HPV λοίμωξη & Υπογονιμότητα

Γεώργιος Λ. ΑντωνάκηςΑναπληρωτής ΚαθηγητήςΜαιευτικής-ΓυναικολογίαςΠανεπιστημίου Πατρών

• Δεν υπάρχει οποιαδήποτε σύγκρουση συμφερόντων.

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ΓΥΝΑΙΚΕΣ & ΥΠΟΒΟΗΘΟΥΜΕΝΗΑΝΑΠΑΡΑΓΩΓΗ

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Μπορεί η πρόκληση πολλαπλής ωοθυλακικήςωρίμανσης με γοναδοτροπίνες να επηρεάσει τηνανίχνευση του HPV ?Gene expression in HPVs 16 and 18 is induced directly by steroidhormones through hormone response elements in the regulatory regionof the viral genome and HPV 16 transcription is enhanced by estrogenin vitro.Gloss B, et al. The upstream regulatory region of the HPV-16 contains an E2protein-independent enhancer which is specific for cervical carcinoma cells andregulated by glucocorticoid hormones. EMBO J 1987Mittal R, et al. HPV type 16 expression in cervical keratinocytes: role ofprogesterone and glucocorticoid hormones. Obstet Gynecol 1993.Michelin D, et al. Regulation of HPV type 18 in vivo: effects of estrogen andprogesterone in transgenic mice. Gynecol Oncol 1997Long-term use of OCs increases the relative risk of condylomataacuminata up to a factor of 9.8. A positive interaction between HPVinfection and the use of OCs has been shown for the risk of cervicalcancer.Franceschi S, et al. Br J Cancer 1983.Daling JR, et al. Sex Transm Dis 1986 4

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Κυτταρολογικά ευρήματα και HPV-DNA test σεγυναίκες που υποβάλλονται σε Υποβοηθούμενη

Αναπαραγωγή

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RESULTS: The cases (n = 669) showed significantly more abnormal cervical smears comparedto the controls (77 055) (6.1 and 3.9%, respectively, P < 0.02).CONCLUSIONS: The probability that subfertile women eligible for IVF are diagnosed with ahigh-grade cervical lesion is almost twice as high compared to women in the generalpopulation. We therefore suggest to take a cervical smear from all women referred for fertilityproblems.

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Επηρεάζει η ύπαρξη του HPV την έκβασητης Υποβοηθούμενης Αναπαραγωγής;

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ΜΗΧΑΝΙΣΜΟΣ

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Ασφάλεια

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ΑΝΔΡΕΣ

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Η ΟΜΑΔΑ ΤΗΣ PADOVA ΚΑΙ ΟΙ«ΑΛΛΟΙ»

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ΑΝΙΧΝΕΥΣΗ ΤΟΥ HPV ΣΤΟΓΕΝΝΗΤΙΚΟ ΣΥΣΤΗΜΑ ΤΟΥΑΝΔΡΑ ΚΑΙ ΟΙ ΣΥΝΕΠΕΙΕΣ

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Conclusion(s): These results suggest that HPV can be found in humansperm cells and that certain HPV-specific genes are actively transcribed.Sperm motility parameters seem to be affected by the presence ofHPV in the sperm cells, and also the incidence of asthenozoospermiamay be associated with HPV infection.

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Result(s): HPV infection was present in spermcells of 10 subjects among those 100 youngadults who already had unprotected intercourseand its presence was associated with reducedsperm motility. Furthermore, infected samplesshowed that about 25% of sperm had an HPVDNA positivity at the head site, but it isunclear whether it was integrated in thenucleus or not.

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Result(s): The prevalence of HPV semeninfection found in all groups was as follows:patients with genital warts, 53.8%; infectedpartners, 40.9%; infertile patients, 10.2%, fertilecontrols, 2.2%. Infertile patients had a higherHPV DNA prevalence in sperm cells than theother groups. The results of HPV investigationwere compared with sperm parameters and theresults of FISH analysis. Sperm motility wasmore frequently reduced in infected samplesand in particular when the infection waspresent in the sperm. 50

HPV can infect human sperm, it localizes at the equatorial region of spermhead through interaction between the HPV capsid protein L1 and syndecan-1.Sperm transfected with HPV E6/E7 genes and sperm exposed to HPV L1capsid protein are capable to penetrate the oocyte and transfer the virusinto oocytes, in which viral genes are then activated and transcribed.Sperm might function as vectors for HPV transfer into the oocytes, and opennew perspectives on the role of HPV infection in males and are particularlyintriguing in relation to assisted reproduction techniques.

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Result(s): Infertile patients with HPV semen infection showedhigh percentages of ASAs. In these patients HPV sperminfection was associated with lower sperm motility, which wasworse in subjects with ASAs. No alterations of spermchromosomes were observed. To obtain a significant clearanceof both HPV sperm infection and ASAs at least 24 months offollow-up were needed. Conclusion(s): HPV has been recently suggested to have animportant role in male infertility. This study demonstrated thatHPV sperm infection can be long lasting and frequentlyassociated with ASAs that may further reduce male fertility.Infertile patients with positive sperm Mar test results shouldbe considered for investigation for HPV, especially if they arecandidates for assisted reproduction.

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ΑΝΤΙΛΟΓΟΣ

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Result(s): Results of HPV investigation werecompared with sperm parameters and ISHanalysis. Twenty-four out of 308 semen samples(7.8%) were HPV DNA positive, but HPVinfection did not seem to affect semen quality.Moreover, ISH revealed a clear HPVlocalization at the equatorial region of spermhead in infected samples. Conclusion(s): Oncogenic HPV genotypes weredetected on spermatozoa from asymptomaticsubjects, but a role of the infection in male

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«Preliminary studies show not only that HPV ispresent in semen, but that it might reduce spermmotility probably causing reduced fertility inmales.Moreover, the virus might interfere with thedevelopment of the embryo in animal modelsaccording to some studies.HPV might be a cause of infertility, even so,further studies are needed in order to clarify itsrelationship with fertility.»

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Results. In all, 39% of parents were worriedabout VAI. Parents worried about VAI hadsimilar knowledge of HPV compared with otherparents.Parents worried about VAI had twice the odds ofagreeing the vaccine may cause side effects andagreeing they did not have enough informationcompared to their counterparts.Parents worried about VAI less oftenintended to vaccinate sons than other parents.Conclusions. These findings suggest manyparents worry about VAI in sons with HPV

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Συμπεράσματα

• Ο HPV είναι παρών με αρκετά μεγάλη συχνότητα στοσπέρμα ανδρών, τόσο με προδιαθεσικούς παράγοντεςHPV λοίμωξης, όσο και σε ασυμπτωματικούςυπογόνιμους άνδρες.

• Η παρουσία του HPV στο σπέρμα συσχετίζεται μεελαττωμένη κινητικότητα .

• Τα προσβεβλημένα σπερματοζωάρια μπορούν ναγονιμοποιήσουν το ωάριο, να μεταφέρουν το HPVγονιδίωμα στο ωάριο και τα γονίδια του HPV ναμεταγραφούν από το γονιμοποιημένο ωάριο.

• Υπάρχει αυξημένος κίνδυνος αυτομάτου εκτρώσεωςόταν ο άνδρας είναι HPV DNA (+).

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• Οι συνήθως εφαρμοζόμενες τεχνικές προετοιμασίας τουσπέρματος πριν την Υποβοηθούμενη Αναπαραγωγήδεν δύνανται να απομακρύνουν τα προσβεβλημένα απότον HPV σπερματοζωάρια.

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Ευχαριστώ για την προσοχή Σας!

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