Review Article | Published:

Molecular mechanisms associated with diabetic endothelial–erectile dysfunction

Nature Reviews Urology volume 13, pages 266274 (2016) | Download Citation

Abstract

Erectile dysfunction (ED) is a common complication of diabetes, affecting up to 75% of all diabetic men. Although the aetiology of diabetic ED is multifactorial, endothelial dysfunction is recognized as a mainstay in the pathophysiology of the disease. Endothelial dysfunction is induced by the detrimental actions of high glucose levels and increased oxidative stress on endothelial cells that make up the vascular lining. Besides directly injuring the endothelium, diabetes might also hamper vascular repair mechanisms of angiogenesis and vasculogenesis. These states exacerbate and maintain endothelial dysfunction, impairing vasorelaxation events and cavernosal blood perfusion, which are crucial for normal erectile function.

Key points

  • ED is a prevalent complication of diabetes, affecting up to 75% of all diabetic men, and is responsible for a decreased quality of life for these patients

  • Diabetic ED has a multifactorial aetiology, although cavernosal endothelial dysfunction is currently recognized as a hallmark of the disease pathophysiology

  • Diabetes-induced hyperglycaemia and oxidative stress increase are responsible for the loss of endothelial cell functionality and integrity

  • Diabetic systemic and cavernosal endothelial dysfunction is maintained owing to the detrimental effects of diabetes on the vascular repair mechanisms of angiogenesis and vasculogenesis

  • Improvements in endothelial health and amelioration of ED might be achieved by tight glycaemic control and treatment with PDE5Is and testosterone supplementation

  • Understanding the molecular pathways involved in endothelial dysfunction will aid in the identification of novel therapeutic strategies to improve endothelial and erectile function in diabetic men

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  1. Department of Biochemistry, Faculty of Medicine, University of Porto, Al. Prof Hernâni Monteiro, 4200–319 Porto, Portugal.

    • Ângela Castela
    •  & Carla Costa

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Correspondence to Carla Costa.

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https://doi.org/10.1038/nrurol.2016.23

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