脂肪源性干细胞治疗阴茎勃起功能障碍的研究进展

脂肪源性干细胞(ADSCs)是从脂肪组织中分离得到的一种多能干细胞,具有自我更新和多向分化潜能,可向神经细胞、平滑肌细胞及内皮细胞等多种细胞类型分化。而勃起功能障碍(ED)是一种常见的男性性功能障碍疾病,对患者及其伴侣的生活造成了很大的负面影响。目前治疗ED的方法有手术及药物等,其中5-磷酸二酯酶抑制剂作为临床治疗ED的一线用药,仍对少部分患者不敏感,而且存在无法改善或者治愈ED的病理基础。迄今为止的动物试验及临床前期研究已经证实了ADSCs治疗ED的安全性及有效性,其可通过旁分泌作用达到治疗ED的作用。本文就近5年来ADSCs治疗ED的研究进展进行综述。     

干细胞治疗勃起功能障碍的研究进展

ED是常见的男科疾病,传统的药物常常不能达到满意的治疗效果.而干细胞疗法是生物医学的新领域,近年来针对其治疗ED的研究数量显著增加.本文主要包含了干细胞治疗ED的临床前研究及相关临床研究,临床前研究的动物模型主要分为糖尿病、阴茎海绵体损伤、老龄化和阴茎硬结症性ED.既往研究表明干细胞主要以旁分泌的方式改善阴茎的勃起功能...     

海绵体神经损伤导致阴茎勃起功能障碍的研究进展

神经性勃起功能障碍(erectile eysfunction,ED)是成年男性常见的疾病之一,海绵体神经(cavernous nerves,CN)损伤性是其发生的常见病因。近年来,随着临床上各种盆腔手术(如前列腺癌、膀胱癌、直肠癌根治术等)、放疗和经尿道手术等手术的增加,医源性海绵体神经损伤也逐渐增多。尽管采用了避免CN损伤(如保留CN的根治术等)的手术方法,术后勃起功能障碍仍是影响患者术后生活质量的重要原因。     

勃起功能障碍的干细胞治疗研究进展

勃起功能障碍(erectile dvsfunction,ED)是指阴茎持续不能达到和维持充分的勃起以获得满意的性生活.美国MMAS(Massachusetts Male Aging Study)调查[1]表明,40～50岁成年男性中ED的发生率为54.8%(其中轻度20%,中度25.2%,重度9.6%).ED作为男科中一种常见的疾病,往往给患者本人和家庭均带来极大的痛苦,且不利于社会和家庭的稳定与和谐.因此寻求有效治疗ED的方法成了当前的研究热点之一.     

海绵体神经损伤性勃起功能障碍治疗研究进展

随着前列腺手术的广泛开展和骨盆骨折尿道损伤患者的不断增多,海绵体神经损伤性阴茎勃起功能障碍越来越受到关注。海绵体神经损伤后,阴茎平滑肌和内皮细胞凋亡,NOS阳性神经密度降低,进而出现海绵体平滑肌纤维化。损伤后的神经再生策略一直是ED研究的热点之一。本综述将围绕促进海绵体神经再生的治疗策略,讨论海绵体神经损伤性ED治疗的基础及临床研究现状,既涉及神经营养因子、RhoA/ROCK抑制剂、亲免素配体、促红细胞生成素、干细胞治疗、基因治疗等传统策略,也包含富血小板血浆和低强度体外冲击波治疗等易于临床转化的新的治疗方式。本综述旨在为相关领域学者提供参考,以期开展更多具有较高临床转化意义的研究。     

阴茎勃起功能障碍基因治疗的现状与前景

近20年来,基础研究和临床相结合使对阴茎勃起功能障碍(ED)的诊治水平明显提高。血管活性药物海绵体内注射、负压缩窄装置、阴茎假体植入术、经尿道给药和口服药物为医生提供了纠正严重器质性ED的机会。然而,目前所有的治疗方法都存在着不同程度的副作用。未来理想的ED治疗方法应该在具备良好疗效的同时,很少或没有副作用。近年来,采用基因工程治疗ED的初步研究展示了美好的前景。     

干细胞治疗糖尿病阴茎勃起功能障碍的研究进展

糖尿病阴茎勃起功能障碍(DED)是糖尿病(DM)的一种常见并发症。DED不仅给患者带来了严重的身心创伤, 还可影响家庭稳定和社会安定。DED的患病率约为67.4%, 其病理生理过程涉及神经传递、血管内皮、内分泌功能等多种因素, 其中血管和海绵体损伤为其首要原因。DED的临床治疗仍存在局限性, 且这些治疗方法仅限于缓解症状, 而不能从根本上解决问题。目前, 干细胞疗法(SCT)被广泛应用于再生医学领域, 随着SCT在动物实验上的不断成功, 其作为治疗DED的新疗法备受关注。本文就目前SCT治疗DED的研究进展作一综述。     

勃起功能障碍的药物治疗

勃起功能障碍的定义勃起功能障碍(erectile dysfunction,ED)是指持续或反复不能达到或维持足够阴茎勃起以完成满意性生活。ED是根据患者主诉来诊断的一种疾患,病程至少3个月以上。ED的病因很多,通过病史、体检、实验室检查和一些特殊检查,以期明确ED的病因是心因性还是器质性还是混合性ED,以及ED的程度(轻度、中度还是重度)。勃起功能障碍治疗的选择对ED治疗方法的选择,主要根据ED的病因、程度、医师的经验、患者的愿望以及技术条件等,此外尚需考虑到传统、伦理、社会经济状况及患者和配偶的喜好、期望和心理状况,还要考虑到宗教信仰…     

1160例阴茎勃起功能障碍的病因分析

目的探讨成年男性阴茎勃起功能障碍(ED)的病因。方法对年龄在19—69岁之间的ED患者1160例进行了详细的病史询问、IIEF-5评分表评估、阴茎勃起硬度监测(NEVA，Rigiscan)、性激素全套测定、彩色多普勒检查(Knoll)等，综合分析其病因和临床特点。结果单纯心因性ED者726例(62．6％)，单纯器质性ED者84例(7．2％)，心因性和器质性并存者350例(30．2％)。在后两者中，血管性ED有297例(68．4％)，其中静脉性175例，动脉性122例。内分泌异常引起的ED55例，药源性16例，神经源性21例，多种因素混杂的45例。结论1160例ED患者中心因性ED仍占多数，器质性ED中血管性ED最常见。随年龄增加，其器质性病因增多，ED程度加重。     

Comparative study of different transplantation methods of adipose tissue-derived stem cells in the treatment of erectile dysfunction caused by cavernous nerve injury

We aimed to compare intracavernosal injection (ICI), tail vein injection (IV), and periprostatic injection (PPI) of adipose-derived stem cells (ADSCs) for their ability to improve erectile function in cavernous nerve injury-induced erectile dysfunction (CNIED) rats and to explore the possible mechanism. Eighty-four male SD rats were divided into the sham group (n = 6), BCNI group (bilateral CN crush injury, n = 6), PBS-ICI group (n = 6), PBS-IV group (n = 6), PBS-PPI group (n = 6), ADSC-ICI group (n = 18), ADSC-IV group (n = 18) and ADSC-PPI group (n = 18). ADSCs were labelled with 5-ethynyl-2′-deoxyuridine (EdU), and six rats each in the ADSC-ICI group, ADSC-IV group, and ADSC-PPI group were sacrificed 2, 7, and 28 days after injection. EdU-labelled ADSCs were tracked by immunofluorescence staining. The intracavernosal pressure (ICP)/mean arterial pressure (MAP) ratio, neuronal nitric oxide synthase (nNOS)-positive nerve fibres in the dorsal penile nerve and the smooth muscle/collagen ratio in the cavernosum between groups were also evaluated. ADSCs can significantly improve erectile function through ICI or IV. The two are similar in efficacy and superior to PPI. The mechanism may be that after CN injury, ADSCs are recruited to around the MPG and secrete a variety of neurotrophic factors that promote the repair of the CN, thereby improving erectile function.     

The development of a rat model of erectile dysfunction after radical prostatectomy: preliminary findings

OBJECTIVE

To develop a rat model of erectile dysfunction (ED) after cavernous nerve injury.

MATERIALS AND METHODS

Given the great similarity between the anatomical structure of the cavernous nerve in rats and humans, 24 rats underwent dissections and the cavernous nerves were identified with the aid of an operating microscope. Then the rats were randomized into two groups: sham‐operated controls and a bilateral cavernous nerve section group. At 3 months after surgery, the rats were evaluated for their response to an apomorphine challenge.

RESULTS

The erectile response after an apomorphine challenge was normal in all the control rats, while there were no erections in the bilateral injured group.

CONCLUSION

The rat major autonomic ganglion and its cavernous nerve can be identified with the aid of a microscope. Rats are inexpensive and easy to handle, thus a good animal for developing an ED model of cavernous nerve injury. In the present study, the rats with cavernous nerve injury lost erectile capacity in a reliable and reproducible fashion. Because of the great similarity between the cavernous nerve of rats and humans, one may consider this technique as a reliable experimental model for studying ED after radical prostatectomy.     

内皮细胞凋亡与勃起功能障碍的研究进展

勃起功能障碍(ED)是泌尿男科最常见的疾病之一,严重影响患者的生活质量,引起ED的因素包括衰老、糖尿病、高血压、高脂血症以及不良生活方式等,其确切机制尚未完全明确。目前随着对ED研究的不断深入,其中阴茎海绵体内皮细胞凋亡与ED的关系倍受关注,内皮细胞凋亡增加可引起NOS活性降低导致NO合成受阻,从而影响阴茎勃起,不同病因引起的ED其内皮细胞凋亡的机制不同。本文就阴茎海绵体内皮细胞凋亡在ED中的作用作一综述,对ED与内皮细胞凋亡机制的深入了解将为新药研制及其他治疗措施提供新的思路。     

Progress and prospect of stem cell therapy for diabetic erectile dysfunction

Diabetic erectile dysfunction (DED) is a common complication of diabetes mellitus, significantly impairing the quality of life of patients. The conventional clinical treatment still has limitations. Stem cells (SCs), as a type of cells with multidirectional or directional differentiation capability and sustainable self-renewal potential, are widely used in regenerative medicine and tissue engineering. With the continuous update of regenerative medicine theory and the success of animal experiments, SCs as a treatment for male erectile dysfunction, especially DED, have attracted widespread attention because of curable possibility. This review focus on the current progress in the clinical application of SC treatment for DED. Moreover, we summarize the development prospects of SCs in the field of DMED therapy.     

Stem cells: novel players in the treatment of erectile dysfunction

Stem cells are defined by their capacity for both self-renewal and directed differentiation; thus, they represent great promise for regenerative medicine. Historically, stem cells have been categorized as either embryonic stem cells (ESCs) or adult stem cells (ASCs). It was previously believed that only ESCs hold the ability to differentiate into any cell type, whereas ASCs have the capacity to give rise only to cells of a given germ layer. More recently, however, numerous studies demonstrated the ability of ASCs to differentiate into cell types beyond their tissue origin. The aim of this review was to summarize contemporary evidence regarding stem cell availability, differentiation, and more specifically, the potential of these cells in the diagnosis and treatment of erectile dysfunction (ED) in both animal models and human research. We performed a search on PubMed for articles related to definition, localisation and circulation of stem cells as well as the application of stem cells in both diagnosis and treatment of ED. Strong evidence supports the concept that stem cell therapy is potentially the next therapeutic approach for ED. To date, a large spectrum of stem cells, including bone marrow mesenchymal stem cells, adipose tissue-derived stem cells and muscle-derived stem cells, have been investigated for neural, vascular, endothelial or smooth muscle regeneration in animal models for ED. In addition, several subtypes of ASCs are localized in the penis, and circulating endogenous stem cells can be employed to predict the outcome of ED and ED-related cardiovascular diseases.     

阴茎勃起功能障碍的基因治疗进展

50～70岁男性中50%以上患有勃起功能障碍(ED),40岁的男性中有40%的患有不同程度的ED,全球范围内ED患者已超过1亿人,ED已成为困扰全球男性的重要疾病之一。在过去的20年里,对于ED发生机制及治疗有了很大的进展,现有的PDE5抑制剂对大部分ED患者疗效较好,但是对糖尿病性ED、前列腺癌根治术后ED及严重的心血管病变导致的ED疗效欠佳。人们正在寻找更好的治疗ED的方法——基因治疗。本文总结了近年来临床前期基因治疗ED的新进展,即糖尿病ED、老年性ED、神经损伤性ED及血管病变导致的ED的基因治疗。     

多普勒超声在静脉性勃起功能障碍诊断中的应用价值研究

目的：探讨Doppler超声在静脉性勃起功能障碍（ED）诊断中的应用价值。方法：10例静脉性ED者在阴茎海绵体内血管活性药物注射（ICI）后，行Doppler超声检查，并同时海绵体内灌注生理盐水，动态观察不同勃起状态海绵体动脉舒张期血流变化，30例心理性ED者仅ICI后行Doppler超声检查作对照。结果：静脉性ED者在勃起硬度差时，海绵体动脉舒张期表现为前向血流（正值表示），随着海绵体内生理盐水灌注后，勃起硬度逐渐增加，舒张末期血流消失；达正常勃起时，舒张期表现逆向血清（负值表示）。心理性ED者在阴茎膨胀期、海绵体动脉舒张期表现前向血流，正常勃起时，舒张期表现逆向血流。结论：在海绵体动脉供血正常情况下，静脉关闭障碍导致海绵体内压受损，舒张期出现血流动力学异常，前向血流为一特征性表现，因此Doppler超声在静脉性勃起功能障百的诊断中具有一定价值。     

Effect of mesenchymal stem cell penile transplantation on erectile signaling of aged rats

Stem cell‐based therapy targeted at the penile tissue has been lately considered in preclinical studies. This work aimed to assess the effect of intracavernous administration of mesenchymal stem cells (MSCs) in aged rats (n = 100). They were subjected to single intracavernous injection (ICI) of 1.0 million MSCs, followed up for 3, 4 weeks, 3 and 4 months (each group 25 rats) and compared with both adult and aged controls (n = 50). In dissected cavernous tissues, cGMP and histopathology were assessed in addition to intracavernous pressure (ICP) measurement in some anaesthetised rats. The results showed that cavernous tissue cGMP was significantly increased in MSCs transplanted rats in all investigated groups compared with the controls. The mean cavernous cGMP levels after 3 and 4 months of MSCs transplantation were significantly increased compared with those after 3 or 4 weeks. Cavernous tissue ICP measurement showed significant increase in MSCs transplanted groups compared with the controls, more in the long‐term follow up than in the shorter one. Histopathological examination detected markedly dilated sinusoidal vascular spaces in the long‐term follow‐up study. It is concluded that stem cell‐based therapy is feasible for age‐associated erectile dysfunction and could improve erectile signaling.