title: Metabolomic analysis reveals a unique urinary pattern in normozoospermic infertile men.
abstract: Normozoospermic infertility has become a common and important health problem worldwide. We designed this metabolomic case-control study to investigate the possible mechanism and urinary biomarkers of normozoospermic infertility. Normozoospermic infertile cases (n = 71) and fertile controls (n = 47) were recruited. A urinary metabolome pattern could discriminate normozoospermic infertile cases from fertile controls. A total of 37 potential biomarkers were identified; these have functionally important roles in energy production, antioxidation, and hormone regulation in spermatogenesis. This gave rise to a combined biomarker pattern of leukotriene E4, 3-hydroxypalmitoylcarnitine, aspartate, xanthosine, and methoxytryptophan pointing to a diagnostic capability (AUC = 0.901, sensitivity = 85.7%, and specificity = 86.8%) in a ROC model; these markers may highlight keynote events of normozoospermic infertility. Stalled medium- and long-chain fatty acid metabolism with improved ketone body metabolism, plus decreased levels of malate and aspartate could result in citrate cycle alterations via a malate-aspartate shuttle in ATP generation in spermatogenesis. Inhibitory alterations in the normal hormone-secreting activity in spermatogenesis were suggested in normozoospermic infertility. Folate deficiency and oxidative stress may jointly impact infertile patients. The disruption of eicosanoid metabolism and xanthine oxidase system, which were tightly associated with energy metabolism and oxidative stress, was also a potential underlying mechanism. In addition, depression might be associated with normozoospermic infertility via neural activity-related metabolites. This study suggests that the urinary metabolome can be used to differentiate normozoospermic infertile men from fertile individuals. Potential metabolic biomarkers derived from these analyses might be used to diagnose what remains a somewhat idiopathic condition and provide functional insights into its pathogenesis.
authors.affiliation: Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences , 1799 Jimei Road, Xiamen 361021, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Mu
authors.forename: Yankai
authors.initials: Y
authors.lastname: Xia
authors.forename: Francis L
authors.initials: FL
authors.lastname: Martin
authors.forename: Wei
authors.initials: W
authors.lastname: Hang
authors.forename: Liangpo
authors.initials: L
authors.lastname: Liu
authors.forename: Meiping
authors.initials: M
authors.lastname: Tian
authors.forename: Qingyu
authors.initials: Q
authors.lastname: Huang
authors.forename: Heqing
authors.initials: H
authors.lastname: Shen
mesh_terms: D000328:Adult; D001224:Aspartic Acid / Q000652:urine; D015415:Biomarkers / Q000652:urine; D002331:Carnitine / Q000652:urine; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis / Q000652:urine*; D017999:Leukotriene E4 / Q000652:urine; D008297:Male; D055442:Metabolome; D055432:Metabolomics; D012372:ROC Curve; D012263:Ribonucleosides / Q000652:urine; D014364:Tryptophan / Q000031:analogs & derivatives / Q000652:urine; D014970:Xanthines; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012263:Ribonucleosides; D014970:Xanthines; C027986:5-methoxytryptophan; D001224:Aspartic Acid; D017999:Leukotriene E4; D014364:Tryptophan; C005893:xanthosine; D002331:Carnitine