Research in pharmacotherapy for erectile dysfunction

Abstract

Although oral phosphodiesterase-5 (PDE5) inhibitors are generally accepted as an effective therapy for erectile dysfunction (ED), men with ED from diabetes or radical prostatectomy respond poorly to these drugs. Many researchers have tried to develop novel therapeutics that target alternative molecular pathways. A group of therapeutics belongs to centrally acting agents that target dopamine and melanocortin receptors. The other one is the peripherally acting agents that target soluble guanylate cyclase, Rho-kinase pathway, and Maxi-K channel, etc. Also, a variety of preclinical studies by the application of biotherapies in the concept of therapeutic angiogenesis or neural regeneration as well as anti-fibrosis to regenerate damaged erectile tissue have been reported. This article will address the current therapeutic targets for ED under clinical or preclinical development, including pharmacotherapy and biotherapy which comprises protein therapy and gene therapy. In spite of numerous clinical trials that target alternative pathways, these agents have yet to reach the market. The results from preclinical studies targeting therapeutic angiogenesis, neural regeneration, and anti-fibrosis are promising.

Embryonic stem cell-derived extracellular vesicle-mimetic nanovesicles rescue erectile function by enhancing penile neurovascular regeneration in the streptozotocin-induced diabetic mouse

“…A variety of pathological conditions, including microvascular dysfunction, peripheral neuropathy, and hormonal disturbances, are responsible for diabetic ED 2 . Because the pharmacological efficacy of phosphodiesterase type 5 (PDE5) inhibitors depends on endogenous nitric oxide (NO) production, a lack of bioavailable NO in diabetic men as the results of severe penile neurovascular dysfunction is the most important reason for poor responsiveness to these drugs 5–7 . Therefore, the development of a new therapeutic strategy that regenerates damaged penile neurovascular structure is needed.…”

Health‐related quality of life in patients undergoing TURP: Translating evidence into urological nursing practice

“…Utilizing the "Adi Subrata tion. 53 Relating to the urinary incontinence symptom, the questionnaire for urinary incontinence diagnosis (QUID) is recommended to be utilized for evaluating and diagnosing the type of incontinence in patients administering for urology surgery. 54 In line with the symptom domain, patients experiencing a low-tomoderate level of symptoms do not need any medical intervention.…”

Neuroprotective and Nerve Regenerative Approaches for Treatment of Erectile Dysfunction after Cavernous Nerve Injury

“…Patient-reported outcomes after RP were recently reviewed in the ProtecT trial and sexual dysfunction was found to significantly impact health-related quality of life (HRQOL) in patients with prostate cancer [ 6 , 7 ]. Treatments for ED in post-RP patients have inconsistent safety and efficacy profiles, and there remains an ongoing search for a well-tolerated and clinically durable therapeutic option for treatment-refractory men [ 8 , 9 ].…”

“…Even with bilateral nerve-sparing and minimally invasive approaches to RP, some degree of CN injury (CNI) or neuropraxia is inevitable. Advances in technology and the understanding of penile neurobiology have led to neuromodulatory strategies targeting CN protection and regeneration [ 8 ].…”

“…Due to the significant burden of disease, a copious amount of research has been focused on discovering the molecular pathways underlying neuronal control of erectile function, the mechanism of CNI, and novel therapeutic approaches that promote CN function recovery [ 8 , 14 , 15 , 16 , 17 , 18 ]. With recent advancements in our understanding of CNI and recovery, we move toward new therapeutic options for ED in treatment-refractory men [ 8 ]. Currently, there are no established treatment options that offer CN protection or regeneration at the clinical level, however, investigative efforts are ongoing.…”