Anti-Müllerian Hormone Is a Marker for Chemotherapy-Induced Testicular Toxicity

Endocrinology. 2015 Oct;156(10):3818-27. doi: 10.1210/en.2015-1310. Epub 2015 Aug 7.

Abstract

Due to increased numbers of young cancer patients and improved survival, the impact of anticancer treatments on fertility has become a major health concern. Despite mounting research on ovarian toxicity, there is paucity of data regarding reliable biomarkers of testicular toxicity. Our aim was to evaluate anti-Müllerian hormone (AMH) as a marker for chemotherapy-induced testicular toxicity. Serum AMH and a panel of gonadal hormones were measured in male cancer patients at baseline and after chemotherapy. In the preclinical setting, mice were injected with diverse chemotherapies and were killed 1 week or 1, 3, or 6 months later. We evaluated spermatogenesis by AMH as well as qualitative and quantitative sperm parameters. Nineteen patients were enrolled, the median age was 38 years (21-44 y). Serum AMH was correlated with increased FSH and T and decreased inhibin-B in gonadotoxic protocols (cisplatin or busulfan) and remained unchanged in nongonadotoxic protocols (capecitabine). AMH expression had the same pattern in mice serum and testes; it was negatively correlated with testicular/epididymal weight and sperm motility. The increase in testicular AMH expression was also correlated with elevated apoptosis (terminal transferase-mediated deoxyuridine 5-triphosphate nick-end labeling) and reduced proliferation (Ki67, proliferating cell nuclear antigen; all seminiferous tubules cells were analyzed). Severely damaged mice testes demonstrated a marked costaining of AMH and GATA-4, a Sertoli cell marker; staining that resembled the pattern of the Sertoli cell-only condition. Our study indicates that the pattern of serum AMH expression, in combination with other hormones, can delineate testicular damage, as determined in both experimental settings. Future large-scale clinical studies are warranted to further define the role of AMH as a biomarker for testicular toxicity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Animals
  • Anti-Mullerian Hormone / blood*
  • Anti-Mullerian Hormone / genetics
  • Anti-Mullerian Hormone / pharmacology
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Biomarkers, Tumor / blood*
  • Biomarkers, Tumor / metabolism
  • Blotting, Western
  • Follicle Stimulating Hormone / biosynthesis
  • Gene Expression
  • Humans
  • Inhibin-beta Subunits / blood
  • Male
  • Mice, Inbred ICR
  • Microscopy, Confocal
  • Neoplasms / blood
  • Neoplasms / drug therapy
  • Organ Size / drug effects
  • Reverse Transcriptase Polymerase Chain Reaction
  • Sperm Motility / drug effects
  • Spermatogenesis / drug effects
  • Testis / drug effects*
  • Testis / metabolism
  • Testis / pathology
  • Testosterone / blood
  • Young Adult

Substances

  • Antineoplastic Agents
  • Biomarkers, Tumor
  • Testosterone
  • Anti-Mullerian Hormone
  • Follicle Stimulating Hormone
  • Inhibin-beta Subunits