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Wang W, Liu Y, Zhu ZB, Pang K, Wang JK, Gu J, Li ZB, Wang J, Shi ZD, Han CH. Research Advances in Stem Cell Therapy for Erectile Dysfunction. BioDrugs 2024; 38:353-367. [PMID: 38520608 PMCID: PMC11055746 DOI: 10.1007/s40259-024-00650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/25/2024]
Abstract
Erectile dysfunction (ED) is a common clinical condition that mainly affects men aged over 40 years. Various causes contribute to the progression of ED, including pelvic nerve injury, diabetes, metabolic syndrome, age, Peyronie's disease, smoking, and psychological disorders. Current treatments for ED are limited to symptom relief and do not address the root cause. Stem cells, with their powerful ability to proliferate and differentiate, are a promising approach for the treatment of male ED and are gradually gaining widespread attention. Current uses for treating ED have been studied primarily in experimental animals, with most studies observing improvements in erectile quality as well as improvements in erectile tissue. However, research on stem cell therapy for human ED is still limited. This article summarizes the recent literature on basic stem cell research on ED, including cavernous nerve injury, aging, diabetes, and sclerosing penile disease, and describes mechanisms of action and therapeutic effects of various stem cell therapies in experimental animals. Stem cells are also believed to interact with host tissue in a paracrine manner, and improved function can be supported through both implantation and paracrine factors. To date, stem cells have shown some preliminary promising results in animal and human models of ED.
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Affiliation(s)
- Wei Wang
- School of Medicine, Southeast University, Nanjing, China
| | - Ying Liu
- Department of Central Laboratory, Xuzhou Central Hospital, Xuzhou, China
| | - Zuo-Bin Zhu
- Xuzhou Engineering Research Center of Medical Genetics and Transformation, Key Laboratory of Genetic Foundation and Clinical Application, Department of Genetics, Xuzhou Medical University, Xuzhou, China
| | - Kun Pang
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China
| | - Jing-Kai Wang
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jun Gu
- The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Zhen-Bei Li
- Department of Reproductive Medicine, Xuzhou Central Hospital, Xuzhou, China
| | - Jian Wang
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China
| | - Zhen-Duo Shi
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China.
| | - Cong-Hui Han
- School of Medicine, Southeast University, Nanjing, China.
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China.
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Adipose-Derived Stem Cells from Type 2 Diabetic Rats Retain Positive Effects in a Rat Model of Erectile Dysfunction. Int J Mol Sci 2022; 23:ijms23031692. [PMID: 35163613 PMCID: PMC8836282 DOI: 10.3390/ijms23031692] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 12/18/2022] Open
Abstract
Erectile dysfunction is a common complication associated with type 2 diabetes mellitus (T2DM) and after prostatectomy in relation to cancer. The regenerative effect of cultured adipose-derived stem cells (ASCs) for ED therapy has been documented in multiple preclinical trials as well as in recent Pase 1 trials in humans. However, some studies indicate that diabetes negatively affects the mesenchymal stem cell pool, implying that ASCs from T2DM patients could have impaired regenerative capacity. Here, we directly compared ASCs from age-matched diabetic Goto–Kakizaki (ASCGK) and non-diabetic wild type rats (ASCWT) with regard to their phenotypes, proteomes and ability to rescue ED in normal rats. Despite ASCGK exhibiting a slightly lower proliferation rate, ASCGK and ASCWT proteomes were more or less identical, and after injections to corpus cavernosum they were equally efficient in restoring erectile function in a rat ED model entailing bilateral nerve crush injury. Moreover, molecular analysis of the corpus cavernosum tissue revealed that both ASCGK and ASCWT treated rats had increased induction of genes involved in recovering endothelial function. Thus, our finding argues that T2DM does not appear to be a limiting factor for autologous adipose stem cell therapy when correcting for ED.
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Chen S, Zhu J, Wang M, Huang Y, Qiu Z, Li J, Chen X, Chen H, Xu M, Liu J, She M, Li H, Yang X, Wang Y, Cai X. Comparison of the therapeutic effects of adipose‑derived and bone marrow mesenchymal stem cells on erectile dysfunction in diabetic rats. Int J Mol Med 2019; 44:1006-1014. [PMID: 31257465 PMCID: PMC6658012 DOI: 10.3892/ijmm.2019.4254] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 06/13/2019] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to compare the effects of adipose‑derived mesenchymal stem cell (ADSC) and bone marrow mesenchymal stem cell (BMSC) transplantation into the corpora cavernosa of diabetic rats with erectile function. ADSCs and BMSCs were isolated and identified by flow cytometry. Rats with streptozocin‑induced diabetes were screened using apomorphine to obtain a rat model of diabetic erectile dysfunction, followed by transplantation of ADSCs and BMSCs into the corpora cavernosa. Two weeks later, the rats were again injected with apomorphine, the intracavernous pressure (ICP) and mean arterial pressure (MAP) of the penile tissue were measured, and the corpus cavernosum tissues were harvested. Angiogenic endothelial nitric oxide synthase (eNOS) expression was detected by western blotting and immunofluorescence analysis. The blood vessels in the corpus cavernosum were observed following hematoxylin and eosin (H&E) staining, and the expression of collagen was detected by Sirius Red staining. The cellular ultrastructure was examined by transmission electron microscopy. Intracavernous injection of ADSCs significantly increased ICP and ICP/MAP. Western blotting and immunofluorescence results revealed that ADSC treatment improved the expression of eNOS in the penile tissue of diabetic rats. The H&E staining results demonstrated that ADSC treatment promoted revascularization of the corpus cavernosum, and the results of Sirius Red staining revealed that ADSC treatment reduced penile collagen in diabetic rats. Transmission electron microscopy examination revealed that the ultrastructure of the tissues in the ADSC‑treated group was more complete compared with that in the untreated diabetic model group. In conclusion, ADSCs were found to be more effective compared with BMSCs in treating diabetes‑related erectile dysfunction.
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Affiliation(s)
- Sansan Chen
- Department of Urology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080
- Institute of Biotherapy, Southern Medical University, Guangzhou, Guangdong 510515
| | - Jianbin Zhu
- Technology Center, Guangdong Vitalife Bio-Tech Co., Ltd., Foshan, Guangdong 528200
| | - Mingzhu Wang
- Reproductive Center of Obstetrics and Gynecology, Southern Medical University, Guangzhou, Guangdong 510515
| | - Yanting Huang
- Clinical Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080
| | - Zhuolin Qiu
- Reproductive Center of Obstetrics and Gynecology, Southern Medical University, Guangzhou, Guangdong 510515
| | - Jingjing Li
- Technology Center, Guangdong Vitalife Bio-Tech Co., Ltd., Foshan, Guangdong 528200
| | - Xinglu Chen
- Clinical Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080
| | - Huiying Chen
- Institute of Biotherapy, Southern Medical University, Guangzhou, Guangdong 510515
| | - Mingyu Xu
- Institute of Biotherapy, Southern Medical University, Guangzhou, Guangdong 510515
| | - Jun Liu
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong 510091
| | - Miaoqin She
- Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, Guangdong 510660
| | - Hongwei Li
- Institute of Biotherapy, Southern Medical University, Guangzhou, Guangdong 510515
| | - Xiaorong Yang
- Clinical Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080
- Correspondence to: Dr Xiangsheng Cai or Dr Xiaorong Yang, Clinical Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, 39 Nonglin Xia Road, Guangzhou, Guangdong 510080, P.R. China, E-mail: , E-mail:
| | - Yi Wang
- Central Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080, P.R. China
| | - Xiangsheng Cai
- Institute of Biotherapy, Southern Medical University, Guangzhou, Guangdong 510515
- Clinical Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080
- Correspondence to: Dr Xiangsheng Cai or Dr Xiaorong Yang, Clinical Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, 39 Nonglin Xia Road, Guangzhou, Guangdong 510080, P.R. China, E-mail: , E-mail:
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Rezaee ME, Ward CE, Brandes ER, Munarriz RM, Gross MS. A Review of Economic Evaluations of Erectile Dysfunction Therapies. Sex Med Rev 2019; 8:497-503. [PMID: 31326359 DOI: 10.1016/j.sxmr.2019.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a common and costly urologic condition with increasing prevalence as men age. Cost-effectiveness of ED therapies and whether cost-effectiveness varies for different populations of men remains underexplored. AIM To review and summarize available published data on the economic evaluation of ED therapies and to identify gaps in the literature that still need to be addressed. METHODS All relevant peer-reviewed publications and conference abstracts were reviewed and incorporated. RESULTS There are a number of medical and surgical treatment options available for ED. The economic evaluation of phosphodiesterase-5 inhibitors, particularly sildenafil, has been well described. However, minimal research has been conducted to assess the cost-effectiveness of intracavernosal injections, intraurethral suppositories, penile prosthesis surgery, vacuum erection devices, and other emerging therapies in men with different causes of ED. CONCLUSION Available economic evaluations of ED therapies are dated, do not reflect present-day physician, pharmaceutical, and device costs, fail to account for patient comorbidities, and may not be generalizable to today's ED patients. Substantial research is needed to evaluate the cost-effectiveness of ED treatments across different patient populations, countries, and reimbursement systems. Rezaee ME, Ward CE, Brandes ER, et al. A Review of Economic Evaluations of Erectile Dysfunction Therapies. Sex Med Rev 2019;8:497-503.
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Affiliation(s)
- Michael E Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Charlotte E Ward
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - Eileen R Brandes
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Ricardo M Munarriz
- Department of Urology, Boston University Medical Center, Boston, MA, USA
| | - Martin S Gross
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Qin F, Wang S, Li J, Wu C, Yuan J. The Early Use of Vacuum Therapy for Penile Rehabilitation After Radical Prostatectomy: Systematic Review and Meta-Analysis. Am J Mens Health 2018; 12:2136-2143. [PMID: 30182794 PMCID: PMC6199422 DOI: 10.1177/1557988318797409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Vacuum therapy has been widely used for penile rehabilitation after radical prostatectomy (RP), but its efficacy and safety are unclear. The study was to evaluate the efficacy and safety of the early use of vacuum therapy for post-RP men. Randomized clinical trials were selected according to predefined inclusion and exclusion criteria. RevMan 5.3 software was used for meta-analyses. In total, six randomized controlled trials were included with a total of 273 post-RP patients. The meta-analysis revealed that the early use of vacuum therapy could significantly improve the five-item International Index of Erectile Function and penile shrinkage in post-RP patients. Few adverse events were reported across the included studies. This review suggests that the early use of vacuum therapy appears to have excellent therapeutic effect on post-RP patients and no serious side effects were identified. Due to overall limited quality of the included studies, the therapeutic benefit of vacuum therapy in penile rehabilitation needs be substantiated to a limited degree in the future. Better methodological, large controlled trials are expected to verify the therapeutic effect of vacuum therapy in penile rehabilitation.
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Affiliation(s)
- Feng Qin
- 1 Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Shuzhen Wang
- 2 Laboratory of Infectious Disease and Vaccine, West China Hospital, Sichuan University, Chengdu, China
| | - Jinhong Li
- 1 Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
- 3 Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Changjing Wu
- 1 Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuhong Yuan
- 1 Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
- 3 Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Milenkovic U, Albersen M, Castiglione F. The mechanisms and potential of stem cell therapy for penile fibrosis. Nat Rev Urol 2018; 16:79-97. [DOI: 10.1038/s41585-018-0109-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Capogrosso P, Montorsi F, Salonia A. Phase I and phase II clinical trials for the treatment of male sexual dysfunction-a systematic review of the literature. Expert Opin Investig Drugs 2018; 27:583-593. [PMID: 29969332 DOI: 10.1080/13543784.2018.1495707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The prevalence of sexual dysfunctions has increased over the last decades; despite a number of available treatments for erectile dysfunction (ED), premature ejaculation (PE), and Peyronie's disease (PD), still several unmet therapeutic needs deserve to be fulfilled. The aim of this review is to detail on phase I and II clinical trials investigating novel medical treatments for ED, PE, and PD. AREAS COVERED We conducted a systematic review of the literature including both published and ongoing phase I and II registered trials focused on medical treatment of ED, PE, and PD during the last 5 years. A total of 35 trials have been identified. Most studies (63%) investigated ED treatments and 26% were still ongoing. Stem cells (SCs) therapy was assessed in 28% of trials. EXPERT OPINION SCs therapy represent a promising treatment for ED although only few patients have been treated to date. Likewise, the oral selective oxytocin receptor antagonists for treating PE showed excellent safety profile and deserve further investigations in phase III trials. Preliminary results of novel topical treatments for PD with fibrinolytic and antiinflammatory drugs are encouraging, but urgently need to be confirmed in large placebo-controlled trials.
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Affiliation(s)
- Paolo Capogrosso
- a Department of Urology , Università Vita-Salute San Raffaele , Milan , Italy
- b Division of Experimental Oncology/Unit of Urology; URI , IRCCS Ospedale San Raffaele , Milan , Italy
| | - Francesco Montorsi
- a Department of Urology , Università Vita-Salute San Raffaele , Milan , Italy
- b Division of Experimental Oncology/Unit of Urology; URI , IRCCS Ospedale San Raffaele , Milan , Italy
| | - Andrea Salonia
- a Department of Urology , Università Vita-Salute San Raffaele , Milan , Italy
- b Division of Experimental Oncology/Unit of Urology; URI , IRCCS Ospedale San Raffaele , Milan , Italy
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Campbell JD, Milenkovic U, Albersen M, Bivalacqua TJ. What Is the Future of Erectile Dysfunction Therapy? CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0153-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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El Osta R, Decot V, Bensoussan D, Stoltz JF, Eschwege P, Hubert J. [Treatment by stem cell therapy of erectile dysfunction of diabetic origin: State of the art]. Prog Urol 2017; 28:74-84. [PMID: 29170014 DOI: 10.1016/j.purol.2017.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/11/2017] [Accepted: 10/20/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Review of various publications on stem cell therapy to treat erectile dysfunction of diabetic origin. MATERIAL AND METHODS Bibliographic search in PUBMED performed using the keywords cell therapy strain/erectile dysfunction associated with diabetes. Among the 51 articles obtained from the PUBMED research, we selected 16 articles for their specificity of studying erectile dysfunction (DE) related to diabetes. RESULTS Different types of stem cells have been studied: adipose derived mesenchymal stem cells/bone marrow derived mesenchymal stem cells as well as progenitor endothelial cells. The experimental protocols are quite similar from one study to the next with nevertheless some specifications concerning the studied cells and the monitoring of the latter. Intracavernous pressure (ICP) measured after the injection of stem cells into the corpus cavernosum was always significantly higher than the control populations. The addition of certain growth factors to stem cells by gene transfection improve the efficacy of the cells. No ideal tracking markers of the cells have been identified. CONCLUSION The positive effect of the injection of stem cells on the ICP belongs to the cellular trans-differentiation effect but especially to the paracrine effects which have not yet been completely elucidated.
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Affiliation(s)
- R El Osta
- Service d'urologie, hôpitaux de Brabois, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France; IADI-UL-Inserm (U947), faculté de médecine, 54500 Vandœuvre-lès-Nancy, France.
| | - V Decot
- CNRS UMR 7563, Bio pôle, faculté de médecine, 54500 Vandœuvre-lès-Nancy, France; CNRS FR3208, UTCT, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - D Bensoussan
- CNRS UMR 7563, Bio pôle, faculté de médecine, 54500 Vandœuvre-lès-Nancy, France; CNRS FR3208, UTCT, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - J F Stoltz
- CNRS UMR 7563, Bio pôle, faculté de médecine, 54500 Vandœuvre-lès-Nancy, France; CNRS FR3208, UTCT, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - P Eschwege
- Service d'urologie, hôpitaux de Brabois, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France; CNRS, UMR 7039 CRAN, université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - J Hubert
- Service d'urologie, hôpitaux de Brabois, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France; IADI-UL-Inserm (U947), faculté de médecine, 54500 Vandœuvre-lès-Nancy, France
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Neuroprotective and Nerve Regenerative Approaches for Treatment of Erectile Dysfunction after Cavernous Nerve Injury. Int J Mol Sci 2017; 18:ijms18081794. [PMID: 28820434 PMCID: PMC5578182 DOI: 10.3390/ijms18081794] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 01/02/2023] Open
Abstract
Erectile dysfunction (ED) is a significant cause of reduced quality of life in men and their partners. Cavernous nerve injury (CNI) during pelvic surgery results in ED in greater than 50% of patients, regardless of additional patient factors. ED related to CNI is difficult to treat and typically poorly responsive to first- and second-line therapeutic options. Recently, a significant amount of research has been devoted to exploring neuroprotective and neuroregenerative approaches to salvage erectile function in patients with CNI. In addition, therapeutic options such as neuregulins, immunophilin ligands, gene therapy, stem cell therapy and novel surgical strategies, have shown benefit in pre-clinical, and limited clinical studies. In the era of personalized medicine, these new therapeutic technologies will be the future of ED treatment and are described in this review.
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Wu XJ, Shen WH, He P, Zhou XZ, Zhi Y, Dai Q, Chen ZW, Zhou ZS. Telomerase reverse transcriptase genetically modified adipose tissue derived stem cells improves erectile dysfunction by inhibiting oxidative stress and enhancing proliferation in rat model. Biomed Pharmacother 2017; 92:595-605. [DOI: 10.1016/j.biopha.2017.04.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 12/21/2022] Open
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Role of Nanotechnology in Erectile Dysfunction Treatment. J Sex Med 2017; 14:36-43. [PMID: 28065359 DOI: 10.1016/j.jsxm.2016.11.318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/22/2016] [Accepted: 11/27/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The biological importance of nanotechnology-based delivery vehicles for in vivo tissue regeneration is gaining acceptance by the medical community; however, its relevance and incorporation into the treatment of sexual dysfunction are evolving and have not been well evaluated. AIM To provide scientific evidence examining the use of state-of-the-art nanotechnology-based delivery methodology in the treatment of erectile dysfunction (ED) in animal models and in patients. METHODS This review assessed the current basic science literature examining the role of nanotechnology-based delivery vehicles in the development of potential ED therapies. RESULTS There are four primary areas where nanotechnology has been applied for ED treatment: (i) topical delivery of drugs for on-demand erectile function, (ii) injectable gels into the penis to prevent morphologic changes after prostatectomy, (iii) hydrogels to promote cavernous nerve regeneration or neuroprotection, and (iv) encapsulation of drugs to increase erectile function (primarily of phosphodiesterase type 5 inhibitors). CONCLUSION Basic science studies provide evidence for a significant and evolving role for nanotechnology in the development of therapies for ED and suggest that properly administered nano-based therapies might be advantageous for treating male sexual dysfunction.
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Abstract
PURPOSE OF REVIEW To summarize recent literature on basic stem cell research in erectile dysfunction in cavernous nerve injury, aging, diabetes, and Peyronie's disease and to provide a perspective on clinical translation of these cellular therapies. RECENT FINDINGS Stem cell research has been concentrated on mesenchymal stem (stromal) cells from bone marrow and adipose tissue. Application of both cell types has produced positive effects on erectile function in various animal models of erectile dysfunction. In acute animal models, such as cavernous nerve injury-induced erectile dysfunction and chemically induced Peyronie's disease, engraftment and differentiation have not been observed, and stem cells are believed to interact with the host tissue in a paracrine fashion, whereas in chronic disease models some evidence suggests both engraftment and paracrine factors may support improved function. Clinical trials are now investigating therapeutic efficacy of cellular therapy, whereas the first safety studies in humans have recently been published. SUMMARY Evidence from preclinical studies has established stem cells as a potential curative treatment for erectile dysfunction and early phase clinical trials are currently performed.
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Albersen M, Bivalacqua TJ. Regenerative Medicine for Erectile Dysfunction Following Radical Prostatectomy: Are we Ready? EBioMedicine 2016; 5:28-9. [PMID: 27077108 PMCID: PMC4816854 DOI: 10.1016/j.ebiom.2016.02.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Maarten Albersen
- Department of Urology, Universtity Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center (SKCCC), Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Abstract
Erectile dysfunction is a multidimensional but common male sexual dysfunction that involves an alteration in any of the components of the erectile response, including organic, relational and psychological. Roles for nonendocrine (neurogenic, vasculogenic and iatrogenic) and endocrine pathways have been proposed. Owing to its strong association with metabolic syndrome and cardiovascular disease, cardiac assessment may be warranted in men with symptoms of erectile dysfunction. Minimally invasive interventions to relieve the symptoms of erectile dysfunction include lifestyle modifications, oral drugs, injected vasodilator agents and vacuum erection devices. Surgical therapies are reserved for the subset of patients who have contraindications to these nonsurgical interventions, those who experience adverse effects from (or are refractory to) medical therapy and those who also have penile fibrosis or penile vascular insufficiency. Erectile dysfunction can have deleterious effects on a man's quality of life; most patients have symptoms of depression and anxiety related to sexual performance. These symptoms, in turn, affect his partner's sexual experience and the couple's quality of life. This Primer highlights numerous aspects of erectile dysfunction, summarizes new treatment targets and ongoing preclinical studies that evaluate new pharmacotherapies, and covers the topic of regenerative medicine, which represents the future of sexual medicine.
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Khera M, Albersen M, Mulhall JP. Mesenchymal Stem Cell Therapy for the Treatment of Erectile Dysfunction. J Sex Med 2015; 12:1105-6. [DOI: 10.1111/jsm.12871] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Weyne E, Castiglione F, Van der Aa F, Bivalacqua TJ, Albersen M. Landmarks in erectile function recovery after radical prostatectomy. Nat Rev Urol 2015; 12:289-97. [PMID: 25868558 DOI: 10.1038/nrurol.2015.72] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The description of the nerve-sparing technique of radical prostatectomy by Walsh was one of the major breakthroughs in the surgical treatment of prostate cancer in the 20(th) century. However, despite this advance and consequent technological refinements to nerve-sparing surgery, a large proportion of men still suffer from erectile dysfunction (ED) as a complication of prostatectomy. A plethora of therapeutic approaches have been proposed to optimize erectile function recovery in these patients. Several preclinical and translational studies have shown benefits of therapies including PDE5 inhibitor (PDE5I) treatment, immunomodulation, neurotrophic factor administration, and regenerative techniques, such as stem cell therapy, in animal models. However, most of these approaches have either failed to translate to clinical use or have yet to be studied in human subjects. Penile rehabilitation with PDE5Is is currently the most commonly used clinical strategy, in spite of the absence of solid clinical evidence to support its use.
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Affiliation(s)
- Emmanuel Weyne
- Laboratory for Experimental Urology, Department of Development and Regeneration, University of Leuven, Herestraat 49, Box 802, 3000 Leuven, Belgium
| | - Fabio Castiglione
- Urological Research Institute, San Raffaele Scientific Institution, via Olgettina 60, 20132 Milano, Italy
| | - Frank Van der Aa
- Laboratory for Experimental Urology, Department of Development and Regeneration, University of Leuven, Herestraat 49, Box 802, 3000 Leuven, Belgium
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Marburg 420, Baltimore, MD 21287, USA
| | - Maarten Albersen
- Laboratory for Experimental Urology, Department of Development and Regeneration, University of Leuven, Herestraat 49, Box 802, 3000 Leuven, Belgium
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Gareri P, Castagna A, Francomano D, Cerminara G, De Fazio P. Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives. Int J Endocrinol 2014; 2014:878670. [PMID: 24744785 PMCID: PMC3976909 DOI: 10.1155/2014/878670] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 11/17/2022] Open
Abstract
Erectile dysfunction (ED) is one of the most common chronic diseases affecting men and its prevalence increases with aging. It is also the most frequently diagnosed sexual dysfunction in the older male population. A number of different diseases potentially worsening sexual function may occur in elderly people, together with polypharmacy. Related causes of ED are variable and can include arterial, neurogenic, hormonal, cavernosal, iatrogenic, and psychogenic causes. The aim of the present review was to examine the main aspects of erectile dysfunction going through epidemiology and pathophysiology and revise most of ED in elderly disabled men and in those affected with psychiatric disorders. Lastly we tried to focus on the main aspects of nonpharmacological and pharmacological treatments of ED and the recreational use in the elderly. Phosphodiesterase-5 inhibitors (PDE5-I) are commonly used for on-demand or chronic treatment of ED. It is widely known that PDE5-I have lower response rates in older men than in younger patients, but they have the advantages of ease of use and excellent safety profile, also in the elderly. The old and new PDE5-I as well as the alternative treatments for ED are extensively discussed.
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Affiliation(s)
- Pietro Gareri
- Elderly Health Care, ASP Catanzaro, Via Spasari, 3, 88100 Catanzaro, Italy
| | | | - Davide Francomano
- Department of Medical Pathophysiology, "Sapienza" University of Rome, 00198 Rome, Italy
| | - Gregorio Cerminara
- Department of Science of Health, School of Medicine, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy ; Psychiatry Unit, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
| | - Pasquale De Fazio
- Department of Science of Health, School of Medicine, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy ; Psychiatry Unit, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
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