Cell Phones Effect on Society

RBMOnline – Vol 18. No 1. 2009 148-157 Reproductive BioMedicine Online; www. rbmonline. com/Article/3628 on web 3 November 2008 Review Cell phones: modern man’s nemesis? Ashok Agarwal is a Professor in the Lerner College of Medicine at Case Western Reserve University and the Director of Center for Reproductive Medicine, and the Clinical Andrology Laboratory at The Cleveland Clinic, Cleveland, Ohio, United States.He has published over 400 scientific articles, reviews and book chapters in different areas of andrology, male/ female infertility and fertility preservation. His research program is known internationally for its focus on disease-oriented cutting edge research in the field of human reproduction. His team has presented over 700 papers at national and international meetings and more than 150 scientists, clinicians and biologists have received their training in his laboratory.Dr Ashok Agarwal Kartikeya Makker1, Alex Varghese1, Nisarg R Desai1, Rand Mouradi2, Ashok Agarwal1,3 1 Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA; 2Department of Electrical Engineering and Telecommunications, Cleveland State University, Cleveland, Ohio, USA 3 Correspondence: Tel: +1 216 444 9485; Fax: +1 216 445 6049; e-mail: [email  protected] org Abstract Over the past decade, the use of mobile phones has increased significantly.However, with every technological development comes some element of health concern, and cell phones are no exception. Recently, various studies have highlighted the negative effects of cell phone exposure on human health, and concerns about possible hazards related to cell phone exposure have been growing. This is a comprehensive, up-to-the-minute overview of the effects of cell phone exposure on human health.The types of cell phones and cell phone technologies currently used in the world are discussed in an attempt to improve the understanding of the technical aspects, including the effect of cell phone exposure on the cardiovascular system, sleep and cognitive function, as well as localized and general adverse effects, genotoxicity potential, neurohormonal secretion and tumour induction. The proposed echanisms by which cell phones adversely affect various aspects of human health, and male fertility in particular, are explained, and the emerging molecular techniques and approaches for elucidating the effects of mobile phone radiation on cellular physiology using high-throughput screening techniques, such as metabolomics and microarrays, are discussed. A novel study is described, which is looking at changes in semen parameters, oxidative stress markers and sperm DNA damage in semen samples exposed in vitro to cell phone radiation.Keywords: biophysics, cell phone, general health, infertility, radiofrequency electromagnetic waves, RF-EMW Introduction Cell phone usage has increased by leaps and bounds in the past decade and a half. From being a luxury limited to the wealthy, cell phones have b ecome a commodity, virtually indispensable in daily lives. However, every technological advance and its overuse have a negative aspect. The increase in popularity of cell phones is accompanied by a growing concern regarding the harmful effects of cell phone radiation (radiofrequency electromagnetic waves; RF-EMW) exposure on human health.An earlier report of the Independent Expert Group on Mobile Phones, established by the UK government, summarized the relevant studies on the biological effects of RF-EMW (Huber et al. , 2000). Since then, a flurry of scientific activities has attempted to define and quantify the adverse effects of RF-EMW. Despite the increasing number of reports concerning the effects of RF-EMW on various biological systems, no satisfactory mechanism has been proposed to explain the effects of this radiation (Feychting, 2005).Although cell phone companies constantly reassure their subscribers about the safety of their product, reports based on animal and human exper iments showing adverse effects of cell phones on biological systems have surfaced. According to various reports, excessive cell phone usage has led to fatigue, headache, decreased concentration and local irritation and burning (Sandstrom et al. , 2001). The possible role of cell phone exposure on tumour induction also has been proposed in an epidemiological study (Hardell et al. , 2006).Recent studies also have highlighted the role of cell phone exposure on sperm motility, morphology and viability, thus proposing a reduction in male fertilizing potential (Agarwal et al. , 2008). Other reports suggest that RF-EMW may lead to DNA damage and chromosomal instability (Diem et al. , 2005). Even though the current research may have been inconclusive, it still has been successful in providing preliminary data and identifying trends on both sides of the argument that cell phone exposure may lead to harmful effects on human health.These 148  © 2009 Published by Reproductive Healthcare Ltd, Duck End Farm, Dry Drayton, Cambridge CB23 8DB, UK Review – Cell phones: modern man’s nemesis? – K Makker et al. studies have been handicapped by many drawbacks in design and methodology. In particular, comparing animal models with humans (Cairnie and Harding, 1981) is impractical. Differences in geometry, size and physiological responses between man and experimental animals imply that the results in animal studies should be interpreted with caution.Experimental approaches involving animal studies and in-vitro studies, along with high-throughput screening techniques like transcriptomics, proteomics and metabolomics, can augment the validity of epidemiological studies addressing the effect of RF-EMW on reproductive tissues, cells and functions. Recent studies using these approaches have yielded interesting clues on the effect of RF-EMW at the cellular and molecular levels. This article highlights the adverse affects of RF-EMW on human biological systems by review ing relevant studies and recent research to aid in deeper understanding of this important health issue.The novel study currently being carried out in the centre is briefly discussed. 1900 MHz), and they have the capacity to switch automatically among these four frequencies. Specific absorption rate (SAR) is the energy flow per unit of mass (watts/kg; W/kg). It is a measurement of the power or heat absorbed by the tissue either in a local area of a human tissue or averaged over the whole body. In the USA, the SAR of cell phones varies from 0. 12–1. 6 W/kg. Standards are designed to limit the SAR in the body to safety levels. The Federal Communications Commission has set a SAR safety limit of 1. W/kg, averaged over a volume of 1 g of tissue, for most parts of the body (see website). Exposure guidelines for RF protection had adopted the value of 4 W/kg averaged over the whole body (SARWB) ‘as the threshold for the induction of adverse thermal effects associated with an inc rease of the body core temperature of about 1 °C in animal experiments’ (Barnes and Greenebaum, 2007). Cell phone radiation output power is measured in units of watts or dBm (decibel referenced to 1 mW). Usually cell phones with higher frequency are assigned less output power. Cell phones commonly used these days operate at an output power of less than 1 W.Power density is a term for characterizing an RF electromagnetic field. It is defined as the power per unit area and is measured in units of mW/m2 or  µW/cm2 (Food and Drug Administration website). Maximum permissible exposures are based on SAR and power density measurements. The Federal Communications Commission has established safety standards on power density for cell phone base station antenna using 1900 MHz band for the general population an uncontrolled exposure of 1000  µW/cm2, and for the 850 MHz band the maximum exposure allowed is about 580  µW/cm2, as averaged over any 30-min period.Recent studies demonst rated that RF-EMW emitted from commercially available cell phones have no thermal effects (Straume et al. , 2005; Anderson and Rowley, 2007; Yan et al. , 2007). An overview of cell phone technology Telecommunications technology has advanced rapidly and explosively in recent years. The earliest, fully automatic cellular phone systems that were used were called Nordic mobile telephone, now classified as first-generation cellular phones. Introduced in the late 1970s and early 1980s, they were based on analogue technology.The second-generation cell phones that replaced the older analogue type are based on digital technology. These digital models have increased voice capacity, provided faster data transfer speeds, longer battery life, less power use and better signal quality than the firstgeneration cell phones. The cell phone technologies that are commonly used nowadays are the global system for mobile communication (GSM) and code division multiple access (CDMA). Both of these technolog ies are used by cell phone companies in the USA.The GSM technology uses narrow-band time division multiple access (TDMA), whereas CDMA incorporates the wider band that allows more users without interference and better security by providing every user with a unique code. The third-generation cell phones, which may be available for general use in the near future, consist of universal mobile telecommunications system (UMTS)/wideband code division multiple access (W-CDMA) and the high-speed downlink packet access (HSDPA) phones.The UMTS utilizes a GSM infrastructure with a W-CDMA air interface (the specification of the radio transmission between a mobile phone and the base station), which adds advantages to UMTS over GSM technology. The HSDPA is based on the W-CDMA technology with improved downlink speed that allows even higher data transfer speeds and capacity. Cell phones in the USA operate on the frequency bands of 850 MHz and 1900 MHz. In most other parts of the world, the frequency bands used are 900 MHz and 1800 MHz.The newer phones offer a quad-band feature, which means that they can operate on the four common frequencies (850/900/1800 and RBMOnline ® Effect of RF-EMW on general health This section provides a discussion of the various aspects of human health that have been proposed to be, or actually are, affected by cell phone radiation (RF-EMW) (Figure 1). Effect on cardiovascular system (CVS) Braune et al. (1998) exposed human volunteers to RF-EMW and reported an increase in blood pressure (both systolic and diastolic) on exposure to RF-EMW at 900 MHz for 35 min.Blood pressure increased by 5–10 mmHg, accompanied by a significant decrease in capillary perfusion due to vasoconstriction. They demonstrated, however, that autoregulatory blood pressure mechanisms were intact, as shown by a decrease in heart rate to nullify the increase in blood pressure. In a follow-up study done by the same group to corroborate their previous findings, a statisticall y significant increase in blood pressure was shown, but the analysis of variance showed that the changes were independent of EMW exposure (Braune et al. , 2002).Later, Tahvanainen et al. (2004) demonstrated cell phone exposure does not acutely change arterial blood pressure and heart rate. 149 Review – Cell phones: modern man’s nemesis? – K Makker et al. Figure 1. Effect of electromagnetic radiation from cell phone usage on various human systems. OS = oxidative stress. In an animal study, Ozguner et al. (2005) reported increase in oxidative stress in rat myocardium on exposure to 900 MHz RF-EMW (30 min/day, for 10 days). kit or using a landline phone to reduce cell phone exposure (Oftedal et al. , 2000).The generation of reactive oxygen species by RF-EMW exposure is still to be proven convincingly, although many groups have provided evidence in animal-based studies. An increase in kidney tissue malonaldehyde and urine N-acetyl-? d-glucosaminidase and decrease in renal superoxide dismutase, catalase and glutathione peroxidase were reported by Oktem et al. (2005). Similar results were shown by another investigator (Irmak et al. , 2002), who provided evidence in favour of EMW-induced oxidative stress. They showed an increase in superoxide dismutase activity and a decrease in nitric oxide concentrations in sera.Conversely, no change was seen in the concentration of intracellular oxidants [oxidized form of glutathione (GSSG) accumulation, oxidation of thiol] and antioxidants (CuZn-superoxide dismutase, catalase) in cells exposed to radiofrequency radiation (CDMA and GSM, 835– 847 MHz for 20–22 h) (Hook et al. , 2004). Effect on sleep Despite concerns that sleep patterns are disturbed due to excessive cell phone usage, Huber et al. (2000) did not report any significant change in sleep quality, sleep latency and rapid-eye-movement sleep latency in healthy young men exposed to 900 MHz for 30 min.The only effect reported was an increa se in electroencephalogram power density during the first 30 min of non-rapid-eye-movement sleep, especially ? waves and sleep spindles (the type of sleep waves seen with an electroencephalogram). They concluded that the effect of RF-EMW exposure was transitory, limited to the initial phase of sleep and outlasting the RF-EMW exposure. Recently, Perentos et al. (2007) found no significant change in resting electroencephalogram on human volunteers exposed to RF-EMW. Cell phones and neurohormonal secretionVarious epidemiological studies have highlighted effects of cell phone usage on neurohormonal secretion. Conflicting results have been reported by different groups regarding the effect of cell phones on melatonin secretion. De Seze et al. (1999) reported no change in maximum serum concentration (P = 0. 63), the time of peak concentration (P = 0. 49) and area under curve (P = 0. 56) of the hormonal profile. On the other hand, Burch et al. (2002) concluded that subjects with cell phone usage >25 min/day had lower creatinine-adjusted mean nocturnal concentrations of a melatonin metabolite, 6-hydroxymelatonin sulphate (6-OHMS), (P = 0. 5) and lower overnight 6-OHMS excretion (P = 0. 03). They concluded that prolonged usage of cell phones may lead to reduced melatonin production. Djeridane et al. (2008) demonstrated 900 MHz RFEMW would not significantly affect endocrine functions in men. RBMOnline ® Local and general adverse effects Sandstrom et al. (2001), in a questionnaire-based study involving some 17,000 respondents, showed that cell phone usage led to complaints such as warmth on and behind the ear (31%), fatigue (28%), headache (21. 4%), decreased concentration (15%), dizziness (10%), memory loss (9%), and tingling and numbness (6. 7%).They also concluded that a statistically significant positive trend was shown by warmth and neurasthenic symptoms (headache, fatigue) with calling time and number of calls per day. They proposed that these changes were due to either radiofrequency exposure or thermal effects of EMW. Of all the people who attributed these symptoms to cell phone usage, 45% of them took steps such as reducing calling time, changing cell phone model, using a hands-free 150 Review – Cell phones: modern man’s nemesis? – K Makker et al. Effects on cognitive function Preece et al. (1999) exposed human volunteers to RF-EMW and reported that the nly cognitive function test that altered post-RF-EMW exposure is choice reaction time, leading to an increase in responsiveness. They reported no change in word, number or picture recall or any change in spatial memory. They proposed that the increase in responsiveness was due to a mild local thermal effect of EMW on angular gyrus (the interface between visual and speech centres) or to mechanisms mediated by heat shock proteins. They also concluded that memory is not commonly affected by cell phone exposure as the memory area of the brain (hippocampus) is deep seated i n the medial temporal lobe of the brain.Later, Regel et al. (2007) demonstrated RFEMW exposure reduces reaction speed and increased accuracy in working-memory tasks. As discussed previously, recent studies reported that RF-EMW emitted from commercially available cell phones have no thermal effect (Straume et al. , 2005; Anderson and Rowley, 2007; Yan et al. , 2007). However, several views were proposed to elucidate the disruption of metabolic pathways by RF-EMW. Some of these views are based on experimental evidences and some on hypothetical models. Isocitrate dehydrogenase, an important enzyme in the citric acid cycle, is one of the targets of cell phone radiation.Alteration in the enzyme activity leads to decreased production of adenosine triphosphate (ATP) in mammalian cells (Nylund and Leszczynski, 2004). Since sperm motility depends on the active generation of ATP, such a mechanism might cause the decline in sperm motility during RF exposure. Spermatozoa lose their cytoplasm po st-spermiation, leading to the loss of their antioxidant protective mechanism and rendering them inherently vulnerable to induction of DNA damage. They are differentiated to the point that they cannot undergo apoptosis in response to any form of severe genetic damage (Aitken, 1999).In addition, during the process of maturation, spermatozoa are separated from the Sertoli cells, their nursing cells. Several investigators have demonstrated an increase in DNA fragmentation in a variety of human and animal cells following cell phone exposure (Lai and Singh, 1996; Diem et al. , 2005; Panagopoulos et al. , 2007). Lai and Singh showed that exposing rats (n = 16) for 2 h to pulsed 2- µs pulse width, 500 pulses/s and continuous wave (2450 MHz) leads to an increase in breaks of single-stranded DNA (P < 0. 01) and double-stranded DNA (P < 0. 01) in rat brain cells.They proposed that this could be due to either direct EMWmediated effects or a defect in DNA repair mechanisms. In contrast, sever al studies found no effect of EMW on genotoxicity. Stronati et al. (2006) demonstrated no effects of RF exposure on DNA strand breakage (assessed by COMET assay), unstable chromosomal alterations (assessed by metaphase analysis) or alterations in the speed of in-vitro cell cycling (assessed by nuclear division index) in lymphocytes in their experiment involving exposure of human blood samples to RF (24 h, 935 MHz). A large-scale in-vitro study conducted by Sakuma et al. 2006) concluded that RF-EMW from mobile phone radio base stations do not act as a genotoxicant (at SAR up to 800 mW/kg). The induction of DNA damage in spermatozoa has been associated with male infertility, early pregnancy loss and morbidity in the offspring, including childhood cancer (Aitken, 1999). Aitken et al. (2005) demonstrated that exposure of mice to RF-EMW, 900 MHz, 12 h/day for 7 days led to damage to both the mitochondrial and nuclear genome of epididymal spermatozoa (P < 0. 01). However, currently no hum an studies are available demonstrating DNA damage in sperm cells by RF radiation exposure.Several animal studies have attempted to highlight histological changes in testicular tissue on exposure to RF-EMW. Dasdag et al. (1999) demonstrated a decrease in mean seminiferous tubule diameter in rats (n = 18) by exposing them to an 890–915 MHz cell phone, 2 h/day for 30 days (P < 0. 05). However, a similar study carried out later by the same group did not reveal any statistically significant result of cell phone exposure on seminiferous tubular diameter, lipid composition, malonaldehyde Tumorigenesis Carcinogenic potential of cell phone radiation is one of the most conflicting aspect in various studies conducted by several groups.Following public concern that cell phone exposure may lead to cancer, Hardell et al. (2006) conducted an epidemiological questionnaire-based study and concluded that astrocytoma (grade III–IV) and acoustic neuroma did show a positive correlation wit h cell phone usage, and the odds ratio increased with latency (10 years). However, no increased risk was shown with astrocytoma (grade I–II), non-Hodgkin lymphoma, salivary tumours or testicular tumours. With regard to testicular tumours, they concluded that the risk of seminoma and non-seminoma was not increased, a dose–response effect was not observed, and he location of the cell phone was not associated with testicular cancers (Hardell et al. , 2007). Other scientists have concluded that the current evidence for a causal association between cancer and EMW exposure is weak and unconvincing (Colonna, 2005). Cell phone and effects on male fertility Pathophysiology Despite reports from numerous groups suggesting a possible role of cell phone exposure in male infertility, the exact mechanism of the effects of EMW on male reproductive system is yet to be elucidated. Though various effects have been proposed, foolproof experimental evidences are lacking to substantiate it. Human testes need physiological temperatures 2 °C lower than body temperature for optimal spermatogenesis. Highintensity RF has heating properties that lead to thermal effects on the testes. An increase in testicular or body temperature on exposure to EMW may cause reversible disruption of spermatogenesis (Kandeel and Swerdloff, 1988; Jung and Schill, 2000). EMW can also affect reproductive function via an EMW-specific effect (a ‘microwave’ effect produced by an increase in tissue temperature less than its normal temperature fluctuation) or in combination with the thermal molecular effect (Blackwell, 1979). 51 RBMOnline ® Review – Cell phones: modern man’s nemesis? – K Makker et al. concentration, sperm count or sperm morphology (Dasdag et al. , 2003). Ribeiro et al. (2007) also did not find any significant adverse effect of cellular phone exposure (GSM 1835–1850 MHz exposure, 1 h/day for 11 weeks) on rat testicular histology and function . However results of in-vitro studies are conflicting. An in-vitro study divided neat semen samples from healthy volunteers (n = 27) into two parts and one part was exposed to 900 MHz EMW for 5 min.Compared with the unexposed sample, the exposed sample was found to have a significant decrease in rapid progressive motility (Grade A, P = 0. 0007), an increase in slow progressive motility (Grade B, P = 0. 0007) and an increase in the percentage of immotile spermatozoa (Grade D, P = 0. 0003) (Erogul et al. , 2006). Recently, Falzone et al. (2008) studied the effect of pulsed 900 MHz radiation on various kinetic parameters and mitochondrial membrane potential (MMP)of purified human spermatozoa (by percoll density gradient). They found significant decrease in straight-line velocity and beatcross frequency at an SAR of 5. W/kg. However, at an SAR of 2. 0 W/kg they found no significant change in any kinetic parameters, including MMP. Significant changes in sperm morphology were not reported in the animal studies carried out by Dasdag et al. (1999, 2003). Similarly no significant (P > 0. 05) alteration in morphology was reported by another group based on their animal experiment (Yan et al. , 2007). However, the same group reported that 80% of the slides in the exposed group showed large clumps of sperm cells that were able only to turn about in their position and were not able to break free.On the other hand, significant data were brought out in a study in which 15. 3% of men using cell phones sporadically for 1–2 years had only 10–19% normal spermatozoa, and 15. 3% had total azoospermia, whereas men frequently using cell phones for >2 years had only 8. 3% normal spermatozoa, and 22. 9% showed total azoospermia (Wdowiak et al. , 2007). EMW and semen parameters The effects of cell phone exposure on male fertility have been studied exhaustively in recent years (Deepinder et al. , 2007).The effects on sperm concentration, motility and morphology have been ev aluated in many animal and human studies, but results are inconclusive. Motility is the only parameter that the majority of studies have shown to be significantly affected. The need to further evaluate the effects of EMW on sperm morphology, viability and concentration still exists. Dasdag et al. (1999) reported a decrease in sperm count; however, the decline was not statistically significant (P > 0. 05), and they were not able to repeat the same results later in a similar study (Dasdag et al. 2003). Another group reported that exposure of rats (n = 16) to a 1. 9 Hz cell phone from a distance of 1 cm for 6 h/ day for 18 weeks did not lead to significant decline in sperm concentration. The exposure group had a mean sperm count of 7. 45 ? 107  ± 1. 03 ? 107 sperm cells/ml, and the non-exposed group had a mean sperm count of 7. 7 ? 107  ± 8. 11 ? 106 sperm cells/ml (P > 0. 05) (Yan et al. , 2007). In an epidemiological study, researchers concluded that no statistically significant (P > 0. 05, chi-squared test = 1. 8) difference in sperm count resulted from cell phone exposure (Wdowiak et al. , 2007). In a study carried out by this centre, a significant decline in sperm count was demonstrated in men who used cell phones for >4 h/ day (n = 114, count 50. 30  ± 41. 92 ? 106/ml) as compared with those who did not use cell phones at all (n = 40, count 85. 89  ± 35. 56 ? 106/ml) (P < 0. 0001) (Agarwal et al. , 2008). As mentioned earlier, motility is the only parameter that consistently has been shown to decline in studies carried out by various groups.In a study involving 371 men presenting for an infertility workup, duration of possession and daily transmission time of cell phones correlated negatively with the proportion of rapid progressive motile spermatozoa (r = –0. 12 and r = –0. 19, P < 0. 01) and positively with the proportion of slow progressive motile spermatozoa (r = 0. 12 and r = 0. 28, P < 0. 01) (Fejes et al. , 2005). The same group also concluded that low transmitter (60 min/ day) groups also differed in the proportion of rapid progressive motile spermatozoa (48. 7% versus 40. 6%, P < 0. 01).Wdowiak et al. (2007) reported that 65. 7% of men not using cell phones had >50% (WHO category A + B) sperm motility, whereas only 35. 4% of men who frequently used cell phones had >50% (A + B) sperm motility. Agarwal et al. (2008) had shown a significant reduction in motility of spermatozoa in men using cell phones >4 h/day versus men not using them at all (67. 80  ± 6. 16% versus 44. 81  ± 16. 30%, P < 0. 0001). In an animal-based study, a significant decrease in sperm motility on exposure to cell phone (n = 16, P < 0. 05) was reported (Yan et al. , 2007).The researchers also reported that the majority of sperm cells in the exposure group were dead (live cells 44. 88  ± 20. 66%); in the control group, the majority of sperm cells were alive with constant, active motility (live cells 70. 93  ± 12. 94%). Transcript omics and proteomics in elucidation of biological response of cell phone radiation Research over the last two decades on the effect of RFEMW has yielded controversial results. It is said that even an extensive epidemiological study might not be sufficient to elucidate the health effects of electromagnetic radiations because of the low sensitivity of this approach.Hence, to validate the results from epidemiological studies, further data from animal and in-vitro studies needs to be analysed. Several lines of evidences suggest that the novel methodologies such as transcriptomics, proteomics and metabolomics could help in the search for clues to the negative impact of cell phone radiation on human health. High-throughput screening techniques combined with modern bioinformatics could be used to pick up minute variations, like those caused by RF-EMW affecting protein or gene expression, that might be of insufficient magnitude to alter cell physiology or give any phenotypic alteration (Fig ure 2).Heat shock proteins (Hsp), which are molecular chaperones, comprise a group of highly conserved, abundantly expressed proteins with diverse functions, including the assembly and sequestering of multiprotein complexes, transportation of nascent polypeptide chains across cellular membranes, and regulation of protein folding. Protein phosphorylation is a first line of cellular response to any stimuli by either RBMOnline ® 152 Review – Cell phones: modern man’s nemesis? – K Makker et al. Figure 2. A proposed model to study the effect of cell phone radiation using the high-throughput technologies.These techniques combined with modern bioinformatics could be helpful to find minute variations caused by RF-EMF in protein or gene expression changes that might be of insufficient magnitude to alter cell physiology or give any phenotypic alteration. MALDI-TOF = matrixassisted laser desorption/ionization time of flight; SAGE = serial analysis of gene expression. int ernal or external factors. By using western blots or mass spectrometry, the phosphoproteins could be located after cellular irradiation from a mobile phone to check for any alterations in cell response.By using this approach, Hsp27 was determined to be a molecular target event of RF-EMW (Leszczynski et al. , 2002). A study using matrix-assisted laser desorption/ionization-mass spectrometry found statistically significant altered expression levels of 38 various proteins in human endothelial cell lines following GSM 900 MHz irradiation (Nylund and Leszczynski, 2004). Two of the affected proteins were determined to be isoforms of cytoskeletal vimentin and might have an effect on the physiological functions that are regulated by the cytoskeleton.Results from a study using human lens epithelial cells (HLEC) cell lines indicate that exposure to non-thermal dosages of RF for wireless communications can induce no or repairable DNA damage and the augmented Hsp70 protein expression in HLEC oc curred without change in the cell proliferation rate (Nylund and Leszczynski, 2004). The induction of Hsp70 by extremely low frequency (ELF) EMW also involves elements of the mitogen-activated phosphokinase (MAPK) family of cell response cascades, which are recognized signal transduction systems present in eukaryotes.MAPK pathways consist of distinct cascades of regulator enzymes that serially activate one another to control the expression of specific sets of genes in response to growth factors, cytokines, tumour promoters and other major biological stimuli. The authors suggest that nonthermal stress response of Hsp70 protein increased on RF exposure might be involved in protecting HLEC from DNA damage and maintaining the cellular capacity for proliferation (Lixia et al. , 2006). RBMOnline ®The phosphorylated Hsp27 (activated) has been shown to inhibit apoptosis by forming a complex with the apoptosome (complex of Apaf 1 protein, procaspase 9, and cytochrome c) or some of its comp onents and preventing proteolytic activation of the procaspase 9 into active form of caspase 9 (Concannon et al. , 2001). This, in turn, prevents activation of procaspase-3, which is activated by caspase 9. Apaf-1 plays an important role in the induction of apoptosis (Zou et al. , 1997). Cytochrome c release from mitochondria occurs when there is a DNAdamaging stimuli-induced apoptosis.Together with dATP/ATP, cytochrome c initiates formation of an apoptosome consisting of Apaf 1 oligomers. The Apaf 1 apoptosome recruits and activates caspase 9, which in turn activates the executioner caspases, caspase 3 and caspase 7 (Zou et al. , 1997). The induction of the increased Hsp27 activation by the RF-EMW exposure might lead to inhibition of the apoptotic pathway that involves apoptosome and caspase 3. It is proposed that such events occurring in RF-EMW-exposed cells that had undergone either spontaneous or external factor-induced transformation or damage could support survival of the tran sformed/damaged cells (Leszczynski et al. 2004). The exposure of the EA. hy926 human endothelial cell line to 900 MHz RF-EMW induces activation of the p38 MAPK stress response pathway and leads to an increase in expression and phosphorylation of the small stress response protein Hsp27 (Leszczynski et al. , 2002). Other studies have shown that the phosphorylated form of Hsp 27 has the ability to translocate to the nucleus and to induce changes in gene expression (Geum et al. , 2002). The evidence suggests that different types of cells from different species might respond differently to mobile phone radiation 53 Review – Cell phones: modern man’s nemesis? – K Makker et al. or might have different sensitivity to this weak stimulus. The results from the studies by (Nylund and Leszczynski, 2006) show that gene and protein expression were altered in multiple cell lines in response to 1-h mobile phone radiation exposure at an average specific absorption rate of 2. 8 W/ kg. However, the same genes and proteins were affected differently by the exposure in each of the cell lines. This suggests that the cell response to mobile phone radiation might be genome- and proteome-dependent.The magnitude of the genetic background for some stimulus-specific responses was highlighted by some studies comparing different cell lines (Czyz et al. , 2004). It is postulated that the genetic constitution, as well as carrier frequency of the modulation schemes and exposure duration, may play a substantial role in responsiveness of cells to RFEMW. These findings might also explain, at least in part, the origin of discrepancies in reproducibility of studies among different laboratories (Nylund and Leszczynski, 2006).Some evidence has suggested that RF-EMW may change expression of DNA transcription factors and cause changes in cell cycle kinetics. Litovitz et al. (1993) have shown that exposure of mouse L929 fibroblasts to 915 MHz at an SAR of 2. 5 W/kg induced the express ion of ornithine decarboxylase protein, an enzyme important in cell cycle regulation. Natarajan et al. (2002) reported that exposure of a monocytic cell line to 8. 2 GHz pulse-modulated RF-EMW increased the binding of the nuclear factor kappa light chain gene to its consensus DNA sequence.Later on, relative expression and localization of bone morphogenetic proteins (BMP) and their receptors (BMPR), major endocrine and autocrine morphogens involved in renal development, were investigated by Pyrpasopoulou et al. (2004) in newborn kidneys from RF-EMW-exposed pregnant rats. The kidneys of newborns from the RF-exposed rats showed up-regulation of BMP4 and BMPR1A and down-regulation of BMPR2. This study suggests that RF-EMW might interfere with gene expression during early gestation and result in aberrations of BMP expression in the newborn (Pyrpasopoulou et al. 2004). RF-EMW has also been reported to affect the expression of Jun, a proto-oncogene (Ivaschuk et al. , 1997). Using serial an alysis of gene expression (SAGE), Lee et al. (2005) reported that in-vitro exposure of HL-60 cells to pulsemodulated 2. 45 GHz RF fields at an SAR of 10 W/kg for 6 h resulted in the differential expression of more than 750 genes. In contrast, many other recent studies have failed to find evidence of RF-field-induced changes in Hsp expression after RF-EMW exposure at frequencies ranging from 900–1950 MHz and SAR from 2–10 W/kg (Capri et al. 2004a,b; Laszlo et al. , 2005). Qutob et al. (2006) also reported no evidence relating nonthermal RF field on gene expression using microarray analysis in cultured U87 MG cells. Studies done on Drosophila melanogaster developmental potential by exposure to non-thermal radiation from the GSM mobile phone found increased numbers of offspring and elevated Hsp70 levels (Weisbrot et al. , 2003). This study also reported increased serum response element DNA-binding and induction of the phosphorylation of the nuclear transcription factor EL K-1 by cell phone radiation.The rapid induction of Hsp70 within minutes by a non-thermal stress, together with identified components of signal transduction pathways, could provide sensitive and reliable biomarkers that could serve as the basis for practical mobile phone safety guidelines (Weisbrot et al. , 2003). The indications to date that certain genes are influenced by EMW suggests that genome-wide scans of the transcriptome are necessary. Among the several technologies used for genomewide gene expression analysis, SAGE is one promising method that seems particularly applicable for EMW research.SAGE has been used in many biological and medical studies involving various eukaryotic species. So far, more than 19 million copies of SAGE tags have been collected from humans (Wang, 2006). In a recent study by Remondini et al. (2006), which was part of the Fifth Framework Programme project REFLEX (Risk Evaluation of Potential Environmental Hazards From LowEnergy Electromagnetic Field Ex posure Using Sensitive InVitro Methods), six human cell types, immortalized cell lines and primary cells were exposed to 900 and 1800 MHz.RNA was isolated from exposed and sham-exposed cells and labelled for transcriptome analysis on whole-genome cDNA arrays. NB69 neuroblastoma cells, T lymphocytes, and CHME5 microglial cells did not show significant changes in gene expression. In EA. hy926 endothelial cells, U937 lymphoblastoma cells and HL-60 leukaemia cells, between 12 and 34 genes were up- or down-regulated (including bcl-2-associated transcription factor BTF gene). The findings conclude that analysis of the affected gene families does not point towards a stress response, and no consistent RF-EMF signatures could be detected.However, following RF-EMW exposure, some but not all human cells might react with an increase in expression of genes encoding ribosomal proteins and therefore up-regulating the cellular metabolism (Remondini et al. , 2006). Theoretical approaches also have b een proposed to elucidate the mechanism behind the stimulation of biosynthesis by EMW (Blank and Goodman, 2008). Electrons have been shown to move in DNA and biochemical reactions could be modulated by EMW (Blank, 2005). Interaction with electrons could explain the activation of DNA by weak, low-frequency EMW, as well as the more energetic high frequencies.Evidence from biochemical reactions suggests that electromagnetic fields can accelerate electron transfer. Interaction with electrons could displace electrons in H bonds that hold DNA together, leading to chain separation and initiating transcription. The electron transfer would favour separation of base pairs, and DNA geometry is optimized for disaggregation under such conditions. The initial interaction could involve the displacement of electrons in the H bonds that hold DNA together, thereby causing chain separation and initiating transcription and translation.EMWinitiated DNA separation can set in motion the interconnected bio chemical signalling pathways that are activated in the stress response (Blank and Goodman, 2008). The effects of lowfrequency EMW on Na/K-ATPase activity (Blank, 2005) to generate ATP is another pertinent field to explore in the context of spermatozoal motility. The Na/K-ATPase is an enzyme of the plasma membrane of most animal cells that uses the free energy from the hydrolysis of ATP to mediate the exchange of cytoplasmic Na+ for extracellular K+ in a 3:2 ratio (Kaplan, 2002; Sanchez et al. , 2006).The Na/K-ATPase plays a key role in numerous cell processes that depend directly or indirectly on the transmembrane gradients of Na+ and K+. The enzyme is essential in maintaining cell osmotic balance, volume, pH and the cell resting membrane potential and in providing the chemical energy for the secondary Na+-coupled transport of other ions, solutes and water across the cell membrane (Skou and Esmann, 1992). This enzyme has an important role, along RBMOnline ® 154 Review – Cel l phones: modern man’s nemesis? – K Makker et al. with Na+/H+ exchanger, in human sperm motility (Woo et al. 2002; Sanchez et al. , 2006) These cellular pathways should be further analysed in the context of EMW. More recently Friedman et al. (2007) found significant increase in plasma membrane NADH oxidase activity of mammalian cells (HeLa cells) after exposure to 875 MHz EMF. Although the use of the discovery science approach employing high-throughput screening techniques will not yield foolproof evidence of a health hazard or its absence, it will be essential in unravelling the complexities of the biological effects potentially exerted by RF-EMF exposure. upport of previous studies, they also will open opportunities for groundbreaking research in this area. References Agarwal A, Deepinder F, Sharma RK et al. 2008 Effect of cell phone usage on semen analysis in men attending infertility clinic: an observational study. Fertility and Sterility 89, 124–128. Agarwa l A, Desai NR, Makker K et al. 2008 Effects of radiofrequency electromagnetic waves (RF-EMW) from cellular phones on human ejaculated semen: an in vitro pilot study. Fertility and Sterility Epub ahead of print. Aitken RJ 1999 The Amoroso Lecture. The human spermatozoon – a cell in crisis?Journal of Reproduction and Fertility 115, 1–7. Aitken RJ, L. E. Bennetts, Sawyer D et al. 2005 Impact of radio frequency electromagnetic radiation on DNA integrity in the male germline. International Journal of Andrology 28, 171–179. Anderson V, Rowley J 2007 Measurements of skin surface temperature during mobile phone use. Bioelectromagnetics 28, 159–162. Barnes FS, Greenebaum B 2007 Bioengineering and biophysical aspects of electromagnetic fields. In: Barnes FS, Greenebaum B (eds) Handbook of Biological Effects of Electromagnetic Fields 3rd edn. CRC Press, Boca Raton, USA.Blackwell RP 1979 Standards for microwave radiation. Nature 282, 360. Blank M 2005 Do electromagne tic fields interact with electrons in the Na,K-ATPase? Bioelectromagnetics 26, 677–683. Blank M, Goodman R 2008 A mechanism for stimulation of biosynthesis by electromagnetic fields: charge transfer in DNA and base pair separation. Journal of Cellular Physiology 214, 20–26. Braune S, Riedel A, Schulte-Monting J et al. 2002 Influence of a radiofrequency electromagnetic field on cardiovascular and hormonal parameters of the autonomic nervous system in healthy individuals.Radiation Research 158, 352–356. Braune S, Wrocklage C, Raczek J et al. 1998 Resting blood pressure increase during exposure to a radio-frequency electromagnetic field. Lancet 351, 1857–1858. Burch JB, Reif S, Noonan CW et al. 2002 Melatonin metabolite excretion among cellular telephone users. International Journal of Radiation Biology 78, 1029–1036. Cairnie AB, Harding RK 1981 Cytological studies in mouse testis irradiated with 2. 45-GHz continuous-wave microwaves. Radiation Researc h 87, 100–108. Capri M, Scarcella E, Bianchi E et al. 004a 1800 MHz radiofrequency (mobile phones, different global system for mobile communication modulations) does not affect apoptosis and heat shock protein 70 level in peripheral blood mononuclear cells from young and old donors. International Journal Radiation Biology 80, 389–397. Capri M, Scarcella E, Fumelli C et al. 2004b In-vitro exposure of human lymphocytes to 900 MHz CW and GSM modulated radiofrequency: studies of proliferation, apoptosis and mitochondrial membrane potential. Radiation Research 162, 211–218. Colonna A 2005 Cellular phones and cancer: current status. Bull Cancer 92, 637–643.Concannon CG, Orrenius S, Samali A 2001 Hsp27 inhibits cytochrome c-mediated caspase activation by sequestering both pro-caspase-3 and cytochrome c. Gene Expression 9, 195–201. Czyz J, Guan K, Zeng Q et al. 2004 High frequency electromagnetic fields (GSM signals) affect gene expression levels in tumor suppressor p53-deficient embryonic stem cells. Bioelectromagnetics 25, 296–307. Dasdag S, Zulkuf Akdag M, Aksen F et al. 2003 Whole body exposure of rats to microwaves emitted from a cell phone does not affect the testes. Bioelectromagnetics 24, 182–188. Dasdag S, Ketani MA, Akdag Z et al. 999 Whole-body microwave exposure emitted by cellular phones and testicular function of rats. Urological Research 27, 219–223. Cleveland Clinic pilot study To validate the results of recent epidemiological studies and to establish a cause and effect relationship between cell phone usage and decrease in semen parameters, a novel in-vitro experiment was designed. Semen samples were exposed to EMW from a commercially available cellular phone (GSM network, 850 MHz,), and the effect of EMW on semen parameters, DNA integrity [using TdT (terminal deoxynucleotidyl transferase)mediated dUDP nick-end labelling assay] (Tesarik et al. 2006; Ozmen et al. , 2007) and disturbance in reactive oxygen species metabolism was assessed post exposure. In this study, healthy donors were enrolled to provide semen samples. The semen sample obtained from each volunteer was divided into two parts: EMW-exposed group and control group. Environmental condition was monitored throughout the experiment. The frequency emitted by the cell phone was also confirmed with help of a radiofrequency spectrum analyser. One portion of the sample was exposed to radiation from a commercially available cell phone.A second portion was kept non-exposed for the same time duration. Measurement of sperm concentration, motility and viability was carried out as described by the World Health Organization (1999). Samples also were assessed for reactive oxygen species, total antioxidant capacity and DNA damage (Agarwal et al. , 2008). Conclusion As highlighted above, many aspects of human health have been proposed to be affected by cell phone exposure. Ranging from mild local warmth to possible tumour inductio n, EMW have been suspected of involvement in many health concerns.At this time, evidence is lacking to strongly prove or disprove any of the proposed harmful effects of EMW. However, the significance of these studies and their possible implications in the future cannot be ignored. Findings and trends available from these studies provide a strong indication to carry out further studies to establish a clearer and more evidence-based conclusion. Both human and animal-based studies have provided a hint that EMW may be involved in the pathogenesis of male infertility, but considerable work is required to provide scientific support for this view.More importantly, studies must be carried out in human semen samples as data from animal studies are limited in their applicability in humans. High-throughput screening techniques may be an important tool to evaluate the molecular effects of EMW on the biological system. Not only will these techniques provide evidence in RBMOnline ® 155 Review à ¢â‚¬â€œ Cell phones: modern man’s nemesis? – K Makker et al. de Seze R, Ayoub J, Peray P et al. 1999 Evaluation in humans of the effects of radiocellular telephones on the circadian patterns of melatonin secretion, a chronobiological rhythm marker.Journal of Pineal Research 27, 237–242. Deepinder F, Makker K, Agarwal A 2007 Cell phones and male infertility: dissecting the relationship. Reproductive BioMedicine Online 15, 266–270. Diem E, Schwarz C, Adlkofer F et al. 2005 Non-thermal DNA breakage by mobile-phone radiation (1800 MHz) in human fibroblasts and in transformed GFSH-R17 rat granulosa cells in vitro. Mutation Research 583, 178–183. Djeridane Y, Touitou T, de Seze R 2008 Influence of electromagnetic fields emitted by GSM-900 cellular telephones on the circadian patterns of gonadal, adrenal and pituitary hormones in men.Radiation Research 169, 337–343. Erogul O, Oztas E, Yildirim I et al. 2006 Effects of electromagnetic radiation from a cellular phone on human sperm motility: an invitro study. Archives of Medical Research 37, 840–843. Falzone N, Huyser C, Fourie F et al. 2008 In-vitro effect of pulsed 900 MHz GSM radiation on mitochondrial membrane potential and motility of human spermatozoa. Bioelectromagnetics 29, 268–276. Federal Communications Commission Available at www. fcc. gov and www. fcc. gov/oet/rfsafety/cellpcs. html [accessed 4 August 2008]. Fejes I, Zavaczki Z, Szollosi J, et al. 005 Is there a relationship between cell phone use and semen quality? Archives of Andrology 51, 385–393. Feychting M 2005 Non-cancer EMF effects related to children. Bioelectromagnetics Suppl. 7, S69–74. Food and Drug Administration Cellular Phone Facts, Questions and Answers. Available at www. fda. gov/cellphones/qa. html [accessed 4 August 2008]. Friedman J, Kraus S, Hauptman Y et al. 2007 Mechanism of shortterm ERK activation by electromagnetic fields at mobile phone frequencies. Biochemistry Journal 405, 559–568. Geum D, Son GH, Kim K 2002 Phosphorylation-dependent cellular localization and thermoprotective role of eat shock protein 25 in hippocampal progenitor cells. Journal of Biological Chemistry 277, 19913–19921. Hardell L, Carlberg M, Ohlson CG et al. 2007 Use of cellular and cordless telephones and risk of testicular cancer. International Journal of Andrology 30, 115–122. Hardell L, Mild KH, Carlberg M, Soderqvist F 2006 Tumour risk associated with use of cellular telephones or cordless desktop telephones. World Journal of Surgical Oncology 4, 74. Hook GJ, Spitz DR, Sim JE et al. 2004 Evaluation of parameters of oxidative stress after in-vitro exposure to FMCW- and CDMAmodulated radiofrequency radiation fields.Radiation Research 162, 497–504. Huber R, Graf T, Cote KA et al. 2000 Exposure to pulsed highfrequency electromagnetic field during waking affects human sleep EEG. Neuroreport 11, 3321–3325. Irmak MK, Fadillioglu E, Gulec M et al. 2002 Effects of electromagnetic radiation from a cellular telephone on the oxidant and antioxidant levels in rabbits. Cell Biochemistry and Function 20, 279–283. Ivaschuk OI, Jones RA, Ishida-Jones T et al. 1997 Exposure of nerve growth factor-treated PC12 rat pheochromocytoma cells to a modulated radiofrequency field at 836. 55 MHz: effects on c-jun and c-fos expression.Bioelectromagnetics 18, 223–229. Jung A, Schill WB 2000 [Male infertility. Current life style could be responsible for infertility]. MMW Fortschritte der Medizin 142, 31–33. Kandeel FR, Swerdloff RS 1988 Role of temperature in regulation of spermatogenesis and the use of heating as a method for contraception. Fertility and Sterility 49, 1–23. Kaplan JH 2002 Biochemistry of Na,K-ATPase. Annual Review of Biochemistry 71, 511–535. Lai H,. Singh NP 1996 Single- and double-strand DNA breaks in rat brain cells after acute exposure to radiofrequency electromagnetic radiation.Inte rnational Journal of Radiational Biology 69, 513–521. Laszlo A, Moros EG, Davidson T et al. 2005 The heat-shock factor is not activated in mammalian cells exposed to cellular phone frequency microwaves. Radiation Research 164, 163–172. Lee S, Johnson D, Dunbar K et al. 2005 2. 45 GHz radiofrequency fields alter gene expression in cultured human cells. FEBS Letters 579, 4829–4836. Leszczynski D, Nylund R, Joenvaara S, Reivinen J 2004 Applicability of discovery science approach to determine biological effects of mobile phone radiation. Proteomics 4, 426–431. Leszczynski D, Joenvaara S, Reivinen J et al. 002 Non-thermal activation of the hsp27/p38MAPK stress pathway by mobile phone radiation in human endothelial cells: molecular mechanism for cancer- and blood-brain barrier-related effects. Differentiation 70, 120–129. Litovitz TA, Krause D, Penafiel M et al. 1993 The role of coherence time in the effect of microwaves on ornithine decarboxylase activi ty. Bioelectromagnetics 14, 395–403. Lixia S, Yao K, Kaijun W et al. 2006 Effects of 1. 8 GHz radiofrequency field on DNA damage and expression of heat shock protein 70 in human lens epithelial cells. Mutation Research 602, 135–142. Natarajan M, Vijayalaxmi, Szzliagyl M et al. 002 NF-kappaB DNAbinding activity after high peak power pulsed microwave (8. 2 GHz) exposure of normal human monocytes. Bioelectromagnetics 23, 271–277. Nylund R, Leszczynski D 2006 Mobile phone radiation causes changes in gene and protein expression in human endothelial cell lines and the response seems to be genome- and proteomedependent. Proteomics 6, 4769–4780. Nylund R, Leszczynski D 2004 Proteomics analysis of human endothelial cell line EA. hy926 after exposure to GSM 900 radiation. Proteomics 4, 1359–1365. Oftedal G, Wilen J, Sandstrom M, et al. 2000 Symptoms experienced in connection with mobile phone use.Occupational Medicine (London) 50, 237–245. Oktem F, Oz guner F, Mollaoglu H et al. 2005 Oxidative damage in the kidney induced by 900-MHz-emitted mobile phone: protection by melatonin. Archives of Medical Research 36, 350–355. Ozguner F, Altinbas A, Ozaydin M et al. 2005 Mobile phone-induced myocardial oxidative stress: protection by a novel antioxidant agent caffeic acid phenethyl ester. Toxicology and Industrial Health 21, 223–230. Ozmen B, Caglar CS, Koster F et al. 2007 Relationship between sperm DNA damage, induced acrosome reaction and viability in ICSI patients. Reproductive BioMedicine Online 15, 208–214.Panagopoulos DJ, Chavdoula ED, Nezis IP, Margaritis LH 2007 Cell death induced by GSM 900-MHz and DCS 1800-MHz mobile telephony radiation. Mutation Research 626, 69–78. Perentos N, Croft RJ, McKenzie RJ, et al. 2007 Comparison of the effects of continuous and pulsed mobile phone like RF exposure on the human EEG. Australasian Physical and Engineering Sciences in Medicine 30, 274–280. Preece AW, Iwi G, Davies-Smith A et al. 1999 Effect of a 915-MHz simulated mobile phone signal on cognitive function in man. International Journal of Radiation Biology 75, 447–456. Pyrpasopoulou A, Kotoula V, Cheva A et al. 004 Bone morphogenetic protein expression in newborn rat kidneys after prenatal exposure to radiofrequency radiation. Bioelectromagnetics 25, 216–227. Qutob SS, Chauhan V, Bellier PV et al. 2006 Microarray gene expression profiling of a human glioblastoma cell line exposed in vitro to a 1. 9 GHz pulse-modulated radiofrequency field. Radiation Research 165, 636–644. Regel SJ, Tinguely G, Schuderer J et al. 2007 Pulsed radio-frequency electromagnetic fields: dose-dependent effects on sleep, the sleep EEG and cognitive performance. Journal of Sleep Research 16, 253–258. Remondini D, Nylund R, Reivinen J et al. 006 Gene expression changes in human cells after exposure to mobile phone microwaves. Proteomics 6, 4745–4754. RBMOnline ® 156 Revi ew – Cell phones: modern man’s nemesis? – K Makker et al. Ribeiro EP, Rhoden EL, Horn MM et al. 2007 Effects of subchronic exposure to radio frequency from a conventional cellular telephone on testicular function in adult rats. Journal of Urology 177, 395–399. Sakuma N, Komatsubara Y, Takeda H et al. 2006 DNA strand breaks are not induced in human cells exposed to 2. 1425 GHz band CW and W-CDMA modulated radiofrequency fields allocated to mobile radio base stations.Bioelectromagnetics 27, 51–57. Sanchez G, Nguyen AN, Timmerberg B et al. 2006 The Na,K-ATPase alpha4 isoform from humans has distinct enzymatic properties and is important for sperm motility. Molecular Human Reproduction 12, 565–576. Sandstrom M, Wilen J, Oftedal G, Hansson Mild K 2001 Mobile phone use and subjective symptoms. Comparison of symptoms experienced by users of analogue and digital mobile phones. Occupational Medicine (Lond) 51, 25–35. Skou JC, Esmann M 1992 The Na,K-ATPase. Journal of Bioenergetics and Biomembranes 24, 249–261. Stronati L, Testa A, Moquet J et al. 2006 935 MHz cellular phone radiation.An in-vitro study of genotoxicity in human lymphocytes. International Journal of Radiation Biology 82, 339–346. Straume A, Oftedal G, Johnsson A et al. 2005 Skin temperature increase caused by a mobile phone: a methodological infrared camera study. Bioelectromagnetics, 26, 510–519. Tahvanainen K, Nino J, Halonen P et al. 2004 Cellular phone use does not acutely affect blood pressure or heart rate of humans. Bioelectromagnetics 25, 73–83. Tesarik J, Mendoza-Tesarik R, Mendoza C 2006 Sperm nuclear DNA damage: update on the mechanism, diagnosis and treatment. Reproductive BioMedicine Online 12, 715–721.Wang SM 2006 Applying the SAGE technique to study the effects of electromagnetic field on biological systems. Proteomics 6, 4765–4768. Wdowiak A, Wdowiak L, Wiktor H 2007 Evaluation of the effect of using mobile phones on male fertility. Annals of Agricultural and Environmental Medicine 14, 169–172. Weisbrot D, Lin H, Ye H et al. 2003 Effects of mobile phone radiation on reproduction and development in Drosophila melanogaster. Journal of Cellular Biochemistry 89, 48–55. Woo AL, James PF, Lingrel JB 2002 Roles of the Na,K-ATPase alpha4 isoform and the Na+/H+ exchanger in sperm motility. Molecular Reproduction and Development 62, 348–356.World Health Organization 1999 WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction. Cambridge University Press, Cambridge. Yan JG, Agresti M, Bruce T, et al. 2007 Effects of cellular phone emissions on sperm motility in rats. Fertility and Sterility 88, 957–964. Zou H, Henzel WJ, Liu X et al. 1997 Apaf-1, a human protein homologous to C. elegans CED-4, participates in cytochrome c-dependent activation of caspase-3. Cell 90, 405–413. Declaration: The authors report no financia l or commercial conflicts of interest. Received 21 April 2008; refereed 6 May 2008; accepted 28 July 2008. 157 RBMOnline ®