oncofertility: the story of the spermatogonial stem cellspermatogonial stem cell (ssc) (measure gene...
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Oncofertility: The Story of the
Spermatogonial Stem Cell
James M. Hotaling, MD MS FECSM
Co-director Fertility Integrated Practice Unit
Asst. Prof of Surgery(Urology) Adjunct Asst. Prof OBGYN
University of Utah
Disclosures: Nanonc, StreamDx, Andro360
1R01HD082062-01, 1R01HD78641 , HHMI (PI: Brad Cairns)
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Sperm Cryopreservation• Patients are now commonly requesting sperm
extractions from terminally ill cancer patients
• 16 yo with lymphoma, intubated in ICU
• This is not the ideal time to think about banking…
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Overview• Cancer treatment and reproduction
• Focus on chemotherapy NOT XRT, surgery
• Spermatogonial stem cells, population health and the future
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Background• 20,000 reproductive age men treated annually
• Focus on Quality of Life after treatment
• ASCO Guidelines: Offer Sperm Banking!
• No such thing as “non-toxic” chemotherapy, many infertile after treatment (24% azoospermic)
Osterberg et al. Urology Annals 2014, Geneseca et al Cancer Genet cytogenet 1990, Lee et al. JCO 2006.
Jahnukainen et al. Best Prac Clin metab 2011, Agarwal et al. Fert Ster 2004, Lopez Ped Hem ONC 2004,
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Sperm Banking• Can bank only 1 sperm and use for ICSI
• Lose 50-60% sperm with freeze-thaw, can freeze indefinitely
• Need >5M motile sperm post thaw for IUI
• OncoTESE cryopreservationIVF
Nangia et al. Fert Ster 2013, Hone et al. Hum Reprod 2004,
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Pretreatment Semen Quality
Cancer Type Oligozoospermia
(%)
Testicular 28
Hodgkin’s lymphoma 25
Leukemia 57
Gastrointestinal 33
Chung, et al. Eur J Obstet Gynecol Reprod Biol. 2004; 113: S7-11.
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Improving Cryopreservation
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“Onco-TESE”
• Testicular sperm extraction in an
azoospermic men with cancer
– Approximately 50% recovery rate
• Prepubertal boys prior to treatment
– Cryopreservation of immature testicular
tissue
– Future use for stem cell spermatogonia?
Schrader M, et al. Urology. 2003;61:421-425, Keros V, et al. Hum Reprod. 2007; 22:1384-1395, Aslam I, et al.
Hum Reprod. 2000;15:2154-2159, Furuhasi et al. Andrologia 2013,
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Congenital Anomalies in Offspring
• 2-3% incidence of congenital anomalies
in general population
• Similar rates in offspring of cancer
survivors
• No risk of de novo cancer in progeny
Li et al. JCI, 1979.
Byrne et al. Am J Hum Genet, 1998.
Boice et al. Health Phys, 2003.
Green et al. JCO, 2009.
Healthy offspring
can be expected
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Key Data Sources Comprising the Utah Population Database
UDOH: Utah
Department of Health
- Vital Records
(Birth, Death, Fetal
Death) and Medical
(Inpatient Discharge
and Ambulatory
Surgery)
UUHSC: University of
Utah Health Sciences
Center
IH: Intermountain
Healthcare
UCR: SEER Utah
Cancer Registry
CDRI: Cancer Data
Registry of Idaho
GSU: Genealogical
Society of Utah
DLD: Driver’s
License Division
Cohort N
Subfertile 39,480
Relatives of Subfertile Individuals 274,190
Historical Subfertile Individuals(married, with complete fertility information born
between 1910 -1925, verified nulliparity)
10,614
Children of IVF/ICSI/IUI 14,372
Fertile Controls(age and SES matched)
50,000
Biobank specimens
(linked to UPDB)
7,000(>700 azoospermic, banking 15-20
testicular tissue specimens monthly and
>50 sperm samples monthly)
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Cancer in relatives of infertile men
• 13k men with semen analysis and fertile
controls with 80k siblings, 435k cousins.
• Oligozoospermia 2x increased risk of
any childhood cancer in sibs NOT cousins
• Are people predisposed to cancer
predisposed to infertility?
12Anderson et al, J. Urol, accepted
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Fertility?
Embryogenesis Quality?
Risk to offspring?
Are the sperm relevant?
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Lamarckian Evolution & Chemo• Mice taught to fear an
odor, both their
offspring and the next
generation are born
fearing it.
• Gene for an olfactory
receptor activated by
the odor demethylated
in the germ line
14
Dias Nat Neurosci 2014
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Germline stem cell therapy
Kubato & Brinster 2006
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Unipotency(normally, only make sperm)
Pluripotency
‘Latent' Pluripotency(evidence: germ cell tumors, GPSCs)
Heterogeneous
Pluripotency versus Unipotency
pluripotent
Profile RNA, DNAme, nucleosomes (+chemical marking/mod)
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Loss of germ cell identity after culture
Zheng et al., 2014
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Mouse vs. human SSC development
Shinaohara, 2013; Valli et al., 2014
Thy1+
Kit+
SSEA4+
Kit+
Adult
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Novel Signaling Pathways in Human SSCs
Guo, Carrell, Hotaling & Cairns, submitted to Cell
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Goals1. Understand Identity, Pluripotency,
and Differentiation of Human
Spermatogonial Stem Cell (SSC)
(measure gene expression, signaling,
and chromatin)
2. Define human SSC
culture, and use
molecular and genetic
tools to further Goals #1
and #3.
3. Understand how germ cell
tumors form, and how infertility
might be treated?
Dmrt1
Kit
Kras
Cdc27
SSC
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Conclusions
• Cancer diagnosis sperm banking offered
• There is no fertility friendly chemo
• Impact of chemo is likely transgenerational
• Future of the field lies in culturing
spermatogonial stem cells