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Resveratrol in Human Male Fertility: Comparison
Please note this is a comparison between Version 2 by Camila Xu and Version 1 by Laura Maria Mongioì.

Resveratrol (RSV) (3,4′,5 trihydroxystilbene) is a natural, non-flavonoid polyphenol widely present in the Mediterranean diet and, particularly, in grapes, peanuts, berries, and red wine.

  • resveratrol
  • human male fertility
  • sperm parameters
  • cryopreservation

1. Introduction

Resveratrol (RSV) (3,4′,5 trihydroxystilbene) is a natural, non-flavonoid polyphenol widely present in the Mediterranean diet and, particularly, in grapes, peanuts, berries, and red wine [1,2]. However, its dietary intake is low, estimated to be only about 100 µg/day [3]. RSV is well absorbed, rapidly metabolized, and eliminated mainly through the urine [4]. This polyphenol belongs to dietary stilbenes, a class of natural compounds that have significant biological activities of medical interest. It derives from phenylalanine through the activation of the enzyme stilbene synthase and exists in two isomeric forms,

Resveratrol (RSV) (3,4′,5 trihydroxystilbene) is a natural, non-flavonoid polyphenol widely present in the Mediterranean diet and, particularly, in grapes, peanuts, berries, and red wine [1][2]. However, its dietary intake is low, estimated to be only about 100 µg/day [3]. RSV is well absorbed, rapidly metabolized, and eliminated mainly through the urine [4]. This polyphenol belongs to dietary stilbenes, a class of natural compounds that have significant biological activities of medical interest. It derives from phenylalanine through the activation of the enzyme stilbene synthase and exists in two isomeric forms,

trans

- and

cis

-RSV [5], but the former is the most common.

RSV is a phytoalexin whose biological function is to protect plants from parasitic attack or environmental stress [6]. This molecule also has beneficial effects on human health. A recent review on clinical trials employing RSV has shown that it improves some clinical aspects in patients with obesity, malignancies (colorectal cancer and breast cancer), hypertension, Alzheimer’s disease, stroke, cardiovascular diseases, and diabetes mellitus [7]. Furthermore, clinical data suggest that RSV is safe even at high doses. Indeed, the administration of micronized RSV in patients with cancer did not lead to serious side effects [8]. Furthermore, it is associated with the “French paradox”. In the early 1990s, epidemiological data showed a low prevalence of coronary disease and, generally, a long life expectancy in French people despite a diet characterized by high saturated fat intake. This paradox was attributed to the moderate consumption of red wine with its anti-oxidative effects due to the high redox properties of phenolic hydroxyl groups, which act as free radical scavengers [9].

Although many studies have investigated the beneficial effects of RSV on experimental animals, there are few clinical trials in humans on the relationship between this compound and male fertility and the results are often controversial [10]. A recent review evaluated the impact of RSV on male and female reproduction, by analyzing studies both on human and animal models [10]. The authors concluded that, although a considerable amount of research supports the positive impact of RSV on human and animal reproduction, further studies are necessary to consolidate the knowledge on the properties of RSV and its role in reproductive functions.

Infertility is a widespread condition in industrialized countries where it affects up to 15% of couples of childbearing age [11]. It is defined as the inability to conceive after 1–2 years of unprotected sexual intercourse [12]. Male factor infertility accounts, cumulatively, for half of the couple’s infertility, being solely present in 30% of couples. Idiopathic male infertility is clinically diagnosed after excluding all other known causes of infertility and it affects up to 25% of patients [13].

2. Resveratrol and Human Fertility: Possible Mechanisms of Action

In recent years, many authors have investigated the effects of RSV in male fertility, reporting an improvement in spermatogenesis, including sperm differentiation and number. However, the exact mechanisms by which RSV carries out its beneficial effects on conventional and biofunctional sperm parameters are not fully understood.

Given its structural similarities with diethylstilbestrol (DES) and 17ß-estradiol and its activity as a modulator of the estrogen-response (ER) systems, RSV has been classified as a phytoestrogen [15]. Some studies [16,17,18] have shown that this compound appears to be able to enhance the estrogenic effects of hormones and, therefore, it is a modulator of the female reproductive function. Estrogens are also secreted by the Leydig cells of the human testis where they play a paracrine regulatory function [19,20]. This suggests a possible role for RSV in male fertility. Furthermore, RSV seems to have a phytoestrogen activity in the androgen receptor (AR) by inhibiting its dimerization [21] and its IL-6 induced transcriptional activity [22] in prostate cancer cells. In testis, the activity of RSV may involve some transcription factors that affect the function of the AR [23].

Given its structural similarities with diethylstilbestrol (DES) and 17ß-estradiol and its activity as a modulator of the estrogen-response (ER) systems, RSV has been classified as a phytoestrogen [14]. Some studies [15][16][17] have shown that this compound appears to be able to enhance the estrogenic effects of hormones and, therefore, it is a modulator of the female reproductive function. Estrogens are also secreted by the Leydig cells of the human testis where they play a paracrine regulatory function [18][19]. This suggests a possible role for RSV in male fertility. Furthermore, RSV seems to have a phytoestrogen activity in the androgen receptor (AR) by inhibiting its dimerization [20] and its IL-6 induced transcriptional activity [21] in prostate cancer cells. In testis, the activity of RSV may involve some transcription factors that affect the function of the AR [22].

RSV is also the most potent natural compound that activates sirtuin 1 (SIRT-1), the most conserved mammalian NAD

+-dependent protein and a member of the SIRT family, which may account for its many metabolic benefits in humans [24]. SIRT-1 belongs to human deacetylase and it negatively regulates the p53 tumor suppressor gene promoting cell survival [25].

-dependent protein and a member of the SIRT family, which may account for its many metabolic benefits in humans [23]. SIRT-1 belongs to human deacetylase and it negatively regulates the p53 tumor suppressor gene promoting cell survival [24].

Another important mechanism is the anti-oxidative activity of RSV, which is due to many different pathways. First, it activates anti-oxidant enzymes, such as catalase and superoxide dismutase [26], which are involved in lipid damage of human spermatozoa during the cryopreservation process [27]. Furthermore, RSV shows an anti-inflammatory activity by decreasing the activity of inflammatory molecules, such as cyclooxygenase 2 (COX2), inducible NOS (iNOS), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) [28]. It also protects cells from DNA damage and apoptosis by modulating anti- and pro-apoptotic mediators [29,30].

Another important mechanism is the anti-oxidative activity of RSV, which is due to many different pathways. First, it activates anti-oxidant enzymes, such as catalase and superoxide dismutase [25], which are involved in lipid damage of human spermatozoa during the cryopreservation process [26]. Furthermore, RSV shows an anti-inflammatory activity by decreasing the activity of inflammatory molecules, such as cyclooxygenase 2 (COX2), inducible NOS (iNOS), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) [27]. It also protects cells from DNA damage and apoptosis by modulating anti- and pro-apoptotic mediators [28][29].

RSV also modulates the expression and activity of multiple drug-metabolizing enzymes. In vitro, it inhibits the enzymatic activity of various cytochrome P450s and blocks their transcription through antagonism of the aryl hydrocarbon receptor (AHR), suggesting that RSV could decrease the exposure of cells to carcinogens [31].

RSV also modulates the expression and activity of multiple drug-metabolizing enzymes. In vitro, it inhibits the enzymatic activity of various cytochrome P450s and blocks their transcription through antagonism of the aryl hydrocarbon receptor (AHR), suggesting that RSV could decrease the exposure of cells to carcinogens [30].

Many evidence suggests that RSV activates adenosine monophosphate-activated protein kinase (AMPK) [24,31,32], which is a serine/threonine kinase that controls cell metabolism by both stimulating catabolic processes and inhibiting anabolic processes [33]. Recently, AMPK has been identified in spermatozoa where it regulates sperm motility, maintains the quality of spermatozoa during long-time storage, and the fertilizing capacity of frozen mouse spermatozoa. This suggests that AMPK can act as a fundamental molecule that allows spermatozoa to adapt to cryopreservation [34]. Studies on AMPK activation by RSV have suggested a variety of apparently contradictory mechanisms. One possibility is an increase in the AMP/ATP ratio. Other studies have suggested that AMPK activation by RSV depends on upstream serine/threonine kinases and calcium/calmodulin-dependent protein kinase β. AMPK can also be activated by reactive oxygen species (ROS), independently of the AMP/ATP ratio, increasing intracellular NAD

Many evidence suggests that RSV activates adenosine monophosphate-activated protein kinase (AMPK) [23][30][31], which is a serine/threonine kinase that controls cell metabolism by both stimulating catabolic processes and inhibiting anabolic processes [32]. Recently, AMPK has been identified in spermatozoa where it regulates sperm motility, maintains the quality of spermatozoa during long-time storage, and the fertilizing capacity of frozen mouse spermatozoa. This suggests that AMPK can act as a fundamental molecule that allows spermatozoa to adapt to cryopreservation [33]. Studies on AMPK activation by RSV have suggested a variety of apparently contradictory mechanisms. One possibility is an increase in the AMP/ATP ratio. Other studies have suggested that AMPK activation by RSV depends on upstream serine/threonine kinases and calcium/calmodulin-dependent protein kinase β. AMPK can also be activated by reactive oxygen species (ROS), independently of the AMP/ATP ratio, increasing intracellular NAD

+, a substrate of SIRT-1 [35]. Notably, activation of AMPK has been reported to reduce intracellular ROS levels [36].

, a substrate of SIRT-1 [34]. Notably, activation of AMPK has been reported to reduce intracellular ROS levels [35].

3. Resveratrol and Human Sperm Parameters

RSV is provided by a peculiarity; at low doses, it improves cell survival, while at high doses, it has cytotoxic effects that are useful in cancer treatment [37]. To assess both these properties, Collodel and collaborators conducted in vitro studies on human spermatozoa [38]. The authors evaluated the motility of swim-up selected spermatozoa to test the effect of different RSV concentrations (from 6 to 100 µM). They found that the maximal effect was reached at the concentrations of 6 and 15 µM of RSV, whereas at the concentration of 100 µM, RSV completely inhibited sperm motility, thus showing cytotoxic effects at higher doses. These data agree with those published subsequently by Nashtaei and co-authors [34]. These authors incubated semen samples with RSV at concentrations of 5, 15, and 25 mM and found that only at the highest concentration tested (25 mM) RSV significantly reduced total and progressive sperm motility (by about 11.5% and 14%, respectively) without any significant effect on the following sperm motility parameters evaluated by computer-assisted sperm analysis: curvilinear velocity, straight-line velocity, average path velocity, linearity of the curvilinear trajectory, and straightness.

RSV is provided by a peculiarity; at low doses, it improves cell survival, while at high doses, it has cytotoxic effects that are useful in cancer treatment [36]. To assess both these properties, Collodel and collaborators conducted in vitro studies on human spermatozoa [37]. The authors evaluated the motility of swim-up selected spermatozoa to test the effect of different RSV concentrations (from 6 to 100 µM). They found that the maximal effect was reached at the concentrations of 6 and 15 µM of RSV, whereas at the concentration of 100 µM, RSV completely inhibited sperm motility, thus showing cytotoxic effects at higher doses. These data agree with those published subsequently by Nashtaei and co-authors [33]. These authors incubated semen samples with RSV at concentrations of 5, 15, and 25 mM and found that only at the highest concentration tested (25 mM) RSV significantly reduced total and progressive sperm motility (by about 11.5% and 14%, respectively) without any significant effect on the following sperm motility parameters evaluated by computer-assisted sperm analysis: curvilinear velocity, straight-line velocity, average path velocity, linearity of the curvilinear trajectory, and straightness.

Furthermore, Collodel and collaborators [38] investigated also the protective effect of RSV against oxidative stress. This latter is an important factor in the etiology of poor sperm function because it causes peroxidative damage to the cell membrane, DNA fragmentation, and protein oxidation [38,39,40]. The authors tested RSV at the concentrations of 6 and 15 µM to assess its effects against lipid peroxidation (LPO) induced by

Furthermore, Collodel and collaborators [37] investigated also the protective effect of RSV against oxidative stress. This latter is an important factor in the etiology of poor sperm function because it causes peroxidative damage to the cell membrane, DNA fragmentation, and protein oxidation [37][38][39]. The authors tested RSV at the concentrations of 6 and 15 µM to assess its effects against lipid peroxidation (LPO) induced by

tert-butyl hydroperoxide in human spermatozoa. At the concentration of 6 µM, RSV did not show any protective effect against LPO, whereas at the concentration of 15 µM exhibited a defensive effect. RSV was particularly effective in preserving sperm chromatin texture, but it was not able to fully preserve acrosome, the most fragile sperm organelle. The authors concluded that RSV could have a role as a ROS scavenger in presence of increased oxidative stress, such as during cryopreservation or IVF-ICSI [38].

-butyl hydroperoxide in human spermatozoa. At the concentration of 6 µM, RSV did not show any protective effect against LPO, whereas at the concentration of 15 µM exhibited a defensive effect. RSV was particularly effective in preserving sperm chromatin texture, but it was not able to fully preserve acrosome, the most fragile sperm organelle. The authors concluded that RSV could have a role as a ROS scavenger in presence of increased oxidative stress, such as during cryopreservation or IVF-ICSI [37].

It is well-known that cigarette smoking and environmental pollution negatively impact male fertility. We have [41] investigated the role of RSV on human sperm damage caused by benzo-α-pyrene (BaP), a polycyclic aromatic hydrocarbon originating from the incomplete combustion of fossil fuels, tobacco smoke, diesel exhaust, and broiled foods [42]. Metabolically activated BaP increases ROS production and consequently the oxidative stress, resulting in increased lipid peroxidation, and caspase, and endonuclease activation [43,44]. We studied the effect of BaP and RSV on human spermatozoa in vitro by assessing total and progressive sperm motility and biofunctional sperm parameters. The latter was evaluated by flow cytometry. We initially tested the effects of BaP alone and found that it significantly inhibited both total and progressive sperm motility in a concentration-dependent manner. Moreover, BaP significantly increased the percentage of spermatozoa with abnormal chromatin compactness, whereas it did not have any significant effect on sperm viability, mitochondrial membrane potential (MMP), and DNA fragmentation. Finally, BaP significantly increased LPO and the production of mitochondrial superoxide. Subsequently, we evaluated the effects of RSV alone and during incubation with BaP on human spermatozoa. RSV alone slightly but significantly decreased the percentage of spermatozoa with abnormal chromatin compactness, did not have any significant effect on LPO, and decreased the percentage of spermatozoa with elevated mitochondrial superoxide production. Moreover, RSV at the concentration of 15 µM/mL significantly counteracted the detrimental effects of BaP on chromatin compactness and LPO. Thus, we concluded that RSV could be considered as a therapeutic option in selected cases of patients with idiopathic infertility. However, further studies were necessary [41].

It is well-known that cigarette smoking and environmental pollution negatively impact male fertility. We have [40] investigated the role of RSV on human sperm damage caused by benzo-α-pyrene (BaP), a polycyclic aromatic hydrocarbon originating from the incomplete combustion of fossil fuels, tobacco smoke, diesel exhaust, and broiled foods [41]. Metabolically activated BaP increases ROS production and consequently the oxidative stress, resulting in increased lipid peroxidation, and caspase, and endonuclease activation [42][43]. We studied the effect of BaP and RSV on human spermatozoa in vitro by assessing total and progressive sperm motility and biofunctional sperm parameters. The latter was evaluated by flow cytometry. We initially tested the effects of BaP alone and found that it significantly inhibited both total and progressive sperm motility in a concentration-dependent manner. Moreover, BaP significantly increased the percentage of spermatozoa with abnormal chromatin compactness, whereas it did not have any significant effect on sperm viability, mitochondrial membrane potential (MMP), and DNA fragmentation. Finally, BaP significantly increased LPO and the production of mitochondrial superoxide. Subsequently, we evaluated the effects of RSV alone and during incubation with BaP on human spermatozoa. RSV alone slightly but significantly decreased the percentage of spermatozoa with abnormal chromatin compactness, did not have any significant effect on LPO, and decreased the percentage of spermatozoa with elevated mitochondrial superoxide production. Moreover, RSV at the concentration of 15 µM/mL significantly counteracted the detrimental effects of BaP on chromatin compactness and LPO. Thus, we concluded that RSV could be considered as a therapeutic option in selected cases of patients with idiopathic infertility. However, further studies were necessary [40].

Recently, Illiano and colleagues published a prospective single-center clinical study to evaluate the effects of a nutraceutical based on RSV (300 mg) but also containing vitamin D, B6, B12, and folic acid on sperm parameters of patients with idiopathic infertility [14]. The authors enrolled 20 patients with oligozoospermia and/or with asthenozoospermia with six months of follow-up after treatment. They found that RSV plus multivitamin supplementation significantly improved sperm concentration, total sperm count, and total and progressive motility. Sperm morphology, pH, and seminal fluid volume did not change after treatment [14]. The authors concluded that the possibility of targeting the metabolic and energetic pathways involved in spermatogenesis and mitochondrial activity with a molecule such as RSV, could lead to potential effects and counteract subfertility/infertility in men through a mitochondrial dynamic mechanism.

Recently, Illiano and colleagues published a prospective single-center clinical study to evaluate the effects of a nutraceutical based on RSV (300 mg) but also containing vitamin D, B6, B12, and folic acid on sperm parameters of patients with idiopathic infertility [44]. The authors enrolled 20 patients with oligozoospermia and/or with asthenozoospermia with six months of follow-up after treatment. They found that RSV plus multivitamin supplementation significantly improved sperm concentration, total sperm count, and total and progressive motility. Sperm morphology, pH, and seminal fluid volume did not change after treatment [44]. The authors concluded that the possibility of targeting the metabolic and energetic pathways involved in spermatogenesis and mitochondrial activity with a molecule such as RSV, could lead to potential effects and counteract subfertility/infertility in men through a mitochondrial dynamic mechanism.

Table 1

summarizes the main studies exploring the effects of RSV on human conventional and biofunctional sperm parameters.

Table 1.

Summary of the main studies on the effects of resveratrol on male fertility.

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