Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Curr Opin Endocrinol Diabetes Obes. 2020 Dec;27(6):419-423. doi: 10.1097/MED.0000000000000580.
In this review, we outline the most recent advances in the development of Leydig stem cells (LSCs) and summarize the current and upcoming treatments for hypogonadism.
In-vitro and in-vivo studies show that inducing stem cells to differentiate into testosterone-producing adult Leydig cells is possible. In addition, LSCs can be grafted with Sertoli cells to increase testosterone levels in vivo. This therapy causes minimal effects on luteinizing hormone and follicle stimulating hormone levels. Novel therapies for hypogonadism include varying methods of testosterone delivery such as intranasal and oral agents, as well as novel selective estrogen and androgen receptor modulators.
LSC therapies provide an effective way of increasing testosterone levels without detrimentally affecting gonadotropin levels. Next steps in developing viable Leydig cell grafting options for the treatment of hypogonadism should include the assessment of efficacy and potency of current animal models in human trials. Recently, both intranasal and oral testosterone have been made available and shown promising results in treating hypogonadism while maintaining fertility. Enclomiphene citrate and selective androgen receptor modulators have been suggested as future therapies for hypogonadism; however, further studies assessing efficacy and adverse effects are needed.
在这篇综述中，我们概述了 Leydig 干细胞（LSCs）发展的最新进展，并总结了目前和即将出现的治疗性腺功能减退症的方法。
体外和体内研究表明，诱导干细胞分化为产生睾酮的成年 Leydig 细胞是可能的。此外，LSCs 可以与支持细胞嫁接，以增加体内的睾酮水平。这种治疗方法对黄体生成素和卵泡刺激素水平的影响最小。性腺功能减退症的新疗法包括各种睾酮递药方法，如鼻内和口服制剂，以及新型选择性雌激素和雄激素受体调节剂。
LSC 疗法为提高睾酮水平提供了一种有效的方法，而不会对促性腺激素水平产生不利影响。下一步开发可行的 Leydig 细胞移植治疗性腺功能减退症的选择，应包括在人体试验中评估当前动物模型的疗效和效力。最近，鼻内和口服睾酮都已上市，并在治疗性腺功能减退症的同时保持生育能力方面显示出良好的效果。克罗米芬和选择性雄激素受体调节剂已被提议作为治疗性腺功能减退症的未来疗法；然而，还需要进一步研究以评估疗效和不良反应。
