Congenital bilateral absence of the vas deferens （CBAVD） is a frequent cause of obstructive azoospermia, and mutations of the cystic fibrosis transmembrane conductance regulator （CFTR） gene have also been frequent...Congenital bilateral absence of the vas deferens （CBAVD） is a frequent cause of obstructive azoospermia, and mutations of the cystic fibrosis transmembrane conductance regulator （CFTR） gene have also been frequently identified in patients with CBAVD. However, the distribution of the CFTR polymorphisms M470V, poly-T, TG-repeats and F508del mutation in the Chinese CBAVD population with presumed low cystic fibrosis （CF） frequency remains to be evaluated. Samples obtained from 109 Chinese infertile males with CBAVD and 104 normal controls were analyzed for the presence of CFTR （TG）m（T）n, M470V and F508del by PCR amplification followed by direct sequencing. Our study showed that the F5OSdel mutation was not found in our patients. The 5T mutation was present with high frequency in Chinese CBAVD patients and IVS8-5T linked to either 12 or 13 TG repeats was highly prevalent among CBAVD patients （97.22% of 72 cases and 96.91% of 97 alleles with IVS8-5T）. Moreover, a statistically significant relationship between TG 12-5T-V470 haplotype and CBAVD was detected. This study indicated that the CFTR polymorphisms poly-T, TG-repeats and M470V might affect the process of CBAVD in the Chinese population.展开更多
Congenital bilateral absence of vas deferens （CBAVD） is a manifestation of the mildest form of cystic fibrosis （CF） and is characterized by obstructive azoospermia in otherwise healthy patients. Owing to the avail...Congenital bilateral absence of vas deferens （CBAVD） is a manifestation of the mildest form of cystic fibrosis （CF） and is characterized by obstructive azoospermia in otherwise healthy patients. Owing to the availability of assisted reproductive technology, CBAVD patients can father children. These fathers are at risk of transmitting a mutated allele of the CF transmembrane conductance regulator （CFTR） gene, responsible for CF, to their offspring. The identification of mutations in both CFTR alleles in CBAVD patients is a crucial requirement for calculating the risk of producing a child with full-blown CF if the female partner is a healthy CF carrier. However, in the majority of CBAVD patients, conventional mutation screening is not able to detect mutations in both CFTR alleles, and this difficulty hampers the execution of correct genetic counselling. To obtain information about the most represented CFTR mutations in CBAVD patients, we analysed 23 CBAVD patients, 15 of whom had a single CFTR mutation after screening for 36 mutations and the 5T allele. The search for the second CFTR mutation in these cases was performed by using a triplex approach： （i） first, a reverse dot-blot analysis was performed to detect mutations with regional impact; （ii） next, multiple ligation-dependent probe amplification assays were conducted to search for large rearrangements; and （iii） finally, denaturing high-performance liquid chromatography was used to search for point mutations in the entire coding region. Using these approaches, the second CFTR mutation was detected in six patients, which increased the final detection rate to 60.8%.展开更多
Congenital bilateral absence of the vas deferens(CBAVD)is observed in 1%–2%of males presenting with infertility and is clearly associated with cystic fibrosis transmembrane conductance regulator(CFTR)mutations.CFTR i...Congenital bilateral absence of the vas deferens(CBAVD)is observed in 1%–2%of males presenting with infertility and is clearly associated with cystic fibrosis transmembrane conductance regulator(CFTR)mutations.CFTR is one of the most well-known genes related to male fertility.The frequency of CFTR mutations or impaired CFTR expression is increased in men with nonobstructive azoospermia(NOA).CFTR mutations are highly polymorphic and have established ethnic specificity.Compared with F508Del in Caucasians,the p.G970D mutation is reported to be the most frequent CFTR mutation in Chinese patients with cystic fibrosis.However,whether p.G970D participates in male infertility remains unknown.Herein,a loss-of-function CFTR p.G970D missense mutation was identified in a patient with CBAVD and NOA.Subsequent retrospective analysis of 122 Chinese patients with CBAVD showed that the mutation is a common pathogenic mutation(4.1%,5/122),excluding polymorphic sites.Furthermore,we generated model cell lines derived from mouse testes harboring the homozygous Cftr p.G965D mutation equivalent to the CFTR variant in patients.The Cftr p.G965D mutation may be lethal in spermatogonial stem cells and spermatogonia and affect the proliferation of spermatocytes and Sertoli cells.In spermatocyte GC-2(spd)ts(GC2)Cftr p.G965D cells,RNA splicing variants were detected and CFTR expression decreased,which may contribute to the phenotypes associated with impaired spermatogenesis.Thus,this study indicated that the CFTR p.G970D missense mutation might be a pathogenic mutation for CBAVD in Chinese males and associated with impaired spermatogenesis by affecting the proliferation of germ cells.展开更多
Recent data suggest that cystic fibrosis transmembrane conductance regulator(CFTR)gene alterations negatively impact male fertility beyond obstruction.We sought to compare gene alterations,sperm retrieval rates,and in...Recent data suggest that cystic fibrosis transmembrane conductance regulator(CFTR)gene alterations negatively impact male fertility beyond obstruction.We sought to compare gene alterations,sperm retrieval rates,and intracytoplasmic sperm injection(ICSI)outcomes among men with cystic fibrosis(CF)disease and congenital bilateral absence of the vas deferens(CBAVD)only.We retrospectively evaluated all men who underwent surgical sperm retrieval at two academic,high-volume andrology centers from 2010 to 2018.Only men with documented CFTR alterations and obstructive azoospermia from either CBAVD or CF were included.Differences between groups for CFTR abnormality,sperm retrieval,and ICSI outcomes were statistically analyzed.Overall,39 patients were included with 10 in the CF and 29 in the CBAVD groups.Surgical sperm retrieval rates were significantly lower in the CF group for sperm concentration(14.8×10^(6)ml^(-1)vs 61.4×10^(6)ml^(−1),P=0.02)and total motile sperm count(2.9 million vs 11.4 million,P=0.01).This difference was only predicted by homozygous delta F508 CFTR mutations(P<0.05).The CF group also demonstrated a significantly higher rate of rescue testicular sperm extraction(70.0%vs 27.6%,P<0.03)and lower fertilization rate with ICSI(32.5%vs 68.9%,P<0.01).In conclusion,those with CF demonstrated lower sperm quality,greater difficulty with sperm retrieval,and worse ICSI outcomes compared with CBAVD-only patients.Homozygous delta F508 CFTR mutations appear to significantly impair spermatogenesis and sperm function.展开更多
Patients with congenital unilateral absence of the vas deferens(CUAVD)manifest diverse symptoms from normospermia to azoospermia.Treatment for CUAVD patients with obstructive azoospermia(OA)is complicated,and there is...Patients with congenital unilateral absence of the vas deferens(CUAVD)manifest diverse symptoms from normospermia to azoospermia.Treatment for CUAVD patients with obstructive azoospermia(OA)is complicated,and there is a lack of relevant reports.In this study,we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA.From December 2015 to December 2020,33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital(Shanghai,China).Patient information,ultrasound findings,semen analysis,hormone profiles,and treatment information were collected,and the clinical outcomes were evaluated.Of 33 patients,29 patients were retrospectively analyzed.Vasoepididymostomy(VE)or cross VE was performed in 12 patients,the patency rate was 41.7%(5/12),and natural pregnancy was achieved in one of the patients.The other 17 patients underwent testicular sperm extraction as the distal vas deferens(contralateral side)was obstructed.These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA,even with a relatively low rate of patency and natural pregnancy.展开更多
Cystic fibrosis(CF)is one of the most common recessive genetic diseases,with a wide spectrum of phenotypes,ranging from infertility to severe pulmonary disease.Mutations in the cystic fibrosis transmembrane conductanc...Cystic fibrosis(CF)is one of the most common recessive genetic diseases,with a wide spectrum of phenotypes,ranging from infertility to severe pulmonary disease.Mutations in the cystic fibrosis transmembrane conductance regulator(CFTR)gene are considered the main genetic cause for CF.In this study,we recruited a consanguineous Iranian pedigree with four male patients diagnosed with congenital unilateral absence of the vas deferens(CUAVD),and one female patient diagnosed with congenital absence of the uterus(CAU).Testicular biopsy of one patient was performed,and hematoxylin and eosin(H and E)staining of testis sections displayed the presence of germ cell types ranging from spermatogonia to mature spermatids,indicating obstructive azoospermia.To explore the underlying genetic factor in this familial disorder,we therefore performed whole-exome sequencing(WES)on all available family members.WES data filtration and CFTR haplotype analysis identified compound heterozygous mutations in CFTR among four patients(two CUAVD patients carried p.H949Y and p.L997F,and one CUAVD and the female CAU patient carried p.H949Y and p.I148T).All these mutations were predicted to be deleterious by at least half of the prediction software programs and were confirmed by Sanger sequencing.Our study reported that CFTR compound heterozygous mutations in a consanguineous Iranian family cause infertility in both sexes.展开更多
When presented with an azoospermic patient, a thorough history and careful, considered physical examination often leads to a definite or presumptive diagnosis. An algorithmic, logical thought process is important to h...When presented with an azoospermic patient, a thorough history and careful, considered physical examination often leads to a definite or presumptive diagnosis. An algorithmic, logical thought process is important to have in mind when embarking on the evaluation. Adjunctive laboratory tests, such as hormonal assays or genetic studies, are often complementary and/or additive and allow a very precise determination to be made as to the etiologies, either genetic or acquired. It is only with this information that a therapeutic plan can be made for the patient. As will be discussed, a targeted approach to testing is far more satisfying and cost-effective than a blind, shotgun approach.展开更多
目的:检测先天性双侧输精管缺如(congenital bilateral absence of the vas deferens,CBAVD)患者中囊性纤维化跨膜转导调节因子(cystic fibrosis transmembrane conductance regulator,CFTR)基因和CBAVD易感基因的突变情况,探讨它们与CB...目的:检测先天性双侧输精管缺如(congenital bilateral absence of the vas deferens,CBAVD)患者中囊性纤维化跨膜转导调节因子(cystic fibrosis transmembrane conductance regulator,CFTR)基因和CBAVD易感基因的突变情况,探讨它们与CBAVD发病风险的相关性。方法:对13例诊断为孤立发生的CBAVD患者的致病基因CFTR及易感基因黏附型G蛋白偶联受体G2(adhesion G protein-coupled receptor G2,ADGRG2)、上皮细胞钠离子通道β亚单位(sodium channel epithelial 1 subunit beta,SCNN1B)和碳酸酐酶12(carbonic anhydrase,CA12)和溶质载体家族9成员3(solute carrier family 9 member A3,SLC9A3)行全外显子测序及Sanger测序验证,针对CFTR基因多态性位点、内含子及侧翼序列行聚合酶链式反应(polymerase chain reaction,PCR)扩增后用Sanger测序,并运用生物信息学方法对CBAVD易感基因新发突变进行保守性分析和有害性预测。对13例CBAVD患者中1例患者的家系进行遗传学分析,评估子代遗传风险。结果:外显子测序发现13例CBAVD患者中,只有6例患者检测到CFTR基因外显子突变,有6种错义突变:c.2684G>A(p.Ser895Asn)、c.4056G>C(p.Gln1352His)、c.2812G>T(p.Val938Leu)、c.3068T>G(p.Ile1023Arg)、c.374T>C(p.Ile125Thr)、c.1666A>G(p.Ile556Val),1种无义突变:c.1657C>T(p.Arg553Ter),这6例患者中有2例患者同时还存在CFTR的纯合p.V470位点,另外7例患者未检测出CFTR基因外显子区域的突变。13例CBAVD患者中,3例患者携带纯合p.V470的多态性位点,4例患者携带5T等位基因,2例患者携带TG13等位基因,10例患者携带c.-966T>G位点。4例CBAVD患者同时携带以上CFTR基因突变位点中的2~3个位点。13例患者中CBAVD易感基因突变情况:1种ADGRG2错义突变c.2312A>G(p.Asn771Ser),2种SLC9A3错义突变c.2395T>C(p.Cys799Arg)、c.493G>A(p.Val165Ile),1种SCNN1B错义突变c.1514G>A(p.Arg505His)和1种CA12错义突变c.1061C>T(p.Ala354Val),其中,SLC9A3基因的c.493G>A(p.Val165Ile)突变位点是首次在CBAVD患者中被发现,以上5种突变位点在gnomAD数据库中的人群变异频率极低,属于罕见突变,用Mutation Taster和Polyphen-2软件预测显示SLC9A3基因的c.493G>A(p.Val165Ile)位点和SCNN1B基因的c.1514G>A(p.Arg505His)位点的有害性等级为致病突变。1例家系遗传分析发现,先证者的c.1657C>T(p.Arg553Ter)突变为新生突变,先证者父亲、母亲均未携带该突变,先证者及其配偶通过辅助生殖技术孕育1女婴,该女婴遗传了先证者的致病性突变c.1657C>T(p.Arg553Ter)。结论:CFTR基因突变仍然是中国CBAVD患者的主要致病原因,但突变的分布与频率与国内外其他研究的数据存在一定差异,需要进一步扩充中国CBAVD患者的CFTR突变谱;ADGRG2、SLC9A3、SCNN1B和CA12易感基因可能解释部分无CFTR突变的CBAVD病例;CBAVD患者多无特殊临床表现,建议临床医生确诊前对患者行进一步的体格检查,并结合其阴囊超声或经直肠超声检查;建议将CFTR基因突变检测应用于辅助生殖前的遗传学筛查,降低子代罹患CBAVD及囊性纤维化的风险。展开更多
目的:探讨先天性单侧输精管缺如(CUAVD)合并无精子症患者囊性纤维化跨膜转导(CFTR)基因全外显子检测的结果与意义。方法:抽取CUAVD合并无精子症6例患者外周血行CFTR全外显子突变及多态性检测,测序结果与UCSC Genome Browser on Human De...目的:探讨先天性单侧输精管缺如(CUAVD)合并无精子症患者囊性纤维化跨膜转导(CFTR)基因全外显子检测的结果与意义。方法:抽取CUAVD合并无精子症6例患者外周血行CFTR全外显子突变及多态性检测,测序结果与UCSC Genome Browser on Human Dec.2013 Assembly进行在线比对及分析。结果:6例CUAVD合并无精子症患者中,1例第6号外显子中可检测到1个已知错义突变c.592G>C,2例患者第10号外显子前非编码区域发现c.1210-12T[5]剪切突变,且该2例患者合并第11号外显子上V470单倍体。结论:CUAVD合并无精子症患者CFTR全外显子基因突变有一定的检出率,有必要对这部分患者进行CFTR基因突变检测。展开更多
目的:探讨囊性纤维化跨膜传导调节因子(CFTR)基因5T位点多态性与先天性双侧输精管缺如(CBAVD)发病风险的相关性。方法:采用病例-对照研究方法,选取40例国内孤立发生的CBAVD患者作为病例组和104例健康男性作为对照组,用Sanger测序方法对C...目的:探讨囊性纤维化跨膜传导调节因子(CFTR)基因5T位点多态性与先天性双侧输精管缺如(CBAVD)发病风险的相关性。方法:采用病例-对照研究方法,选取40例国内孤立发生的CBAVD患者作为病例组和104例健康男性作为对照组,用Sanger测序方法对CFTR基因9号内含子(TG)m-n(T)单倍型进行测序分型;结合本实验和Pubmed、Web of science、Medline和中国知网等数据库文献中相关数据,进行meta分析,来探讨5T突变与CBAVD发病风险的相关性。结果:Sanger测序结果表明,病例组中检测到6种基因型,分别为TG11-5T、TG12-5T、TG13-5T、TG11-7T、TG12-7T、TG11-9T;对照组中检测到7种基因型,分别为TG11-5T、TG12-5T、TG10-7T、TG11-7T、TG12-7T、TG13-7T、TG11-9T。与对照组10/208(4.81%)相比,在病例组13/80(16.25%)中观察到TG12-5T单倍型约增加了3.38倍;与对照组(0)相比,在病例组中观察到TG13-5T单倍型为6/80(7.5%);TG11-5T单倍型在对照组2/80(2.50%)和病例组4/208(1.92%)中差异很小。TG12_13-5T单倍型在病例组与对照组中差异极显著(OR=7.40,95%CI=4.83～11.34,P<0.01)。经meta分析,TG12_13-5T单倍型与男性患CBAVD疾病的相关性较高。结论:TG12_13-5T单倍型增加CBAVD患病风险,为男性生殖提供了理论基础。展开更多
目的:探讨先天性输精管缺如(congenital absence of the vas deferens, CAVD)近段输精管道超声声像图的特异性改变及超声诊断价值。方法:应用高频超声经阴囊观察先天性输精管缺如患者的近段输精管道,其中先天性双侧输精管缺如(congenita...目的:探讨先天性输精管缺如(congenital absence of the vas deferens, CAVD)近段输精管道超声声像图的特异性改变及超声诊断价值。方法:应用高频超声经阴囊观察先天性输精管缺如患者的近段输精管道,其中先天性双侧输精管缺如(congenital bilateral absence of the vas deferens, CBAVD)58例,先天性单侧输精管缺如(congenital unilateral absence of the vas deferens, CUAVD)12例,并回顾性分析其超声声像图改变。结果:所有128条先天性发育异常的输精管道超声检查均可见异常声像图,仅探及附睾头的占32.81%(42/128);探及附睾头及部分附睾体尾部的37.50%(48/128),其中附睾体尾部截断的占34.38%(44/128),呈条索样改变的占3.13%(4/128);探及附睾全程而未探及输精管阴囊段的占24.22%(31/128);探及附睾全程及部分输精管阴囊段,但输精管截断的占5.47%(7/128)。CAVD患者的附睾管均有扩张,其扩张程度大于对照组的正常男性附睾管(P<0.01)。附睾尾-输精管环缺失伴附睾管扩张是CAVD的特征性改变,超声检查中通过判断附睾尾-输精管环结构缺失,来诊断CAVD的灵敏度为94.53%,特异度97.00%。结论:经阴囊高频超声能显示近段输精管道的结构,评估其形态、回声及特征性扩张方式,为临床诊断CAVD和判断其缺失部位提供极有价值的信息。展开更多
先天性双侧输精管缺如(congenital bilateral absence of vas deferens,CBAVD)是梗阻性无精子症的常见原因之一,睾丸生精功能一般正常,除了常见的囊性纤维化穿膜传导调节蛋白(cystic fibrosis transmembrane conductance regulator,CFTR...先天性双侧输精管缺如(congenital bilateral absence of vas deferens,CBAVD)是梗阻性无精子症的常见原因之一,睾丸生精功能一般正常,除了常见的囊性纤维化穿膜传导调节蛋白(cystic fibrosis transmembrane conductance regulator,CFTR)基因突变外,黏附G蛋白耦联受体G2(adhesion G protein-coupled receptor G2,ADGRG2)基因突变以及拷贝数变异也被认为是CBAVD的发病机制。本文报告1例CBAVD伴生精功能障碍的病例,睾丸组织病理学提示唯支持细胞综合征。全外显子组测序未发现该患者CFTR、ADGRG2以及无精子症相关基因存在致病变异,拷贝数变异分析也未发现有意义的拷贝数变异。该病例的确切遗传学病因尚未可知。CBAVD与生精功能障碍并存的临床现象,提示无精子症遗传病因的复杂性。展开更多
目的观察先天性双侧输精管缺如(congenital bilateral absence of the vas defeFens,CBAVD)不育患者肾脏、睾丸、附睾及精囊腺的发育情况,了解家族性不育病史。方法对78例男性不育患者进行遗传咨询,外周血淋巴细胞培养及染色体分析,B超...目的观察先天性双侧输精管缺如(congenital bilateral absence of the vas defeFens,CBAVD)不育患者肾脏、睾丸、附睾及精囊腺的发育情况,了解家族性不育病史。方法对78例男性不育患者进行遗传咨询,外周血淋巴细胞培养及染色体分析,B超探查肾脏、睾丸、附睾及精囊腺,精浆生化指标测定,经皮睾丸细针穿刺细胞学检查生精功能。结果 78例CBAVD患者中精索静脉曲张27例,单侧肾脏缺如2例;单侧附睾缺如4例,仅有附睾头而未及附睾体、尾26例; 睾丸体积≤12ml的14例;遗传咨询,同胞兄弟姐妹中有不育症患者的有12人,其中有一家弟兄3人都为CBAVD患者 (都是本项目中的诊治对象),有一家弟兄2人都被确诊为CBAVD患者(也是本项目中的诊治对象)。外周血淋巴细胞培养及G显带染色体核型分析,染色体核型均为:46,XY,正常男性核型。精浆果糖、α-糖苷酶及肉毒碱含量分别平均为 0．82±0．56μmoL／ml、4．8±3．2mU／ml及83．2±24．5nmol／ml,明显低于正常值范围(P<0．001);细针穿刺细胞学检查睾丸生精功能56例正常(占71．8％56／78),其余22例无生精功能或生精功能低下。结论 CBAVD患者睾九、附睾、精索、精囊腺及肾脏的发育都有不同程度的先天异常;2个家系中有同胞兄弟罹患CBAVD;部分CBAVD患者睾丸无生精功能或生精功能低下。展开更多
文摘Congenital bilateral absence of the vas deferens （CBAVD） is a frequent cause of obstructive azoospermia, and mutations of the cystic fibrosis transmembrane conductance regulator （CFTR） gene have also been frequently identified in patients with CBAVD. However, the distribution of the CFTR polymorphisms M470V, poly-T, TG-repeats and F508del mutation in the Chinese CBAVD population with presumed low cystic fibrosis （CF） frequency remains to be evaluated. Samples obtained from 109 Chinese infertile males with CBAVD and 104 normal controls were analyzed for the presence of CFTR （TG）m（T）n, M470V and F508del by PCR amplification followed by direct sequencing. Our study showed that the F5OSdel mutation was not found in our patients. The 5T mutation was present with high frequency in Chinese CBAVD patients and IVS8-5T linked to either 12 or 13 TG repeats was highly prevalent among CBAVD patients （97.22% of 72 cases and 96.91% of 97 alleles with IVS8-5T）. Moreover, a statistically significant relationship between TG 12-5T-V470 haplotype and CBAVD was detected. This study indicated that the CFTR polymorphisms poly-T, TG-repeats and M470V might affect the process of CBAVD in the Chinese population.
文摘Congenital bilateral absence of vas deferens （CBAVD） is a manifestation of the mildest form of cystic fibrosis （CF） and is characterized by obstructive azoospermia in otherwise healthy patients. Owing to the availability of assisted reproductive technology, CBAVD patients can father children. These fathers are at risk of transmitting a mutated allele of the CF transmembrane conductance regulator （CFTR） gene, responsible for CF, to their offspring. The identification of mutations in both CFTR alleles in CBAVD patients is a crucial requirement for calculating the risk of producing a child with full-blown CF if the female partner is a healthy CF carrier. However, in the majority of CBAVD patients, conventional mutation screening is not able to detect mutations in both CFTR alleles, and this difficulty hampers the execution of correct genetic counselling. To obtain information about the most represented CFTR mutations in CBAVD patients, we analysed 23 CBAVD patients, 15 of whom had a single CFTR mutation after screening for 36 mutations and the 5T allele. The search for the second CFTR mutation in these cases was performed by using a triplex approach： （i） first, a reverse dot-blot analysis was performed to detect mutations with regional impact; （ii） next, multiple ligation-dependent probe amplification assays were conducted to search for large rearrangements; and （iii） finally, denaturing high-performance liquid chromatography was used to search for point mutations in the entire coding region. Using these approaches, the second CFTR mutation was detected in six patients, which increased the final detection rate to 60.8%.
基金support from the National Key Research and Developmental Program of China (No.2018YFC1003603)the National Natural Science Foundation of China (No.81971445).
文摘Congenital bilateral absence of the vas deferens(CBAVD)is observed in 1%–2%of males presenting with infertility and is clearly associated with cystic fibrosis transmembrane conductance regulator(CFTR)mutations.CFTR is one of the most well-known genes related to male fertility.The frequency of CFTR mutations or impaired CFTR expression is increased in men with nonobstructive azoospermia(NOA).CFTR mutations are highly polymorphic and have established ethnic specificity.Compared with F508Del in Caucasians,the p.G970D mutation is reported to be the most frequent CFTR mutation in Chinese patients with cystic fibrosis.However,whether p.G970D participates in male infertility remains unknown.Herein,a loss-of-function CFTR p.G970D missense mutation was identified in a patient with CBAVD and NOA.Subsequent retrospective analysis of 122 Chinese patients with CBAVD showed that the mutation is a common pathogenic mutation(4.1%,5/122),excluding polymorphic sites.Furthermore,we generated model cell lines derived from mouse testes harboring the homozygous Cftr p.G965D mutation equivalent to the CFTR variant in patients.The Cftr p.G965D mutation may be lethal in spermatogonial stem cells and spermatogonia and affect the proliferation of spermatocytes and Sertoli cells.In spermatocyte GC-2(spd)ts(GC2)Cftr p.G965D cells,RNA splicing variants were detected and CFTR expression decreased,which may contribute to the phenotypes associated with impaired spermatogenesis.Thus,this study indicated that the CFTR p.G970D missense mutation might be a pathogenic mutation for CBAVD in Chinese males and associated with impaired spermatogenesis by affecting the proliferation of germ cells.
文摘Recent data suggest that cystic fibrosis transmembrane conductance regulator(CFTR)gene alterations negatively impact male fertility beyond obstruction.We sought to compare gene alterations,sperm retrieval rates,and intracytoplasmic sperm injection(ICSI)outcomes among men with cystic fibrosis(CF)disease and congenital bilateral absence of the vas deferens(CBAVD)only.We retrospectively evaluated all men who underwent surgical sperm retrieval at two academic,high-volume andrology centers from 2010 to 2018.Only men with documented CFTR alterations and obstructive azoospermia from either CBAVD or CF were included.Differences between groups for CFTR abnormality,sperm retrieval,and ICSI outcomes were statistically analyzed.Overall,39 patients were included with 10 in the CF and 29 in the CBAVD groups.Surgical sperm retrieval rates were significantly lower in the CF group for sperm concentration(14.8×10^(6)ml^(-1)vs 61.4×10^(6)ml^(−1),P=0.02)and total motile sperm count(2.9 million vs 11.4 million,P=0.01).This difference was only predicted by homozygous delta F508 CFTR mutations(P<0.05).The CF group also demonstrated a significantly higher rate of rescue testicular sperm extraction(70.0%vs 27.6%,P<0.03)and lower fertilization rate with ICSI(32.5%vs 68.9%,P<0.01).In conclusion,those with CF demonstrated lower sperm quality,greater difficulty with sperm retrieval,and worse ICSI outcomes compared with CBAVD-only patients.Homozygous delta F508 CFTR mutations appear to significantly impair spermatogenesis and sperm function.
基金supported by grants from the Shanghai Science and Technology Innovation Action Plan Project (20Y11907600)National Natural Science Foundation of China (82001530)+1 种基金Shanghai Key Laboratory of Molecular Andrology (SLMA-014)Strategic Priority Research Program of the Chinese Academy of Sciences (XDA16020701).
文摘Patients with congenital unilateral absence of the vas deferens(CUAVD)manifest diverse symptoms from normospermia to azoospermia.Treatment for CUAVD patients with obstructive azoospermia(OA)is complicated,and there is a lack of relevant reports.In this study,we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA.From December 2015 to December 2020,33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital(Shanghai,China).Patient information,ultrasound findings,semen analysis,hormone profiles,and treatment information were collected,and the clinical outcomes were evaluated.Of 33 patients,29 patients were retrospectively analyzed.Vasoepididymostomy(VE)or cross VE was performed in 12 patients,the patency rate was 41.7%(5/12),and natural pregnancy was achieved in one of the patients.The other 17 patients underwent testicular sperm extraction as the distal vas deferens(contralateral side)was obstructed.These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA,even with a relatively low rate of patency and natural pregnancy.
基金supported by the National Key Research and Developmental Program of China(No.2018YFC1003403 and No.2018YFC1004700)the National Natural Science Foundation of China(No.32070850 and No.31771668).
文摘Cystic fibrosis(CF)is one of the most common recessive genetic diseases,with a wide spectrum of phenotypes,ranging from infertility to severe pulmonary disease.Mutations in the cystic fibrosis transmembrane conductance regulator(CFTR)gene are considered the main genetic cause for CF.In this study,we recruited a consanguineous Iranian pedigree with four male patients diagnosed with congenital unilateral absence of the vas deferens(CUAVD),and one female patient diagnosed with congenital absence of the uterus(CAU).Testicular biopsy of one patient was performed,and hematoxylin and eosin(H and E)staining of testis sections displayed the presence of germ cell types ranging from spermatogonia to mature spermatids,indicating obstructive azoospermia.To explore the underlying genetic factor in this familial disorder,we therefore performed whole-exome sequencing(WES)on all available family members.WES data filtration and CFTR haplotype analysis identified compound heterozygous mutations in CFTR among four patients(two CUAVD patients carried p.H949Y and p.L997F,and one CUAVD and the female CAU patient carried p.H949Y and p.I148T).All these mutations were predicted to be deleterious by at least half of the prediction software programs and were confirmed by Sanger sequencing.Our study reported that CFTR compound heterozygous mutations in a consanguineous Iranian family cause infertility in both sexes.
文摘When presented with an azoospermic patient, a thorough history and careful, considered physical examination often leads to a definite or presumptive diagnosis. An algorithmic, logical thought process is important to have in mind when embarking on the evaluation. Adjunctive laboratory tests, such as hormonal assays or genetic studies, are often complementary and/or additive and allow a very precise determination to be made as to the etiologies, either genetic or acquired. It is only with this information that a therapeutic plan can be made for the patient. As will be discussed, a targeted approach to testing is far more satisfying and cost-effective than a blind, shotgun approach.
文摘目的:检测先天性双侧输精管缺如(congenital bilateral absence of the vas deferens,CBAVD)患者中囊性纤维化跨膜转导调节因子(cystic fibrosis transmembrane conductance regulator,CFTR)基因和CBAVD易感基因的突变情况,探讨它们与CBAVD发病风险的相关性。方法:对13例诊断为孤立发生的CBAVD患者的致病基因CFTR及易感基因黏附型G蛋白偶联受体G2(adhesion G protein-coupled receptor G2,ADGRG2)、上皮细胞钠离子通道β亚单位(sodium channel epithelial 1 subunit beta,SCNN1B)和碳酸酐酶12(carbonic anhydrase,CA12)和溶质载体家族9成员3(solute carrier family 9 member A3,SLC9A3)行全外显子测序及Sanger测序验证,针对CFTR基因多态性位点、内含子及侧翼序列行聚合酶链式反应(polymerase chain reaction,PCR)扩增后用Sanger测序,并运用生物信息学方法对CBAVD易感基因新发突变进行保守性分析和有害性预测。对13例CBAVD患者中1例患者的家系进行遗传学分析,评估子代遗传风险。结果:外显子测序发现13例CBAVD患者中,只有6例患者检测到CFTR基因外显子突变,有6种错义突变:c.2684G>A(p.Ser895Asn)、c.4056G>C(p.Gln1352His)、c.2812G>T(p.Val938Leu)、c.3068T>G(p.Ile1023Arg)、c.374T>C(p.Ile125Thr)、c.1666A>G(p.Ile556Val),1种无义突变:c.1657C>T(p.Arg553Ter),这6例患者中有2例患者同时还存在CFTR的纯合p.V470位点,另外7例患者未检测出CFTR基因外显子区域的突变。13例CBAVD患者中,3例患者携带纯合p.V470的多态性位点,4例患者携带5T等位基因,2例患者携带TG13等位基因,10例患者携带c.-966T>G位点。4例CBAVD患者同时携带以上CFTR基因突变位点中的2~3个位点。13例患者中CBAVD易感基因突变情况:1种ADGRG2错义突变c.2312A>G(p.Asn771Ser),2种SLC9A3错义突变c.2395T>C(p.Cys799Arg)、c.493G>A(p.Val165Ile),1种SCNN1B错义突变c.1514G>A(p.Arg505His)和1种CA12错义突变c.1061C>T(p.Ala354Val),其中,SLC9A3基因的c.493G>A(p.Val165Ile)突变位点是首次在CBAVD患者中被发现,以上5种突变位点在gnomAD数据库中的人群变异频率极低,属于罕见突变,用Mutation Taster和Polyphen-2软件预测显示SLC9A3基因的c.493G>A(p.Val165Ile)位点和SCNN1B基因的c.1514G>A(p.Arg505His)位点的有害性等级为致病突变。1例家系遗传分析发现,先证者的c.1657C>T(p.Arg553Ter)突变为新生突变,先证者父亲、母亲均未携带该突变,先证者及其配偶通过辅助生殖技术孕育1女婴,该女婴遗传了先证者的致病性突变c.1657C>T(p.Arg553Ter)。结论:CFTR基因突变仍然是中国CBAVD患者的主要致病原因,但突变的分布与频率与国内外其他研究的数据存在一定差异,需要进一步扩充中国CBAVD患者的CFTR突变谱;ADGRG2、SLC9A3、SCNN1B和CA12易感基因可能解释部分无CFTR突变的CBAVD病例;CBAVD患者多无特殊临床表现,建议临床医生确诊前对患者行进一步的体格检查,并结合其阴囊超声或经直肠超声检查;建议将CFTR基因突变检测应用于辅助生殖前的遗传学筛查,降低子代罹患CBAVD及囊性纤维化的风险。
文摘目的:探讨先天性单侧输精管缺如(CUAVD)合并无精子症患者囊性纤维化跨膜转导(CFTR)基因全外显子检测的结果与意义。方法:抽取CUAVD合并无精子症6例患者外周血行CFTR全外显子突变及多态性检测,测序结果与UCSC Genome Browser on Human Dec.2013 Assembly进行在线比对及分析。结果:6例CUAVD合并无精子症患者中,1例第6号外显子中可检测到1个已知错义突变c.592G>C,2例患者第10号外显子前非编码区域发现c.1210-12T[5]剪切突变,且该2例患者合并第11号外显子上V470单倍体。结论:CUAVD合并无精子症患者CFTR全外显子基因突变有一定的检出率,有必要对这部分患者进行CFTR基因突变检测。
文摘目的:探讨囊性纤维化跨膜传导调节因子(CFTR)基因5T位点多态性与先天性双侧输精管缺如(CBAVD)发病风险的相关性。方法:采用病例-对照研究方法,选取40例国内孤立发生的CBAVD患者作为病例组和104例健康男性作为对照组,用Sanger测序方法对CFTR基因9号内含子(TG)m-n(T)单倍型进行测序分型;结合本实验和Pubmed、Web of science、Medline和中国知网等数据库文献中相关数据,进行meta分析,来探讨5T突变与CBAVD发病风险的相关性。结果:Sanger测序结果表明,病例组中检测到6种基因型,分别为TG11-5T、TG12-5T、TG13-5T、TG11-7T、TG12-7T、TG11-9T;对照组中检测到7种基因型,分别为TG11-5T、TG12-5T、TG10-7T、TG11-7T、TG12-7T、TG13-7T、TG11-9T。与对照组10/208(4.81%)相比,在病例组13/80(16.25%)中观察到TG12-5T单倍型约增加了3.38倍;与对照组(0)相比,在病例组中观察到TG13-5T单倍型为6/80(7.5%);TG11-5T单倍型在对照组2/80(2.50%)和病例组4/208(1.92%)中差异很小。TG12_13-5T单倍型在病例组与对照组中差异极显著(OR=7.40,95%CI=4.83～11.34,P<0.01)。经meta分析,TG12_13-5T单倍型与男性患CBAVD疾病的相关性较高。结论:TG12_13-5T单倍型增加CBAVD患病风险,为男性生殖提供了理论基础。
文摘目的:探讨先天性输精管缺如(congenital absence of the vas deferens, CAVD)近段输精管道超声声像图的特异性改变及超声诊断价值。方法:应用高频超声经阴囊观察先天性输精管缺如患者的近段输精管道,其中先天性双侧输精管缺如(congenital bilateral absence of the vas deferens, CBAVD)58例,先天性单侧输精管缺如(congenital unilateral absence of the vas deferens, CUAVD)12例,并回顾性分析其超声声像图改变。结果:所有128条先天性发育异常的输精管道超声检查均可见异常声像图,仅探及附睾头的占32.81%(42/128);探及附睾头及部分附睾体尾部的37.50%(48/128),其中附睾体尾部截断的占34.38%(44/128),呈条索样改变的占3.13%(4/128);探及附睾全程而未探及输精管阴囊段的占24.22%(31/128);探及附睾全程及部分输精管阴囊段,但输精管截断的占5.47%(7/128)。CAVD患者的附睾管均有扩张,其扩张程度大于对照组的正常男性附睾管(P<0.01)。附睾尾-输精管环缺失伴附睾管扩张是CAVD的特征性改变,超声检查中通过判断附睾尾-输精管环结构缺失,来诊断CAVD的灵敏度为94.53%,特异度97.00%。结论:经阴囊高频超声能显示近段输精管道的结构,评估其形态、回声及特征性扩张方式,为临床诊断CAVD和判断其缺失部位提供极有价值的信息。
文摘先天性双侧输精管缺如(congenital bilateral absence of vas deferens,CBAVD)是梗阻性无精子症的常见原因之一,睾丸生精功能一般正常,除了常见的囊性纤维化穿膜传导调节蛋白(cystic fibrosis transmembrane conductance regulator,CFTR)基因突变外,黏附G蛋白耦联受体G2(adhesion G protein-coupled receptor G2,ADGRG2)基因突变以及拷贝数变异也被认为是CBAVD的发病机制。本文报告1例CBAVD伴生精功能障碍的病例,睾丸组织病理学提示唯支持细胞综合征。全外显子组测序未发现该患者CFTR、ADGRG2以及无精子症相关基因存在致病变异,拷贝数变异分析也未发现有意义的拷贝数变异。该病例的确切遗传学病因尚未可知。CBAVD与生精功能障碍并存的临床现象,提示无精子症遗传病因的复杂性。
文摘目的观察先天性双侧输精管缺如(congenital bilateral absence of the vas defeFens,CBAVD)不育患者肾脏、睾丸、附睾及精囊腺的发育情况,了解家族性不育病史。方法对78例男性不育患者进行遗传咨询,外周血淋巴细胞培养及染色体分析,B超探查肾脏、睾丸、附睾及精囊腺,精浆生化指标测定,经皮睾丸细针穿刺细胞学检查生精功能。结果 78例CBAVD患者中精索静脉曲张27例,单侧肾脏缺如2例;单侧附睾缺如4例,仅有附睾头而未及附睾体、尾26例; 睾丸体积≤12ml的14例;遗传咨询,同胞兄弟姐妹中有不育症患者的有12人,其中有一家弟兄3人都为CBAVD患者 (都是本项目中的诊治对象),有一家弟兄2人都被确诊为CBAVD患者(也是本项目中的诊治对象)。外周血淋巴细胞培养及G显带染色体核型分析,染色体核型均为:46,XY,正常男性核型。精浆果糖、α-糖苷酶及肉毒碱含量分别平均为 0．82±0．56μmoL／ml、4．8±3．2mU／ml及83．2±24．5nmol／ml,明显低于正常值范围(P<0．001);细针穿刺细胞学检查睾丸生精功能56例正常(占71．8％56／78),其余22例无生精功能或生精功能低下。结论 CBAVD患者睾九、附睾、精索、精囊腺及肾脏的发育都有不同程度的先天异常;2个家系中有同胞兄弟罹患CBAVD;部分CBAVD患者睾丸无生精功能或生精功能低下。
