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| LETTER TO THE EDITOR |
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| Ahead of print publication |
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Seminal HPV detection: a pilot study comparing the preservation effectiveness and cost between a methanol-based solution and cryopreservation with liquid nitrogen
Jynfiaf Francis1, Cecilia Kärrberg1,2, Jonas Hermansson3, Magnus Lindh4, Sofia Ganidou1, Ann Thurin-Kjellberg1,2, Kersti Lundin1,2, Randa Akouri1,2, Panagiotis Tsiartas1,5
1 Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
2 Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg 405 30, Sweden
3 Department of Research and Development, Angered Hospital, Angered 424 65, Sweden
4 Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg 413 46, Sweden
5 Department of Oncology- Pathology, Karolinska Institute, Stockholm 171 77, Sweden
| Date of Submission | 22-Dec-2021 |
| Date of Acceptance | 20-Feb-2022 |
| Date of Web Publication | 26-Apr-2022 |
Correspondence Address:
Panagiotis Tsiartas,
Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg 413 45; Department of Oncology- Pathology, Karolinska Institute, Stockholm 171 77
Sweden
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/aja202213
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How to cite this URL:
Francis J, Kärrberg C, Hermansson J, Lindh M, Ganidou S, Thurin-Kjellberg A, Lundin K, Akouri R, Tsiartas P. Seminal HPV detection: a pilot study comparing the preservation effectiveness and cost between a methanol-based solution and cryopreservation with liquid nitrogen. Asian J Androl [Epub ahead of print] [cited 2022 May 21]. Available from: https://www.ajandrology.com/preprintarticle.asp?id=344123 |
Dear Editor,
Human papillomavirus (HPV) is the most common sexually transmitted virus worldwide, and high-risk HPV infection is the most important risk factor for cervical cancer.[1] However, few conclusive data are available on the prevalence of the male HPV infection and its health consequences. It has been found that the prevalence of seminal HPV infection is higher in men with unexplained infertility, ranging between 10% and 35% compared with the general population (range: 2% to 11%).[2],[3],[4] In three recent systematic reviews, it was seen that HPV sperm infection may be associated with impaired sperm function that could lead to male infertility.[2],[4],[5] HPV sperm infection with high-risk HPV among infertile men was shown to be associated with lower progressive sperm motility and higher DNA fragmentation index.[6] Moreover, a high rate of pregnancy loss has been found among couples with HPV sperm infection after in vitro fertilization (IVF).[7] In the majority of the studies performed to assess seminal HPV infection, samples were preserved in liquid nitrogen until analysis with polymerase chain reaction (PCR). Liquid nitrogen is used to store cells at low temperatures; however, its handling and laboratory safety requires special infrastructure. An alternative, not requiring cryopreservation, is the methanol-based ThinPrep PreservCyt Solution (Hologic, Marlborough, MA, USA). It is a low-cost and safe reagent that serves as a collection, transport, and preservative medium widely used in Sweden for cervical HPV detection.
The purpose of this study was to compare the preservation effectiveness and resources needed, between the methanol-based solution and cryopreservation with a cryoprotectant in liquid nitrogen, for the detection of seminal HPV by TaqMan Real-time PCR (Applied Biosystems-7300 Real-time PCR system, Thermo Fisher Scientific Inc., Waltham, MA, USA).
A total of 18 men undergoing infertility workup between February 2021 and April 2021 at Sahlgrenska University Hospital, Gothenburg, Sweden, were included in the pilot study. No extra samples were collected, but the sample collected for the infertility workup was used for the study. All participants signed an informed consent form before inclusion. The study was approved by the Swedish Ethical Review Authority (Dnr. 2020-06127).
After collection, the semen sample was prepared for analysis by gradient centrifugation (PureSperm, Nidacon International AB, Mölndal, Sweden) at 300g for 20 min according to the clinic's routines. The upper layer with seminal plasma was pipetted off and kept. A volume of 0.2 ml of the prepared sample was used for the routine analysis. The remaining part was washed with buffer (PureSperm Wash, Nidacon International AB) and then mixed with the seminal plasma. The reason for this re-mixture was to enable the HPV analysis on a full ejaculate including both sperm cells and seminal plasma, while at the same time, not compromising the routine workup analysis by splitting the sample. Half of the samples (n = 9) were then diluted with the methanol-based solution (1:2) and stored at room temperature, and the other half (n = 9) was diluted with cryoprotectant (1:2) CryoProTec (Nidacon International AB), directly frozen in liquid nitrogen and stored at −20°C.
In order to assess whether HPV DNA could be detected in the sperm samples by TaqMan Real-time PCR, a plasmid mixture including a total of 1 million copies of HPV 6, HPV 11, HPV 16, and HPV 18 genomes cloned into plasmid vectors was added per positive control sample [Figure 1]. All samples were then analyzed for HPV 6, HPV 11, HPV 16, and HPV 18. β-globulin was used as a quality indicator of the samples that contained spermatozoa. Every HPV subtype contained in the plasmid mixture that was added to the samples used as positive controls was detected by TaqMan Real-time PCR. All native sperm samples were negative for HPV and positive for β-globulin. Both of the tested sperm sample preservation methods resulted in equivalent results for the detection of seminal HPV presence, validated through the comparison of the PCR cycle threshold (CT) values from all analyses (ThinPrep PreservCyt Solution mean CT value of 26.16 vs cryoprotectant and liquid nitrogen mean CT value of 26). However, the cryopreservation method requires specialized equipment such as liquid nitrogen, cryotubes, and freezing devices, as well as cryo-storage space. Thus, after comparing the necessary time and costs involved to preserve the sperm samples between the two methods, and considering their equal quality and effectiveness of seminal HPV detection, ThinPrep PreservCyt Solution came out as the most optimal alternative. | Figure 1: Flowchart of the study. Comparison of sperm sample preservation for the detection of HPV by TaqMan Real-time PCR. Comparison between preservation with a methanol-based solution and with cryoprotectant and liquid nitrogen. HPV: human papillomavirus; PCR: polymerase chain reaction.
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In conclusion, sperm sample preservation in a methanol-based (ThinPrep PreservCyt) solution and analysis by TaqMan Real-time PCR can be an effective, low-cost, and safe method of seminal HPV detection.
| Author Contributions | |  |
PT conceived the study. PT, JF, CK, JH, ML, SG, ATK, KL, and RA participated in the design of the study. PT, JF, and KL participated in the coordination of the study and helped draft the manuscript. All authors read and approved the final manuscript.
| Competing Interests | | |
All authors declare no competing interests.
| Acknowledgments | | |
We would like to thank Dr. Peter Horal who passed away before the publication of this study for his assistance with the design of the study and the HPV analyses.
| References | | |
| 1. | Bosch FX, Broker TR, Forman D, Moscicki AB, Gillison ML, et al. Comprehensive control of human papillomavirus infections and related diseases. Vaccine 2013; 31 Suppl 7: H1–31.  |
| 2. | Foresta C, Noventa M, De Toni L, Gizzo S, Garolla A. HPV-DNA sperm infection and infertility: from a systematic literature review to a possible clinical management proposal. Andrology 2015; 3: 163–73. |
| 3. | Kero K, Rautava J, Syrjanen K, Grenman S, Syrjanen S. Human papillomavirus genotypes in male genitalia and their concordance among pregnant spouses participating in the Finnish Family HPV study. J Sex Med 2011; 8: 2522–31. |
| 4. | Lyu Z, Feng X, Li N, Zhao W, Wei L, et al. Human papillomavirus in semen and the risk for male infertility: a systematic review and meta-analysis. BMC Infect Dis 2017; 17: 714. |
| 5. | Muscianisi F, De Toni L, Giorato G, Carosso A, Foresta C, et al. Is HPV the novel target in male idiopathic infertility? A systematic review of the literature. Front Endocrinol (Lausanne) 2021; 12: 643539. |
| 6. | Boeri L, Capogrosso P, Ventimiglia E, Pederzoli F, Cazzaniga W, et al. High-risk human papillomavirus in semen is associated with poor sperm progressive motility and a high sperm DNA fragmentation index in infertile men. Hum Reprod 2019; 34: 209–17. |
| 7. | Perino A, Giovannelli L, Schillaci R, Ruvolo G, Fiorentino FP, et al. Human papillomavirus infection in couples undergoing in vitro fertilization procedures: impact on reproductive outcomes. Fertil Steril 2011; 95: 1845–8. |
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