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Huang YY, Ye N, Peng DW, Li GY, Zhang XS. Peripheral platelet count is a diagnostic marker for predicting the risk of rapid ejaculation: findings from a pilot study in rats. Asian J Androl 2024:00129336-990000000-00214. [PMID: 39091143 DOI: 10.4103/aja202447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/19/2024] [Indexed: 08/04/2024] Open
Abstract
Parameters of peripheral blood cell have been shown as the potential predictors of erectile dysfunction (ED). To investigate the clinical significance of hematological parameters for predicting the risk of rapid ejaculation, we established a rat copulatory model on the basis of ejaculation distribution theory. Blood samples from different ejaculatory groups were collected for peripheral blood cell counts and serum serotonin (5-HT) tests. Meanwhile, the relationship between hematological parameters and ejaculatory behaviors was assessed. Final analysis included 11 rapid ejaculators, 10 normal ejaculators, and 10 sluggish ejaculators whose complete data were available. The platelet (PLT) count in rapid ejaculators was significantly lower than that in normal and sluggish ejaculators, whereas the platelet distribution width (PDW) and mean platelet volume (MPV) were significantly greater in rapid ejaculators. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis showed that the PLT was an independent protective factor for rapid ejaculation. Meanwhile, rapid ejaculators were found to have the lowest serum 5-HT compared to normal and sluggish ejaculators (P < 0.001). Furthermore, there was a positive correlation between the PLT and serum 5-HT (r = 0.662, P < 0.001), indicating that the PLT could indirectly reflect the serum 5-HT concentration. In addition, we assessed the association between the PLT and ejaculatory parameters. There was a negative correlation between ejaculation frequency (EF) and the PLT (r = -0.595, P < 0.001), whereas there was a positive correlation between ejaculation latency (EL) and the PLT (r = 0.740, P < 0.001). This study indicated that the PLT might be a useful and convenient diagnostic marker for predicting the risk of rapid ejaculation.
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Affiliation(s)
- Yuan-Yuan Huang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230011, China
- Department of Urology, Anhui Public Health Clinical Center, Hefei 230011, China
- Anhui Provincial Institute of Translational Medicine, Hefei 230031, China
| | - Nan Ye
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230011, China
- Department of Urology, Anhui Public Health Clinical Center, Hefei 230011, China
| | - Dang-Wei Peng
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230011, China
| | - Guang-Yuan Li
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230011, China
- Department of Urology, Anhui Public Health Clinical Center, Hefei 230011, China
| | - Xian-Sheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei 230011, China
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Wu C, Huang S, Liu Z, Wang Y, Zhu Y, Zang ZJ. Correlation between serum tryptophan metabolism and treatment efficacy of dapoxetine in patients with premature ejaculation: A pilot study. Andrology 2024. [PMID: 38511846 DOI: 10.1111/andr.13632] [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: 01/07/2024] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Primary premature ejaculation (PPE) is a common male neurobiological disorder. Currently, there is consensus that the impairment in central serotonin (5-HT) neurotransmission constitutes a key pathogenic factor in PPE. Selective serotonin reuptake inhibitors (SSRIs) serve as the primary pharmacological intervention; however, a comprehensive elucidation of their mechanism of action remains incomplete. Owing to significant individual variability in efficacy, SSRIs exhibit a high discontinuation rate. Hence, there is an urgent need to address the selection of SSRIs for PPE treatment. OBJECTIVE This study aims to investigate the characteristics of tryptophan (TRP) metabolism in patients with PPE and to assess its influence on the efficacy of SSRIs. METHODS The exploratory study included a total of 16 patients with PPE and 16 control subjects who were healthy men without any sexual dysfunction. Upon enrollment in the study, all participants underwent a thorough medical history review and physical examination. Subsequently, their serum levels of TRP, its metabolites, large neutral amino acids (LNAAs), and metabolite ratios were assessed using a liquid chromatography-mass spectrometry (LC-MS) assay. After a period of 4 weeks of dapoxetine treatment, all patients with PPE underwent reassessment using the Premature Ejaculation Diagnostic Tool (PEDT) score and intravaginal ejaculatory latency time (IELT) test. RESULTS The ratio of serum TRP to other LNAAs (TRP/LNAAs) in patients with PPE was found to be significantly lower compared to the control group (P < 0.05). Conversely, the ratio of kynurenine to TRP (KYN/TRP) was observed to be significantly higher in the PPE patients compared to the control group (P < 0.05). Including the serum TRP/LNAAs ratio and KYN/TRP ratio in the prediction model yielded the highest prediction efficiency for PPE. There was a significant negative correlation between the ratio of TRP/LNAAs before the treatment and the IELT after 4 weeks of the treatment. Additionally, there was a significant positive correlation observed between the ratio of TRP/LNAAs before the treatment and the PEDT score after 4 weeks of the treatment. CONCLUSIONS This study demonstrates that the reduction in the TRP/LNAAs ratio and the elevation of the KYN/TRP ratio are significant characteristics associated with PPE. These findings suggest that diminished tryptophan availability in the brain and the activation of the kynurenine (KYN) pathway may play a role in the pathogenesis of PPE. The TRP/LNAAs ratio has potential as a reliable indicator of central serotonin (5-HT) levels. Considering the TRP/LNAAs ratio when selecting SSRIs for the treatment of PPE may enhance the response rate of this medication.
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Affiliation(s)
- Chenglun Wu
- Department of Infertility and Sexual Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shengyu Huang
- Department of Infertility and Sexual Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Urology, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, China
| | - Zhuojie Liu
- Department of Infertility and Sexual Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yixin Wang
- Department of Infertility and Sexual Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuanqiang Zhu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Zhaoqing Hospital, Zhaoqing, Guangdong, China
| | - Zhi-Jun Zang
- Department of Infertility and Sexual Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Luan JC, Zhang QJ, Zhou X, Zhou X, Gu Q, Xia JD, Song NH. Orexin receptors in paraventricular nucleus influence sexual behavior via regulating the sympathetic outflow in males. Andrology 2024; 12:198-210. [PMID: 37084406 DOI: 10.1111/andr.13444] [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: 09/06/2022] [Revised: 02/22/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Orexins are hypothalamic neuropeptides associated with various neurophysiological activities such as sleep, arousal, and reward. However, there are few studies investigating the relationships between orexin receptors in the paraventricular nucleus and sexual behaviors. OBJECTIVES To explore the roles of orexin receptors in the paraventricular nucleus on sexual behaviors and uncover its potential mechanisms in males. MATERIALS AND METHODS Orexin A, orexin 1 receptor antagonist SB334867, and orexin 2 receptor antagonist TCS-OX2-29 were microinjected into the paraventricular nucleus to investigate the effects of orexin receptors on copulatory behavior testing of C57BL/6 mice. To explore if ejaculation could activate orexin 1 receptor-expressing neurons in the paraventricular nucleus, fluorescence immunohistochemical double staining was utilized. The levels of serum norepinephrine were measured and the lumbar sympathetic nerve activity was recorded to reflect the sympathetic nervous system activity. Moreover, the bulbospongiosus muscle-electromyogram was recorded and analyzed. To test whether perifornical/lateral hypothalamic area orexinergic neurons directly projected to the paraventricular nucleus, virus retrograde tracing technology was utilized. RESULTS Orexin A significantly enhanced sexual performance by shortening the intromission and ejaculation latencies, and increasing the mount and intromission frequencies, while the opposite outcomes appeared with SB334867. However, TCS-OX2-29 had no significant effects on sexual behaviors. Moreover, orexin A increased lumbar sympathetic nerve activity and the levels of serum norepinephrine, while SB334867 decreased lumbar sympathetic nerve activity and norepinephrine, which caused a significant decrease in sympathetic nervous system outflow. Meanwhile, a robust increase in the bulbospongiosus muscle-electromyogram activity was identified after microinjecting orexin A. Furthermore, cFos immunopositive cells were increased and double stained with orexin 1 receptor-expressing neurons in the mating group. Additionally, the retrograde tracing results demonstrated that orexinergic neurons in the perifornical/lateral hypothalamic area directly projected to the paraventricular nucleus. CONCLUSIONS Orexin 1 receptor in the paraventricular nucleus could influence the ejaculatory reflex via mediating the sympathetic nervous system activity, which might be of great importance in the treatment of premature ejaculation in the future.
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Affiliation(s)
- Jiao-Chen Luan
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qi-Jie Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Zhou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Zhou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qi Gu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia-Dong Xia
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ning-Hong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Urology, The Affiliated Kezhou People's Hospital of Nanjing Medical University, Kezhou, China
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Li J, Liao Z, Xu Z, Huang X. Clinical value of penile sympathetic skin response to assess the efficacy of sertraline in the treatment of patients with sympathetic hyperexcitability in primary premature ejaculation. Sex Med 2023; 11:qfac012. [PMID: 37007857 PMCID: PMC10065178 DOI: 10.1093/sexmed/qfac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/29/2022] [Accepted: 11/06/2022] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
The pathogenesis of primary premature ejaculation (PPE) is complex, and the pathologic basis may be an overactive sympathetic nervous system.
Aim
To investigate sertraline efficacy in patients with sympathetic hyperexcitability in PPE and clarify the value of penile sympathetic skin response (PSSR) in assessing the efficacy of sertraline for PPE treatment.
Methods
Sixty-three patients with PPE were recruited in the outpatient clinic and asked to take 50 mg of oral sertraline daily for a 4-week treatment period. Changes in intravaginal ejaculation latency time (IELT), Premature Ejaculation Diagnostic Tool, International Index of Erectile Function (IIEF-5), and PSSR latency and wave amplitude were compared before and after treatment.
Outcomes
The principal aim was to determine the relationships among sertraline efficacy, IELT, and PSSR latency and amplitude.
Results
After sertraline treatment, patients with PPE demonstrated a significant decrease in Premature Ejaculation Diagnostic Tool scores (P < .001); a significant increase in IELT, PSSR latency, and wave amplitude (P < .001); and no significant change in International Index of Erectile Function scores (P > .05). Moreover, the latency changes of PSSR were positively correlated with the increment of IELT (r = 0.550, P < .001). In addition, there was some degree of improvement vs pretreatment, although IELT and PSSR latencies were significantly shorter after drug discontinuation when compared with posttreatment (both P < .001).
Clinical Implications
We aimed to find an objective test that accurately reflects the efficacy of treatment for sympathetic hyperexcitability in PPE.
Strengths and Limitations
The strengths include a well-powered study, use of validated instruments, and self-assessment of treatment benefit. The limitations include the single-center design, relatively short-term follow-up, and lack of more comprehensive monitoring between treatment and drug discontinuation.
Conclusion
These findings suggest that sertraline is effective for PPE treatment, that its efficacy can be partially maintained even after drug discontinuation, and that PSSR may be reliable for evaluating treatment success in patients with PPE.
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Affiliation(s)
- Jiacheng Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University , Hangzhou 310053, China
| | - Zedong Liao
- Department of Urology, the Second Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou 310009, China
| | - Zilei Xu
- The Second Clinical Medical College, Zhejiang Chinese Medical University , Hangzhou 310053, China
| | - Xiaojun Huang
- Department of Urology, the Second Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou 310009, China
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Chang X, Xu M, Chen Y, Che C, Du Y, Wang X. Selective serotonin reuptake inhibitors combined with traditional Chinese medicine for premature ejaculation: A systematic review and meta-analysis. Andrology 2023; 11:112-124. [PMID: 36193003 DOI: 10.1111/andr.13307] [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: 08/02/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Premature ejaculation (PE) is still a tough problem in drug treatment. Many clinical trials have proven that traditional Chinese medicine (TCM) has a significant effect in the treatment of PE. This article aims to provide the latest evidence for the efficacy and safety of TCM combined with selective serotonin reuptake inhibitors (SSRIs) in the treatment of PE. METHODS We looked for randomized controlled trials (RCTs) from China National Knowledge Infrastructure, Wanfang, VIP Database, MEDLINE, PubMed, Web of Science, EMBASE, and Cochrane Library until June 30, 2022. STATA 15.1 software was used to analyze all data for this article. The quality of the included articles was evaluated using the Cochrane Reviewer's Handbook 5.3. RESULTS Finally, we selected 16 high-quality RCTs in our meta-analysis, which containing 889 patients. Meta-analysis suggested that, compared with SSRIs alone, combination of TCM with SSRIs increased significantly intravaginal ejaculation latencv time and the scores of ejaculation control ability, sexual life satisfaction, PE-related distress, and communication difficulties between partners related to PE. Also, there was no significant difference in adverse effects between the two groups. In addition, the results of publication bias test showed that no significant bias occurred. CONCLUSION The combined use of TCM and SSRIs has significant effect in the treatment of PE compared with SSRIs monotherapy and was generally well tolerated. Due to the small sample size, multicenter and large sample RCT is still needed in the future to further confirm the effectiveness and safety of TCM combined with SSRIs in the treatment of PE.
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Affiliation(s)
- Xuefeng Chang
- Fuyang People's Hospital, Anhui Medical University, Fuyang, China
| | - Mingwei Xu
- The Affiliated Hongqi Hospital, Mudanjiang Medical University, Mudanjiang, China
| | - Yuanzhe Chen
- Fuyang People's Hospital, Anhui Medical University, Fuyang, China
| | - Chunguang Che
- Fuyang People's Hospital, Anhui Medical University, Fuyang, China
| | - Yongqiang Du
- Fuyang People's Hospital, Anhui Medical University, Fuyang, China
| | - Xiao Wang
- Fuyang People's Hospital, Anhui Medical University, Fuyang, China
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Liu G, Zhang Y, Zhang W, Wu X, Gao H, Jiang H, Dai Y, Zhang X. Novel Marker for Premature Ejaculation: Serum Leptin Level. Sex Med 2022; 10:100509. [PMID: 35398789 PMCID: PMC9177876 DOI: 10.1016/j.esxm.2022.100509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 10/26/2022] Open
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Gao J, Gao R, Li H, Liu X, Gao P, Du J, Jiang H, Zhang X. BGIG10116_34868: A Newly Discovered Gene Regulating Ejaculation Function. Front Physiol 2022; 13:762272. [PMID: 35295563 PMCID: PMC8919286 DOI: 10.3389/fphys.2022.762272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Ejaculation is a complex biphasic process involving a series of neurophysiological activities, such as the contraction of a large number of muscle groups and the ejaculation of semen from the urethra anterior. Due to the complexity of the process, many related factors have not been fully clarified, resulting in ejaculation dysfunction. As a common ejaculation dysfunction, lifelong premature ejaculation (LPE) is a problem for many people. Notably, gene polymorphism might play an important role in the etiology of LPE. However, the quest for identifying the actual genetic loci that contribute to LPE etiology has not been successful. Due to discrepancies in the design and methods of research, the correlation of most reports was not obtained in subjective replication experiments, and the conclusions may be inconsistent. In our study, three groups of ejaculation rats, namely, “rapid, normal, and delayed,” were selected based on the animal model of premature ejaculation (PE) in rats and the theory of ejaculation. Among them, the rats in the “rapid” ejaculation group can be used to stimulate humans with PE. Subsequently, we used the rat brain tissue for whole-transcriptome sequencing to screen the differential genes among the three groups. We tried to identify the actual genetic loci that contribute to PE etiology and provide a theoretical basis for the targeted therapy of PE.
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Affiliation(s)
- Jingjing Gao
- Department of Urology and Andrology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Rui Gao
- Department of Urology and Andrology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hu Li
- Department of Urology and Andrology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xi Liu
- Department of Urology and Andrology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pan Gao
- Department of Urology and Andrology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Junhua Du
- Department of Urology and Andrology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Jiang
- Department of Andrology, The Third Hospital of Peking University, Beijing, China
| | - Xiansheng Zhang
- Department of Urology and Andrology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Wang F, Luo D, Chen J, Pan C, Wang Z, Fu H, Xu J, Yang M, Mo S, Zhuang L, Ye L, Wang W. Genome-Wide Association Analysis to Search for New Loci Associated with Lifelong Premature Ejaculation Risk in Chinese Male Han Population. World J Mens Health 2022; 40:330-339. [PMID: 35021295 PMCID: PMC8987137 DOI: 10.5534/wjmh.210084] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Genetic factors play an indispensable role in the pathogenesis of lifelong premature ejaculation (LPE). The susceptibility genes/SNPs that have been discovered are very limited and can only explain part of the genetic effects of LPE. Therefore, discovering more genetic polymorphisms associated with the occurrence and development of LPE will help reveal the pathogenesis of LPE. MATERIALS AND METHODS We conducted a genome-wide association study of LPE in 486 Chinese male Han people (cases and controls). We used Gene Titan multi-channel instrument and Axiom Analysis Suite 6.0 software for genotyping. Imputation was performed by IMPUTE2 software and the 1000 Genomes Project (Phase3) was used as reference for haplotype. Finally, logistic regression analysis was performed on all loci that passed the quality control. The odds ratio and 95% confidence interval were calculated to determine the association between each SNPs and Chinese male Han population LPE risk. RESULTS The results showed that a total of 33 genetic variants in 13 genes (LACTBL1, SSBP3, ACOT11, LINC02486, TMEM154, LINC01098, NONE, HCG27, HLA-C, TNFSF8, TNC, FAM53B, SULF2) have a suggestively significant genome-wide association with LPE risk (p<5×10-6). CONCLUSIONS This study is the first to conduct a GWAS on LPE in Chinese male Han population 33 genetic polymorphisms have a suggestive genome-wide association with LPE risk. This study have provided data supplement for the genetic loci of LPE risk, and laid a scientific foundation for the pathogenesis and the targeted therapy of LPE.
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Affiliation(s)
- Fei Wang
- Department of Urology, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Defan Luo
- Department of Urology, Hainan General Hospital, Affiliated Hainan Hospital to University of South China, Hengyang, Hunan, China
| | - Jianxiang Chen
- Department of Urology, Affiliated Hospital of Xiangnan University, Chenzhou, Hunan, China
| | - Cuiqing Pan
- Department of Urology, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Zhongyao Wang
- Department of Urology, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Housheng Fu
- Department of Urology, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Jianbing Xu
- Department of Urology, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Meng Yang
- Department of Urology, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Shaowei Mo
- Ministry of Science and education, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Liying Zhuang
- Library, Hainan Medical University, Haikou, Hainan, China
| | - Liefu Ye
- Department of Urology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China, China.
| | - Weifu Wang
- Department of Urology, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical University, Haikou, Hainan, China.
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9
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Zhu T, Gao P, Gao J, Liu X, Jiang H, Zhang X. The upregulation of tryptophan hydroxylase-2 expression is important for premature ejaculation treatment with the selective serotonin reuptake inhibitor. Andrology 2021; 10:595-603. [PMID: 34874128 DOI: 10.1111/andr.13135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/14/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although there was some evidence to suggest that the serotonergic system in the brain played an important role in premature ejaculation (PE), tryptophan hydroxylase-2 (TPH2) is considered to be the key enzyme for the synthesis of 5-hydroxytryptamine (5-HT) and few studies have reported that brain TPH2 is involved in the regulation of ejaculation. OBJECTIVES This study aimed to investigate whether changes in brain TPH2 levels were associated with PE and to explore the effects of acute administration of dapoxetine on TPH2 expression in the brain of rats with rapid ejaculation. MATERIALS AND METHODS Based on the ejaculation frequency, the male rats were split into three groups: "rapid," "normal," and "sluggish" ejaculators. The level of 5-HT in the brain was determined by an enzyme-linked immunosorbent assay. TPH2 expression was detected by western blot analysis and immunohistochemistry. RESULTS The results showed that the concentration of 5-HT and the expression of TPH2 in rapid rats were the lowest, while those in sluggish rats were the highest. Correlation analysis also indicated the level of TPH2 was positively correlated with ejaculation latency (r = 0.8633, p < 0.0001) and negatively correlated with ejaculation frequency (r = -0.874, p < 0.001). In addition, dapoxetine acute administration to rapid rats resulted in upregulation of TPH2 expression in the brain. DISCUSSION There was an important link between the level of TPH2 and the change of ejaculation behaviors. Decreased expression of TPH2 in relevant brain regions will lead to rapid ejaculation. Moreover, the effect of dapoxetine on prolonging ejaculation may be due to the upregulation of TPH2 expression. CONCLUSION We found the correlation between the level of TPH2 in the brain and PE. The findings in this study will open up a novel way for future research in PE therapy.
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Affiliation(s)
- Tianle Zhu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pan Gao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jingjing Gao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xi Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Jiang
- Department of Andrology, Peking University Third Hospital, Beijing, China.,Department of Human Sperm Bank, Peking University Third Hospital, Beijing, China
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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10
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Huang Y, Peng D, Geng H, Dai Y, Jiang H, Zhang X. Endogenous Deficiency of Brain-Derived Neurotrophic Factor Induces the Downregulation of Tryptophan Hydroxylase-2 Expression in Raphe Nuclei of Rapid Ejaculator Rats. J Sex Med 2021; 18:1491-1499. [PMID: 37057442 DOI: 10.1016/j.jsxm.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/03/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Premature ejaculation (PE) is one of the most common ejaculatory disorders. Recent studies have suggested a close relationship between the serotonin (5-hydroxytryptamine [5-HT]) system and brain-derived neurotrophic factor (BDNF), raising the question of whether BDNF plays a role in ejaculation regulation. To our knowledge, no previous studies have explored BDNF level of the central nervous system in ejaculatory disorders. At the same time, the interaction of central BDNF and 5-HT systems has not been undertaken in ejaculation regulation field. AIM The aim of this study was to investigate the interaction between BDNF and 5-HT levels in raphe nuclei which contains the serotonergic neurons in a rat animal model with different ejaculatory behavior. METHODS Eighteen male rats were selected and classified as "sluggish," "normal," and "rapid" ejaculators on the basis of ejaculation frequency during copulatory behavioral testing. BDNF and 5-HT levels were determined by enzyme-linked immunosorbent assay (ELISA). Real-Time Quantitative PCR and Western blot analyses were used to measure the mRNA level of Tryptophan Hydroxylase-2 (TPH2) gene and the expression of TPH2 protein (the rate-limiting enzyme in central 5-HT synthesis) in raphe nuclei, respectively. OUTCOMES Male rat sexual behavior, the levels of BDNF and 5-HT in raphe nuclei of rats with different ejaculatory behavior, the mRNA level of gene encoding TPH2 and the expression of TPH2 protein in raphe nuclei. RESULTS The primary finding of our study was that BDNF concentration was significantly decreased in raphe nuclei of rapid ejaculators. There was a strong positive correlation between the levels of BDNF and 5-HT (r = 0.944, P < .001). Further results showed that decreased TPH2 gene expression accompanied by TPH2 protein was shown in rapid ejaculators with lower BDNF level. CLINICAL IMPLICATIONS With refinement of current knowledge, BDNF may eventually serve as a promising biomarker in patients with PE. STRENGTHS & LIMITATIONS There are no previous studies examining the interaction of the brain BDNF and 5-HT in ejaculation regulation field. The main limitation is the limited sample size. CONCLUSION BDNF may act via increasing the synthesis of central 5-HT in the process of ejaculation regulation. Our results suggest lack of endogenous BDNF induces the downregulation of TPH2 gene expression and the decrease of 5-HT synthesis in raphe nuclei of rapid ejaculator rats.
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Affiliation(s)
- Yuanyuan Huang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dangwei Peng
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hao Geng
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, The First Affiliated Hospital of Anhui Medical University, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, China
| | - Yutian Dai
- Department of Andrology, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China.
| | - Hui Jiang
- Department of Andrology, Peking University Third Hospital, Beijing, China.
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Mostafa T, Abdel-Hamid IA. Ejaculatory dysfunction in men with diabetes mellitus. World J Diabetes 2021; 12:954-974. [PMID: 34326948 PMCID: PMC8311479 DOI: 10.4239/wjd.v12.i7.954] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/06/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) is a metabolic disorder that is characterized by elevated blood glucose levels due to absolute or relative insulin deficiency, in the background of β-cell dysfunction, insulin resistance, or both. Such chronic hyperglycemia is linked to long-term damage to blood vessels, nerves, and various organs. Currently, the worldwide burden of DM and its complications is in increase. Male sexual dysfunction is one of the famous complications of DM, including abnormal orgasmic/ejaculatory functions, desire/libido, and erection. Ejaculatory dysfunction encompasses several disorders related to DM and its complications, such as premature ejaculation, anejaculation (AE), delayed ejaculation, retrograde ejaculation (RE), ejaculatory pain, anesthetic ejaculation, decreased ejaculate volume, and decreased force of ejaculation. The problems linked to ejaculatory dysfunction may extend beyond the poor quality of life in diabetics as both AE and RE are alleged to alter the fertility potential of these patients. However, although both diabetes patients and their physicians are increasingly aware of diabetic ejaculatory dysfunction, this awareness still lags behind that of other diabetes complications. Therefore, all these disorders should be looked for thoroughly during the clinical evaluation of diabetic men. Besides, introducing the suitable option and/or maneuvers to treat these disorders should be tailored according to each case. This review aimed to explore the most important findings regarding ejaculatory dysfunction in diabetes from pre-clinical and clinical perspectives.
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Affiliation(s)
- Taymour Mostafa
- Department of Andrology & Sexology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
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Xia JD, Chen F, Zhang QJ, Wang YM, Dai YT, Song NH, Wang ZJ, Zhang B, Yang J. Abnormal Thalamic Metabolism in Patients With Lifelong Premature Ejaculation. J Sex Med 2020; 18:275-283. [PMID: 33358559 DOI: 10.1016/j.jsxm.2020.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/22/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although some recent neuroimaging studies have indicated the abnormal brain structure or function in patients with lifelong premature ejaculation (LPE), whether and how the abnormal thalamic function participates in processing sexual behavioral information are still unclear in patients with LPE. AIM The aim of this study was to assess the changes in the thalamus metabolism and structural integrity in patients with LPE. METHODS We performed a multimodal magnetic resonance approach in a 3.0 T system, including proton magnetic resonance spectroscopy (1H-MRS), diffusion tensor imaging, and volumetric analysis to detect the differences in thalamic metabolism and structure between 20 patients with LPE and 15 healthy controls. OUTCOMES We analyzed and correlated the clinical symptoms of the subjects with significant 1H-MRS-based features. Peak areas of N-acetylaspartate, choline, creatine (Cr), and glutamate/glutamine (Glu) were calculated with the LCModel software. RESULTS Diffusion tensor imaging and volumetric analysis of thalami showed no differences between the 2 groups. On the contrary, 1H-MRS study disclosed that both Glu concentrations and Glu/Cr ratio values in the thalami of patients with LPE were remarkably increased when compared with healthy controls (P < .01 for both variables). In addition, both the intravaginal ejaculatory latency time score and Chinese Index of Sexual Function for Premature Ejaculation-5 score were negatively related to increased Glu concentrations and Glu/Cr ratio values. CLINICAL IMPLICATIONS Glutamatergic activity changes of thalamus may be an underlying indicator for evaluating sensory conduction efficiency in patients with LPE. STRENGTHS & LIMITATIONS The present study first found the abnormal thalamic metabolism in patients with LPE and contributed to a better understanding of the LPE etiology. Limitations include a cross-sectional study design with small samples and no examination of other brain areas. CONCLUSION Our findings show that the increase in glutamatergic activity of thalamus is related to LPE, suggesting that the increased Glu neurotransmission in the thalamus may contribute to the development of premature ejaculation. Xia J-D, Chen F, Zhang Q-J, et al. Abnormal Thalamic Metabolism in Patients With Lifelong Premature Ejaculation. J Sex Med 2021;18:275-283.
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Affiliation(s)
- Jia-Dong Xia
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Fei Chen
- Department of Radiology, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
| | - Qi-Jie Zhang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ya-Min Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu-Tian Dai
- Department of Andrology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Ning-Hong Song
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zeng-Jun Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bing Zhang
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jie Yang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Network Pharmacology-Based Strategy to Investigate Pharmacological Mechanisms of Qiaoshao Formula for Treatment of Premature Ejaculation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:1418634. [PMID: 33273947 PMCID: PMC7676949 DOI: 10.1155/2020/1418634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022]
Abstract
Background Qiaoshao (QS) formula, a traditional Chinese medicine (TCM) comprising seven herbs, has been clinically proven to have a favorable treatment effect on premature ejaculation (PE). However, its underlying pharmacological mechanisms in the treatment of PE need to be further clarified. Methods In the present study, a network pharmacology-based strategy was adopted. The active compounds of QS formula were obtained from the Chinese medicine database, and the potential targets of these compounds were collected from the DrugBank database to construct compound-compound targets network. PE-related targets were identified from human disease databases and used to construct the protein-protein interaction (PPI) networks. Compound-disease target PPI network was constructed by merging the PPI network of disease-targets and compound-targets. Cluster and enrichment analyses were performed on the PPI network of disease targets and compound-disease targets. The influence of QS formula on serum 5-HT, NO, oxytocin, and thyroid hormones of PE patients was verified. Results Four primary pharmacological networks of QS formula were constructed, including the compound-compound targets network, PPI network of PE-related targets and compound-disease targets, and the QS-PE mechanism network. The module and pathway enrichment analyses revealed that the QS formula had the potential to affect varieties of biological process and pathways, such as nitric oxide biosynthetic process, oxytocin, thyroid hormone, TNF, PI3K-Akt, and the HIF-1 signaling pathway, that play an important role in the pathogenesis of PE. Meanwhile, the QS formula has been clinically confirmed to regulate the serum level of 5-HT, NO, oxytocin, and TT in PE patients. Conclusion This study preliminarily discovered the potential targets and pathways of QS formula in the treatment of PE, which laid a good foundation for further experimental research.
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