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Testicular function in patients with type 1 diabetes treated with high-dose CY and autologous hematopoietic SCT

Bone Marrow Transplantation volume 47, pages 467–468 (2012)Cite this article

Recently, our group published the results of the first patients with type 1 diabetes treated with autologous hematopoietic SCT (AHSCT).1 AHSCT is an experimental procedure aiming to reverse autoimmune destruction of islet cells in type 1 diabetes mellitus. It was performed in 12–35-year-old patients, less than 6 weeks from diagnosis and positive anti-GAD antibodies. BM hematopoietic stem cells were mobilized with 2 g/m2 CY plus 10 μg/kg/day granulocyte CSF, harvested, cryopreserved and reinfused after conditioning with 200 mg/kg CY plus 4.5 mg/kg rabbit anti-thymocyte globulin. Alkylating agents such as CY are usually associated with deleterious effects upon reproductive function2 and infertility after treatment is a psychosocial burden, as most of the type 1 diabetic patients are young. However, disturbances in reproductive function other than the chronic complications including erectile dysfunction and retrograde ejaculation have received little attention in patients with diabetes.3 We analyzed pituitary-testicular function and sperm characteristics of male patients with type 1 diabetes undergoing AHSCT to evaluate potential impairment of gonadal function before and after treatment.

The data of 13 patients with confirmed type 1 diabetes enrolled into the clinical trial for treatment with AHSCT at the BMT Unit of the School of Medicine of Ribeirão Preto, Brazil, were retrospectively analyzed. Samples were collected before AHSCT and at 12-month intervals. Semen samples were evaluated for seminal volume, sperm count and motility according to the World Health Organization Guidelines. Morphology of spermatozoa was quantified according to Kruger's criteria.4, 5 Plasma follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were determined by immunofluorometric assays (Delfia 80/505, Turku, Finland), and plasma testosterone level was determined by RIA. Serum C-peptide levels were measured during a 2-h mixed-meal tolerance test by RIA using commercial kits (Diagnostic Systems Laboratories Inc., Webster, TX, USA). Glycated hemoglobin A1C (HbA1C) was measured by low-pressure liquid chromatography. Data were analyzed by Kruskal–Wallis test. C-peptide levels were analyzed as area under the curve (AUC). Correlations were analyzed by Spearman correlation test. Statistical significance was set at P<0.05.

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Authors and Affiliations

  1. Department of Medicine, Federal University of São Carlos, São Carlos, Brazil

    A M O Leal

  2. Department of Clinical Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil

    M C Oliveira, C E B Couri, D A Moraes, A-BPL Stracieri, F Pieroni, R D A Soares, G N Barros, B P Simões, M C Foss & J C Voltarelli

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  1. A M O Leal
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  2. M C Oliveira
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  3. C E B Couri
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  4. D A Moraes
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  5. A-BPL Stracieri
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  6. F Pieroni
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  7. R D A Soares
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  8. G N Barros
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Correspondence to A M O Leal.

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Leal, A., Oliveira, M., Couri, C. et al. Testicular function in patients with type 1 diabetes treated with high-dose CY and autologous hematopoietic SCT. Bone Marrow Transplant 47, 467–468 (2012). https://doi.org/10.1038/bmt.2011.113

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