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Alhefnawy MA, Salah E, Bakry S, Khalifa TM, Rafaat A, Hammad R, Sobhy A, Wahsh A. Autologous mesenchymal stem cell therapy for diabetic men with erectile dysfunction. Is it promising? A pilot study. Arch Ital Urol Androl 2023; 95:11669. [PMID: 37990987 DOI: 10.4081/aiua.2023.11669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE to assess safety and efficacy of autologous mesenchymal bone marrow stem cell injection in penile cavernosal tissue for erectile dysfunction therapy in diabetic men. METHODS The subjects of this study were diabetic men suffering erectile dysfunction, non-responding to maximum dose of oral PDE5I. Mesenchymal bone marrow stem cells were aspirated and injected after preparation in both corpora cavernosa at 3, 9 o'clock position. Erectile function was assessed by the International Index of Erectile Function and penile Doppler study, before and after 6 months after injection. RESULTS 4 patients out of 10 achieve hard erection adequate for satisfactory coitus, and 2 patients achieved penile hardness with addition of pharmacological therapy with sildenafil 100mg. Peak systolic velocity increased significantly in 4 patients (2 arteriogenic and 2 mixed erectile dysfunction), from 12∼22 cm/s to 32∼69 cm/s. Variations in end-diastolic velocity increased substantially in 2 patients with venogenic insufficiency alone at follow-up from 4∼5 cm /s to -4∼-3 cm/s. CONCLUSIONS Despite promising stem cell treatment efficacy for patients with erectile dysfunction, more clinical studies and researches are still warranted.
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Affiliation(s)
| | - Emad Salah
- Department of Urology, Al-Azhar University.
| | - Sayed Bakry
- Department of Embriology and Genetic engineering, Faculty of Science, Al-Azhar University.
| | | | | | - Refaat Hammad
- Department of Dermatology and Andrology, Al-Azhar University.
| | - Ali Sobhy
- Department of Dermatology and Andrology, Al-Azhar University.
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Wani MM, Rai BP, Webb WR, Madaan S. Is there a role for stem cell therapy in erectile dysfunction secondary to cavernous nerve injury? Network meta-analysis from animal studies and human trials. Ther Adv Urol 2022; 14:17562872221086999. [PMID: 35371295 PMCID: PMC8972940 DOI: 10.1177/17562872221086999] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/24/2022] [Indexed: 12/09/2022] Open
Abstract
Introduction: We carried out systematic review and network meta-analysis to investigate the role of stem cell therapy (SCT) in the management of erectile dysfunction (ED) secondary to cavernous nerve injury in rats and post-radical prostatectomy (RP) in humans. Patients and Methods: The protocol was registered with PROSPERO database. We searched studies analyzing the efficacy of SCT for ED due to bilateral cavernous nerve injury (BCNI) in rats using Healthcare Databases Advanced Search (HDAS) Export software (MEDLINE, EMBASE, Scopus) from inception to September 2020. The outcome measurements, for 29 animal studies, were intracavernosal pressure (ICP), ICP/MAP (mean arterial pressure) ratio, and histological/molecular changes. All three available human trials evaluating SCT in post-RP ED were assessed for International Index for Erectile Function (IIEF) Score and Erection Hardness Score (EHS). Results: For ICP measurement, animal studies were divided into adipose-derived stem cells (ADSCs) subgroup and bone marrow–derived stem cells (BMSCs) subgroup. Pooled analysis of these studies showed a beneficial effect of SCT in improving erectile function in rats with BCNI using network meta-analysis (95% confidence interval, CI; p < 0.001). There was an increase in ICP/MAP ratio in stem cell groups (including co-intervention) compared with control BCNI group. Histological and molecular evaluation of penile tissue revealed an increase in neuronal nitric oxide synthase (nNOS), smooth muscle content, and anti-apoptotic activity. Human trials revealed improved IIEF (70–150% from baseline at 6 months) and EHS (80–200% from baseline). Conclusion: Our results confirm that SCT does improve the erectile function in rats having cavernous nerve injury. Similarly, early human results have shown promising results. PROSPERO registration ID: CRD42020201343.
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Affiliation(s)
- Mudassir M. Wani
- Royal Glamorgan Hospital, Cardiff, UK
- Institute of Medical Sciences, Faculty of Medicine, Health and Social Sciences, Canterbury Christ Church University, Kent, UK
| | | | - William Richard Webb
- SCRABEL, Institute of Medical Sciences, Faculty of Medicine, Health and Social Sciences, Canterbury Christ Church University, Kent, UK
| | - Sanjeev Madaan
- Darent Valley Hospital, Darenth Wood Road, Dartford DA2 8DA, UK. Canterbury Christ Church University, Kent, UK
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Moussa M, Abou Chakra M, Moussa Y. Advances in stem cell therapy for the treatment of Peyronie's disease. Intractable Rare Dis Res 2020; 9:10-13. [PMID: 32201669 PMCID: PMC7062597 DOI: 10.5582/irdr.2019.01130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Peyronie's disease (PD) is a connective tissue disorder of the penis characterized by fibrosis and plaque formation within the tunica albuginea. PD is characterized by painful penile curvature that impairs sexual intercourse. Stem cell therapy is one of the recent non-invasive treatment options for patients with PD and it has promising results. Stem cells are undifferentiated cells that are capable of self-renewal and differentiation, promoting the repair of tissues via their immunomodulatory and anti-inflammatory action. Adipose-derived stem cells (ADSC) are used most widely due to their abundant tissue source and ease of isolation. Multiple studies have indicated the efficacy of stem cell therapy as a potential treatment for fibrotic diseases. Clearly, ADSCs may represent a way to treat and prevent PD in both rat and human models. Further clinical studies are needed to confirm the efficacy of stem cell therapy for PD in humans.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Address correspondence to:Mohamad Abou Chakra, Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon. E-mail:
| | - Yasmin Moussa
- Clinic of Dermatology, Dr. Brinkmann, Schult & Samimi-Fard, Gladbeck, Germany
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Kim JK, Jang MJ, Kim BH, Choi KR, Song G, Shin HC, Suh N, Kim YM, You D, Ahn TY, Kim CS. Establishment of NOAEL for intracavernous injections of human bone marrow-derived mesenchymal stem cells in rats. Investig Clin Urol 2019; 61:88-98. [PMID: 31942468 PMCID: PMC6946817 DOI: 10.4111/icu.2020.61.1.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/21/2019] [Indexed: 01/09/2023] Open
Abstract
Purpose To assess the possible negative health effects of human bone marrow-derived mesenchymal stem cells (hBMSCs) on fertility and early embryonic development following intracavernous injections in rats. Materials and Methods A total of 88 Crl:CD(SD) male and female rats were equally divided into 4 groups in a random manner: control group (normal saline), low-dose group (2×105 hBMSCs), moderate-dose group (1×106 hBMSCs), and high-dose group (2×106 hBMSCs). hBMSCs or normal saline was injected into the penis of the rats 3 times at 2-week-intervals prior to mating. We compared each group with respect to parameters of reproduction and histopathology. Results For male rats, various degrees of flushing and swelling were observed at the penile injection site in all the groups, although the severity increased in a dose-dependent manner in the hBMSC injection groups. There were no statistically significant differences in mean body weights and food consumption among all the groups of both sexes. There were no statistically significant differences in reproductive parameters among all the groups of both sexes. The absolute and relative organ weights did not significantly differ among the groups. At the time of necropsy, no remarkable findings were observed in gross examinations in all groups. On histopathological analysis, minimal mononuclear cell infiltration was observed in the right epididymis of each rat in the moderate- and high-dose groups. Conclusions The non-toxic amount of hBMSCs for male fertility and early embryogenesis in rats under the test conditions was determined to be 2×106 cells/head.
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Affiliation(s)
- Jong Keun Kim
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Myoung Jin Jang
- Asan Institute for Life Science, Asan Medical Center, Seoul, Korea
| | - Bo Hyun Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Geehyun Song
- Department of Urology, Kangwon National University School of Medicine, Chuncheon, Korea
| | | | - Nayoung Suh
- Department of Pharmaceutical Engineering, College of Medical Sciences, Soon Chun Hyang University, Asan, Korea
| | | | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tai Young Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chermansky C, Mitsogiannis I, Abrams P, Apostolidis A. Stem cells and lower urinary tract dysfunction: Has its potential finally reached clinical maturity? ICI‐RS2018. Neurourol Urodyn 2019; 38 Suppl 5:S134-S141. [DOI: 10.1002/nau.24069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/10/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Iraklis Mitsogiannis
- 2nd Department of UrologySismanogleio General HospitalNational and Kapodistrian University of AthensAthens Greece
| | - Paul Abrams
- Bristol Urological InstituteUniversity of BristolBristol UK
| | - Apostolos Apostolidis
- 2nd Department of Urology, Papageorgiou General HospitalAristotle University of ThessalonikiThessaloniki Greece
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Gómez-Guerra LS, Robles-Torres JI, Garza-Bedolla A, Mancías-Guerra C. Erectile dysfunction treated with intracavernous stem cells: A promising new therapy? Rev Int Androl 2018; 16:119-127. [PMID: 30300133 DOI: 10.1016/j.androl.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/27/2017] [Accepted: 10/08/2017] [Indexed: 10/17/2022]
Abstract
In the past decades, great interest has been shown in the development of new therapies for erectile dysfunction. Stem cell therapy has generated promising results in numerous preclinical trials in animal models, which is why has led to the development of the first clinical trials in humans. The main cause involved in the pathophysiology of erectile dysfunction is vascular damage related to endothelial and neuronal injury. The interest in stem cell therapy is justified by their capability to differentiate into specific damaged tissues, including endothelium and nervous tissue, and induction of the host own cell proliferation. Despite the great effort of the many studies carried out to date, knowledge about biological effects, therapeutic efficacy and safety of stem cells therapy for erectile dysfunction is still very limited.
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Affiliation(s)
- Lauro S Gómez-Guerra
- Servicio de Urología, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico.
| | - J Iván Robles-Torres
- Servicio de Urología, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Alejandra Garza-Bedolla
- Servicio de Hematología, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Consuelo Mancías-Guerra
- Servicio de Hematología, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
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Abstract
INTRODUCTION Like other fibrotic diseases, the cause of Peyronie's disease (PD) is still obscure. Since there is now increasing evidence for the role of Mesenchymal Stem Cells (MSCs) as potential treatment to fibrosis, it is crucial to determine their possible efficacy in the treatment of PD. Areas covered: In this review, the authors summarize the emerging data and published studies regarding the use of SCs for the treatment of PD. The authors provide particular focus on the three-first experimental studies for the use of SCs in rat models as well as the sole two studies undertaken in humans. Expert opinion: It seems evident in experimental settings that SCs in general (Adipose Derived SCs in particular) provide a feasible, safe and effective therapy for PD. The potential limits of the rat models used initially have been somewhat overcome with the inception of studies in men. However, further prospective studies are needed in humans to further elucidate the therapeutic potential of stem cell therapy in PD.
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Affiliation(s)
- Athanasios Dellis
- a University Department of Urology , Sismanoglio General Hospital , Athens , Greece
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Reed-Maldonado AB, Lue TF. The Current Status of Stem-Cell Therapy in Erectile Dysfunction: A Review. World J Mens Health 2016; 34:155-164. [PMID: 28053944 PMCID: PMC5209555 DOI: 10.5534/wjmh.2016.34.3.155] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 07/18/2016] [Accepted: 08/08/2016] [Indexed: 12/13/2022] Open
Abstract
Stem cells are undifferentiated cells that are capable of renewal and repair of tissue due to their capacity for division and differentiation. The purpose of this review is to describe recent advances in the use of stem cell (SC) therapy for male erectile dysfunction (ED). We performed a MEDLINE database search of all relevant articles regarding the use of SCs for ED. We present a concise summary of the scientific principles behind the usage of SC for ED. We discuss the different types of SCs, delivery methods, current pre-clinical literature, and published clinical trials. Four clinical trials employing SC for ED have been published. These articles are summarized in this review. All four report improvements in ED after SC therapy. SC therapy remains under investigation for the treatment of ED. It is reassuring that clinical trials thus far have reported positive effects on erectile function and few adverse events. Safety and methodical concerns about SC acquisition, preparation and delivery remain and require continued investigation prior to wide-spread application of these methods.
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Affiliation(s)
| | - Tom F Lue
- Department of Urology, University of California San Francisco, CA, USA
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Reed-Maldonado AB, Lue TF. Learning Penile Anatomy to Improve Function. J Urol 2016; 196:643-4. [PMID: 27316452 DOI: 10.1016/j.juro.2016.06.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 02/06/2023]
Affiliation(s)
| | - Tom F Lue
- Department of Urology, University of California-San Francisco, San Francisco, California
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Affiliation(s)
- Jae Heon Kim
- Department of Urology, Soonchunyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yun Seob Song
- Department of Urology, Soonchunyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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