Personalized Signature of Chronic Inflammation and Early Aging Predictive of the Comorbidities in Infertile Men

Study Overview
=================
Brief Summary
-----------------
The aim of the project is identify new biomarkers and/or prognostic factors in order to develop personalized strategies to prevent the onset of tumor and/or non tumor comorbidity in infertile men.

Detailed Description
-----------------
Infertility is a disease of nearly endemic proportions, affecting up to 15% of couples of reproductive ages. Overall, a pure male factor infertility underlies the problem in at least 30% of cases. General health status in infertile men is gaining increasing clinical attention throughout the last decades. Indeed, infertile men were shown to be at increased risk of nononcologic and oncologic morbidity and mortality compared to age-comparable fertile ones. Despite emerging and solid epidemiological studies, the common ground fostering overall health status and male infertility is still far from being understood. Notwithstanding the numerous hypotheses that have been considered to explain the potential link overall men's health status and male infertility - e.g., including genetic, endocrinological, and metabolic abnormalities - the exact nature of these associations remains unclear. Recent clinical findings showed evidence of onset of age-related comorbidities 10-15 years earlier in infertile compared to fertile men. Single-cell transcriptome profiling of testes of men with idiopathic germ cell aplasia revealed an immature testis with a somatic environment stuck at puberty with immaturity of Leydig cells associated with chronic tissue inflammation, fibrosis, and senescence phenotype of the somatic cells, as well markers of chronic inflammation in the blood. Compelling evidence indicate that defects in the regulatory arms of the immune system and metabolic status can be associated with the risk of developing numerous oncological and non-oncological diseases. Thus far, limited reliable data on the immunological status of infertile men are available. Preliminary data from the coordinating group of the project revealed increased pro-inflammatory cells and reduced T cells in peripheral blood of infertile men. Moreover, the few T cells observed in infertile men displayed an exhausted phenotype. The investigators proposed an innovative multidisciplinary approach to identify causal links between infertility as a disease and chronic inflammation and comorbidities. Moreover, the investigators aim at identifying novel prognostic biomarkers/tools toward the development of tailored prevention strategies of severe comorbidities in infertile men. They will combine extensive clinical data of a unique and homogenous cohort of infertile men and controls with state-of-the art transcriptomic approaches, a comprehensive monitoring and functional characterization of adaptive and innate immune cells, and the endocrine-metabolomic signature of men with primary infertility. The success of our strategy will be instrumental for defining novel molecular causes of male infertility, along with the pathophysiological mechanism behind the higher burden of comorbid conditions. Results will provide information on cell compartments, and the senescent and endocrine status, mostly in men with primary idiopathic infertility, and new insights into the etiology responsible for the early onset of comorbidities in infertile men. This will represent a breakthrough in the infertility field and a major advancement towards better caring of male patients and healthy ageing in the real-life setting and will set the stage for the development of more tailored clinical approaches to prevent malignant and nonmalignant comorbidities in infertile men. Thereof, the findings of the research project will have a significant rebound in terms of cost-effectiveness on the national health system.

Official Title
-----------------
Definition of a Personalized Signature of Chronic Inflammation and Early Aging Predictive of the Development of Comorbidities in Infertile Men

Conditions
-----------------
Male Infertility

Intervention / Treatment
-----------------
* Other: Collection of clinical and biological material


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Age > 18 and < 50 years; White race Men with OAT o iNOA infertility diagnosis ability to sign the consent information Exclusion Criteria: inability to sign the consent information secondary infertility diagnosis history of hematological diseases people treated with antibiotics in the six months prior the enrollment

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
-----------------
Male

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Infertile men<br>Men with infertility | Other: Collection of clinical and biological material<br>* Collection of clinical and biological material (e.g., samples of semen, stool, urine, blood, buccal swab)<br>|
| Fertile men<br>Fertile men | Other: Collection of clinical and biological material<br>* Collection of clinical and biological material (e.g., samples of semen, stool, urine, blood, buccal swab)<br>|
| Oncologic patients<br>Patients with kidney, bladder, chest, or pancreas tumors | Other: Collection of clinical and biological material<br>* Collection of clinical and biological material (e.g., samples of semen, stool, urine, blood, buccal swab)<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Endocrine-metabolomic parameters | Endocrine-metabolomic parameters from blood samples: Sex Hormone Binding Globulin (SHBG), 17 beta estradiol (E2), Follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, thyroid-stimulating hormone (TSH), inhibin B, Anti-Muller Hormone (AMH), Glucose 6-phosphate Dehydrogenase (G6PD), parathyroid hormone (PTH), Vitamine D, blood glucose test, osteocalcin, Prostate Specific Antigen (PSA), albumin. | Baseline | 
| Functional characterization of immune cells | We will assess: presence and frequency of different myeloid and lymphoid populations through a multi-color flow cytometry the ability of Cluster of Differentiation CD4+ cells and of Cluster of Differentiation CD8+ T cells to proliferate and secrete cytokines in response to anti-Cluster of Differentiation CD3 monoclonal antibodies the presence and concentration of cytokines and chemokines in the other leucocyte populations Depth T cell compartments through a single cell RiboNucleic Acid-sequencing analysis | Baseline | 
| Clinical data | We will collect: Clinical andrological and medical data through the physician's assessment Body Mass Index (BMI) waist circumference a spermiogram analysis: the presence, the number, the motility, and the shape of spermatozoa | Baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Immunological outcomes | We will assess: the activation of the inflammasome IL-1ß/IL-18 release in response to Toll-like receptors stimulation through Enzyme-Linked Immunosorbent Assay the expression of CASP1, NLRP3, AIM2, NLRC4, ASC, and IL1B genes through real-time PCR (polymerase chain reaction) We will assess: the activation of the inflammasome IL-1ß/IL-18 release in response to Toll-like receptors stimulation through Enzyme-Linked Immunosorbent Assay the expression of CASP1, NLRP3, AIM2, NLRC4, ASC, and IL1B genes through real-time polymerase chain reaction (PCR) | Baseline | 
| Senescence biomarkers | We will assess: senescence markers mutations in a well-defined set of genes associated with normal ageing | Baseline | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Infertility, Male Infertility, Comorbidity, Andrology, Immuno-epidemiology, Environmental factors, Genetic factors