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Journal of Andrology, Vol. 26, No. 1, January/February 2005
Copyright © American Society of Andrology

Permanent Induction of Morphological Abnormalities in the Penis and Penile Skeletal Muscles in Adult Rats Treated Neonatally With Diethylstilbestrol or Estradiol Valerate: A Dose-Response Study

HARI O. GOYAL*, TIM D. BRADEN{dagger}, CAROL S. WILLIAMS*, PRASAD DALVI*, MANSOUR M. MANSOUR* AND JOHN W. WILLIAMS{ddagger}

From the Departments of * Biomedical Sciences and {dagger} Biology/CBR/RCMI, Tuskegee University, Tuskegee, Alabama; and the {ddagger} Department of Anatomy, Physiology, and Pharmacology, Auburn University, Auburn, Alabama.

Correspondence to: H. O. Goyal, Department of Biomedical Science, School of Veterinary Medicine, Tuskegee University, Tuskegee, AL 36088 (e-mail: goyalho{at}tuskegee.edu).
Received for publication April 28, 2004; accepted for publication July 16, 2004.

   Abstract
 Top
 Abstract
 Materials and Methods
 Results
 Discussion
 References
 
This study evaluated the effects of neonatal exposure to different doses of diethylstilbestrol (DES) or estradiol valerate (EV) on penile morphology, penile skeletal muscles, and fertility. Male pups received DES or EV at a dose of 10 µg, 1 µg, 100 ng, 10 ng, or 1 ng per rat on alternate days from postnatal days 2-12. Fertility was tested at 120 days, and tissues were examined at 150 days. Generally, DES and EV induced similar effects within the 10- and 1-µg groups. Fertility was reduced to 0; the weight, length, and diameter of the penis and the weight of penile skeletal muscles, especially bulbocavernosus muscle, were decreased (P < .05) in a dose-dependent manner; the preputial sheath was partially released or its release was delayed; testicular descent was delayed; and the cavernous spaces and smooth muscle cells in the corpora cavernosa penis were replaced by fat cells. Conversely, all of the above parameters were similar in controls and the lower dose groups, except in the 100-ng DES group, in which 4 of 7 males did not sire pups (compared with 1 of 7 in controls and 2 of 6 in the 100-ng EV group). The loss of fertility in these 4 males of the DES group and 1 male of the EV group was associated with partial release of the preputial sheath and abnormal penile morphology. Plasma testosterone was reduced (P < .05) in the 100-ng and higher dose groups for DES and EV. Hence, neonatal exposure to DES or EV at a cumulative dose of 600 ng per rat or more lowers fertility, which is associated with permanent alterations in penile morphology and penile skeletal muscles and decreased testosterone.

     Key words: Estrogen, DES, fertility, testosterone, bulbocavernosus



Male reproductive disorders account for at least 50% of infertility cases in sexually active couples. Although causes of infertility in most men remain idiopathic, concerns have been raised about a possible link between environmental estrogens and lower sperm counts (see reviews in Jouannet et al, 2001; Fisher, 2004) and higher incidence of reproductive abnormalities in men (see reviews in Toppari et al, 1996). Similarly, laboratory animals exposed neonatally to excessive doses of estrogens develop cryptorchidism, epididymal cysts, smaller penis, hypospadias, or a combination of these conditions (McLachlan et al, 1975; Toppari et al, 1996; Newbold, 2001). Small phalluses in alligators from Lake Apopka in Florida have been linked to an excessive spill of estrogens (Guillette et al, 1994, 1996). Male offspring of women exposed to diethylstilbestrol (DES) during pregnancy are reported to have a higher incidence of reproductive tract abnormalities (see reviews in Gill et al, 1979; Shawn, 2000). Additionally, neonatal exposure to estrogens at very low doses can enlarge the prostate gland, whereas higher doses have the opposite effect (vom Saal et al, 1997; Gupta, 2000; Putz et al, 2001). Hence, exposure to estrogens or related xenobiotics during critical periods of development can have long-term consequences for male reproductive health later in life. However, mechanisms of estrogen action in male reproductive health or male reproductive disorders remain unclear.

Considering the possible deleterious effects of estrogenic compounds on human health, our long-range goal is to understand how estrogens mediate pathophysiology of male reproduction. In this endeavor, we previously reported that adult rats treated neonatally with DES at a dose of 10 µg/pup/d (equal to a total dose of 3-4 mg/kg) on alternate days from postnatal days 2-12 were infertile, and the loss of fertility was associated with abnormal penile morphology, including replacement of cavernous spaces and associated smooth muscle cells by fat cells in the corpora cavernosa penis (Goyal et al, 2004a). Realizing the novelty of these findings and their possible effect in male human health, we first sought to determine the dose-dependent effects of neonatal DES exposure on penile morphology. In addition, we determined the effects on descent of testes, release of preputial sheath, and weights of bulbocavernosus and levator ani muscles because these parameters can affect function, development, or both of the penis and were not included in our previous study.

Second, we sought to compare the dose-dependent effects of DES with those of another potent estrogenic compound such as estradiol valerate (EV) because it has a uterotrophic effect and binding affinity for estrogen receptors similar to those for DES. Moreover, because both humans and wildlife are constantly exposed to a mixture of environmental estrogenic compounds, it will be significant to determine whether penile abnormalities resulting from the DES treatment can also be caused by another estrogen.


   Materials and Methods
 Top
 Abstract
 Materials and Methods
 Results
 Discussion
 References
 
Animals and Treatments

Neonatal and adult Sprague-Dawley male and female rats (Harlan Sprague Dawley, Indianapolis, Ind) were maintained at 22°C-23°C ambient temperature, 55%-60% relative humidity, and a 12:12 hours light:dark cycle and had free access to food (Rodent Chow 5001; Purina Mills, St Louis, Mo) and water for 24 hours. Animals were handled in accordance with the guidelines of the National Institutes of Health Guiding Principles for the Care and Use of Animal Research, and all animal procedures were approved by the Institutional Animal Care and Use Committee at Tuskegee University.

Timed-pregnant female rats were housed individually. Within 24 hours of delivery, the litter size was adjusted to 8 pups/litter, with as many as 8 males, if possible. Pups (5-8 males/group, all pups within a group littermates, 2 groups each for controls and the 10- and 1-µg DES and EV treatments) received subcutaneous injections of 25 µL of olive oil containing DES or EV (Sigma, St Louis, Mo) at a dose of 10 µg, 1 µg, 100 ng, 10 ng, or 1 ng/pup/d on alternate days from postnatal days 2-12. The maximal 10-µg dose was selected on the basis of our previous study, in which it caused 100% infertility in male rats at adulthood; the loss of fertility was associated with the loss of cavernous spaces and accumulation of fat cells in the body of the penis (Goyal et al, 2004a). The control pups received olive oil only. Animals were weaned at 22 days and regularly observed for development until necropsied at 150 days.

Descent of Testes

Testicular descent was observed every other day from day 22 to day 38 and thereafter every third or fourth day (every Friday and Tuesday of the week). Testes were characterized as fully descended when they were palpated in the scrotum while holding the animal in a supine position. The formation of a scrotal bulge usually marked the descent in most animals.

Release of Preputial Sheath

The preputial sheath was examined every third or fourth day, beginning from day 38 to 119, 1 day prior to the fertility trial. While holding the animal in a supine position, the prepuce was gently pushed proximally (toward the abdominal wall) and was characterized as fully released when it completely retracted from the glans penis up to its transition with the shaft of the penis. More frequent examination of the sheath was avoided because of the fear of causing undue stress to the animal or accelerating the release process.

Fertility

Six to seven 120-day-old male rats from each of the 10 µg, 1 µg, 100 ng, 10 ng, and control groups were transferred to mating cages floored with a mesh grid and cohabited with untreated, 60-70-day-old females (1:1) for 12 days. Cages were checked twice daily for the presence of copulatory plugs. The plug-positive females were separated and evaluated for the presence of sperm in vaginal washings. These females were killed on day 15 of pregnancy, and those without plugs were killed on day 15 after the end of cohabitation. The uterus was removed and examined for the number of implantation sites and live fetuses. In addition, both ovaries were removed and the number of corpora lutea was counted. Data were analyzed to determine the pre- and postimplantation loss, as described previously (Goyal et al, 2004a).

Body Weight and Organ Weights

All animals were weighed and terminated at 150 days. The testis, caput and corpus of the epididymis, cauda of the epididymis, and seminal vesicle (including coagulating gland) of both sides were weighed, and the relative weights (weight of the organ per 100 g body weight) were calculated. Testes and epididymides were trimmed of fat prior to recording their weights. In addition, the caudal epididymal fat pad, located between the cauda epididymis and the distal extremity of the testis, was removed and weighed. The rationale was to determine whether DES, EV, or both had an effect on body fat because estrogens have been shown to decrease the weight of parametrial fat pads (Naaz et al, 2003). The caudal epididymal fat pad was selected for convenience because it can be easily and cleanly isolated.

Penis and Penile Skeletal Muscles

The penis was grossly examined for its length, diameter, and weight. The prepuce was retracted or incised in animals in which it was still partially attached to the glans, and the entire body of the penis was exposed by making a dorsal skin incision that extended through the body wall up to the ischial arch, the point of origin of the root of the penis. The stretched length was measured from the tip of the glans penis to the midpoint of the ischial arch and the diameter from the middle of the body of the penis with a caliper (calibrations up to 0.1 mm). After removing the free loose connective tissue, the entire penis was weighed. Sections (3-5 mm long) from the middle of the body were processed for histological examination and histochemical demonstration of fat (n ≥ 5 per group, except n = 4 for the 10-µg EV group) as described previously from our laboratory (Goyal et al, 2004b). Briefly, for histological examination, paraffin sections (5 µm thick) were stained with hematoxylin and eosin (H&E), and for fat demonstration, formaldehyde-fixed tissues were stained en block for 8 hours with 1% osmium tetroxide dissolved in 2.5% potassium dichromate solution, then processed for paraffin embedding. Undeparaffinized sections (5 µm thick) were examined by light microscopy, and the adjacent serial sections were stained with H&E to allow for examination of histological details. In addition, for controls and the 10- and 1-µg DES and EV groups (n = 3-4 per group), epoxy sections (1 µm thick) of glutaraldehyde-fixed tissues were stained with toluidine blue, and frozen sections of formaldehyde-fixed tissues were stained with Sudan Black. Also, to evaluate the development of the os penis, 1 penis from each group was radiographed with a cabinet radiographic system (Faxitron series, Hewlett-Packard, McMinnville, Ore) as described previously by our laboratory (Goyal et al, 2004b).

The penile skeletal muscles consisted of 3 pairs of muscles: ischicavernosus, bulbocavernosus, and levator ani. The latter 2 were included in this study because they can be isolated easily. The bulbocavernosus is a massive muscle covering the ventro-lateral surface of the bulb of the penis. Conversely, the levator ani muscle is in the form of a circular, thin band that surrounds the anus and terminates at the bulbocavernosus muscle. Both muscles were isolated by freeing the attached connective tissue and fat and then weighed separately.

Digital images of histopathological and histochemical, as well as gross specimens of the penis, were captured with a Leitz Orthoplan microscope (Vashaw Scientific, Inc, Norcross, Ga) and the Kodak Microscopy Documentation System 290 (Eastman Kodak Company, Rochester, NY) and were assembled with the use of Adobe Photoshop 7.0.

Hormone Measurements

One blood sample was collected from the heart of each animal before necropsy, and plasma was frozen at -20°C until assayed. Luteinizing hormone (LH) was measured with the use of materials obtained through National Hormone and Peptide Program (NHPP), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and Dr A. F. Parlow (antibodies: NIDDK-anti-rLH-S-11; reference standards: NIDDK-rLH-RP-3; tracers: NIDDK-rLH-I-10). The sensitivity of the assay was 0.3 ng/mL. Testosterone (T) was measured by a Coat-a-Count testosterone radioimmunoassay (Diagnostic Products Corporation, Los Angeles, Calif) according to the manufacturer's protocol. The sensitivity of the assay was 0.2 ng/mL. All samples were quantified in a single assay, and the intra-assay coefficient of variation was 6% and 7% for LH and T, respectively.

Statistics

Statistical analyses were performed with Sigma Stat statistical software (Jandel Scientific, Chicago, Ill). Analysis of variance was performed on body weight, hormones, penile length, and penile weight. In addition, to account for the litter effect, penile data from the 10- and 1-µg DES and EV treatments (n = 2 litters for each treatment) and controls (n = 2 litters) were grouped by individual litter and analyzed by analysis of variance with litter as the experimental unit. Treatment groups with means significantly different (P < .05) from controls were identified by Dunnett's test. When data were not distributed normally, or heterogeneity of variance was identified, analyses were performed on transformed data or ranked data.


   Results
 Top
 Abstract
 Materials and Methods
 Results
 Discussion
 References
 
Body Weight

The mean body weight (±SEM) at 150 days in animals treated with DES or EV at doses of 1 µg or lower was not significantly (P < .05) different from that of controls (466 ± 11 g); however, it was lower by 9% in the 10-µg DES group and by 15% in the 10-µg EV group than in controls (Table 1). In this context, it is noteworthy that 7 of 12 males in the 10-µg EV group and 3 of 14 males in the 1-µg EV group died between 43 and 108 days of age, and all of them appeared to die from urinary problems. None of the animals died in the 10- and 1-µg DES groups or in the lower dose EV and DES groups.


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Table 1. Effect of diethylstilbestrol (DES) or estradiol valerate (EV) exposure on body weight and paired absolute weight of the testis, head, and body of the epididymis (H/B EP); tail of the epididymis (Tail EP); and seminal vesicle (SV) in rats at 150 days of age
 

Organ Weight

     Testis, Epididymis, and Seminal Vesicle— Although the focus of the study was to determine dose-dependent effects of DES and EV on the penis and associated skeletal muscles, effects on the absolute and relative weights of the testis, epididymis, and seminal vesicle are included here for the sake of comparison and validity because estrogenic effects on these organs are well established in the literature, including from our laboratory (Goyal et al, 2001, 2003). Generally, effects were similar between the DES and EV groups; both caused reductions in weights in a more or less dose-dependent manner, with higher reductions in the 100-ng and higher dose groups and minimal to no reductions in the 10-ng and lower dose groups (Table 1). Among organs, the reduction was more pronounced in the seminal vesicle than in other organs (eg, 65% vs 20% in testes in the 1-µg EV group).

     Caudal Epididymal Fat Pad— The mean weight of the caudal epididymal fat pad in control animals was 338 mg, ranging from 237 to 460 mg among animals (Figure 1). However, it was significantly (P < .05) reduced to 50% of controls in the 10- and 100-ng DES groups and to less than 10% of controls in the 10-µg DES group. Similar significant reductions in weight were observed in the 100- to 10-µg EV groups (Figure 1).



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Figure 1. Effect of neonatal diethylstilbestrol (DES) or estradiol valerate (EV) exposure on the caudal epididymal fat pad in rats at 150 days of age. Data are expressed as mean ± SEM. * Significantly different (P < .05) from controls.

 

Descent of Testes

Testicular descent occurred at 24 days in controls (n = 10), 1- and 10-ng DES groups (n = 7 per group), and 1- to 100-ng EV groups (n = 7 per group). Conversely, it was delayed by 3 days in the 100-ng DES group (n = 7), 7-10 days in the 1-µg DES (n = 13) and EV (n = 14 per group) groups, 22-32 days in the 10-µg DES group (mean age of descent, 47.8 days; n = 16), and 39-67 days in the 10-µg EV group (mean age of descent, 77.0 days; n = 8).

Release of Preputial Sheath

The preputial sheath was completely separate from the glans penis at 47-50 days of age in controls (n = 10) and the 1- and 10-ng DES and EV groups (n = 7 per group). Conversely, it was delayed by 3 days in 2 males and 20 days in 1 male of the 100-ng EV group (n = 7); delayed by 3, 6, or 27 days, respectively, in 1 male each, and partially attached until day 119 in 4 males of the 100-ng DES group (n = 7); and partially attached until day 119 in all males of the 1- and 10-µg EV (n = 11 and 5, respectively) and DES (n = 13 and 16, respectively) groups.

Penile Measurements

Penile measurements, including weight, length, and diameter, were significantly (P < .05) reduced in a dose-dependent manner in the 10- and 1-µg DES and EV groups (Figure 2), although the percent decrease was higher for weight than length (eg, 41% vs 19% in the 1-µg EV group). Neither measurement was significantly different from that of controls in the 100-ng or less DES and EV groups, except the diameter in the 100-ng DES group (Figure 2). However, within the 100-ng group, 4 of 7 males had lower penile weight (174-205 vs 244-267 mg in the remaining 3) and shorter penile length (33-34 vs 40-41 mm), and all 4 of these males failed to sire pups (see details under "Fertility"). Similarly, the penis in 1 of 7 males in the 100-ng EV group was also lighter (234 vs 282-318 mg in 6 males) and shorter (34 vs 39-41 mm), and this male also did not sire pups. An analysis of data with Litter as the statistical experimental unit, to account for any litter effects (2 litters each for controls and the 10- and 1-µg DES and EV treatments), also showed significant reductions (P < .05) for all penile measurements as a result of treatments (Table 2).



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Figure 2. Effect of neonatal diethylstilbestrol (DES) or estradiol valerate (EV) exposure on the weight, length, and diameter of the penis in rats at 150 days of age. Data are expressed as mean ± SEM. * Significantly different (P < .05) from controls.

 

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Table 2. Effect of diethylstilbestrol (DES) and estradiol valerate (EV) on penile parameters. Analysis is based on individual litters as the experimental unit to account for any litter effect (2 litters each for controls and treatment groups)*
 

Penile Skeletal Muscles

The weight of the bulbocavernosus muscle was significantly (P < .05) decreased to 50% of controls in the 1-µg and to less than 20% of controls in the 10-µg DES and EV groups (Figure 3). Conversely, significant weight reduction in the levator ani muscle was found only in the 10-µg DES and EV groups. Furthermore, the percent weight reduction was comparatively much lower for the levator ani than the bulbocavernosus in both the 1- and 10-µg DES and EV groups (Figure 3).



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Figure 3. Effect of neonatal diethylstilbestrol (DES) or estradiol valerate (EV) exposure on the weight of the bulbocavernosus (BC) and levator ani (LA) muscles in rats at 150 days of age. Data are expressed as mean ± SEM. * Significantly different (P < .05) from controls.

 

Penile Gross Morphology

The rodent penis, including the rat, has 2 distinguishing gross, morphological features: os penis and right angle between the body and the glans penis. Both features were adversely altered in the 10- and 1-µg DES and EV groups, especially so in the 10-µg groups (Figure 4). The os penis comprised 2 parts: proximal and distal. A radiographic examination revealed that not only were both parts of the os penis malformed, underdeveloped, and undercalcified, but the distal part (closer to the tip of the glans penis) did not even develop in the 10-µg groups. Except for somewhat less calcification of the distal part of the os penis in the 100-ng groups, the penile gross morphology appeared unaltered in the remaining lower dose groups (Figure 4).



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Figure 4. Radiographs of the penis at 150 days of age in control rats and in rats treated neonatally with diethylstilbestrol (DES) or estradiol valerate (E2). Note reductions in the length and thickness of the penis, the angle between the body and glans of the penis, the thickness of the proximal part of the os penis (PO), and the lack of development or reduced thickness of the distal part of the os penis (DO) in the 10- and 1-µg DES and EV groups and somewhat less development of the DO in the 100-ng groups.

 

Penile Histopathology and Histochemistry

The body of the penis in most mammalian species, including rodents, comprises 3 erectile bodies: 2 corpora cavernosa that are located dorsolateral to the urethra and a corpus spongiosus that surrounds the urethra. The corpora cavernosa penis in rats, as in most other species with a vascular penis, consist of a network of endothelial-lined cavernous spaces (similar to sinusoids) that are surrounded by smooth muscle cells and separated by dense bundles of collagen fibers, which also form a part of the tunica albuginea that surrounds the corpora cavernosa. Both DES and EV in the 1- and 10-µg groups caused similar, dramatic histological changes in the corpora cavernosa penis. An examination of H&E-stained paraffin sections revealed that cavernous spaces and the surrounding smooth muscle cells were altogether absent and were replaced by cells that appeared to be empty (Figures 5A through D), which were confirmed as fat cells in paraffin sections stained with osmium tetroxide, frozen sections stained with Sudan Black, and epoxy sections stained with toluidine blue (Figures 5E through H). Only few, if any, collagen fibers were present between fat cells, and the tunica albuginea was reduced to a thin band of collagen fibers. It should be noted that, despite the absence of cavernous spaces, arterioles and capillaries (the latter have smaller and regular diameter, in contrast to irregular and wider diameter of the cavernous spaces) were invariably present in the corpora cavernosa (Figure 5D).



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Figure 5. (A-J) Micrographs of the corpora cavernosa penis from the body of the adult penis in control rats and in rats treated neonatally with estradiol valerate (EV) or diethylstilbestrol (DES). (A, B) Low-magnification micrographs of undeparaffinized sections from the control (A) and the 1-µg EV (B) rats. Note accumulation of fat cells in the treated animal, in contrast to their virtual absence in the control rat. Also, note reduced thickness of the tunica albuginea (ta) as a result of the treatment; cavernous spaces (cs), blood vessels (bv), and nerves (n) in the intercrural septum. (C, D) High-magnification micrographs of paraffin sections from the control (C) and the 1-µg EV groups. Note the cavernous spaces (cs) and adjoining smooth muscle cells (arrows) and dense collagen fibers (arrowheads) in the control rat in contrast to fat cells that appear to be empty in the treated rat. Also note that, despite the absence of cavernous spaces, arterioles (arrows) and capillaries (arrowhead) are present in the treated animal. (E-H) Frozen and epoxy sections in the control (E, F) and the 1-µg EV (G, H) groups. Again, note the abundance of cavernous spaces (cs) in the control rats and their replacement by fat cells in the treated rats. (I, J) Low-magnification micrographs of undeparaffinized sections from the 100-ng DES group. Note many more fat cells in the rat that did not sire pups (J) than in the rat that did (I), but the latter animal still has more fat cells than controls, which have only 1 or 2 isolated fat cells. Effects in the 10-µg DES and EV groups and the 1-µg DES group were similar to those reported above and thus are not shown. (A, B, E, G, I, J) fat stain; (C, D) hematoxylin and eosin; (F, H) toluidine blue.

 

The histology of the corpora cavernosa in the 10- and 1-ng DES and EV groups was unaltered. However, it showed a differential response among animals in the 100-ng groups, especially in the DES group. Although cavernous spaces and smooth muscle cells were clearly visible in 3 of 7 males in the DES group and 6 of 7 males in the EV group, they were altogether absent and replaced by fat cells in the remaining males of both groups. Even those males that had cavernous spaces had apparently more fat cells, especially in the DES group, compared with controls (Figures 5I and J).

Unlike the corpora cavernosa, there was no apparent loss of cavernous spaces or smooth muscle cells or aggregation of fat cells in the corpus spongiosus, regardless of the dose or the estrogenic compound (not shown).

Reproductive Hormones

The mean concentration of plasma testosterone in the 1- or 10-ng DES and EV groups was not significantly (P < .05) different from that of controls (2.78 ng/mL), but it was significantly reduced in the 100-ng and higher dose DES and EV groups (Figure 6). Plasma LH level was not significantly different between controls and any of the DES and EV groups, except in the 10-ng and 1-µg EV groups.



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Figure 6. Effect of neonatal diethylstilbestrol (DES) or estradiol valerate (EV) exposure on plasma testosterone and luteinizing hormone (LH) concentration in rats at 150 days of age. Data are expressed as mean ± SEM. * Significantly different (P < .05) from controls.

 

Fertility

Although 6 of 7 males in the control group, 7 of 7 males in the 10-ng DES group, and 5 of 6 males in the 10-ng EV group sired pups, none of the females mated with the 10- or 1-µg DES and EV groups (n = 6 per group), had pups, or had copulatory plugs (Table 3). In the 100-ng groups, 4 of 7 males in the DES group and 2 of 6 males in the EV group did not sire pups. Also, none of the females that mated with these 6 males had copulatory plugs. A comparison of reproductive data between those who sired and those who did not sire in the 100-ng DES group revealed that all animals of the latter group had lighter and shorter penes and lower testosterone levels than those in the former, although there were no apparent differences in the body weight and organ weights between the 2 groups (Table 4).


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Table 3. Fertility in male rats treated with diethylstilbestrol (DES) or estradiol valerate (EV) neonatally and that cohabited at 120 days of age with 60-70-day-old untreated females (1:1) for up to 12 days. Controls received oil only
 

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Table 4. Comparison in the 100-ng diethylstilbestrol (DES) group of organ weight, penile length, and plasma testosterone level between those males that sired pups (Sire) and those that did not (Nonsire)*
 


   Discussion
 Top
 Abstract
 Materials and Methods
 Results
 Discussion
 References
 
Previously, we reported that adult male rats treated neonatally with DES at a dose of 10 µg/rat/d on alternate days from postnatal days 2-12 were infertile and that the loss of fertility was accompanied by dramatic phenotypic and histopathological changes in the penis (Goyal et al, 2004a). The objectives of this study were to determine dose-dependent effects of neonatal DES exposure on the penis and to determine whether another estrogen compound, such as EV, can also cause similar abnormalities. Results confirmed our previous findings and revealed for the first time that EV, similar to DES, is capable of inducing penile abnormalities, including reductions in weight, length, and diameter of the penis; maldevelopment of the os penis; reduction in the angle between the glans penis and body of the penis; and histopathological changes in the corpora cavernosa penis. These abnormalities were manifested more or less dose dependently, with higher adverse effects observed in the 100-ng and higher dose groups and minimal to no effects in the 10- and 1-ng groups, although within the same dose groups of DES and EV, effects were more severe in the 10-µg EV and 100-ng DES groups.

Hence, neonatal DES or EV exposure at a cumulative dose of 600 ng or higher per rat can result in permanent morphological changes in the rat penis, which are associated with lower fertility. This information is clinically valuable considering that more than 2 million men in the world are now in their 40s and 50s and were exposed to DES in utero when their mothers were treated with DES for preventing miscarriage (Shawn, 2000). According to one study, DES males born to a cohort of women at the Boston Lying-in Hospital were exposed to a total median dose of 12 200 mg (equal to 200 mg/kg, on the basis of a weight of 60 kg for a pregnant woman; Heinonen, 1973) in contrast to a total dose of 0.03-0.04 mg/kg received by male pups of the 100-ng dose groups of the present study. Although some might argue against the appropriateness of direct comparisons of exposure between neonatal rats and human embryos, male external genitalia are as undifferentiated in rats at birth as in the first trimester of pregnancy in humans (Williams-Ashman and Reddi, 1991; George and Wilson, 1994; Klonisch et al, 2004). Moreover, daughters exposed to DES during the first 7 weeks of their mothers' pregnancy had a much higher chance of developing vaginal adenocarcinoma than those who were exposed after 16 weeks (Shawn, 2000). In light of these observations, it is prudent to find out whether the incidence of erectile dysfunction is higher in DES-exposed men than in the general population. To our knowledge, such information is not available, although fertility in a small cohort of the DES men was found to be normal (Wilcox et al, 1995).

A notable finding of this study, as well as that of our previous studies (Goyal et al, 2004a,b), was the replacement of cavernous spaces and smooth muscle cells with fat cells in the corpora cavernosa penis in rats treated neonatally with DES. Neonatal EV exposure also resulted in similar histopathological changes, reinforcing estrogen-related adverse effects in the penis. Furthermore, both DES and EV induced structural alterations in the corpora cavernosa, but not in the adjoining corpus spongiosus, underscoring the specificity of estrogenic effects within the body of the penis. In light of this information, it is reasonable to predict that cavernous spaces are not likely to be replaced by fat cells in the glans penis because the latter is anatomically an extension of the corpus spongiosus (Dyce et al, 2002). Whether this prediction is true or not remains to be determined, but the glans penis was reduced in size in this study. However, this reduction probably resulted from the underdeveloped os penis, which is a part of the glans penis but is developmentally an extension of the distal part of the corpora cavernosa (Murakami and Mizuno, 1984).

The understanding of how neonatal estrogen exposure selectively transforms the corpora cavernosa could lie in unraveling the mechanisms of early differentiation of corpora cavernosa because estrogen-induced effects were already visible at 18 days of age, the earliest age at which we examined penises from rats treated neonatally with DES in an earlier study (Goyal et al, 2004b). Observations by other authors that cavernous spaces, smooth muscle cells, and os penis are absent in the rat penis at birth and start to differentiate from undifferentiated mesenchymal cells at 2-7 days of age (Murakami 1986, 1987a) suggest that the structural changes that we observed in the corpora cavernosa might have resulted from estrogen-induced alterations in the differentiation of mesenchymal cells. If this hypothesis has some validity, then estrogen exposure during a critical period of differentiation only should result in permanent structural changes in the penis. Although such a study is in progress in our laboratory, it is worth noting that penile morphology did not change in rats treated with DES at adulthood, although they did not sire pups, similar to those treated with DES neonatally (Goyal et al, 2004a). Furthermore, testosterone substitution at adulthood restored fertility in rats that received DES at adulthood but not in rats that received DES neonatally, thus implying that the loss of fertility was probably because of deficits in sexual behavior (central effect) in the former and abnormal penile morphology in the latter (peripheral effect).

In addition to the above histopathological changes, both DES and EV neonatal exposure reduced the weight, length, and diameter of the penis and delayed the release of the preputial sheath and the descent of testes. Interestingly, all these changes, except testicular descent, were directly related with the inability of males to sire pups. The best correlation came from observations in the 100-ng DES group, in which 4 of 7 males, which were unable to sire pups, had lighter and shorter penes and delayed preputial sheath release than the remaining 3 males, which sired. Similar observations were recorded in 1 of 7 males of the 100-ng EV group, which also did not sire. The delayed separation of preputial sheath, dose-dependent reductions in the length of the penis, or both were reported in rats treated neonatally with estrogen (Zanida et al, 1979; Putz et al, 2001). Similarly, phalluses in alligators exposed to excessive estrogenic contaminants in Lake Apopka, Florida, were significantly smaller than those in Lake Woodruff, a control lake in the area (Guillette et al, 1994, 1996).

Another important finding of the study was the dose-dependent reductions in weights of the penile skeletal muscles. More importantly, the reduction between 2 muscles was differential. For example, the bulbocavernosus muscle was decreased by 80% and 50%, respectively, in the 10- and 1-µg DES groups, in contrast to 40% and 10% reductions, respectively, for the levator ani muscle, implying a more severe effect of estrogen in the former muscle. To our knowledge, similar differential response to neonatal estrogen treatment has not been demonstrated in these 2 penile muscles previously, although it is known that both muscles are androgen dependent (Breedlove and Arnold, 1983; Mansouri et al, 2003), innervated by dimorphic spinal nucleus, and reduced in size by antiandrogens (Breedlove, 1992). In addition, their contraction augments erection of the penis (Sachs, 1982; Benson, 1994). Whether the decreased size of both muscles directly contributed in the loss of fertility cannot be assessed in this study because, in the absence of cavernous spaces and smooth muscle cells in the corpora cavernosa, it is difficult for the penis to become erect, or at least attain sufficient erection to enable penetration. However, a recent study reported much thicker ischicavernosus and bulbocavernosus muscles in potent than impotent men (Hsu et al, 2004).

The dose-dependent reductions in organ weights, including the testis, epididymis, and seminal vesicle, resulting from neonatal estrogen exposure were essentially similar to those reported earlier from our laboratory (Goyal et al, 2003), as well as from other laboratories (Sharpe et al, 1998; Atanassova et al, 2000; Putz et al, 2001). However, new information from this study that, to our knowledge, has not been reported previously is the effect of neonatal estrogen exposure on the caudal epididymal fat pad, which was decreased by 90% in the 10-µg and by 30%-50% in the 1-µg DES and EV groups. These decreases were similar to those observed in the seminal vesicle (eg, 90% and 30% in the 10- and 1-µg DES groups, respectively) and thus rank the caudal epididymal fat pad at par, in terms of estrogen sensitivity, with the seminal vesicle, which is by far one of the most sensitive reproductive organs to estrogen exposure (Robaire et al, 1987; Goyal et al, 2001; Putz et al, 2001). Whether similar levels of reductions occurred in other body fat pads was not studied presently; however, parametrial fat pads decreased in weight in adult female mice treated with 17ß-estradiol or the phytoestrogen genistein (Naaz et al, 2003). Conversely, epididymal, perirenal, and inguinal fat pads were more than 2-fold heavier in estrogen receptor-{alpha} (ER{alpha}) knockout mice than in wild male mice (Cooke et al, 2001).

An important question that remains to be answered is what hormonal and molecular mechanisms brought about the observed penile changes, especially the replacement of cavernous spaces by fat cells in the corpora cavernosa. Could they result from a direct effect of estrogens, an indirect effect via estrogen-induced decreased T on mesenchymal cells during their differentiation, or both? Although a detailed discussion on this question is beyond the scope of this study, some pertinent data are worth noting. Estrogen receptors have been identified in mesenchymal cells in 1-day-old rat penis (Jesmin et al, 2002). ER{alpha} expression was enhanced in fibroblastlike cells of the corpora cavernosa at 18 days of age in rats treated neonatally with DES (Goyal et al, 2004b), implying a role for ER{alpha} in estrogen-induced penile abnormalities. Additional support for a similar role of this receptor in reproduction comes from observations that ER{alpha} knockout mice of both sexes are infertile (Eddy et al, 1996) and that the prostate (Prins et al, 2001) and female reproductive tract (Couse et al, 2001) of ER{alpha} knockout mice are resistant to DES-induced developmental abnormalities.

Alternatively, androgen receptors are present in the genital tubercle of the fetal rat (Murakami, 1987b); they are seen ubiquitously in endothelial cells of cavernous spaces, smooth muscle cells, and fibroblastlike cells throughout the body of the rat penis at prepuberty, puberty, and adulthood (Goyal et al, 2004b); and their concentration reaches a peak level at a time when the rat penis is differentiating or developing at, or before, puberty (Rajfer et al, 1980; Takane et al, 1990; Goyal et al, 2004b). All these observations point to androgen action in differentiation of the penis. In this context, it is noteworthy that the simultaneous administration of testosterone with DES mitigated most of the male reproductive tract abnormalities in rats treated neonatally with DES alone (Rivas et al, 2003). Although it remains to be seen whether similar supplementation with testosterone will prevent DES-induced penile abnormalities, plasma T level was significantly lower in the 100-ng and higher DES and EV groups in this study. Similarly, previous authors (Rivas et al, 2003), as well as our laboratory (Goyal et al, 2004b), reported marked reduction in plasma T in prepubertal, pubertal, or both ages of rats treated neonatally with DES.

In this study, we describe for the first time neonatal EV exposure, similar to DES, inducing permanent penile abnormalities, including reductions in the length, weight, and diameter of the penis and histopathological changes characterized by the replacement of cavernous spaces and smooth muscle cells with fat cells in the corpora cavernosa penis. These penile abnormalities are associated with a decreased size of penile skeletal muscle cells and lower fertility and can be caused by a dose that is as low as 100 ng/rat/d, given subcutaneously on alternate days from postnatal days 2-12 (cumulative dose of 600 ng, or 0.03-0.04 mg/kg body weight).


   Acknowledgments
 
The authors acknowledge the technical help of Barbara Drescher in paraffin sections, Marya Towio-Kinnucan (Auburn University) in epoxy sections, and John R. Kammermann (Auburn University) in radiographs, and we thank Dr Alfonza Atkinson (deceased), Dean, for encouragement and support.


   Footnotes
 
Supported by NIH grants MBRS-5-S06-GM-08091 (H.G.) and RCMI-5-G12RR03059 and by US Department of Agriculture grant CSR-EESALX-TU-CTIF.


   References
 Top
 Abstract
 Materials and Methods
 Results
 Discussion
 References
 
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