In clinical studies, the presence of a varicocele has been shown to correlate with excess ROS generation by the spermatozoa, high rates of DNA damage in these cells and depleted antioxidant levels in the seminal plasma.6567 In a recent study, surgical correction of left sided varicocele was shown to significantly improve sperm concentration, total count, morphology and motility in concert with significant improvements in the antioxidant status of the spermatozoa and seminal plasma.68 This reduction in oxidative stress secondary to varicocele excision was accompanied by a reduction in both protein carbonyl expression and DNA damage in the spermatozoa.68 Independent studies have also shown that the testicular expression of 4-hydroxy-2-nonenal modified proteins (another marker of oxidative stress) is significantly higher in patients that responded positively to varicocelectomy, suggesting that surgical treatments are capable of reducing oxidative stress in the testes.69 Immunocytochemical analyses of 8-hydroxy-2-deoxyguanosine expression in the testes of varicocele patients also revealed particularly high levels of oxidative DNA damage in the spermatogonia and spermatocytes that correlated well with the severity of the varicosity.70 The general concept that testicular pathologies associated with varicocele are linked with the induction of oxidative stress has been confirmed in animal models

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Therefore, we propose a new vicious cycle involved in neurodegeneration that includes glutamate excitotoxicity, oxidative stress, and mitochondrial dynamics. Stablon (tianeptine) is an atypical antidepressant that has demonstrated remarkable clinical effectiveness in major depressive disorder that is often resistant to treatment with traditional SSRIs