testis, but also in mouse testis. Dig labelled cDNA for mouse protamine 1 (mP1) was used to study the expression of mP1 gene during the process of sexual maturation of mouse. 7～8 d after birth, no mP1 mRNA could be detected. At d 24～26, mP1 mRNA was detectable migrating as a homogeneous band at 580 nucleotides, whereas in sexually mature animals, a heterogeneous mixture of RNAs ranging from 450～580 bases in length was observed. Histological studies revealed that in the testis of 7～8 day old mouse, spermatogenesis has developed to the spermatocyte stage, whereas round spermatids (Rs) were present in the testis of the mice with 24～26 d age and elongating spermatids (Es) were present in the testis of sexually mature animals. Electrophoresis of total nuclear basic proteins (TNBP) revealed that the Rs could possess the somatic histones, while Es was found to have protamine and less histone. These results indicate that the P1 protamine gene is tissues specifically expressed and the P1 protamine is showing to be conservative in evolution. During the process of sexual maturation, along with morphological changes, mP1 gene was transcribed in Rs and translated in Es. The mechanism of protamine gene expression was discussed.

Initiation of Basal Insulin in Patients with Uncontrolled Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is a growing health problem, characterized by insulin resistance progressing to beta cell dysfunction and insulin deficiency, most of these patients will need intensification of treatment and initiation of insulin to delay or prevent diabetic complications. Glycemic control is the most important aspect of management, and in reducing morbidity and mortality of the diseases. Control of plasma glucose in patients with diabetes can be assessed by HbA1c, FPG, PPG, but still HbA1c% remains the gold standard for assessment of glycemic control and follow up of diabetic patients. The aim of this study is to assess HbA1c% in patients on oral anti-diabetic drugs, with poor glycemic control before and after adding basal insulin, with titration of the dose of insulin depending on fasting blood sugar. 82 patients with uncontrolled type 2 diabetes (43.9% male, 56.1% female), with HbA1c more than 9%, on two types of oral diabetic medication or more, were started on basal insulin (glargine, lantus) and followed for three to six months. Overall 82 patients with type 2 diabetes mellitus were included in the study. The mean age of the study population was 58.4 years, the mean duration of the disease range was 13.4 years. All patients with HbA1c more than 9%, without organ failure, were included in the study. The mean HbA1c overall had decreased from mean of 11.15% before starting basal insulin to the mean of 8.43% within 3 to 6 month, after initiating basal insulin, this difference was significant at p < 0.001. There was no adverse effect on this medication in any of the study group. The addition of basal insulin to oral anti-diabetic medication in uncontrolled insulin-naïve type 2 diabetic patients resulted in significant improvement of glycemic control, with improved HbA1c level, without adverse effects.

Retrospective descriptive analysis of the physiological kinetics of prostate-specific antigen in men older than 75 years

Several studies have compared prostate-specific antigen （PSA） kinetics in men with and without cancer, but there has been no adequate analysis of the longitudinal variation in PSA. The aim of this study was to assess the fluctuations in PSA in a cohort of elderly men in an attempt to define a physiological pattern of PSA kinetics. We searched a specific cohort of patients aged 〉 75 years and with PSA value 〈 2.0 ng mL^-1. A history of all PSA values over the past 10 years was compiled for each patient to create a database of patients fitting the following criteria： （1） minimum of five PSA measurements, （2） over at least 5 years. Exclusion criteria were： （1） PSA 〈 0.2 ng mL^-1 at each measurement and （2） having had more than one PSA test per year. In all, 1 327 patients （mean age： 78.52 years） fit the inclusion criteria. The mean variation from the first to the last PSA test was 0.05 ± 0.43, with a mean follow-up of 6.79 ± 1.71 years. Over the same period, the mean fluctuation from the lowest to the highest PSA value was 0.04 ± 0.55 （P = 0.925）. The mean annual PSA velocity （PSAV） was calculated by dividing the mean variation from the first to the last PSA test by the number of years of observation for each patient and was set at 0.0104 ± 0.1050. Concluding, in a large-scale cohort of elderly individuals considered healthy and evaluated for a considerable follow-up, the average annual PSAV as well as the average fluctuation from the lowest to the highest PSA value are insignificant.

Influence of N-acetylcysteine on pituitary-gonadal axis hormones and protamine expression level in streptozotocin-induced diabetic male rats

Objective:To study the influence of N-acetylcysteine on the pituitary-gonadal axis hormones and protamine expression level in streptozotocin-induced diabetic male rats.Methods:Forty-two adult male Wistar rats were divided into 6 groups,with 7 rats in each group.The control group left untreated;the streptozotocin group only received 50 mg/kg body weight streptozotocin intraperitoneally for 5 days to induce diabetes;the N-acetylcysteine group only received 200 mg/kg body weight N-acetylcysteine intraperitoneally,and the streptozotocin+N-acetylcysteine groups 1,2 and 3 received 50 mg/kg streptozotocin intraperitoneally for 5 days to induce diabetes and then received 100,200 and 400 mg/kg body weight doses of N-acetylcysteine intraperitoneally for 28 days,respectively.Enzyme-linked immunosorbent assay was used to measure the serum levels of luteinizing hormone(LH),follicle-stimulating hormone(FSH)and testosterone,and real-time PCR was applied for measuring protamine expression level.Results:Compared to the control and N-acetylcysteine groups,a significant decrease in the body weight,testicular weight and levels of testosterone and protamine expression was observed in the streptozotocin group and the streptozotocin+N-acetylcysteine groups 1 and 2.On the contrary,the levels of LH and FSH increased significantly.In the streptozotocin+N-acetylcysteine group 3,the body weight,testicular weight and expression level of protamine were significantly higher than those of the streptozotocin group.In the streptozotocin+N-acetylcysteine groups,testosterone and LH levels were significantly higher than and lower than the streptozotocin group,respectively.In the streptozotocin+N-acetylcysteine groups 2 and 3,the level of FSH was significantly lower than that of the streptozotocin group and streptozotocin+N-acetylcysteine group 1.Furthermore,a significant increase in the expression level of protamine was observed in the streptozotocin+N-acetylcysteine groups 2 and 3 when compared to the streptozotocin group and streptozotocin+N-acetylcysteine group 1.Conclusions:N-acetylcysteine in an optimal dose of 400 mg/kg body weight has a protective influence on the pituitary-gonadal axis hormones and also on the expression level of protamine in diabetic male rats.

Neutral protamine hagedorn/regular insulin in the treatment of inpatient hyperglycemia: Comparison of 3 basal-bolus regimens

AIM To compare the safety and efficacy or 3 basal-bolus regimens of neutral protamine hagedorn(NPH)/regular insulin in the management of inpatient hyperglycemia.METHODS We randomized 105 patients with blood glucose levelsbetween 140 and 400 mg/dL to a basal-bolus regimen of NPH insulin given once(n = 30), twice(n = 40) or three times(n = 35) daily, in addition to pre-meal regular insulin. Major outcomes included were differences in glycemic control, frequency of hypoglycemia and total insulin dose.RESULTS NPH insulin given in a once-daily regimen was associated with better glycemic control(58.3%) compared to twice daily(42.4%) and three times daily(48.9) regimens(P = 0.031). The frequency of hypoglycemia was similar between the three groups(2.0%, 0.7% and 1.2%, P = 0.21). The mean insulin dose at discharge was 0.48 ± 0.14 U/kg in the once-daily group compared to 0.69 ± 0.28 in the twice-daily, and 0.65 ± 0.20 in the three times daily regimens(P < 0.001).CONCLUSION NPH insulin administered in a once-daily regimen resulted in improvement in glycemic control with similar rates of hypoglycemia compared to a twice-daily and a three times-daily regimen. Further studies are needed to evaluate whether this regimen could be implemented in all hospitalized patients with hyperglycemia.

Studies on P_1, P_2 Protamine mRNA in Sperms of Human,Rat and Mouse

ve To investigate the existence of the protamine mRNA in sperms of human, rat and mouse

Physiological Effects of Salmon Milt Nucleoprotein on Movement, Stress Tolerance and Lifespan of <i>C. elegans</i>

In recent years, various physiological functions of salmon milt extract, which consists of nucleic acid and nucleoprotein, have been reported. The objective of this study is to analyze the physiological function and its mechanism of salmon milt extract (NG) on nematodes (C. elegans). The wild type nematode N2 strain was bred on the plate containing of NG for four days, and its body length increased depending on NG concentration. When nematodes were bred with NG for a longer period, average lifespan was increased, and survival rate was increased by up to 20%. Generally, the movement of nematodes decreases with longer breeding period (i.e. aging). Analysis of movement (both gross thrashing movement and local pumping movement) showed that NG suppressed this decrease f movement with aging. Furthermore, the deease of survival rate by heat stress and oxidative stress was suppressed by NG administration. Nile Red staining analysis showed that fat accumulation varied depending on the concentration of NG. RT-PCR analysis revealed that the mRNA expression levels of the stress resistance genes sod-3 and sod-4 were increased. These results indicated that NG administration increased the expression of stress-tolerance-related genes, promoted stress tolerance, increased movement and prolonged lifespan in nematode.

Death as a Drug Side Effect in FAERS: Is Glyphosate Contamination a Factor?

An analysis of selected datasets from the FDA’s drug Adverse Event Reporting System (FAERS) leads us to hypothesize that glyphosate contamination in both food and drugs is a major contributor to chronic and acute kidney failure respectively. In chronic kidney failure, glyphosate-induced pancreatitis results in the release of trypsin, causing a leaky vasculature. The albumin-bound glyphosate escapes into the tissues, protecting the circulatory system and kidneys but resulting in multiple symptoms related to skin, gut, brain, bones, lungs, etc. The rare and poorly understood acute kidney failure response reported for protamine sulfate and Trasylol? is strikingly similar to that associated with glyphosate poisoning. Both drugs are derived from biological tissues that are plausibly contaminated with glyphosate. These drugs protect from haemorrhage, which leads to retention of glyphosate in the vasculature, are followed by circulatory collapse and a high likelihood of death as an outcome. We support our argument by comparing symptom profiles of selected subsets of FAERS with those related to glyphosate poisoning, anomalous reactions to protamine sulfate, and conditions showing strong statistical time-trend correlations with glyphosate.

The Effect of Tripterygium Wilfordii Monomer T4 on Rat Spermatid Nuclear Protein Transition

Rat testis elongating spermatids and epididymal sperms were collected after 7 weeks of treatment with Tripterygium wilfordii monomer T4.Total nuclear basic protein(TNBP)was extracted from the elongating spermatid nuclei and the sperm nuclei isolated by sonication.Polyacrylamide gel electrophoresis has been used to separate the TNBP and individual proteins were quantified by scanning microdensitometry.It was found that the content of protamine was reduced and the TH(Total Histones)/RP(Rat Protamine)ratios were increased following treatment in the testis elongating spermatids, and same result was found in the epididymal sperms.These results suggest that the interruption of nuclear protein transition of testis spermatids induced by T4 might cause aberrant epididymal sperm nuclear protein and lead to infertility.The relationship between protamine and fertility was discussed.

Comparison of ART outcomes in men with altered mRNA protamine 1/protamine 2 ratio undergoing intracytoplasmic sperm injection with ejaculated and testicular spermatozoa

Assisted reproductive technologies invoIving the use of spermatozoa and eggs for in vitro fertilization(IVF)have come as the solution for many infertile couples to become parents.However,in some cases,the use of ejaculated spermatozoa delivers poor IVF performance.Some studies have suggested the use of testicular spermatozoa in severe male in fertility cases,but no guideli nes regarding their utilization are currently available.In the present study,we found the mRNA protamine 1/protamine 2(P1/P2)ratio to be a valuable biomarker of poor sperm function that could be used as a diagnostic key for the identification of cases that would benefit from the use of testicular spermatozoa.A total of 23 couples undergoing egg donation cycles with at least one previous cycle failure were studied.All couples underwent two consecutive intracytoplasmic sperm injection(ICSI)cycles with either ejaculated or testicular spermatozoa(TESA).The sperm mRNA P1/P2 ratio,fertilization rate,blastocyst rate,and pregnancy and live birth rate were compared.Results showed improved ICSI and clinical outcomes in cycles with testicular spermatozoa in men with altered mRNA P1/P2 ratios.TESA cycles presented significantly higher rates of fertilization(mean±standard deviation:76.1%±15.1%vs 65.5%±18.8%),blastocyst formation(55.0%±20.3%vs 30.8%±23.8%),and good morphological quality blastocyst(28.9%±22.9%vs 13.5%±17.9%)and also improvements on pregnancy(60.9%vs 0%)and healthy birth rates(56.5%vs 0%)than EJACULATE cycles.The results described here suggest that in patients with previous IVF/ICSI failures and aberrant mRNA protamine ratios,the use of testicular spermatozoa may be a good alternative to improve clinical outcomes.