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Gene Polymorphisms Affecting Erectile Dysfunction. Sex Med Rev 2020; 8:561-572. [PMID: 32169432 DOI: 10.1016/j.sxmr.2020.02.001] [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: 12/04/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is usually developed from psychological, neurological, hormonal, and vascular pathologies or a combination of these factors. However, the possible genetic polymorphisms that might underlie this disorder were not thoroughly investigated. OBJECTIVES This review article aimed to assess the possible involvement of gene polymorphisms in men with ED. METHODS A systematic review was conducted until January 2020 based on a search of all relevant articles in many electronic sites such as PubMed, Medline Medical Subject Headings, Science Direct, Scopus, Cochrane Library, EMBASE, CINAHL, and Egyptian Knowledge Bank databases with no language restriction. Keywords used to assess the outcome and estimates for relevant associations were sexual health, genes, erectile dysfunction, polymorphisms, and cavernous tissues. RESULTS Many genetic studies were carried out to inspect the contribution of different encoded genotypes and ED. Overall, 50 studies were reviewed and were classified as per the type of gene polymorphisms. These studies have investigated 10,174 men with ED compared with 6,891 healthy men as controls. 35 studies were case-controlled, 13 cross-sectional cohort studies, one retrospective study, and one genome-wide association study. So far, the most relevant gene polymorphisms linked with men with ED included endothelial nitric oxide synthase (eNOS), angiotensin-converting enzyme (ACE), androgen receptor (AR) CAG repeat, G-protein β3 (GNB3) subunit, methylenetetrahydrofolate reductase (MTHFR), vascular endothelial growth factor (VEGF), TGFB1, proprotein convertase subtilisin/kexin type 9 (PCSK9), ARG1, DRD2, DRD4, DDAH, and HNF4A genes. Both PROGINS and IGFBP-3 polymorphisms were investigated in only one study each but with irrelevant significance. CONCLUSIONS Although several genetic studies exposed the association between different genotypes and men with ED with varied outcomes, such a relationship should not be overlooked. Therefore, more studies should be encouraged to elucidate the exact role, if any, for such association. Mostafa T, Taymour M. Gene Polymorphisms Affecting Erectile Dysfunction. Sex Med 2020;8:561-572.
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Nicolini Y, Tramacere A, Parmigiani S, Dadomo H. Back to Stir It Up: Erectile Dysfunction in an Evolutionary, Developmental, and Clinical Perspective. JOURNAL OF SEX RESEARCH 2019; 56:378-390. [PMID: 29932774 DOI: 10.1080/00224499.2018.1480743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this review, we analyze erectile dysfunction (ED) in the context of sexual selection. We highlight that ED is a specific human male characteristic linked to the loss of the baculum or penile bone and results from a range of physical and psychological factors. We discuss evolutionary interpretations that consider dysfunctional penile erection as an honest signal of a low-quality male. We further emphasize the importance of considering psychosocial context and early attachment dynamics for understanding the etiology of some types of ED. Finally, we suggest that the integration of developmental factors for understanding the emergence of this sexual disorder is instrumental for the calibration of more effective therapies.
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Affiliation(s)
- Ylenia Nicolini
- a Unit of Neuroscience, Department of Medicine and Surgery , University of Parma
| | - Antonella Tramacere
- b Lichtenberg-Kolleg/The Göttingen Institute for Advanced Study and the German Primate Center/Leibniz Institute for Primate Research , Georg-August-Universität Göttingen; Max Planck for the Science of Human History , Jena , Germany
| | - Stefano Parmigiani
- c Evolutionary and Functional Biology Unit, Department of Chemistry , Life Sciences and Sustainability, University of Parma
| | - Harold Dadomo
- a Unit of Neuroscience, Department of Medicine and Surgery , University of Parma
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Romac R, Barak O, Glavas D, Susilovic Grabovac Z, Lozo P, Roje I, Caljkusic K, Drmic-Hofman I, Davis JT, Dujic Z, Lovering AT. Characterization of blood flow through intrapulmonary arteriovenous anastomoses and patent foramen ovale at rest and during exercise in stroke and transient ischemic attack patients. Echocardiography 2017; 34:676-682. [DOI: 10.1111/echo.13519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rinaldo Romac
- Department of Neurology; University Hospital Center Split; Split Croatia
| | - Otto Barak
- Department of Integrative Physiology; University of Split School of Medicine; Split Croatia
- Faculty of Medicine; University of Novi Sad; Novi Sad Serbia
| | - Duska Glavas
- Division of Cardiology; Department of Internal Medicine; University Hospital Center Split; Split Croatia
| | - Zora Susilovic Grabovac
- Division of Cardiology; Department of Internal Medicine; University Hospital Center Split; Split Croatia
| | - Petar Lozo
- Division of Cardiology; Department of Internal Medicine; University Hospital Center Split; Split Croatia
| | - Igor Roje
- Department of Neurology; University Hospital Center Split; Split Croatia
| | - Kresimir Caljkusic
- Department of Anesthesiology; University Hospital Center Split; Split Croatia
| | - Irena Drmic-Hofman
- Department of Pathology, Forensic Medicine and Cytology; University Hospital Center Split; Split Croatia
- Department of Medical Chemistry and Biochemistry; University of Split School of Medicine; Split Croatia
| | - James T. Davis
- Department of Kinesiology, Recreation and Sport; Indiana State University; Terre Haute IN USA
| | - Zeljko Dujic
- Department of Integrative Physiology; University of Split School of Medicine; Split Croatia
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Abstract
BACKGROUND Erectile dysfunction (ED) is a common disorder in man that influences the quality of life of the patient and his partner. Known risk factors for ED comprise diabetes, coronary artery disease, hypertension but also lifestyle modifications such as smoking, diminished physical activity as well as obesity. In this manuscript the current scientific literature about genetics and erectile dysfunction is reviewed. MATERIALS AND METHODS A literature search using the databank PubMed covering the topics genetics and erectile dysfunction was performed and relevant papers selected for presentation. RESULTS Several aspects of genetics and ED are described in the current literature. Association studies of candidate polymorphisms and ED risk in comparison to healthy controls is a major area of research. Another topic is the genome-wide search for candidate polymorphisms with erectile dysfunction. The paper closes with the presentation of the pharmacogenomic analysis of treatment response to phosphodiesterase-5 inhibitors. DISCUSSION The heterogeneous results of genetic association studies are possibly due to small sample sizes of the study population and/or due to ethnic differences of the analyzed populations. This underlines the need for validation of this data in larger prospective multinational multicenter studies.
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Affiliation(s)
- A Eisenhardt
- Praxisklinik Urologie Rhein Ruhr, Schulstr. 11, 45468, Mülheim an der Ruhr, Deutschland,
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Rosas-Vargas H, Coral-Vazquez RM, Tapia R, Borja JL, Salas RA, Salamanca F. Glu298Asp Endothelial Nitric Oxide Synthase Polymorphism Is a Risk Factor for Erectile Dysfunction in the Mexican Mestizo Population. ACTA ACUST UNITED AC 2013; 25:728-32. [PMID: 15292102 DOI: 10.1002/j.1939-4640.2004.tb02847.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Penile erection depends on the balanced action between antagonist vasoactive molecules such as nitric oxide (NO) and angiotensin. Endothelial nitric oxide synthase (eNOS) and angiotensin-converting enzyme (ACE) polymorphisms have been associated with endothelial dysfunction, which is described as a cause of erectile dysfunction (ED). Endothelial NOS and ACE are both regulators of vascular and corporal smooth muscle tone, which are connected by interaction between the NO-cyclic guanosine monophosphate pathway and the renin-angiotensin system. We analyzed the frequencies of 894 G/T (Glu298Asp) eNOS and ACE I/D polymorphisms in Mexican patients with ED (n=53) and in an age-matched control group (n=62). The populations analyzed were in Hardy Weinberg equilibrium. We found significant differences in allelic (chi2=4.42; P=.03) and genotypic frequencies (chi2=3.96; P=.04) between patients and controls for the 894 G/T eNOS polymorphism. Presence of the 894T allele in carriers increased the risk of ED (odds ratio [TT + GT versus GG] = 2.37; 95% confidence interval, 1.08 to 5.21; P=.02). Multiple logistic regression analysis showed that the Glu298Asp polymorphism was an independent factor for ED, as was diabetes mellitus, hypertension, cardiac disease, and cigarette smoking. No association was found between ACE I/D polymorphism and ED in the population studied. Therefore, our results suggest that Glu298Asp eNOS polymorphism plays a role as a genetic susceptibility factor for ED.
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Affiliation(s)
- Haydee Rosas-Vargas
- Unidad de Investigacion Medica en Genetica Humana, Hospital de Pediatria, Centro Medico Nacional Siglo XXI-IMSS, Av Cuauhtemoc No 330, Col Doctores, Delegacion Cuauhtemoc. 06725 Mexico, D.F., Mexico.
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Zhang T, Li WL, He XF, Wu ZY, Liu LH, He SH, Wei AY. The insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme gene and erectile dysfunction risk: a meta-analysis. Andrology 2012; 1:274-80. [PMID: 23413140 DOI: 10.1111/j.2047-2927.2012.00029.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 09/17/2012] [Accepted: 09/17/2012] [Indexed: 11/28/2022]
Affiliation(s)
- T. Zhang
- Department of Urology; Medical Center for Overseas Patients; Nanfang Hospital; Southern Medical University; Guangzhou; Guangdong; China
| | - W. L. Li
- Department of Obstetrics and Gynecolog; Nanfang Hospital; Southern Medical University; Guangzhou; Guangdong; China
| | - X. F. He
- Information Section; Peace Hospital of Changzhi Medical College; Changzhi; Shanxi; China
| | - Z. Y. Wu
- Department of Urology; Medical Center for Overseas Patients; Nanfang Hospital; Southern Medical University; Guangzhou; Guangdong; China
| | - L. H. Liu
- Department of Urology; Medical Center for Overseas Patients; Nanfang Hospital; Southern Medical University; Guangzhou; Guangdong; China
| | - S. H. He
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou; Guangdong; China
| | - A. Y. Wei
- Department of Urology; Medical Center for Overseas Patients; Nanfang Hospital; Southern Medical University; Guangzhou; Guangdong; China
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Affiliation(s)
| | - Kanchan Chitaley
- Department of Urology, University of Washington, Seattle, Washington
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Lippi G, Plebani M, Montagnana M, Cervellin G. Biochemical and genetic markers of erectile dysfunction. Adv Clin Chem 2012; 57:139-62. [PMID: 22870589 DOI: 10.1016/b978-0-12-394384-2.00005-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Erectile dysfunction (ED) is a very common pathology, affecting over 150 million men worldwide. The pathogenesis is typically multifactorial, involving a kaleidoscope of organic, endocrine, and psychogenic factors. In general, ED is divided into organic and psychogenic impotence, but most men with organic etiologies have an associated psychogenic component. Given the high frequency of this pathology, the identification of biochemical and genetic correlates and/or markers is of pivotal interest not only for treating preciously these patients and preventing serious psychological consequences but also for the high risk for occult cardiovascular disease (CVD) that often accompanies or follows this pathology. A variety of cardiovascular risk factors have been associated with both the onset and the severity of ED, including markers of endothelial function, thrombosis, and especially dyslipidemia, so that their measurement should now be considered as an important part of the increased global cardiometabolic risk profile in patients with ED. While nitric oxide (NO), asymmetric dimethylarginine (ADMA), and endothelin (ET) hold some promises as biochemical markers of both CVD and ED, there are several technical and clinical drawbacks that make their measurement overall meaningless in the clinical practice. As regards genetic polymorphisms, controversial results have been provided so far. Although some genetic markers were consistently associated with ED, other studies failed to demonstrate significant associations, highlighting a substantial bias in standardization of methodologies and patient enrolment. Nevertheless, further research in this area should be encouraged, since the first promising evidence that gene therapy might be effective to restore the decline in ED has been provided in the animal model.
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Andersen ML, Guindalini C, Tufik S. Genetics of Erectile Dysfunction: A Review of the Interface between Sex and Molecular Biomarkers. J Sex Med 2011; 8:3030-9. [DOI: 10.1111/j.1743-6109.2011.02422.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lynch AI, Tang W, Shi G, Devereux RB, Eckfeldt JH, Arnett DK. Epistatic effects of ACE I/D and AGT gene variants on left ventricular mass in hypertensive patients: the HyperGEN study. J Hum Hypertens 2011; 26:133-40. [PMID: 21248783 PMCID: PMC3775641 DOI: 10.1038/jhh.2010.131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Identifying predictors of left ventricular hypertrophy has been an active study topic because of its association with cardiovascular morbidity and mortality. We examined the epistatic effect (gene-gene interaction) of two genes (angiotensin-converting enzyme (ACE) insertion/deletion (I/D); angiotensinogen (AGT) -6G-A, M235T, -20A-C) in the renin-angiotensin system on left ventricular mass (LVM) among hypertensive participants in the Hypertension Genetic Epidemiology Network study. Included were 2156 participants aged 20-87 years (60% women, 63% African American). We employed mixed linear regression models to assess main effects of four genetic variants on echocardigraphically determined LVM (indexed for height), and ACE-by-AGT epistatic effects. There was evidence that AGT -6G-A was associated with LVM among white participants: adjusted mean LVM (gm(-2.7)) increased with 'G' allele copy number ('AA':41.2, 'AG':42.3, 'GG':44.0; P=0.03). There was also evidence of an ACE I/D-by-AGT -20A-C epistatic effect among white participants (interaction P=0.03): among ACE 'DD' participants, AGT -20A-C 'C' allele carriers had lower mean LVM than 'AA' homozygotes ('DD/CC':39.2, 'DD/AC':39.9, 'DD/AA':43.9), with no similar significant effect among ACE 'I' allele carriers ('ID/CC':47.2, 'ID/AC':43.4, 'ID/AA':42.6; 'II/CC': NA, 'II/AC':41.3, 'II/AA':43.1). These findings indicate that renin-angiotensin system variants in at least two genes may interact to modulate LVM.
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Affiliation(s)
- A I Lynch
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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Pharmacogenetic association of hypertension candidate genes with fasting glucose in the GenHAT Study. J Hypertens 2011; 28:2076-83. [PMID: 20577119 DOI: 10.1097/hjh.0b013e32833c7a4d] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Several clinical studies report increased risk of diabetes mellitus with pharmacologic treatment for hypertension (HTN). HTN genes may modify glycemic response to antihypertensive treatment. METHOD The current study examined the association of 24 single nucleotide polymorphisms (SNPs) in 11 HTN candidate genes with fasting glucose measured at 2, 4, and 6 years after treatment initiation. The study sample included participants free of diabetes at baseline in the Genetics of Hypertension Associated Treatment (GenHAT) study (N = 9309). GenHAT participants were randomized to receive treatment with a diuretic (chlorthalidone), calcium channel blocker (amlodipine), or angiotensin-converting enzyme (ACE) inhibitor (lisinopril). Mixed models for repeated measures were employed to test for gene and pharmacogenetic associations with fasting glucose during follow-up. RESULTS Fasting glucose at year 2 increased on average 6.8, 4.8 and 3.0 mg/dl from baseline in the chlorthalidone, amlodipine and lisinopril groups, respectively. Carrying the I allele (rs1799752) of the ACE I/D polymorphism was associated with lower fasting glucose levels (P = 0.02). Additionally, an ACE promoter polymorphism (-262, rs4291) was associated with lower fasting glucose for the model AA/AT vs. TT, which remained significant after correction for multiple testing (P = 0.001). Finally, a SNP in the α-subunit of the amiloride-sensitive epithelial sodium channel (SCNN1A, rs2228576) modified the association of amlodipine vs. chlorthalidone treatment with fasting glucose (P < 0.001). CONCLUSION Further examination of these genes and their relationships with cardiometabolic disease could foster development of pharmacogenetic guidelines aimed to prevent increases in fasting glucose during antihypertensive treatment.
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Andersen ML, Guindalini C, Santos-Silva R, Bittencourt LR, Tufik S. Angiotensin-Converting Enzyme Polymorphism and Erectile Dysfunction Complaints in the Brazilian Population. J Sex Med 2010; 7:2791-7. [DOI: 10.1111/j.1743-6109.2010.01796.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eisenhardt A, Stief C, Porst H, Wetterauer U, Weidner W, Rübben H, Sperling H. Genetic association study of the GNB3 C825T, the ACE I/D and the eNOS G894T polymorphisms and the risk to develop erectile dysfunction in a German ED population. Andrologia 2010; 42:218-24. [DOI: 10.1111/j.1439-0272.2009.00975.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Sexual dysfunction: the 'prima ballerina' of hypertension-related quality-of-life complications. J Hypertens 2008; 26:2074-84. [PMID: 18854743 DOI: 10.1097/hjh.0b013e32830dd0c6] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sexual dysfunction is currently considered a serious quality-of-life-related health problem, exerting a major impact on patients' and their sexual partners' life. Available data indicate that essential hypertension is a risk factor for sexual dysfunction, as male and female sexual dysfunction is more prevalent in hypertensive patients than normotensive individuals. Several mechanisms have been implicated in the pathogenesis of sexual dysfunction in hypertensive patients, and major determinants include severity and duration of hypertension, age, and antihypertensive therapy. Female sexual dysfunction, although more frequent than its male counterpart, remains largely under-recognized. Older antihypertensive drugs (diuretics, beta-blockers, centrally acting) exert negative results, whereas newer drugs have either neutral (calcium antagonists, angiotensin-converting enzyme inhibitors) or beneficial effects (angiotensin receptor blockers). Erectile dysfunction is related to ischemic heart disease and might be an 'early therapeutic window' of asymptomatic coronary artery disease. It seems of utmost importance for every physician treating hypertensive patients to become familiar with sexual dysfunction (through better education and specific seminars) for the proper management of these patients.
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Eisenhardt A, Rübben H, Sperling H. Einzelbasenpaarpolymorphismen und erektile Dysfunktion. Urologe A 2008; 47:1579-81. [DOI: 10.1007/s00120-008-1800-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lynch AI, Arnett DK, Davis BR, Boerwinkle E, Ford CE, Eckfeldt JH, Leiendecker-Foster C. Sex-Specific Effects of AGT-6 and ACE I/D on Pulse Pressure After 6 Months on Antihypertensive Treatment: The GenHAT Study. Ann Hum Genet 2007; 71:735-45. [PMID: 17608790 DOI: 10.1111/j.1469-1809.2007.00381.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research suggests pulse pressure (PP) is a predictor of cardiovascular disease, and genes likely influence PP levels. Additionally, gender may be an effect modifier between PP and cardiovascular disease. This study addresses whether two renin-angiotensin-aldosterone system (RAAS) variants are associated with PP in a sex-specific manner (genotype-by-sex interaction). Subjects comprised 35,048 GenHAT study participants over 55 years old, approximately half were women and half non-Hispanic white. Blood pressure measurements were obtained 6 months after randomization to one of four antihypertensive medications. The polymorphisms considered were AGT-6 and ACE-I/D. We employed linear regression to assess the interaction. AGT-6 showed a significant (p < 0.001) genotype-by-sex interaction. Men with the 'G/G' genotype had a higher PP (0.6 mm HG) than men carrying an 'A' allele, while 'G/G' women had a lower PP (0.7 mm Hg) than women carrying an 'A' allele. Three of the four treatment groups (chlorthalidone, amlodipine and lisinopril) suggested a consistent interaction in sub-group analyses (only amlodipine was statistically significant, p < 0.001), whereas doxazosin did not. The interaction was evident among non-Hispanic participants but not among Hispanic participants. For ACE-I/D no evidence for a genotype-by-sex interaction was detected. This finding of genotype-by-sex interaction on PP helps our understanding of the complexity of genetic effects on blood pressure.
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Affiliation(s)
- A I Lynch
- University of Minnesota, Department of Laboratory Medicine and Pathology, Minneapolis, Minnesota, USA
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Lynch AI, Arnett DK, Pankow JS, Miller MB, North KE, Eckfeldt JH, Hunt SC, Rao DC, Djoussé L. Sex-specific effects of ACE I/D and AGT-M235T on pulse pressure: the HyperGEN Study. Hum Genet 2007; 122:33-40. [PMID: 17492314 DOI: 10.1007/s00439-007-0370-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 04/18/2007] [Indexed: 12/01/2022]
Abstract
Evidence shows that an elevated pulse pressure (PP) may lead to an increased risk of cardiovascular morbidity and mortality. There is also evidence that PP is a sexually dimorphic trait, and that genetic factors influence inter-individual variation in PP. The aim of this project was to assess the genotype-by-sex interaction on PP in a sample of mostly hypertensive African American and White participants using candidate genes involved in the renin-angiotensin-aldosterone system. Subjects were participants in the HyperGEN Study, including men (43%) and women (57%) over the age of 55 years (mean age = 65). Candidate gene polymorphisms used were ACE insertion/deletion (1,789 subjects genotyped) and AGT-M235T (1,800 subjects genotyped). We employed linear regression methods to assess the genotype-by-sex interaction. For ACE, genotype-by-sex interaction on PP was detected (P = 0.04): the "D/D" genotype predicted a 2.2 mmHg higher pulse pressure among women, but a 1.2 mmHg lower PP among men, compared to those with an "I" allele, after adjusting for age, weight, height, ethnicity, and antihypertension medication use. A similar interaction was found for systolic blood pressure. The genotype-by-sex interaction was consistent across ethnicity. The interaction was evident among those on antihypertensive medications (P = 0.05), but not among those not taking such medications (P = 0.55). In our analysis of AGT, no evidence of a genotype-by-sex interaction affecting PP, SBP, or DBP was detected. This evidence for a genotype-by-sex interaction helps our understanding of the complex genetic underpinnings of blood pressure phenotypes.
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Affiliation(s)
- Amy I Lynch
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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Cirino G, Fusco F, Imbimbo C, Mirone V. Pharmacology of erectile dysfunction in man. Pharmacol Ther 2006; 111:400-23. [PMID: 16443277 DOI: 10.1016/j.pharmthera.2005.10.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 10/19/2005] [Indexed: 12/28/2022]
Abstract
Erectile dysfunction (ED) is defined as the consistent or recurrent inability of a man to attain and/or maintain a penile erection sufficient for sexual activity (2nd International Consultation on Sexual Dysfunction-Paris, June 28th-July 1st, 2003). Following the discovery and introduction of sildenafil, research on the mechanisms underlying penile erection has had an enormous boost and many preclinical and clinical papers have been published in the last 5 years. This review is structured in order to give the reader an overview of the clinical and preclinical data available on the peripheral regulation of and the mediators involved in human penile erection. The most widely accepted risk factors for ED are discussed. The article is focused on human data, and the safety and effectiveness of the 3 commercially available Phosphodiesterase-5 (PDE5) inhibitors used to treat ED are also discussed.
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Affiliation(s)
- Giuseppe Cirino
- Dipartimento di Farmacologia Sperimentale, Via Domenico Montesano 49, 8031 Napoli, Italy.
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Sáenz de Tejada I, Angulo J, Cellek S, González-Cadavid N, Heaton J, Pickard R, Simonsen U. Pathophysiology of Erectile Dysfunction. J Sex Med 2005; 2:26-39. [PMID: 16422902 DOI: 10.1111/j.1743-6109.2005.20103.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Multiple regulatory systems are involved in normal erectile function. Disruption of psychological, neurological, hormonal, vascular, and cavernosal factors, individually, or in combination, can induced erectile dysfunction (ED). The contribution of neurogenic, vascular, and cavernosal factors was thoroughly reviewed by our committee, while psychological and hormonal factors contributing to ED were evaluated by other committees. AIM To provide state of the art knowledge on the physiology of ED. METHODS An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five different continents developed in a process over a 2-year period. Concerning the pathophysiology of ED committee, there were seven experts from five different countries. MAIN OUTCOME MEASURE Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS The epidemiology and classification of neurogenic ED was reviewed. The evidence for the association between vascular ED and atherosclerosis/hypercholesterolemia, hypertension and diabetes was evaluated. In addition, the pathophysiological mechanisms implicated in vascular ED were defined, including: arterial remodeling, increased vasoconstriction, impaired neurogenic vasodilatation, and impaired endothelium-dependent vasodilatation. The possible mechanisms underlying the association between chronic renal failure and ED were also evaluated as well as the evidence supporting the association of ED with various classes of medications. CONCLUSIONS A better understanding of how diseases interfere with the physiological mechanisms that regulate penile erection has been achieved over the last few years, which helps establish a strategy for the prevention and treatment of ED.
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Abstract
PURPOSE OF REVIEW Few human studies have been performed with specific genetic endpoints coupled with erectile function or dysfunction. Most knowledge of gene expression and the function thereof on penile erection has been acquired in experimental models. The purpose of the present review is to give an overview of the available information obtained in studies of genes or genetic products versus erectile function or dysfunction. RECENT FINDINGS The association of, for example, systemic vascular disease with diminished erectile function has brought attention to investigations of the distribution, in men with erectile dysfunction, of some genotype variants proposed to be involved in cardiovascular disease. Altered expression or activities of some smooth muscle regulatory components of the ischaemic, diabetic, or ageing penis have been reported. SUMMARY Although penile erection can be considered a polygenic trait, some key effectors for normal erectile function within, for example, the nitric oxide/cyclic guanosine monophosphate pathway may be identified. Findings in future population-based studies may disclose the presence of a particular mutation of a gene or gene variants that may predispose to the development of erectile dysfunction. The exact molecular pathogenesis of erectile dysfunction is not known, and may vary between different forms of erectile dysfunction. With integrated approaches in genetic, molecular, and functional investigations, we can learn more of the impact of a particular genotype on erectile function, and also identify targets for preventive, pharmacological, or molecular measures.
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Affiliation(s)
- Petter Hedlund
- Department of Clinical Pharmacology, Lund University Hospital, Lund, Sweden.
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Eisenhardt A, Sperling H, Hauck E, Porst H, Stief C, Rübben H, Müller N, Siffert W. ACE gene I/D and NOS3 G894T polymorphisms and response to sildenafil in men with erectile dysfunction. Urology 2003; 62:152-7. [PMID: 12837457 DOI: 10.1016/s0090-4295(03)00137-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine a potential association between the response to the phosphodiesterase-5 inhibitor sildenafil and angiotensin-converting enzyme (ACE), as well as NOS3 G894T genotypes in patients with erectile dysfunction (ED). An insertion/deletion (I/D) polymorphism in the gene encoding the ACE and a single nucleotide exchange polymorphism (G894T) in the gene NOS3 encoding endothelial nitric oxide synthase have been associated with cardiovascular disorders. METHODS The response to sildenafil in 113 men with ED was monitored according to the patients' diaries. ACE and NOS3 genotypes were determined in patients with ED and in 108 healthy male blood donors. RESULTS Genotype distributions of ACE and NOS3 polymorphisms in the patient group were similar to those of the healthy control group. Analysis of the response to sildenafil revealed that 15 of 20 individuals homozygous for the ACE II genotype showed a positive erectile response after sildenafil use and only 46 of 93 D allele (combined DD and DI genotypes) carriers had a positive response (positive erectile response, odds ratio 3.07, 95% confidence interval 1.03 to 9.13, P = 0.04; chi-square test). Analysis of NOS3 genotypes revealed that 30 of 52 individuals homozygous for the G894 allele had a sufficient response to sildenafil and only 4 of 12 patients homozygous for the 894T allele had a sufficient erection. CONCLUSIONS It appears that patients with elevated ACE serum concentrations, as associated with the D allele of the ACE I/D polymorphism, are less likely to respond to sildenafil.
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