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Akakpo W, Schirmann A, Ferretti L, Ben-Naoum K, Carnicelli D, Graziana JP, Hupertan V, Madec FX, Marcelli F, Methorst C, Morel-Journel N, Savareux L, Terrier JE, Faix A, Huyghe E, Yiou R. [Biotherapies for erectile dysfunction and Peyronie's disease: Where are we now?]. Prog Urol 2020; 30:1000-1013. [PMID: 32826194 DOI: 10.1016/j.purol.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Clinical trials of cell therapy for erectile dysfunction (ED) and Peyronie's disease (PD) were recently conducted after preclinical studies. AIMS The aims of this study are to give an update on biotherapy for ED and PD and to describe the regulatory framework for these therapies. MATERIALS AND METHODS A literature review was performed through PubMed and Clinical.trials.gov addressing cell therapy for ED and PD and using following keywords "erectile dysfunction", "Peyronie's disease", "stem cell", and "platelet-rich plasma". RESULTS Preclinical studies in rodent models have shown the potential benefit of cell therapy for ED after radical prostatectomy or caused by metabolic diseases, and PD. The tissues used to obtain the therapeutic product were bone marrow, adipose tissue and blood (PRP, platelet-rich plasma). Mechanism of action was shown to be temporary and mainly paracrine. Four clinical trials were published concerning ED after radical prostatectomy and in diabetic patients and one for PD. Eleven clinical trials including three randomized trials are currently going on. Preclinical and preliminary clinical results suggested the possibility to improve spontaneous erectile function and response to pharmaceutical treatment in initially non-responder patients. This effect is mediated by an improvement of penile vascularization. A reduction of penile curvature without side effect was noted after injections into the plaque of PD patients. Most of these therapeutic strategies using autologous cells were considered as "Advanced Therapy Medicinal Products" with strict regulatory frameworks imposing heavy constraints, in particular in case of "substantial" modification of the cells. The regulatory framework remains unclear and more permissive for PRP and cell therapy processes with extemporaneous preparation/injection and no "substantial" modifications. CONCLUSIONS First results on cell therapy for ED and PD are promising. The regulatory framework can significantly change according to cell preparations and origins leading to various constraints. This regulatory framework is crucial to consider for the choice of the procedure.
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Affiliation(s)
- W Akakpo
- Service d'urologie, université Pierre et Marie Curie, hôpital universitaire de la Pitié-Salpêtrière, 75013 Paris, France
| | - A Schirmann
- Service d'urologie, hôpitaux universitaires Henri-Mondor, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - L Ferretti
- Service d'urologie, hôpital d'instruction des armées Robert-Picqué, Villenave-d'Ornon, France
| | - K Ben-Naoum
- Service d'urologie, CHU de Nîmes, Nîmes, France
| | - D Carnicelli
- Service d'urologie, CH de Chambery, Chambery, France
| | - J-P Graziana
- Clinique mutualiste de la porte de l'Orient, Lorient, France
| | - V Hupertan
- Cabinet médical Paris Batignolles, Paris, France
| | - F X Madec
- Service d'urologie, CHU de Nantes, Nantes, France
| | - F Marcelli
- Service d'urologie, CHRU de Lille, Lille, France
| | - C Methorst
- Service d'urologie, CH des Quatre Villes, Saint-Cloud, France
| | | | - L Savareux
- Hôpital privé de La Châtaignerie, Beaumont, France
| | | | - A Faix
- Clinique mutualiste Beau-Soleil, Montpellier, France
| | - E Huyghe
- Service d'urologie, CHU de Toulouse, Toulouse, France
| | - R Yiou
- Service d'urologie, hôpitaux universitaires Henri-Mondor, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Gur S, Hellstrom WJ. Harnessing Stem Cell Potential for the Treatment of Erectile Function in Men with Diabetes Mellitus: From Preclinical/Clinical Perspectives to Penile Tissue Engineering. Curr Stem Cell Res Ther 2020; 15:308-320. [DOI: 10.2174/1574888x14666190828142045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/10/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
Abstract
Background::
According to the World Health Organization, more than 150 million people
are diabetic, and this number will increase twofold by the year 2025. Diabetes-related complications
affect all body organ systems, including the penis. Diabetes-induced Erectile Dysfunction (ED) is
caused by neuropathy of the penile nerves and vasculopathy involving the smooth muscle and endothelium
of the corpus cavernosum.
Objective::
This study aims to present an overview of Stem Cell (SC) research in diabetic animal models
of ED, focusing on the function, signaling, and niches that have a prominent role in the regeneration
of cavernosal cells and penile tissues. We highlight common erectile pathologies caused by diabetes
and review relevant preclinical trials. We also discuss paracrine mechanisms of various SC therapies
involved in the repair of endothelial cells and cavernous nerves in these diabetic models.
Method::
A PubMed search was performed, with dates ranging from inception until Mar 31, 2019.
Results::
This review provides a comprehensive evaluation of the various strategies that have been
investigated for improving SC delivery methods, through preclinical literature and published clinical
trials regarding ED in men with diabetes. Various cell-type applications have benefited erectile function
in diabetic models of ED.
Conclusion::
This review examines the progress and remaining challenges in diabetes-related SC research
regarding ED. Moving forward, it is only with a combined effort of basic biology and translational
work that the potential of SC-based therapies in diabetes in ED can be realized.
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Affiliation(s)
- Serap Gur
- Department of Urology, Tulane University Health Sciences Center, New Orleans, LA, United States
| | - Wayne J.G. Hellstrom
- Department of Urology, Tulane University Health Sciences Center, New Orleans, LA, United States
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