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The relationship between the gut microbiota, benign prostatic hyperplasia, and erectile dysfunction

International Journal of Impotence Research volume 35, pages 350–355 (2023)Cite this article

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A Correction to this article was published on 05 July 2022

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Abstract

Microbiota is defined as the group of commensal microorganisms that inhabit a specific human body site. The composition of each individual’s gastrointestinal microbiota is influenced by several factors such as age, diet, lifestyle, and drug intake, but an increasing number of studies have shown that the differences between a healthy microbiota and a dysbiotic one can be related to different diseases such as benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). The aim of this review is to give an overview of the role of the gut microbiota on BPH and ED. Gut microbiota modifications can influence prostate health indirectly by the activation of the immune system and the production of proinflammatory cytokines such as IL-17, IL-23, TNF-alpha, and IFN-gamma, which are able to promote an inflammatory state. Gut dysbiosis may lead to the onset of ED by the alteration of hormone levels and metabolic profiles, the modulation of stress/anxiety-mediated sexual dysfunction, the development of altered metabolic conditions such as obesity and diabetes mellitus, and the development of hypertension. In conclusion, much evidence suggests that the intestinal microbiota has an influence on various pathologies including BPH and ED.

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Fig. 1: The relationship between the gut microbiota and cytokine release in benign prostatic hyperplasia.
Fig. 2: The relationship between the production of inflammation mediators and erectile dysfunction.

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References

  1. Ursell LK, Metcalf JL, Parfrey LW, Knight R. Defining the human microbiome. Nutr Rev. 2012;70:S38–44.

    Article  PubMed  Google Scholar 

  2. Gill SR, Pop M, DeBoy RT, Eckburg PB, Turnbaugh PJ, Samuel BS, et al. Metagenomic analysis of the human distal gut microbiome. Science. 2006;312:1355–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Cresci GA, Bawden E. Gut microbiome. Nutr Clin Pract. 2015;30:734–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Suau A, Bonnet R, Sutren M, Godon J-J, Gibson GR, Collins MD, et al. Direct analysis of genes encoding 16S rRNA from complex communities reveals many novel molecular species within the human gut. Appl Environ Microbiol. 1999;65:4799–807.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lepage P, Leclerc MC, Joossens M, Mondot S, Blottière HM, Raes J, et al. A metagenomic insight into our gut’s microbiome. Gut. 2013;62:146–58.

    Article  PubMed  Google Scholar 

  6. Gallo A, Passaro G, Gasbarrini A, Landolfi R, Montalto M. Modulation of microbiota as treatment for intestinal inflammatory disorders: an uptodate. World J Gastroenterol. 2016;22:7186–202.

    Article  PubMed  PubMed Central  Google Scholar 

  7. LeBlanc JG, Milani C, de Giori GS, Sesma F, van Sinderen D, Ventura M. Bacteria as vitamin suppliers to their host: a gut microbiota perspective. Curr Opin Biotechnol. 2013;24:160–8.

    Article  CAS  PubMed  Google Scholar 

  8. Bull MJ, Plummer NT. Part 1: the human gut microbiome in health and disease. Integr Med (Encinitas). 2014;13:17–22.

    PubMed  Google Scholar 

  9. Björkstén B, Sepp E, Julge K, Voor T, Mikelsaar M. Allergy development and the intestinal microflora during the first year of life. J Allergy Clin Immunol. 2001;108:516–20.

    Article  PubMed  Google Scholar 

  10. Sidhu M, van der Poorten D. The gut microbiome. Aust Fam Physician. 2017;46:206–11.

    PubMed  Google Scholar 

  11. Odamaki T, Kato K, Sugahara H, Hashikura N, Takahashi S, Xiao J-Z, et al. Age-related changes in gut microbiota composition from newborn to centenarian: a cross-sectional study. BMC Microbiol. 2016;16:90.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wu GD, Chen J, Hoffmann C, Bittinger K, Chen Y-Y, Keilbaugh SA, et al. Linking long-term dietary patterns with gut microbial enterotypes. Science. 2011;334:105–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Blaser MJ, Falkow S. What are the consequences of the disappearing human microbiota? Nat Rev Microbiol. 2009;7:887–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Vich Vila A, Collij V, Sanna S, Sinha T, Imhann F, Bourgonje AR, et al. Impact of commonly used drugs on the composition and metabolic function of the gut microbiota. Nat Commun. 2020;11:362.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cho I, Blaser MJ. The human microbiome: at the interface of health and disease. Nat Rev Genet. 2012;13:260–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Devkota S, Wang Y, Musch MW, Leone V, Fehlner-Peach H, Nadimpalli A, et al. Dietary-fat-induced taurocholic acid promotes pathobiont expansion and colitis in Il10−/− mice. Nature. 2012;487:104–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Osman MM, El-Khatib FM, Roberts NH, Huynh LM, Yafi FA. The gut microbiome and men’s sexual health. Curr Sex Heal Rep. 2019;11:348–57.

    Article  Google Scholar 

  18. Collins MM, Meigs JB, Barry MJ, Walker Corkery E, Giovannucci E, Kawachi I. Prevalence and correlates of prostatitis in the health professionals follow-up study cohort. J Urol. 2002;167:1363–6.

    Article  PubMed  Google Scholar 

  19. Vlachopoulos C, Aznaouridis K, Ioakeimidis N, Rokkas K, Vasiliadou C, Alexopoulos N, et al. Unfavourable endothelial and inflammatory state in erectile dysfunction patients with or without coronary artery disease. Eur Heart J. 2006;27:2640–8.

    Article  CAS  PubMed  Google Scholar 

  20. Golombos DM, Ayangbesan A, O’Malley P, Lewicki P, Barlow L, Barbieri CE, et al. The role of gut microbiome in the pathogenesis of prostate cancer: a prospective, pilot study. Urology. 2018;111:122–8.

    Article  PubMed  Google Scholar 

  21. Nickel JC, True LD, Krieger JN, Berger RE, Boag AH, Young ID. Consensus development of a histopathological classification system for chronic prostatic inflammation. BJU Int. 2001;87:797–805.

    Article  CAS  PubMed  Google Scholar 

  22. Krsmanovic A, Tripp DA, Nickel JC, Shoskes DA, Pontari M, Litwin MS, et al. Psychosocial mechanisms of the pain and quality of life relationship for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Can Urol Assoc J. 2014;8:403.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Shoskes DA, Wang H, Polackwich AS, Tucky B, Altemus J, Eng C. Analysis of gut microbiome reveals significant differences between men with chronic prostatitis/chronic pelvic pain syndrome and controls. J Urol. 2016;196:435–41.

    Article  PubMed  Google Scholar 

  24. Alipour M, Zaidi D, Valcheva R, Jovel J, Martínez I, Sergi C, et al. Mucosal barrier depletion and loss of bacterial diversity are primary abnormalities in paediatric ulcerative colitis. J Crohn’s Colitis. 2016;10:462–71.

    Article  Google Scholar 

  25. Kostic AD, Gevers D, Siljander H, Vatanen T, Hyötyläinen T, Hämäläinen A-M, et al. The dynamics of the human infant gut microbiome in development and in progression toward type 1 diabetes. Cell Host Microbe. 2015;17:260–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Bosch J, Tilling K, Bohnen AM, Bangma CH, Donovan JL. Establishing normal reference ranges for prostate volume change with age in the population-based Krimpen-study: prediction of future prostate volume in individual men. Prostate. 2007;67:1816–24.

    Article  CAS  PubMed  Google Scholar 

  27. Wilson JD. The critical role of androgens in prostate development. Endocrinol Metab Clin North Am. 2011;40:577–90, ix.

    Article  CAS  PubMed  Google Scholar 

  28. Zlotta AR, Egawa S, Pushkar D, Govorov A, Kimura T, Kido M, et al. Prevalence of inflammation and benign prostatic hyperplasia on autopsy in Asian and Caucasian men. Eur Urol. 2014;66:619–22.

    Article  PubMed  Google Scholar 

  29. Konkol Y, Keskitalo A, Vuorikoski H, Pietilä S, Elo LL, Munukka E, et al. Chronic nonbacterial prostate inflammation in a rat model is associated with changes of gut microbiota that can be modified with a galactoglucomannan-rich hemicellulose extract in the diet. BJU Int. 2019;123:899–908.

    Article  CAS  PubMed  Google Scholar 

  30. Minutoli L, Rinaldi M, Marini H, Irrera N, Crea G, Lorenzini C, et al. Apoptotic pathways linked to endocrine system as potential therapeutic targets for benign prostatic hyperplasia. Int J Mol Sci. 2016;17:1311.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ratajczak W, Mizerski A, Rył A, Słojewski M, Sipak O, Piasecka M, et al. Alterations in fecal short chain fatty acids (SCFAs) and branched short-chain fatty acids (BCFAs) in men with benign prostatic hyperplasia (BPH) and metabolic syndrome (MetS). Aging (Albany NY). 2021;13:10934–54. https://doi.org/10.18632/aging.202968.

  32. Takezawa K, Fujita K, Matsushita M, Motooka D, Hatano K, Banno E, et al. The Firmicutes/Bacteroidetes ratio of the human gut microbiota is associated with prostate enlargement. Prostate. 2021;81:1287–93.

    Article  CAS  PubMed  Google Scholar 

  33. Holland B, Karr M, Delfino K, Dynda D, El-Zawahry A, Braundmeier-Fleming A, et al. The effect of the urinary and fecal microbiota on lower urinary tract symptoms measured by the international prostate symptom score: analysis utilizing next-generation sequencing. BJU Int. 2020;125:905–10. https://doi.org/10.1111/bju.14972.

  34. Heintz-Buschart A, Wilmes P. Human gut microbiome: function matters. Trends Microbiol. 2018;26:563–74.

    Article  CAS  PubMed  Google Scholar 

  35. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993;270:83–90.

    Article  Google Scholar 

  36. Salonia A, Castagna G, Saccà A, Ferrari M, Capitanio U, Castiglione F, et al. Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function-Erectile Function domain. J Sex Med. 2012;9:2708–15.

    Article  PubMed  Google Scholar 

  37. Corona G, Petrone L, Mannucci E, Magini A, Lotti F, Ricca V, et al. Assessment of the relational factor in male patients consulting for sexual dysfunction: the concept of couple sexual dysfunction. J Androl. 2006;27:795–801.

    Article  PubMed  Google Scholar 

  38. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151:54–61.

    Article  CAS  PubMed  Google Scholar 

  39. Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, et al. One patient out of four with newly diagnosed erectile dysfunction is a young man—worrisome picture from the everyday clinical practice. J Sex Med. 2013;10:1833–41.

    Article  PubMed  Google Scholar 

  40. Salonia A, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, et al. European Association of Urology Guidelines on Sexual and Reproductive Health—2021 update: male sexual dysfunction. Eur Urol. 2021;80:333–57.

    Article  PubMed  Google Scholar 

  41. Okamoto T, Hatakeyama S, Imai A, Yamamoto H, Yoneyama T, Mori K, et al. The association between gut microbiome and erectile dysfunction: a community-based cross-sectional study in Japan. Int Urol Nephrol. 2020;52:1421–8.

    Article  CAS  PubMed  Google Scholar 

  42. Nagashima K, Hisada T, Sato M, Mochizuki J. Application of new primer-enzyme combinations to terminal restriction fragment length polymorphism profiling of bacterial populations in human feces. Appl Environ Microbiol. 2003;69:1251–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Takahashi S, Tomita J, Nishioka K, Hisada T, Nishijima M. Development of a prokaryotic universal primer for simultaneous analysis of bacteria and archaea using next-generation sequencing. PLoS One. 2014;9:e105592.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Li J, Zhao F, Wang Y, Chen J, Tao J, Tian G, et al. Gut microbiota dysbiosis contributes to the development of hypertension. Microbiome. 2017;5:14.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Barlow GM, Yu A, Mathur R. Role of the gut microbiome in obesity and diabetes mellitus. Nutr Clin Pract. 2015;30:787–97.

    Article  CAS  PubMed  Google Scholar 

  46. Kanbay M, Onal EM, Afsar B, Dagel T, Yerlikaya A, Covic A, et al. The crosstalk of gut microbiota and chronic kidney disease: role of inflammation, proteinuria, hypertension, and diabetes mellitus. Int Urol Nephrol. 2018;50:1453–66.

    Article  PubMed  Google Scholar 

  47. Li H, Qi T, Huang Z, Ying Y, Zhang Y, Wang B. et al. Relationship between gut microbiota and type 2 diabetic erectile dysfunction in Sprague-Dawley rats. J Huazhong Univ Sci Technolog Med Sci. 2017;37:523–30.

    Article  CAS  PubMed  Google Scholar 

  48. Tirandaz H, Ebrahim-Habibi M-B, Moradveisi B, Raoofi S, Salehi-Najafabadi A, Mohammadi E. Microbiota potential for the treatment of sexual dysfunction. Med Hypotheses. 2018;115:46–49.

    Article  PubMed  Google Scholar 

  49. Markle JGM, Frank DN, Mortin-Toth S, Robertson CE, Feazel LM, Rolle-Kampczyk U, et al. Sex differences in the gut microbiome drive hormone-dependent regulation of autoimmunity. Science. 2013;339:1084–8.

    Article  CAS  PubMed  Google Scholar 

  50. Markle JG, Frank DN, Adeli K, von Bergen M, Danska JS. Microbiome manipulation modifies sex-specific risk for autoimmunity. Gut Microbes. 2014;5:485–93.

    Article  PubMed  Google Scholar 

  51. Yurkovetskiy L, Burrows M, Khan AA, Graham L, Volchkov P, Becker L, et al. Gender bias in autoimmunity is influenced by microbiota. Immunity. 2013;39:400–12.

    Article  CAS  PubMed  Google Scholar 

  52. Dinan TG, Cryan JF. Regulation of the stress response by the gut microbiota: Implications for psychoneuroendocrinology. Psychoneuroendocrinology. 2012;37:1369–78.

    Article  CAS  PubMed  Google Scholar 

  53. Messaoudi M, Lalonde R, Violle N, Javelot H, Desor D, Nejdi A, et al. Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr. 2011;105:755–64.

    Article  CAS  PubMed  Google Scholar 

  54. Esposito K, Giugliano F, Ciotola M, De Sio M, D’Armiento M, Giugliano D. Obesity and sexual dysfunction, male and female. Int J Impot Res. 2008;20:358–65.

    Article  CAS  PubMed  Google Scholar 

  55. Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Human gut microbes associated with obesity. Nature. 2006;444:1022–3.

    Article  CAS  PubMed  Google Scholar 

  56. Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, et al. Innate immunity and intestinal microbiota in the development of Type 1 diabetes. Nature. 2008;455:1109–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Cani PD, Bibiloni R, Knauf C, Waget A, Neyrinck AM, Delzenne NM, et al. Changes in gut microbiota control metabolic endotoxemia-induced inflammation in high-fat diet–induced obesity and diabetes in mice. Diabetes. 2008;57:1470–81.

    Article  CAS  PubMed  Google Scholar 

  58. Qin J, Li Y, Cai Z, Li S, Zhu J, Zhang F, et al. A metagenome-wide association study of gut microbiota in type 2 diabetes. Nature. 2012;490:55–60.

    Article  CAS  PubMed  Google Scholar 

  59. Yang T, Santisteban MM, Rodriguez V, Li E, Ahmari N, Carvajal JM, et al. Gut dysbiosis is linked to hypertension. Hypertension. 2015;65:1331–40.

    Article  CAS  PubMed  Google Scholar 

  60. Jose PA, Raj D. Gut microbiota in hypertension. Curr Opin Nephrol Hypertens. 2015;24:403–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Urology Section, University of Catania, Catania, Italy

    Giorgio Ivan Russo

  2. Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, 95125, Catania, Italy

    Dafne Bongiorno, Carmelo Bonomo, Nicolò Musso & Stefania Stefani

  3. Department of Urology, ‘Martha-Maria’ Hospital Nuremberg, Nuremberg, Germany

    Ioannis Sokolakis & Georgios Hatzichristodoulou

  4. Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, 21100, Varese, Italy

    Marco Falcone

  5. Department of Urology, Santa Chiara Regional Hospital, Trento, Italy

    Tommaso Cai

  6. Urology Unit, Department of Medicine, Surgery, Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy

    Francesco Smarrazzo & Paolo Verze

  7. EAU-YAU Sexual and Reproductive Health Group, Arnhem, The Netherlands

    Giorgio Ivan Russo, Ioannis Sokolakis & Marco Falcone

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  • Giorgio Ivan Russo
  • , Ioannis Sokolakis
  •  & Marco Falcone

Contributions

GIR: conceptualization. DB, CB, NM, TC, FS, PV: writing—original draft. DB, CB, NM, TC, FS, PV: writing—review and editing. SS, GIR, IS, GH, MF: supervision.

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Correspondence to Giorgio Ivan Russo.

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Russo, G.I., Bongiorno, D., Bonomo, C. et al. The relationship between the gut microbiota, benign prostatic hyperplasia, and erectile dysfunction. Int J Impot Res 35, 350–355 (2023). https://doi.org/10.1038/s41443-022-00569-1

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