背景:勃起功能障碍(ED)是男性性功能障碍的主要原因,这通常与肥胖有关,糖尿病,动脉粥样硬化性心血管疾病,和吸烟。Peyronie病是一种慢性疾病,与导致ED的白膜不可逆纤维化损伤相关,痛苦的勃起,性交障碍,身体和社会的抱怨。这两种情况都以慢性炎症为特征,氧化应激,海绵体内流体动力学的显著变化。在这种情况下,氧化脂蛋白,M1极化的巨噬细胞,促炎细胞因子(如肿瘤坏死因子α),内皮型一氧化氮合酶,阴茎平滑肌细胞,和toll样受体代表ED炎症过程的主要触发因素。磷酸二酯酶-5抑制剂是最常见的ED治疗方法。这种治疗是间歇性使用的,因为它被认为是一种有症状而不是治愈性的疗法。此外,并非所有患者对磷酸二酯酶-5抑制剂(35%-85%),特别是那些代谢异常的表型。因此,需要额外的或替代的治疗,主要是在难治性病例中。
目的:在这篇综述中,我们描述了ED和Peyronie病(PD)的免疫介导的发病机制。在我们的文献检索中,我们特别强调潜在的实用治疗方法,包括天然产物(如多酚),由于它们的抗炎和抗氧化活性,干细胞疗法,和血小板衍生制剂。
方法:我们搜索了PubMed/MEDLINE,WebofScience,Scopus,科克伦图书馆,谷歌学者,和机构网站。原始研究,叙事评论,系统评价,搜索了用英语写的荟萃分析,筛选,并选择。
结果:在ED和PD的动物模型中,治疗方法,包括抗炎剂和抗氧化剂,干细胞疗法,和血小板衍生制剂,提供了积极的结果,包括改善阴茎功能,减少炎症和氧化应激,促进组织修复。然而,在人类患者中改善的临床证据仍然不足。
结论:临床前和初步临床研究显示了治疗ED和PD的有希望的结果,但需要具体的临床试验来验证这些治疗方法在男性ED患者中的疗效.
BACKGROUND: Erectile dysfunction (ED) represents the major cause of male sexual dysfunction, which is often associated with obesity, diabetes mellitus, atherosclerotic cardiovascular disease, and cigarette smoking. Peyronie\'s disease is a chronic disorder associated with irreversible fibrotic damage of the tunica albuginea leading to ED, painful erection, coital disturbance, and physical and social complaints. Both conditions are characterized by chronic inflammation, oxidative stress, and significant changes in intracavernous hydrodynamics. In this scenario, oxidized lipoproteins, M1-polarized macrophages, proinflammatory cytokines (such as the tumor necrosis factor α), endothelial nitric oxide synthase, penile smooth muscle cells, and toll-like receptors represent the main triggers of the inflammatory process in ED. Phosphodiesterase-5 inhibitors are the most common treatment for ED. This treatment is used intermittently, as it is conceived as a symptomatic and not curative therapy. Moreover, not all patients respond to phosphodiesterase-5 inhibitors (35%-85%), particularly those with dysmetabolic phenotypes. Additional or alternative treatments are therefore desirable, mostly in refractory cases.
OBJECTIVE: In this review, we describe the immune-mediated pathogenesis of ED and Peyronie\'s disease (PD). In our literature search we placed particular emphasis on potentially practical therapeutic approaches, including natural products (such as polyphenols), due to their anti-inflammatory and antioxidant activities, stem cell therapy, and platelet-derived preparations.
METHODS: We searched PubMed/MEDLINE, Web of Science, Scopus, Cochrane Library, Google Scholar, and institutional websites. Original studies, narrative reviews, systematic reviews, and meta-analyses written in English were searched, screened, and selected.
RESULTS: In animal models of ED and PD, therapeutic approaches, including anti-inflammatory and antioxidant agents, stem cell therapy, and platelet-derived preparations, have provided positive results, including improved penile function, reduced inflammation and oxidative stress, and promotion of tissue repair. However, clinical evidence of improvement in human patients is still insufficient.
CONCLUSIONS: Promising results for treating ED and PD have been shown in preclinical and pilot clinical studies, but specific clinical trials are needed to validate the efficacy of these therapeutic approaches in men with ED.