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Pérez-Aizpurua X, Garranzo-Ibarrola M, Simón-Rodríguez C, García-Cardoso JV, Chávez-Roa C, López-Martín L, Tufet i Jaumot JJ, Alonso-Román J, Maqueda-Arellano J, Gómez-Jordana B, Ruiz de Castroviejo-Blanco J, Osorio-Ospina F, González-Enguita C, García-Arranz M. Stem Cell Therapy for Erectile Dysfunction: A Step towards a Future Treatment. Life (Basel) 2023; 13:life13020502. [PMID: 36836859 PMCID: PMC9963846 DOI: 10.3390/life13020502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Background: The improvement of absent or partial response in the medical treatment of erectile dysfunction (ED) has led to the development of minimally invasive new treatment modalities in the field of regenerative medicine. Methods: A literature review on stem cell therapy for the treatment of ED was performed. We searched for the terms "erectile dysfunction" and "stem cell therapy" in PubMed and Clinicaltrials.gov. Literature searching was conducted in English and included articles from 2010 to 2022. Results: New treatment modalities for ED involving stem cell therapy are not only conceived with a curative intent but also aim to avoid unnecessary adverse effects. Several sources of stem cells have been described, each with unique characteristics and potential applications, and different delivery methods have been explored. A limited number of interventional studies over the past recent years have provided evidence of a safety profile in their use and promising results for the treatment of ED, although there are not enough studies to generate an appropriate protocol, dose or cell lineage, or to determine a mechanism of action. Conclusions: Stem cell therapy is a novel treatment for ED with potential future applications. However, most urological societies agree that further research is required to conclusively prove its potential benefit.
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Affiliation(s)
- Xabier Pérez-Aizpurua
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
- Correspondence:
| | | | | | | | - César Chávez-Roa
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Leticia López-Martín
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | | | - Josué Alonso-Román
- Urology Department, Hospital Universitario Virgen de la Macarena, 41009 Sevilla, Spain
| | | | - Blanca Gómez-Jordana
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | | | - Felipe Osorio-Ospina
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | | | - Mariano García-Arranz
- Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
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Hatampour M, Sohrabi K, Mazdak H, Ghadimi K, Salehi H, Kazemi R. Evaluating the efficacy of intraplaque injection of dexamethasone with oral tadalafil in the chordee patients with Peyronie disease. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2022; 10:25-30. [PMID: 35291415 PMCID: PMC8918397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Some studies demonstrated the effect of the combination of modalities in Peyronie's disease (PD) therapy; however, there is no comprehensive study for evaluation of dexamethasone and phosphodiesterase type 5 (PDE5) inhibitors such as tadalafil in the treatment of PD, so the study aimed to evaluate the efficacy of intraplaque injection of dexamethasone with oral tadalafil in the patients with PD. MATERIALS AND METHODS This double-blinded randomized, controlled trial was conducted on the patients with PD referred to Alzahra and Khorshid hospitals, Isfahan, Iran. Then the patients were randomly divided into two groups as intervention and control groups. In the intervention group, tadalafil (5 mg PO) was administered once daily for 12 weeks and dexamethasone (8 mg) was injected once a week for 12 weeks. In the control group, the verapamil (5 mg: 2 cc) was injected once a week for 12 weeks. Before and after 12 weeks, an ultrasound was performed to assess the size, number and location of the plaque. The degree of penile curvature from the midline, dorsal and lateral curvature was also determined. RESULTS The means of penis curvature in the intervention and control groups before therapy were 34.09±7.05˚ and 31.09±7.06˚, respectively (P=0.097) and also after therapy were 27.3±7.79˚ and 24.6±6.64˚, respectively (P=0.13). The means of plaque count in the intervention and control groups before treatment were 2.0±1.03 and 1.96±1.06, respectively (P=0.9) and after treatment were 1.22±0.71 and 1.40±0.79, respectively (P=0.34). The means of plaque size in the intervention and control groups were 12.31±4.9 cm and 12.45±4.12 cm, respectively (P=0.9) and after intervention 7.8±3.08 and 9.03±3.46 cm, respectively (P=0.15). CONCLUSION According to these findings, there was no significant difference between intervention and control groups regarding the degree of penis curvature, and the count and size of the plaque. Therefore, it seems that tadalafil therapy with dexamethasone did not improve PD compared to verapamil.
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Affiliation(s)
| | - Karim Sohrabi
- Department of Emergency Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Hamid Mazdak
- Department of Urology, Al-Zahra Hospital, Isfahan University of Medical SciencesIsfahan, Iran
| | - Keyvan Ghadimi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Hanieh Salehi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Reza Kazemi
- Department of Urology, Al-Zahra Hospital, Isfahan University of Medical SciencesIsfahan, Iran
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Drury R, Natale C, Hellstrom WJG. Reviewing the evidence for shockwave- and cell-based regenerative therapies in the treatment of erectile dysfunction. Ther Adv Urol 2021; 13:17562872211002059. [PMID: 33796149 PMCID: PMC7968013 DOI: 10.1177/17562872211002059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
Erectile dysfunction (ED) is both a common and complex disease process. Existing ED treatments do not always achieve adequate results. There is clinical interest in employing regenerative therapies, including low-intensity extracorporeal shockwave therapy (Li-ESWT), platelet rich plasma (PRP), and stem cell therapy (SCT), in the treatment of ED as adjunct or alternative treatments. Here, we present evidence for emerging shockwave- and cell-based regenerative therapies for the treatment of ED following a thorough review of the existing PubMed literature pertaining to Li-ESWT, PRP, and SCT in relation to the treatment of ED. Li-ESWT causes microtrauma in tissue that hypothetically upregulates angiogenesis and recruits stem cells. Several large-scale systematic reviews and meta-analyses have reported that Li-ESWT improved ED in humans. Additionally, evidence has commenced to show that Li-ESWT may be effective against two recognized and complex etiologies of ED: diabetic and neurogenic. PRP delivers an autologous sample rich in growth factors to damaged tissue. Animal model studies have demonstrated improved erectile function recovery as well as preservation of cavernous nerve axons. Studies with PRP in humans are limited. SCT utilizes the regenerative potential of stem cells for healing of damaged tissue. In the treatment of ED, SCT has been used in the setting of diabetic and post-prostatectomy ED. Results of human studies are varied, although SCT treatments did result in increased erectile rigidity with some patients recovering the ability to achieve penetration. While these regenerative therapies show potential to augment the current treatment regimen for ED, there is a paucity of evidence to support the safety and efficacy of these treatments. Further research is necessary to define the role of these alternative therapies in the treatment of ED.
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Affiliation(s)
- Robert Drury
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Caleb Natale
- Tulane University School of Medicine, New Orleans, LA, USA
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Yan S, Yap T, Minhas S. Collagenase clostridium histolyticum intralesional injections for the treatment of Peyronie's disease: a safety profile. Transl Androl Urol 2017; 6:123-126. [PMID: 28217460 PMCID: PMC5313303 DOI: 10.21037/tau.2016.12.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Sylvia Yan
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Tet Yap
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Suks Minhas
- University College London Hospitals NHS Foundation Trust, London, UK
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Abstract
Penile traction therapy (PTT) is a new therapeutic option for men with Peyronie’s disease (PD). However, it has a long history of use in other fields of medicine including bone, skin, skeletal muscle, and Dupuytren’s. Mechanotransduction, or gradual expansion of tissue by traction, leads to the formation of new collagen tissue by cellular proliferation. As a molecular result, continuous extension of the fibrous plaque causes significant increases in collagenase and metalloproteinases, and, ultimately, to fibrous plaque softening and extension. This hypothetical knowledge has been supported by recent well designed experimental studies. Furthermore, several clinical papers have provided promising results on the use of PTT in PD patients. It has been shown in some series that the use of PTT significantly increases flaccid and stretched penile lengths and results in significant penile curvature improvement when compared to baseline. Furthermore, the use of PTT concomitantly with either verapamil or interferon α-2b has also been shown to be an effective therapy. Additionally, the beneficial effect of PTT on penile length before or after penile surgery in men with corporal fibrosis has been described. Finally, as a minimally invasive alternative treatment option to penile augmentation surgery in men with dysmorphophobia, PTT use has shown promising results by several experts. Studies have shown that PTT provides an acceptable, minimally invasive method that can produce effective and durable lengthening of the penis in men complaining of a small/short penis. There are, however, several criticisms related to the designs of the reported studies, such as small sample size and selection bias. Well-designed studies with larger numbers of patients and longer follow-up periods are, however, needed to establish the true benefits of PTT.
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Affiliation(s)
- Mustafa Faruk Usta
- 1 Department of Urology, Section of Andrology, Akdeniz University School of Medicine, Antalya, Turkey ; 2 Department of Urology, Başkent University Alanya Research Hospital, Antalya, Turkey
| | - Tumay Ipekci
- 1 Department of Urology, Section of Andrology, Akdeniz University School of Medicine, Antalya, Turkey ; 2 Department of Urology, Başkent University Alanya Research Hospital, Antalya, Turkey
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Gokce A, Abd Elmageed ZY, Lasker GF, Bouljihad M, Braun SE, Kim H, Kadowitz PJ, Abdel-Mageed AB, Sikka SC, Hellstrom WJ. Intratunical Injection of Genetically Modified Adipose Tissue-Derived Stem Cells with Human Interferon α-2b for Treatment of Erectile Dysfunction in a Rat Model of Tunica Albugineal Fibrosis. J Sex Med 2015; 12:1533-44. [PMID: 26062100 DOI: 10.1111/jsm.12916] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Peyronie's disease (PD) has frequently been associated with erectile dysfunction (ED) and may further compromise coitus. AIM To investigate the efficacy of intratunical injection of genetically modified rat adipose tissue-derived stem cells (ADSCs) expressing human interferon α-2b (ADSCs-IFN) in decreasing fibrosis and restoring erectile function in a rat model of tunica albugineal fibrosis (TAF). METHODS A total of 36 Sprague-Dawley rats (12 weeks old; 300-350 g) were randomly divided in six equal groups: (i) sham group (50 μL saline-injected into the tunica albuginea [TA]); (ii) TAF group (transforming growth factor [TGF]-β1 [0.5 μg/50 μL] injected into the TA); (iii) TGF-β1 plus 5 × 10(5) control ADSCs injected same day; (iv) TGF-β1 plus 5 × 10(5) ADSCs-IFN injected same day; (v) TGF-β1 plus 5 × 10(5) control ADSCs injected after 30 days; and (vi) TGF-β1 plus 5 × 10(5) ADSCs-IFN injected after 30 days. Rat allogeneic ADSCs were harvested from inguinal fat tissue. MAIN OUTCOME MEASURES Forty-five days following the TGF-β1 injection, erectile function was assessed, and penile tissues were harvested for further evaluations. RESULTS In the same-day injection groups, intratunical injection of ADSCs and ADSC-IFN improved erectile response observed upon stimulation of cavernous nerve compared with TAF group. Intratunical ADSC-IFN injection at day 30 improved erectile responses 3.1, 1.8, and 1.3 fold at voltages of 2.5, 5.0, and 7.0, respectively, when compared with TAF group. Furthermore, at voltages of 2.5 and 5.0, treatment on day 30 with ADSCs-IFN improved erectile responses 1.6- and 1.3-fold over treatment with ADSCs alone. Local injection of ADSCs or ADSCs-IFN reduced Peyronie's-like manifestations, and these effects might be associated with a decrease in the expression of tissue inhibitors of metalloproteinases. CONCLUSION This study documents that transplantation of genetically modified ADSCs, with or without human IFN α-2b, attenuated Peyronie's-like changes and enhanced erectile function in a rat model of TAF.
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Affiliation(s)
- Ahmet Gokce
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
| | | | - George F Lasker
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Stephen E Braun
- Tulane National Primate Research Center, New Orleans, LA, USA
| | - Hogyoung Kim
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Philip J Kadowitz
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Asim B Abdel-Mageed
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Suresh C Sikka
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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