Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Endothelial dysfunction in diabetic erectile dysfunction

Abstract

Erectile dysfunction (ED) is highly prevalent in diabetes mellitus. Pathophysiological mechanisms underlying diabetes-associated ED are in large part due to endothelial dysfunction, which functionally refers to the inability of the endothelium to produce vasorelaxing messengers and to maintain vasodilation and vascular homeostasis. The precise mechanisms leading to endothelial dysfunction in the diabetic vasculature, including the penis, are not yet fully understood. Hyperglycemia affects endothelial nitric oxide synthase activity and nitric oxide production/bioavailability, nitric oxide-independent relaxing factors, oxidative stress, production and/or action of hormones, growth factors and/or cytokines, and generation and activity of opposing vasoconstrictors. Considering recent advances in the field of vascular biology and diabetes, the emphasis in this review is placed on the mechanisms of hyperglycemia-induced endothelial dysfunction in the pathophysiology of diabetes-associated ED.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Meuleman EJ . Prevalence of erectile dysfunction: need for treatment? Int J Impot Res 2002; 14 (Suppl 1): S22–S28.

    PubMed  Google Scholar 

  2. Billups KL . Erectile dysfunction as an early sign of cardiovascular disease. Int J Impot Res 2005; 17 (Suppl 1): S19–S24.

    PubMed  Google Scholar 

  3. World Health Organization. Diabetes Mellitus. Fact Sheet No. 138, 2002.

  4. Hakim LS, Goldstein I . Diabetic sexual dysfunction. Endocrinol Metab Clin North Am 1996; 25: 379–400.

    CAS  PubMed  Google Scholar 

  5. Creager MA, Luscher TF, Cosentino F, Beckman JA . Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Circulation 2003; 108: 1527–1532.

    PubMed  Google Scholar 

  6. Du X, Matsumura T, Edelstein D, Rossetti L, Zsengeller Z, Szabo C et al. Inhibition of GAPDH activity by poly(ADP-ribose) polymerase activates three major pathways of hyperglycemic damage in endothelial cells. J Clin Invest 2003; 112: 1049–1057.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Du X, Edelstein D, Obici S, Higham N, Zou MH, Brownlee M . Insulin resistance reduces arterial prostacyclin synthase and eNOS activities by increasing endothelial fatty acid oxidation. J Clin Invest 2006 Mar 9; [E-pub ahead of print].

  8. Esposito K, Giugliano F, Martedi E, Feola G, Marfella R, D’Armiento M et al. High proportions of erectile dysfunction in men with the metabolic syndrome. Diabet Care 2005; 28: 1201–1203.

    Google Scholar 

  9. Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D’Andrea F et al. Effect of lifestyle changes on erectile dysfunction in obese men. randomized controlled trial. JAMA 2004; 291: 2978–2984.

    CAS  PubMed  Google Scholar 

  10. Vernet D, Cai L, Garban H, Babbitt ML, Murray FT, Rajfer J et al. Reduction of penile nitric oxide synthase in diabetic BB/WORdp (type I) and BBZ/WORdp (type II) rats with erectile dysfunction. Endocrinology 1995; 136: 5709–5717.

    CAS  PubMed  Google Scholar 

  11. Escrig A, Marin R, Abreu P, Gonzalez-Mora JL, Mas M . Changes in mating behavior, erectile function, and nitric oxide levels in penile corpora cavernosa in streptozotocin-diabetic rats. Biol Reprod 2002; 66: 185–189.

    CAS  PubMed  Google Scholar 

  12. Bivalacqua TJ, Usta MF, Champion HC, Adams D, Namara DB, Abdel-Mageed AB et al. Gene transfer of endothelial nitric oxide synthase partially restores nitric oxide synthesis and erectile function in streptozotocin diabetic rats. J Urol 2003; 169: 1911–1917.

    Article  CAS  PubMed  Google Scholar 

  13. Bivalacqua TJ, Champion HC, Usta MF, Cellek S, Chitaley K, Webb RC et al. RhoA/Rho-kinase suppresses endothelial nitric oxide synthase in the penis: A mechanism for diabetes-associated erectile dysfunction. Proc Natl Acad Sci USA 2004; 101: 9121–9126.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Park CS, Ryu SD, Hwang SY . Elevation of intracavernous pressure and NO-cGMP activity by a new herbal formula in penile tissues of aged and diabetic rats. J Ethnopharmacol 2004; 94: 85–92.

    PubMed  Google Scholar 

  15. Akingba AG, Burnett AL . Endothelial nitric oxide synthase protein expression, localization, and activity in the penis of the alloxan-induced diabetic rat. Mol Urol 2001; 5: 189–197.

    CAS  PubMed  Google Scholar 

  16. Podlasek CA, Zelner DJ, Bervig TR, Gonzalez CM, McKenna KE, McVary KT . Characterization and localization of nitric oxide synthase isoforms in the BB/WOR diabetic rat. J Urol 2001; 166: 746–755.

    CAS  PubMed  Google Scholar 

  17. Bivalacqua TJ, Usta MF, Champion HC, Leungwattanakij S, Dabisch PA, McNamara DB et al. Effect of combination endothelial nitric oxide synthase gene therapy and sildenafil on erectile function in diabetic rats. Int J Impot Res 2004; 16: 21–29.

    CAS  PubMed  Google Scholar 

  18. Musicki B, Kramer MF, Becker RE, Burnett AL . Inactivation of phosphorylated endothelial nitric oxide synthase (Ser-1177) by O-GlcNAc in diabetes-associated erectile dysfunction. Proc Natl Acad Sci USA 2005; 102: 11870–11875.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Li H, Wallerath T, Munzel T, Forstermann U . Regulation of endothelial-type NO synthase expression in pathophysiology and in response to drugs. Nitric Oxide 2002; 7: 149–164.

    CAS  PubMed  Google Scholar 

  20. Yildirim S, Ayan S, Sarioglu Y, Gultekin Y, Butunet C . The effects of long-term oral administration of l-arginine on the erectile response of rabbits with alloxan-induced diabetes. BJU Int 1999; 83: 679–685.

    CAS  PubMed  Google Scholar 

  21. Gur S, Ozturk B, Karahan ST . Impaired endothelium-dependent and neurogenic relaxation of corpus cavernosum from diabetic rats: improvement with L-arginine. Urol Res 2000; 28: 14–19.

    CAS  PubMed  Google Scholar 

  22. Lin KY, Ito A, Asagami T, Tsao PS, Adimoolam S, Kimoto M et al. Impaired nitric oxide synthase pathway in diabetes mellitus: role of asymmetric dimethylarginine and dimethylarginine dimethylaminohydrolase. Circulation 2002; 106: 987–992.

    CAS  PubMed  Google Scholar 

  23. Posch K, Simecek S, Wascher TC, Jurgens G, Baumgartnwe-Parzer S, Kostner GM et al. Glycated low-density lipoprotein attenuates shear stress-induced nitric oxide synthesis by inhibition of shear stress-activated L-arginine uptake in endothelial cells. Diabetes 1999; 48: 1331–1337.

    CAS  PubMed  Google Scholar 

  24. Cox JD, Kim NN, Traish AM, Christianson DW . Arginase-boronic acid complex highlights a physiological role in erectile function. Nat Struct Biol 1999; 6: 1043–1047.

    CAS  PubMed  Google Scholar 

  25. Bivalacqua TJ, Hellstrom WJ, Kadowitz PJ, Champion HC . Increased expression of arginase II in human diabetic corpus cavernosum: in diabetic-associated erectile dysfunction. Biochem Biophys Res Commun 2001; 283: 923–927.

    CAS  PubMed  Google Scholar 

  26. Kim NN, Cox JD, Baggio RF, Emig FA, Mistry SK, Harper SL et al. Probing erectile function: S-(2-boronoethyl)-L-cysteine binds to arginase as a transition state analogue and enhances smooth muscle relaxation in human penile corpus cavernosum. Biochemistry 2001; 40: 2678–2688.

    CAS  PubMed  Google Scholar 

  27. Vasquez-Vivar J, Kalyanaraman B, Martasek P, Hogg N, Masters BS, Karoui H et al. Superoxide generation by endothelial nitric oxide synthase: the influence of cofactors. Proc Natl Acad Sci USA 1998; 95: 9220–9225.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Zou MH, Shi C, Cohen RA . Oxidation of the zinc-thiolate complex and uncoupling of endothelial nitric oxide synthase by peroxynitrite. J Clin Invest 2002; 109: 817–826.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Pieper GM . Acute amelioration of diabetic endothelial dysfunction with a derivative of the nitric oxide synthase cofactor tetrahydrobiopterin. J Cardiovasc Pharmacol 1997; 29: 8–15.

    CAS  PubMed  Google Scholar 

  30. Heitzer T, Krohn K, Albers S, Meinertz T . Tetrahydrobiopterin improves endothelium-dependent vasodilation by increasing nitric oxide activity in patients with Type II diabetes mellitus. Diabetologia 2000; 43: 1435–1438.

    CAS  PubMed  Google Scholar 

  31. Hurt KJ, Musicki B, Palese MA, Crone JK, Becker RE, Moriarity JL et al. Akt-dependent phosphorylation of endothelial nitric-oxide synthase mediates penile erection. Proc Natl Acad Sci USA 2002; 99: 4061–4066.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Ryu JK, Cho CH, Shin HY, Song SU, Oh SM, Lee M et al. Combined Angiopoietin-1 and vascular endothelial growth factor gene transfer restores cavernous angiogenesis and erectile function in a rat model of hypercholesterolemia. Mol Ther 2005 Dec 24; [E-pub ahead of print].

  33. Di Villa Bianca R, Sorrentino R, Sorrentino R, Imbimbo C, Palmieri A, Fusco F et al. Sphingosine 1-phosphate induces endothelial nitric-oxide synthase activation through phosphorylation in human corpus cavernosum. J Pharmacol Exp Ther 2006; 316: 703–708.

    PubMed  Google Scholar 

  34. Xie D, Kontos CD, Donatucci CF, Annex BH . Cholesterol feeding reduces vascular endothelial growth factor signaling in rabbit corporal tissues. J Sex Med 2005; 2: 634–640.

    CAS  PubMed  Google Scholar 

  35. Dimmeler S, Fleming I, Fisslthaler B, Hermann C, Busse R, Zeiher AM . Activation of nitric oxide synthase in endothelial cells by Akt-dependent phosphorylation. Nature 1999; 399: 601–605.

    CAS  PubMed  Google Scholar 

  36. Fulton D, Gratton JP, McCabe TJ, Fontana J, Fujio Y, Walsh K et al. Regulation of endothelium-derived nitric oxide production by the protein kinase Akt. Nature 1999; 399: 597–601.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Burnett AL, Lowenstein CJ, Bredt DS, Chang TS, Snyder SH . Nitric oxide: a physiologic mediator of penile erection. Science 1992; 57: 401–403.

    Google Scholar 

  38. Michell BJ, Chen ZP, Tiganis T, Stapleton D, Katsis F, Power DA et al. Coordinated control of endothelial nitric-oxide synthase phosphorylation by protein kinase C and the cAMP-dependent protein kinase. J Biol Chem 2001; 276: 17625–17628.

    CAS  PubMed  Google Scholar 

  39. Du XL, Edelstein D, Dimmeler S, Ju Q, Sui C, Brownlee M . Hyperglycemia inhibits endothelial nitric oxide synthase activity by posttranslational modification at the Akt site. J Clin Invest 2001; 108: 1341–1348.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Federici M, Menghini R, Mauriello A, Hribal ML, Ferrelli F, Lauro D et al. Insulin-dependent activation of endothelial nitric oxide synthase is impaired by O-linked glycosylation modification of signaling proteins in human coronary endothelial cells. Circulation 2002; 106: 466–472.

    CAS  PubMed  Google Scholar 

  41. Garcia-Cardena G, Fan R, Shah V, Sorrentino R, Cirino G, Papapetropoulos A et al. Dynamic activation of endothelial nitric oxide synthase by Hsp90. Nature 1998; 392: 821–824.

    CAS  PubMed  Google Scholar 

  42. Fontana J, Fulton D, Chen Y, Fairchild TA, McCabe TJ, Fujita N et al. Domain mapping studies reveal that the M domain of hsp90 serves as a molecular scaffold to regulate Akt-dependent phosphorylation of endothelial nitric oxide synthase and NO release. Circ Res 2002; 90: 866–873.

    CAS  PubMed  Google Scholar 

  43. Takahashi S, Mendelsohn ME . Synergistic activation of endothelial nitric-oxide synthase (eNOS) by HSP90 and Akt: calcium-independent eNOS activation involves formation of an HSP90-Akt-CaM-bound eNOS complex. J Biol Chem 2003; 278: 30821–30827.

    CAS  PubMed  Google Scholar 

  44. Lin LY, Lin CY, Ho FM, Liau CS . Up-regulation of the association between heat shock protein 90 and endothelial nitric oxide synthase prevents high glucose-induced apoptosis in human endothelial cells. J Cell Biochem 2005; 94: 194–201.

    CAS  PubMed  Google Scholar 

  45. Davis BJ, Xie Z, Viollet B, Zou MH . Activation of the AMP-activated kinase by antidiabetes drug metformin stimulates nitric oxide synthesis in vivo by promoting the association of heat shock protein 90 and endothelial nitric oxide synthase. Diabetes 2006; 55: 496–505.

    CAS  PubMed  Google Scholar 

  46. Garcia-Cardena G, Martasek P, Masters BS, Skidd PM, Couet J, Li S et al. Dissecting the interaction between nitric oxide synthase (NOS) and caveolin. Functional significance of the nos caveolin binding domain in vivo. J Biol Chem 1997; 272: 25437–25440.

    CAS  PubMed  Google Scholar 

  47. Michel JB, Feron O, Sacks D, Michel T . Reciprocal regulation of endothelial nitric-oxide synthase by Ca2+-calmodulin and caveolin. J Biol Chem 1997; 272: 15583–15586.

    CAS  PubMed  Google Scholar 

  48. Bucci M, Roviezzo F, Brancaleone V, Lin MI, Di Lorenzo A, Cicala C et al. Diabetic mouse angiopathy is linked to progressive sympathetic receptor deletion coupled to an enhanced caveolin-1 expression. Arterioscler Thromb Vasc Biol 2004; 24: 721–726.

    CAS  PubMed  Google Scholar 

  49. Bakircioglu ME, Sievert KD, Nunes L, Lau A, Lin CS, Lue TF . Decreased trabecular smooth muscle and caveolin-1 expression in the penile tissue of aged rats. J Urol 2001; 166: 734–738.

    CAS  PubMed  Google Scholar 

  50. Linder AE, Leite R, Lauria K, Mills TM, Webb RC . Penile erection requires the association of soluble guanylyl cyclase with endothelial caveolin-1 in rat corpus cavernosum. Am J Physiol Regul Integr Comp Physiol 2005 Dec 22; [E-pub ahead of print].

  51. Munzel T, Daiber A, Ullrich V, Mulsch A . Vascular consequences of endothelial nitric oxide synthase uncoupling for the activity and expression of the soluble guanylyl cyclase and the cGMP-dependent protein kinase. Arterioscler Thromb Vasc Biol 2005; 25: 1551–1557.

    PubMed  Google Scholar 

  52. Cai S, Khoo J, Mussa S, Alp NJ, Channon KM . Endothelial nitric oxide synthase dysfunction in diabetic mice: importance of tetrahydrobiopterin in eNOS dimerization. Diabetologia 2005; 48: 1933–1940.

    CAS  PubMed  Google Scholar 

  53. Zou MH, Hou XY, Shi CM, Nagata D, Walsh K, Cohen RA . Modulation by peroxynitrite of Akt- and AMP-activated kinase-dependent Ser1179 phosphorylation of endothelial nitric oxide synthase. J Biol Chem 2002; 277: 32552–32557.

    CAS  PubMed  Google Scholar 

  54. Fleming I, Mohamed A, Galle J, Turchanowa L, Brandes RP, Fisslthaler B et al. Oxidized low-density lipoprotein increases superoxide production by endothelial nitric oxide synthase by inhibiting PKCalpha. Cardiovasc Res 2005; 65: 897–906.

    CAS  PubMed  Google Scholar 

  55. Pritchard Jr KA, Ackerman AW, Gross ER, Stepp DW, Shi Y, Fontana YT et al. Heat shock protein 90 mediates the balance of nitric oxide and superoxide anion from endothelial nitric-oxide synthase. J Biol Chem 2001; 276: 17621–17624.

    CAS  PubMed  Google Scholar 

  56. Tuncayengin A, Biri H, Onaran M, Sen I, Tuncayengin O, Polat F et al. Cavernosal tissue nitrite, nitrate, malondialdehyde and glutathione levels in diabetic and non-diabetic erectile dysfunction. Int J Androl 2003; 26: 250–254.

    CAS  PubMed  Google Scholar 

  57. Bivalacqua TJ, Usta MF, Kendirci M, Pradhan L, Alvarez X, Champion HC et al. Superoxide anion production in the rat penis impairs erectile function in diabetes: influence of in vivo extracellular superoxide dismutase gene therapy. J Sex Med 2005; 2: 187–198.

    CAS  PubMed  Google Scholar 

  58. Paskaloglu K, Sener G, Ayangolu-Dulger G . Melatonin treatment protects against diabetes-induced functional and biochemical changes in rat aorta and corpus cavernosum. Eur J Pharmacol 2004; 499: 345–354.

    CAS  PubMed  Google Scholar 

  59. Ryu JK, Kim DJ, Lee T, Kang YS, Yoon SM, Suh JK . The role of free radical in the pathogenesis of impotence in streptozotocin-induced diabetic rats. Yonsei Med J 2003; 44: 236–241.

    CAS  PubMed  Google Scholar 

  60. Nangle MR, Cotter MA, Cameron NE . Correction of nitrergic neurovascular dysfunction in diabetic mouse corpus cavernosum by p38 mitogen-activated protein kinase inhibition. Int J Impot Res 2005 Dec 15; [E-pub ahead of print].

  61. Igarashi M, Wakasaki H, Takahara N, Ishii H, Jiang ZY, Yamauchi T et al. Glucose or diabetes activates p38 mitogen-activated protein kinase via different pathways. J Clin Invest 1999; 103: 185–195.

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Yeni E, Gulum M, Selek S, Erel O, Unal D, Verit A et al. Comparison of oxidative/antioxidative status of penile corpus cavernosum blood and peripheral venous blood. Int J Impot Res 2005; 17: 19–22.

    CAS  PubMed  Google Scholar 

  63. De Young L, Yu D, Bateman RM, Brock GB . Oxidative stress and antioxidant therapy: their impact in diabetes-associated erectile dysfunction. J Androl 2004; 25: 830–836.

    PubMed  Google Scholar 

  64. Gocmen C, Secilmis A, Kumcu EK, Ertug PU, Onder S, Dikmen A et al. Effects of vitamin E and sodium selenate on neurogenic and endothelial relaxation of corpus cavernosum in the diabetic mouse. Eur J Pharmacol 2000; 398: 93–98.

    CAS  PubMed  Google Scholar 

  65. Gur S, Karahan ST, Ozturk B, Badilli M . Effect of ascorbic acid treatment on endothelium-dependent and neurogenic relaxation of corpus cavernosum from middle-aged non-insulin dependent diabetic rats. Int J Urol 2005; 12: 821–828.

    CAS  PubMed  Google Scholar 

  66. Keegan A, Cotter MA, Cameron NE . Corpus cavernosum dysfunction in diabetic rats: effects of combined alpha-lipoic acid and gamma-linolenic acid treatment. Diabetes Metab Res Rev 2001; 17: 380–386.

    CAS  PubMed  Google Scholar 

  67. Khan MA, Thompson CS, Jeremy JY, Mumtaz FH, Mikhailidis P, Morgan RJ . The effect of superoxide dismutase on nitric oxide-mediated and electrical field-stimulated diabetic rabbit cavernosal smooth muscle relaxation. BJU Int 2001; 87: 98–103.

    CAS  PubMed  Google Scholar 

  68. Keegan A, Cotter MA, Cameron NE . Effects of chelator treatment on aorta and corpus cavernosum from diabetic rats. Free Radic Biol Med 1999; 27: 536–543.

    CAS  PubMed  Google Scholar 

  69. Nangle MR, Cotter MA, Cameron NE . Effects of the peroxynitrite decomposition catalyst, FeTMPyP, on function of corpus cavernosum from diabetic mice. Eur J Pharmacol 2004; 502: 143–148.

    CAS  PubMed  Google Scholar 

  70. Lassègue B, Clempus RE . Vascular NAD(P)H oxidases: specific features, expression, and regulation. Am J Physiol Regul Integr Comp Physiol 2003; 285: R277–R297.

    PubMed  Google Scholar 

  71. Quagliaro L, Piconi L, Assaloni R, Martinelli L, Motz E, Ceriello A . Intermittent high glucose enhances apoptosis related to oxidative stress in human umbilical vein endothelial cells: the role of protein kinase C and NAD(P)H-oxidase activation. Diabetes 2003; 52: 2795–2804.

    CAS  PubMed  Google Scholar 

  72. Hink U, Li H, Mollnau H, Oelze M, Matheis E, Hartmann M et al. Mechanisms underlying endothelial dysfunction in diabetes mellitus. Circ Res 2001; 88: E14–E22.

    CAS  PubMed  Google Scholar 

  73. Wendt MC, Daiber A, Kleschyov AL, Mulsch A, Sydow K, Schulz E et al. Differential effects of diabetes on the expression of the gp91phox homologues nox1 and nox4. Free Radic Biol Med 2005; 39: 381–391.

    CAS  PubMed  Google Scholar 

  74. Guzik TJ, Mussa S, Gastaldi D, Sadowski J, Ratnatunga C, Pillai R et al. Mechanisms of increased vascular superoxide production in human diabetes mellitus: role of NAD(P)H oxidase and endothelial nitric oxide synthase. Circulation 2002; 105: 1656–1662.

    CAS  PubMed  Google Scholar 

  75. Shukla N, Jones R, Persad R, Angelini GD, Jeremy JY . Effect of sildenafil citrate and a nitric oxide donating sildenafil derivative, NCX 911, on cavernosal relaxation and superoxide formation in hypercholesterolaemic rabbits. Eur J Pharmacol 2005; 517: 224–231.

    CAS  PubMed  Google Scholar 

  76. Koupparis AJ, Jeremy JY, Muzaffar S, Persad R, Shukla N . Sildenafil inhibits the formation of superoxide and the expression of gp47 NAD[P]H oxidase induced by the thromboxane A2 mimetic, U46619, in corpus cavernosal smooth muscle cells. BJU Int 2005; 96: 423–427.

    CAS  PubMed  Google Scholar 

  77. Molnar J, Yu S, Mzhavia N, Pau C, Chereshnev I, Dansky HM . Diabetes induces endothelial dysfunction but does not increase neointimal formation in high-fat diet fed C57BL/6J mice. Circ Res 2005; 96: 1178–1184.

    CAS  PubMed  Google Scholar 

  78. Brownlee M . Biochemistry and molecular cell biology of diabetic complications. Nature 2001; 414: 813–820.

    CAS  PubMed  Google Scholar 

  79. Keegan A, Jack AM, Cotter MA, Cameron NE . Effects of aldose reductase inhibition on responses of the corpus cavernosum and mesenteric vascular bed of diabetic rats. J Cardiovasc Pharmacol 2000; 35: 606–613.

    CAS  PubMed  Google Scholar 

  80. Seftel AD, Vaziri ND, Ni Z, Razmjouei K, Fogarty J, Hampel N et al. Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or eNOS. Urology 1997; 50: 1016–1026.

    CAS  PubMed  Google Scholar 

  81. Cellek S, Qu W, Schmidt AM, Moncada S . Synergistic action of advanced glycation end products and endogenous nitric oxide leads to neuronal apoptosis in vitro: a new insight into selective nitrergic neuropathy in diabetes. Diabetologia 2004; 47: 331–339.

    CAS  PubMed  Google Scholar 

  82. Usta MF, Bivalacqua TJ, Yang DY, Ramanitharan A, Sell DR, Viswanathan A et al. The protective effect of aminoguanidine on erectile function in streptozotocin-diabetic rats. J Urol 2003; 170: 1437–1442.

    CAS  PubMed  Google Scholar 

  83. Usta MF, Bivalacqua TJ, Koksal IT, Toptas B, Surmen S, Hellstrom WJ . The protective effect of aminoguanidine on erectile function in diabetic rats is not related to the timing of treatment. BJU Int 2004; 94: 429–432.

    CAS  PubMed  Google Scholar 

  84. Cartledge JJ, Eardley I, Morrison JF . Advanced glycation end-products are responsible for the impairment of corpus cavernosal smooth muscle relaxation seen in diabetes. BJU Int 2001; 87: 402–407.

    CAS  PubMed  Google Scholar 

  85. Cartledge JJ, Eardley I, Morrison JF . Impairment of corpus cavernosal smooth muscle relaxation by glycosylated human haemoglobin. BJU Int 2000; 85: 735–741.

    CAS  PubMed  Google Scholar 

  86. Husain S, Young D, Wingard CJ . Role of PKCalpha and PKCiota in phenylephrine-induced contraction of rat corpora cavernosa. Int J Impot Res 2004; 16: 325–333.

    CAS  PubMed  Google Scholar 

  87. Ganz MB, Seftel A . Glucose-induced changes in protein kinase C and nitric oxide are prevented by vitamin E. Am J Physiol Endocrinol Metab 2000; 278: E146–E152.

    CAS  PubMed  Google Scholar 

  88. Nangle MR, Cotter MA, Cameron NE . Protein kinase C beta inhibition and aorta and corpus cavernosum function in streptozotocin-diabetic mice. Eur J Pharmacol 2003; 475: 99–106.

    CAS  PubMed  Google Scholar 

  89. Zou M, Martin C, Ullrich V . Tyrosine nitration as a mechanism of selective inactivation of prostacyclin synthase by peroxynitrite. Biol Chem 1997; 378: 707–713.

    CAS  PubMed  Google Scholar 

  90. Sullivan M, Thompson CS, Mikhailidis DP, Morgan RJ, Angelini GD, Jeremy JY . Differential alterations of prostacyclin, cyclic AMP and cyclic GMP formation in the corpus cavernosum of the diabetic rabbit. Br J Urol 1998; 82: 578–584.

    CAS  PubMed  Google Scholar 

  91. Jeremy JY, Mikhailidis DP, Thompson CS, Dandona P . The effect of cigarette smoke and diabetes mellitus on muscarinic stimulation of prostacyclin synthesis by the rat penis. Diabet Res 1986; 9: 467–469.

    Google Scholar 

  92. Bryan Jr RM, You J, Golding EM, Marrelli SP . Endothelium-derived hyperpolarizing factor: a cousin to nitric oxide and prostacyclin. Anesthesiology 2005; 102: 1261–1277.

    CAS  PubMed  Google Scholar 

  93. Angulo J, Cuevas P, Fernandez A, Gabancho S, Allona A, Martin-Morales A et al. Diabetes impairs endothelium-dependent relaxation of human penile vascular tissues mediated by NO and EDHF. Biochem Biophys Res Commun 2003; 312: 1202–1208.

    CAS  PubMed  Google Scholar 

  94. Angulo J, Cuevas P, Gabancho S, Gonzalez-Corrochano R, Videla S, Saenz de Tejada I . Enhancement of both EDHF and NO/cGMP pathways is necessary to reverse erectile dysfunction in diabetic rats. J Sex Med 2005; 2: 341–346.

    CAS  PubMed  Google Scholar 

  95. Chitaley K, Wingard CJ, Webb RC, Branam H, Stopper VS, Lewis RW et al. Antagonism of Rho-kinase stimulates rat penile erection via a nitric oxide-independent pathway. Nat Med 2001; 7: 119–122.

    CAS  PubMed  Google Scholar 

  96. Wang H, Eto M, Steers WD, Somlyo AP, Somlyo AV . RhoA-mediated Ca2+ sensitization in erectile function. J Biol Chem 2002; 277: 30614–30621.

    CAS  PubMed  Google Scholar 

  97. Wingard CJ, Husain S, Williams J, James S . RhoA-Rho kinase mediates synergistic ET-1 and phenylephrine contraction of rat corpus cavernosum. Am J Physiol Regul Integr Comp Physiol 2003; 285: R1145–R1152.

    CAS  PubMed  Google Scholar 

  98. Rees RW, Ziessen T, Ralph DJ, Kell P, Moncada S, Cellek S . Human and rabbit cavernosal smooth muscle cells express Rho-kinase. Int J Impot Res 2002; 14: 1–7.

    CAS  PubMed  Google Scholar 

  99. Feng J, Ito M, Ichikawa K, Isaka N, Nishikawa M, Hartshorne DJ et al. Inhibitory phosphorylation site for Rho-associated kinase on smooth muscle myosin phosphatase. J Biol Chem 1999; 274: 37385–37390.

    CAS  PubMed  Google Scholar 

  100. Mills TM, Chitaley K, Lewis RW, Webb RC . Nitric oxide inhibits RhoA/Rho-kinase signaling to cause penile erection. Eur J Pharmacol 2002; 439: 173–174.

    CAS  PubMed  Google Scholar 

  101. Sauzeau V, Le Jeune H, Cario-Toumaniantz C, Smolenski A, Lohmann SM, Bertoglio J et al. Cyclic GMP-dependent protein kinase signaling pathway inhibits RhoA-induced Ca2+ sensitization of contraction in vascular smooth muscle. J Biol Chem 2000; 275: 21722–21729.

    CAS  PubMed  Google Scholar 

  102. Chitaley K, Bivalacqua TJ, Champion HC, Usta MF, Hellstrom WJ, Mills TM et al. Adeno-associated viral gene transfer of dominant negative RhoA enhances erectile function in rats. Biochem Biophys Res Commun 2002; 298: 427–432.

    CAS  PubMed  Google Scholar 

  103. Rees RW, Ralph DJ, Royle M, Moncada S, Cellek S . Y-27632, an inhibitor of Rho-kinase, antagonizes noradrenergic contractions in the rabbit and human penile corpus cavernosum. Br J Pharmacol 2001; 133: 455–458.

    CAS  PubMed  PubMed Central  Google Scholar 

  104. Teixeira CE, Ying Z, Webb RC . Pro-erectile effects of the Rho-kinase inhibitor (S)-(+)-2-methyl-1-[(4-methyl-5-isoquinolinyl)sulfonyl]homopiperazine (H-1152) in the rat penis. J Pharmacol Exp Ther 2005; 315: 155–162.

    CAS  PubMed  Google Scholar 

  105. Ming XF, Viswambharan H, Barandier C, Ruffieux J, Kaibuchi K, Rusconi S et al. Rho GTPase/Rho kinase negatively regulates endothelial nitric oxide synthase phosphorylation through the inhibition of protein kinase B/Akt in human endothelial cells. Mol Cell Biol 2002; 22: 8467–8477.

    CAS  PubMed  PubMed Central  Google Scholar 

  106. Jin L, Ying Z, Webb RC . Activation of Rho/Rho kinase signaling pathway by reactive oxygen species in rat aorta. Am J Physiol Heart Circ Physiol 2004; 287: H1495–H1500.

    CAS  PubMed  Google Scholar 

  107. Higashi M, Shimokawa H, Hattori T, Hiroki J, Mukai Y, Morikawa K et al. Long-term inhibition of Rho-kinase suppresses angiotensin II-induced cardiovascular hypertrophy in rats in vivo: effect on endothelial NAD(P)H oxidase system. Circ Res 2003; 93: 767–775.

    CAS  PubMed  Google Scholar 

  108. Chang S, Hypolite JA, Changolkar A, Wein AJ, Chacko S, DiSanto ME . Increased contractility of diabetic rabbit corpora smooth muscle in response to endothelin is mediated via Rho-kinase beta. Int J Impot Res 2003; 15: 53–62.

    CAS  PubMed  Google Scholar 

  109. Shirai M, Yamanaka M, Shiina H, Igawa M, Kawakami T, Ishii N et al. Vascular endothelial growth factor restores erectile function through modulation of the insulin-like growth factor system and sex hormone receptors in diabetic rat. Biochem Biophys Res Commun 2006; 341: 755–762.

    CAS  PubMed  Google Scholar 

  110. Jesmin S, Sakuma I, Salah-Eldin A, Nonomura K, Hattori Y, Kitabatake A . Diminished penile expression of vascular endothelial growth factor and its receptors at the insulin-resistant stage of a type II diabetic rat model: a possible cause for erectile dysfunction in diabetes. J Mol Endocrinol 2003; 31: 401–418.

    CAS  PubMed  Google Scholar 

  111. Yamanaka M, Shirai M, Shiina H, Tanaka Y, Enokida H, Tsujimura A et al. Vascular endothelial growth factor restores erectile function through inhibition of apoptosis in diabetic rat penile crura. J Urol 2005; 173: 318–323.

    CAS  PubMed  Google Scholar 

  112. Suetomi T, Hisasue S, Sato Y, Tabata Y, Akaza H, Tsukamoto T . Effect of basic fibroblast growth factor incorporating gelatin microspheres on erectile function in the diabetic rat. J Urol 2005; 173: 1423–1428.

    CAS  PubMed  Google Scholar 

  113. Abdelbaky TM, Brock GB, Huynh H . Improvement of erectile function in diabetic rats by insulin: possible role of the insulin-like growth factor system. Endocrinology 1998; 139: 3143–3147.

    CAS  PubMed  Google Scholar 

  114. Ahn GJ, Sohn YS, Kang KK, Ahn BO, Kwon JW, Kang SK et al. The effect of PDE5 inhibition on the erectile function in streptozotocin-induced diabetic rats. Int J Impot Res 2005; 17: 134–141.

    CAS  PubMed  Google Scholar 

  115. El-Sakka AI, Lin CS, Chui RM, Dahiya R, Lue TF . Effects of diabetes on nitric oxide synthase and growth factor genes and protein expression in an animal model. Int J Impot Res 1999; 11: 123–132.

    CAS  PubMed  Google Scholar 

  116. Murray FT, Johnson RD, Sciadini M, Katovich MJ, Rountree J, Jewett H . Erectile and copulatory dysfunction in chronically diabetic BB/WOR rats. Am J Physiol 1992; 263: E151–E157.

    CAS  PubMed  Google Scholar 

  117. Corona G, Mannucci E, Petrone L, Ricca V, Balercia G, Mansani R et al. Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic. Int J Impot Res 2006; 18: 190–197.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by NIH/NIDDK Grants DK 02568 and DK 067223 (to ALB) and NKF-Maryland Professional Development Award (to BM).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to B Musicki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Musicki, B., Burnett, A. Endothelial dysfunction in diabetic erectile dysfunction. Int J Impot Res 19, 129–138 (2007). https://doi.org/10.1038/sj.ijir.3901494

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijir.3901494

Keywords

This article is cited by

Search

Quick links