ACUTE EFFECTS OF SPINAL CORD INJURY ON SPERM FUNCTION

众所周知，不孕不育是患有脊椎病的男性的常见后遗症。 脊髓损伤(SCI)。这种不孕不育有两个原因--贫穷 精液质量和射精功能障碍。射精的问题 通过使用电射精，功能障碍在很大程度上得到了解决。 然而，糟糕的精液质量，特别是精子的活力，仍然是一种 未解决的问题。人们普遍认为，相当多的人 的男性也有精子发生的异常。有 一直没有关于精子发生、精子活力、 或脊髓损伤后的精子功能。我们的初步数据显示， 大鼠脊髓损伤后不久可能开始精子发生。精液质量差 在男性脊髓损伤后2-4周也有发现。既不是临床也不是 动物研究已经确定了导致这些变化的机制 减损。这项提议的广泛长期目标是理解 SCI男性和女性睾丸-附睾功能障碍的机制 脊髓横断大鼠。对这些机制的理解及其 时间进程是制定保护措施的关键 脊髓损伤男性的生育能力。第一个调查领域是时间 生精和精子功能受损的病程及其影响因素 在老鼠和人身上都会影响这一时间进程。大鼠受到 胸中段和骶段脊髓横断术将用 以下具体目标：1)量化时间进程和严重程度 生精损伤和精子活力；2)确定 生精损伤在8个月内是不可逆的；3)确定 随着时间的推移，特定的生精细胞最容易受到攻击 横切面。最近完全创伤性脊髓损伤的男性将被分组到 神经学水平达到或超过T6、T7-T11，并有完整的骶骨 脊髓和T12及以下累及骶髓，使每个 他们的自主神经系统将相对同质 功能。具体目标是：1)精子发生的时间进程 通过连续测量睾丸体积，这是已知的相关 精子发生正常；2)精子的时间进程 通过连续评估精子密度、活动率、 形态和精子功能。的具体机制。 将对睾丸-附睾部损伤进行调查。这些措施包括 睾丸血流调节异常与阴囊过热 无论是老鼠还是人类。在老鼠研究中，重点将放在 中国人精子运输和成熟异常的调查 附精，以及支持细胞功能异常，这是 是支持精子发生的睾丸体细胞。一个 脊髓损伤后精子质量低下的机制探讨 男性将形成治疗努力的科学基础，以改善他们的 生育潜力。最后，即使精子质量不能保持 在慢性脊髓损伤患者中，保存精子质量直到脊髓损伤患者 在医学上稳定并且能够接受电射精 具有重要的临床意义。精子库，这需要良好的 高质量的精子，然后可以提供给患者。

It is well known that infertility is a common sequela in men with spinal cord injury (SCI). There are two causes of this infertility -- poor semen quality and ejaculatory dysfunction. The problem with ejaculatory dysfunction has largely been solved with use of electroejaculation. However, poor semen quality, particularly sperm motility, continues as an unresolved problem. It is generally accepted that a significant number of SCI men have abnormalities of spermatogenesis as well. There have been no prospective clinical studies of spermatogenesis, sperm motility, or sperm function following SCI. Our preliminary data have shown that spermatogenesis may begin shortly after SCI in rats. Poor semen quality has also been noted 2-4 weeks after SCI in men. Neither clinical nor animal studies have identified mechanisms responsible for these impairments. The broad long-term aim of this proposal is to understand mechanisms underlying testicular-epididymal dysfunction in SCI men and in spinal cord transected rats. Understanding of these mechanisms and their time course is critical to development of interventions to preserve fertility in men with SCI. The first area of investigation is the time course of impaired spermatogenesis and sperm function and factors that affect this time course in both rats and men. Rats subjected to mid-thoracic and sacral spinal cord transection will be studied with the following specific aims: 1)to quantify the time course and severity of spermatogenic injury and sperm motility; 2) to determine if the spermatogenic injury is irreversible over 8 months; 3) to determine which specific spermatogenic cells are most vulnerable over time after transection. Men with recent complete traumatic SCI will be grouped into those with neurologic levels at or above T6, T7 - T11 with intact sacral cord and T12 and below with involvement of the sacral cord, so that each group will be relatively homogeneous in their autonomic nervous system function. Specific aims will be: 1) the time course of spermatogenesis by serial measurement of testicular volume, which is known to correlate well with normalcy of spermatogenesis, 2) the time course of sperm quality by serial evaluation of sperm concentration, motility, morphology, and sperm function. Specific mechanisms of testicular-epididymal injury will be investigated. These include abnormal regulation of testicular blood flow and scrotal hyperthermia in both rats and humans. In rat studies, emphasis will be placed on investigating abnormalities of spermatozoa transport and maturation in the epididymis, as well as abnormal function of the Sertoli cells, which are testicular somatic cells that support spermatogenesis. An understanding of the mechanisms contributing to poor sperm quality in SCI men will form a scientific basis for therapeutic efforts to improve their fertility potential. Finally, even if sperm quality cannot be maintained in chronic SCI men, preservation of sperm quality until SCI men are medically stable and able to undergo electroejaculation would have important clinical significance. Sperm banking, which requires good quality sperm, could then be offered to patients.