Protective effects of CAPE against testicular damage in streptozotocin-induced diabetic rats

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Introduction
Diabetes mellitus is a disease that causes male infertility by affecting sperm quality through altered steroidogenesis characterized by hyperglycemia and endocrine disorder [1].
Various experimental and clinical observations show that hyperglycemia directly or indirectly increases free radical formation and causes oxidative stress [2,3].Increasing oxidative stress and changes in antioxidant capacity play an important role in the pathogenesis of chronic diabetes [4].In the current study, we used STZ-induced diabetic rats as models for type 1 diabetes [5,6].There are experimental and clinical studies on male infertility due to diabetes [7,8].It has been reported in studies that diabetes causes testicular damage, especially by causing cell death and apoptosis.Changes in the testicles in diabetes include atrophy in the seminiferous tubules,

Experimental protocol
The rats were divided into 4 groups randomly, each group including 8 animals.Group 1: Control, Group 2: CAPE, Group 3: STZ Group 4: STZ+CAPE.Experimental animals were rendered diabetic by an intraperitoneal injection of a single dose STZ (55 mg/kg) dissolved in physiological saline (0.9 % NaCl), CAPE (10 μmol/kg) was given by IP to rats for 20 days after the experimental animals were made diabetic.The plasma glucose level was measured; at the start of the experiment, 72 hours after administration of injection STZ, and after 20 days to as certain diabetic status of the animals using a glucometer.
At the end of the experiment, blood glucose levels of the animals were measured.The rats were sacrifi ced under ketamine/xylazine anesthesia.The testes of the animals were removed and the left testicles were taken into the deep freezer for biochemical studies, while the right testicles were fi xed in 10% formalin solution for histological studies.

Histological assessment
Paraffi n-embedded blocks of testicle tissue were sectioned at 5 μm thickness.Hematoxylin-Eosin (H&E) staining methods were applied to the section to observe the general histological structure and immunohistochemical staining methods were applied to the section to show the caspase-3 (Thermo Fisher Scientifi c, Inc., Waltham, MA, USA) activity.In this study, Johnsen's score was used to evaluate spermatogenesis [13].
In addition, the 20 most circular seminiferous tubules were randomly selected in each part of the testis in H-E stained preparations, and the diameters of these tubules were measured.
Leica DFC280 light microscope and a Leica Q Win Image Analysis system (Leica Micros Imaging Solutions Ltd., Cambridge, UK) were used for light microscopy and immunohistochemical evaluations.

Biochemical assessment
Tissue homogenate from the testis of each rat was used for analyzing oxidative stress biomarkers.Protein levels of the tissue samples were measured according to Lowry, et al. [14].Tissue Malondialdehyde (MDA) was evaluated colorimetrically as described by Uchiyama M, Mihara M [15] to assess lipid peroxidation in the form of thiobarbituric acid reactivity substances.Measurement of reduced GSH was done using modifi ed Elman's method [16].Tissue Superoxide Dismutase (SOD) activity was evaluated using the method of Sun Y. [17].

Statistical analysis
A computer program (SPSS 17.0) was used to perform the statistical analysis of the study.The results were compared with Kruskal-Wallis variance analysis of variance and differences were detected between the groups.Mann-Whitney U test was used to compare group means and p < 0.05 values were considered statistically signifi cant.All results were expressed as means ± Standard Error (SE).

Blood glucose level
Table 1 shows the blood glucose levels of the rats in the control and experimental groups.Before diabetes induction, the blood glucose levels of all groups were similar.After Streptozotocin (STZ) injection, a signifi cant increase was observed in the blood glucose levels of diabetic rats on day 20 compared to day 0 (p < 0.05).CAPE treatment produced signifi cant changes in the blood glucose levels in nondiabetic rats (p < 0.05).The administration of CAPE for 20 days caused a decrease in the level of blood glucose in diabetic rats.

Histological evaluation
Evaluation of hematoxylin-eosin staining: In control (Figure 1A) and CAPE (Figure 1B) groups, testes were observed with normal histological structure.However, disorders of seminiferous tubule germinal epithelium (Figure 1C), congestion of vessels, edema in interstitial spaces (Figure 1D), and desquamation of epithelial cells in the lumen were observed in diabetic rats (Figure 1E), in addition to these fi ndings, atrophy of the tubules with varying degree of spermatogenetic arrest was detected (Figure 1F).In the CAPE-treated diabetic rats, most of the seminiferous tubules in this group were more regular.However, spermatogenic cells that have stagnated in certain stages of meiosis (Figure 1G), and congestion of vessels (Figure 1H), were found in this group.The number of tubules containing stagnated spermatogenic cells was observed less frequently than in the diabetes group.Around these tubules were intact tubules with germinative epithelium that continued to develop normally.
The mean seminiferous tubule diameter (MSTD): It was observed that the diameter of the seminiferous tubule in the STZ group was signifi cantly reduced compared to the control group (p = 0.001).When the STZ+CAPE group was compared with the STZ group, there was no signifi cant increase in this group (p > 0.05).In addition, when the STZ+CAPE group and the control group were compared, no statistically signifi cant differences were found between them (p > 0.05).The seminiferous tubule diameter values of each group are shown in Table 2.
Evaluation of caspase staining: Apoptotic cells in the testis of diabetic groups were identifi ed by caspase staining.No caspase-3 positive cells were observed in the control (Figure 2A) and CAPE groups (Figure 2B).However, the number of caspase-3 positive germ cells was found to be signifi cantly increased in the STZ group (Figure 2C).In the STZ+CAPE group, a number of apoptotic germ cells statistically signifi cant decrease was observed (Figure 2D).Mean histopathological scor, MSDT, and caspase (+) cells of all groups are given in Table 2.

Biochemical evaluation
STZ-induced diabetes group was compared with the control group, tissue MDA level was measured signifi cantly increased (p < 0.05), while SOD activity was signifi cantly decreased in STZ-induced diabetes (p < 0.05).In diabetic rats, GSH levels were upper in the testis than in control, CAPE, and CAPEtreated diabetic groups but this rise was not signifi cant (p > 0.05).On the other hand, when the CAPE-treated diabetic group was examined, the MDA level was decreased in this group compared to the STZ-induced diabetes group (p < 0.05).Also, in the CAPE-treated diabetic group, the activity of SOD was increased compared with the diabetic group Mean tissue MDA and GSH levels and SOD activities of all groups are summarized in Table 3.

Discussion
This study demonstrated that STZ-induced diabetes in adult male rats caused testicular damage both histologically and biochemically, and CAPE administration effectively reduced this damage.
Diabetes mellitus, one of the most common metabolic diseases, represents a major concern of global health due to its serious complications [18].There are experimental and clinical studies on diabetes-related male infertility [19,20].Approximately 90% of diabetic patients have been reported in several studies with a decrease in sexual functions (erection, ejaculation, and libido), testicular structural and functional disorders as well as spermatogenesis disorders [21].
It has been shown in previous studies that diabetes increases oxidative stress in testicular tissue.under increased oxidative stress, reactive oxygen radicals cause cellular damage by various mechanisms including oxidative damage of DNA and proteins and membrane lipid peroxidation [22][23][24].MDA levels have been widely used as a marker of lipid peroxidation products and lipid peroxidation damage in tissue and experimental studies [25,26].In our study, while STZ increased MDA activity, SOD activity decreased signifi cantly.The decline in the activities of these antioxidant enzymes might be due to their inactivation caused by excessive ROS production [27].A decrease in SOD activity has been shown to increase the level of superoxide.In recent years, antioxidant usage to reduce oxidative stress-related tissue damage caused by diabetes has In conclusion, our results suggest that the benefi cial properties of CAPE treatment, via its potent antioxidants, may reduce the adverse effects of diabetes in the reproductive system in rats.Caspase (+) cell 0.00 ± 0.00 0.00 ± 0.00 5.85 ± 0.

Figure 1 :
Figure 1: Control [A] and CAPE [B] groups.The seminiferous epithelium is structurally intact and shows normal association of germ cells.STZ group.Revealing disorder of seminiferous tubule germinal epithelium [arrows] [C] congestion of vessels and edema in interstitial spaces [asterisk] [D], desquamation of epithelial cells in the lumen [asterisk] [E], atrophy of the tubules with varying degree of spermatogenetic arrest [F] [arrows].STZ+CAPE group.Revealing atrophy of the tubules with varying degree of spermatogenetic arrest [arrows] [G] and congestion of vessels and edema in interstitial spaces [asterisk] [H].H&E x 400.

Table 1 :
Initial and final blood glucose levels of all group.
a Signifi cant increase (p = 0.0001), vs. control and CAPE groups b Signifi cant decrease (p = 0.0001), vs. STZ group c Not signifi cant change (p > 0.05), vs. control and CAPE groups d Not signifi cant change (p > 0.05), vs. STZ group e Signifi cant decrease (p = 0.0146), vs. control and CAPE groups f