Département d'obstétrique, gynécologie et reproduction, Centre de recherche du Centre hospitalier de l'Université Laval, axe reproduction, santé de la mère et de l'enfant,
Médecine de la Reproduction, CHU Toulouse, 31059 Toulouse, France Groupe de Recherche en Fertilité Humaine EA 3694, Université Paul Sabatier, Toulouse, France.
Hum Reprod Update. 2016 Sep;22(5):574-87. doi: 10.1093/humupd/dmw015. Epub 2016 Jun 15.
Spermatozoa acquire their fertilizing ability and forward motility properties during epididymal transit. Our knowledge of gamete physiology is based on studies conducted in laboratory and domestic species; our knowledge of these processes in humans is limited. Medical indications for assisted reproductive technologies (ART) have progressed to include male infertility. Surgical procedures allow collection of spermatozoa from all along the human excurrent ducts, and the former have been used with some success in reproductive medicine. This has raised questions over the role of the epididymis in human sperm physiology.
To reanalyze what we now know about epididymal physiology in humans and to assess the relevance of laboratory animal models for understanding human physiology and the pathophysiology of the epididymis.
A systematic bibliographic search of PubMed for articles published in English before May 2015 was carried out using the search terms 'epididymis' and 'sperm maturation'. Literature on the consequences of vasectomy on the epididymis was also searched.
Whereas the proximal epididymis is almost exclusively occupied by efferent ducts, the sperm reservoir capacity is poorly developed in humans. At the molecular level, the human transcriptome and proteome show some segment specificity; conflicting results persist with regard to secretome variation along the tubule. The number of genes regulated along the excurrent ducts in men is lower when compared to rodent species, but remains significant. It is challenging to reconcile biochemical and physiological studies with clinical data obtained from men undergoing reanastomosis of the vas deferens at different points along the excurrent duct. We propose that vasectomy/vasovasostomy is a model to understand the consequences of obstruction on epididymis function in humans.
Despite the scarcity of biological material available, the interspecies variability of the male reproductive tract urges us to use modern molecular and cellular biology tools to better understand human epididymis physiology in order to apply ART in a more responsible manner.
精子在附睾转运过程中获得受精能力和向前运动特性。我们对配子生理学的认识是基于在实验室和家养物种中进行的研究；我们对人类这些过程的了解有限。辅助生殖技术（ART）的医学适应证已扩展到男性不育症。外科手术允许从人类所有的输出管中收集精子，并且前者在生殖医学中已经取得了一些成功。这就提出了关于附睾在人类精子生理学中的作用的问题。
重新分析我们现在对人类附睾生理学的了解，并评估实验室动物模型对理解人类生理学和附睾病理生理学的相关性。
使用“附睾”和“精子成熟”这两个搜索词，对 2015 年 5 月之前发表的英文文章进行了系统的文献检索，在 PubMed 上进行了搜索。还搜索了关于输精管结扎对附睾影响的文献。
虽然近端附睾几乎完全被输出管占据，但人类的精子储存能力发育不良。在分子水平上，人类的转录组和蛋白质组显示出一些节段特异性；关于沿小管的分泌组变化仍存在矛盾的结果。与啮齿动物相比，在男性中沿输出管调节的基因数量较少，但仍然显著。将生化和生理学研究与从不同部位行输精管再吻合术的男性获得的临床数据进行协调具有挑战性。我们提出，输精管结扎/吻合术是理解人类附睾功能阻塞后果的模型。
尽管可用的生物材料稀缺，但男性生殖道的种间变异性促使我们使用现代分子和细胞生物学工具更好地理解人类附睾生理学，以便以更负责任的方式应用 ART。
