by Meritxell Jodar, Edward Sendler, Sergey I. Moskovtsev, Clifford L

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Absence of sperm RNA elements correlates with idiopathic male infertility by Meritxell Jodar, Edward Sendler, Sergey I. Moskovtsev, Clifford L. Librach, Robert Goodrich, Sonja Swanson, Russ Hauser, Michael P. Diamond, and Stephen A. Krawetz Sci Transl Med Volume 7(295):295re6-295re6 July 8, 2015 Copyright © 2015, American Association for the Advancement of Science

Fig. 1. Genomic localization (exon, intron, intergenic, and noncoding RNAs) and function of the 648 required SREs. Most of the required SREs are located in exons of annotated genes (585 of 648; 90.3%), and the remainder are in intronic regions (12 of 648; 1.9%), intergenic regions (9 of 648; 1.4%), or mat Genomic localization (exon, intron, intergenic, and noncoding RNAs) and function of the 648 required SREs. Most of the required SREs are located in exons of annotated genes (585 of 648; 90.3%), and the remainder are in intronic regions (12 of 648; 1.9%), intergenic regions (9 of 648; 1.4%), or match to noncoding transcriptional elements including small nuclear RNAs, microRNAs, and long noncoding RNAs (42 of 648; 6.5%) with potential regulatory function. About 40% of the genes that contain one or more SREs have a known role in spermatogenesis, sperm physiology (sperm energy production or acrosome reaction), fertilization, and/or early embryogenesis. Additionally, 20% have a known role in cellular process such as transcription regulation, protein transport, ubiquitin-like conjugation pathway, and lipid metabolism. The potential function of the remaining transcripts has yet to be defined. Meritxell Jodar et al., Sci Transl Med 2015;7:295re6 Copyright © 2015, American Association for the Advancement of Science

Fig. 2. Distribution of the 648 required SREs Fig. 2. Distribution of the 648 required SREs. The percentile rank distribution of the SREs in control (group I) and test set [group II: (i) exclusively use TIC or IUI, (ii) unsuccessful IUI followed by ART, and (iii) directly use ART] is presented. Distribution of the 648 required SREs. The percentile rank distribution of the SREs in control (group I) and test set [group II: (i) exclusively use TIC or IUI, (ii) unsuccessful IUI followed by ART, and (iii) directly use ART] is presented. The percentile rank of each element is indicated in a gradient color scale. Red indicates the complete absence of an element (zero percentile rank). In contrast, elements that are present range from yellow for the 60th abundance percentile to green that corresponds to >90th percentile of abundance. (A) (Left) Seven TIC individuals who were used to identify the SREs because they were considered to have successful natural conception and presented with all 648 SREs. (Middle) Thirty-seven samples from group II (25 group II-i, 5 group II-ii, and 7 group II-iii) with the complete set of SREs. (Right) Nineteen samples from group II (4 group II-i, 8 group II-ii, and 7 group II-iii) with at least one missing SRE. The first 33 sperm elements were absent in at least one sample from the test set (right). The remaining SREs (34 to 648) were present in all samples from groups I and II, showing that the vast majority of SREs are uniformly abundant in all samples surveyed. (B) Couples with all SREs using TIC/IUI or ART have a success rate of 72% (16 of 22) during the first two treatment cycles (6 months) after sperm RNA evaluation. Meritxell Jodar et al., Sci Transl Med 2015;7:295re6 Copyright © 2015, American Association for the Advancement of Science

Fig. 3. Analysis of treatment outcome as a function of required SREs Fig. 3. Analysis of treatment outcome as a function of required SREs. (A). Analysis of treatment outcome as a function of required SREs. (A). Most of the 37 group II couples with all SREs present underwent TIC/IUI, achieving an LB rate of 73% (22 of 30). The remaining samples reflecting patient preference along with the previously unsuccessful TIC/IUI cases were treated by ART, achieving a 75% (9 of 12) LB rate. (B) RNA analysis from samples with at least one SRE absent. Note that only 3 of the 11 TIC/IUI samples with an absent SRE achieved LB. The success ratio of LB using ART is similar to the ratio observed in samples with all SREs. (C) The percentage of LB using a noninvasive treatment for couples presenting with the complete set of SREs is higher compared to those with at least one SRE absent (two-tailed Fisher’s exact test, P = 0.012). Meritxell Jodar et al., Sci Transl Med 2015;7:295re6 Copyright © 2015, American Association for the Advancement of Science