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GLUTAMATE QUANTIFICATION VIA MR SPECTROSCOPY AIDS FERTILITY ASSESSMENT IN AZOOSPERMIC PATIENTS

Glutamate is the most abundant excitatory neurotransmitter in the central nervous system, but glutaminergic systems can be found in non- neural tissues as well, including the testis. Various types of glutamate receptors are present in germinal as well as interstitial Leydig cells in the testis which suggests that glutamate could play a role in regulating reproductive functions. Higher levels of glutamate can also lead to excitotoxicity due to excessive calcium ion influx and enzyme activation which damages cell structures. Patients with azoospermia, a condition in which there are no sperm in the ejaculate, who wish to have children, undergo testicular sperm extraction (TESE). 11 samples of testicular tissue were obtained via TESE and magnetic resonance spectroscopy (MRS) was performed. Tetramethylsilane (TMS) was used as an internal reference and the concentration of glutamate was determined using the QUEST algorithm of the jMRUI software. The samples were then histologicaly analyzed, scored according to the Johnsen scoring system and divided into four groups: Sertoli cell- only syndrome (SCOS), maturation arrest, hypospermatogenesis and mixed atrophy. A higher concentration of glutamate was observed in patients with SCOS, in which there are no germ cells in the tissue, compared to the other groups. This finding warrants further research of the glutaminergic system in the testis and points to MRS as a potentially useful tool in predicting outcomes of the TESE procedure and impacting patient selection.

Azoospermia, Testis, Magnetic resonance spectroscopy

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