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 <!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.0 20120330//EN" "http://jats.nlm.nih.gov/publishing/1.0/JATS-journalpublishing1.dtd"> <article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" article-type="research-article" dtd-version="1.0" xml:lang="en">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">JAA</journal-id>
      <journal-title-group>
        <journal-title>Journal of Antioxidant Activity</journal-title>
      </journal-title-group>
      <issn pub-type="epub">2471-2140</issn>
      <publisher>
        <publisher-name>Open Access Pub</publisher-name>
        <publisher-loc>United States</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.14302/issn.2471-2140.jaa-21-3910</article-id>
      <article-id pub-id-type="publisher-id">JAA-21-3910</article-id>
      <article-categories>
        <subj-group>
          <subject>research-article</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Antioxidative Protective Effect of Ozone Therapy on Isolated Mitochondria from Human Sperm </article-title>
        <alt-title alt-title-type="running-head">ozone therapy protected sperm cell</alt-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Parvaneh</surname>
            <given-names>Naserzadeh</given-names>
          </name>
          <xref ref-type="aff" rid="idm1842688588">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Farshad</surname>
            <given-names>Shahi</given-names>
          </name>
          <xref ref-type="aff" rid="idm1842689020">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Morteza</surname>
            <given-names>Izadi</given-names>
          </name>
          <xref ref-type="aff" rid="idm1842689020">2</xref>
          <xref ref-type="aff" rid="idm1842692260">*</xref>
        </contrib>
      </contrib-group>
      <aff id="idm1842688588">
        <label>1</label>
        <addr-line>Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran.</addr-line>
      </aff>
      <aff id="idm1842689020">
        <label>2</label>
        <addr-line>Ozone CRC BMSU Tehran, Iran.</addr-line>
      </aff>
      <aff id="idm1842692260">
        <label>*</label>
        <addr-line>Corresponding author</addr-line>
      </aff>
      <contrib-group>
        <contrib contrib-type="editor">
          <name>
            <surname>Abdelmonem</surname>
            <given-names>Awad Mustafa Hegazy</given-names>
          </name>
          <xref ref-type="aff" rid="idm1842526196">1</xref>
        </contrib>
      </contrib-group>
      <aff id="idm1842526196">
        <label>1</label>
        <addr-line>Professor and Former Chairman of Anatomy and Embryology Department, Faculty of Medicine, Zagazig University, Egypt</addr-line>
      </aff>
      <author-notes>
        <corresp>
    
    Morteza Izadi, <addr-line>Professor of Health Research                Center BMSU.</addr-line><email>morteza_izadi@yahoo.com</email></corresp>
        <fn fn-type="conflict" id="idm1850780524">
          <p>The authors have declared that no competing interests exist.</p>
        </fn>
      </author-notes>
      <pub-date pub-type="epub" iso-8601-date="2021-08-19">
        <day>19</day>
        <month>08</month>
        <year>2021</year>
      </pub-date>
      <volume>2</volume>
      <issue>2</issue>
      <fpage>15</fpage>
      <lpage>28</lpage>
      <history>
        <date date-type="received">
          <day>26</day>
          <month>07</month>
          <year>2021</year>
        </date>
        <date date-type="accepted">
          <day>10</day>
          <month>08</month>
          <year>2021</year>
        </date>
        <date date-type="online">
          <day>19</day>
          <month>08</month>
          <year>2021</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>© </copyright-statement>
        <copyright-year>2021</copyright-year>
        <copyright-holder>Parvaneh Naserzadeh, et al.</copyright-holder>
        <license xlink:href="http://creativecommons.org/licenses/by/4.0/" xlink:type="simple">
          <license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
        </license>
      </permissions>
      <self-uri xlink:href="http://openaccesspub.org/jaa/article/1700">This article is available from http://openaccesspub.org/jaa/article/1700</self-uri>
      <abstract>
        <p>Oxidative stress is implicated in male                 infertility and significantly higher reactive oxygen Species (ROS) are detected in 25% of infertile males. We showed that Ozone oxygen therapy (O<sub>2</sub>/O<sub>3</sub>)                    induces protective effects for oxidative stress factors and its consequences on isolated mitochondria                     obtained sperm which may provide insight into the role of Ozone oxygen in human infertility. The                  present study was carried out to further                           characterize and compare protective effect of Ozone oxygen on isolated mitochondria obtained from sperm. Semen was collected from human normal donors. We gained human sperm mitochondria by differential centrifugation and isolated mitochondria incubated with different concentrations (5µg/ml, 30 µg/ml, 80 µg/ml) of O<sub>2</sub>/O<sub>3</sub>. O<sub>2</sub>/O<sub>3 </sub>prevent significant decrease in reactive oxygen species formation and mitochondrial membrane potential collapse on             isolated Human sperm mitochondria. Ozone oxygen therapy induced increase in ATP concentration on                isolated mitochondria. Our findings showed that O<sub>2</sub>/O<sub>3 </sub>prevent toxicity in sperm, effect on mitochondrial                   respiratory chain and avoid to cytochrome c release and apoptosis signaling.</p>
      </abstract>
      <kwd-group>
        <kwd>Ozone/oxygen therapy</kwd>
        <kwd>mitochondrial dysfunction</kwd>
        <kwd>oxidative stress</kwd>
        <kwd>Human spermatozoa</kwd>
        <kwd>motility</kwd>
        <kwd>anti-oxidative protection.</kwd>
      </kwd-group>
      <counts>
        <fig-count count="5"/>
        <table-count count="6"/>
        <page-count count="14"/>
      </counts>
    </article-meta>
  </front>
  <body>
    <sec id="idm1842525188" sec-type="intro">
      <title>Introduction</title>
      <p>Spermatogenesis is an intricate cellular function   involving the differentiation and proliferation of male germ cells, the role of spermatozoa is to fertilize eggs. The entire process takes 35 and 76 days in mice and humans , in that order, and needs a particular microenvironment produced by testicular somatic cells, Sertoli  <xref ref-type="bibr" rid="ridm1842942356">28</xref><xref ref-type="bibr" rid="ridm1842995332">18</xref> . Sperm cells contain a significant number of mitochondria relative to their cytoplasm, making them susceptible to oxidative relative damages. Oxidative stress damages the human sperm acrosome and causes major loss of sperm motility <xref ref-type="bibr" rid="ridm1843310324">3</xref><xref ref-type="bibr" rid="ridm1842976436">22</xref> and enzymatic activity in mouse                     spermatozoa <xref ref-type="bibr" rid="ridm1843054092">8</xref> Moreover, many risk factors can                   stimulate various reactive oxygen species (ROS) creation in human sperms maturation and may be detrimental because of the production of a burst of ROS <xref ref-type="bibr" rid="ridm1843298012">2</xref>. For                 example, Varicocele is defined as a dilatation of the                    pampiniform plexus veins. It is the most common cause of male infertility affecting about 15%–20% of the                 general population and 35%–40% of men presenting for an infertility evaluation (replace with numbers).                   Oxidative stress and elevated sperm DNA fragmentation have been associated with varicocele mediated infertility <xref ref-type="bibr" rid="ridm1843052020">14</xref> Ozone therapy acts by regulating oxidative stress mainly through stimulating the antioxidant system of the cell <xref ref-type="bibr" rid="ridm1843061220">9</xref>. The cell structure of spermatozoa, the plasma membrane, a large number of mitochondria, low                     cytoplasm, and low antioxidant in sperm cytoplasm make them potentially susceptible to damage from free                      radicals <xref ref-type="bibr" rid="ridm1843039348">13</xref> ROS which is produced on cold-shock and osmotic stress of this procedure affect sperm organelles.                        Exposure to high ROS concentrations can result in the disruption of mitochondrial and plasma membranes, cause chromosomal and DNA fragmentation and lead to a reduction in sperm motility <xref ref-type="bibr" rid="ridm1842926876">32</xref>. It is recognized that  human sperm generate ROS in physiologic amounts, which play a role in sperm functions during sperm        capacitation, acrosome reaction, and oocyte fusion <xref ref-type="bibr" rid="ridm1843231948">1</xref>. Notably, repeated rectal administration of ozone is able to induce an adaptation to oxidative stress and promote an oxidative preconditioning preventing hepatocellular damage mediated by free radical <xref ref-type="bibr" rid="ridm1843061220">9</xref> . In addition to ROS evaluation, changes in MMP (mitochondrial membrane potential) could be a good display of a functional damage because sperm mitochondria side piece generate energy to support motility <xref ref-type="bibr" rid="ridm1843039348">13</xref> However, the special effects of several stress factors (mechanical stresses and                       environmental conditions) on mitochondria obtained from humans sperm (reactive oxygen species and                         mitochondrial membrane potential) have not been                     studied. There is still a lack of information regarding the mechanism by which rat spermatozoa are affected by physical interventions. Motility is strongly related to the ability of spermatozoa to manage its energy status.                  Flagella of sperm movement is the product of dynein ATPase activity that is restricted into the axoneme along the entire length of the flagellum and depends on the              supply of ATP <xref ref-type="bibr" rid="ridm1843088900">5</xref> One of the reasons for sperm                        immobility may be impairment of the function of sperm mitochondria. In the past decade a growing number of tests have been developed to explore different functions of sperm cells <xref ref-type="bibr" rid="ridm1842976436">22</xref>. Imaging and flow cytometer have been implied to increase the accuracy, selectively speed, power, and suitability of semen analysis in the clinic and basic research. Ozone therapy or more specifically,             O3-AHT, has been used for almost 40 years. The first                   report on ozone ozone/oxygen therapy was published by Wolff in 1974 <xref ref-type="bibr" rid="ridm1842999580">17</xref><xref ref-type="bibr" rid="ridm1842942356">28</xref>. Though ozone therapy is now used all over the world, it has not been accepted as               orthodox medicine in all countries. ozone/oxygen                  therapy has been used in the treatment of ischemic                  disorders, although there are no data from clinical trials. .It is suggested that ozone could enhance antioxidant  systems and regulate inflammatory response, improve vascular rheology, and increase blood flow in cerebral arteries and tissue oxygenation in hypoxic tissues <xref ref-type="bibr" rid="ridm1843039348">13</xref> Several authors have clearly demonstrated the                            therapeutic efficacy of ozone/oxygen is related to           controlled and moderate oxidative stress produced by the reactions of ozone/oxygen with biological components and moderate exercise could reverse this moderate side effect <xref ref-type="bibr" rid="ridm1843044100">12</xref><xref ref-type="bibr" rid="ridm1842926876">32</xref>  The adverse effects of oxidation can be reduced by antioxidants that are present as an element of seminal plasma. An equilibrium between ROS production and seminal antioxidants normally exists; however,              special effects of endogenous antioxidants in poor semen samples are often diminished while the concentration of ROS is abnormally high  <xref ref-type="bibr" rid="ridm1842999580">17</xref> . Ozone/Oxygen therapy acts by regulating oxidative stress mainly through stimulating the antioxidant system of the cell <xref ref-type="bibr" rid="ridm1842999580">17</xref> The aim of this study was to determine antioxidant effect of Ozone/Oxygen therapy on isolated mitochondria from semen specimen.</p>
    </sec>
    <sec id="idm1842524324" sec-type="materials">
      <title>Materials and Method</title>
    </sec>
    <sec id="idm1842524252" sec-type="materials">
      <title>Materials </title>
      <p>All chemicals and reagents were purchased from Sigma-Aldrich (Taufkrichen, Germany) in the best                      commercial grade.</p>
      <sec id="idm1842523892">
        <title>Experimental Design</title>
        <p>Fractions were classified intothree groups as follows: group 1: control group (without ozone=C), group 2: varicocele group (C.V) and varicocele group (incubation with 5µg/ml ozone/Oxygen; group 3:                        incubation with 30µg/ml ozone/Oxygen, group 4:                    incubation with 80µg/ml ozone/Oxygen) and choose 5µg/ml ozone/Oxygen.</p>
      </sec>
      <sec id="idm1842521516">
        <title>Medozon </title>
        <p>The Medozon serves for medical application (HAB company 2015, ozone generator,                                  UMDNS-Nr.12899) was used for the generation of an    oxygen/ozone mixture (Ozone/ Oxygen ratio: 99.95%/0.05%). The ozone / oxygen concentration can be adjusted from 5 to 80 µg/ml (ozone / oxygen                         concentration was regulated by spectrophotometry.</p>
      </sec>
      <sec id="idm1842522956">
        <title>Semen collection</title>
        <p>Semen samples were produced by masturbation into sterile containers from voricosperm, (N=5) human volunteers with proved varicocele. The mean age was between 20-25years and all of them were non-smoker. They were referred to the Hilal Ahmar infertility Clinic in Tehran. We give of ethics committee. The full description of the subject with participants, we collected semen. all of the participants accepted detail sentence. We give ethical code  of Baqiyatallah University (Ir.bmsu.rec.1395.2) .    </p>
      </sec>
      <sec id="idm1842521444">
        <title>Semen Analysis</title>
        <p>Sample of Semen were collected by masturbation after 3–5 days of moderation. All samples were allowed to liquefy at 37°C for 60 minutes and were then measured according to World Health Organization guidelines (WHO 2010) (<xref ref-type="bibr" rid="ridm1843050004">11</xref> , <xref ref-type="bibr" rid="ridm1842958636">26</xref> Following incubation for 1 hour at 37 °C in air, 10 ml of sperm suspension was placed on a Makler chamber and sperm motility parameters were analyzed by Computer Assisted Sperm Analysis (CASA). The semen analyzer used was the Hamilton Thorne                Research semen analyzer (IVOS, Version 10.8x. Hamilton Thorne, Beverly, USA). The resulting variables were taken into reflection: ejaculate volume (mL), sperm                            concentration (10<xref ref-type="bibr" rid="ridm1843072612">6</xref>/mL), total sperm number (10<sup>6</sup>/ejaculate), motility (%), and morphology (% abnormal forms). In addition to raw data on the percentage of             motility, we also reflected absolute values in terms of motile sperm of millions per ejaculate (obtained by                  multiplying the total sperm per ejaculate by the                             percentage of sperm motility). Automated computer  analysis of sperm motility (CASA System; Hamilton Thorne) was carried out on all Semen samples and              included a heated stage at 37°C. The variables taken into consideration were curvilinear velocity (VCL m/s) , Beat frequency (BCF),Straightness= VSL/VAP×100) STR(,velocity of average nice if you have it path) VAP(, amplitude lateral head) ALH(,velocity of straight line )VSL<xref ref-type="bibr" rid="ridm1842981476">21</xref> .</p>
      </sec>
      <sec id="idm1842522524">
        <title>Cellular Toxicity Assay</title>
      </sec>
      <sec id="idm1842522164">
        <title>Cell Viability Assay</title>
        <p>Cell viability was assessed by3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyl tetrazolium bromide (MTT) staining as described by Mosmann <xref ref-type="bibr" rid="ridm1843072612">6</xref> The MTT assay is based on the reduction of the tetrazolium salt, MTT, by viable cells .The dehydrogenases using NADH or NADPH as co enzyme can convert the yellow form of the MTT salt to in soluble, purple formazan crystals  <xref ref-type="bibr" rid="ridm1842922556">33</xref> Formazan solution is read spectrophotometrically after the crystals are dissolved DMSO). Spermatozoa (1×10<xref ref-type="bibr" rid="ridm1843090412">4</xref> cells/well) were incubated in 96-wellplates in the                 presence or absence of O<sub>2</sub>/O<sub>3 </sub>for 48h in a final volume of 100 µl. At the end of the treatment, 20 µl of MTT (5mg/ml in PBS) was added to each well and incubated for an additional 4 h at 37 °C. The purple blue MTT formazan precipitate was dissolved in100 ml of DMSO and the  absorbance was measured at 570nm using a ELISA    reader (Tecan, Rainbow Thermo, Austria). Each                 concentration was tested in five different experiments run in five replicates for each sample. The concentrate of Ozone /oxygen (O<sub>2</sub>/O<sub>3</sub>) used were 5, 30 and 80 μg/ml and mitochondrial fractions were incubated in Tris            buffer to we give optimum dose.</p>
      </sec>
      <sec id="idm1842498980">
        <title>Mitochondrial Preparation</title>
        <p>Sperm samples were directly used after two washes in PBS and centrifugation at 800g for 5min.           Finally, mitochondrial pellets (0.5 mg/ml) were                    suspended in Tris buffer at room temperature for all other experiments. Except for mitochondria used to            assess ROS production, in which MMP were suspended in respiration buffer, MMP assay buffer. Protein                             concentrations were determined through the Coomassie blue protein-binding method as explained by Bradford <xref ref-type="bibr" rid="ridm1843056828">10</xref>. For in vitro experiments, Ozone oxygen (O<sub>2</sub>/O<sub>3</sub>) was dissolved in distilled water. </p>
      </sec>
      <sec id="idm1842499700">
        <title>Dehydrogenase (Complex II) Activity </title>
        <p>Mitochondrial succinate dehydrogenase (complex II) activity was measured by the reduction of MTT to formazan at 570 nm as described in previous studies <xref ref-type="bibr" rid="ridm1842922556">33</xref></p>
      </sec>
      <sec id="idm1842496388">
        <title>Quantification of Mitochondrial ROS Level</title>
        <p>The mitochondrial ROS measurement was                 performed by flow cytometry using DCFH-DA. Briefly, isolated sperm mitochondria were incubated with, Ozone/ oxygen (5μg/ml) in respiration buffer. In the interval times of 5 and 60 min following the Ozone        oxygen addition, a sample was taken and DCFH-DA was added (final concentration, 10 μm) to mitochondria and was then incubated for 10 min. O<sub>2</sub>/O<sub>3 </sub>prevented   ROS generation in isolated sperm mitochondria were                    determined through the flow cytometry (BD) equipped with a 488-nm argon ion laser and supplied with the softwaring 1.2.5 and the signals were obtained using a 530-nm band pass filter (FL-1 channel). Each                              determination is based on the mean fluorescence                 intensity of 10,000 counts <xref ref-type="bibr" rid="ridm1843077004">7</xref></p>
      </sec>
      <sec id="idm1842497252">
        <title>Determination of the MMP</title>
        <p>Mitochondrial uptake of the cationic fluorescent dye, rhodamine 123, has been used for the estimation of mitochondrial membrane potential. The mitochondrial fractions (0.5 mg protein/ml) were incubated with              various concentrations of O<sub>2</sub>/O<sub>3 </sub>and then 10 μm of               rhodamine 123 was added to mitochondrial solution in MMP assay buffer. The fluorescence was monitored              using determined through the flow cytometry (BD) equipped with a 488-nm argon ion laser and supplied with the softwaring 1.2.5 and the signals were obtained using a 530-nm band pass filter (FL-1 channel). Each determination is based on the mean fluorescence                     intensity of 10,000 counts<xref ref-type="bibr" rid="ridm1843077004">7</xref>, <xref ref-type="bibr" rid="ridm1842919460">34</xref></p>
      </sec>
      <sec id="idm1842497684">
        <title>Assay of ATP </title>
        <p>The ATP level was measured by luciferase               enzyme as described by <xref ref-type="bibr" rid="ridm1842937388">30</xref> Bioluminescence intensity was measured using Sirius tube luminometer (Berthold Detection System, Germany).</p>
      </sec>
    </sec>
    <sec id="idm1842496676">
      <title>Statistical Analysis </title>
      <p>Results are presented as means ± SD. All                  statistical analyses were performed using the SPSS                 software, version 17. Assays were performed in                  triplicate and the mean was used for the statistical      analysis. Statistical significance was determined using the one-way ANOVA test, followed by the post-hoc Tukey test. Statistical significance was set at P &lt; 0.05, P &lt; 0.01, P &lt; 0.001 and   P &lt; 0.0001.</p>
    </sec>
    <sec id="idm1842496532" sec-type="results">
      <title>Results</title>
      <sec id="idm1842498188">
        <title>Determination of Semen Collection</title>
        <p>Semen were collected by masturbation after 3–5 days of moderation. We showed  for All Samples generally characterize: Sperm number(×10<xref ref-type="bibr" rid="ridm1843072612">6</xref>/ejaculate) , Volume(ml), Sperm viability (%),Sperm concentration(M/ml),Normal sperm morphology(%).there are generally characterize on the standard semen collection.(<xref ref-type="table" rid="idm1849565140">Table 1</xref>) There are not  significant differences between all of the treatment groups (varicocele ) and health groups.</p>
        <table-wrap id="idm1849565140">
          <label>Table 1.</label>
          <caption>
            <title> Semen collection and semen characteristic. Values represented as mean ± SD (n=5). **P &gt; 0.01compared to                       control health group (C).</title>
          </caption>
          <table rules="all" frame="box">
            <tbody>
              <tr>
                <td>Parameters</td>
                <td>C</td>
                <td>T</td>
              </tr>
              <tr>
                <td>Sperm number(×10<xref ref-type="bibr" rid="ridm1843072612">6</xref>/ejaculate)</td>
                <td>22±1 </td>
                <td>25±2.1</td>
              </tr>
              <tr>
                <td>Volume(ml) </td>
                <td>±1.11</td>
                <td>1.5±2</td>
              </tr>
              <tr>
                <td>Sperm viability (%) </td>
                <td>±1001</td>
                <td>94.2±2</td>
              </tr>
              <tr>
                <td>Sperm concentration(M/ml) </td>
                <td>±47.110.4</td>
                <td>42.16±21.12</td>
              </tr>
              <tr>
                <td>Normal sperm morphology (%)</td>
                <td>1.2±100</td>
                <td>87±1**</td>
              </tr>
            </tbody>
          </table>
        </table-wrap>
      </sec>
      <sec id="idm1842475972">
        <title>Determination of Sperm Motility and Kinetic                        Parameters</title>
        <p>The post swim-up sperm motility parameters and kinetic parameters are shown in <xref ref-type="table" rid="idm1849566940">Table 2</xref>, <xref ref-type="table" rid="idm1849518364">Table 3</xref> and <xref ref-type="table" rid="idm1849486036">Table 4</xref>. There are significant differences between the treatment group with varicocele groups +5μg/ml O<sub>2</sub>/O<sub>3 </sub>(5μg/ml) and the control group (C) and varicocele groups (C.V).</p>
        <table-wrap id="idm1849566940">
          <label>Table 2.</label>
          <caption>
            <title> CASA result for the semen parameters and sperm vitality of the motility classes of diseases group (C. V) and 5 µg/ml of O2/O3 compared control health group(C). Values represented as mean ± SD (n=5). *P &gt; 0.05; **P &gt; 0.01; *** P&gt; 0.001</title>
          </caption>
          <table rules="all" frame="box">
            <tbody>
              <tr>
                <td>Groups</td>
                <td>Fields</td>
                <td>Quantity</td>
                <td>Concentration (M/ml)</td>
                <td>Class: A+B(PR)%</td>
                <td>Class: C(NP) %</td>
                <td>Class: D(IM) %</td>
                <td>Class: A+B(PR)+C %</td>
              </tr>
              <tr>
                <td>C</td>
                <td>4±1</td>
                <td>282±19.11</td>
                <td>15±1.2</td>
                <td>60±6.22</td>
                <td>21±10.21</td>
                <td>10±4.2</td>
                <td>81±10.11</td>
              </tr>
              <tr>
                <td>C.V</td>
                <td>3.5±0.57*</td>
                <td>134.5±10.34***</td>
                <td>34.4175±30**</td>
                <td>37.5±19.2**</td>
                <td>18.25±8.8*</td>
                <td>38±30.1**</td>
                <td>54.25±28.1***</td>
              </tr>
              <tr>
                <td>5 µg/ml</td>
                <td>4±1.1</td>
                <td>288±19.16</td>
                <td>24.085±19.5</td>
                <td>62±6.44</td>
                <td>25±12.21</td>
                <td>18±6.66</td>
                <td>80±11.23</td>
              </tr>
            </tbody>
          </table>
        </table-wrap>
        <table-wrap id="idm1849518364">
          <label>Table 3.</label>
          <caption>
            <title> Comparison between mean percentages kinematic parameters in human sperm in diseases group (C.V) and 5 µg/ml of O2/O3 compared control health group (C). Values represented as mean ± SD (n=5). *P &gt; 0.05; **P &gt; 0.01; *** P&gt; 0.001.</title>
          </caption>
          <table rules="all" frame="box">
            <tbody>
              <tr>
                <td>Parameters</td>
                <td>Class Name</td>
                <td>VSL, µm/s</td>
                <td>VCL, µm/s</td>
                <td>VAP, µm/s</td>
                <td>ALH, µm</td>
                <td>STR, rel. units</td>
                <td>BCF, Hz</td>
              </tr>
              <tr>
                <td>C</td>
                <td>A+B(PR)</td>
                <td>92.47±2.1</td>
                <td>111.95±2</td>
                <td>104.67±1.1</td>
                <td>1.68±1</td>
                <td>88.34±1.3</td>
                <td>3.44±1.4</td>
              </tr>
              <tr>
                <td>C.V</td>
                <td>D(IM)</td>
                <td>31.22±1.1</td>
                <td>129±2.2</td>
                <td>55.1±2.45</td>
                <td>1±0.5</td>
                <td>55.66±1</td>
                <td>1.1±0.7</td>
              </tr>
              <tr>
                <td>5 µg/ml</td>
                <td>A+B(PR)</td>
                <td>90.21±0.1**</td>
                <td>111.95±2*</td>
                <td>100.00±2.1***</td>
                <td>1.68±1*</td>
                <td>90.21±1.3***</td>
                <td>3.44±1.4**</td>
              </tr>
            </tbody>
          </table>
        </table-wrap>
        <table-wrap id="idm1849486036">
          <label>Table 4.</label>
          <caption>
            <title> Comparison between mean percentages motion parameters in human sperm in diseases group (C. V) and 5 µg/ml of O2/O3 compared control health group (C) Values represented as mean ± SD (n=5). *P &gt; 0.05; **P &gt; 0.01; *** P&gt; 0.001, compared to control group</title>
          </caption>
          <table rules="all" frame="box">
            <tbody>
              <tr>
                <td>Groups</td>
                <td>C</td>
                <td>C.V</td>
                <td>5 µg/ml</td>
              </tr>
              <tr>
                <td>Progressive (%) </td>
                <td>39±8</td>
                <td>11±3**</td>
                <td>35±8.2*</td>
              </tr>
              <tr>
                <td>Non-progressive (%) </td>
                <td>35±8</td>
                <td>17.1±3**</td>
                <td>35±10</td>
              </tr>
              <tr>
                <td>Immotile (%) </td>
                <td>57.4±18</td>
                <td>77.68±11***</td>
                <td>20.12±26.60 **</td>
              </tr>
              <tr>
                <td>Total motility (%)</td>
                <td>39.5±14.5</td>
                <td>20.18±2***</td>
                <td>±5529.2** </td>
              </tr>
            </tbody>
          </table>
        </table-wrap>
      </sec>
      <sec id="idm1842418716">
        <title>Cell Viability Assay</title>
        <p>For determination of O<sub>2</sub>/O<sub>3 </sub>we used MTT assay. First, we measured the probable cytotoxicity of O2/O3on sperm. Our results on sperm showed that O<sub>2</sub>/O<sub>3 </sub>was           cytotoxic at the 30 and 80 μg/mL concentration. The            results with MTT assay showed that only at the lowest concentration (5 μg/ml) O<sub>2</sub>/O<sub>3 </sub>has nontoxic effect toward sperm. As shown, O<sub>2</sub>/O<sub>3 </sub>at concentrations of 30 (p&lt;0.01) and 80 μg/mL, significantly (p&lt;0.001) reduced cell                            viability. When mitochondria have normal activity in 5μg/ml concentration of O2/O3 <xref ref-type="bibr" rid="ridm1843077004">7</xref> then we chose 5μg/ml             concentration of for step 2. (<xref ref-type="fig" rid="idm1849442060">Figure 1</xref>)</p>
        <fig id="idm1849442060">
          <label>Figure 1.</label>
          <caption>
            <title> Effect O2/O3on cell viability. Succinate dehydrogenase activity was measured using MTT dye as described in Materials and methods. Isolated mitochondria (0.5 mg/ml) were incubated for 1h with various concentrations of O2/O3 (5,30, 80µg/ml). Values represented as mean ± SD (n=5). *P &gt; 0.05; **P &gt; 0.01; *** P&gt; 0.001, **** P&gt; 0.0001compared to control mitochondria. </title>
          </caption>
          <graphic xlink:href="images/image1.jpg" mime-subtype="jpg"/>
        </fig>
      </sec>
      <sec id="idm1842415764">
        <title>Effects of O2/O3 (5μg/ml) on Mitochondrial Succinate           Dehydrogenase Activity</title>
        <p>In varicocele groups +5μg/ml O<sub>2</sub>/O<sub>3 </sub>(5μg/ml)group, significantly decrease (p&lt;0.01)succinate                       dehydrogenase (complex II) activity after 5 min but we show did not any reduce in enzyme activity compared with control group (C) after 60 min .varicocele groups (C.V) significantly decreased (p&lt;0.001) enzyme activity compare with control group (C). (<xref ref-type="fig" rid="idm1849441844">Figure 2</xref>)</p>
        <fig id="idm1849441844">
          <label>Figure 2.</label>
          <caption>
            <title> Effect O2/O3 on Succinate dehydrogenase activity. Succinate dehydrogenase activity was measured using MTT dye as described in Materials and methods. Isolated mitochondria (0.5 mg/ml) were incubated for 5, 60min with concentrations of O2/O3 (5µg/ml). Values represented as mean ± SD (n=5). *P &gt; 0.05; **P &gt; 0.01; *** P&gt; 0.001, **** P&gt; 0.0001 compared to control mitochondria.</title>
          </caption>
          <graphic xlink:href="images/image2.jpg" mime-subtype="jpg"/>
        </fig>
      </sec>
      <sec id="idm1842412236">
        <title>Effects of O2/O3 (5μg/mL) on Mitochondrial ROS                       Production</title>
        <p>As shown in (<xref ref-type="fig" rid="idm1849438964">Figure 3</xref>), in varicocele groups +5μg/ml O<sub>2</sub>/O<sub>3 </sub>(5μg/ml), the rate of ROS formation in isolated sperm mitochondria low level increase compared to                control group (C) after 5 but we show did not any         different ROS production between varicocele groups +5μg/ml O<sub>2</sub>/O<sub>3 </sub>(5μg/ml) and control group (C) after 60 min. we did not a difference in Ratio of DCF fluorescence (H1/H2)/all event) intensity between the varicocele groups +5μg/ml O<sub>2</sub>/O<sub>3 </sub>(5μg/ml) and the control group (C). (<xref ref-type="table" rid="idm1849436156">Table 5</xref>)</p>
        <fig id="idm1849438964">
          <label>Figure 3A and B.</label>
          <caption>
            <title> ROS formation in O2/O3-treated mitochondria. ROS formation after the addition of             various concentrations of O2/O3 (5 μg/ml) at intervals of A) 5 min after the addition, B) 60 min after the addition. C) ROS formation was determined through flow cytometry using DCF-DA as described in                 Materials and methods. FL1: the fluorescence intensity of DCF.</title>
          </caption>
          <graphic xlink:href="images/image3.jpg" mime-subtype="jpg"/>
        </fig>
        <table-wrap id="idm1849436156">
          <label>Table 5.</label>
          <caption>
            <title> Ratio of DCF fluorescence (H1/H2)/all event) intensity, after incubation time. ROS formation in diseases group (C. V) and 5 µg/ml of O2/O3 compared control health (C). mitochondria. ROS formation after the addition of various concentrations of O2/O3 (5 μgr/ml) at intervals of 5 ,60 min after the addition. ROS formation was determined through flow cytometry using DCF-DA as described in Materials and methods. Values represented as mean ± SD (n=5). </title>
          </caption>
          <table rules="all" frame="box">
            <tbody>
              <tr>
                <td colspan="3">ROS</td>
              </tr>
              <tr>
                <td>Time /Groups</td>
                <td>5min</td>
                <td>60min</td>
              </tr>
              <tr>
                <td>C</td>
                <td>0.83±2.3</td>
                <td>0.83±2.3</td>
              </tr>
              <tr>
                <td>C.V</td>
                <td>14.16±1</td>
                <td>18.10±1</td>
              </tr>
              <tr>
                <td>5µg/ml</td>
                <td>1.28±0.34</td>
                <td>1.08±1.7</td>
              </tr>
            </tbody>
          </table>
        </table-wrap>
      </sec>
      <sec id="idm1842388604">
        <title>Effects of O2/O3 (5μg/ml) on Mitochondrial                    Membrane Potential (MMP)</title>
        <p>As shown in (<xref ref-type="fig" rid="idm1849458980">Figure 4</xref>), in varicocele groups +5μg/ml O2/O3 (5μg/ml), the rate of ROS formation in isolated sperm mitochondria low level increase compared to control group (C) after 5 but we show did not any different ROS production between varicocele groups +5μg/ml O<sub>2</sub>/O<sub>3 </sub>(5μg/ml) and control group (C) after 60 min. we did not a difference in Ratio of DCF fluorescence (H1/H2)/all event) intensity between the varicocele groups +5μg/ml O<sub>2</sub>/O<sub>3 </sub>(5μg/ml) and the control group (C). (<xref ref-type="table" rid="idm1849456316">Table 6</xref>)</p>
        <fig id="idm1849458980">
          <label>Figure 4.</label>
          <caption>
            <title> The effect of O2/O3 on the mitochondrial membrane potential (MMP) in sperm mitochondria. MMP was    measured by rhodamine 123 as described in Materials and methods. A) The effect of O2/O3 (5μg/ml) on the mitochondrial membrane potential in Sperm mitochondria. Values represented as mean ± SD (n=5). *P &gt; 0.05; **P &gt; 0.01; *** P&gt; 0.001, **** P&gt; 0.0001compared to control mitochondria MMP was determined through flow cytometry using Rh123 as described in Materials and methods. FL1: the fluorescence intensity of Rh123.</title>
          </caption>
          <graphic xlink:href="images/image4.jpg" mime-subtype="jpg"/>
        </fig>
        <table-wrap id="idm1849456316">
          <label>Table 6.</label>
          <caption>
            <title> Ratio of MMP fluorescence (H1/H2)/all event) intensity, after incubation time. MMP in diseases group (C.V) and 5 µg/ml of O2/O3 compared control health (C) mitochondria at intervals of 5 ,60 min after the addition, ROS                    formation was determined through flow cytometry using Rh123 as described in Materials and methods. Values                         represented as mean ± SD (n=5). **P &gt; 0.01; *** P&gt; 0.001.</title>
          </caption>
          <table rules="all" frame="box">
            <tbody>
              <tr>
                <td colspan="3">MMP</td>
              </tr>
              <tr>
                <td>Time /Groups</td>
                <td>5min</td>
                <td>60min</td>
              </tr>
              <tr>
                <td>C</td>
                <td>1.1±1</td>
                <td>1.1±1</td>
              </tr>
              <tr>
                <td>C.V</td>
                <td>35.11±1</td>
                <td>35.11±1</td>
              </tr>
              <tr>
                <td>5µg/ml</td>
                <td>9.21±1***</td>
                <td>11.1±1.2**</td>
              </tr>
            </tbody>
          </table>
        </table-wrap>
      </sec>
      <sec id="idm1842381044">
        <title>Effects of O2/O3 (5μg/ml) on Mitochondrial ATP               Level</title>
        <p>Mitochondrial electron transfer chain is required for mitochondrial ATP production. In varicocele groups +5μg/ml O<sub>2</sub>/O<sub>3 </sub>(5μg/ml)group, significantly decrease (p&lt;0.01)ATP after 5 min but we show low level decreased  in ATP compared with control group (C) after 60 min  varicocele groups (C.V) significantly decreased (p&lt;0.001) enzyme activity compare with control group (C). (<xref ref-type="fig" rid="idm1849398276">Figure 5</xref>). <xref ref-type="bibr" rid="ridm1842937388">30</xref></p>
        <fig id="idm1849398276">
          <label>Figure 5.</label>
          <caption>
            <title> Effect of O2/O3 on mitochondrial ATP level. Sperm mitochondria (0.5 mg/ml) were incubated with of O2/O3 (5µg/ml) and A ATP level were determined using Luciferin/Luciferase Enzyme System as described in Materials and methods. Values represented as mean ± SD (n=5). *P &gt; 0.05; **P &gt; 0.01; *** P&gt; 0.001, **** P&gt; 0.0001compared to control mitochondria.</title>
          </caption>
          <graphic xlink:href="images/image5.png" mime-subtype="png"/>
        </fig>
      </sec>
    </sec>
    <sec id="idm1842394796" sec-type="discussion">
      <title>Discussion</title>
      <p>Previous studies showed that low-level ROS play a critical role in normal sperm physiology, such as fertilizing ability (acrosome reaction, hyper activation, capacitation, and chemotaxis) and sperm motility, while increased ROS generation and/or decreased antioxidant capacity upsets the balance  between oxidation and reduction in sperm physiology, a state dubbed sperm oxidative stress <xref ref-type="bibr" rid="ridm1843052020">14</xref> This condition is widely considered to be a significant contributor to sperm DNA damage/apoptosis, lipid peroxidation, and reduced motility, which, in turn, increases the risk of male infertility/sub-fertility and birth defects. So far, numerous studies have focused on antioxidant therapy. Although a great many studies have experimentally and clinically documented that the therapeutic strategy could significantly improve sperm function and motility, the overall effectiveness remains controversial, principally due to non-standardized assay used to measure the level of ROS and sperm DNA damage, various antioxidant supplementation strategies, and inadequate data on fertilization and pregnancy after clinical                                      treatment <xref ref-type="bibr" rid="ridm1843007356">15</xref><xref ref-type="bibr" rid="ridm1842974636">19</xref><xref ref-type="bibr" rid="ridm1842981476">21</xref><xref ref-type="bibr" rid="ridm1842932708">31</xref> Therapeutic effect of ozone on Adriamycin (ADR) induced testicular toxicity in an              experimental rat model showed that treatment with rut and/or ozone, however, improved the aforementioned parameters. Ozone therapy alone almost completely            reversed  the toxic effects of ADR and restored all                  parameters to normal levels<xref ref-type="bibr" rid="ridm1843090412">4</xref><xref ref-type="bibr" rid="ridm1842938180">29</xref> .According to some epidemiological studies, environmental and genetical    factors plays a role in the development of Infertility and it is a major health hazard. Environmental factors are             components with toxicological properties. Infertility is an imperative clinical problem, affecting people                                psychosocially and medically. Oxidative stress has been recognized as one factor that affects fertility status.                 Researchers are trying to prevent the oxidative damage on human body but antioxidants. O<sub>2</sub>/O<sub>3 </sub>is one of the             special antioxidant materials used in the clinic. O<sub>2</sub>/O<sub>3 </sub>therapy has been used in the treatment of ischemic                 disorders, although there are no data from clinical trials yet and it has not yet been accepted as orthodox                     medicine. Hoping to make it possible for the treatment of urological diseases such as O<sub>2</sub>/O<sub>3</sub> therapy on testicular torsion as a urological emergency disorder in which one testicle gets twisted in the scrotum, subsequently cutting off its blood supply. An affected testicle tends toward ischemia and reproductive system dysfunction <xref ref-type="bibr" rid="ridm1843054092">8</xref><xref ref-type="bibr" rid="ridm1842914276">27</xref> It is suggested that O<sub>2</sub>/O<sub>3 </sub>could enhance antioxidant systems and regulate inflammatory response, improve vascular rheology, and increase blood flow in cerebral arteries and tissue oxygenation in hypoxic tissues <xref ref-type="bibr" rid="ridm1843039348">13</xref> Several authors have clearly demonstrated the therapeutic efficacy of O<sub>2</sub>/O<sub>3 </sub>is related to the reactions of O<sub>2</sub>/O<sub>3 </sub>with biological               components <xref ref-type="bibr" rid="ridm1842926876">32</xref><xref ref-type="bibr" rid="ridm1843044100">12</xref> Spermatogenesis is an intricate                  cellular function involving the differentiation and                  proliferation of male germ cells result in production of spermatozoa with capacity to fertilize egg. The                       importance of sperm motility during the progression of fertilization has established considerable attention over the past decades. Iguer-Ouada and Verstegen (2001) showed Computer Assisted Sperm Analysis (CASA)                     enables the observation of numerous factors of sperm motility and provides repeatable and accurate results with specific and standardized settings. Motility is one of the most important criteria in assessing sperm quality in normal and abnormal semen specimen. CASA is an                  automated method that can provide specific information on the kinetic of sperm cells with standard manual semen analysis of World Health Organization (WHO). “CASA has been developed to decrease the amount of time spend in sperm observation, reduce intra-observer differences, and improve the accuracy of final results.<xref ref-type="bibr" rid="ridm1842963676">25</xref> This method is objective, accurate, and enables quantification of physical components of sperm movement. Researchers showed that ROS-induced oxidative damage could be minimized by a wide variety of antioxidants in mixture with basic common cry protectants in fish <xref ref-type="bibr" rid="ridm1843231948">1</xref>, bull <xref ref-type="bibr" rid="ridm1843044100">12</xref>, ram <xref ref-type="bibr" rid="ridm1842958636">26</xref> goat <xref ref-type="bibr" rid="ridm1843050004">11</xref>, boar <xref ref-type="bibr" rid="ridm1842954028">23</xref>, canine <xref ref-type="bibr" rid="ridm1842999580">17</xref> and human sperm cryopreservation<xref ref-type="bibr" rid="ridm1842926876">32</xref> . Several researchers have reported the relationship of potential fertility in vitro and sperm motility parameters measured with CASA. <xref ref-type="bibr" rid="ridm1842942356">28</xref>Objective analysis of sperm motility parameters resulted in significant correlations between the value of VCL m/s <xref ref-type="bibr" rid="ridm1842995332">18</xref> and LIN % and the in vitro fertilization rates. a       subsequent morphological change known as the                  acrosome reaction.<xref ref-type="bibr" rid="ridm1843077004">7</xref> Mitochondria is stationary cellular energy producer which can be considered as the source of the ATP production and metabolic center. It is also         reported that beyond interacting with other organelles, mitochondria interact with microtubules and is in direct contact with the ER (endoplasmic reticulum) (6) the physical association and dynamic cellular distribution of mitochondria in networks and with organelles are                  reflective of the dynamic functions of mitochondria. The thermal regulation, the ROS containment, the apoptotic regulation, the assists with extracellular and intracellular trafficking as well as cell movement, the central to              inflammation, immunity, the stress response, and the cell hazard response.  Energy is stored in the mitochondria as a proton concentration gradient and an electric potential gradient across the membrane. These different gradients are generated by electron transport maintained by the inner mitochondrial membrane and drive the synthesis of ATP. O<sub>2</sub>/O<sub>3 </sub>(5µg /ml) was intended to protect the                      mitochondrial inner membrane from lipid peroxidation instead of mitigation ROS production in general.                    Rhodamine 123 is a cationic color, have been used to show the mitochondria membrane potential. Any changes in mitochondrial membrane potential could be indirectly pointer of sperm motility. Mitochondria membrane                 potential of spermatozoa has been evaluated with                    Rhodamine 123 in a variety of species <xref ref-type="bibr" rid="ridm1843003684">16</xref><xref ref-type="bibr" rid="ridm1842926876">32</xref> we showed, Rhodamine 123 was used and flow cytometry, (BD) fluorescence spectrophotometer singly to assess the sperm mitochondrial functional status. Our results show that there are not significant differences in mitochondrial membrane potential between the treatment groups and the control groups (<xref ref-type="fig" rid="idm1849458980">Figure 4</xref>, <xref ref-type="table" rid="idm1849456316">Table 6</xref>). ROS generated from electron ‘‘leakage’’ of the mitochondrial respiratory chain, which can be evaluated by the production of DCF, the highly fluorescent oxidized derivative of DCFH-DA. The reliability of the DCF method is proved by using control, which is well known to induce a ROS increase in                   isolated mitochondria. Using ROS probe and flow                  cytometry, (BD) <xref ref-type="bibr" rid="ridm1842948628">24</xref><xref ref-type="bibr" rid="ridm1842963676">25</xref> it is shown that untreated isolated mitochondria displayed substantial fluorescence, but exposing them to O<sub>2</sub>/O<sub>3 </sub>(5µg/ml) concentration caused a decrease in ROS formation (<xref ref-type="fig" rid="idm1849438964">figure 3</xref> and <xref ref-type="table" rid="idm1849436156">Table 5</xref>). After incubation time we also deliberately tested the effect of hydrogen peroxide on production of ROS and sperm viability, succinate dehydrogenase activity in sperm samples <xref ref-type="bibr" rid="ridm1843077004">7</xref> Indeed, H<sub>2</sub>O<sub>2</sub>-induced ROS production and lipid peroxidation were inversely correlated with sperm viability. In the   present study, we found that addition of mitochondrial-targeted antioxidant O<sub>2</sub>/O<sub>3 </sub>(5µg/ml) and mitochondrial reduced the production of ROS and ATP production increased significantly when treatment groups were compared with the control sperm samples. Previous studies suggested that the Krebs cycle and electron flow in the mitochondrial                respiratory chain provide the proton motive force for the transformation of ADP to ATP in the F0F1 ATP                  synthesis complex <xref ref-type="bibr" rid="ridm1843077004">7</xref><xref ref-type="bibr" rid="ridm1842986876">20</xref> Our results showed that O<sub>2</sub>/O<sub>3 </sub>(5µg/ml) prepared the electron transfer in complex (V) of the mitochondrial respiratory chain via leading to ATP production (<xref ref-type="fig" rid="idm1849398276">Figure 5</xref>). We also observed that O<sub>2</sub>/O<sub>3 </sub>(5µg/ml) significantly increased ATP in the treated group (<xref ref-type="fig" rid="idm1849398276">Figure 5</xref>). ATP acts as a molecular motor generating and force for sperm flagella, thus sperm motility is the result of a complex molecular process, comprising                 oxidation of energy substrate, phosphorylation of the proteins involved in signal transduction through the plasma membrane, and the conversion of chemical                   energy into mechanical energy in the axoneme. It is    supposed that increased ROS formation and oxidation of membrane protein thiol groups caused mitochondrial permeability transition (MPT) pore opening as an event in mitochondrial dysfunction, followed by un-limited proton movement across the inner mitochondrial         membrane and induction of mitochondrial swelling, MMP collapse  and uncoupling of oxidative phosphorylation <xref ref-type="bibr" rid="ridm1843077004">7</xref> . Also, we suggested that oxidation of thiol groups in the inner mitochondrial membrane could  promote the MPTinduction and release of cytochrome c from mitochondria as an endpoint of cell death                  signaling <xref ref-type="bibr" rid="ridm1843077004">7</xref> . However, O<sub>2</sub>/O<sub>3 </sub>at low concentration (5µg/ml), did not induce release of cytochrome c, and did not produce death signaling (apoptosis or necrosis).  In addition, we will also explore whether these                           mitochondrial specific approaches could have enhanced benefits for individuals or species that are highly sensitive to oxidative damage. Future studies are needed to explore whether the improvement in sperm viability, as well as reduced ROS and lipid peroxidation could result in a better fertilization.</p>
    </sec>
    <sec id="idm1842332740">
      <title>Funding</title>
      <p>This research did not receive any specific grant from any funding agency in the public, commercial or not for profit sector.</p>
    </sec>
  </body>
  <back>
    <ack>
      <p>The data provided in this article was extracted from the project of Parvaneh Naserzadeh. The project was conducted under supervision of Prof. Morteza Izadi at Ozone Complementary Research Center, Tehran, Iran.</p>
    </ack>
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