title: Alterations in the proliferative/apoptotic equilibrium in semen of adolescents with varicocele.
abstract: OBJECTIVE
  To verify if the presence of varicocele (grades II and III) with and without seminal alterations, using the 5thcentile cutoff values in table A1.1 of the World Health Organization (WHO, 2010) manual, alters the seminal plasma levels of proteins DNASE1 (deoxyribonuclease-1) and IGFBP7 (Insulin-like growth factor-binding protein 7), which are related to apoptosis regulation and cell proliferation, respectively, demonstrating that these proteins are important for correct spermatogenesis.
  
  
  METHODS
  This cross sectional study was performed at the Sao Paulo Federal University Paulo between May 2014 and April 2016. A total of 61 male adolescents were included in this study, of which 20 controls without varicocele (C), 22 with varicocele and normal semen analysis (VNS) and 19 with varicocele and altered semen analysis (VAS). Seminal plasma from each patient was used for Western blotting analysis of individual protein levels. Values of each protein were normalized to a testicular housekeeping protein (PARK7-protein deglycase DJ-1).
  
  
  RESULTS
  Levels of IGFBP7 protein are increased in varicocele. Levels of DNASE1 are progressively decreased in varicocele (lower in varicocele and normal semen analysis, lowest in varicocele and altered semen analysis) when compared to adolescents without varicocele. DNASE1 levels are positively correlated with sperm concentration and morphology (correlation values of 0.400 and 0.404, respectively; p values of 0.001 and 0.001, respectively).
  
  
  CONCLUSIONS
  In conclusion, in adolescents, seminal plasma levels of IGFBP7, responsible for proliferative activity, are increased in varicocele grades II and III, and DNASE1, responsible for apoptosis regulation, are lower in varicocele, lowest in varicocele and low semen quality. These proteins demonstrate molecular alterations brought upon by varicocele. Moreover, DNASE1 is capable of discriminating a varicocele that causes alterations to semen quality from one that does not. We propose that the initial response of varicocele is to increase proliferative activity which, if followed by regulation of apoptosis, may lead to the ejaculation of a population of sperm that are in accordance with WHO cutoff values but, in the presence of dysregulated apoptosis, leads to lower sperm concentration and morphology.
authors.affiliation: Department of Surgery, Division of Urology, Universidade Federal de São Paulo, R Embau, 231, 04039-060, Sao Paulo, SP, Brazil.
authors.forename: Larissa Berloffa
authors.initials: LB
authors.lastname: Belardin
authors.affiliation: Department of Surgery, Division of Urology, Universidade Federal de São Paulo, R Embau, 231, 04039-060, Sao Paulo, SP, Brazil.
authors.forename: Paula Toni
authors.initials: PT
authors.lastname: Del Giudice
authors.affiliation: Department of Surgery, Division of Urology, Universidade Federal de São Paulo, R Embau, 231, 04039-060, Sao Paulo, SP, Brazil.
authors.forename: Mariana
authors.initials: M
authors.lastname: Camargo
authors.affiliation: Department of Surgery, Division of Urology, Universidade Federal de São Paulo, R Embau, 231, 04039-060, Sao Paulo, SP, Brazil.
authors.forename: Paula
authors.initials: P
authors.lastname: Intasqui
authors.affiliation: Department of Surgery, Division of Urology, Universidade Federal de São Paulo, R Embau, 231, 04039-060, Sao Paulo, SP, Brazil.
authors.forename: Mariana Pereira
authors.initials: MP
authors.lastname: Antoniassi
authors.affiliation: Department of Surgery, Division of Urology, Universidade Federal de São Paulo, R Embau, 231, 04039-060, Sao Paulo, SP, Brazil. rbertolla@yahoo.com.|Hospital São Paulo, São Paulo, Brazil. rbertolla@yahoo.com.
authors.forename: Ricardo Pimenta
authors.initials: RP
authors.lastname: Bertolla
authors.affiliation: Department of Surgery, Division of Urology, Universidade Federal de São Paulo, R Embau, 231, 04039-060, Sao Paulo, SP, Brazil.
authors.forename: Agnaldo Pereira
authors.initials: AP
authors.lastname: Cedenho
mesh_terms: D000293:Adolescent; D000328:Adult; D017209:Apoptosis / Q000235:genetics; D049109:Cell Proliferation / Q000235:genetics; D006801:Humans; D007248:Infertility, Male / Q000235:genetics* / Q000473:pathology; D008297:Male; D012661:Semen / Q000502:physiology; D013076:Sperm Count; D013081:Sperm Motility / Q000502:physiology; D013091:Spermatogenesis; D013094:Spermatozoa / Q000473:pathology*; D014646:Varicocele / Q000235:genetics* / Q000473:pathology
keywords: Adolescent; Apoptosis; Seminal plasma; Spermatogenesis; Varicocele