|
Inma
Castilla-Cortázar, Nieves Diez, María García-Fernández, Fernando
Diez-Caballero, Matías Díaz-Sánchez, Department of Human
Physiology, University of Navarra, Pamplona, Navarra, Spain
Jorge Quiroga, Jesús Prieto, Department of Internal
Medicine, Liver Unit, University of Navarra, Pamplona, Navarra,
Spain
Inma Castilla-Cortázar, María García-Fernández, Juan Enrique
Puche, Amelia Díaz Casares, Salvador González-Barón,
Department of Human Physiology, School of Medicine, University of Málaga,
Malaga, Spain
Alberto Castilla, Department of Internal Medicine, Hospital
Sierrallana, Tollelavega and School of Medicine, University of the
Basque Country-Vitoria-Gasteiz, Spain
Isabel Varela-Nieto, Instituto de Investigaciones Biomédicas
“Alberto Sols”, Consejo Superior de Investigaciones
Cientificas-Universidad Autónoma de Madrid (CSIC-UAM), Madrid,
Spain
Supported by the Spanish Program I+D, SAF 99/0072 and SAF
2001/1672
Correspondence to: Inma Castilla-Cortázar, MD, PhD,
Department of Human Physiology, School of Medicine, University of Málaga,
Campus Teatinos 29080, Málaga, Spain.
iccortazar@uma.es
Telephone: +34-952131577
Fax: +34-952131650
Received: 2004-02-06
Accepted: 2004-03-04
Abstract
AIM: The pathogenesis of hypogonadism in liver cirrhosis is not
well understood. Previous results from our laboratory showed that
IGF-1 deficiency might play a pathogenetic role in hypogonadism of
cirrhosis. The administration of IGF-1 for a short period of time
reverted the testicular atrophy associated with advanced
experimental cirrhosis. The aim of this study was to establish the
historical progression of the described alterations in the testes,
explore testicular morphology, histopathology, cellular
proliferation, integrity of testicular barrier and hypophyso-gonadal
axis in rats with no ascitic cirrhosis.
METHODS: Male Wistar rats with histologically-proven cirrhosis
induced with carbon tetrachloride (CCl4) for 11 wk, were
allocated into two groups (n = 12, each) to receive
recombinant IGF-1 (2 mg/100
g.d, sc) for two weeks or vehicle. Healthy rats receiving vehicle
were used as control group (n = 12).
RESULTS: Compared to controls, rats with compensated cirrhosis
showed a normal testicular size and weight and very few
histopathological testicular abnormalities. However, these animals
showed a significant diminution of cellular proliferation and a
reduction of testicular transferrin expression. In addition,
pituitary-gonadal axis was altered, with significant higher levels
of FSH (P<0.001 vs controls) and increased levels of LH in
untreated cirrhotic animals. Interestingly, IGF-1 treatment
normalized testicular transferrin expression and cellular
proliferation and reduced serum levels of LH (P = ns vs
controls, and P<0.01 vs untreated cirrhotic group).
CONCLUSION: The testicular barrier is altered from an early stage of
cirrhosis, shown by a reduction of transferrin expression in Sertoli
cells, a diminished cellular proliferation
and an altered gonadal axis. The treatment with IGF-1 could be also
useful in this initial stage of testicular disorder associated with
compensated cirrhosis.
Castilla-Cortázar I,
Diez N, García-Fernández M, Puche JE, Diez-Caballero F, Quiroga J,
Díaz-Sánchez M, Castilla A, Casares AD,
Varela-Nieto I, Prieto J,
González-Barón S. Hematotesticular barrier is altered from early
stages of liver cirrhosis: Effect of insulin-like growth factor 1.
World J Gastroenterol 2004;
10(17): 2529-2534
http://www.wjgnet.com/1007-9327/10/2529.asp
INTRODUCTION
Hypogonadism (characterized by low testosterone levels and
relative hyperestrogenism, loss of libido, sexual impotence and
feminine body features in men) is a common complication of advanced
liver cirrhosis[1]. Previous data demonstrated that rats
with advanced cirrhosis showed reduced testicular size and weight
and severe histopathological testicular abnormalities, including
reduced tubular diameters, loss of the germinal line, and
diminutions in cellular proliferation and spermatogenesis and
testicular transferrin expression, a good marker of the integrity of
blood-testis barrier[2]. In addition, low serum
testosterone and high serum LH were present in cirrhotic animals, as
well as decreased levels of serum IGF-1. Interestingly, the
administration of IGF-1 at low doses for a short period of time
reverted the testicular atrophy and improved the altered
pituitary-testicular axis in these animals[2]. In
cirrhotic patients, hypogonadism has been attributed to a variety of
mechanisms including gonadal toxicities of alcohol, malnutrition and
increased production of estrogens from androgens in peripheral
tissues due to the existence of portal systemic shunting[3-9]
.
Insulin-like growth factor-1 (IGF-1) is an anabolic hormone
produced in different tissues although the liver accounts for 90% of
the circulating hormone, which is synthesized in response to growth
hormone (GH) stimulation[10,11]. In cirrhosis the
reduction of receptors for GH in hepatocytes and the diminished
synthesizing ability of the liver parenchyma caused a progressive
fall of serum IGF-1 levels[11-14]. Although in an early
stage of cirrhosis serum levels of IGF-1 were normal, its
bio-availability seemed to be diminished[15]. The
clinical impact of the reduced production or availability of IGF-1
in cirrhosis was largely unknown[11-14]. Recent studies
from our laboratory have demonstrated that short courses of
treatment with low doses of IGF-1 were able to induce marked
improvements in nutritional state[15], nitrogen retention[16],
intestinal absorption[17-19], osteopenia[20,21],
liver function reducing fibrogenesis[22,23], and restore
the reduced somatostatinergic tone[24] in rats with experimental
cirrhosis. These data suggest that IGF-1 deficiency plays a
pathogenetic role in several systemic complications occurring in
cirrhosis.
It is well known that IGF-1 stimulates testosterone
synthesis and spermatogenesis[25-32]. Its deficiency
could contribute to the development of hypogonadism associated with
cirrhosis as the previous data supported[2]. Since the
pathogenesis of hypogonadism in cirrhosis is not yet well
understood, the aim of the present study was to study the
chronological progression of the described alterations in testes[2]
in advanced cirrhosis, explore testicular morphology, histopathology,
cellular proliferation, integrity of testicular barrier and
hypophyso-gonadal axis in rats with cirrhosis in an early stage,
without ascites.
MATERIALS
AND METHODS
Induction of liver cirrhosis
All experimental procedures were performed in conformity
with The Guiding Principles for Research Involving Animals[33].
Cirrhosis was induced as previously described[15,16].
Briefly, male Wistar rats (3-week-old, 130-150 g) were subjected to
CCl4 inhalation (Merck, Darmstadt, Germany) twice a week for 11 wk
with a progressively increasing exposure time from 1 to 5
min. During the whole period of cirrhosis induction animals received
Phenobarbital (Luminal, Bayer, Leverkusen, Germany) in the drinking
water (400 mg/L). Both food (standard semipurified diet for rodents;
B.K. Universal, Sant Vicent del Horts, Spain) and water were given
ad libitum. Healthy, age and sex-matched control rats were
maintained under the same conditions but receiving neither CCl4
nor Phenobarbital.
Study
design
The treatment was administrated for 2 wk after stopping of
CCl4 exposure. In the morning of d 0, animals were
weighed and blood samples were drawn from the retroocular venous
plexus from all rats with capillary tubes (Marienfeld, Germany) and
stored at -20 °C until used for
analytical purposes. Cirrhotic rats were randomly assigned to
receive either vehicle (saline) (group CI, n = 12) or
recombinant human IGF-1 (Pharmacia-Uppsala, Sweden) (2 mg/100
g.d in two divided doses, subcutaneously) (group CI+IGF, n =
12) for two weeks. Control rats (group CO, n = 10) received
saline during the same period.
In the morning of the 15th d, rats were weighed,
blood was obtained from the retroocular plexus and animals were
killed by decapitation. After the abdominal cavity was opened, the
liver and testes were dissected and weighed. Samples from the left
major liver lobe and testes were processed for histological
examination (fixed in Bouin’s solution). The testicular diameters
(AP and LM) were measured using a precision calliper, Mituyotoâ
(±0.05
mm). Ascites was ruled out by direct exploration of abdominal cavity
in all cirrhotic animals.
Liver
histopathology
Bouin-fixed tissues were processed and sections (4-mm)
were stained with Haematoxylin and Eosin and Masson’s trichrome.
Livers were scored (1 to 4) as previously reported[15,22].
Preestablished criteria for inclusion of cirrhotic (CI) animals in
the final analysis were the presence of: (1) altered baseline
biochemical data of liver function; and (2) in retrospect,
histologically proven liver cirrhosis (scores 3 or 4 of the
classification) in CCl4-treated-animals. All animals had
compensated cirrhosis without ascites.
Testicular histopathology and PCNA and transferrin
immuno-histochemistry
For
histopathological evaluation of testes, 30 seminiferous tubules from
each rat of the three groups were blindly evaluated by two observers
and the arithmetic mean of the scores was taken as the final result.
Transverse sections of seminiferous tubuli were examined and
evaluation of histological changes was made using a light projection
microscope (Micro Promar Leitz GMBH, Wetzlar, Germany) at 150× magnification. The following parameters were studied: tubular
diameter, quantitation of the presence of different types of cells
in tubuli, presence of peritubular fibrosis, and the number of
proliferating cells. For general purposes haematoxylin & eosin
stain and Masson’s trichrome stain were used. Specific techniques
for other purposes are specified in the corresponding paragraphs.
Changes in tubuli were classified into 5 categories (Category
I: highest damage to Category V: full normality). Category I:
presence of only Sertoli cells; category II: Sertoli cells plus
spermatids; category III: Sertoli cells, plus spermatides, and
spermatocytes; category IV: presence of all kinds of cells but
showing some morphological alterations (i.e.: severe vacuolization,
aberrant cells); category V: presence of all kinds of cells without
morphological alterations. The presence of peritubular fibrosis was
evaluated in Masson’s trichrome preparations according to the
thickness of the staining of collagen deposition surrounding tubuli.
Proliferating cells were identified by immunostaining of
proliferating cellular nuclear antigen (PCNA) using an avidin-biotin
peroxidase method[34] with retrieval of antigen by means
of microwave irradiation. Specific anti-PCNA antibody (mouse anti-PCNA,
clone PC 10, DAKO, Denmark) biotinylated rabbit anti-mouse IgG (DAKO,
Denmark) were used and the avidin-biotin complex technique (ABC,
DAKO kit) was performed. The bound antibodies were visualized by
means of 3,3’-diaminobenzidine tetrahydrochloride (Sigma Chemical
Company, St. Louis, MO) with nickel enhancement[34].
Finally, samples were slightly counterstained (10 s) in hematoxylin,
dehydrated, and mounted in DPX. Controls were performed by
substitution of the primary antibody by TBS. The number of PCNA
positive cells was recorded. The result was expressed as stained
cells per tubuli (arithmetic mean of 30 screened tubuli).
In addition, the expression of transferrin[35] in
tubuli was evaluated by immunostaining using similar technique as
for PCNA with specific anti-transferrin antibody (obtained from
rabbit, RARa/TRf, Nordic Immunological Laboratories, Teknovas, The
Netherland). Transferrin expression was scored from 0 to 4 points.
If 30 tubuli expressed transferrin normally all over the germinal
epithelium, it was scored 0 points. The remaining scores were
obtained according to the following formula: (30-tubuli showing
expression of transferrin all over the germinal epithelium) ×0.075.
Analytical
methods
Serum levels of albumin, total proteins, glucose,
cholesterol, bilirubin, alkaline phosphatase, transferrin and
aminotransferases (AST and ALT) were determined by routine
laboratory methods using a Hitachi 747 autoanalyzer (Boerhringer-Mannheim,
Germany). Serum levels of the different hormones were assessed by
RIA in a GammaChen 9612 Plus (Serono Diagnostics, Roma, Italy) using
specific commercial assay systems: total and free testosterone and
estradiol-6, Coat-a-Count, DPC (Diagnostic Products Corporation, Los
Angeles, CA); rat luteinizing hormone (rLH) and rat follicle
stimulating hormone (rFSH) from Amersham International Plc (Little
Chalfont Buckinghamshire, England HP7 9NA); IGF-1 by extraction
(Nichols Institute Diagnostics, San Juan Capistrano, CA, USA).
Lipid peroxidation assessment of testicular homogenates
Malondyaldehyde (MDA) was assessed after heating samples at
45 °C for 60 min in acid
medium. It was quantitated by a colorimetric assay using LPO-586 (Bioxytech;
OXIS International Inc., Portland, OR, USA), which after reacting
with MDA, generated a stable chromophore that could be measured at
586 nm (Hitachi U2 000 Spectro; Roche).
Statistical analysis
Data are expressed as mean±SE. To assess the homogeneity
between the three groups of rats a Kruskall-Wallis test was used,
followed by multiple post-hoc comparisons using Mann-Withney U tests
(two tailed) with Bonferroni adjustment. A regression model was
fitted considering histopathological score, PCNA or transferrin
expression scores and IGF-1 plasma concentration as the dependent
and independent variables respectively. Within group differences
between pre-and post-treatment values were assessed by means of
Wilcoxon matched pairs signed rank sum test. Any P value less than
0.05 was considered to be statistically significant. Calculations
were performed by SPSS Win v.6.0. program.
RESULTS
At baseline, CI groups showed abnormal values compared to
controls (CO) in serum levels of alanine aminotransferase (CO = 26±2;
CI = 273±49 IU/L, P<0.01), aspartate aminotransferase (CO
= 55±5; CI = 297±49 IU/L, P<0.001), cholesterol (CO = 82±4;
CI = 115±5 mg/dL, P<0.05), alkaline phosphatase (CO = 310±43;
CI = 701±146 IU/L, P<0.05),
bilirubin (CO = 0.4±0.0; CI = 1.2±0.3 mg/dL, P<0.05),
total proteins (CO = 6.9±0.1; CI = 6.4±0.2 g/dL, P<0.05)
and albumin (CO = 3.6±0.1; CI = 3.1±0.2 g/dL, P<0.05).
No differences were found between cirrhotic groups.
At
the end of the experimental period, all rats from groups CI and
CI+IGF showed established cirrhosis (mixed micro-macronodular
cirrhosis in liver histopathology) with some signs of portal
hypertension (spleen weight, g, CO = 0.8±0.0; CI = 1.4±0.2; CI+IGF
= 1.4±0.1, P<0.001 both cirrhotic groups vs controls).
Ascites was absent in all of the cirrhotic animals.
Testicular
morphology and morphometry
The testicular size and volume were normal in the cirrhotic
groups as compared to controls. Morphometric study showed reduction
in testicular weight (in absolute values but not if it was corrected
by body mass) in untreated cirrhotic group as compared to controls
and CI+IGF group. Findings regarding longitudinal and transverse
testicular diameters were similar to those in testicular weight.
Morphometric data in the three groups are summarized in Table 1.
Testicular
histopathology
Figure 1 shows testicular morphology in the three
experimental groups. Testicular histological section of normal rat
(CO) demonstrated active spermatogenesis in normal-size seminiferous
tubuli with thin basement membranes and minimal peritubular
fibrosis. Leydig cells were scarce, being widely separated by
seminiferous tubuli. No evidence of peritubular fibrosis and other
alterations was found in cirrhotic groups. Cellular analyses (see
Methods) in 30 seminiferous tubuli were performed in each
preparation and summarized in Table 2. No relevant findings were
obtained in this morphologic study.
Testicular cellular proliferation, as evaluated by PCNA[35],
was significantly reduced in CI rats while CI+IGF rats showed values
similar to controls (CO: 66±2, CI: 57±1, CI+IGF: 61±1, P<0.001
untreated cirrhotic group vs controls and P<0.05 CI+IGF vs
controls and CI group). Figure 2 shows PCNA immunohistochemistry (PCNA+cells)
in the three groups.
Testicular
transferrin, a marker of the integrity of hemato-testicular barrier[36-38],
was evaluated from 0 to 4 points by immunohistochemistry in
testicular slices (see Methods). Transferrin expression was
decreased in CI rats (3.40±0.03 points, P<0.001 vs CO and
CI+IGF groups) as compared to controls (3.98±0.04 points) and to
cirrhotic rats receiving IGF-1 (3.76±0.05 points). Figure 3 shows
transferrin expression in the three experimental groups.
Testicular
levels of MDA in order to study the likely direct damage of CCl4
to testes, MDA levels, an index of lipid peroxidation[39],
were assessed in testicular homogenates. No differences were
found between the three experimental groups in testicular MDA
content (nmoL/mg protein, CO = 9.1±0.8, CI = 13.0±3.2, CI+IGF =
8.9±1.6).
Pituitary-gonadal
axis
Serum levels of sexual hormones are summarized in Table 3.
No significant differences were found between groups, either in
total and free testosterone, or estradiol, or in the ratio of
estradiol/testosterone. However, a significant increase of FSH (P<0.001
vs controls) and also high levels of LH (P = 0.06 vs
controls) were observed in untreated rats with compensated
cirrhosis, suggesting an altered negative feed-back since this early
stage of the cirrhosis. On the other hand, LH concentrations were
moved towards normal values in IGF-1 treated cirrhotic group (P =
ns vs controls, and P<0.01 vs untreated cirrhotic rats).
Serum levels of IGF-1
At the time of animal sacrifice (d 15), no significant
differences between the three groups were found in serum levels of
IGF-1 (CO: 1030±67, CI: 1165±58, CI+IGF: 1030±38 ng/mL), similar
to those described previously in early stage of cirrhosis[16-18,24].
Table
1 Body mass and
parameters of testicular size and weight in the three experimental
groups (d 15)
| |
Healthy
control rats (CO,
n = 12) |
Untreated
cirrhotic rats
(CI, n = 12) |
Cirrhotic
rats treated with IGF-1
(CI+IGF, n=12) |
| Body
mass (g) |
545.0±1.0 |
460.0±1.0d |
458.0±9.0d |
| Right
testis (g) |
2.0±0.0 |
1.6±0.1d |
1.7±0.1d |
| (×100
g/bm) |
(0.4±0.0) |
(0.3±0.0) |
(0.4±0.0) |
| External
testicular diameters (mm) |
|
|
|
| •
Longitudina |
20.4±0.26 |
18.56±0.22d |
18.37±0.34d |
| •
Transversal |
10.3±0.24 |
9.41±0.23b |
9.64±0.14a |
aP<0.05;
bP<0.01;
dP<0.001
vs CO group.
Table
2 Cellular
analysis: Thirty seminiferous tubuli were examined in each
preparation. The table summarizes the number of tubuli in each
category: category I, only Sertoli s cells; category II,
I+spermatids; category III, II+spermatocytes; category IV, all types
of cells but with some alterations; category V, all types of cells
with normal features
| Category |
I |
II |
III |
IV |
V |
| Controls
(CO) (n = 10)×30 tubuli |
0 |
0 |
0 |
2 |
298 |
| Untreated
cirrhotic rats (CI) (n = 10)×30 tubuli |
0 |
0 |
5 |
20 |
275 |
| IGF-treated
cirrhotic rats (CI+IGF) (n = 10)×30 tubuli |
0 |
0 |
0 |
8 |
29
2 |
| Statistical
analysis (P) |
ns |
ns |
ns |
aP<0.05 |
ns |
aP<0.05,
CI vs CO group.
Table
3 The pituitary-gonadal
axis (on d 15) in the three experimental groups
| |
Healthy
control rats (CO, n = 12) |
Untreated
cirrhotic rats (CI, n =
12) |
IGF-1-treated
cirrhotic rats (CI+IGF,
n = 12) |
| Total
testosterone (ng/dL) |
62±13 |
77±17 |
64±7 |
| Free
testosterone (pg/mL) |
0.36±0.09 |
0.36±0.10 |
0.41±0.05 |
| Estradiol
(pg/mL) |
31±2 |
33±2 |
29±1 |
| Estradiol/Total
testosterone |
0.5±0.1 |
0.5±0.1 |
0.6±0.1 |
| LH
(ng/mL) |
4.8±0.6 |
6.0±0.5 |
3.8±0.7d |
| FSH
(ng/mL) |
22±8 |
27±1f |
26±4b |
bP<0.01CI+IGF
vs CO group; dP<0.01
CI+IGF vs CI group;
fP<0.001 CI vs CO group.
Figure 1 Microscopy
of testes (×150 magnification, Masson’s stain). Testicular
histological sections of normal rat (CO) demonstrated active
spermatogenesis in normal-size seminiferous tubuli with thin
basement membranes and minimal peritubular fibrosis. Leydig cells
were scarce, being widely separated by seminiferous tubuli. No
evidence of peritubular fibrosis and other alterations were found in
testes from cirrhotic animals. A:
B: C:
Figure 2 Study
of proliferative activity, assessed by PCNA immunostaining. A
significant reduction of cellular proliferation were observed in
rats with compensated cirrhosis. This reduction was normalized in
IGF-1 treated cirrhotic group (CI+IGF). (×200 magnification, in the
three pictures). A:
B: C:
Figure
3
Immunohistochemistry for testicular transferrin in seminiferous
tubuli. Transferrin immunostaining was observed at the level of
Sertoli cells and in germ cells in normal rats (CO) and in cirrhotic
rats treated with IGF-1 (CI+IGF) but a lower or absent transferrin
immunostaining was observed in several tubuli of untreated cirrhotic
rats (CI) (score, CI: 3.40±0.03,
CO: 3.98±0.04,
CI+IGF-1: 3.76±0.05).
A:
B: C:
DISCUSSION
This study demonstrates that rats with compensated CCl4-induced
cirrhosis show some testicular alterations and gonadal dysfunction,
from early stages of liver cirrhosis. The main finding of this study
is that there is an altered hemato-testicular barrier, probably
responsible for the reduction of cellular proliferation, as well as
a paradoxical response of pituitary-testicular axis.
The occurrence of testicular atrophy and gonadal dysfunction
in advanced cirrhosis is a well known clinical event[1,3-9].
Both testicular histopathological abnormalities and low levels of
serum testosterone have been described in patients with alcoholic
and nonalcoholic cirrhosis several years ago[3-9].
Previous experimental data[2] showed that severe
testicular atrophy and gonadal insufficiency treated with low doses
of IGF-1 recovered to normal in a very short time (21 d). Data
regarding experimentally induced cirrhosis are, however, scarce. Our
previous data showed a severe testicular damage[2] as
manifested by macroscopic testicular atrophy and a variety of
histopathological abnormalities including a reduction in tubular
diameters, presence of aberrant cells in tubular lumen, peritubular
fibrosis, loss of the germinal line and a marked reduction in
cellular proliferation. These alterations resembled those found in
necropsic studies in alcoholic cirrhotics[1] and those
reported in experimental models of testicular damage such as chronic
testicular ischemia[35].
The
mechanisms responsible for the described alterations are not fully
understood, although the relationship between IGF-1 deficiency and
testicular damage in cirrhosis was demonstrated in the mentioned
work[2]. In cirrhotic rats included in the current work,
no IGF-1 deficiency was present but there was a reduced availability
of this hormone as it has been suggested previously[16-18,22].
Moreover, we have previously demonstrated that the changes induced
by cirrhosis in the serum profile of IGF-1 binding proteins further
reduce bio-availability of IGF-1 in cirrhotic rats[16].
In fact, exogenous administration of IGF-1 was able to reverse
several abnormalities (decreased food utility and intestinal
absorption of nutrients, and somatostatinergic tone and osteopenia)
associated with cirrhosis in animals with normal serum levels of
this hormone[16-20,22-24].
On
the other hand, a direct effect of IGF-1 on testes seemed to be the
most important factor to explain previous findings[2].
This idea is supported by the existence of receptors for IGF-1 in
Sertoli cells, germ cells and Leydig cells[25-27] and by
findings demonstrating a direct effect of IGF-1 on testes[27-31].
Since IGF-1 is a well recognized trophic factor for testis, its
deficiency could be a contributing factor to testicular damage in
cirrhosis.
The
present work was designed in order to gain more insights into the
mechanisms involved in the pathogenesis of hypogonadism associated
with liver cirrhosis. In fact, many factors that have been involved
in this process, such as portal systemic shunting[1,39,40] or
undernutrition[1,41] were minimized in this early stage
of the liver disease. Specifically, this study was targeted to
establish the historical progression of the described testicular
alterations[2].
The
blood-testis barrier is considered nearly as specific as the
blood-brain barrier[42]. Although all cells require irons
from serum transferrin produced by hepatocytes, cells that create a
blood barrier such as Sertoli cells in the testis and choroid plexus
epithelium in the brain also express the transferrin gene to provide
irons to cells sequestered within the serum-free environment.
Testicular transferrin expression was a good marker of the integrity
of the hemato-testicular barrier[36,37].
A major finding of this work was that transferrin expression
by Sertoli cells was reduced in untreated cirrhotic rats. The
medical bioavailability of IGF-1 could be due to the mechanism of
testicular transferrin reduction. IGF-1 treatment increased the
expression of this protein in Sertoli cells of cirrhotic rats
(Figure 3). This possibility seemed to be plausible since several
metabolic functions of Sertoli cells were also influenced by IGF-1[32,43-45].
Interestingly, the recovery of transferrin expression in Sertoli
cells observed in our study suggested a role for IGF-1 in
maintaining the integrity of the hematotesticular barrier[2,33-38].
The
first step of the pathogenesis of testicular atrophy occurring in
advanced cirrhosis seems to be the decreased expression of
transferrin, showing a dysfunction of Sertoli cells and consequently
the disruption in blood-testis barrier integrity. Therefore, the
observed reduction of cellular proliferation finally affecting
spermatogenesis[2,46] would be its logical consequence.
A
question arises as to whether direct toxicity of CCl4 on
testicular tissue could contribute to testicular injury. Alcohol was
known to produce oxidative damage and to be able to pass across
testicular barrier[47,48]. This toxic possibility has
been reasonably ruled out by the presence of similar levels of MDA,
a marker of lipid peroxidation[39], in testicular
homogenates from the three experimental groups. Certainly, a slight
increase of testicular MDA was found in untreated cirrhotic rats,
but this did not reach statistical significance.
In
the early stage of cirrhosis, testosterone levels were normal.
However, both FSH and LH were increased in untreated cirrhotic
animals. This abnormal response of the negative feedback could be an
initial hormonal reaction of primary hypogonadism. In advanced
stages of cirrhosis, we found increased levels of serum LH
associated with a significant reduction of total and free serum
testosterone defining a picture of primary hypogonadism, thus ruling
out hypothalamic-pituitary dysfunction as the responsible mechanism[2].
Interestingly, LH levels were reduced by IGF-1 treatment in this
series with compensated cirrhosis and an incipient gonadal
dysfunction. The significant increase of FSH could be related to the
observed reduction of cellular proliferation in cirrhotic rats.
Since a close relationship has been reported between IGF-1 and
gonadotropins[49-51], our findings require further
investigation.
In
summary, this study shows an altered hemato-testicular barrier from
an early stage of cirrhosis and suggests that the reduction of IGF-1
bioavailability may play a critical role in the beginning stage of
testicular damage and hypogonadism associated with liver cirrhosis.
In addition, these results support the conclusion that the exogenous
administration of IGF-1 may be useful for the treatment of
testicular alterations in cirrhotic patients.
ACKNOWLEDGEMENTS
The authors wish to express their gratitude to Dr. Bruce
Scharschmidt, Chiron, for generously granting the rhIGF-1 used in
this study. We are as well deeply indebted to the "Real
Academia de Medicina de Cataluña" (Barcelona) and
Mrs.C.Alonso-Borrás and Mr. J. Celaya for financial collaboration.
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