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Emerging tools for erectile dysfunction: a role for regenerative medicine

Nature Reviews Urology volume 9, pages 520–536 (2012)Cite this article

Abstract

Erectile dysfunction (ED) is the most common sexual disorder reported by men to their health-care providers and the most investigated male sexual dysfunction. Currently, the treatment of ED focuses on 'symptomatic relief' of ED and, therefore, tends to provide temporary relief rather than providing a cure or reversing the cause. The identification of a large population of “difficult-to-treat” patients has triggered researchers to identify novel treatment approaches, which focus on cure and restoration of the underlying cause of ED. Regenerative medicine has developed extensively in the past few decades and preclinical trials have emphasized the benefit of growth factor therapy, gene transfer, stem cells and tissue engineering for the restoration of erectile function. Development of clinical trials involving immunomodulation in postprostatectomy ED patients and the use of maxi-K channels for gene therapy are illustrative of the advances in the field. However, the search for novel treatment targets and a wealth of preclinical studies represent a dynamic and continuing field of enquiry.

Key Points

  • Erectile dysfunction is the most commonly reported sexual disorder in men

  • A large subpopulation of men with ED are unresponsive to available oral pharmacotherapy (PDE5 inhibitors), owing to a loss of NO signalling and changes in penile tissue composition

  • Unresponsive patients might benefit from regenerative medicine options that restore tissue integrity and signalling in penis-projecting neurons, penile smooth muscle cells and endothelial cells

  • According to the degree of ED and tissue damage, regenerative medicine for ED includes tissue-protective pharmacotherapy, gene therapy, (stem) cell-based therapies or whole tissue replacement using bioengineered tissues

  • Aside from one clinical trial, these studies so far remain in the preclinical phase; however, current research is aiming to translate various regenerative treatments to clinical trials

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Figure 1: Future strategy for the role of regenerative medicine in the management of ED.
Figure 2: Main targets for gene transfer in the future treatment of ED.

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Acknowledgements

M. Albersen is a fellow of Research Foundation-Flanders and of the Federico Foundation.

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Authors and Affiliations

  1. Department of Urology, Laboratory of Experimental Urology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium

    Lukman Hakim, Frank Van der Aa & Maarten Albersen

  2. Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Marburg 143, Baltimore, 21287, MD, USA

    Trinity J. Bivalacqua

  3. URI (Urological Research Institute), DIBIT-San Raffaele Scientific Institute, Via Olgettina 58, Milan, 20132, Italy

    Petter Hedlund

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L. Hakim and M. Albersen researched data for the article and wrote the manuscript. All authors made a substantial contribution to discussion of content and reviewed and edited the article before submission.

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Hakim, L., Van der Aa, F., Bivalacqua, T. et al. Emerging tools for erectile dysfunction: a role for regenerative medicine. Nat Rev Urol 9, 520–536 (2012). https://doi.org/10.1038/nrurol.2012.143

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