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Melchiode Z, Nguyen T, Dawood O, Bobo GA, Hellstrom WJG. Phosphodiesterase 5 inhibitors: preclinical and early-phase breakthroughs for impotence treatments. Expert Opin Investig Drugs 2023; 32:635-642. [PMID: 37507822 DOI: 10.1080/13543784.2023.2242768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/27/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a condition that affects millions of men worldwide and is characterized by the inability to achieve or maintain an erection for satisfactory sexual performance. There are numerous treatment options for ED, including medications, mechanical assist devices, and surgical management; however, first-line treatment is usually a phosphodiesterase 5 (PDE5) inhibitor. There is a growing interest in developing novel, efficacious PDE5 inhibitors that provide better quality, safety, and tolerability profiles with less adverse effects. Our review of udenafil, mirodenafil, youkenafil, lodenafil, and SLx-2101 analyzes the safety, efficacy, and pharmacokinetic properties of these new ED drugs. AREAS COVERED Clinical trials demonstrated improved scores in questionnaires, such as the International Index of Erectile Function and Sexual Encounter Profile, for udenafil, mirodenafil, and lodenafil, while youkenafil and SLx-2101 revealed enhanced safety and tolerability in early pharmacokinetic studies. EXPERT OPINION It is our opinion that more robust clinical trials are required before these medications can be made available in the United States. Additionally, the field of urology may benefit from pursuing other avenues of pharmacotherapy, such as injections, tablets with a different mechanism of action, or stem cell therapy, to restore the integrity of the endothelium within the penis.
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Affiliation(s)
- Zachary Melchiode
- Ochsner Clinical School, University of Queensland, New Orleans, LA, USA
| | - Tivoli Nguyen
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Omar Dawood
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Graham A Bobo
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Jabir NR, Firoz CK, Zughaibi TA, Alsaadi MA, Abuzenadah AM, Al-Asmari AI, Alsaieedi A, Ahmed BA, Ramu AK, Tabrez S. A literature perspective on the pharmacological applications of yohimbine. Ann Med 2022; 54:2861-2875. [PMID: 36263866 PMCID: PMC9590431 DOI: 10.1080/07853890.2022.2131330] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Phytochemicals have garnered much attention because they are useful in managing several human diseases. Yohimbine is one such phytochemical with significant pharmacological potential and could be exploited for research by medicinal chemists. It is an indole alkaloid obtained from various natural/synthetic sources.Aims and Results: The research on yohimbine started early, and its use as a stimulant and aphrodisiac by humans has been reported for a long time. The pharmacological activity of yohimbine is mediated by the combined action of the central and peripheral nervous systems. It selectively blocks the pre and postsynaptic α2-adrenergic receptors and has a moderate affinity for α1 and α2 subtypes. Yohimbine also binds to other behaviourally relevant monoaminergic receptors in the following order: α-2 NE > 5HT-1A>, 5HT-1B > 1-D > D3 > D2 receptors.Conclusion: The current review highlights some significant findings that contribute to developing yohimbine-based drugs. It also highlights the therapeutic potential of yohimbine against selected human diseases. However, further research is recommended on the pharmacokinetics, molecular mechanisms, and drug safety requirements using well-designed randomized clinical trials to produce yohimbine as a pharmaceutical agent for human use.Key MessagesYohimbine is a natural indole alkaloid with significant pharmacological potential.Humans have used it as a stimulant and aphrodisiac from a relatively early time.It blocks the pre- and postsynaptic α2-adrenergic receptors that could be exploited for managing erectile dysfunction, myocardial dysfunction, inflammatory disorders, and cancer.
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Affiliation(s)
- Nasimudeen R Jabir
- Department of Biochemistry and Biotechnology, Centre for Research and Development, PRIST University, Vallam, Thanjavur, India
| | - Chelapram K Firoz
- Department of Medical Laboratory Technology, MIMS College of Allied Health Sciences, ASTER MIMS Academy, Malappuram, Kerala University of Health Sciences, Kerala, India
| | - Torki A Zughaibi
- Toxicology and Forensic Science Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Abdullah Alsaadi
- Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel M Abuzenadah
- Toxicology and Forensic Science Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Ibrahim Al-Asmari
- Toxicology and Forensic Science Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Laboratory Department, King Abdul-Aziz Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | - Ahdab Alsaieedi
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bakrudeen Ali Ahmed
- Department of Biochemistry and Biotechnology, Centre for Research and Development, PRIST University, Vallam, Thanjavur, India
| | - Arun Kumar Ramu
- Department of Biochemistry and Biotechnology, Centre for Research and Development, PRIST University, Vallam, Thanjavur, India
| | - Shams Tabrez
- Toxicology and Forensic Science Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Wang W, Chen J, Peng L, Gao X, Lin L, Xiong Y, Zhang F, Ma Y, Qin F, Yuan J. Food Insecurity May be an Independent Risk Factor Associated With Erectile Dysfunction in the United States: Analysis of the National Health and Nutrition Examination Survey Data. Sex Med 2022; 10:100549. [PMID: 35930975 PMCID: PMC9537275 DOI: 10.1016/j.esxm.2022.100549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION While food insecurity is a global public health problem associated with obesity, diabetes, hypertension and coronary heart disease, literature regarding the relationship between food insecurity and erectile dysfunction (ED) is scarce. AIM We aimed to determine the associations between food insecurity and ED in the National Health and Nutrition Examination Survey. METHODS Data was extracted from 3,891 participants (aged ≥ 20 years) with ED in the 2001-2004 National Health and Nutrition Examination Survey. Multivariable logistic regression analysis with sampling weights was conducted to evaluate the associations. MAIN OUTCOME MEASURE Food security was assessed utilizing the Household Food Security Module. A single-question self-report from the Massachusetts Male Aging Study was utilized to evaluate ED status. RESULTS Approximately 10.2% of individuals had food insecurity. Food insecurity was significantly associated with ED after full adjustment (odds ratio [OR] 1.56; 95% confidence interval [95% CI] 1.16-2.09; P = .003). Men with very low food insecurity had 59% higher risks of ED compared with those having high food security (OR 1.59; 95% CI 1.13-2.27; P = .006). Moreover, the associations were stronger in the old people (age ≥ 60) (OR 2.15; 95% CI 1.26-3.66; P = .004). CONCLUSIONS Food insecurity might be associated with higher risks of developing ED. Wang W, Chen J, Peng L, et al. Food Insecurity May be an Independent Risk Factor Associated With Erectile Dysfunction in the United States: Analysis of the National Health and Nutrition Examination Survey Data. Sex Med 2022;XX:XXXXXX.
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Affiliation(s)
- Wei Wang
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Jiawei Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xiaoshuai Gao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Lede Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yang Xiong
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Fuxun Zhang
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yucheng Ma
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Feng Qin
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiuhong Yuan
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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The synthetic peptide PnPP-19 potentiates erectile function via nNOS and iNOS. Nitric Oxide 2021; 113-114:23-30. [PMID: 33915274 DOI: 10.1016/j.niox.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 01/27/2023]
Abstract
PnPP-19 peptide has a primary sequence design based on molecular modeling studies of PnTx2-6 toxin. It comprises the amino acid residues that are potentially significant for the pharmacological action of PnTx2-6. Ex vivo and in vivo experiments in normotensive, hypertensive, or diabetic murine models have shown a significant improvement in penile erection after administration of PnPP-19. Given the potential use of PnPP-19 in pharmaceutical formulations to treat erectile dysfunction and the lack of information concerning its mode of action, the present work investigates its activities on the nitrergic system. PnPP-19 induced a significant increase in nitric oxide (NO) and cGMP levels in corpus cavernosum (cc). These effects were inhibited by l-NAME, a non-selective inhibitor of nitric oxide synthase (NOS); were partially inhibited by 7- Nitroindazole, a selective inhibitor of neuronal NOS (nNOS); and were abolished by L-NIL, a selective inhibitor of inducible NOS (iNOS). This potentiating effect was not affected by atropine. PnPP-19 also led to changes in mRNA levels, protein expression and phosphorylation at specific sites of NOS, in cc. Assays using cavernous tissue from knockout mice to endothelial NOS (eNOS), nNOS or iNOS showed that PnPP-19 potentiates relaxation only in eNOS-knockout mice, which suggests an essential role for nNOS. Surprisingly, iNOS enhanced the potentiation of erectile function evoked by PnPP-19. Our results demonstrate that this new synthetic peptide potentiates erectile function via nitric oxide activation and reinforce its role as a new pharmacological tool for the treatment of erectile dysfunction.
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Bimonte VM, Marampon F, Antonioni A, Fittipaldi S, Ferretti E, Pestell RG, Curreli M, Lenzi A, Vitale G, Brunetti A, Migliaccio S, Aversa A. Phosphodiesterase Type-5 Inhibitor Tadalafil Modulates Steroid Hormones Signaling in a Prostate Cancer Cell Line. Int J Mol Sci 2021; 22:ijms22020754. [PMID: 33451122 PMCID: PMC7828628 DOI: 10.3390/ijms22020754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/29/2023] Open
Abstract
Background: The androgen receptor (AR) plays a key role in normal prostate homeostasis and in prostate cancer (PCa) development, while the role of aromatase (Cyp19a1) is still unclear. We evaluated the effects of a treatment with Tadalafil (TAD) on both these proteins. Methods: Androgen-sensitive human PCa cell line (LnCAP) was incubated with/without TAD (10−6 M) and bicalutamide (BCT) (10−4 M) to evaluate a potential modulation on cell proliferation, protein and mRNA expression of Cyp19a, AR and estrogen receptor-β (ERβ), respectively. Results: TAD increased early AR nuclear translocation (p < 0.05, after 15 min of exposure), and increased AR transcriptional activity (p < 0.05) and protein expression (p < 0.05) after 24 h. Moreover, after 24 h this treatment upregulated Cyp19a1 and ERβ mRNA (p < 0.05 and p < 0.005 respectively) and led to an increase in protein expression of both after 48 h (p < 0.05). Interestingly, TAD counteracted Cyp19a1 stimulation induced by BCT (p < 0.05) but did not alter the effect induced by BCT on the AR protein expression. Conclusion: We demonstrate for the first time that TAD can significantly modulate AR expression and activity, Cyp19a1 and ERβ expression in PCa cells, suggesting a specific effect of these proteins. In addition, TAD potentiates the antiproliferative activity of BCT, opening a new clinical scenario in the treatment of PCa.
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Affiliation(s)
- Viviana M. Bimonte
- Department of Movement, Human and Health Sciences, “Foro Italico” University, 00135 Rome, Italy; (V.M.B.); (S.M.)
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (A.A.); (E.F.); (M.C.); (A.L.)
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy
| | - Francesco Marampon
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University, 00161 Rome, Italy;
| | - Ambra Antonioni
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (A.A.); (E.F.); (M.C.); (A.L.)
| | - Simona Fittipaldi
- Department of Biomedicine and Prevention, “Tor Vergata” University, 00133 Rome, Italy;
| | - Elisabetta Ferretti
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (A.A.); (E.F.); (M.C.); (A.L.)
| | - Richard G. Pestell
- Pennsylvania Cancer and Regenerative Medicine Research Center, Baruch S. Blumberg Institute, Pennsylvania Biotechnology Center, Wynnewood, PA 19111, USA;
| | - Mariaignazia Curreli
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (A.A.); (E.F.); (M.C.); (A.L.)
| | - Andrea Lenzi
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (A.A.); (E.F.); (M.C.); (A.L.)
| | - Giovanni Vitale
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20122 Milan, Italy;
- Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, 20095 Milan, Italy
| | - Antonio Brunetti
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, “Foro Italico” University, 00135 Rome, Italy; (V.M.B.); (S.M.)
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy
- Correspondence:
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Mohd Yusop AY, Xiao L, Fu S. Fluorescence polarisation for high-throughput screening of adulterated food products via phosphodiesterase 5 inhibition assay. Drug Test Anal 2020; 13:953-964. [PMID: 32959983 DOI: 10.1002/dta.2926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
The surge in the consumption of food products containing herbal aphrodisiacs has driven their widespread adulteration. A rapid screening strategy is, therefore, warranted to curb this problem. This study established an enzyme inhibition assay to screen phosphodiesterase 5 (PDE5) inhibitors as adulterants in selected food products. Fluorescein-labelled cyclic-3',5'-guanosine monophosphate was utilised as substrates for the PDE5A1 enzyme, aided by the presence of nanoparticle phosphate-binding beads on their fluorescence polarisation. The sample preparation was optimised to improve the enzyme inhibition efficiency and applied to calculate the threshold values of six blank food matrices. The assay was validated using sildenafil, producing an IC50 of 4.2 nM. The applicability of the assay procedure was demonstrated by screening 55 distinct food samples. The results were subsequently verified using confirmatory liquid chromatography-high-resolution mass spectrometry (LC-HRMS) analysis. Altogether, 49 samples inhibited the PDE5 enzyme above the threshold values (75.7%-105.5%) and were registered as potentially adulterated samples. The remaining six samples were marked as nonadulterated with percentage inhibition below the threshold values (-3.3%-18.2%). The LC-HRMS analysis agreed with the assay results for all food products except for the instant coffee premix (ICP) samples. False-positive results were obtained for the ICP samples at 32% (8/25), due to possible PDE5 inhibition by caffeine. Contrarily, all other food samples were found to produce 0% (0/30) false-positive or false-negative results. The broad-based assay, established via a simple mix-incubate-read format, exhibited promising potential for high-throughput screening of PDE5 inhibitors in various food products, except those with naturally occurring phosphodiesterase inhibitors such as caffeine.
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Affiliation(s)
- Ahmad Yusri Mohd Yusop
- Centre for Forensic Science, University of Technology Sydney, Ultimo, New South Wales, Australia.,Pharmacy Enforcement Division, Ministry of Health, Petaling Jaya, Selangor, Malaysia
| | - Linda Xiao
- Centre for Forensic Science, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Shanlin Fu
- Centre for Forensic Science, University of Technology Sydney, Ultimo, New South Wales, Australia
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Grice PT, Liu J, Gabrielson AT, Pearce I, Bivalacqua TJ, Modgil V. Drug delivery options and therapeutic advances in the management of erectile dysfunction. Expert Opin Drug Deliv 2020; 17:1259-1268. [PMID: 32531183 DOI: 10.1080/17425247.2020.1782383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It is estimated that 20-30% of adult men will have at least one episode of ED during their lifetime and the prevalence increases with age. ED is known to have significant negative psychological implications for men, resulting in impaired functional status and a greater prevalence of anxiety and depression. AREAS COVERED Medications for the treatment of erectile dysfunction largely revolve around oral, injection, and topical therapies. Though all three modalities are widely used, each delivery option has its own advantages and specific indications. Likewise, there are several new developing treatments for ED that may change the landscape of treatment. The goal of this review is to summarize contemporary drug delivery options used in the treatment of ED and highlight future promising pharmacological developments. EXPERT OPINION There are a myriad of new developments on the horizon including new PDE5Is and drug targets, nanotechnology enhancements, stem cell and gene therapy, shockwave therapy, and platelet-rich plasma injections. These are all promising new methods to not only treat ED but also to address the pathology and prevent or eliminate further damage.
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Affiliation(s)
- P T Grice
- Nottingham Urology Centre, Nottingham University Hospitals NHS Trust , Nottingham, UK
| | - J Liu
- James Buchanan Brady Urological Institute, Johns Hopkins Hospital , Baltimore, Maryland, United States
| | - A T Gabrielson
- James Buchanan Brady Urological Institute, Johns Hopkins Hospital , Baltimore, Maryland, United States
| | - I Pearce
- Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust , UK
| | - T J Bivalacqua
- James Buchanan Brady Urological Institute, Johns Hopkins Hospital , Baltimore, Maryland, United States
| | - V Modgil
- Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust , UK
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Ammar HO, Tadros MI, Salama NM, Ghoneim AM. Therapeutic Strategies for Erectile Dysfunction With Emphasis on Recent Approaches in Nanomedicine. IEEE Trans Nanobioscience 2019; 19:11-24. [PMID: 31567099 DOI: 10.1109/tnb.2019.2941550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This review addressed erectile dysfunction, regarding pathophysiology and therapeutic strategies. The line of treatment includes phosphodiesterase type-5 inhibitors and other types of therapy like topical and stem-cell transplant. Scientific literature was assessed to investigate the impact of nanotechnology on erectile dysfunction therapy. Various nanotechnology approaches were applied, like vesicular systems, lipid-based carriers, nanocrystals, dendrimers, liquid crystalline systems and nanoemulsions. Smart nano-systems can alter the landscape of the modern pharmaceutical industry by re- investigation of pharmaceutically suboptimal but biologically active entities for treatment of erectile dysfunction which were previously considered undeveloped.
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Hull EM, Dominguez JM. Neuroendocrine Regulation of Male Sexual Behavior. Compr Physiol 2019; 9:1383-1410. [DOI: 10.1002/cphy.c180018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Potential of phloroglucinol to improve erectile dysfunction associated with streptozotocin-induced diabetes in rats. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2019; 17:282-287. [PMID: 31005601 DOI: 10.1016/j.joim.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/20/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Diabetes is a common metabolic disease with several complications in its patients. Often, people living with diabetes develop erectile dysfunction (ED). The primary aim of this work was to investigate the effect of phloroglucinol in diabetes-induced ED in rats. METHODS Male Wistar rats were given 52 mg/kg of streptozotocin, by intraperitoneal injection, to induce diabetes and ED. Subsequently, animals were grouped into three groups: group 1, diabetic control; group 2, low-dose phloroglucinol (150 mg/kg body weight); and group 3, high-dose phloroglucinol (250 mg/kg body weight). A group of six normal rats served as a normal control. The rats were treated with phloroglucinol for six weeks and then were assessed for treatment effects. Sexual behavior, glycosylated hemoglobin A1c (HbA1c) values, serum testosterone, serum nitric oxide (NO), blood pressure and sperm count were measured after the end of treatment. RESULTS After a 6-week treatment period, the high dose of phloroglucinol significantly decreased HbA1c values in diabetic rats. Rats treated with phloroglucinol had increased serum testosterone, NO and sperm count. Animals treated with 250 mg/kg phloroglucinol performed similar to normal rats in the sexual behavioral study, suggesting the reversal of complications of ED. Conversely, a decrease in the blood pressure in treated groups was observed. CONCLUSION The results highlight the protective effect of phloroglucinol in diabetes-induced ED in rats warranting further studies.
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Lai BY, Cao HJ, Yang GY, Jia LY, Grant S, Fei YT, Wong E, Li XL, Yang XY, Liu JP. Acupuncture for Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis. World J Mens Health 2019; 37:322-338. [PMID: 30929323 PMCID: PMC6704310 DOI: 10.5534/wjmh.180090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/18/2019] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the effectiveness and safety of acupuncture for erectile dysfunction (ED). Materials and Methods We searched six major English and Chinese databases included randomized controlled trials (RCTs) testing acupuncture alone or in combination for ED. Dichotomous data were presented as risk ratio (RR) and continuous data were presented as mean difference (MD) both with 95% confidence interval (CI). The Revman (v.5.3) was used for data analyses. Quality of evidence across studies was assessed by the online GRADEpro tool. Results We identified 22 RCTs, fourteen of them involving psychogenic ED. Most of the included RCTs had high or unclear risk of bias. There was no difference between electro-acupuncture and sham acupuncture with electrical stimulation on the rate of satisfaction and self-assessment (RR, 1.50; 95% CI, 0.71–3.16; 1 trial). Acupuncture combined with tadalafil appeared to have better effect on increasing cure rate (RR, 1.31; 95% CI, 1.00–1.71; 2 trials), and International Index of Erectile Function-5 scores (MD, 5.38; 95% CI, 4.46–6.29; 2 trials). When acupuncture plus herbal medicine compared with herbal medicine alone, the combination therapy showed significant better improvement in erectile function (RR, 1.68; 95% CI, 1.31–2.15; 7 trials). Only two trials reported facial red and dizziness cases, and needle sticking and pruritus cases in acupuncture group. Conclusions Low quality evidence shows beneficial effect of acupuncture as adjunctive treatment for people mainly with psychogenic ED. Safety of acupuncture was insufficiently reported. The findings should be confirmed in large, rigorously designed and well-reported trials.
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Affiliation(s)
- Bao Yong Lai
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Hui Juan Cao
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Guo Yan Yang
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Li Yan Jia
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Suzanne Grant
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Yu Tong Fei
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Emma Wong
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Xin Lin Li
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Ying Yang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jian Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,Institute of Integrated Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, China.
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Abstract
Melanocortin analogues, such as melanotan, are illegally used for artificial tanning. They have also been suggested as possible therapeutic agents in the treatment of erectile dysfunction. This case study presents a patient attending the accident and emergency department, in a tertiary urology centre, with acute priapism after abdominal subcutaneous injection of melanotan. The priapism was diagnosed as 'low-flow' and managed with cavernosal aspiration, irrigation and subsequent intracavernosal injection of phenylephrine. The patient avoided requiring surgical shunting but had not yet recovered erectile function at 4-week follow-up. Acute priapism is an unreported side effect of melanocortin analogue use and this case report presents a patient managed without surgical intervention. Future therapeutic application of these agents will need to take this potential life altering complication into consideration.
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Affiliation(s)
| | - Tarik Amer
- Urology, Queen Elizabeth University Hospital, Glasgow, UK
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13
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PnPP-19 Peptide Restores Erectile Function in Hypertensive and Diabetic Animals Through Intravenous and Topical Administration. J Sex Med 2019; 16:365-374. [PMID: 30773502 DOI: 10.1016/j.jsxm.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 01/18/2023]
Abstract
INTRODUCTION With the aim of overcoming the high toxicity of PnTx2-6 (or δ-CNTX-Pn2a), a toxin from the venom of the armed spider (Phoneutria nigriventer), the 19-aminoacid peptide, PnPP-19 (P nigriventer potentiator peptide), was synthesized based on molecular modeling studies of PnTx2-6. PnPP-19 improved the erectile function of normotensive rats and mice, without eliciting side effects, and no signs of toxicity were observed. In addition, PnPP-19 was able to potentiate the effect of sildenafil. AIM To evaluate the efficacy of PnPP-19 in hypertensive and diabetic mouse/rat models in restoring erectile function, after topical administration; verify the biodistribution of PnPP-19 administration (topical and intravenous), permeation, and cyclic guanosine monophosphate (cGMP)/nitric oxide via implication. METHODS Corpus cavernosum relaxation was evaluated using cavernous strips from male spontaneous hypertensive rats (SHR) and from streptozotocin (STZ)-diabetic mice contracted with phenylephrine and submitted to electrical field stimulation before and after incubation with PnPP-19 (10-8 mol/L, 10 minutes) or vehicle. This procedure was also used to determine cGMP/nitric oxide levels, at 8 Hz and to check the effect of PnPP-19 with sildenafil citrate. Biodistribution assays were performed using iodine 123-radiolabeled PnPP-19. In vivo erectile function was evaluated using intracavernosal pressure/main arterial pressure ratio in STZ-diabetic rats after PnPP-19 topical administration. MAIN OUTCOME MEASURES PnPP-19 may become a new drug able to fill the gap in the pharmacologic treatment of erectile dysfunction, especially for hypertensive and diabetic individuals RESULTS: PnPP-19 potentiated corpus cavernosum relaxation, in both control and SHR rats. SHR-cavernosal tissue treated with PnPP-19 (1-32 Hz) reached the same relaxation levels as control Wistar rats (16 and 32 Hz). PnPP-19 treatment improved cavernosal tissue relaxation in STZ-diabetic mice and rats. PnPP-19 enhanced cGMP levels in STZ-diabetic mice corpus cavernosum strips. After topical or intravenous administration in rats, 123I-PnPP-19 was mainly recruited to the penis. When topically administered (400 μg/rat), PnPP-19 restores erectile function in STZ-diabetic rats, also improving it in healthy rats by increasing the intracavernosal pressure/main arterial pressure ratio. PnPP-19 exhibited an additive effect when co-administered with sildenafil, showing a novel mode of action regardless of phosphodiesterase type 5 inhibition. CLINICAL IMPLICATIONS PnPP-19 seems to be an indicated drug to be tested to treat ED in diabetic and hypertensive patients. STRENGTH & LIMITATIONS PnPP-19, although active by topical application and showing safety to human beings (not shown), has low permeability, about 10% of the applied dose. CONCLUSION Our results showed that PnPP-19 may emerge as a potent new drug that can be topically administered, becoming a promising alternative for erectile dysfunction treatment. Nunes da Silva C, Pedrosa Nunes K, De Marco Almeida F, et al. PnPP-19 Peptide Restores Erectile Function In Hypertensive And Diabetic Animals Through Intravenous And Topical Administration. J Sex Med 2019;16:365-374.
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Chang JF, Hsu JL, Sheng YH, Leu WJ, Yu CC, Chan SH, Chan ML, Hsu LC, Liu SP, Guh JH. Phosphodiesterase Type 5 (PDE5) Inhibitors Sensitize Topoisomerase II Inhibitors in Killing Prostate Cancer Through PDE5-Independent Impairment of HR and NHEJ DNA Repair Systems. Front Oncol 2019; 8:681. [PMID: 30705876 PMCID: PMC6344441 DOI: 10.3389/fonc.2018.00681] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/27/2018] [Indexed: 01/17/2023] Open
Abstract
Human castration-resistant prostate cancer (CRPC) is a significant target of clinical research. The use of DNA-damaging agents has a long history in cancer chemotherapy but is limited by their toxicities. The combination with a safer drug can be a strategy in reducing dosage and toxicity while increasing anticancer activity in CRPC treatment. Phosphodiesterase type 5 (PDE5) inhibitors are used to treat erectile dysfunction through the selective inhibition of PDE5 that is responsible for cGMP degradation in the corpus cavernosum. Several studies have reported that PDE5 inhibitors display protective effect against doxorubicin-induced cardiotoxicity. The combinatory treatment of CRPC with doxorubicin and PDE5 inhibitors has been studied accordingly. The data demonstrated that sildenafil or vardenafil (two structure-related PDE5 inhibitors) but not tadalafil (structure-unrelated to sildenafil) sensitized doxorubicin-induced apoptosis in CRPC cells with deteriorating the down-regulation of anti-apoptotic Bcl-2 family members, including Bcl-xL and Mcl-1, and amplifying caspase activation. Homologous recombination (HR) and non-homologous end joining (NHEJ) DNA repair systems were inhibited in the apoptotic sensitization through detection of nuclear foci formation of Rad51 and DNA end-binding of Ku80. PDE5 knockdown to mimic the exposure to PDE5 inhibitors did not reproduce apoptotic sensitization, suggesting a PDE5-independent mechanism. Not only doxorubicin, sildenafil combined with other inhibitors of topoisomerase II but not topoisomerase I also triggered apoptotic sensitization. In conclusion, the data suggest that sildenafil and vardenafil induce PDE5-independent apoptotic sensitization to doxorubicin (or other topoisomerase II inhibitors) through impairment of both HR and NHEJ repair systems that are evident by a decrease of nuclear Rad51 levels and their foci formation in the nucleus, and an inhibition of Ku80 DNA end-binding capability. The combinatory treatment may enable an important strategy for anti-CRPC development.
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Affiliation(s)
- Jo-Fan Chang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jui-Ling Hsu
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Hua Sheng
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wohn-Jenn Leu
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Chun Yu
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - She-Hung Chan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Cosmetic Science, Providence University, Taichung, Taiwan
| | - Mei-Ling Chan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lih-Ching Hsu
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Jih-Hwa Guh
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Milenkovic U, Campbell J, Roussel E, Albersen M. An update on emerging drugs for the treatment of erectile dysfunction. Expert Opin Emerg Drugs 2018; 23:319-330. [DOI: 10.1080/14728214.2018.1552938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- U. Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - J. Campbell
- Department of Surgery, Division of Urology, University of Western Ontario, London, ON, Canada
| | - E. Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - M. Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Decaluwé K, Pauwels B, Boydens C, Thoonen R, Buys ES, Brouckaert P, Van de Voorde J. Erectile Dysfunction in Heme-Deficient Nitric Oxide-Unresponsive Soluble Guanylate Cyclase Knock-In Mice. J Sex Med 2017; 14:196-204. [PMID: 28161078 DOI: 10.1016/j.jsxm.2016.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/29/2016] [Accepted: 12/06/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The nitric oxide (NO), soluble guanylate cyclase (sGC), and cyclic guanosine monophosphate (cGMP) pathway is the leading pathway in penile erection. AIM To assess erectile function in a mouse model in which sGC is deficient in heme (apo-sGC) and unresponsive to NO. METHODS Mutant mice (sGCβ1ki/ki) that express an sGC enzyme that retains basal activity but fails to respond to NO because of heme deficiency (apo-sGC) were used. Isolated corpora cavernosa from sGCβ1ki/ki and wild-type mice were mounted in vitro for isometric tension recordings in response to sGC-dependent and -independent vasorelaxant agents. In addition, the erectile effects of some of these agents were tested in vivo at intracavernosal injection. MAIN OUTCOME MEASURES In vitro and in vivo recordings of erectile responses in sGCβ1ki/ki and wild-type mice after stimulation with sGC-dependent and -independent vasorelaxant agents. RESULTS NO-induced responses were abolished in sGCβ1ki/ki mice in vitro and in vivo. The ability of the heme-dependent, NO-independent sGC stimulator BAY 41-2272 to relax the corpora cavernosa was markedly attenuated in sGCβ1ki/ki mice. In contrast, the relaxation response to the heme- and NO-independent sGC activator BAY 58-2667 was significantly enhanced in sGCβ1ki/ki mice. The relaxing effect of sGC-independent vasorelaxant agents was similar in wild-type and sGCβ1ki/ki mice, illustrating that the observed alterations in vasorelaxation are limited to NO-sGC-cGMP-mediated processes. CONCLUSION Our results suggest that sGC is the sole target of NO in erectile physiology. Furthermore, this study provides indirect evidence that, in addition to sGCα1β1, sGCα2β1 is important for erectile function. In addition, the significant relaxation observed in sGCβ1ki/ki mice with the cumulative addition of the sGC activator BAY 58-2667 indicates that sGC activators might offer value in treating erectile dysfunction.
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Affiliation(s)
- Kelly Decaluwé
- Department of Pharmacology, Ghent University, Ghent, Belgium
| | - Bart Pauwels
- Department of Pharmacology, Ghent University, Ghent, Belgium
| | | | - Robrecht Thoonen
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emmanuel S Buys
- Anesthesia Center for Critical Care Research, Department of Anesthesia and Critical Care and Pain Medicine, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA, USA
| | - Peter Brouckaert
- Inflammation Research Center, Flanders Interuniversity Institute for Biotechnology (VIB), Ghent, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
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Smith-Harrison L, Starke NR, Smith RP, Kovac JR. Drugs in preclinical to phase II clinical development for the treatment of erectile dysfunction. Expert Opin Investig Drugs 2017; 26:669-675. [PMID: 28460540 DOI: 10.1080/13543784.2017.1324570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Erectile function is an important aspect in the quality of life of many men. For men with erectile dysfunction (ED), a spectrum of treatment options exists. Novel therapies for ED are currently being developed in order to delay surgical placement of a penile prosthesis - the final step in the management of treatment-refractory ED. Areas covered: This review examines innovative treatments such as alternative vasoactive agents, trophic factors and bio-compounds as well as gene and stem cell therapy. All therapies are currently in some phase of development for the management of ED. Using the MedLine and FDA Clinical Trials Registry, recent developments in treatment of ED were queried. Expert opinion: Recent studies have demonstrated the potential for multiple, novel therapies in the treatment of ED. Much of the work requires further experimentation in large-scale, blinded, placebo-controlled studies. This will require a concerted effort to bring these products to market.
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Affiliation(s)
- Li Smith-Harrison
- a Department of Urology , University of Virginia , Charlottesville , VA , USA
| | - Nathan R Starke
- a Department of Urology , University of Virginia , Charlottesville , VA , USA
| | - Ryan P Smith
- a Department of Urology , University of Virginia , Charlottesville , VA , USA
| | - Jason R Kovac
- b Men's Health Center , Urology of Indiana , Indianapolis , IN , USA
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Affiliation(s)
- M S Reddy
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India E-mail:
| | - M Starlin Vijay
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India E-mail:
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Lee JKC, Tan RBW, Chung E. Erectile dysfunction treatment and traditional medicine-can East and West medicine coexist? Transl Androl Urol 2017; 6:91-100. [PMID: 28217454 PMCID: PMC5313309 DOI: 10.21037/tau.2016.11.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Erectile dysfunction (ED) is a common sexual problem affecting many men irrespective of cultures, beliefs and nationalities. While medical therapy for ED has been revolutionized by the advent of oral phosphodiesterase type 5 inhibitors and intracavernosal injection of vasoactive agents, recent technological advances such stem cell therapy, low intensity shock wave and newer generation of penile prosthesis implant offer hope to men who do not respond to conventional medical therapy. In contrast, traditional and complementary medicine (TCM) focuses on the restoration and better overall bodily regulation with the use of various herbal and animal products as well as exercises to invigorate qi (energy) in vital organs. Western medicine involves an analysis of ED symptom and underlying causes that contribute to ED, while TCM emphases the concept of holism and harmonization of body organs to achieve natural sexual life. The following article reviews our current understanding regarding the philosophical approach, and evaluates the evidence surrounding various ED therapies between mainstream Western Medicine and TCM.
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Affiliation(s)
- Joe K C Lee
- Department of Urology, National University Hospital, Singapore 119074, Singapore
| | - Ronny B W Tan
- Department of Urology, Tan Tock Seng Hospital, Singapore ; Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore - Imperial College, London, UK
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia;; Andro Urology Centre, St Andrew's War Memorial Hospital, Brisbane, Australia
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Simonsen U, Comerma-Steffensen S, Andersson KE. Modulation of Dopaminergic Pathways to Treat Erectile Dysfunction. Basic Clin Pharmacol Toxicol 2016; 119 Suppl 3:63-74. [DOI: 10.1111/bcpt.12653] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/16/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Ulf Simonsen
- Department of Biomedicine, Pulmonary and Cardiovascular Pharmacology; Aarhus University; Aarhus C Denmark
| | - Simon Comerma-Steffensen
- Department of Biomedicine, Pulmonary and Cardiovascular Pharmacology; Aarhus University; Aarhus C Denmark
- Department of Biomedical Science; Faculty of Veterinary Science; Central University of Venezuela; Maracay Bolivarian Republic of Venezuela
| | - Karl-Erik Andersson
- Department of Biomedicine, Pulmonary and Cardiovascular Pharmacology; Aarhus University; Aarhus C Denmark
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Schmidt BZ, Haaf JB, Leal T, Noel S. Cystic fibrosis transmembrane conductance regulator modulators in cystic fibrosis: current perspectives. Clin Pharmacol 2016; 8:127-140. [PMID: 27703398 PMCID: PMC5036583 DOI: 10.2147/cpaa.s100759] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Mutations of the CFTR gene cause cystic fibrosis (CF), the most common recessive monogenic disease worldwide. These mutations alter the synthesis, processing, function, or half-life of CFTR, the main chloride channel expressed in the apical membrane of epithelial cells in the airway, intestine, pancreas, and reproductive tract. Lung disease is the most critical manifestation of CF. It is characterized by airway obstruction, infection, and inflammation that lead to fatal tissue destruction. In spite of great advances in early and multidisciplinary medical care, and in our understanding of the pathophysiology, CF is still considerably reducing the life expectancy of patients. This review highlights the current development in pharmacological modulators of CFTR, which aim at rescuing the expression and/or function of mutated CFTR. While only Kalydeco® and Orkambi® are currently available to patients, many other families of CFTR modulators are undergoing preclinical and clinical investigations. Drug repositioning and personalized medicine are particularly detailed in this review as they represent the most promising strategies for restoring CFTR function in CF.
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Affiliation(s)
- Béla Z Schmidt
- Stem Cell Biology and Embryology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven
| | - Jérémy B Haaf
- Louvain Center for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Brussels, Belgium
| | - Teresinha Leal
- Louvain Center for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Brussels, Belgium
| | - Sabrina Noel
- Louvain Center for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Brussels, Belgium
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Abstract
Erectile dysfunction adversely affects up to 20% of all men and is the most commonly treated sexual disorder. The public health implications of this condition are significant and represent a challenge for our healthcare system. The physiological pathways responsible for erections have been extensively studied, and much advancement has been made since the introduction of phosphodiesterase 5 inhibitors. Newer agents, such as dopaminergic and melanocortin receptor agonists, which target central erectogenic pathways, are under investigation. Newer formulations and delivery methods of existing medications such as alprostadil will also be introduced in the near future. Furthermore, low-intensity shockwave lithotripsy and stem cell regenerative techniques are innovative approaches to the treatment of erectile dysfunction.
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Affiliation(s)
- Chintan K Patel
- Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Nelson Bennett
- Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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