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Kataoka T, Hotta Y, Kimura K. A review of experimental techniques for erectile function researches and development of medical technology using animal erectile dysfunction models in sexual and reproductive medicine. Reprod Med Biol 2023; 22:e12513. [PMID: 37020643 PMCID: PMC10069627 DOI: 10.1002/rmb2.12513] [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: 02/06/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
Background Erectile dysfunction (ED) is one of the causes of male infertility and is a disease that requires treatment. The first‐line drugs for ED are phosphodiesterase 5 (PDE‐5) inhibitors, and further treatment options are currently limited. Medical technologies, such as genetic control and regenerative medicine, are developing rapidly. Research on erectile function is progressing rapidly, coupled with technological innovations in other areas. Methods A PubMed search using the keywords “animal (rat, mouse, rabbit, dog, and monkey)” and “erectile” was conducted, and all relevant peer‐reviewed English results were evaluated. Main findings The methods for evaluating erectile function include intracavernous pressure (ICP) measurements, isometric tension studies, and dynamic infusion cavernosometry. Papers also reported various disease model animals for the study of diabetes mellitus, cavernous nerve injury, and drug‐induced ED. Conclusion Basic research on ED treatment has progressed rapidly over the past 20 years. In particular, research on the mechanism of ED has been accelerated by the publication of a study on the evaluation of erectile function using ICP measurements in rats. In addition, molecular biological experimental methods such as polymerase chain reaction (PCR) and western blotting have become relatively easy to perform due to technological progress, thus advancing research development.
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Affiliation(s)
- Tomoya Kataoka
- Department of Pharmacology, Graduate School of Pharmaceutical SciencesChiba Institute of Science15‐8 Shiomi‐choChoshiChiba288‐0025Japan
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical SciencesNagoya City University3‐1 Tanabe‐dori, Mizuho‐kuNagoya467‐8603Japan
| | - Yuji Hotta
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical SciencesNagoya City University3‐1 Tanabe‐dori, Mizuho‐kuNagoya467‐8603Japan
| | - Kazunori Kimura
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical SciencesNagoya City University3‐1 Tanabe‐dori, Mizuho‐kuNagoya467‐8603Japan
- Department of Clinical Pharmaceutics, Graduate School of Medical SciencesNagoya City University1‐Kawasumi, Mizuho‐cho, Mizuho‐kuNagoya467‐8601Japan
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Randolph JT, Pak ES, McMains JC, Koontz BF, Hannan JL. Cocultured Schwann Cells Rescue Irradiated Pelvic Neuron Outgrowth and Increase Survival. J Sex Med 2022; 19:1333-1342. [DOI: 10.1016/j.jsxm.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/13/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022]
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Deng CJ, Li X, Zeng Y, Jiang J, Jiang R. Icariin inhibits the formation of mitochondria-associated membranes (MAMs) and improves erectile function in rats treated with prostate radiation. Andrology 2022; 10:1208-1216. [PMID: 35765205 DOI: 10.1111/andr.13218] [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: 03/15/2022] [Revised: 05/11/2022] [Accepted: 06/20/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Erectile function is usually impaired after radiation therapy in prostate cancer patients. eNOS is a key enzyme in the process of erection. Mitochondria-associated membranes (MAMs) are closely contacted with the production and bioactivity of eNOS. OBJECTIVE To study the mechanism of icariin improves the erectile function of rats treated with prostate radiation by controling the expression of MAMs in penile corpus cavernosum. METHODS Twenty 8-week-old healthy male SD rats were randomized to four groups: control group, radiation therapy (RT) group, icariin (10 mg/kg/d gavage) group, and RT + icariin (10 mg/kg/d gavage) group (n = 5). In RT group and RT + icariin group, rats were irradiated with X-rays to the prostate region (total dose 37.5 gray; 7.5 gray/day for 5 days). The ICPmax/MAP, NO concentration and the level of IP3 R1, PACS2, FACL4, nNOS, p-eNOS, and eNOS in rats' penile cavernous tissue was determined 9 weeks after radiation therapy. RESULTS Compared with the control group and the RT + icariin group, the ICPmax/MAP of the RT group was remarkably reduced (P<0.05). The levels of p-eNOS/eNOS, nNOS and the concentration of NO in the penile cavernous tissue of the penis in the RT group were remarkably decreased compared to the control group and the RT + icariin group (P<0.05). The levels of IP3 R1, PACS2, and FACL4 in penile cavernous tissue of the RT group were significantly higher than those in the control group and the RT + icariin group (P<0.05). CONCLUSIONS After prostate X-ray radiotherapy in rats, the formation of MAMs may be increased by increased expression of IP3 R1, PACS2, and FACL4 in penile cavernous tissue, resulting in impaired erectile function. Icariin might increase p-eNOS/eNOS and improve erectile function in rats after prostate radiotherapy by inhibiting the expression of IP3 R1, PACS2, and FACL4. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chang-Jian Deng
- Department of Urology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Xiong Li
- Department of Urology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Yang Zeng
- Department of Urology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Jun Jiang
- Department of Thyroid Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Rui Jiang
- Department of Urology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, China
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Cranial irradiation-induced impairment of axonal transport and sexual function in male rats and imaging of the olfactory pathway by MRI. Neurotoxicology 2022; 91:119-127. [DOI: 10.1016/j.neuro.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/27/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022]
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Mahmood J, Pandita R, Zhang A, Kamlapurkar S, Saeed A, Chen M, Staats PN, Shukla HD, Anvari A, Sawant A, Vujaskovic Z. RhoA/ROCK pathway inhibitor ameliorates erectile dysfunction induced by radiation therapy in rats. Radiother Oncol 2020; 150:174-180. [PMID: 32565390 DOI: 10.1016/j.radonc.2020.06.021] [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: 01/14/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Prostate cancer (PCa) treatment with radiation therapy (RT) has an excellent cure rate. However, Radiation-induced Erectile Dysfunction (RiED) is a common and irreversible toxicity impacting quality of life, and there is no FDA approved specific drug for RiED. We previously showed that prostate RT increased RhoA/ROCK signaling in the cavernous nerve (CN) and penile tissues, which may lead to RiED in rats. In this study, we investigated whether RhoA/ROCK pathway inhibition by a specific inhibitor called Hydroxyfasudil (HF) can improve RiED in our well-established rat model. MATERIALS/METHODS Male Sprague-Dawley rats were randomized to the following groups: sham-RT, HF-only, RT-only, and RT + HF. Rats were either exposed to a single dose of 25 Gy prostate-confined RT or a sham procedure. 10 mg/kg HF or normal saline was injected intraperitoneally. Erectile function was evaluated by intracavernosal pressure (ICP) and mean arterial pressure (MAP) measurements at week 14 post-RT. Cavernous nerve (CN) injury was evaluated by transmission electron microscopy (TEM), and penile tissue fibrosis by Masson trichrome staining (MT). RESULTS We have found that the HF treatment prior to RT showed significant (p < 0.001) improvement in ICP/MAP ratio, area under the curve, and maximum ICP value, compared to RT-alone rats. Furthermore, RT + HF treated rats exhibited increased CN myelination and decreased axonal atrophy, comparted to RT-only. HF treatment showed significantly decreased penile tissue fibrosis (p < 0.05) compared to RT-alone treated rats. CONCLUSION Our results provide the first preclinical evidence that targeting RhoA/ROCK pathway by HF may provide a novel therapeutic option for the treatment of RiED.
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Affiliation(s)
- Javed Mahmood
- Division of Translational Radiation Sciences (DTRS), Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA.
| | - Ravina Pandita
- Division of Translational Radiation Sciences (DTRS), Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Angel Zhang
- Division of Translational Radiation Sciences (DTRS), Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Shriya Kamlapurkar
- Division of Translational Radiation Sciences (DTRS), Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Ali Saeed
- Division of Translational Radiation Sciences (DTRS), Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Minjie Chen
- Division of Translational Radiation Sciences (DTRS), Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Paul N Staats
- Department of Pathology, University of Maryland School of Medicine, Baltimore, USA
| | - Hem D Shukla
- Department of Neurology and Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Akbar Anvari
- Division of Translational Radiation Sciences (DTRS), Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Amit Sawant
- Division of Translational Radiation Sciences (DTRS), Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Zeljko Vujaskovic
- Division of Translational Radiation Sciences (DTRS), Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
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Ashcraft KA, Hannan JL, Eichenbaum G, Zhang X, Pak ES, Faught AM, Patel P, Dewhirst MW, Koontz BF. Clarifying the Relative Impacts of Vascular and Nerve Injury That Culminate in Erectile Dysfunction in a Pilot Study Using a Rat Model of Prostate Irradiation and a Thrombopoietin Mimetic. Int J Radiat Oncol Biol Phys 2018; 103:1212-1220. [PMID: 30529374 DOI: 10.1016/j.ijrobp.2018.11.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Radiation therapy (RT) offers an important and curative approach to treating prostate cancer, but it is associated with a high incidence of erectile dysfunction (ED). It is not clear whether the etiology of radiation-induced ED (RI-ED) is driven by RT-mediated injury to the vasculature, the nerves, or both. This pilot study sought to distinguish the effects of vascular and nerve injury in RI-ED by applying a vascular radioprotectant in a rat model of prostate RT. METHODS A single dose of the thrombopoietin mimetic (TPOm; RWJ-800088), previously shown to mitigate radiation-induced vascular injury, was administered 10 minutes after single-fraction conformal prostate RT. Nine weeks after RT, rats were assessed for erectile and arterial function. Nerve markers were quantified with reverse transcriptase polymerase chain reaction. Immunofluorescent microscopy further characterized vascular effects of RT and TPOm. RESULTS Sham animals and animals that received RT and TPOm showed significant arterial vasodilation in response to systemic hydralazine (24.1% ± 7.3% increase; P = .03 in paired t test). However, animals that received RT and vehicle were unable to mount a vasodilatory response (-7.4% ± 9.9% increase; P = .44 in paired t test). TPOm prevented RT-induced change in the penile artery cross-sectional area (P = .036), but it did not ameliorate cavernous nerve injury as evaluated by gene expression of neuronal injury markers. Despite significant structural and functional vascular protective effects and some trends for differences in nerve injury/recovery markers, TPOm did not prevent RI-ED at 9 weeks, as assessed by intracavernous pressure monitoring after cavernous nerve stimulation. CONCLUSIONS These data suggest that vascular protection alone is not sufficient to prevent RI-ED and that cavernous nerve injury plays a key role in RI-ED. Further research is required to delineate the multifactorial nature of RI-ED and to determine if TPOm with modified dosing regimens can mitigate against nerve injury either through direct or vascular protective effects.
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Affiliation(s)
- Kathleen A Ashcraft
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina
| | - Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Gary Eichenbaum
- Johnson & Johnson, Office of the Chief Medical Officer, New Brunswick, New Jersey
| | - Xiaojie Zhang
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina
| | - Elena S Pak
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Austin M Faught
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina
| | - Pranalee Patel
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina
| | - Mark W Dewhirst
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina
| | - Bridget F Koontz
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina.
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Ashcraft KA, Miles D, Sunday ME, Choudhury KR, Young KH, Palmer GM, Patel P, Woska EC, Zhang R, Oldham M, Dewhirst MW, Koontz BF. Development and Preliminary Evaluation of a Murine Model of Chronic Radiation-Induced Proctitis. Int J Radiat Oncol Biol Phys 2018; 101:1194-1201. [DOI: 10.1016/j.ijrobp.2018.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/24/2018] [Accepted: 04/23/2018] [Indexed: 01/28/2023]
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Resveratrol treatment may preserve the erectile function after radiotherapy by restoring antioxidant defence mechanisms, SIRT1 and NOS protein expressions. Int J Impot Res 2018; 30:179-188. [PMID: 29973698 DOI: 10.1038/s41443-018-0042-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/23/2018] [Accepted: 05/09/2018] [Indexed: 12/30/2022]
Abstract
Radiotherapy (RT) for prostate cancer (PC) can cause erectile dysfunction (ED) by damaging neurovascular structures with oxidative stress. In this study, we evaluated the effects of resveratrol, an antioxidant, on post-RT ED. Fifty rats in five groups were evaluated; control (C), prostate-confined radiotherapy with short- and long-term vehicle or resveratrol treatment. Cavernosal tissues were obtained to analyze glutathione (GSH), nitric oxide (NO), cyclic guanosine monophosphate (cGMP), 8-hydroxy-2'-deoxy-guanosine (8-OHdG) levels and superoxide dismutase (SOD), caspase-3 activities, sirtuin-1, Foxo-3, nNOS, and eNOS protein expressions. Intracavernosal pressures (ICP) were measured for the long-term treatment group. In the RT + long-term vehicle treatment group, tissue GSH, NO, cGMP, and SOD activity were decreased while 8-OHdg levels and caspase-3 activities were increased. Radiotherapy caused a decrease in sirtuin-1, nNOS, and eNOS protein expressions. These parameters were reversed by resveratrol treatment. Foxo-3 protein expressions were unaltered in the RT + short-term vehicle treatment group and started to increase as a defense mechanism in the RT + long-term vehicle group; however, resveratrol treatment caused a significant increase in Foxo-3 expressions. Resveratrol preserved the metabolic pathways involved in erectile function and provided functional protection. Resveratrol can be used as a supplementary agent in patients undergoing radiotherapy to preserve erectile function.
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Dess RT, Hartman HE, Aghdam N, Jackson WC, Soni PD, Abugharib AE, Suy S, Desai NB, Zumsteg ZS, Mehra R, Morgan TM, Feng FY, Hamstra DA, Schipper MJ, Collins SP, Spratt DE. Erectile function after stereotactic body radiotherapy for localized prostate cancer. BJU Int 2017; 121:61-68. [PMID: 28710895 DOI: 10.1111/bju.13962] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To elucidate the functional erection rate after prostate stereotactic body radiotherapy (SBRT) and to develop a comprehensive prognostic model of outcomes after treatment. PATIENTS AND METHODS Between 2008 and 2013, 373 consecutive men with localized prostate cancer were treated with SBRT at a single academic institution as part of a prospective clinical trial or prospective registry. Prospective longitudinal patient-reported health-related quality of life (HRQoL) data was collected using the Expanded Prostate Cancer Index Composite (EPIC)-26 instrument. Functional erections were strictly defined as 'firm enough for intercourse' according to EPIC-26. Detailed comorbidity data were also collected. Logistic regression models were used to predict 24- and 60-month functional erection rates. Observed erection rates after SBRT were compared with those after other radiation therapies (external beam radiation therapy [EBRT] and brachytherapy) using prospectively validated models. RESULTS The median (interquartile range) follow-up was 56 (37-73) months and the response rate at 2 years was 84%. For those with functional erections at baseline, 57% and 45% retained function at 24 and 60 months, respectively. On multivariable analysis for 24-month erectile function, significant variables included higher baseline sexual HRQoL (adjusted odds ratio [aOR] 1.55 per 10 points, 95% confidence interval [CI] 1.37-1.74; P < 0.001) and older age (aOR 0.66 per 10 years, 95% CI 0.43-1.00; P = 0.05). At 60 months, baseline HRQoL and age remained associated with erectile function, along with body mass index (aOR 0.45, 95% CI 0.26-0.78; P < 0.001). The 24- and 60-month models had excellent discrimination (c-index 0.81 and 0.84, respectively). Erection rates after SBRT were not statistically different from model-predicted rates after EBRT or brachytherapy for the whole cohort and the cohort with baseline erectile function. CONCLUSIONS Intermediate- to long-term post-SBRT erectile function results are promising and not significantly different from other radiotherapy techniques. Clinicians can use our prognostic model to counsel patients regarding expected erectile function after SBRT.
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Affiliation(s)
- Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Holly E Hartman
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Nima Aghdam
- Department of Radiation Oncology, Georgetown University, Washington, DC, USA
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Payal D Soni
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Ahmed E Abugharib
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Simeng Suy
- Department of Radiation Oncology, Georgetown University, Washington, DC, USA
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai, Los Angeles, CA, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Daniel A Hamstra
- Department of Radiation Oncology, Beaumont Health System, Dearborn, MI, USA
| | | | - Sean P Collins
- Department of Radiation Oncology, Georgetown University, Washington, DC, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
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Mahmood J, Connors CQ, Alexander AA, Pavlovic R, Samanta S, Soman S, Matsui H, Sopko NA, Bivalacqua TJ, Weinreich D, Ho CY, Eley J, Sawant A, Jackson IL, Vujaskovic Z. Cavernous Nerve Injury by Radiation Therapy May Potentiate Erectile Dysfunction in Rats. Int J Radiat Oncol Biol Phys 2017; 99:680-688. [PMID: 29280463 DOI: 10.1016/j.ijrobp.2017.06.2449] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE/OBJECTIVES Radiation-induced erectile-dysfunction (RiED) is one of the most common side effects of radiation therapy (RT) and significantly reduces the quality of life (QoL) of cancer patients. Approximately 50% of prostate cancer patients experience RiED within 3 to 5 years after completion of RT. A series of vascular, muscular, and neurogenic injuries after prostate RT lead to RiED; however, the precise role of RT-induced neurogenic injury in RiED has not been fully established. The cavernous nerves (CN) are postganglionic parasympathetic nerves located beside the prostate gland that assist in penile erection. This study was designed to investigate the role of CN injury, tissue damage, and altered signaling pathways in an RiED rat model. METHODS AND MATERIALS Male rats were exposed to a single dose of 25 Gy prostate-confined RT. Erectile function was evaluated by intracavernous pressure (ICP) measurements conducted both 9 and 14 weeks after RT. Neuronal injury was evaluated in the CN using quantitative polymerase chain reaction, conduction studies, transmission electron microscopy, and immunoblotting. Masson trichrome staining was performed to elucidate fibrosis level in penile tissues. RESULTS There were significant alterations in the ICP (P<.0001) of RT rats versus non-RT rats. TEM analysis showed decreased myelination, increased microvascular damage, and progressive axonal atrophy of the CN fibers after RT. Electrophysiologic analysis showed significant impairment of the CN conduction velocity after RT. RT also significantly increased RhoA/Rho-associated protein kinase 1 (ROCK1) mRNA and protein expression. In addition, penile tissue showed increased apoptosis and fibrosis 14 weeks after RT. CONCLUSIONS RT-induced CN injury may contribute to RiED; this is therefore a rationale for developing novel therapeutic strategies to mitigate CN and tissue damage. Moreover, further investigation of the RhoA/ROCK pathway's role in mitigating RiED is necessary.
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Affiliation(s)
- Javed Mahmood
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Caroline Q Connors
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Allen A Alexander
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Radmila Pavlovic
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Santanu Samanta
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sandrine Soman
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hotaka Matsui
- Department of Urology, University of Tokyo, Tokyo, Japan
| | - Nikolai A Sopko
- James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trinity J Bivalacqua
- James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Weinreich
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cheng-Ying Ho
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - John Eley
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amit Sawant
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Isabel L Jackson
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Zeljko Vujaskovic
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
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Mahmood J, Shamah AA, Creed TM, Pavlovic R, Matsui H, Kimura M, Molitoris J, Shukla H, Jackson I, Vujaskovic Z. Radiation-induced erectile dysfunction: Recent advances and future directions. Adv Radiat Oncol 2016; 1:161-169. [PMID: 28740886 PMCID: PMC5514009 DOI: 10.1016/j.adro.2016.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 12/29/2022] Open
Abstract
Prostate cancer is one of the most prevalent cancers and the second leading cause of cancer-related deaths in men in the United States. A large number of patients undergo radiation therapy (RT) as a standard care of treatment; however, RT causes erectile dysfunction (radiation-induced erectile dysfunction; RiED) because of late side effects after RT that significantly affects quality of life of prostate cancer patients. Within 5 years of RT, approximately 50% of patients could develop RiED. Based on the past and current research findings and number of publications from our group, the precise mechanism of RiED is under exploration in detail. Recent investigations have shown prostate RT induces significant morphologic arterial damage with aberrant alterations in internal pudendal arterial tone. Prostatic RT also reduces motor function in the cavernous nerve which may attribute to axonal degeneration may contributing to RiED. Furthermore, the advances in radiogenomics such as radiation induced somatic mutation identification, copy number variation and genome-wide association studies has significantly facilitated identification of biomarkers that could be used to monitoring radiation-induced late toxicity and damage to the nerves; thus, genomic- and proteomic-based biomarkers could greatly improve treatment and minimize arterial tissue and nerve damage. Further, advanced technologies such as proton beam therapy that precisely target tumor and significantly reduce off-target damage to vital organs and healthy tissues. In this review, we summarize recent advances in RiED research and novel treatment modalities for RiED. We also discuss the possible molecular mechanism involved in the development of RiED in prostate cancer patients. Further, we discuss various readily available methods as well as novel strategies such as stem cell therapies, shockwave therapy, nerve grafting with tissue engineering, and nutritional supplementations might be used to mitigate or cure sexual dysfunction following radiation treatment.
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Affiliation(s)
- Javed Mahmood
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Aksinija A Shamah
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - T Michael Creed
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Radmila Pavlovic
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hotaka Matsui
- The James Buchanan Brady Urological Institute, and Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaki Kimura
- Department of Urology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Jason Molitoris
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hem Shukla
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Isabel Jackson
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Zeljko Vujaskovic
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
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Changes in penile bulb dose when using the Clarity transperineal ultrasound probe: A planning study. Pract Radiat Oncol 2016; 6:e337-e344. [PMID: 27161954 DOI: 10.1016/j.prro.2016.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The Clarity system allows monitoring of intrafraction target organ movements in external beam radiation therapy of prostate cancer by using transperineal ultrasound. The probe positioning at the perineum could lead to a compression and shift of the penile bulb (PB) toward the high-dose region. Dose to the PB has been reported to be associated with the risk of posttreatment erectile dysfunction. This planning study reports on PB translations and changes in volume and dose when applying the transperineal ultrasound probe. METHODS AND MATERIALS For 10 patients treated with external beam radiation therapy for prostate cancer between 2013 and 2014, a planning computed tomography scan with and without the ultrasound probe in place was acquired. The planning target volume and organs at risk including the PB were contoured in the computed tomography scan with and without the probe. Radiation therapy plans for both scenarios were calculated. In a second step, for planning with the probe in position, an additional objective for improved sparing of the PB was introduced. RESULTS The median PB volume was 5.5 mL (range, 3.8-7.1 mL) without the probe and 3.5 mL (range, 2.0-5.8 mL) with the probe. The median shift of the PB was 1 mm in the posterior (range, 3 mm posterior-2 mm anterior) and 6 mm in the superior direction (range, 0-14 mm superior), with no relevant shift of the prostate. The median mean dose in 95% of the PB was 34.1 Gy (range, 6.0-50.4 Gy), 48.3 Gy (range, 7.2-56.8 Gy), and 39.4 Gy (range, 5.6-51.3 Gy) for plans without probe, with probe, and with probe and additional planning objective, respectively. CONCLUSIONS Dose to the PB increased when using the transperineal probe. After introducing an additional plan-optimization objective for PB sparing, dose-volume parameters were below Quantitative Analyses of Normal Tissue Effects in the Clinic thresholds for all but one patient.
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Abstract
Animal models have contributed to a great extent to understanding and advancement in the field of sexual medicine. Many current medical and surgical therapies in sexual medicine have been tried based on these animal models. Extensive literature search revealed that the compiled information is limited. In this review, we describe various experimental models of erectile dysfunction (ED) encompassing their procedures, variables of assessment, advantages and disadvantages. The search strategy consisted of review of PubMed based articles. We included original research work and certain review articles available in PubMed database. The search terms used were “ED and experimental models,” “ED and nervous stimulation,” “ED and cavernous nerve stimulation,” “ED and central stimulation,” “ED and diabetes mellitus,” “ED and ageing,” “ED and hypercholesteremia,” “ED and Peyronie's disease,” “radiation induced ED,” “telemetric recording,” “ED and mating test” and “ED and non-contact erection test.”
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Affiliation(s)
- Snehlata V Gajbhiye
- Departments of Pharmacology and Therapeutics, Seth Gordhandas Sundardas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Kshitij S Jadhav
- Departments of Pharmacology and Therapeutics, Seth Gordhandas Sundardas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Padmaja A Marathe
- Departments of Pharmacology and Therapeutics, Seth Gordhandas Sundardas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Dattatray B Pawar
- Departments of Pharmacology and Therapeutics, Seth Gordhandas Sundardas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Hu C, Wang F, Dong Y, Dai J. A novel method to establish a rat ED model using internal iliac artery ligation combined with hyperlipidemia. PLoS One 2014; 9:e102583. [PMID: 25047124 PMCID: PMC4105595 DOI: 10.1371/journal.pone.0102583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/20/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate a novel method, namely using bilateral internal iliac artery ligation combined with a high-fat diet (BCH), for establishing a rat model of erectile dysfunction (ED) that, compared to classical approaches, more closely mimics the chronic pathophysiology of human ED after acute ischemic insult. Materials and Methods Forty 4-month-old male Sprague Dawley rats were randomly placed into five groups (n = 8 per group): normal control (NC), bilateral internal iliac artery ligation (BIIAL), high-fat diet (HFD), BCH, and mock surgery (MS). All rats were induced for 12 weeks. Copulatory behavior, intracavernosal pressure (ICP), ICP/mean arterial pressure, hematoxylin-eosin staining, Masson's trichrome staining, serum lipid levels, and endothelial and neuronal nitric oxide synthase immunohistochemical staining of the cavernous smooth muscle and endothelium were assessed. Data were analyzed by SAS 8.0 for Windows. Results Serum total cholesterol and triglyceride levels were significantly higher in the HFD and BCH groups than the NC and MS groups. High density lipoprotein levels were significantly lower in the HFD and BCH groups than the NC and MS groups. The ICP values and mount and intromission numbers were significantly lower in the BIIAL, HFD, and BCH groups than in the NC and MS groups. ICP was significantly lower in the BCH group than in the BIIAL and HFD groups. Cavernous smooth muscle and endothelial damage increased in the HFD and BCH groups. Cavernous smooth muscle to collagen ratio, nNOS and eNOS staining decreased significantly in the BIIAL, HFD, and BCH groups compared to the NC and MS groups. Conclusions The novel BCH model mimics the chronic pathophysiology of ED in humans and avoids the drawbacks of traditional ED models.
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Affiliation(s)
- Chao Hu
- Departments of Urology, Affiliated Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Feixiang Wang
- Institute of Forensic Science, National Ministry of Justice, Shanghai Key Laboratory of Forensic Medicine, Shanghai, P.R. China
| | - Yehao Dong
- Departments of Urology, Affiliated Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Jican Dai
- Departments of Urology, Affiliated Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- * E-mail:
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15
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Abstract
Stem cell (SC) therapy for erectile dysfunction (ED) has been investigated in 35 published studies, with one being a small-scale clinical trial. Out of these 35 studies, 19 are concerned with cavernous nerve (CN) injury-associated ED while 10 with diabetes mellitus- (DM-) associated ED. Adipose-derived SCs (ADSCs) were employed in 18 studies while bone marrow SCs (BMSCs) in 9. Transplantation of SCs was done mostly by intracavernous (IC) injection, as seen in 25 studies. Allogeneic and xenogeneic transplantations have increasingly been performed but their immune-incompatibility issues were rarely discussed. More recent studies also tend to use combinatory therapies by modifying or supplementing SCs with angiogenic or neurotrophic genes or proteins. All studies reported better erectile function with SC transplantation, and the majority also reported improved muscle, endothelium, and/or nerve in the erectile tissue. However, differentiation or engraftment of transplanted SCs has rarely been observed; thus, paracrine action is generally believed to be responsible for SC’s therapeutic effects. But still, few studies actually investigated and none proved paracrine action as a therapeutic mechanism. Thus, based exclusively on functional outcome data shown in preclinical studies, two clinical trials are currently recruiting patients for treatment with IC injection of ADSC and BMSC, respectively.
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Lin CS, Xin Z, Dai J, Huang YC, Lue TF. Stem-cell therapy for erectile dysfunction. Expert Opin Biol Ther 2013; 13:1585-97. [PMID: 24090162 DOI: 10.1517/14712598.2013.847085] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Stem cells (SCs) have been investigated for the treatment of erectile dysfunction (ED). AREAS COVERED This review covers key disease targets and all 33 preclinical studies, including their use of SC types, animal models, transplantation routes, and outcome assessment methods. EXPERT OPINION In the past one and half years there have been more stem-cell-for-erectile-dysfunction studies than the prior 8 years combined. These new studies tend to use combinatory treatment approaches by modifying or supplementing SCs with angiogenic or neurotrophic genes or proteins. However, when considering all risks and benefits, these combinatory approaches do not seem more advantageous than single-SC approaches. Another trend is the choice of transplantation routes other than the standard intracavernous (IC) injection. However, with the exception of intravenous injection, these new transplantation approaches are more cumbersome than IC injection and yet offer no evidence of producing better outcomes. In contrast to these variations, a consensus among these studies is the suggestion that paracrine action, as opposed to cellular differentiation, is the principal therapeutic mechanism. In conclusion, IC injection of a single SC type should be the choice protocol for initial clinical trials, and this is clearly the case with two clinical trials that are currently recruiting patients.
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Affiliation(s)
- Ching-Shwun Lin
- University of California, School of Medicine, Department of Urology, Knuppe Molecular Urology Laboratory , San Francisco, CA 94143-0738 , USA +1 415 476 3800 ; +1 415 476 3803 ;
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17
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Rivin del Campo E, Thomas K, Weinberg V, Roach M. Erectile dysfunction after radiotherapy for prostate cancer: a model assesing the conflicting literature on dose–volume effects. Int J Impot Res 2013; 25:161-5. [DOI: 10.1038/ijir.2013.28] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/26/2013] [Accepted: 05/08/2013] [Indexed: 11/09/2022]
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Kovanecz I, Rivera S, Nolazco G, Vernet D, Segura D, Gharib S, Rajfer J, Gonzalez-Cadavid NF. Separate or combined treatments with daily sildenafil, molsidomine, or muscle-derived stem cells prevent erectile dysfunction in a rat model of cavernosal nerve damage. J Sex Med 2012; 9:2814-26. [PMID: 22974131 DOI: 10.1111/j.1743-6109.2012.02913.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Long-term daily administration of phosphodiesterase type 5 (PDE5) inhibitors in the rat prevents or reverses corporal veno-occlusive dysfunction (CVOD) and smooth muscle cell (CSMC) loss and fibrosis, in both aging and bilateral cavernosal nerve resection (BCNR) models for erectile dysfunction. In the aging rat model, corporal implantation of skeletal muscle-derived stem cells (MDSC) reverses CVOD. Nitric oxide (NO) and cyclic guanosine monophosphate can modulate stem cell lineage. AIM To investigate in the BCNR model the effects of sildenafil at lower doses, alone or in combination with MDSC or the NO donor molsidomine, on CVOD and the underlying corporal histopathology. MAIN OUTCOMES MEASURES CVOD, histological, and biochemical markers in rat corporal tissue. Methods. Rats subjected to BCNR were maintained for 45 days either untreated, or received sildenafil in the water or retrolingually at 10, 2.5, and 1.25 mg/kg/day (medium, low, and very low doses), or intraperitoneal molsidomine, or MDSC implantation into the corpora cavernosa separately or in combination. Cavernosometry evaluated CVOD. Histopathology was assessed on penile sections by Masson trichrome, immunohistochemistry for α-smooth muscle actin (ASMA), or immunofluorescence for neuronal nitric oxide synthase (nNOS)/neurofilament 70, and in fresh tissue by Western blot for various markers and picrosirius red for collagen. RESULTS All treatments normalized erectile function (drop rate), and most increased the CSMC/collagen ratio and ASMA expression in corporal tissue sections, and reduced collagen content in the penile shaft. MDSC also increased nNOS and brain-derived neurotrophic factor. The combination treatment was not superior to MDSC or sildenafil given alone, and upregulated PDE5. CONCLUSIONS Lowering the dose of a continuous long-term sildenafil administration still maintained the prevention of CVOD in the BCNR rat previously observed, but it was less effective on the underlying histopathology. As in the aging rat model, MDSC also counteracted CVOD, but supplementation with very low-dose sildenafil did not improve the outcome.
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Affiliation(s)
- Istvan Kovanecz
- Department of Surgery, Division of Urology, Los Angeles Biomedical Research Institute (LABioMed) at Harbor-UCLA Medical Center, Torrance, CA, USA
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Oberley-Deegan RE, Steffan JJ, Rove KO, Pate KM, Weaver MW, Spasojevic I, Frederick B, Raben D, Meacham RB, Crapo JD, Koul HK. The antioxidant, MnTE-2-PyP, prevents side-effects incurred by prostate cancer irradiation. PLoS One 2012; 7:e44178. [PMID: 22984473 PMCID: PMC3440381 DOI: 10.1371/journal.pone.0044178] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 08/02/2012] [Indexed: 11/18/2022] Open
Abstract
Prostate cancer is the most commonly diagnosed cancer, with an estimated 240,000 new cases reported annually in the United States. Due to early detection and advances in therapies, more than 90% of patients will survive 10 years post diagnosis and treatment. Radiation is a treatment option often used to treat localized disease; however, while radiation is very effective at killing tumor cells, normal tissues are damaged as well. Potential side-effects due to prostate cancer-related radiation therapy include bowel inflammation, erectile dysfunction, urethral stricture, rectal bleeding and incontinence. Currently, radiation therapy for prostate cancer does not include the administration of therapeutic agents to reduce these side effects and protect normal tissues from radiation-induced damage. In the current study, we show that the small molecular weight antioxidant, MnTE-2-PyP, protects normal tissues from radiation-induced damage in the lower abdomen in rats. Specifically, MnTE-2-PyP protected skin, prostate, and testes from radiation-induced damage. MnTE-2-PyP also protected from erectile dysfunction, a persistent problem regardless of the type of radiation techniques used because the penile neurovascular bundles lay in the peripheral zones of the prostate, where most prostate cancers reside. Based on previous studies showing that MnTE-2-PyP, in combination with radiation, further reduces subcutaneous tumor growth, we believe that MnTE-2-PyP represents an excellent radioprotectant in combination radiotherapy for cancer in general and specifically for prostate cancer.
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Affiliation(s)
- Rebecca E Oberley-Deegan
- Pulmonary Division, Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
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Leroy T, Gabelle Flandin I, Habold D, Hannoun-Lévi JM. [The impact of radiation therapy on sexual function]. Cancer Radiother 2012; 16:377-85. [PMID: 22921960 DOI: 10.1016/j.canrad.2012.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 05/20/2012] [Indexed: 10/28/2022]
Abstract
The aim of this study was to evaluate the impact of radiation therapy on sexual life. The analysis was based on a Pubmed literature review. The keywords used for this research were "sexual, radiation, oncology, and cancer". After a brief reminder on the anatomy and physiology, we explained the main complications of radiation oncology and their impact on sexual life. Preventive measures and therapeutic possibilities were discussed. Radiation therapy entails local, systematic and psychological after-effects. For women, vaginal stenosis and dyspareunia represent the most frequent side effects. For men, radiation therapy leads to erectile disorders for 25 to 75% of the patients. These complications have an echo often mattering on the patient quality of life of and on their sexual life post-treatment reconstruction. The knowledge of the indications and the various techniques of irradiation allow reducing its potential sexual morbidity. The information and the education of patients are essential, although often neglected. In conclusion, radiation therapy impacts in variable degrees on the sexual life of the patients. Currently, there are not enough preventive and therapeutic means. Patient information and the early screening of the sexual complications are at stake in the support of patients in the reconstruction of their sexual life.
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Affiliation(s)
- T Leroy
- Département universitaire de radiothérapie, centre Oscar-Lambret, Lille, France.
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Imamura T, Ishizuka O, Lei Z, Hida S, Sudha GS, Kato H, Nishizawa O. Bone Marrow-Derived Cells Implanted into Radiation-Injured Urinary Bladders Reconstruct Functional Bladder Tissues in Rats. Tissue Eng Part A 2012; 18:1698-709. [DOI: 10.1089/ten.tea.2012.0061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tetsuya Imamura
- Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Osamu Ishizuka
- Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine, Nagano, Japan
- Department of Urology, Shinshu University School of Medicine, Nagano, Japan
| | - Zhang Lei
- Department of Urology, Shinshu University School of Medicine, Nagano, Japan
| | - Shigeaki Hida
- Department of Molecular Oncology, Institute on Aging and Adaptation, Shinshu University Graduate School of Medicine, Nagano, Japan
| | | | - Haruaki Kato
- Department of Urology, Shinshu University School of Medicine, Nagano, Japan
| | - Osamu Nishizawa
- Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine, Nagano, Japan
- Department of Urology, Shinshu University School of Medicine, Nagano, Japan
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22
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Qiu X, Villalta J, Ferretti L, Fandel TM, Albersen M, Lin G, Dai Y, Lue TF, Lin CS. Effects of intravenous injection of adipose-derived stem cells in a rat model of radiation therapy-induced erectile dysfunction. J Sex Med 2012; 9:1834-41. [PMID: 22548750 DOI: 10.1111/j.1743-6109.2012.02753.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Radiation therapy (RT) for prostate cancer is frequently associated with posttreatment erectile dysfunction (ED). AIM To investigate whether injection of adipose-derived stem cells (ADSCs) can ameliorate RT-associated ED. METHODS Thirty male rats were divided into three groups. The control + phosphate-buffered saline (PBS) group received tail-vein injection of PBS. The radiation + PBS group received radiation over the prostate and tail-vein injection of PBS. The radiation + ADSC group received radiation over the prostate and tail-vein injection of ADSCs, which were labeled with 5-ethynyl-2-deoxyuridine (EdU). Seventeen weeks later, erectile function was evaluated by intracavernous pressure (ICP) in response to electrostimulation of cavernous nerves (CNs). Penile tissue and major pelvic ganglia (MPG) were examined by immunofluorescence (IF) and EdU staining. MAIN OUTCOME MEASURES Erectile function was measured by ICP. Protein expression was examined by IF, followed by image analysis and quantification. RESULTS Radiation over the prostate caused a significant decrease in erectile function and in the expression of neuronal nitric oxide synthase (nNOS) in penis and MPG. Cavernous smooth muscle (CSM) but not endothelial content was also reduced. Injection of ADSCs significantly restored erectile function, nNOS expression, and CSM content in the irradiated rats. EdU-positive cells were visible in MPG. CONCLUSIONS Radiation appears to cause ED via CN injury. ADSC injection can restore erectile function via CN regeneration.
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Affiliation(s)
- Xuefeng Qiu
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
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Kimura M, Rabbani ZN, Zodda AR, Yan H, Jackson IL, Polascik TJ, Donatucci CF, Moul JW, Vujaskovic Z, Koontz BF. Role of oxidative stress in a rat model of radiation-induced erectile dysfunction. J Sex Med 2012; 9:1535-49. [PMID: 22489731 DOI: 10.1111/j.1743-6109.2012.02716.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Chronic oxidative stress is one of the major factors playing an important role in radiation-induced normal tissue injury. However, the role of oxidative stress in radiation-induced erectile dysfunction (ED) has not been fully investigated. Aims. To investigate role of oxidative stress after prostate-confined irradiation in a rat model of radiation-induced ED. METHODS Fifty-four young adult male rats (10-12 weeks of age) were divided into age-matched sham radiotherapy (RT) and RT groups. Irradiated animals received prostate-confined radiation in a single 20 Gy fraction. MAIN OUTCOME MEASURES Intracavernous pressure (ICP) measurements with cavernous nerve electrical stimulation were conducted at 2, 4, and 9 weeks following RT. The protein expression of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunits (Nox4 and gp91(phox)), markers of oxidative DNA damage (8-hydroxy-2'-deoxyguanosine [8-OHdG]), lipid peroxidation (4-hydroxynonenal [4HNE]), and inflammatory response including inducible nitric oxide synthase, macrophage activation (ED-1), and nitrotyrosine, and endogenous antioxidant defense by nuclear factor erythroid 2-related factor (Nrf2) were evaluated in irradiated prostate tissue and corpora cavernosa (CC). In addition, we investigated the relationships between results of ICP/mean arterial pressure (MAP) ratios and expression level of oxidative stress markers. RESULTS In the RT group, hemodynamic functional studies demonstrated a significant time-dependent decrease in ICP. Increased expression of Nox4, gp91(phox), 8-OHdG, and 4HNE were observed in the prostate and CC after RT. Similarly, expressions of inflammatory markers were significantly increased. There was a trend for increased Nrf2 after 4 weeks. ICP/MAP ratio negatively correlated with higher expression level of oxidative markers. CONCLUSION NADPH oxidase activation and chronic oxidative stress were observed in irradiated prostate tissue and CC, which correlated with lower ICP/MAP ratio. Persistent inflammatory responses were also found in both tissues after RT. These findings suggest that oxidative stress plays a crucial role in the development of radiation-induced ED.
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Affiliation(s)
- Masaki Kimura
- Division of Urologic Surgery, Department of Surgery and Duke Prostate Center, Duke University Medical Center, Durham, NC, USA.
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