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Role of oxidative stress and antioxidants in Peyronie's disease

International Journal of Impotence Research volume 14, pages 353–360 (2002)Cite this article

Although Francois Gigot de la Peyronie first reported penile curvature in 1743 and named it as Peyronie's disease the etiology, pathophysiology, and treatment of this now well-recognized penile condition remains complex and undetermined. Peyronie's disease usually affects 1–3% of males between the ages of 40 and 70, and the number of patients with such lesions have increased since the advent of oral sildenafil (Viagra, Pfizer) either because more men are becoming manifest and/or not hesitant anymore to come to clinics for such evaluations.1,2 Men with Peyronie's disease usually complain of palpable plaque, penile angulation with or without pain, decreased erectile function, some discomfort to their partners, and poor quality of their sexual life. Recent scientific developments in understanding the pathophysiology of this localized connective tissue disorder, which is characterized by the presence of one or more fibrous plaques has shown an excessive amount of collagen and elastin in the tunica albuginea of the penis.3,4 Both collagen and elastin play a vital role in the penile elasticity, rigidity, vascular compliance, and veno-occlusion mechanisms. Several etiological factors have been proposed to explain fibrosis and plaque formation in Peyronie's disease.5 The most common factors are: (a) repetitive penile trauma/inflammation,6 (b) low-level autoimmune response,7,8,9 (c) genetic predisposition, as witnessed by its association with Dupuytren's contracture and HLA-B7 antigens.10 The inflammatory response involves perivascular infiltration of lymphocytes, monocytes, and neutrophils at the site of injury.3 This is followed by excessive generation of free radicals called reactive oxygen species (ROS), and inflammatory cytokines (chemokines). During plaque formation, there is increased myofibroblast/fibroblast proliferation accompanied by overexpression of fibrin and collagen, the main extracellular matrix components of a Peyronie's plaque.8,11 Despite these many etiological theories, the scientific understanding of pathophysiology and treatment of Peyronie's disease is still in its infancy. This article focuses on our understanding of the nature of ROS, oxidative stress, and inflammation as related to etiology and pathophysiology of plaque formation and the role of ROS scavengers (antioxidants) towards possible prevention and/or therapy of Peyronie's disease.

ROS belong to the class of free radicals derived from oxygen and are highly reactive oxidizing agents. A free radical contains one or more unpaired electrons ready to be shared by other molecules, and this makes them very reactive. Biologically important ROS include superoxide (O2˙−) anion, hydrogen peroxide (H2O2), and the very reactive hydroxyl (OH˙), and peroxyl (ROO˙) radicals.12 In addition, some nitrogen-derived free radicals, eg nitric oxide (NO˙) and peroxynitrite anion (ONOO−), referred to as reactive nitrogen species, also belong to the class of ROS. Elevated levels of ROS have been implicated in numerous disease states, eg cancer, arthritis, connective tissue disorders, toxin exposure, physical injury, infection, inflammation, infertility, acquired immunodeficiency syndrome and aging. It seems that collective action of these ROS play a significant role in development of these diseases.13 Knowledge about the role of ROS and oxidative stress in Peyronie's disease is still primitive and an approach to counteract their impact on penile tissue with antioxidants (eg vitamin E) has met with limited success and is under investigation.

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Acknowledgements

Thanks to numerous Peyronie's patients for making us understand their problems, and also to Samar Sikka for his help in making the schematic diagrams.

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  1. Department of Urology, Tulane University Health Sciences Center, New Orleans, Lousiana, USA

    S C Sikka & W J G Hellstrom

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Correspondence to S C Sikka.

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Sikka, S., Hellstrom, W. Role of oxidative stress and antioxidants in Peyronie's disease. Int J Impot Res 14, 353–360 (2002). https://doi.org/10.1038/sj.ijir.3900880

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