Indications de la recherche des anticorps anti-spermatozoïdes

The clinical significance of antisperm antibodies (ASA) is highly controversial. A significant percentage of infertile men and women present immunity to spermatozoa, suggesting that ASA may interfere with the fertilizing capacity. ASA can act negatively on sperm parameters, sperm-cervical mucus interaction, gamete fusion and possibly also on the first step of embryonic development. ASA are present in approximately 2.8% to 26% of the male population and 0.2% to 1.6% of women. The pathogenesis of immunity to spermatozoa had not been fully elucidated: breakdown of normal protective mechanisms, i.e. blood-testis barrier, or epithelial barrier in women, and other mechanisms of immunological sperm tolerance, such as regulation of suppressor T lymphocytes. The indication for antisperm antibody testing is based on clinical and laboratory findings of infertile patients. In men, indictions for ASA testing include a history of genital disease, surgery for genital abnormalities, vasectomy, obstruction or injuries of the male genital tract, infection of accessory glands, long-standing infertility, alteration of semen parameters (agglutination, motility), mucus penetration, and reduced fertilizing capacity in IVF. In many cases, no etiological cause of autoimmunity is found and a genetic predisposition has been suggested. A majority of women do not develop antisperm antibodies, despite repeated contact with spermatozoa during their sexual life. Upper genital tract infection is the main cause of isoimmunization in females, although sexual practices, endometriosis, surgery for cervical neoplasia, recurrent spontaneous abortion and long-term infertility may also be involved. Sperm-cervical mucus impairment is the most obvious effect of immunization in women associated with IVF failure. Autoantibodies are frequently associated with antisperm antibodies. One of the consequences of the success of ICSI has been a decreased research effort to further the understanding of the origin and relevance of antisperm antibodies and specific antibody-antigen interactions. A better understanding of the natural history of immunological infertility would be useful for patient conseiling and to develop the most effective, efficient and safest management strategies. Such data could also be useful for the development of new tests and immunological methods of male contraception.     

Presence of antisperm antibodies in the serum of Sardinian adult people. I. Study on healthy adult men in north Sardinia

Infertility is a problem estimated to occur in 15-20% of couples. Among many possible causes of this condition, an immunological factor must be considered, in particular the presence of antibodies to spermatozoa in the serum and also in the seminal plasma. Several researches agree in reporting that the incidence of such antibodies is considerably higher in men affected by impairment of spermatogenesis than in healthy subjects as showed also in our Institute. In order to widen our knowledge of the topic at issue, considering that there are no data concerning this problem in Sardinia, we thought it right to begin an epidemiological research about the incidence of antispermatozoal antibodies in the resident, adult and seemingly healthy male population. Therefore, we have tested the serum of 250 men, aged from 20 to 50, habitual blood donors registered in Transfusional Centres of North Sardinia, who have never manifested failures of the reproductive system; for the detection of the antispermatozoal antibodies, we have adopted the indirect immunofluorescence assay. The first results show that, in a few cases, corresponding to 2.4 per cent, also in a highly selected population antibodies to spermatozoa were present, and they were directed particularly against the acrosome and the equatorial segment. The ultimate aim of the research is to give epidemiological data, concerning both sexes, that may be utilized in a wider study of the local causes of infertility.     

Effects of experimentally generated bull antisperm antibodies on in vitro fertilization.

To test the hypothesis that bull antisperm antibodies have the capacity to interfere with fertilization, antisperm antibodies were generated in three 13-mo-old Holstein bulls by auto-immunizing each bull with sperm three times. All bulls produced serum antisperm IgG1 and IgG2 antibodies. No serum antisperm IgA nor seminal plasma antisperm antibodies of any isotype could be detected by ELISA. Western blots were performed with immunopurified IgG1 and IgG2 from pre- and post-immunization sera from one test bull. Both post-immunization IgG1 and IgG2 recognized a 45-kDa sperm antigen. Serum samples from a normal bull stud population tested by ELISA had significantly higher levels of antisperm antibodies than did heifers. The bull stud serum samples giving the highest ELISA values differed from those of the immunized bulls in that their antisperm antibodies were of the IgM isotype only. Bull sperm were incubated with serum from the immunized and control bulls, then added to bovine oocytes in vitro. Incubation of sperm with post-immunization serum reduced in vitro fertilization rates (p < 0.01). This study demonstrated that antisperm IgG1 and IgG2 generated by sperm auto-immunizations reduced fertility in vitro, and therefore naturally occurring antisperm antibodies may affect fertility in bulls.     

La stérilité d'origine immunologique.

Antispermatozoal antibodies in the woman, the man, or both, may be the cause of nonorganic infertility in a small number of couples. The antibodies are most often found in the serum or in the genital fluids. Diagnosis is based on the postcoital test and on various laboratory tests to assess sperm-cervical mucous compatibility and to detect antispermatozoal antibodies. In women the strongest relation between results of laboratory tests and infertility is between the presence of serum antispermatozoal antibodies and infertility of more than 3 years'' duration. In men there is a relation between high levels of these antibodies in the semen and infertility. Various treatments have been proposed, but further prospective studies are needed. However, promising results have been reported with homologous intrauterine insemination and with immunosuppression in men.     

Antisperm antibodies associated with infertility: properties and encoding genes of target antigens

Infertility among couples of reproductive age is a perplexing condition when the cause is indeterminate. These cases are classified as unexplained infertility. In a subset of subjects, antisperm antibodies with sperm agglutinating and/or immobilizing activities have been detected in the blood or fluids of the reproductive tract. These cases are designated as immunologic infertility although a cause and effect relationship of the antibodies to infertility has not been established. In this review, seven target sperm antigens to antibodies associated with infertility and their encoding genes are described. The antisperm antibodies (ASAs) examined were obtained from infertile women or were monoclonal antibodies (mAb) raised against human sperm proteins. All the ASAs studied possessed potent sperm agglutinating and/or immobilizing activities. The target antigens were isolated from human and other mammalian sperm, and the encoding genes identified. The seven antigens are YWK-II, BE-20, rSMP-B, BS-63 (nucleoporin-related), BS-17 (calpastatin), HED-2 (zyxin), and 75- kDa. Each antigen is a distinct and separate entity and is produced by different cells of the reproductive tract, (e.g., germ cells, epididymal epithelial cells, and Sertoli cells). No single predominant target component has been found to interact with the ASAs. It is proposed that immunologic infertility is the consequence of the combined actions of multiple ASAs in immobilizing and/or agglutinating spermatozoa, blocking spermegg interaction, preventing implantation, and/or arresting embryo development.     

Antifertility effects in rats actively immunized with 80 kDa human semen glycoprotein.

A 80 kDa human sperm antigen has been identified using the serum of an infertile woman having circulating antisperm antibodies. The antigen was then purified to homogeneity by gel permeation chromatography using HPLC (protein PAK-125 column) system and on FPLC (superose-12 column) system. The antigen was found to be a glycoprotein. The antigen was mainly localized in the postacrosomal region of the human sperm, while it was localized in the head region of the rat sperm as demonstrated by immunofluorescent staining. The presence of this antigen was also demonstrated in the human prostate and endometrium and in the rat testis; epididymis and the prostate by immunocytochemical staining. The purified protein upon active immunization in female rats caused infertility in 100 percent animals. While in male rats it caused infertility in 90 percent animals. On morphometric analysis of testicular tissue it was observed that there was no significant change in spermatogonia and spermatocytes, but significant decrease in spermatids and sperm number as well as daily sperm production in the immunized male rats. The epididymal spermatozoa were markedly reduced in number and were largely found to be agglutinated. The results suggest that 80 kDa human sperm antigen appears to be a suitable candidate for immunocontraception both in male and female.     

Detection of anti-sperm antibodies on the surface of live spermatozoa by the method of flow cytometry

Detection of antisperm antibodies is an important step of the diagnosis of infertility. In present study we conducted comparative studies with the detection of antisperm antibodies in IgG, IgA and IgM classes on the surface of living spermatozoa by flow cytometry and with Mixed Agglutination Reaction and Sperm immobilization. Our data show that flow cytometry may be used to verify that immunoglobulins are on the surface of living spermatozoa, either retrieved directly from an ejaculate or following exposure to cervical mucus or serum and to determine their isotype, proportion of sperm which bound antibody and quantity of immunoglobulins bound to cell surface.     

Prevalence of antibodies to Chlamydia trachomatis in healthy population groups in Manitoba.

The prevalence of antibodies to Chlamydia trachomatis was determined in 1877 serum samples from healthy population groups of Caucasians, native Indians and recent Vietnamese immigrants in Manitoba. Testing was done with a commercially available immunofluorescence kit containing C. trachomatis antigen. The presence of antibodies was age-related; a progressive increase in prevalence was observed in children aged 1 to 15 years, and the overall prevalence was higher in female Caucasian blood donors and female Vietnamese immigrants than in males in both groups. However, there was no sex-related difference in prevalence among the subjects undergoing premarital testing or among the native Indians. Antibodies were more prevalent (p less than 0.001) in pregnant than in nonpregnant women matched for race and age, and a relatively high prevalence (66.6%) was found in the cord serum of newborns. The overall prevalence rate of antibodies in all Manitobans was 48.8% (44.9% in men, 55.9% in women and 35.3% in children.     

Anticorps anti-spermatozoïdes: techniques de dépistage et interprétation des résultats

Since the first publication on the detection of sperm-agglutinating antibodies in infertile men, multiple assays have been described. The most useful tests are able to detect antibodies bound to the sperm membrane of motile spermatozoa. The immunobeads test (IBT) is considered to be the most advantageous in terms of its sensitivity, the low incidence of false-positive results, and its ability to localize antibodies of different immunoglobulin classes on the sperm surface. The IBT assay can be used in parallel with the mixed antiglobulin reaction (MAR), to detect sperm-associated antibodies in the ejaculates of infertile men, the most rational way to test for antisperm antibodies (ASA) in males. In view of the high level of agreement between the two assays, MAR, the easier of the two, may be used as a first step in the detection of these antibodies. A positive MAR must be confirmed by IBT, as this assay is more specific for the detection of IgA antibodies. The clinical significance of sperm-associated antibodies is usually established according to the proportion of motile spermatozoa coated with immunobeads, its class and its localization on the sperm surface. However, binding of immunobeads does not provide any information about the antigens against which the antibodies are directed. As the functional effects of sperm-associated antibodies may vary as a function of their antigenic specificities, other assays, using purified fertilization related antigens, are necessary to establish, for each individual, the specific impact of the antibodies on the fertilization process. The indirect IBT assay has recently become the most widely used test to detect the various classes of ASA in serum and cervical mucus of infertile women and in the serum and seminal fluid of infertile men, in combination with the direct assay described above. However, in most laboratories, it is performed with only one dilution of the biological fluid tested, usually a low dilution, so that antibody levels of no significance for fertility could be detected. This may explain a recente debate (Human Reprod, 1999) on the significance of ASA as a cause of infertility. At present, and in the absence of standardized assays able to identify the antigens involved in each individual immune reaction, antibody assays, as detected by the IBT assay, in the serum and/or genital secretions of infertile subjects might provide useful clinical guidance.     

Spermagglutinins in serum and seminal fluid of bulls and their relationship to fertility classification

Twenty-five satisfactory and 25 unsatisfactory potential breeder bulls were examined with a modified Shulman spermagglutination test for the presence of spermagglutinating antibodies in their serum and seminal fluid. This was done to determine whether antibodies to spermatozoa were a contributing factor to classification of the bull as an unsatisfactory potential breeder. No correlation was found between classification as an unsatisfactory potential breeder and the presence of spermagglutinating antibodies. In addition, indirect fluorescent antibody tests were performed to detect antisperm antibodies in the serum and seminal fluid of the bulls. Again, no correlation was found between antisperm antibodies and breeding soundness classification. Finally, there was no correlation between the age of the bulls and occurrences of spermagglutination antibodies in serum or seminal fluid.     

Human sperm proteome: immunodominant sperm surface antigens identified with sera from infertile men and women.

The objective of this study was to identify those immunodominant sperm antigens recognized by antisperm antibodies (ASA) in the serum samples of infertile men and women. High-resolution two-dimensional gel electrophoresis was employed to separate human sperm proteins using isoelectric focusing or nonequilibrium pH gradient electrophoresis, followed by PAGE. Serum samples from 15 infertile male subjects and 6 infertile female subjects that contained ASA as assayed by the immunobead binding test (IBT) were analyzed by Western blotting followed by enhanced chemiluminescence (ECL). Serum samples from 10 fertile subjects (5 males and 5 females) that were ASA negative by IBT were used as controls. The ECL blots were analyzed by computer scanning to compare the immunoreactivity between serum samples from fertile and infertile subjects and to identify the antigens unique to the sera of the infertile subjects; 98 sperm auto- and iso-antigenic protein spots were recognized by sera from infertile males and females but not from fertile subjects. Based on vectorial labeling with 125I at the sperm surface, a subset of 6 auto- and iso-antigens was identified as possibly relevant to antibody-mediated infertility.     

Anticorps antispermatozo?des : indications, étiologies et applications en 2011, de l’exploration de l’infertilité au concept d’immunocontraception masculine

The present literature review aims at clarifying the techniques used in the screening of antisperm antibodies (ASAS), the value of screening at different physiological and pathological conditions, and the choice of infertility treatment in assisted reproduction. Moreover, studying the targets and the role of ASAS in infertility allowed for the development of antisperm contraceptive vaccines, which are found effective in some animal models and potentially usable in humans.     

The serologic screening for celiac disease in the general population (blood donors) and in some high-risk groups of adults (patients with autoimmune diseases,osteoporosis and infertility) in the Czech republic

The prevalence of celiac disease (CD) was determined in healthy blood donors and in high-risk groups of adults (a total of 1835 adults—randomly selected 1312 healthy blood donors, 102 patients with primary osteoporosis, 58 patients with autoimmune diseases and 365 infertile women). It was calculated on the basis of a two-step serologic screening method—in the first step IgA and IgG antigliadin antibodies (AGA) and IgA anti-γ-glutamyltransferase (‘transglutaminase’) antibodies (ATG) were estimated, in the second step sera positive for IgA AGA and/or IgA ATG were examined for antiendomysial IgA (AEA) antibodies. Immunoenzymic assay (ELISA) was used for determining of AGA and ATG antibodies; immunoflurescence method, performed on human umbilical cord tissue, was used for assaying of AEA antibodies. Total serum IgA level in only IgG AGA positive subjects was measured by routine turbidimetric method. 0.45% of healthy blood donors, 0.98% of osteoporotic patients, 2.7% of patients suffering from autoimmune disease and 1.13% of women with infertility considered as immunologically mediated were found to be positive in both steps of serologic screening (AGA and/or ATG and antiendomysium positive). The presumed high prevalence of seropositivity for CD in apparently healthy Czech adult population was confirmed. In the high-risk groups, the prevalence of seropositivity for CD was approximately 2–4 times higher than in healthy blood donors. The real prevalence of CD in the tested groups, however, can be estimated after performing small intestinal biopsy in the seropositive patients.     

Characterization of anti-Cryptosporidium IgA antibodies in sera from immunocompetent individuals and HIV-infected patients.

Human antibody response to Cryptosporidium parvum has been previously shown as involving immunoglobulin (Ig)M and IgG isotypes. The interest in anti-cryptosporidial IgA antibody response has been recently stimulated by studies on the therapeutic effects of secretory IgA antibodies to Cryptosporidium in animal models and in patients. In the present study, isotypes of serum anti-Cryptosporidium antibodies have been characterized in donors of the following categories: (a) healthy adults, (b) healthy children, (c) immunocompetent children with transient cryptosporidial diarrhea, (d) HIV-infected patients without clinical and parasitological evidence of Cryptosporidium infection and (e) AIDS patients with cryptosporidial diarrhea. Antibodies were detected using C. parvum oocysts purified by density gradient centrifugation from bovine faeces. The IgA antibodies were revealed using alpha-chain specific antibodies. Indirect immunofluorescence analysis with oocysts was used as control. Although high levels of serum antibodies of the IgA class were detected in some donors in the group of healthy adults, elevated values were consistently found in HIV-infected patients. Higher values were found in HIV patients with clinical cryptosporidiosis. The presence of a secretory component in serum IgA antibodies in these patients has been documented. Data indicate that IgA serum antibodies are produced as well as IgM and IgG antibodies upon contact with the parasite, and suggest that elevated IgA serum antibodies to Cryptosporidium are not associated with protection in HIV patients.     

Does immunity regulate ejaculate quality and fertility in humans?

The production of high-quality ejaculates may represent significantcosts during male reproduction. Spermatozoa are perceived asnonself by the immune system and are exposed to immunologicalattacks in the male reproductive tract. Autoimmunity to spermatozoaresults in the production of antisperm antibodies that reducesperm quality and hence fertility. Thus, males are dependenton the testis being an immunoprivileged site to reduce immunologicalreactions against their own sperm, and immunoprivilege is obtainedby the blood-testis barrier and by hormonal immunosuppression.A meta-analysis on the effects of immunosuppressive corticosteroidtreatment of male infertility revealed that treatment reducedthe level of antisperm antibodies, improved sperm motility andsperm count, and increased conception rate. These results emphasizethe importance of immunosuppression and the associated pathogenicityfrom infectious organisms as important costs for the productionof high-quality ejaculates.     

Heterophilic infectious mononucleosis antigen used in the latex diagnostic test. II. Preliminary evaluation of the usefulness of latex reagents for detection of serum heterophile antibodies in patients with infectious mononucleosis

The aim of this study was to evaluate the usefulness of laboratory made reagent of polystyrene latex coated with three preparations of mononucleosis antigen (reagent MZ-I, MZ-II, and MZ-III) for detection of heterophile antibodies in patients sera with clinical symptoms of infectious mononucleosis. These studies were carried out on 153 serum samples taken from persons suspected of being infected with EB virus and on 100 healthy controls--blood donors. The results of latex tests were compared to the results of Paul-Bunnell-Davidsohn (PBD) and hemolytic tests. Out of three latex reagents evaluated only one (reagent MZ-I) showed sensitivity equal to PBD and haemolytic tests. The sensitivity reached 91.1%. Agglutination reaction when appeared in latex test at serum dilution 1:5, is considered positive and diagnostically significant result.     

Epididymis as a target for contraception

Advantage of using a vaccine based on sperm antigens is that it can be used both in males and females as individuals who have antisperm antibodies are usually infertile but otherwise healthy. Several sperm specific antigens identified as prospective candidates for immunocontraception are of testicular origin. For the purpose of immunocontraception it may be desirable not to disrupt spermatogenesis and testicular function. Concept of post testicular maturation of spermatozoa has been very well established. During post testicular voyage spermatozoa undergo a series of complex and sequential events which transforms the immature immotile spermatozoa into mature sperm. Acquisition of functional maturity is necessary for progressive motility, zona pellucida recognition culminating in sperm egg binding. Importance of epididymal maturation is highlighted by the fact that high percentage of male infertility in human originates from the malfunction of the epididymis. The epididymis has also shown to be involved in sperm storage and provides an adequate environment for final maturation of the sperm. It provides a conducive microenvironment by virtue of which the spermatozoa are protected during the storage. In view of this it is imperative that more attention needs to be focused on epididymal antigens. The information obtained will enable us to identify epididymal antigens relevant to fertility and also help in infertility diagnosis.     

抗小鼠精子特有乳酸脱氢酶C4的与分泌片装配或未装配的单克隆抗体IgA的生物学功能

为了测定抗精子ＩｇＡ在免疫不育和抗精子避孕疫苗研制方面的生物学作用,用肠道内免疫的方法制备了一组抗乳酸脱氢酶Ｃ４（ＬＤＨ－Ｃ４）的单克隆ＩｇＡ抗体（ｍｏＩｇＡ）。以免疫印迹证实了它们的异质同形体。大部分ｍｏＩｇＡ（ＰＡ１－ＰＡ５）是用肠道内免疫和以派依尔氏淋巴细胞作为亲本细胞进行融合来获得的。在豚鼠血清补体存在的情况下,小鼠精子可以被ｍｏＩｇＡＰＡ１、ＰＡ２和ＰＡ４所制动。高浓度ＰＡ４和ＰＡ５可凝集小鼠精子。小鼠体外受精率可被３个ｍｏＩｇＡ（ＰＡ２、ＰＡ３和ＰＡ４）显著降低,但用ＰＡ１、ＰＡ２和ＰＡ５被动免疫之后,小鼠体内受精无明显变化。纯化的小鼠胆汁分泌片可同纯化的ｍｏＩｇＡ或腹水中的ｍｏＩｇＡ在体外组装起来。同分泌片结合之后,ｍｏＩｇＡ对精子的制动、凝集和体外受精无明显变化。这些研究结果提供了抗ＬＤＨ－Ｃ４的ｍｏＩｇＡ和分泌性ＩｇＡ对精子功能和体外受精的生物学作用的直接证据,在免疫不育的防治,避孕疫苗的研制以及性传播疾病的防治方面均有一定的指导意义。     

Detection of autoreactive antibodies to serum IgG and IgA in amoebic liver abscess cases.

Assessment of autoreactive antibodies in response to healthy human serum IgA and IgG was performed by indirect haemagglutination assay on serum samples from 81 amoebic liver abscess cases for IgA and 70 for IgG. Appropriate controls were taken simultaneously. IgA, IgG were isolated and purified from a healthy human serum through Sephadex G-200 and protein A CL 4B sepharose chromatography. These immunoglobulins were used for the detection of its own antibodies in amoebic liver abscess cases. This revealed that 43.20% and 48.50% of the cases were positive for IgA and IgG respectively, where as only 19.35% and 28.30% of the controls were in positive category (IgA and IgG respectively). The mean titres with standard deviation of the autoreactive antibodies to serum IgA both in ALA cases and controls shows a highly significant difference between tests and controls (P less than 0.001). Similarly the mean titres with standard deviation both in ALA and controls for the serum IgG differed significantly (P less than 0.001). This suggests the presence of autoreactive antibodies against serum IgA and IgG in amoebic liver abscess cases.     

Seroprevalence of Lyme disease in gray wolves from Minnesota and Wisconsin.

To determine the seroprevalence of Lyme disease in gray wolves (Canis lupus) from various counties of Minnesota and Wisconsin (USA), 589 serum samples were collected from 528 wolves from 1972 to 1989. An indirect fluorescent antibody (IFA) test was used to detect the presence of antibodies against Borrelia burgdorferi. Titers of greater than or equal to 1:100 were considered positive. Results were confirmed by testing a few selected sera by Western blotting. Of the 589 sera tested, 15 (3%) had IFA titers of greater than or equal to 1:100. Three of the positive samples were collected from Douglas County in Wisconsin and twelve were from Minnesota counties. This study indicates that wolves are exposed to B. burgdorferi and are susceptible to Lyme disease.