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Liu Y, Jin B. Mechanism of Traditional Chinese medicine extract in the treatment of diabetic erectile dysfunction. JOURNAL OF ETHNOPHARMACOLOGY 2025:119332. [PMID: 39778785 DOI: 10.1016/j.jep.2025.119332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 11/28/2024] [Accepted: 01/05/2025] [Indexed: 01/11/2025]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Diabetic erectile dysfunction (DED) is a prevalent but often overlooked microvascular complication of type 2 diabetes mellitus (T2DM), with strong associations to cardiovascular disease. The pathophysiology of erectile dysfunction (ED) in T2DM patients is more intricate than in non-diabetic individuals, likely involving multiple pathogenic mechanisms such as endothelial dysfunction, vascular alterations, neuropathy, and oxidative stress. Traditional Chinese Medicine (TCM) has long been utilized in the management of DED, drawing on an extensive body of clinical experience. In TCM, DED is typically attributed to imbalances such as renal yang deficiency or insufficiencies in qi and blood. Herbal therapies within the TCM framework offer a multifaceted approach to treatment, targeting not only the replenishment of kidney yang and the regulation of qi and blood but also incorporating strategies for glycemic control and renal protection. This holistic approach has demonstrated effectiveness in alleviating erectile dysfunction in diabetic patients, thereby improving quality of life. However, the complexity of Chinese herbal formulations, with their diverse bioactive constituents, complicates the identification of specific active compounds and the mechanistic understanding of their therapeutic actions. This complexity has contributed to ongoing skepticism regarding the clinical utility of TCM and herbal remedies in the treatment of DED. AIM OF THE STUDY This study aimed to investigate the pathological mechanisms underlying the therapeutic effects of TCM in the treatment of DED, with a specific focus on the associated signaling pathways. By elucidating these mechanisms, the study seeks to provide a scientific basis for novel therapeutic strategies and enhance the viability of TCM-based approaches for DED management. Future research should prioritize the development of efficacious Chinese patent medicines tailored for the treatment of DED. METHODS This study utilizes keywords such as "diabetic erectile dysfunction" , "signaling pathways", "traditional Chinese Medicine", "bioactive compounds", "herbal", "herbal monomers", and "herbal extracts" to conduct a comprehensive literature search in databases including Embase, PubMed, Web of Science, CNKI, Wanfang, and VIP, spanning all relevant publications up to February 2024. RESULTS It has been demonstrated that TCM extract can treat the DED by influencing the signaling pathways involved. CONCLUSION A comprehensive literature review was conducted across multiple databases, followed by rigorous screening, exclusion, summarization, synthesis, and analysis of relevant studies. The results indicate that TCM for DED primarily targets key pathological features, including endothelial dysfunction, vascular and neural abnormalities, and oxidative stress. The underlying mechanisms involve the NO/ cGMP, eNOS, and PI3K/Akt/mTOR signaling pathways, contributing to significant improvements in erectile function. These findings provide a scientific basis for the use of TCM in DED, offering viable therapeutic options and innovative strategies to advance TCM-based treatment approaches. Furthermore, TCM exhibits notable potential in mitigating the pathological progression of DED. The pharmacological mechanisms and molecular signaling pathways of TCM extracts have been extensively investigated, underscoring their high value for clinical research and therapeutic development.
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Affiliation(s)
- Yuanyuan Liu
- School of Medicine, Southeast University, Nanjing 210003, China
| | - Baofang Jin
- Department of Integrative Medicine and Andrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China.
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Engin S, Barut EN, Kaya Yaşar Y, Işık S, Kerimoğlu G, Burnett AL, Sezen SF. Niclosamide attenuates erectile dysfunction and corporal fibrosis via reversal of Smad signaling in diabetic rat model. J Sex Med 2024; 21:1111-1119. [PMID: 39403936 DOI: 10.1093/jsxmed/qdae129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 08/20/2024] [Accepted: 09/17/2024] [Indexed: 12/14/2024]
Abstract
BACKGROUND Diabetes mellitus-induced erectile dysfunction (DMED) is a common urological complication of diabetes, and current drugs often fail to provide an effective treatment. Smad2/3 signaling-mediated corporal fibrosis has a critical role in the molecular basis of DMED. AIM We investigated the effect of Niclosamide (Nic), an antihelmintic drug with antifibrotic effects, on erectile function in a rat DMED model. METHODS Male Sprague Dawley rats were injected intraperitoneally (i.p) with streptozotocin (75 mg/kg) to induce diabetes. At week 8, both diabetic and nondiabetic rats were treated with Nic (10 mg·kg-1/day; i.p) or vehicle for 4 weeks. At week 12, erectile function was evaluated as intracavernous pressure (ICP) response to the electrical stimulation of the cavernous nerve (CN). Penile tissues were harvested for Masson's trichrome staining or western blotting to determine corporal fibrosis and Smad2/3 pathway-related protein expression, respectively. OUTCOMES At the end of the experimental protocol, in vivo erectile function was assessed by measuring the ratio of ICP/ mean arterial pressure (MAP) and total ICP following CN stimulation. Smooth muscle content and collagen fibers were evaluated by Masson's trichrome staining of the penile tissues. The expressions of fibrosis-related proteins (Smad2, Smad3, fibronectin) were determined using western blotting in the penile tissues. RESULTS Erectile function, as determined by the maximum ICP/MAP and total ICP/MAP ratios, was drastically decreased in diabetic rats. Corporal tissues of diabetic rats were severely fibrotic with a significant increase in collagen fibers and a marked reduction in smooth muscle content. Also, the protein expressions of phosphorylated (p-)Smad2, p-Smad3 and fibronectin were significantly increased in the penis of diabetic rats. Both functional and molecular alterations in DMED were effectively reversed by Nic-treated diabetic rats without a glycemic alteration. CLINICAL IMPLICATIONS Nic could be a promising candidate for the treatment of DMED due to its antifibrotic effects. STRENGTHS AND LIMITATIONS The present study provides the first evidence that Nic has beneficial effect on erectile dysfunction by attenuating corporal fibrosis in a rat model of DMED. The effect of Nic on penile endothelial function and the other potential underlying mechanisms needs to be further elucidated. CONCLUSIONS Nic improved erectile function in DMED rats possibly suppressing penile fibrosis by inhibiting Smad2/3 signaling. These results suggest a potential therapeutic repurposing of Nic as an adjuvant treatment in DMED.
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Affiliation(s)
- Seçkin Engin
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, 61080, Trabzon, Türkiye
- Department of Pharmacology, Institute of Health Sciences, Karadeniz Technical University, 61080, Trabzon, Türkiye
| | - Elif Nur Barut
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, 61080, Trabzon, Türkiye
- Department of Pharmacology, Institute of Health Sciences, Karadeniz Technical University, 61080, Trabzon, Türkiye
| | - Yeşim Kaya Yaşar
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, 61080, Trabzon, Türkiye
- Department of Pharmacology, Institute of Health Sciences, Karadeniz Technical University, 61080, Trabzon, Türkiye
| | - Semanur Işık
- Department of Histology and Embryology, Faculty of Medicine, Karadeniz Technical University, 61080, Trabzon, Türkiye
| | - Gökçen Kerimoğlu
- Department of Histology and Embryology, Faculty of Medicine, Karadeniz Technical University, 61080, Trabzon, Türkiye
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Sena F Sezen
- Department of Pharmacology, Faculty of Pharmacy, Karadeniz Technical University, 61080, Trabzon, Türkiye
- Department of Pharmacology, Institute of Health Sciences, Karadeniz Technical University, 61080, Trabzon, Türkiye
- Drug and Pharmaceutical Technology Application and Research Center, Karadeniz Technical University, 61080, Trabzon, Türkiye
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Bagheri SM, Shieh A, Ghalenoei JA, Yadegari M, Alborzi N. Review of potential spermatogenic and aphrodisiac effects of the Ferula genus. Clin Exp Reprod Med 2023; 50:143-153. [PMID: 37643827 PMCID: PMC10477414 DOI: 10.5653/cerm.2023.05995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Men's sexual health plays an important role in male fertility and childbearing, as it is associated with factors such as sexual desire, healthy spermatogenesis, and erectile function. In various cultures, medicinal plants have been utilized to address male sexual issues, including infertility and erectile dysfunction. Despite recent advancements in medical science for treating male impotence, some men opt for herbal supplements as an alternative, given that numerous herbs have the potential to enhance male sexual performance. The Apiaceae family is one of the oldest plant families used for medicinal purposes. Ferula, a genus within this family, comprises approximately 170 different species worldwide. Members of this genus possess numerous therapeutic properties due to the presence of various compounds. This article aims to explore the potential impacts of Ferula plants on the male reproductive system. METHODS This review article was prepared by searching for terms including Ferula and "aphrodisiac," Ferula and "spermatogenesis," and Ferula and "male reproductive system." Relevant information was gathered through electronic databases, including ISI Web of Knowledge, PubMed, and Google Scholar. RESULTS The findings indicated that relatively comprehensive studies have been conducted in this area, revealing that certain Ferula species have been employed in folk medicine to boost fertility and libido. Recent research has corroborated these effects. CONCLUSION It is hoped that new aphrodisiac compounds with fewer side effects can be isolated from Ferula plants in the future.
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Affiliation(s)
- Seyyed Majid Bagheri
- Department of Physiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Neuroendocrine Research Center, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amir Shieh
- Department of Physiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Maryam Yadegari
- Department of Anatomical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasrin Alborzi
- Neuroendocrine Research Center, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Guven H, Durmus N, Hocaoglu N, Guner O, Acar S, Akan P, Calan OG. Protective effects of wheat germ oil against erectile and endothelial dysfunction in streptozotocin-induced diabetic rats. Int J Impot Res 2021; 34:581-587. [PMID: 34108653 DOI: 10.1038/s41443-021-00453-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 12/14/2022]
Abstract
Our aim was to investigate the protective effect of wheat germ oil (WGO) at different doses on diabetes mellitus (DM)-induced erectile and endothelial dysfunction. Twenty-four male Wistar rats weighing 250-300 g were divided into four groups as; control group treated with saline, DM group, DM group treated with 3 ml/kg WGO (DM + 3WGO group), DM group treated with 6 ml/kg WGO. Type 1 DM was induced by intraperitoneal injection of 60 mg/kg streptozotocin (STZ). STZ-induced diabetic rats received saline, 3 ml/kg WGO, and 6 ml/kg WGO via oral gavage daily for 5 weeks. The density of WGO used was 0.92 g/ml. The protective effect of WGO was evaluated by (i) in vitro vascular function, (ii) in vivo erectile function, and (iii) oxidative stress parameters in both aorta and penile tissue. Acetylcholine-mediated relaxation in the aorta and erectile functions decreased significantly in the DM group (p = 0.018 and p = 0.005). WGO (3 and 6 ml/kg) improved vascular functions in the DM groups (p = 0.001 and p = 0.014). The beneficial effect of WGO on erectile function appeared at higher doses of WGO. However, a higher dose of WGO substantially increased the oxidative stress parameters in both aorta and penile tissue. These findings suggest that the improvement in vascular or erectile function by WGO was not related to antioxidant effects, and new studies are needed to clarify the mechanism.
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Affiliation(s)
- Hulya Guven
- Department of Medical Pharmacology, Istanbul Yeni Yuzyıl University School of Medicine, Istanbul, Turkey.
| | - Nergiz Durmus
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Nil Hocaoglu
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ozge Guner
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Selin Acar
- Dokuz Eylul University, Institute of Health Sciences, Izmir, Turkey
| | - Pınar Akan
- Department of Medical Biochemistry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ozlem Gursoy Calan
- Department of Medical Biochemistry, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Miski M. Next Chapter in the Legend of Silphion: Preliminary Morphological, Chemical, Biological and Pharmacological Evaluations, Initial Conservation Studies, and Reassessment of the Regional Extinction Event. PLANTS (BASEL, SWITZERLAND) 2021; 10:plants10010102. [PMID: 33418989 PMCID: PMC7825337 DOI: 10.3390/plants10010102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 05/04/2023]
Abstract
Silphion was an ancient medicinal gum-resin; most likely obtained from a Ferula species growing in the Cyrene region of Libya ca. 2500 years ago. Due to its therapeutic properties and culinary value, silphion became the main economic commodity of the Cyrene region. It is generally believed that the source of silphion became extinct in the first century AD. However, there are a few references in the literature about the cultivated silphion plant and its existence up to the fifth century. Recently, a rare and endemic Ferula species that produces a pleasant-smelling gum-resin was found in three locations near formerly Greek villages in Anatolia. Morphologic features of this species closely resemble silphion, as it appears in the numismatic figures of antique Cyrenaic coins, and conform to descriptions by ancient authors. Initial chemical and pharmacological investigations of this species have confirmed the medicinal and spice-like quality of its gum-resin supporting a connection with the long-lost silphion. A preliminary conservation study has been initiated at the growth site of this rare endemic Ferula species. The results of this study and their implications on the regional extinction event, and future development of this species will be discussed.
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Affiliation(s)
- Mahmut Miski
- Department of Pharmacognosy, Faculty of Pharmacy, Istanbul University, Istanbul 34116, Turkey
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Sabzehzari M, Naghavi MR, Bozari M, Orafai HM, Johnston TP, Sahebkar A. Pharmacological and Therapeutic Aspects of Plants from the Genus Ferula: A Comprehensive Review. Mini Rev Med Chem 2020; 20:1233-1257. [PMID: 32368975 DOI: 10.2174/1389557520666200505125618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/31/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022]
Abstract
Inspired by nature, humankind has been able to attain significant achievements in the drug and food industries. Particularly, medicinal plants are a rich source of medicinal, cosmetic, sanitary, and aromatic substances. Genus Ferula from the Apiaceae family is a plant genus that possesses over 170 species, which have been carefully documented with regard to their medicinal properties. Ferula spp. affects many body organs, and their respective functions, in humans, such as the immune system, gastrointestinal tract, genitourinary, endocrine, respiratory, cardiovascular, nervous system, bone (skeleton), and teeth. In spite of the benefits, ferulosis (Ferula toxicity) is an important aspect of Ferula consumption in humans and animals. Hemorrhagic problems and infertility are important signs of ferulosis. In this review, we have described all of the effects of the active ingredients of Ferula spp. and their mechanisms of actions, when known, based on an extensive literature review. Thus, our review opens a window of the benefits of Ferula as a phyto-pharmaceutical and its therapeutic applications in pharmacy, dentistry, and medicine.
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Affiliation(s)
- Mohammad Sabzehzari
- Division of Biotechnology, Agronomy and Plant Breeding Department, University of Tehran, Tehran, Iran
| | - Mohammad Reza Naghavi
- Division of Biotechnology, Agronomy and Plant Breeding Department, University of Tehran, Tehran, Iran
| | - Motahare Bozari
- Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein M Orafai
- Department of Pharmaceutics, Faculty of Pharmacy, University of Ahl Al Bayt, Karbala, Iraq
| | - Thomas P Johnston
- Division of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, MO 64106, United States
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