Abstract
Objective: Testicular torsion (TT) may cause testicular necrosis. Although restoration of blood flow is essential to prevent testicular loss, reperfusion may induce testicular ischemia-reperfusion injury (TIRI), leading to testicular damage and potentially long-term infertility. All-trans retinoic acid (ATRA) has been shown to enhance the transcription of antioxidant enzymes and anti-apoptotic proteins, inhibit NF-κB-mediated transcription of inflammatory cytokines, and support germ-cell differentiation and spermatogenesis. This study investigated the protective effect of ATRA on the ipsilateral testis following unilateral testicular torsion/detorsion.
Methods: Twenty-four male Wistar rats were divided into four groups (n=6): Sham, Torsion/Detorsion (TD), ATRA+TD (7.5mg/kg administered 3 days before TIRI induction), and TD+ATRA (7.5mg/kg administered 3 days after TIRI induction). Torsion was induced for 1 hour and was followed immediately by detorsion.
Results: TD reduced the levels of reproductive hormones (testosterone and inhibin), Bcl-2, sperm indices, SOD, CAT, GPx, GST, GSH, and total protein, with concomitant increases in testicular MDA, NO, TNF-α, MPO, IL-6, NF-κB, Bax, caspase-3, DFI, and 8-OHdG levels. Histological evaluation of TD rats revealed reduced spermatogenesis indices, disruption of the seminiferous tubules, germ-cell loss, and vascular congestion. ATRA treatment significantly improved antioxidant enzyme activity, downregulated NF-κB and Bax signaling, restored reproductive hormones and sperm parameters, and protected testicular and epididymal structures.
Conclusion: ATRA protects against ipsilateral testicular damage following torsion/detorsion, as shown by restoration of depleted antioxidant enzymes, downregulation of inflammatory and pro-apoptotic markers, and enhancement of spermatogenesis and hormonal balance. These findings support the potential role of ATRA in preserving fertility after testicular torsion/detorsion.